Fundamentals of emergency care in urgent conditions. Cheat sheet: Algorithm for the provision of emergency care for cardiac diseases and poisoning. Features of emergency care for a child

First aid is a set of urgent measures aimed at saving a person's life. An accident, a sharp attack of illness, poisoning - in these and other emergencies, competent first aid is needed.

According to the law, first aid is not medical - it is provided before the arrival of doctors or the delivery of the victim to the hospital. First aid can be provided by anyone who is at a critical moment next to the victim. For some categories of citizens, first aid is an official duty. We are talking about police officers, traffic police and the Ministry of Emergency Situations, military personnel, firefighters.

The ability to provide first aid is an elementary but very important skill. He can save someone's life. Here are 10 basic first aid skills.

First aid algorithm

In order not to get confused and competently provide first aid, it is important to follow the following sequence of actions:

1. Make sure that when giving first aid you are not in danger and you do not endanger yourself.
2. Ensure the safety of the victim and others (for example, remove the victim from a burning car).
3. Check for signs of life (pulse, breathing, pupillary reaction to light) and consciousness in the victim. To check for breathing, you need to tilt the victim's head back, bend over to his mouth and nose and try to hear or feel breathing. To detect the pulse, it is necessary to attach the fingertips to the carotid artery of the victim. To assess consciousness, it is necessary (if possible) to take the victim by the shoulders, shake gently and ask a question.
4. Call specialists:, from the city - 03 (ambulance) or 01 (rescuers).
5. Provide emergency first aid. Depending on the situation, this may be:
   • restoration of airway patency;
   • cardiopulmonary resuscitation;
   • stop bleeding and other measures.
6. Provide the victim with physical and psychological comfort, wait for the arrival of specialists.

Artificial respiration

Artificial ventilation of the lungs (ALV) is the introduction of air (or oxygen) into the respiratory tract of a person in order to restore natural ventilation of the lungs. Refers to elementary resuscitation measures.

Typical situations requiring IVL:

• car accident;
• accident on the water
• electric shock and others.

There are various ways of IVL. Mouth-to-mouth and mouth-to-nose artificial respiration is considered the most effective in providing first aid to a non-specialist.

If during examination of the victim natural breathing is not detected, it is necessary to immediately carry out artificial ventilation of the lungs.

mouth-to-mouth artificial respiration technique

1. Ensure patency of the upper airway. Turn the head of the victim to one side and use your finger to remove mucus, blood, foreign objects from the oral cavity. Check the victim's nasal passages, clean them if necessary.
2. Tilt the victim's head back while holding the neck with one hand.
   

   Do not change the position of the head of the victim with a spinal injury!

3. Place a tissue, handkerchief, piece of cloth, or gauze over the victim's mouth to protect yourself from infections. Pinch the victim's nose with your thumb and forefinger. Inhale deeply, press your lips tightly against the victim's mouth. Exhale into the victim's lungs.
   

   The first 5–10 breaths should be fast (20–30 seconds), then 12–15 breaths per minute.

4. Watch the movement of the victim's chest. If the victim's chest rises when inhaling air, then you are doing everything right.

Indirect cardiac massage

If there is no pulse along with breathing, it is necessary to do an indirect heart massage.

An indirect (closed) heart massage, or chest compression, is the compression of the muscles of the heart between the sternum and the spine in order to maintain the circulation of a person during cardiac arrest. Refers to elementary resuscitation measures.

Attention! It is impossible to carry out a closed heart massage in the presence of a pulse.

Chest Compression Technique

1. Lay the victim down on a flat, hard surface. Do not perform chest compressions on a bed or other soft surfaces.
2. Determine the location of the affected xiphoid process. The xiphoid process is the shortest and narrowest part of the sternum, its end.
3. Measure 2-4 cm upward from the xiphoid process - this is the point of compression.
4. Place the base of your palm on the compression point. In this case, the thumb should point either to the chin or to the stomach of the victim, depending on the location of the resuscitator. Place the other hand on top of one hand, fold your fingers into the lock. Pressing is carried out strictly with the base of the palm - your fingers should not come into contact with the victim's sternum.
5. Perform rhythmic chest thrusts strongly, smoothly, strictly vertically, with the weight of the upper half of your body. Frequency - 100-110 pressures per minute. In this case, the chest should bend by 3-4 cm.
   

   For infants, indirect heart massage is performed with the index and middle fingers of one hand. Teenagers - the palm of one hand.

If mechanical ventilation is performed simultaneously with closed heart massage, every two breaths should alternate with 30 chest compressions.

If, during resuscitation, the victim regains breathing or a pulse appears, stop first aid and lay the person on his side, putting his hand under his head. Keep an eye on his condition until paramedics arrive.

Heimlich maneuver

When food or foreign bodies get into the trachea, it becomes blocked (fully or partially) - the person suffocates.

Signs of airway obstruction:

• Lack of complete breathing. If the windpipe is not completely blocked, the person coughs; if completely - holds on to the throat.
• Inability to speak.
• Blueness of the skin of the face, swelling of the vessels of the neck.

Airway clearance is most often performed using the Heimlich method.

1. Stand behind the victim.
2. Grab it with your hands, clasping them into a lock, just above the navel, under the costal arch.
3. Strongly press on the victim's abdomen, sharply bending your elbows.
   

   Do not apply pressure to the victim's chest, except for pregnant women who apply pressure to the lower chest.

4. Repeat this several times until the airways are clear.

If the victim has lost consciousness and fallen, lay him on his back, sit on his hips and with both hands press on the costal arches.

To remove foreign bodies from the child's respiratory tract, turn him on his stomach and pat 2-3 times between the shoulder blades. Be very careful. Even if the baby coughs quickly, see a doctor for a medical examination.

Bleeding

Bleeding control is a measure to stop blood loss. When providing first aid, we are talking about stopping external bleeding. Depending on the type of vessel, capillary, venous and arterial bleeding is distinguished.

Stopping capillary bleeding is carried out by applying an aseptic bandage, and also, if the arms or legs are injured, by raising the limbs above the level of the body.

With venous bleeding, a pressure bandage is applied. To do this, tamponade of the wound is performed: gauze is applied to the wound, several layers of cotton wool are placed on top of it (if there is no cotton wool, a clean towel), tightly bandaged. The veins squeezed by such a bandage quickly thrombose, and the bleeding stops. If the pressure bandage gets wet, apply firm pressure with the palm of your hand.

To stop arterial bleeding, the artery must be clamped.

Artery Clamping Technique: Firmly press the artery with your fingers or fist against the underlying bone formations.

Arteries are easily accessible for palpation, so this method is very effective. However, it requires physical strength from the first aid provider.

If the bleeding does not stop after applying a tight bandage and pressing on the artery, apply a tourniquet. Remember that this is a last resort when other methods fail.

Technique for applying a hemostatic tourniquet

1. Apply a tourniquet to clothing or a soft pad just above the wound.
2. Tighten the tourniquet and check the pulsation of the vessels: the bleeding should stop, and the skin below the tourniquet should turn pale.
3. Put a bandage on the wound.
4. Record the exact time the tourniquet was applied.

A tourniquet can be applied to the limbs for a maximum of 1 hour. After its expiration, the tourniquet must be loosened for 10-15 minutes. If necessary, you can tighten again, but no more than 20 minutes.

fractures

A fracture is a break in the integrity of a bone. The fracture is accompanied by severe pain, sometimes - fainting or shock, bleeding. There are open and closed fractures. The first is accompanied by a wound of soft tissues, bone fragments are sometimes visible in the wound.

Fracture First Aid Technique

1. Assess the severity of the victim's condition, determine the location of the fracture.
2. If there is bleeding, stop it.
3. Determine whether it is possible to move the victim before the arrival of specialists.
   

   Do not carry the victim and do not change his position in case of spinal injuries!

4. Ensure the immobility of the bone in the fracture area - perform immobilization. To do this, it is necessary to immobilize the joints located above and below the fracture.
5. Put on a tire. As a tire, you can use flat sticks, boards, rulers, rods, etc. The tire must be tightly, but not tightly fixed with bandages or plaster.

With a closed fracture, immobilization is performed over clothing. With an open fracture, you can not apply a splint to places where the bone protrudes outward.

burns

A burn is damage to body tissues caused by high temperatures or chemicals. Burns vary in degrees as well as types of damage. According to the last reason, burns are distinguished:

• thermal (flame, hot liquid, steam, hot objects);
• chemical (alkalis, acids);
• electrical;
• radiation (light and ionizing radiation);
• combined.

In case of burns, the first step is to eliminate the effect of the damaging factor (fire, electric current, boiling water, and so on).

Then, in case of thermal burns, the affected area should be freed from clothing (gently, without tearing off, but cutting off the adhering tissue around the wound) and, for the purpose of disinfection and anesthesia, irrigate it with a water-alcohol solution (1/1) or vodka.

Do not use oily ointments and greasy creams - fats and oils do not reduce pain, do not disinfect the burn, and do not promote healing.

Then irrigate the wound with cold water, apply a sterile dressing and apply cold. Also, give the victim warm salted water.

To speed up the healing of minor burns, use sprays with dexpanthenol. If the burn covers an area of ​​more than one palm, be sure to consult a doctor.

Fainting

Fainting is a sudden loss of consciousness due to a temporary disruption of cerebral blood flow. In other words, it is a signal to the brain that it lacks oxygen.

It is important to distinguish between ordinary and epileptic syncope. The first is usually preceded by nausea and dizziness.

A fainting state is characterized by the fact that a person rolls his eyes, becomes covered with cold sweat, his pulse weakens, his limbs become cold.

Typical situations of fainting:

• fright,
• excitement,
• stuffiness and others.

If the person faints, put him in a comfortable horizontal position and provide fresh air (unbutton clothes, loosen belt, open windows and doors). Sprinkle cold water on the face of the victim, pat him on the cheeks. If you have a first-aid kit on hand, give a cotton swab moistened with ammonia to sniff.

If consciousness does not return for 3-5 minutes, call an ambulance immediately.

When the victim comes to, give him strong tea or coffee.

Drowning and sunstroke

Drowning is the entry of water into the lungs and airways, which can lead to death.

First aid for drowning

1. Remove the victim from the water.
   

   A drowning man grabs everything that comes to hand. Be careful: swim up to him from behind, hold him by the hair or armpits, keeping your face above the surface of the water.

2. Lay the victim on his knee with his head down.
3. Clear the oral cavity of foreign bodies (mucus, vomit, algae).
4. Check for signs of life.
5. In the absence of a pulse and breathing, immediately start mechanical ventilation and chest compressions.
6. After the restoration of breathing and cardiac activity, lay the victim on his side, cover him and ensure comfort until the arrival of paramedics.

In the summer, sunstroke is also a danger. Sunstroke is a brain disorder caused by prolonged exposure to the sun.

Symptoms:

• headache,
• weakness,
• noise in ears,
• nausea,
• vomit.

If the victim is still exposed to the sun, his temperature rises, shortness of breath appears, sometimes he even loses consciousness.

Therefore, when providing first aid, first of all, it is necessary to transfer the victim to a cool, ventilated place. Then release him from clothes, loosen the belt, undress. Place a cold, wet towel on his head and neck. Let me smell the ammonia. Give artificial respiration if necessary.

In case of sunstroke, the victim should be given plenty of cool, slightly salted water (drink often, but in small sips).

Causes of frostbite - high humidity, frost, wind, immobility. Aggravates the condition of the victim, as a rule, alcohol intoxication.

Symptoms:

• feeling cold;
• tingling in the frost-bitten part of the body;
• then - numbness and loss of sensation.

First aid for frostbite

1. Keep the victim warm.
2. Take off any cold or wet clothing.
3. Do not rub the victim with snow or a cloth - this will only injure the skin.
4. Wrap the frostbitten area of ​​the body.
5. Give the victim hot sweet drink or hot food.

Poisoning

Poisoning is a disorder of the body's vital functions that has arisen due to the ingress of poison or toxin into it. Depending on the type of toxin, poisoning is distinguished:

• carbon monoxide,
• pesticides,
• alcohol
• drugs,
• food and others.

First aid measures depend on the nature of the poisoning. The most common food poisoning is accompanied by nausea, vomiting, diarrhea and stomach pain. In this case, the victim is recommended to take 3-5 grams of activated charcoal every 15 minutes for an hour, drink plenty of water, refrain from eating and be sure to consult a doctor.

In addition, accidental or intentional drug poisoning and alcohol intoxication are common.

In these cases, first aid consists of the following steps:

1. Rinse the victim's stomach. To do this, make him drink several glasses of salted water (for 1 liter - 10 g of salt and 5 g of soda). After 2-3 glasses, induce vomiting in the victim. Repeat these steps until the vomit is "clean".
   

   Gastric lavage is possible only if the victim is conscious.

2. Dissolve 10-20 tablets of activated charcoal in a glass of water, let the victim drink it.
3. Wait for the specialists to arrive.

ALGORITHMS FOR PROVIDING FIRST MEDICAL AID IN EMERGENCY CONDITIONS

FAINTING
Fainting is an attack of short-term loss of consciousness due to transient cerebral ischemia associated with a weakening of cardiac activity and an acute dysregulation of vascular tone. Depending on the severity of the factors contributing to the violation of cerebral circulation.
There are: cerebral, cardiac, reflex and hysterical types of fainting.
Stages of development of fainting.
1. Harbingers (pre-syncope). Clinical manifestations: discomfort, dizziness, tinnitus, shortness of breath, cold sweat, numbness of the fingertips. Lasts from 5 seconds to 2 minutes.
2. Violation of consciousness (actual fainting). Clinic: loss of consciousness lasting from 5 seconds to 1 minute, accompanied by pallor, decreased muscle tone, dilated pupils, their weak reaction to light. Breathing shallow, bradypnea. The pulse is labile, more often bradycardia is up to 40-50 per minute, systolic blood pressure drops to 50-60 mm. rt. Art. With deep fainting, convulsions are possible.
3. Post-fainting (recovery) period. Clinic: correctly oriented in space and time, pallor, rapid breathing, labile pulse and low blood pressure may persist.

2. Unbutton the collar.
3. Provide access to fresh air.
4. Wipe your face with a damp cloth or spray with cold water.
5. Inhalation of ammonia vapors (reflex stimulation of the respiratory and vasomotor centers).
In case of ineffectiveness of the above measures:
6. Caffeine 2.0 IV or IM.
7. Cordiamin 2.0 i/m.
8. Atropine (with bradycardia) 0.1% - 0.5 s / c.
9. When recovering from fainting, continue dental manipulations with measures to prevent relapse: treatment should be carried out with the patient in a horizontal position with adequate premedication and sufficient anesthesia.

COLLAPSE
Collapse is a severe form of vascular insufficiency (decrease in vascular tone), manifested by a decrease in blood pressure, dilation of venous vessels, a decrease in the volume of circulating blood and its accumulation in blood depots - capillaries of the liver, spleen.
Clinical picture: a sharp deterioration in the general condition, severe pallor of the skin, dizziness, chills, cold sweats, a sharp decrease in blood pressure, frequent and weak pulse, frequent, shallow breathing. Peripheral veins become empty, their walls collapse, which makes it difficult to perform venipuncture. Patients retain consciousness (during fainting, patients lose consciousness), but are indifferent to what is happening. Collapse can be a symptom of such severe pathological processes as myocardial infarction, anaphylactic shock, bleeding.

Algorithm of therapeutic measures
1. Give the patient a horizontal position.
2. Provide fresh air supply.
3. Prednisolone 60-90 mg IV.
4. Norepinephrine 0.2% - 1 ml IV in 0.89% sodium chloride solution.
5. Mezaton 1% - 1 ml IV (to increase venous tone).
6. Korglucol 0.06% - 1.0 IV slowly in 0.89% sodium chloride solution.
7. Polyglukin 400.0 IV drip, 5% glucose solution IV drip 500.0.

HYPERTENSIVE CRISIS
Hypertensive crisis is a sudden rapid increase in blood pressure, accompanied by clinical symptoms from target organs (often the brain, retina, heart, kidneys, gastrointestinal tract, etc.).
clinical picture. Sharp headaches, dizziness, tinnitus, often accompanied by nausea and vomiting. Visual impairment (grid or fog before the eyes). The patient is excited. In this case, there is trembling of the hands, sweating, a sharp reddening of the skin of the face. The pulse is tense, blood pressure is increased by 60-80 mm Hg. compared to normal. During a crisis, angina attacks, acute cerebrovascular accident may occur.

Algorithm of therapeutic measures
1. Intravenously in one syringe: dibazol 1% - 4.0 ml with papaverine 1% - 2.0 ml (slowly).
2. In severe cases: clonidine 75 mcg under the tongue.
3. Intravenous Lasix 1% - 4.0 ml in saline.
4. Anaprilin 20 mg (with severe tachycardia) under the tongue.
5. Sedatives - Elenium inside 1-2 tablets.
6. Hospitalization.

It is necessary to constantly monitor blood pressure!

ANAPHYLACTIC SHOCK
A typical form of drug-induced anaphylactic shock (LASH).
The patient has an acute state of discomfort with vague painful sensations. There is a fear of death or a state of inner unrest. There is nausea, sometimes vomiting, coughing. Patients complain of severe weakness, tingling and itching of the skin of the face, hands, head; a feeling of a rush of blood to the head, face, a feeling of heaviness behind the sternum or chest compression; the appearance of pain in the heart, difficulty breathing or the inability to exhale, dizziness or headache. Disorder of consciousness occurs in the terminal phase of shock and is accompanied by impaired verbal contact with the patient. Complaints occur immediately after taking the drug.
The clinical picture of LASH: hyperemia of the skin or pallor and cyanosis, swelling of the eyelids of the face, profuse sweating. Noisy breathing, tachypnea. Most patients develop restlessness. Mydriasis is noted, the reaction of pupils to light is weakened. The pulse is frequent, sharply weakened in the peripheral arteries. Blood pressure decreases rapidly, in severe cases, diastolic pressure is not detected. There is shortness of breath, shortness of breath. Subsequently, the clinical picture of pulmonary edema develops.
Depending on the severity of the course and the time of development of symptoms (from the moment of antigen administration), lightning-fast (1-2 minutes), severe (after 5-7 minutes), moderate (up to 30 minutes) forms of shock are distinguished. The shorter the time from the introduction of the drug to the onset of the clinic, the more severe the shock, and the less chance of a successful outcome of treatment.

Algorithm of therapeutic measures
Urgently provide access to the vein.
1. Stop the administration of the drug that caused anaphylactic shock. Call for an ambulance.
2. Lay the patient down, raise the lower limbs. If the patient is unconscious, turn his head to the side, push the lower jaw. Humidified oxygen inhalation. Ventilation of the lungs.
3. Intravenously inject 0.5 ml of 0.1% adrenaline solution in 5 ml of isotonic sodium chloride solution. If venipuncture is difficult, adrenaline is injected into the root of the tongue, possibly intratracheally (puncture of the trachea below the thyroid cartilage through the conical ligament).
4. Prednisolone 90-120 mg IV.
5. Diphenhydramine solution 2% - 2.0 or suprastin solution 2% - 2.0, or diprazine solution 2.5% - 2.0 i.v.
6. Cardiac glycosides according to indications.
7. In case of airway obstruction - oxygen therapy, 2.4% solution of eufillin 10 ml intravenously in saline solution.
8. If necessary - endotracheal intubation.
9. Hospitalization of the patient. Allergy identification.

TOXIC REACTIONS TO ANESTHETICS

clinical picture. Restlessness, tachycardia, dizziness and weakness. Cyanosis, muscle tremor, chills, convulsions. Nausea, sometimes vomiting. Respiratory distress, decreased blood pressure, collapse.

Algorithm of therapeutic measures
1. Give the patient a horizontal position.
2. Fresh air. Let the vapors of ammonia be inhaled.
3. Caffeine 2 ml s.c.
4. Cordiamin 2 ml s.c.
5. In case of respiratory depression - oxygen, artificial respiration (according to indications).
6. Adrenaline 0.1% - 1.0 ml in saline IV.
7. Prednisolone 60-90 mg IV.
8. Tavegil, suprastin, diphenhydramine.
9. Cardiac glycosides (according to indications).

ANGINA

An attack of angina pectoris is a paroxysm of pain or other unpleasant sensations (heaviness, constriction, pressure, burning) in the region of the heart lasting from 2-5 to 30 minutes with characteristic irradiation (to the left shoulder, neck, left shoulder blade, lower jaw), caused by an excess of myocardial consumption in oxygen over its intake.
An attack of angina pectoris provokes an increase in blood pressure, psycho-emotional stress, which always occurs before and during treatment with a dentist.

Algorithm of therapeutic measures
1. Cessation of dental intervention, rest, access to fresh air, free breathing.
2. Nitroglycerin tablets or capsules (bite the capsule) 0.5 mg under the tongue every 5-10 minutes (total 3 mg under BP control).
3. If the attack is stopped, recommendations for outpatient monitoring by a cardiologist. Resumption of dental benefits - to stabilize the condition.
4. If the attack is not stopped: baralgin 5-10 ml or analgin 50% - 2 ml intravenously or intramuscularly.
5. In the absence of effect - call an ambulance and hospitalization.

ACUTE MYOCARDIAL INFARCTION.

Acute myocardial infarction is an ischemic necrosis of the heart muscle, resulting from an acute discrepancy between the need for oxygen in a myocardial region and its delivery through the corresponding coronary artery.
Clinic. The most characteristic clinical symptom is pain, which is more often localized in the region of the heart behind the sternum, less often captures the entire front surface of the chest. Irradiates to the left arm, shoulder, shoulder blade, interscapular space. The pain usually has a wave-like character: it intensifies, then weakens, it lasts from several hours to several days. Objectively noted pale skin, cyanosis of the lips, excessive sweating, decreased blood pressure. In most patients, the heart rhythm is disturbed (tachycardia, extrasystole, atrial fibrillation).

Algorithm of therapeutic measures

1. Urgent termination of intervention, rest, access to fresh air.
2. Calling a cardiological ambulance team.
3. With systolic blood pressure; 100 mm Hg. sublingually 0.5 mg nitroglycerin tablets every 10 minutes (total dose 3 mg).
4. Mandatory relief of pain syndrome: baralgin 5 ml or analgin 50% - 2 ml intravenously or intramuscularly.
5. Inhalation of oxygen through a mask.
6. Papaverine 2% - 2.0 ml / m.
7. Eufillin 2.4% - 10 ml per physical. r-re in / in.
8. Relanium or Seduxen 0.5% - 2 ml
9. Hospitalization.

CLINICAL DEATH

Clinic. Loss of consciousness. Absence of pulse and heart sounds. Stopping breathing. Paleness and cyanosis of the skin and mucous membranes, lack of bleeding from the surgical wound (tooth socket). Pupil dilation. Respiratory arrest usually precedes cardiac arrest (in the absence of respiration, the pulse on the carotid arteries is preserved and the pupils are not dilated), which is taken into account during resuscitation.

Algorithm of therapeutic measures
REANIMATION:
1. Lay on the floor or couch, throw back your head, push your jaw.
2. Clear the airways.
3. Insert an air duct, carry out artificial ventilation of the lungs and external heart massage.
during resuscitation by one person in the ratio: 2 breaths per 15 compressions of the sternum;
with resuscitation together in the ratio: 1 breath for 5 compressions of the sternum .;
Take into account that the frequency of artificial respiration is 12-18 per minute, and the frequency of artificial circulation is 80-100 per minute. Artificial ventilation of the lungs and external heart massage are carried out before the arrival of "resuscitation".
During resuscitation, all drugs are administered only intravenously, intracardiac (adrenaline is preferable - intratracheally). After 5-10 minutes, the injections are repeated.
1. Adrenaline 0.1% - 0.5 ml diluted 5 ml. physical solution or glucose intracardiac (preferably - intertracheally).
2. Lidocaine 2% - 5 ml (1 mg per kg of body weight) IV, intracardiac.
3. Prednisolone 120-150 mg (2-4 mg per kg of body weight) IV, intracardiac.
4. Sodium bicarbonate 4% - 200 ml IV.
5. Ascorbic acid 5% - 3-5 ml IV.
6. Cold to the head.
7. Lasix according to indications 40-80 mg (2-4 ampoules) IV.
Resuscitation is carried out taking into account the existing asystole or fibrillation, which requires electrocardiography data. When diagnosing fibrillation, a defibrillator (if the latter is available) is used, preferably before medical therapy.
In practice, all of these activities are carried out simultaneously.

Angina.

angina pectoris

Symptoms:

Nurse tactics:

1. Syringes and needles for i/m, s/c injections.

2. Preparations: analgin, baralgin or tramal, sibazon (seduxen, relanium).

3. Ambu bag, ECG machine.

Evaluation of what has been achieved: 1. Complete cessation of pain

2. If pain persists, if this is the first attack (or attacks within a month), if the primary stereotype of an attack is violated, hospitalization in the cardiology department, resuscitation is indicated

Note: if a severe headache occurs while taking nitroglycerin, give a validol tablet sublingually, hot sweet tea, nitromint or molsidomine inside.

Acute myocardial infarction

myocardial infarction is an ischemic necrosis of the heart muscle, which develops as a result of a violation of the coronary blood flow.

Characterized by retrosternal pain of unusual intensity, pressing, burning, tearing, radiating to the left (sometimes right) shoulder, forearm, shoulder blade, neck, lower jaw, epigastric region, pain lasts more than 20 minutes (up to several hours, days), may be undulating (it intensifies, then subsides), or growing; accompanied by a feeling of fear of death, lack of air. There may be violations of the heart rhythm and conduction, instability of blood pressure, taking nitroglycerin does not relieve pain. Objectively: skin is pale, or cyanosis; extremities are cold, cold clammy sweat, general weakness, agitation (the patient underestimates the severity of the condition), restlessness, thready pulse, may be arrhythmic, frequent or rare, deafness of heart sounds, pericardial rub, fever.

atypical forms (options):

Ø asthmatic- asthma attack (cardiac asthma, pulmonary edema);

Ø arrhythmic Rhythm disturbances are the only clinical manifestation

or prevail in the clinic;

Ø cerebrovascular- (manifested by fainting, loss of consciousness, sudden death, acute neurological symptoms like a stroke;

Ø abdominal- pain in the epigastric region, may radiate to the back; nausea,

vomiting, hiccups, belching, severe bloating, tension in the anterior abdominal wall

and pain on palpation in the epigastric region, Shchetkin's symptom

Blumberg negative;

Ø asymptomatic (painless) - vague sensations in the chest, unmotivated weakness, increasing shortness of breath, causeless fever;

Ø with atypical irradiation of pain in - neck, lower jaw, teeth, left arm, shoulder, little finger ( superior - vertebral, laryngeal - pharyngeal)

When assessing the patient's condition, it is necessary to take into account the presence of risk factors for coronary artery disease, the appearance of pain attacks for the first time or a change in habitual

Nurse tactics:

Prepare tools and preparations:

1. System for intravenous administration, tourniquet, electrocardiograph, defibrillator, heart monitor, Ambu bag.

2. As prescribed by a doctor: analgin 50%, 0.005% fentanyl solution, 0.25% droperidol solution, promedol solution 2% 1-2 ml, morphine 1% IV, tramal - for adequate pain relief, Relanium, heparin - for the purpose of prevention repeated blood clots and improvement of microcirculation, lidocaine - lidocaine for the prevention and treatment of arrhythmias;

Hypertensive crisis

Hypertensive crisis - a sudden increase in individual blood pressure, accompanied by cerebral and cardiovascular symptoms (disorder of cerebral, coronary, renal circulation, autonomic nervous system)

- hyperkinetic (type 1, adrenaline): is characterized by a sudden onset, with the onset of intense headache, sometimes pulsating, with predominant localization in the occipital region, dizziness. Excitation, palpitations, trembling throughout the body, hand tremor, dry mouth, tachycardia, increased systolic and pulse pressure. The crisis lasts from several minutes to several hours (3-4). The skin is hyperemic, moist, diuresis is increased at the end of the crisis.

- hypokinetic (type 2, norepinephrine): develops slowly, from 3-4 hours to 4-5 days, headache, "heaviness" in the head, "veil" before the eyes, drowsiness, lethargy, the patient is inhibited, disorientation, "ringing" in the ears, transient visual impairment , paresthesia, nausea, vomiting, pressing pains in the region of the heart, such as angina pectoris (pressing), swelling of the face and pastosity of the legs, bradycardia, diastolic pressure mainly increases, pulse decreases. The skin is pale, dry, diuresis is reduced.

Nurse tactics:

Prepare preparations:

Nifedipine (Corinfar) tab. under the tongue, ¼ tab. capoten (captopril) under the tongue, clonidine (clophelin) tab., amp; anaprilin tab., amp; droperidol (ampoules), furosemide (lasix tab., ampoules), diazepam (relanium, seduxen), dibazol (amp), magnesia sulfate (amp), eufillin amp.

Prepare tools:

Apparatus for measuring blood pressure. Syringes, intravenous infusion system, tourniquet.

Evaluation of what has been achieved: Reduction of complaints, gradual (in 1-2 hours) decrease in blood pressure to the normal value for the patient

Fainting

Fainting this is a short-term loss of consciousness that develops due to a sharp decrease in blood flow to the brain (several seconds or minutes)

The reasons: fright, pain, blood type, blood loss, lack of air, hunger, pregnancy, intoxication.

Pre-fainting period: feeling of lightheadedness, weakness, dizziness, darkening in the eyes, nausea, sweating, ringing in the ears, yawning (up to 1-2 minutes)

Fainting: consciousness is absent, pallor of the skin, decreased muscle tone, cold extremities, breathing is rare, shallow, the pulse is weak, bradycardia, blood pressure is normal or reduced, the pupils are constricted (1-3-5 min, prolonged - up to 20 min)

Post-mortem period: consciousness returns, pulse, blood pressure normalize , weakness and headache are possible (1-2 min - several hours). Patients do not remember what happened.

Nurse tactics:

Prepare tools and preparations:

Syringes, needles, cordiamine 25% - 2 ml / m, caffeine solution 10% - 1 ml s / c.

Prepare preparations: eufillin 2.4% 10ml IV or atropine 0.1% 1ml s.c. if syncope is due to transverse heart block

Evaluation of what has been achieved:

1. The patient regained consciousness, his condition improved - a doctor's consultation.

3. The patient's condition is alarming - call for emergency assistance.

Collapse

Collapse- this is a persistent and prolonged decrease in blood pressure, due to acute vascular insufficiency.

The reasons: pain, trauma, massive blood loss, myocardial infarction, infection, intoxication, a sharp decrease in temperature, a change in body position (getting up), getting up after taking antihypertensive drugs, etc.

Ø cardiogenic form - with heart attack, myocarditis, pulmonary embolism

Ø vascular form- with infectious diseases, intoxication, a critical drop in temperature, pneumonia (symptoms develop simultaneously with symptoms of intoxication)

Ø hemorrhagic form - with massive blood loss (symptoms develop several hours after blood loss)

Clinic: general condition is severe or extremely severe. First there is weakness, dizziness, noise in the head. Disturbed by thirst, chilliness. Consciousness is preserved, but patients are inhibited, indifferent to the environment. The skin is pale, moist, the lips are cyanotic, acrocyanosis, the extremities are cold. BP less than 80 mm Hg. Art., pulse is frequent, thready", breathing is frequent, shallow, heart sounds are muffled, oliguria, body temperature is reduced.

Nurse tactics:

Prepare tools and preparations:

Syringes, needles, tourniquet, disposable systems

cordiamine 25% 2 ml i/m, caffeine solution 10% 1 ml s/c, 1% mezaton solution 1 ml,

0.1% 1 ml of adrenaline solution, 0.2% norepinephrine solution, 60-90 mg of prednisolone polyglucin, reopoliglyukin, saline.
Evaluation of what has been achieved:

1. Condition improved

2. Condition has not improved - be prepared for CPR

shock - a condition in which there is a sharp, progressive decline in all vital body functions.

Cardiogenic shock develops as a complication of acute myocardial infarction.
Clinic: a patient with acute myocardial infarction develops severe weakness, skin
pale wet, "marble" cold to the touch, collapsed veins, cold hands and feet, pain. BP is low, systolic about 90 mm Hg. Art. and below. The pulse is weak, frequent, "filamentous". Breathing shallow, frequent, oliguria

Ø reflex form (pain collapse)

Ø true cardiogenic shock

Ø arrhythmic shock

Nurse tactics:

Prepare tools and preparations:

Syringes, needles, tourniquet, disposable systems, heart monitor, ECG machine, defibrillator, Ambu bag

0.2% norepinephrine solution, mezaton 1% 0.5 ml, saline solution, prednisolone 60 mg, reopo-

liglyukin, dopamine, heparin 10,000 IU IV, lidocaine 100 mg, narcotic analgesics (promedol 2% 2 ml)
Evaluation of what has been achieved:

Condition has not worsened

Bronchial asthma

Bronchial asthma - chronic inflammatory process in the bronchi, predominantly of an allergic nature, the main clinical symptom is an asthma attack (bronchospasm).

During an attack: a spasm of the smooth muscles of the bronchi develops; - swelling of the bronchial mucosa; formation in the bronchi of viscous, thick, mucous sputum.

Clinic: the appearance of seizures or their increase is preceded by exacerbation of inflammatory processes in the bronchopulmonary system, contact with an allergen, stress, meteorological factors. The attack develops at any time of the day, often at night in the morning. The patient has a feeling of "lack of air", he takes a forced position relying on his hands, expiratory dyspnea, unproductive cough, auxiliary muscles are involved in the act of breathing; there is retraction of the intercostal spaces, retraction of the subclavian fossae, diffuse cyanosis, puffy face, viscous sputum, difficult to separate, breathing is noisy, wheezing, dry wheezing, heard at a distance (remote), boxed percussion sound, pulse frequent, weak. In the lungs - weakened breathing, dry rales.

Nurse tactics:

Features of the use of freon-free inhalers (N) - the first dose is released into the atmosphere (these are vapors of alcohol that have evaporated in the inhaler).

Prepare tools and preparations:

Syringes, needles, tourniquet, intravenous infusion system

Medications: 2.4% 10 ml solution of eufillin, prednisolone 30-60 mg IM, IV, saline solution, adrenaline 0.1% - 0.5 ml s / c, suprastin 2% -2 ml, ephedrine 5% - 1 ml.

Evaluation of what has been achieved:

1. Suffocation has decreased or stopped, sputum comes out freely.

2. The condition has not improved - continue the ongoing activities until the arrival of the ambulance.

3. Contraindicated: morphine, promedol, pipolfen - depress breathing

Pulmonary bleeding

The reasons: chronic lung diseases (BEB, abscess, tuberculosis, lung cancer, emphysema)

Clinic: cough with the release of scarlet sputum with air bubbles, shortness of breath, possible pain when breathing, lowering blood pressure, skin is pale, moist, tachycardia.

Nurse tactics:

Prepare tools and preparations:

Everything you need to determine the blood type.

2. Calcium chloride 10% 10ml IV, vikasol 1%, dicynone (sodium etamsylate), 12.5% ​​-2 ml IM, IV, aminocaproic acid 5% IV drops, polyglucin, reopoliglyukin

Evaluation of what has been achieved:

Decrease in cough, decrease in the amount of blood in the sputum, stabilization of the pulse, blood pressure.

hepatic colic

Clinic: intense pain in the right hypochondrium, epigastric region (stabbing, cutting, tearing) radiating to the right subscapular region, scapula, right shoulder, collarbone, neck, jaw. Patients rush about, moan, scream. The attack is accompanied by nausea, vomiting (often with an admixture of bile), a feeling of bitterness and dryness in the mouth, and bloating. Pain worsens with inspiration, palpation of the gallbladder, positive Ortner's symptom, subicteric sclera, dark urine, fever

Nurse tactics:

Prepare tools and preparations:

1. Syringes, needles, tourniquet, intravenous infusion system

2. Antispasmodics: papaverine 2% 2 - 4 ml, but - shpa 2% 2 - 4 ml i / m, platifillin 0.2% 1 ml s / c, i / m. Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: Promedol 1% 1 ml or Omnopon 2% 1 ml IV.

Do not inject morphine - causes spasm of the sphincter of Oddi

Renal colic

Occurs suddenly: after physical exertion, walking, shaky driving, copious fluid intake.

Clinic: sharp, cutting, unbearable pain in the lumbar region radiating along the ureter to the iliac region, groin, inner thigh, external genitalia lasting from several minutes to several days. Patients toss and turn in bed, moan, scream. Dysuria, pollakiuria, hematuria, sometimes anuria. Nausea, vomiting, fever. Reflex intestinal paresis, constipation, reflex pain in the heart.

On examination: asymmetry of the lumbar region, pain on palpation along the ureter, a positive symptom of Pasternatsky, tension in the muscles of the anterior abdominal wall.

Nurse tactics:

Prepare tools and preparations:

1. Syringes, needles, tourniquet, intravenous infusion system

2. Antispasmodics: papaverine 2% 2 - 4 ml, but - shpa 2% 2 - 4 ml i / m, platifillin 0.2% 1 ml s / c, i / m.

Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: Promedol 1% 1 ml or Omnopon 2% 1 ml IV.

Anaphylactic shock.

Anaphylactic shock- this is the most formidable clinical variant of an allergic reaction that occurs with the introduction of various substances. Anaphylactic shock can develop when ingested:

a) foreign proteins (immune sera, vaccines, extracts from organs, poisons on-

insects...);

b) medicines (antibiotics, sulfonamides, B vitamins…);

c) other allergens (plant pollen, microbes, food products: eggs, milk,

fish, soybeans, mushrooms, tangerines, bananas...

d) with insect bites, especially bees;

e) in contact with latex (gloves, catheters, etc.).

Ø lightning form develops 1-2 minutes after the administration of the drug;

is characterized by the rapid development of the clinical picture of an acute ineffective heart, without resuscitation, it ends tragically in the next 10 minutes. Symptoms are poor: severe pallor or cyanosis; dilated pupils, lack of pulse and pressure; agonal breathing; clinical death.

Ø mild shock, develops 5-7 minutes after the administration of the drug

Ø severe form develops in 10-15 minutes, maybe 30 minutes after the administration of the drug.

Most often, shock develops within the first five minutes after the injection. Food shock develops within 2 hours.

Clinical variants of anaphylactic shock:

1. Typical shape: a feeling of heat "doused with nettles", fear of death, severe weakness, tingling, itching of the skin, face, head, hands; sensation of a rush of blood to the head, tongue, heaviness behind the sternum or chest compression; pain in the heart, headache, shortness of breath, dizziness, nausea, vomiting. With a lightning-fast form, patients do not have time to complain before losing consciousness.
2. Cardiac variant manifested by signs of acute vascular insufficiency: severe weakness, pallor of the skin, cold sweat, "threadlike" pulse, blood pressure drops sharply, in severe cases, consciousness and breathing are depressed.
3. Asthmoid or asphyxial variant manifested by signs of acute respiratory failure, which is based on bronchospasm or swelling of the pharynx and larynx; there is a feeling of tightness in the chest, coughing, shortness of breath, cyanosis.
4. cerebral variant manifested by signs of severe cerebral hypoxia, convulsions, foaming at the mouth, involuntary urination and defecation.

5. Abdominal variant manifested by nausea, vomiting, paroxysmal pain in
stomach, diarrhea.

Urticaria appears on the skin, in some places the rash merges and turns into a dense pale edema - Quincke's edema.

Nurse tactics:

Prepare tools and preparations:

tourniquet, ventilator, tracheal intubation kit, Ambu bag.

2. Standard set of drugs "Anaphylactic shock" (0.1% adrenaline solution, 0.2% norepinephrine, 1% mezaton solution, prednisone, 2% suprastin solution, 0.05% strophanthin solution, 2.4% aminophylline solution, saline .solution, albumin solution)

Medical care for anaphylactic shock without a doctor:

1. Intravenous administration of adrenaline 0.1% - 0.5 ml per physical. r-re.

After 10 minutes, the introduction of adrenaline can be repeated.

In the absence of venous access, adrenaline
0.1% -0.5 ml can be injected into the root of the tongue or intramuscularly.

Actions:

Ø adrenaline increases heart rate, increases heart rate, constricts blood vessels and thus increases blood pressure;

Ø adrenaline relieves spasm of the smooth muscles of the bronchi;

Ø adrenaline slows down the release of histamine from mast cells, i.e. fights an allergic reaction.

2. Establish intravenous access and start fluid administration (physiological

solution for adults> 1 liter, for children - at the rate of 20 ml per kg) - replenish the volume

fluid in the vessels and increase blood pressure.

3. The introduction of prednisolone 90-120 mg IV.

By doctor's prescription:

4. After stabilization of blood pressure (BP above 90 mm Hg) - antihistamines:

5. With a bronchospastic form, eufillin 2.4% - 10 iv. On saline. When on-
cyanosis, dry rales, oxygen therapy. Possible inhalations

alupenta

6. With convulsions and strong arousal - in / in sedeuxen

7. With pulmonary edema - diuretics (lasix, furosemide), cardiac glycosides (strophanthin,

corglicon)

After removing from shock, the patient is hospitalized for 10-12 days..

Evaluation of what has been achieved:

1. Stabilization of blood pressure, heart rate.

2. Restoration of consciousness.

Urticaria, angioedema

Hives: allergic disease , characterized by a rash on the skin of itchy blisters (edema of the papillary layer of the skin) and erythema.

The reasons: medicines, serums, foodstuffs…

The disease begins with intolerable skin itching in various parts of the body, sometimes on the entire surface of the body (on the trunk, extremities, sometimes the palms and soles of the feet). Blisters protrude above the surface of the body, from point sizes to very large, they merge, forming elements of various shapes with uneven, clear edges. Rashes can remain in one place for several hours, then disappear and reappear in another place.

There may be fever (38 - 39 0), headache, weakness. If the disease lasts more than 5-6 weeks, it becomes chronic and is characterized by an undulating course.

Treatment: hospitalization, withdrawal of drugs (stop contact with the allergen), fasting, repeated cleansing enemas, saline laxatives, activated charcoal, polypefan orally.

Antihistamines: diphenhydramine, suprastin, tavigil, fenkarol, ketotefen, diazolin, telfast ... orally or parenterally

To reduce itching - in / in the solution of sodium thiosulfate 30% -10 ml.

Hypoallergenic diet. Make a note on the title page of the outpatient card.

Conversation with the patient about the dangers of self-treatment; when applying for honey. with the help of the patient should warn the medical staff about intolerance to the drugs.

Quincke's edema- characterized by edema of the deep subcutaneous layers in places with loose subcutaneous tissue and on the mucous membranes (when pressed, the fossa does not remain): on the eyelids, lips, cheeks, genitals, back of the hands or feet, mucous membranes of the tongue, soft palate, tonsils, nasopharynx, gastrointestinal tract (clinic of acute abdomen). When the larynx is involved in the process, asphyxia may develop (anxiety, puffiness of the face and neck, increasing hoarseness, "barking" cough, difficulty stridor breathing, lack of air, cyanosis of the face), with swelling in the head region, the meninges are involved in the process (meningeal symptoms) .

Nurse tactics:

Prepare tools and preparations:

1. System for intravenous infusion, syringes and needles for i/m and s/c injections,
tourniquet, ventilator, tracheal intubation kit, Dufo needle, laryngoscope, Ambu bag.

2. Adrenaline 0.1% 0.5 ml, prednisolone 30-60 mg; antihistamines 2% - 2 ml of suprastin solution, pipolfen 2.5% - 1 ml, diphenhydramine 1% - 1 ml; fast-acting diuretics: lasix 40-60mg IV bolus, mannitol 30-60mg IV drip

Inhalers salbutamol, alupent

3. Hospitalization in the ENT department

First aid for emergency conditions and acute diseases

Angina.

angina pectoris- this is one of the forms of coronary artery disease, the causes of which may be: spasm, atherosclerosis, transient thrombosis of the coronary vessels.

Symptoms: paroxysmal, squeezing or pressing pain behind the sternum, loads lasting up to 10 minutes (sometimes up to 20 minutes), passing when the load is stopped or after taking nitroglycerin. The pain radiates to the left (sometimes right) shoulder, forearm, hand, shoulder blade, neck, lower jaw, epigastric region. It can be manifested by atypical sensations in the form of lack of air, inexplicable sensations, stabbing pains.

Nurse tactics:

Life sometimes brings surprises, and they are not always pleasant. We get into difficult situations or become their witnesses. And often we are talking about the life and health of loved ones or even random people. How to act in this situation? After all, quick action, the correct provision of emergency assistance can save a person's life. What are emergencies and emergency medical care, we will consider further. And also find out what should be the help in case of emergency, such as respiratory arrest, heart attack and others.

Types of medical care

The medical care provided can be divided into the following types:

• Emergency. It appears in the event that there is a threat to the life of the patient. This can be with an exacerbation of any chronic diseases or with sudden acute conditions.
• Urgent. It is necessary during the period of exacerbated chronic pathology or in case of an accident, but there is no threat to the life of the patient.

• Planned. This is the implementation of preventive and planned activities. At the same time, there is no threat to the patient's life even if the provision of this type of assistance is delayed.

Emergency and emergency care

Emergency and emergency medical care are very closely related to each other. Let's take a closer look at these two concepts.

In emergencies, medical attention is required. Depending on where the process takes place, in case of emergency, assistance is provided:

• External processes that arise under the influence of external factors and directly affect human life.
• internal processes. The result of pathological processes in the body.

Emergency care is one of the types of primary health care, provided during exacerbation of chronic diseases, in acute conditions that do not threaten the patient's life. It can be provided both on a day hospital and on an outpatient basis.

Emergency assistance should be provided in case of injuries, poisoning, acute conditions and diseases, as well as in case of accidents and in situations where assistance is vital.

Emergency care must be provided in any medical institution.

Pre-hospital care is very important in emergency situations.

Major emergencies

Emergency conditions can be divided into several groups:

1. Injuries. These include:

• Burns and frostbite.
• Fractures.
• Damage to vital organs.
• Damage to blood vessels with subsequent bleeding.
• Electric shock.

2. Poisoning. Damage occurs within the body, unlike injuries, it is the result of external influences. Violation of the work of internal organs with untimely emergency care can lead to death.

Poison can enter the body:

• Through the respiratory organs and mouth.
• Through the skin.
• Through the veins
• Through mucous membranes and through damaged skin.

Medical emergencies include:

1. Acute conditions of internal organs:

• Stroke.
• Myocardial infarction.
• Pulmonary edema.
• Acute liver and kidney failure.
• Peritonitis.

2. Anaphylactic shock.

3. Hypertensive crises.

4. Attacks of suffocation.

5. Hyperglycemia in diabetes mellitus.

Emergency conditions in pediatrics

Every pediatrician should be able to provide emergency care to the child. It may be required in case of a serious illness, in case of an accident. In childhood, a life-threatening situation can progress very quickly, since the child's body is still developing and all processes are imperfect.

Pediatric emergencies requiring medical attention:

• Convulsive syndrome.
• Fainting in a child.
• Coma in a child.
• collapse in a child.
• Pulmonary edema.
• The child is in shock.
• infectious fever.
• Asthmatic attacks.
• Croup syndrome.
• Incessant vomiting.
• Dehydration of the body.
• Emergency conditions in diabetes mellitus.

In these cases, the emergency medical service is called.

Features of emergency care for a child

The doctor's actions must be consistent. It must be remembered that in a child, the disruption of the functioning of individual organs or the whole organism occurs much faster than in an adult. Therefore, emergencies and emergency medical care in pediatrics require a quick response and coordinated action.

Adults should ensure the calm condition of the child and provide full cooperation in collecting information about the patient's condition.

The doctor should ask the following questions:

• Why did you seek emergency help?
• How was the injury received? If it's an injury.
• When did the child get sick?
• How did the disease develop? How did it go?
• What preparations and agents were used before the arrival of the doctor?

The child must be undressed for examination. The room should be at normal room temperature. In this case, the rules of asepsis must be observed when examining a child. If it is a newborn, a clean gown should be worn.

It should be borne in mind that in 50% of cases where the patient is a child, the diagnosis is made by the doctor based on the information collected, and only in 30% - as a result of the examination.

At the first stage, the doctor should:

• Assess the degree of disruption of the respiratory system and the work of the cardiovascular system. Determine the degree of need for emergency therapeutic measures according to vital signs.
• It is necessary to check the level of consciousness, breathing, the presence of convulsions and cerebral symptoms and the need for urgent measures.

You need to pay attention to the following points:

• How does the child behave?
• Sluggish or hyperactive.
• What an appetite.
• Condition of the skin.
• The nature of the pain, if any.

Medical emergencies and care

The health worker must be able to quickly assess emergencies, and emergency medical care must be provided in a timely manner. A correct and quick diagnosis is the key to a quick recovery.

Treatment emergencies include:

1. Fainting. Symptoms: pallor of the skin, skin moisture, muscle tone is reduced, tendon and skin reflexes are preserved. Blood pressure is low. There may be tachycardia or bradycardia. Fainting can be caused by the following reasons:

• Failure of the organs of the cardiovascular system.
• Asthma, various types of stenosis.
• Diseases of the brain.
• Epilepsy. Diabetes mellitus and other diseases.

Assistance is as follows:

• The victim is placed on a flat surface.
• Unbutton clothes, provide good access to air.
• You can spray water on the face and chest.
• Give a sniff of ammonia.
• Caffeine benzoate 10% 1 ml is administered subcutaneously.

2. Myocardial infarction. Symptoms: pain burning, squeezing, similar to an attack of angina pectoris. Pain attacks are undulating, decrease, but do not stop completely. The pain gets worse with every wave. At the same time, it can give to the shoulder, forearm, left shoulder blade or hand. There is also a feeling of fear, a breakdown.

Assistance is as follows:

• The first stage is pain relief. Nitroglycerin is used or Morphine or Droperidol is administered intravenously with Fentanyl.
• It is recommended to chew 250-325 mg of Acetylsalicylic acid.
• You need to measure your blood pressure.
• Then it is necessary to restore the coronary blood flow.
• Beta-adrenergic blockers are prescribed. During the first 4 hours.
• Thrombolytic therapy is carried out in the first 6 hours.

The doctor's task is to limit the size of necrosis and prevent the occurrence of early complications.

The patient must be urgently admitted to an emergency medicine center.

3. Hypertensive crisis. Symptoms: headache, nausea, vomiting, goosebumps, numbness of the tongue, lips, hands. Double vision, weakness, lethargy, high blood pressure.

Emergency assistance is as follows:

• It is necessary to provide the patient with rest and good access to air.
• With crisis type 1 "Nifedipine" or "Clonidine" under the tongue.
• At high pressure intravenously "Clonidine" or "Pentamine" up to 50 mg.
• If tachycardia persists, - "Propranolol" 20-40 mg.
• In a type 2 crisis, Furosemide is administered intravenously.
• With convulsions, Diazepam is administered intravenously or Magnesium sulfate.

The doctor's task is to reduce the pressure by 25% of the initial one during the first 2 hours. With a complicated crisis, urgent hospitalization is necessary.

4. Coma. It may be of different types.

Hyperglycemic. Develops slowly, begins with weakness, drowsiness, headache. Then there is nausea, vomiting, increased thirst, itchy skin. Then loss of consciousness.

Urgent care:

• Eliminate dehydration, hypovolemia. Sodium chloride solution is injected intravenously.
• Intravenously administered "Insulin".
• With severe hypotension, a solution of 10% "Caffeine" subcutaneously.
• Carry out oxygen therapy.

Hypoglycemic. It starts off sharp. The moisture of the skin is increased, the pupils are dilated, blood pressure is reduced, the pulse is quickened or normal.

Emergency care means:

• Ensuring complete rest.
• Intravenous administration of glucose.
• Correction of arterial pressure.
• Urgent hospitalization.

5. Acute allergic diseases. Serious diseases include: bronchial asthma and angioedema. Anaphylactic shock. Symptoms: the appearance of skin itching, there is excitability, increased blood pressure, a feeling of heat. Then loss of consciousness and respiratory arrest, failure of the heart rhythm are possible.

Emergency care is as follows:

• Position the patient so that the head is below the level of the legs.
• Provide air access.
• Open the airways, turn the head to the side, protrude the lower jaw.
• Introduce "Adrenaline", re-introduction is allowed after 15 minutes.
• "Prednisolone" in / in.
• Antihistamines.
• With bronchospasm, a solution of "Euphyllin" is administered.
• Urgent hospitalization.

6. Pulmonary edema. Symptoms: well expressed shortness of breath. Cough with white or yellow sputum. The pulse is fast. Seizures are possible. Breath is wheezing. Wet rales are heard, and in a serious condition "dumb lungs"

We provide emergency assistance.

• The patient should be in a sitting or semi-sitting position, legs lowered.
• Carry out oxygen therapy with defoamers.
• Enter / in "Lasix" in saline.
• Steroid hormones such as Prednisolone or Dexamethasone in saline.
• "Nitroglycerin" 1% intravenously.

Let's pay attention to emergency conditions in gynecology:

1. Ectopic pregnancy disturbed.
2. Torsion of the pedicle of an ovarian tumor.
3. Apoplexy of the ovary.

Consider the provision of emergency care for ovarian apoplexy:

• The patient should be in a supine position, with a raised head.
• Glucose and "Sodium chloride" are administered intravenously.

It is necessary to control indicators:

• Blood pressure.
• Heart rate.
• body temperature.
• Respiratory frequency.
• Pulse.

Cold is applied to the lower abdomen and urgent hospitalization is indicated.

How are emergencies diagnosed?

It is worth noting that the diagnosis of emergency conditions should be carried out very quickly and take literally seconds or a couple of minutes. The doctor must at the same time use all his knowledge and make a diagnosis in this short period of time.

The Glasgow scale is used when it is necessary to determine the impairment of consciousness. It evaluates:

• Eye opening.
• Speech.
• Motor responses to pain stimuli.

When determining the depth of the coma, the movement of the eyeballs is very important.

In acute respiratory failure, it is important to pay attention to:

• Color of the skin.
• Color of mucous membranes.
• Breathing frequency.
• Movement during breathing of the muscles of the neck and upper shoulder girdle.
• Retraction of the intercostal spaces.

Shock can be cardiogenic, anaphylactic, or post-traumatic. One of the criteria may be a sharp decrease in blood pressure. In traumatic shock, first of all, determine:

• Damage to vital organs.
• The amount of blood loss.
• Cold extremities.
• Symptom of "white spot".
• Decreased urine output.
• Decreased blood pressure.
• Violation of the acid-base balance.

The organization of emergency medical care consists, first of all, in maintaining breathing and restoring blood circulation, as well as in delivering the patient to a medical institution without causing additional harm.

Emergency Algorithm

For each patient, the methods of treatment are individual, but the algorithm of actions for emergency conditions must be performed for each patient.

The principle of action is as follows:

• Restoration of normal breathing and circulation.
• Help with bleeding.
• It is necessary to stop convulsions of psychomotor agitation.
• Anesthesia.
• Elimination of disorders that contribute to the failure of the heart rhythm and its conduction.
• Conducting infusion therapy to eliminate dehydration of the body.
• Decrease in body temperature or its increase.
• Conducting antidote therapy in acute poisoning.
• Strengthening natural detoxification.
• If necessary, enterosorption is carried out.
• Fixation of the damaged part of the body.
• Correct transportation.
• Constant medical supervision.

What to do before the doctor arrives

First aid in emergency conditions consists of performing actions that are aimed at saving human life. They will also help prevent the development of possible complications. First aid for emergencies should be provided before the doctor arrives and the patient is taken to a medical facility.

Action algorithm:

1. Eliminate the factor that threatens the health and life of the patient. Conduct an assessment of his condition.
2. Take urgent measures to restore vital functions: restoring breathing, artificial respiration, heart massage, stopping bleeding, applying a bandage, and so on.
3. Maintain vital functions until the ambulance arrives.
4. Transportation to the nearest medical facility.

1. Acute respiratory failure. It is necessary to carry out artificial respiration "mouth to mouth" or "mouth to nose". We tilt our head back, the lower jaw needs to be shifted. Close your nose with your fingers and take a deep breath into the victim's mouth. It is necessary to take 10-12 breaths.

2. Heart massage. The victim is in a supine position on his back. We stand on the side and put palm on palm on top of the chest at a distance of 2-3 fingers above the lower edge of the chest. Then we perform pressure so that the chest is displaced by 4-5 cm. Within a minute, 60-80 pressures must be done.

Consider the necessary emergency care for poisoning and injuries. Our actions in gas poisoning:

• First of all, it is necessary to take the person out of the polluted area.
• Loosen tight clothing.
• Assess the patient's condition. Check pulse, breathing. If the victim is unconscious, wipe the temples and give a sniff of ammonia. If vomiting has begun, then it is necessary to turn the head of the victim to one side.
• After the victim was brought to his senses, it is necessary to carry out inhalation with pure oxygen so that there are no complications.
• Then you can give hot tea, milk or slightly alkaline water to drink.

Help with bleeding:

• Capillary bleeding is stopped by applying a tight bandage, while it should not compress the limb.
• We stop arterial bleeding by applying a tourniquet or clamping the artery with a finger.

It is necessary to treat the wound with an antiseptic and contact the nearest medical facility.

Providing first aid for fractures and dislocations.

• With an open fracture, it is necessary to stop the bleeding and apply a splint.
• It is strictly forbidden to correct the position of the bones or remove fragments from the wound.
• Having fixed the place of injury, the victim must be taken to the hospital.
• A dislocation is also not allowed to be corrected on its own; a warm compress cannot be applied.
• It is necessary to apply cold or a wet towel.
• Rest the injured part of the body.

First aid for fractures should occur after bleeding has stopped and breathing has normalized.

What should be in a first aid kit

In order for emergency assistance to be provided effectively, it is necessary to use a first aid kit. It should contain components that may be needed at any moment.

The first aid kit must meet the following requirements:

• All medicines, medical instruments, as well as dressings should be in one special case or box that is easy to carry and transport.
• First aid kit should have many departments.
• Store in an easily accessible place for adults and out of the reach of children. All family members should know about her whereabouts.
• Regularly check the expiration dates of the drugs and replenish the used medicines and products.

What should be in the first aid kit:

1. Preparations for the treatment of wounds, antiseptics:

• Brilliant green solution.
• Boric acid in liquid or powder form.
• Hydrogen peroxide.
• Ethanol.
• Alcoholic iodine solution.
• Bandage, tourniquet, adhesive plaster, dressing bag.

2. Sterile or plain gauze mask.

3. Sterile and non-sterile rubber gloves.

4. Analgesics and antipyretics: "Analgin", "Aspirin", "Paracetamol".

5. Antimicrobials: Levomycetin, Ampicillin.

6. Antispasmodics: Drotaverine, Spazmalgon.

7. Cardiac drugs: "Corvalol", "Validol", "Nitroglycerin".

8. Adsorbents: "Atoxil", "Enterosgel".

9. Antihistamines: Suprastin, Dimedrol.

10. Ammonia.

11. Medical instruments:

• Clamp.
• Scissors.
• Cooling package.
• Disposable sterile syringe.
• Tweezers.

12. Antishock drugs: Adrenaline, Eufillin.

13. Antidotes.

Emergencies and emergency medical care are always highly individual and depend on the person and specific conditions. Every adult should have an understanding of emergency care in order to be able to help their loved one in a critical situation.

Article 11 of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) states that emergency medical care is provided by a medical organization and a medical worker to a citizen without delay and is free. Refusal to provide it is not allowed. A similar wording was in the old Fundamentals of Legislation on the Protection of the Health of Citizens in the Russian Federation (approved by the Supreme Court of the Russian Federation on July 22, 1993 N 5487-1, became invalid on January 1, 2012), although the concept of “emergency medical care” appeared in it. What is emergency medical care?

Forms of medical care

Article 32 of the Federal Law No. 323 identifies the following forms of medical care:

emergency

Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the life of the patient.

urgent

Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.

Planned

Medical assistance provided during preventive measures, in case of diseases and conditions that are not accompanied by a threat to the life of the patient, that do not require emergency and urgent medical care, and the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.

The difference between the concepts of "emergency" and "urgent" care

An attempt to isolate emergency medical care from emergency, or emergency medical care familiar to each of us, was made by officials of the Ministry of Health and Social Development of Russia (since May 2012 - the Ministry of Health of the Russian Federation).

Approximately since 2007, we can talk about the beginning of some separation or differentiation of the concepts of "emergency" and "urgent" care at the legislative level.

However, in the explanatory dictionaries of the Russian language there are no clear differences between these categories. urgent- one that cannot be postponed; urgent. Extra urgent, emergency, emergency. Federal Law No. 323 put an end to this issue by approving three different forms of medical care: emergency, urgent and planned.

As you can see, emergency and emergency medical care are opposed to each other. At the moment, any medical organization is obliged to provide only emergency medical care free of charge and without delay. Are there any significant differences between the two discussed concepts? It is especially important to talk about fixing this difference at the normative level.

Cases of emergency and urgent care

According to officials of the ministry, emergency medical care is provided if the existing pathological changes in the patient are not life-threatening. But from various regulatory legal acts of the Ministry of Health and Social Development of Russia, it follows that there are no significant differences between emergency and emergency medical care. They do not match only on the following points:

Emergency medical care

It turns out with sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the life of the patient, is a type of primary health care and is provided on an outpatient basis and in a day hospital. For this purpose, an emergency medical service is being created in the structure of medical organizations.

emergency medical care

It turns out with sudden acute diseases, conditions, exacerbation of chronic diseases that are life-threatening for the patient (accidents, injuries, poisoning, pregnancy complications and other conditions and diseases). According to the new law, emergency medical care is provided in an emergency or emergency form outside a medical organization, as well as on an outpatient and inpatient basis. Any medical organizations and medical workers are required to provide emergency assistance.

The presence of a threat to life

Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves, and when introducing a new concept of separate provision of emergency and emergency medical care, a number of problems arise, the main of which is the difficulty of determining in practice the existence of a threat to life.

There was an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the life of the patient, with the exception of the most obvious (for example, penetrating wounds of the chest, abdominal cavity). It is not clear what the mechanism for determining the threat should be. It follows from the analyzed acts that often the conclusion about the presence of a threat to life is made either by the victim himself or by the ambulance dispatcher, based on the subjective opinion and assessment of what is happening by the person who applied for help. In such a situation, both an overestimation of the danger to life and a clear underestimation of the severity of the patient's condition are possible.

The Need for a Regulatory Definition of a Threat to Life

Therefore, especially at the initial stage of the implementation of the concept that divides the flow of patients according to fuzzy guidelines, we can expect an increase in deaths. Hopefully, the most important details will soon be spelled out in by-laws.

At the moment, medical organizations should probably focus on the medical understanding of the urgency of the situation, the presence of a threat to the life of the patient and the urgency of action. In a medical organization, it is mandatory to develop local instructions for emergency medical care on the territory of the organization, with which all medical workers must be familiarized.

Emergency medical care costs

In accordance with paragraph 10 of Article 83 of Federal Law No. 323, the costs associated with the provision of free medical care to citizens in an emergency form by a medical organization, including a medical organization of a private healthcare system, are subject to reimbursement in the manner and in the amount established by the program of state guarantees of free provision to citizens medical care. However, it is worth noting that to date, the mechanism for such compensation at the legislative level has not been established.

Emergency Medical Licensing

After the entry into force of the Order of the Ministry of Health of Russia dated March 11, 2013 No. 121n “On approval of the Requirements for the organization and performance of work (services) in the provision of primary health care, specialized (including high-tech) ...” (hereinafter - the Order of the Ministry of Health No. 121n ) many citizens have a well-founded misconception that emergency medical care must be included in the license for medical activity. The type of medical service "emergency medical care", subject to licensing, is also indicated in the Decree of the Government of the Russian Federation dated April 16, 2012 No. 291 "On licensing medical activities".

Clarifications of the Ministry of Health of the Russian Federation on the issue of licensing emergency care

However, the Ministry of Health of the Russian Federation in its Letter No. 12-3 / 10 / 2-5338 dated July 23, 2013 gave the following explanation on this topic: “As for the work (service) in emergency medical care, this work (service) was introduced for licensing the activities of medical organizations that, in accordance with Part 7 of Article 33 of Federal Law N 323-FZ, have created units in their structure to provide primary health care in an emergency form. In other cases of providing medical care in an emergency form, obtaining a license providing for the performance of works (services) in emergency medical care is not required.

Thus, the type of medical service "emergency medical care" is subject to licensing only by those medical organizations, in the structure of which, in accordance with Article 33 of the Federal Law No. 323, medical care units are created that provide the specified assistance in an emergency form.

The article uses materials from the article Mokhov A.A. Peculiarities of emergency and emergency care in Russia // Legal issues in health care. 2011. N 9.