Orthostatic collapse emergency. First aid for fainting and collapse. Emergency care for collapse, fainting, shock

COLLAPSE

it life threatening acute vascular insufficiency, characterized by a sharp decrease in vascular tone, a decrease in circulating blood volume, signs of cerebral hypoxia and depression of vital important functions organism.

Most common causes collapse in children: severe course of acute infectious pathology (intestinal infection, , , pneumonia, , etc.); acute adrenal insufficiency; overdose antihypertensive drugs; acute blood loss; severe injury.

The collapse clinic develops, as a rule, during the height of the underlying disease and is characterized by a progressive deterioration in the general condition of the patient. Depending on the clinical manifestations conventionally, there are three phases (options) of collapse: sympathotonic, vagotonic and paralytic.

Sympathotonic collapse

He due to impaired peripheral circulation due to spasm of arterioles and centralization of blood circulation, compensatory release of catecholamines. It is characterized by the excitation of the child, increased muscle tone; pallor and marbling of the skin, cold hands and feet; tachycardia, blood pressure normal and elevated. However, these symptoms are short-lived, and collapse is more often diagnosed in later phases.

Vagotonic collapse

In this phase, note significant expansion arterioles and arteriovenous anastomoses, which is accompanied by the deposition of blood in the capillary bed. Clinically characteristic: lethargy, adynamia, decreased muscle tone, pronounced pallor of the skin with marbling, pronounced acrocyanosis, a sharp decline HELL. Pulse usually weak filling, bradycardia is often noted, noisy and rapid breathing of the Kussmaul type, oliguria may occur.

paralytic collapse

It is caused by passive expansion of capillaries due to the depletion of the mechanisms of regulation of blood circulation. This condition is characterized by: lack of consciousness with inhibition of skin and bulbar reflexes, the appearance of blue-purple spots on the skin of the trunk and extremities, bradycardia, bradypnoe with a transition to periodic, blood pressure decreases to critical numbers, thready pulse, anuria. In the absence of emergency care, a fatal outcome occurs.

Urgent care

Therapeutic measures must be started immediately!

• It is necessary to lay the child horizontally on his back with slightly
  head thrown back, overlay with warm heating pads, provide with
  flow of fresh air.
• Ensuring free patency of the upper respiratory tract
  (review oral cavity remove tight clothing).

• With the phenomena of sympathotonic collapse, it is necessary to remove
  spasm peripheral vessels i / m administration of antispasmodics (2% rast
  thief papaverine 0.1 ml / year of life or drotaverine solution 0.1 ml / year
  life).
• With the phenomena of vagotonic and paralytic collapse, it is necessary
  walk:

Establish access to a peripheral vein and begin infusion therapy rheopolyglucin solution or crystalloids (0.9% solution or Ringer's solution) at the rate of 20 ml/kg for 20-30 minutes;

Simultaneously administer corticosteroids in a single dose: hydro
cortisone 10–20 mg/kg IV or 5–10 mg/kg IV, or
in the bottom of the mouth, or 0.3-0.6 mg/kg IV.

• With intractable arterial hypotension necessary:
• re-introduce intravenously 0.9% solution or
  Ringer's solution in a volume of 10 ml / kg in combination with a solution of re-
  opoliglucin 10 ml/kg under control, blood pressure and diuresis;
• prescribe a 1% solution of mezaton 0.1 ml/year of life i/v bolus
  slowly or 0.2% solution of noradrenaline 0.1 ml/year of life IV
  drip (in 50 ml of 5% glucose solution) at a rate of 10-20 ka
  pelt per minute (in very severe cases- 20-30 drops per mi
  chickpeas) under the control of blood pressure.

• According to the indications, the primary cardiopulmonary resuscitation, after which the patient is hospitalized in the intensive care unit after the provision of urgent measures.

AT modern world so many various diseases that sometimes you don’t even suspect what problem will overtake you at the next stage of life. There are diseases that for our body, and sometimes life, represent great danger. In some cases, when serious complications collapse may occur, emergency care will be required in urgently to save a person's life.

What is collapse

In many diseases, there may be a disruption in the work of the vegetative nervous system, which is responsible for the regulation of vascular tone. In such situations, acute

During collapse, pressure drops, as paresis sets in. small vessels. The volume of blood moving through them decreases sharply, blood flow slows down. This causes the brain to stop receiving required amount oxygen and nutrients. The same goes for the heart muscle.

In this condition, the blood supply throughout the body is disrupted, which leads to metabolic disorders. Not only neuro-reflex disorders can lead to vascular insufficiency, but also toxic substances protein nature. This usually happens when infectious diseases, for example, pneumonia, typhus, during a heart attack or severe blood loss.

Varieties of collapse

Depending on the clinic and pathogenesis, the collapse is divided into three types:

1. Sympathotonic. This form of collapse is accompanied increased tone sympathetic department nervous system, which leads to spasm of the arteries throughout the body. Systolic pressure in such situations, normal or slightly elevated, and diastolic high. If such a collapse is observed, emergency care is required urgently so as not to earn more serious complications.
2. vagotonic collapse. In this state, the tone comes parasympathetic system. Arteries, on the contrary, expand, diastolic pressure decreases, bradycardia is observed. The cause of this condition is fright, fainting, hypoglycemic coma.
3. Paralytic. Most often it happens with a strong depletion of the mechanisms that are responsible for the regulation of blood circulation. Vessels expand, pressure drops, and collapse occurs, emergency care is reduced to normalization in the first place blood pressure.

Causes of the collapse

A collapse can be caused by many reasons:

If a collapse occurs as a result of these causes, emergency care will depend on them. In each case, the steps will be different.

Signs of collapse

As a rule, recognizing a collapse is not difficult. Its manifestations are usually clear and bright, so it is almost impossible to confuse with other diseases. The main symptoms of collapse include the following:

The emergency treatment of collapse should be carried out immediately in order to remove as much as possible faster than a human from this state.

Symptoms of collapse in children

The child's body perceives any malfunctions in its work much more strongly, so the onset of collapse can be accurately recorded. The symptoms are usually the following:

In such situations, emergency care is urgently needed for collapse in children.

First aid for collapse

It may happen that your close person will need help with the collapse. No one is immune from this, so every person should have basic skills in providing it. Although the rendering algorithm is voluminous, it is quite possible for anyone to remember it.

1. Call an ambulance.
2. In the event of such an attack, it is necessary to put the patient on his back on a flat surface.
3. Unfasten the top buttons on the garment, if any.
4. It is advisable to open a window in the room so that more fresh air enters.
5. The legs can be slightly elevated to increase blood flow to the head.
6. Since there is a decrease in body temperature, the patient must be warmed with a heating pad.
7. Bring a swab dipped in ammonia to your nose.
8. Introduce 0.1% solution of Adrenaline, 0.5% solution of Ephedrine.
9. If the collapse is caused heavy bleeding then it needs to be stopped.
10. Provide the patient with complete rest.
11. In case of cardiac arrest, it is necessary to indirect massage heart combined with artificial respiration.

We have looked at what collapse is. the algorithm for its implementation - these issues were also raised by us, but there are other points that must be taken into account.

Forbidden when collapsing

If you need to give a person first aid for a collapse, this does not mean that all means are good. There are things you can't do:

1. In no case should you give the patient heart drugs, as they dilate the blood vessels.
2. During it, you should not try to pour a little water into your mouth or shove a pill.
3. It is also not recommended to resort to the help of slaps in the face to bring a person to his senses.

Most often, in such situations, the score goes for minutes, so even before the arrival of the ambulance, competent emergency care should be provided for fainting and collapse.

Drug therapy during collapse

Arriving ambulance will certainly take the patient to the hospital. Assistance will be provided within its walls, but with the use of medicines. First of all, intravenous infusions of sodium chloride are prescribed. The amount of the drug is determined by the patient's condition. The doctor pays attention to the following signs:

As additional therapy appoint:

• Anti-inflammatory drugs, for example, Metipred, Prednisolone.
• Vasopressor drugs are administered intravenously.
• For fast withdrawal spasm is injected with Novocain.

After the patient's condition returns to normal, they begin to treat the disease that provoked the collapse. You must always remember: if your native person there is a collapse, the emergency care you give him can save his life. That is why everyone should know the list of necessary actions during such a situation. Health to all, may such situations never happen in your life.

Collapse - acute vascular insufficiency - differs from syncope in the severity of manifestations and the duration of the course. Accompanied sharp drop arterial, venous pressure, a decrease in the volume of circulating blood, a minute volume of blood circulation, severe hypoxia, metabolic disorders, lesions of the centers of the brain.

Occurs with intoxication, infectious diseases, acute adrenal insufficiency, heart disease, etc. It can be combined with heart failure (often moderately severe) - mainly with myocardial infarction, with rapidly progressing acute myocarditis Consciousness is partially preserved. There are vascular, hemorrhagic collapse, cardiogenic hypotension.

Vascular collapse

It is characterized by a drop in vascular tone and an acute decrease in the volume of circulating blood. The inflow is decreasing venous blood to the heart, arterial and venous pressure decreases, the heart rate quickens.

hemorrhagic collapse

Cardiogenic hypotension

Symptoms

Pulse quickened, small filling, weak tension, sometimes threadlike; often difficult to determine. Heart sounds are muffled. Arterial pressure up to 40-50 mm Hg, is determined with difficulty. Body temperature is lowered. Possible vomiting.

In acute infectious diseases, a decrease in body temperature is prognostically unfavorable (may indicate the development of collapse)

Differentiate mainly with heart failure (Table 3)

Table 3 Differential Diagnosis vascular and heart failure

Urgent care

1. Complete rest. Strict bed rest. Warm (cover with a blanket, put heating pads) Hot strong tea, coffee.

2. Cordiamin - 0.5 ml, mezaton - 0.5 ml of a 1% solution intravenously, slowly.

When especially serious condition (vascular collapse, overdose drugs etc.), severe drug poisoning, analgesics, sleeping pills - cordiamine 2-4 ml, 5 ml intravenously, slowly; hydrocortisone - 100-150 mg intravenously; norepinephrine - 1-2 ml of a 0.2% solution in 250 ml of a 5% glucose solution intravenously, drip, up to 60 drops / min, under the control of blood pressure (up to 100-110 mm Hg)

Contraindications: cardiogenic shock, hemorrhagic, severe atherosclerosis, complete atrioventricular block; poisoning with chloroform, halothane, cyclopropane.

At less pronounced manifestations- cordiamin 1 ml, mezaton - 1 ml of a 1% solution subcutaneously or intramuscularly.

3. Camphor - 2-4 ml 20% oil solution subcutaneously. Caffeine - 1-2 ml of a 10% solution subcutaneously.

4. Strychnine - 1 ml of 0.1% solution subcutaneously. Analeptic solution (see page 23) 0.5-1 ml subcutaneously or intramuscularly.

5. Inhalation of a humidified oxygen-air mixture (40-60%) through a nasal catheter.

6. With severe intoxication - glucose up to 1 liter of 5% solution intravenously, drip (or isotonic solution sodium chloride)

7. With hemorrhagic collapse of blood transfusion (500-1000 ml), plasma substitutes (250-1000 ml)

8. When combined with collapse with heart failure, strophanthin - 0.25-0.5 ml of a 0.05% solution intravenously or corglicon - 0.5-1 ml of a 0.06% solution intravenously.

9. Treatment of the underlying disease. Symptomatic therapy.

10. Hospitalization after removal from the collapse. Transportation is gentle. Blood pressure control.

V.F. Bogoyavlensky, I.F. Bogoyavlensky

Collapse- one of the most complex forms of acute vascular insufficiency. This problem requires immediate professional intervention. Everyone should know how to provide emergency care for a collapse. During an attack, the score can go for minutes. And due to the fact that the first aid algorithm is very simple, it will not be difficult to remember it.

How to understand that this is a collapse, and a person needs first aid?

The collapse comes suddenly. The amount of blood entering the brain decreases sharply, which suddenly worsens the patient's well-being. The sooner signs of collapse are recognized, the more likely that can be avoided unpleasant consequences illness.

So, emergency care may be required for collapse when the following symptoms occur:

• sharp darkening in the eyes;
• pallor;
• weak but rapid pulse;
• nausea;
• vomit;
• blurred consciousness;
• cold sweat;
• headache;
• blurred vision;
• decrease in body temperature;
• fainting;
• absent look.

Emergency care for collapse, fainting, shock

Of course, to help the patient get out of the state of collapse for a person without medical education fail. And yet there are some actions that will help alleviate the patient's condition during an attack:

1. The patient should be gently placed on a hard surface.
2. The patient's legs should be raised and fixed in this position. This will help ensure blood flow to the heart and brain.
3. An obligatory stage of emergency care for collapse is to ensure the flow of fresh air.
4. Outerwear that makes it difficult to breathe, remove or unfasten.
5. Give a sniff of cotton wool with ammonia, if one is at hand. If not, you can just rub your temples, earlobes, a hole above upper lip gentle massage movements.
6. If collapse is a consequence severe blood loss trying to stop the bleeding.

The term collapse defines a severe pathological condition of the child, in which significant reduction smooth muscle tone of the walls of arterial vessels, as a result of which the level of systemic arterial pressure decreases. This condition requires emergency care, as it can lead to sharp deterioration functional state all organs and systems, which is a consequence of impaired blood flow in them. First of all, against the background of collapse, the central nervous system suffers, since neurocytes (cells of the nervous system) are very sensitive to oxygen starvation.

The reasons

A sharp and pronounced decrease in the tone of the smooth muscle structures of the walls of arterial vessels is a polyetiological pathological condition, which can be caused by several factors. In children, the most common of these are:

• Significant increase (hyperglycemia) or decrease (hypoglycemia) in blood sugar levels.
• Insufficiency of the functional activity of the adrenal glands, which produce hormones that increase the tone of the smooth muscles of the walls of the arteries (glucocorticosteroids, adrenaline, norepinephrine).
• Poisoning of the body associated with exogenous (from outside) intake various toxins.
• Severe course infectious pathology with severe intoxication of the child's body.
• Somatic pathology with defeat internal organs, hearts, endocrine glands in the stage of decompensation.

Girls in puberty possible development of vascular collapse, which can be triggered by exposure to psycho-emotional stress factors.

Clinical picture

The development of collapse is characterized by the manifestation of a fairly characteristic clinical picture with the following symptoms:

In general, the severity of the child's condition is determined by the severity of the decrease in the level of systemic arterial pressure. The lower it is, the worse condition and more pronounced clinical picture collapse.

Help at the prehospital stage

When the first clinical signs the development of collapse in a child should be immediately called ambulance. Prior to the arrival of medical specialists, assistance is provided on prehospital stage which includes several events:

Further measures require intravenous or intramuscular injection medicines, which is performed medical specialists already in the ambulance. After the child is hospitalized, care at the hospital stage necessarily includes an objective diagnosis of the causes of the collapse.