What is a agonal state? Sudden death Terminal state of the ICD
INn.e.perpNand I fromm.e.rt.
TOoD etcaboutt.abouttoola: E-003.
C.e.l. e.t.butpbut: Restoring the function of all vital systems and organs.
TOoD (toaboutd.s) pabout M.TOB.- 10:
R96. D.rw.g.e. inandd.s inn.e.perpNoh fromm.e.rt.and pabout n.e.andz.ineUt.n.oh prandc.ine.
IS.tol.yuc.e.n.about:
sudden heart death, as described (I46.1)
sudden death baby (R95)
OPRfoodl.e.n.e.:
Death comes suddenly or within 60 minutes after the emergence of symptoms of deterioration of well-being in individuals who were in a stable state,
the absence of signs of a particular disease.
Sun do not include cases of violent death, death as a result of injury, asphyxia,
drowning and poisoning.
Sun can be cardiogenic and negrotogenic genesis.
Basic cardiac causes of OEC: ventricular fibrillation, ventricular tachycardia without pulse, full of AV-blockade with idioventricular rhythm, electromechanical dissociation, asistolia, pronounced vascular dystonia with a critical add blood pressure.
F.andb.randllyaq.i j.e.lu.d.aboutc.tos.
Discorded and disintegrated reductions of myocardial fibers, leading
to the impossibility of the formation of St.
It is 60-70% of all cases of OEK.
FZh is more often observed in acute coronary insufficiency, drowning in fresh water, hypothermia, electric shock.
FZHA harbingers: early, paired and political ventricular extrasystoles.
Prefabral forms Zht: alternating and pyruette rail, polymorphic zht.
J.e.lu.d.aboutc.toovaya T.buth.iKbutrd.andi b.e.z. pw.l.bsA
The frequency of ventricular tachycardia is so high that during the diastole cavity
ventricles are not able to fill with enough blood, which leads to a sharp decrease heart Emission (absence of pulse) and, consequently, to inadequate blood circulation.
Stomatricular tachycardia without a pulse according to forecasts equal to fibrillation
ventricles.
ACandfromt.oL.and I
Lack of heart abbreviations and signs of electrical activity,
confirmed in three leads to the ECG.
It is 20-25% of all cases of stopping effective blood circulation.
Divided into sudden (especially unfavorable in prognostic plan) and
delayed (arising after preceding rhythm violations).
ELe.tot.roh.e.h.butn.schtoand I d.andsSaboutq.butq.i (E.M.D.)
Heavy oppression of myocardial cuttlens with a drop in cardiac ejection and blood pressure, but under the preserving cardiac complexes on the ECG.
It is about 10% of all cases of OEK.
P e. r in and c. n. and I E. M. D. - Myocardium loses the opportunity to perform effective contract
the availability of the source of electrical pulses.
The heart quickly goes to idiochentricular rhythm, which soon replaces
asistolia.
The primary EMD includes:
1) acute myocardial infarction (especially its lower wall);
2) a state after repeated, depleting myocardiums, fibrillation episodes,
eliminated with SLMR;
3) the final stage of severe heart disease;
4) inhibition of myocardial endotoxins and drugs in overdose (beta blockers,
calcium antagonists, tricyclic antidepressants, heart glycosides).
5) atrial thrombosis, a tumor of the heart.
IN t. oR and c. n. and I E. M. D. - a sharp reduction in cardiac output not related to
direct violation of the processes of excitability and myocardial reductions.
Causes of secondary EMD:
1) Pericarda Tamponade;
2) lung artery thromboembolism;
4) pronounced hypovolemia;
5) Occlusion Trombus Prosthetic Valve.
The cause of EMD can be:
sinus bradycardia, an atrioventricular blockade, slow idiovativericular rhythm. FROM me. sh but nNU e. f. oR m. s E. MD
The progression of toxic-metabolic processes is noted:
1) severe endotoxemia;
2) hypoglycemia;
3) hypo- and hypercalcemia;
4) pronounced metabolic acidosis;
Principles cerdEVn.about- l.e.g.aboutc.n.about- moz.g.oova re.butn.andma.q.and (SLM.R)
The brain is experiencing the lack of blood flow only for 2-3 minutes - it is for this period of time that glucose reserves in the brain for ensuring
energy exchange in anaerobic glycolysis.
Resuscitation should begin with the prosthetics of the heart, the main task is -
provide perfusions with blood brain!
ABOUTfromn.oVn.y perd.butc.and pe.rhowling re.butn.ma.q.aboutnN.oh pomo.shand:
1. Restoration of efficient hemodynamics.
2. Restoration of breathing.
3. Restoration and correction of brain functions.
4. Prevention of recurrence of terminal state.
5. Warning of possible complications.
ABOUTfromn.oVn.y fromandm.pt.omi. inn.e.perpNoh aboutfromt.butn.oVtoand e.fFe.tot.andinn.aboutg.about krobobrbutshe.n.i:
1. The loss of consciousness develops within 8-10 seconds from the moment of stopping the blood circulation.
2. Causes usually appear at the time of loss of consciousness.
3. Lack of pulsation on large main arteries.
4. Stop breathing more often comes later than the rest of the symptoms - about 20 -
30 - 40 s. Sometimes agonal breathing is marked for 1-2 minutes and more.
5. The expansion of pupils appears after 30-90 seconds from the start of the circulatory stop.
6. Pallor, sinusia, "marble" of the skin.
Pabouttoaza.n.i to reUw.sSandt.butq.and:
1. The absence and pronounced weakness of ripples on sleepy (or femoral and shoulder) arteries.
2. No breathing.
furious breathing).
4. Lack of consciousness.
5. No photoreacts and extended pupils.
Etcaboutt.andinpabouttoaza.n.andi to reUw.sSandt.butq.and:
1. Terminal stages of the incurable disease.
2. Significant traumatic brain destruction.
3. Early (drying and clouding of the cornea, the symptom of the "cat eye") and the late (body spots and the corpse stuff) signs of biological death.
4. Documented patient failure from resuscitation.
5. Stay in a state clinical death more than 20 minutes before arrival
qualified assistance.
TObutki.e. ma.nIPulyaq.and n.e. froml.elfw.e.t. etcoVOd.andt.b inabout andzBe.j.butn.e. Paboutt.e.rand inre.m.e.n.and:
1. Auscult heart.
2. To search for pulsation on the radial artery.
3. To carry out the algorithm - "I feel, I see, I hear."
4. Determine corneal, tendon and sipboard reflexes.
5. Measure blood pressure.
G.lav.n.y krandt.e.r.and etcaboutd.oL.j.e.n.i reUw.sSandt.buttion:
1. Pulse on carotid arteries, synchronous with chest compression -
indicates the correctness of the massage of the heart and the preservation of tone
myocardium.
2. Change the color of the skin (corporation).
3. The narrowing of the pupil (improvement of oxygenation in the medium brain area).
4. High "artifact-complexes" on ECG.
5. Restoration of consciousness during resuscitation.
Pabouttoaza.t.e.lie b.eUpe.rfrompe.tot.andinn.aboutfromt.and d.al.bn.e.j.she.j. reUw.sSandt.butq.and:
1. Areasiveness of extended pupils.
2. No or steady reduction in muscle tone.
3. No reflexes from the upper respiratory tract.
4. Low deformed "artifact-complexes" on ECG.
The term "closed heart massage" is unauthorized, because Introducing the sternum to 4-5 cm in the anterorable direction, it is impossible to grind the heart between the sternum and the vertebral pillar - the specified size of the chest is 12-15 cm, and the heart size in this area is 7-8 cm.
With the compression of the chest basically, the effect of the thoracic effect
pump, i.e. Increased intrabringe pressure during compression and reduction in intricure pressure during decompression.
Etce.toaboutrd.andal.bn.oh w.d.aR
1. The patient is applied 4-5 sharp blows to a fist in the area of \u200b\u200bthe center of the middle and lower
third of sternum from a distance of at least 30 cm.
2. The blow should be strong enough, but not extremely powerful.
3. Indications to precordial strikes are ventricular fibrillation and ventricular tachycardia without a pulse.
4. Effectiveness of the stomach tachycardia without a pulse ranges from 10
5. When ventricular fibrillation, the recovery of the rhythm occurs much less frequently.
6. Used only in the absence of a defibrillator prepared for the work and
patients with reliable blood circulation stop.
7. Premordial strike should not be applied instead of electric
heart defibrillation (EMF).
8. The precodal strike can translate the ventricular tachycardia into the asistolism,
fibrillation of ventricles or EMD, respectively, FZ - asistol or EMD.
9. When asystolia and EMD, the precordial strike is not used.
T.e.h.nickbut etcoVfoodn.i t.aboutrbuttobutl.bn.oh poh.ps:
1. The palm surface of the right brush is stacked on the middle of the sternum or 2-3
see above the sword-shaped grudge process, and the palm of the left brush on the right.
2. It is impossible to tear the palm from the chest in pauses.
3. Compression is carried out at the expense of the severity of the bodyguard.
4. Depth excursion sternum towards the spine should be 4-5
see adults.
five . The pace of pressing should be 60-80 in 1 min.
6. To estimate the effectiveness of the thoracic pump, the pulse on carotid arteries periodically palp.
7. Resuscitation is suspended by 5 seconds by an end of 1 minute and then every 2-3 minutes,
to evaluate whether the restoration of spontaneous breathing occurred and
blood circulation.
8. Resuscitation can not be stopped by more than 5-10 seconds for conducting
additional medical events and for 25-30 seconds for trachea intubation.
9. The ratio of inhale compression should be 20: 2 with any number of rescuers
before intubating trachea, then 10: 1.
INfrompomo.g.butt.e.l.bn.y pr.e.we,pomarshbutyushande. effe.tot.t.aboutrbuttobutl.bn.oh poh.ps:
1. Conducting a thoracic pump only on a solid basis.
2. Raising legs by 35-40 ° reduces "functioning" vascular channel due to
lower limbs. This leads to centralization of blood circulation and an increase in the BCC at 600-700 ml. Flowing blood accelerates slamming aortic valves In the phase of stopping the compressions of the chest, thereby improving the coronary blood flow.
The situation of Trendelenburg is dangerous, for it contributes to the development of brain hypoxic edema.
1. The infusion of plasma substitutes increases venous pressure and increases the venous support.
2. Insert abdominal compression is to compress the abdomen after the cessation of the chest. This action is squeezing
blood from the vascular bed of belly. Conduct only in intubed patients due to the danger of regurgitation.
M.e.h.butn.zM T.aboutrbuttobutl.bn.oh poh.ps:
1. The chest pump is the compression of the chambers of the heart and the lungs due to the increase in pressure in the whole
chest cavity.
2. In the phase of the compression of the chest, all heart cameras are squeezed, coronary
arteries and large vessels.
3. Pressure in the aorta and the right of atrium is equal and coronary
blood circulation stops.
4. When breastproofing, blood flow to the heart is improved,
a small pressure gradient is established between the aorta and the right atrium.
5. Increased pressure in the arc of the aorta leads to the closure of the semi-lunged valves, behind which the mouths are departed coronary arteries, and, consequently, to restore
blood flow by coronary arteries.
E.fFe.tot.andinn.aboutfromt.bt.aboutrbuttoal.bn.oh poh.ps:
1. Creates a low pressure gradient and low diastolic pressure (driving force for coronary blood flow) due to uniform pressure distribution on
the structures of the chest cavity.
2. The heart rate is less than 20-25% of the norm, which is lower than it is observed.
with severe cardiogenic shock.
3. The productivity of the thoracic pump is quickly reduced, even in the absence of severe myocardial damage leads to the disappearance of efficiency by 30-40 minutes. Rising hypoxia and mechanical heart injury in a short time lead to a drop of myocardial tone.
4. Provides no more than 5-10% normal indicators Coronary
blood circulation.
5. Brain blood flow in the production of thoracic pumps does not exceed 10-20%
standards, while most of the artificial blood flow is carried out in soft tissues Heads.
6. The minimum blood circulation in the brain, which is able to create a thoracic pump is a 10-minute temporary barrier. After the specified
the time of time completely disappears the entire stock of oxygen in myocardium, the energy reserves are completely depleted, the heart loses the tone and becomes a flabby.
E.fFe.tot.andinn.aboutfromt.b aboutt.krst.aboutg.about ma.sSbutj.but cerd.c.but (ABOUTM.FROM) :
1. OMS provides greater survival with full function recovery
brain. Most patients are recovered with the restoration of cerebral life even after a two-hour SCL.
2. Infection is not a serious problem after thoracotomy, even in non-sterile conditions.
3. OMS provides more adequate cerebral (up to 90% of the norm) and coronary (more than 50% of the norm) blood flow than the thoracic pump, because Last
enhances intragenuary pressure, blood pressure and venous pressure.
4. OMS creates a higher arterio-venous perfusion pressure.
5. With thoracotomy, you can directly observe and palpate the heart, which helps to estimate the effect of drug therapy and EMF with SSTL.
6. Open chest allows you to stop intrathoracic bleeding.
7. In the case of intra-abdominal bleeding, it allows you to temporarily overlook the chest
aorta above the diaphragm.
8. Remedy Massage Mechanical Heart Irritation
promotes the emergence of myocardial cuts.
The OMS should be proceeding as early as possible in cases where the adequately conductive thoracic pump restores independent blood circulation. Discrediting of OMS depends on the delay of its use.
After unsuccessful long-term production of thoracic pump transition to OMS
equivalent to the massage of the deceased heart.
ABOUTfromn.oVn.y Pabouttoaza.n.i to etcoVfoodn.yu etcyamog.about ma.sSbutj.but cerd.c.but:
1. Pericarda Tamponade In most cases, it can be eliminated only by direct emptying of the pericardium cavity from the liquid.
2. Extensive pulmonary thromboembolia.
3. Deep hypothermia - a persistent FZ occurs. Thoracotomy allows you to heat
heart with warm saline during direct massage.
4. penetrating wounds of the chest and abdominal cavity, stupid injury with clinical
pattern of heart stop.
5. The loss of the elasticity of the chest is the deformation and rigidity of the chest and
spine, displacement of the mediastinum.
6. unsuccessful attempts (for 3-5 min) of external defibrillation (at least 12
maximum on energy discharges).
7. Sudden asistolia in young people and the inefficiency of thoracic
8. Massive hemotorax.
11. Gap the aortic aneurysm.
12. A pronounced emphysema of the lungs.
13. Multiple fractures of ribs, sternum, spine.
F.buttot.aboutrs w.frompe.h.but def.andb.r.llyac.andand:
1. Effective production of thoracic pump, ventilation of the lungs with maximum oxygen supply in the breathing mixture.
2. Defibrillation after administration of adrenaline is more efficient. Finelywall fibrillation is transferred to large-scale with adrenaline. Defibrillation
with finelywall fibrillation, it is ineffective and can cause ashistol.
3. With the introduction of cardiotonic or antiarrhythmic drugs, the discharge must
applied not earlier than 30-40 seconds after the introduction of the medication. Follow the scheme: Medicine → Thoracic pump and IVL → Defibrillation → Medicine → Thoracic pump and IVL → Defibrillation.
4. It is necessary to observe the density and uniformity of the pressed electrodes to the skin:
pressure about 10 kg.
5. The location of the electrodes should not be close to each other.
6. To overcome the resistance of the chest constituting an average of 70-80
Ohm, and the heart of greater energy is applied with three discharges with an increasing
energy: 200 J → 300 J → 360 J.
7. The interval between discharges must be minimal - only at the time of control
pulse or ECG (5-10 seconds).
8. The polarity of the pulse supplied does not have a fundamental value.
9. The decomposition of the discharge should be made in the phase of the patient's exhalation. This reduces the head cover with light and reduces the ohmic resistance by 15-20%, which increases the efficiency of the defibrillator discharge.
9. In the event of repeated episodes of fibrillation, that energy is used
the discharge that previously had a positive effect.
10. If it is impossible to ECG control, the blocking of the "blind" discharge on the first minute
heart stops are quite acceptable.
11. Avoid avoiding the location of the electrodes over the artificial rhythm driver.
12. With a significant thicker of the patient, the initial discharge of the EIT
there must be 300 J, then 360 J and 400 J.
ABOUTshandb.toand and aboutfromloj.n.e.n.i E.l.e.tot.raboutandm.pw.l.bfromn.oh t.e.rbutp.and (EIT.)
1. It is impossible to conduct an EIT at the asistolia.
2. The accidental impact of an electric discharge on the surrounding can lead to a fatal outcome.
3. After the EIT (cardioversion), there may be a temporary or constant violation of the artificial driver of the rhythm.
4. Cannot allow long interruptions in resuscitation when preparing a defibrillator to the category.
5. It is not allowed a loose pressed electrodes.
6. Do not use electrodes without sufficient moistening of their surface.
7. It is impossible to leave tracks (liquid, gel) between the defibrillator electrodes.
8. It is impossible to be distracted when conducting an EIT.
9. Do not apply the discharge of low or excessively high voltage.
events that increase myocardial energy resources.
11. You cannot have resuscitation at the time of the EIT.
Pabouttoaza.n.i and etcaboutt.andinpabouttoaza.n.andi to etcoVfoodn.andyu ma.nIPulyatsii.
Form.e.n.e.n.e. Pe.raboutrbutl.bn.aboutg.about wHOd.w.h.oVOd.but n.e. Re.tooh.e.n.d.w.e.t.fromi for:
1) unreasonable obstruction of the upper respiratory tract;
2) the injury of the oral cavity;
3) a fracture of the jaw;
4) staggering teeth;
5) acute bronchospasm.
ABOUTfromloj.n.e.n.i etcand andfrompoL.bzovan.andand pe.raboutral.bn.aboutg.about wHOd.w.h.oVOd.but:
1) bronchospastic reaction;
2) vomiting with subsequent regurgitation;
3) laryngospasm;
4) exacerbating the obstruction of the respiratory tract.
Pabouttoaza.n.i to andn.t.uA.q.and t.rbuth.e.and:
1. The ineffectiveness of ventilation of the lungs in other ways.
2. A large resistance to blowing the air (displeased laryngospasm, a large weight of the inferior glands during obesity, with toxicosis in pregnant women).
3. Regurgitation and suspicion of aspiration of gastric content.
4. The presence of a large amount of sputum, mucus and blood in the oral cavity, in the trachea,
bronchi.
5. Inadequate shanction of tracheobronchial wood in the presence of consciousness.
6. Lack of pharyngeal reflexes.
7. Multiple fractures of ribs.
8. Transition to an open heart massage.
9. The need for a long IVL.
Poh.n.t.e., c.t.about:
With the availability of a defibrillator with FZh discharges are applied before creating
intravenous access.
With the availability of peripheral veins, the catheterization of the main veins do not conduct
in order to avoid complications (intense pneumothorax, injury of a subclavian artery and breast lymphatic duct, an air embolism, etc.).
With a fracture of ribs and / or patient's sterns, the skeleton of the chest,
what sharply reduces the effectiveness of the thoracic pump.
Medicines (adrenaline, atropine, lidocaine) can be administered to an endotracheal tube or directly in the trachea by constituting, increasing the dose by 2-3 times and explores 10-20 ml of isotonic sodium chloride solution with subsequent 3-4 forced breaths for pulverying drugs.
The intracardiac injections "in the blind" are not applied, due to the risk of damage to coronary vessels and conducting pathways, the development of hemopericard and intense pneumothorax, the introduction of medication directly into myocardium.
TOlasSandf.iKbutq.i:
Sudden death:
1. Cardiogenic: asistolia, ventricular fibrillation, ventricular tachycardia without
pulse, electromechanical dissociation;
2. NARDOGICAL: Asian, ventricular fibrillation, ventricular tachycardia
without pulse, electromechanical dissociation.
D.andbutgNaboutfromt.andschki.e. krandt.e.r.and:
Signs of a sudden stop of effective blood circulation:
1. There is no consciousness.
2. Pulsation on large main arteries is not determined.
3. Breathing agonal or absent.
4. Pupils are expanded, the light does not react.
5. Skin covers are pale gray, occasionally with a cyanotic tint.
Pe.rdesignn.b aboutfromn.oVn.oh d.andbutgNaboutfromt.andschki.h. m.e.raboutpr.it.andj.:
1) to identify the presence of consciousness;
2) check the pulse on both carotid arteries;
3) establish the passability of the upper respiratory tract;
4) determine the magnitude of the pupils and their reaction to the light (in the course of resusation);
5) Determine the form of the stop of the effective blood circulation on the monitor
defibrillator (ECG) (in the course of resassation);
6) Rate the color of the skin (along the reserissation).
T.buttot.iKbut abouttoazbutn.i n.e.aboutt.loj.n.oh pomo.shand:
Principles l.designn.i:
1. The effectiveness of restoring the effective work of the heart depends on the start time
SCL and from the adequacy of the events held.
2. Creating a tight support under the head and the patient's body allows you to increase the effectiveness of the chest pump.
3. Rimming the legs by 30-40 ° increases the passive blood return to the heart -
increases preload.
4. Insert abdominal compression in the interval between the next boobs compresses increases the preload and increases the coronary perfusion pressure.
5. Outdoor Heart massage after trachea intubation creates an effective gradient
pressures and significantly increases the perfusion of the brain and the heart, which allows us to extend SCL up to 2 hours and more with the restoration of biological and social life. P rO and z. in about d. and t. from i n. but D. about g. about from p and t. but l. b n. oh. e. t. but p e. t. about l. b to about about teaching nNU m. me. ditin from to them slave t. n. and to about m. !
F.andb.randllyaq.i j.e.lu.d.aboutc.tooV
1. Premordial strikes to apply during the preparation of the defibrillator to work if
from the moment of stopping the effective blood circulation passed no more than 30 seconds. Remember
that the precodal imagination itself can lead to the development of asistolia and EMD!
100% oxygen.
6. The discharge of the defibrillator is applied only in the presence of large-lit fibrillation:
200 J - 300 J - 360 J. The discharges must follow each other without continuing SCL and check the pulse.
7. If fails: Epinephrine (0.1%) in / in 1.0 ml (1 mg) per 10 ml of isotonic solution
NaCl, after which it is produced by SL and repeat the EIT - 360 J.
8. If you fail: inkjet / in amiodarone (Curdaron) 300 mg per 20 ml of 5% glucose; With the unavailability of amiodarone - lidocaine 1.5 mg / kg in / in inkjet. SLMR - EIT (360 J). Search for a disposable cause of FZH.
9. With failure: Epinephrine 3.0 mg V / B, sodium bicarbonate 2 ml of 4% solution per 1 kg (1
mmol / kg) in / c, amiodarone 300 mg per 20 ml of 5% glucose (lidocaine 1.5 mg / kg in / c). SLMR
- Eit (360 J).
10. With failure: magnesium sulfate 5-10 ml 25% solution in / in and / or propranolol 0.1% - 10
ml in / c. SLMR - EIT (360 J).
11. With failure: thoracotomy, conducting an open heart massage with drug support and an EIT.
12. If FZ is eliminated: to evaluate hemodynamics, determine the nature of post-conversational rhythm. Continue supporting infusion
antiarrhythmic agent that gave a positive effect.
J.e.lu.d.aboutc.toovaya T.buth.iKbutrd.andi b.e.z. pw.l.bsA
Treatment is similar to that such when fibrillation of ventricles.
ACandfromt.oL.and I
1. Premordial strikes when installed or suspected asistolia do not use!
2. Chest compression (60-80 in 1 min).
3. IVL. At the beginning, "mouth in the mouth", a bag of Ambo. After intubating trachea use
100% oxygen.
4. VERENNECTION or WORDALTERIZATION.
6. Epinephrine (0.1%) V / B1.0 ml (1 mg) per 10 ml of isotonic solution NaCl (repeated every 3 min.). Dose to increase to 3 mg, then 5 mg, then 7 mg, if the standard does not give effect. SLMR between injections.
7. Atropine (0.1%) V / in 1.0 ml (1 mg), repeat every 3 min. Dose increase to 3 mg,
if the standard does not give effect to the total dose of 0.04 mg / kg. SLMR.
8. Eliminate possible cause Asistolia (hypoxia, acidosis, hypokalemia and
hypercalemia, overdose of drugs, etc.).
9. Aminophyllin (2.4%) V / in 10 ml for 1 min. SLMR.
10. External electrocardialism is effective when saving myocardial function.
11. Sodium Bicarbonate (4%) 1 mmol / kg V \u200b\u200b/ B is shown if the ashistolia originated against the background of acidosis.
ELe.tot.roh.e.h.butn.schtoand I d.andsSaboutq.butq.i (E.M.D.)
1. Premordial strikes when installed or suspected EMD not use!
2. Chest compression (60-80 in 1 min).
3. IVL. At the beginning, "mouth in the mouth", a bag of Ambo. After intubating trachea use
100% oxygen.
4. VERENNECTION or WORDALTERIZATION.
6. Epinephrine (0.1%) V / B1.0 ml (1 mg) per 10 ml of isotonic NaCl solution (repeat
every 3 min.). Dose to increase to 3 mg, then 5 mg, then 7 mg, if the standard does not give effect. SLMR between injections.
7. To identify the cause (shock, hypokalemia, hypercalemia, acidosis, inadequate ventilation, hypovolemia, etc.) and eliminate it.
8. Infusion therapy - 0.9% solution NaCl or 5% glucose solution up to 1 l / h.
9. At low heart rate - atropine of 1 mg in / every 3 min., Around up to 3 mg.
10. Sodium bicarbonate (4%) 1 mmol / kg in / in with the development of acidosis.
11. Electrocardiosulation.
Form.exbutn.e.:
Sodium bicarbonate is administered by 1 mmol / kg (2 ml of 4% solution per 1 kg of body weight), and then
0.5 mmol / kg every 7-10 minutes. Apply with a protracted SCL (10 minutes or more), the development of sudden death against the background of acidosis, hypercalemia, overdose of tricyclic antidepressants.
In hypercalemia, the administration of calcium chloride is shown at the rate of 20-40 ml of 10%
solution in / c.
Pe.rdesignn.b aboutfromn.oVn.oh and d.aboutpoL.n.andt.e.l.bn.oh m.elfandtoaMe.n.t.s:
1) Epinephrine
2) Atropine
3) amiodaron
4) aminoofillin
5) 0.9% sodium chloride solution
6) 4% sodium solution of bicarbonate
7) Lidocaine
8) 25% magnesium sulfate solution
9) Propranolol
IN.d.iKbutt.aboutrs e.f.f.e.tot.andinn.aboutfromt.and abouttoaza.n.i m.elficycfromtooh pomo.shand:
G.lav.n.y krandt.e.r.and etcaboutd.oL.j.e.n.i re.butn.ma.c.andand:
1) Pulse on carotid arteries;
This indicates the correctness of the implementation of the massage of the heart and the preservation of myocardial tone.
2) change in the color of the skin (corporation);
3) the narrowing of the pupil (improvement of oxygenation in the medium brain area);
4) High "artifact-complexes" on the ECG.
5) Restoration of consciousness during resuscitation.
FROMp.fromoK andfrompaboutl.bzovanN.oh l.andt.e.rbutt.w.rs:
1. Emergency Guide medical care. Bagnenko S.F., Velkin A.L,
Miroshnichenko A.G., Habutiya M.Sh. Gootar Media, 2006
2. Prefigure help With urgent critical states. I.F.
Bogoyavlensky. St. Petersburg, "Hippocrat", 2003
3. Secrets emergency care. P. E. Parsonz, J. P. Winner Cronysh. Moscow,
"Medpress-Inform", 2006
4. Elementary cardiac and brain resuscitation. F.R. Achmer and others. Kazan, 2002
5. Intensive therapy of threatening states. Ed. V.A. Koryachkin and V.I.
Strachnov. St. Petersburg, 2002
6. Guide for intensive therapy. Ed. A.I. Trezchinsky and F.S.
Depth. Kiev, 2004
7. Intensive therapy. Moscow, Gootar, 1998
8. Henderson. Emergency Medicine. Texas, 2006.
9. Vital Signs and Resuscitation. Stewart. Texas, 2003.
10. Rosen`s Emergency Medicine. MOSBY, 2002.
5. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development of clinical guidelines and protocols of diagnosis and treatment, taking into account modern requirements. Guidelines. Almaty, 2006, 44 s.
No. 883 "On approval of a list of basic (vital) medicines."
854 "On approval of the instructions for the formation of a list of basic (vital drugs) of medicines."
FROMp.fromoK razrab.aboutt.c.iKs:
Head of the Department of Emergency and Emergency Medical Aid, Internal
diseases number 2 of the Kazakh National Medical University. S.D. Asphendiyarova - D.M., Professor Turlanov KM Employees of the emergency and emergency medical care, domestic diseases No. 2 of the Kazakh National Medical University. S.D. Asphendiyarova: Ph.D., Associate Professor Vodnev VP; Ph.D., Associate Professor Diasebyev B.K.; K.M.N., Associate Professor Akhmetova G.D.; Ph.D., Associate Professor Babybaeva G.G.; Almukhambetov MK; Laskin A.A.; Madenov N.N.
Head of the Department of Emergency Medicine of the Almaty State Institute of Improvement of Doctors - Ph.D., Associate Professor Rakhimbaev R.S. Employees of the Department of Emergency Medicine of the Almaty State Institute of Improvement of Doctors: Ph.D., Associate Professor Solchev Yu.I.; Volkova N.V.; Hairulin R.Z.; Sedrenko V.A.
* - Preparations included in the list of basic (vital drugs) drugs
This class includes symptoms, signs and deviations from the norm identified during clinical or other studies, as well as inaccurately designated states in respect of which any diagnosis classified in other categories is not specified.
Signs and symptoms, on the basis of which it is possible to put a sufficiently defined diagnosis, are classified under the headings of other classes. The rubrics of this class, as a rule, do not include not so exactly designated states and symptoms, which can equally relate to two or more diseases or to two or more organism systems, with the absence of a necessary study that allows you to establish a final diagnosis. Almost all states included in the headings of this class can be defined as "unspecified", "without other instructions", "unknown etiology" or "transient". In order to establish, those or other symptoms and features to this class or other partitions of the classification should be used by an alphabetic pointer. The remaining subheadings with families are commonly provided for other reported symptoms that cannot be attributed to other classification sections.
To states, features and symptoms included in the R00-R99 category include:
- a) cases in which more accurate diagnosis was impossible even after studying all the existing actual data;
- b) cases of the appearance of transient symptoms or features, the reasons for which it was impossible to establish;
- c) cases of the preliminary diagnosis, which was impossible to confirm due to the non-appearance of the patient for further surveys or treatment;
- d) cases of the patient to another institution for examination or treatment before the final diagnosis;
- e) cases where a more accurate diagnosis was not set for any other reason;
- (e) Some symptoms for which additional information is presented is not valuable to provide medical care.
Excluded:
- deviations from the norm identified during the antenatal examination of the mother (O28.-)
- separate states arising in the perinatal period (P00-P96)
This class contains the following blocks:
- R00-R09 Symptoms and features related to blood circulation and respiration systems
- R10-R19 Symptoms and Signs related to digestive and abdominal systems
- R20-R23 Symptoms and signs related to the skin and subcutaneous tissue
- R25-R29 Symptoms and signs related to nervous and muscular Systems
- R30-R39 Symptoms and features related to urine system
- R40-R46 Symptoms and signs related to cognitive ability, perception, emotional and behavior
- R47-R49 Symptoms and Signs related to speech and voice
- R50-R69 General Symptoms and Signs
- R70-R79 deviations from the norm identified in the study of blood, in the absence of a diagnosis
The diagnosis with the R00-R99 code includes 13 clarifying diagnoses (CCM-10 columns):
- R00-R09 - Symptoms and signs related to blood circulation systems and breathing
Contains 9 diagnoses blocks. - R10-R19 - Symptoms and signs related to the digestive and abdominal system
Excluded: gastrointestinal bleeding (K92.0-K92.2). In the newborn (P54.0-P54.3) intestinal obstruction (K56.-). in the newborn (P76.-) Pylorospasm (K31.3). Congenital or infant (Q40.0) Symptoms and features related to the urinary system (R30-R39) Symptoms related to sexual organs :. Women's (N94.-). Male (N48-N50). - R20-R23 - symptoms and signs related to the skin and subcutaneous tissue
Contains 4 diagnoses block. - R25-R29 - symptoms and signs related to nervous and muscle systems
Contains 4 diagnoses block. - R30-R39 - symptoms and signs related to the urinary system
Contains 8 diagnoses blocks. - R40-R46 - symptoms and signs related to cognitive ability, perception, emotional state and behavior
Contains 7 diagnoses blocks.
Excluded: symptoms and signs that are part clinical picture mental disorder (F00-F99). - R47-R49 - Symptoms and Signs Related to Speech and Voice
Contains 3 diagnoses block. - R50-R69 - common symptoms and signs
Contains 17 diagnoses blocks. - R70-R79 - deviations from the norm identified in the study of blood, in the absence of an established diagnosis
Contains 10 blocks of diagnoses.
Excluded: deviations from the norm (when) :. Antenatal examination of the mother (O28.-). Coagulation (D65- D68). Lipids (E78.-). platelet (D69.-). Leukocytes classified in other categories (D70-D72) deviations from the norm identified in diagnostic studies of blood, classified in other categories - see the hemorrhagic and hematological violations of the fetus and newborn (P50-P61). - R80-R82 - deviations from the norm identified in the study of urine, in the absence of an established diagnosis
Contains 3 diagnoses block.
The deviations from the norm identified during the antenatal examination of the mother (O28.-) deviations from the norm identified during diagnostic studies of urine, classified in other categories - see the alphabetical indicator specific indicators indicating violations :. Amino acid exchange (E70-E72). Carbohydrate metabolism (E73-E74). - R83-R89 - deviations from the norm identified in the study of other liquids, substances and body tissues, in the absence of an established diagnosis
Contains 6 blocks of diagnoses.
Excluded: deviations from the norm identified at :. Antenatal examination of the mother (O28.-). study :. blood, in the absence of a set diagnosis (R70-R79). urine, in the absence of an established diagnosis (R80-R82) deviations from the norm, identified in diagnostic studies, classified in other categories - see the alphabetical index below is a classification for the fourth sign used in the headings (R83-R89):. - R90-R94 - deviations from the norm identified in the receipt of diagnostic images and conducting research, in the absence of an established diagnosis
Contains 5 blocks of diagnoses.
Included: nonspecific deviations from the norm identified (when) :. Computer axial tomography [cat scanning]. Magnetic resonance study [Mri]. positron emission tomography (PET). thermography. Ultrasound [echogram] study. X-ray study. - R95-R99 - inaccurately designated and unknown causes of death R95-R99
Contains 4 diagnoses block.
Excelves: the death of the fetus for an unknown reason (P95) obstetric death BDU (O95).
Chain in classification:
1
2 R00-R99 Symptoms, signs and deviations from the norm identified during clinical and laboratory studies not classified in other categories
Terminal state — critical level Life disorders with a catastrophic drop of blood pressure, deep disorders of gas exchange and metabolism. In the course of the provision of surgical assistance and intensive care, the acute development of respiratory disorders and blood circulation of extreme degrees with severe rapidly progressive brain hypoxia is possible.
Code of PO international Classification MKB-10 diseases:
Classification . Independent state. Agony. Clinical death. Note. Often the concept of terminal states narrow to clinical death. This approach is justified when clinical death develops as a result of a sudden respiratory stop and / or blood circulation under the influence of external or internal factors associated with damage itself or with non-heroic causes.
The reasons
Pathogenesis. When the shock is divided according to the parameters of systolic blood pressure, it is important to highlight the levels of 70 and 50 mm Hg. With systolic blood pressure above 70 mm Hg. Perfusion of vital organs (relative safety level) is maintained. At 50 mm Hg. And below significantly suffers from the blood supply of the heart, the brain, and the dying processes begin.
Symptoms (signs)
Clinical picture
Predalone state .. General inhibition .. Violation of consciousness up to a spin or coma .. Giodeflection .. Reducing systolic blood pressure below 50 mm Hg. The pulse on the peripheral arteries is missing, but palpable on sleepy and femoral arteries.. pronounced shortness of breath .. cyanosis or pallor of skin.
Agony .. Consciousness is lost (deep coma) .. Pulse and hell are not defined .. Heart tones are deaf .. breathing superficial, agonal.
Clinical Death .. Fix from the moment of full stopping of breathing and cessation of cardiac activity .. If it is not possible to restore and stabilize life functions for 5-7 minutes, then the death of the cerebral cortex most sensitive to hypoxia occurs, and then biological death.
Primary clinical signs Clearly detected in the first 10-15 s from the moment of the blood circulation stop .. a sudden loss of consciousness .. The disappearance of the pulse on the main arteries .. clonic and tonic convulsions.
Secondary clinical signs. Manifest themselves in the next 20-60 s and include: .. expansion of pupils in the absence of their reaction to light. Pupils can remain narrow and after a long time after the development of clinical death: ... in the poisoning of phosphorodorganic substances ... in the overdose of opiates .. The cessation of respiration .. The appearance of the earth - gray, less often a cianotic color of the skin of the face, especially the nasolabic triangle .. relaxation arbitrary muscles with relaxation of sphincter ... involuntary urination ... involuntary defecation. It is quite reliable for a practically indisputable diagnosis of clinical death, a combination is considered: .. the disappearance of the pulse on the carotid artery .. the expansion of the pupils without their reaction to the light .. Stop breathing.
Treatment
TREATMENT
Tactics of keeping. Revitalization (resuscitation) is a complex of emergency measures used in the dismissal of a patient from clinical death. The success of resuscitation assistance is determined primarily by the time factor. Successful removal of a patient from clinical death is possible only when the first person applies measures, in front of which the blood circulation ceased and the consciousness disappeared.
Events to remove the patient from the terminal state.
At the stage stage - the events of higher urgency .. IVL .. Heart massage.
Scheme of cardiovascular - lightweight resuscitation (scheme ABC, see also Note) .. Objective - resumption of blood circulation, sufficiently saturated oxygen, primarily in brain and coronary arteries. BUT (Air Ways). Ensuring the passability of the upper respiratory tract ... Throwing the head with the re-installing of the neck ... Breaking forward lower jaw... use of the breathing tube (nasal or oral s - shaped duct) ... trachea intubation (under the conditions of the operating or chamber of intensive therapy) .. IN (Breath). IVL ... expiratory methods: from mouth to mouth, from mouth to the nose, from the mouth to the duct ... various breathing devices: Bag Ambo, IVL devices .. FROM (Circulation). Maintaining blood circulation ... outside the operating room - a closed heart massage ... in operating conditions, especially when opened chest- open heart massage ... during laparotomy - heart massage through a diaphragm.
At the 2nd stage: .. Cardigo - easy resuscitation According to the ABC scheme .. selective drug and infusion treatment .. Objective: fixing the success of revival, if it is achieved and independent blood circulation was restored as a result of the patient's myocardial pump.
In the 3 stage in the conditions of a fairly effective blood circulation with the recovery of heartbreak and subnormal or even normal system hell. Drugs .. Transfusion .. Surgical effects .. Goals ... Secure the achieved success of resuscitation ... Prevent the recurrence of the circulatory stop ... Conduct correction Early manifestations of the disease of the lively organism.
Sequence of actions after the diagnosis of clinical death
Free airways from possible obstacles.
To change the filling of the right chambers of the heart, especially if there is a critical bloodstream in a patient .. lift the legs of the victim 50-70 cm above the heart level (if it is low) .. Translate to the Trendelenburg position.
Produce 3-4 blows into the lung patient.
Check availability of blood circulation stops.
Apply 1-2 precartial blow to the fist on the chest.
Perform 5-6 chest compresses.
Subsequent working rhythm of resuscitation - 2 pins and 10 compressions for 10-15 minutes.
Against the background of continuing resuscitation, to establish an infusion system with a crystalloid r - rum in an affordable peripheral vein.
Introduce 1-2 mg of epinephrine in the trachea diluted in the crystalloid r - re, the bunch below the thyroid cartilage in the midline.
If by this moment the patient is intouted, introduce 3-4 mg of epinephrine into the intubation tube.
Connect an ECG - monitor (if it is nearby) and evaluate the character of cardiac disorders .. asistolia .. fibrillation of ventricles.
Only in fibrillation - defibrillation (electric depolarization).
Because of the high frequency of complications (pneumothorax, damage to corrugated arteries, myocardial necrosis after administration of epinephrine or calcium chloride) intracardiac administration of drugs are used as an event of the last reserve.
Signs of resuscitation efficiency. Disconfirmable rhythmic shocks that coincide with the rhythm of the heart massage, on a sleepy, femoral or radial artery. The skin of the nasolabial triangle is pink. Pupils are narrowed by passing the stages of anisocoria and deformation. Restoration of self-breathing on the background closed massage Hearts.
Direct success of resuscitation. Restoration of independent heart abbreviations. Determination of ripples on peripheral arteries. The absence of gross changes in the rhythm of heart abbreviations .. significant bradycardia .. limit tachycardia. Clear definition of system hell. As soon as the immediate success is achieved, you can: complete the necessary emergency surgical intervention .. Translate the patient to the ward of intensive therapy.
The final success of resuscitation. Recovery: .. self-breathing .. reflex activity .. Consciousness of the oath. This option of successful resuscitation may not be revealed immediately after the events conducted, but after some time.
MKB-10. R57 shock, not classified in other categories. R57 shock, not classified in other categories. Note. These codes are applied only in the absence of an established or alleged diagnosis. In other cases, the condition is encoded by the disease that caused its illness.
Note to ABC scheme: At the hospital stage, the stage D (Definitive Treatment: Defibribration, Drugs, Diagnostic AIDS) is different - specialized resuscitation activities (defibrillation, drug therapy, diagnostic studies [cardiac monitoring, detection of rhythm violations, etc.]).
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