Foreign bodies

Foreign body outdoor earAs a rule, it does not represent danger to the patient and does not require urgent removal. Dangerous inept attempts to remove foreign bodies. It is forbidden to use tweezers to remove round items, only the foreign body of the elongated shape (match) can be removed. With living foreign bodies, it is recommended to influence into the outer hearing passage of heated sunflower or vaseline oil, which leads to the death of the insect. Before removing bulk foreign bodies (peas, beans) for their dehydration, they are preliminarily poured into the ear of a few drops of a heated 70 ° ethyl alcohol. The removal of the foreign body is made by washing the ear with warm water or disinfectant solution (permanganate potassium, furacilin) \u200b\u200bfrom the zhana or rubber cylinder syringe. The fluid stream is sent along the upper-length wall of the outer auditory passage, and a foreign body is removed along with the liquid. During the washing of the ear, the head must be well fixed. The washing of the ear is contraindicated in perforation of the eardrum, complete obturation of the auditory passage of the foreign body, foreign objects of the pointed form (metal chips).

Fighting foreign bodies in the nose Close the opposite nostril and ask the child, having gone very much, unimportant. If the foreign body remains, then the removal of its nasal cavity is produced only by the doctor. Repeated attempts to remove the foreign bodies and instrumental interventions at the pre-hospital stage are contraindicated, as they can lead to pushing foreign objects into the underlying respiratory tract departments, their blockage and the occurrence of choking.

When hit foreign bodies in the bottom airways An early child's child turns down his head, holding down, produce shocking movements, trying to remove the foreign object. Senior children, if failed to free themselves from the foreign body when coughing, is performed by one of the methods:

The child is placed by the stomach on the bent knee of an adult, the head of the victim is lowered down and tangle with hand on the back;

The patient is wrapped with her left hand at the level of the rib arc and apply 3-4 impacts with palm of the right hand on the spine between the blades;

The adult worst the child from the back of the back by both hands, drives his hands into the castle and there is a slightly lower arc below, then presses the victims of the victim to himself, trying to press the epigastric area as much as possible;

If the patient is unconscious, it is turned onto the side, perform 3-4 sharp and strong impacts with palm on the spine between the blades.

In any case, you need to call a doctor.

Stenzing laryngotracheitis

Urgent prefigible assistance to the prolonged laryngotrachite is aimed at restoring respiratory tract. They are trying to remove or reduce the phenomena of stained stenosis with distracting procedures. Conduct alkaline or steam inhalations, warm foot and hand baths (temperatures from 37 ° C with gradual up to 40 ° C), hot water or semisporate compresses on the neck and the area of \u200b\u200bthe icy muscles. In the absence of increasing body temperature, the overall hot bath is carried out in compliance with all precautions. Give warm alkaline drink in small portions. Provide fresh air access.

Artificial ventilation of the lungs

The most important condition for successful artificial respiration is the provision of respiratory tract. The child is placed on the back, free from shy clothes, the chest and the abdomen of the patient, unbutton the collar, belt. The oral cavity is released from saliva, mucus, vomit. Then one hand is placed on the dark area of \u200b\u200bthe victim, the second hand is put under the neck and sweep the baby's head as much as possible. If the patient's jaws are tightly closed, the mouth is discovered, putting forward the lower jaw and presses the stable fingers on the cheekbones.

When using the method "Isot of mouth"the mouth of the child is tightly closed with palm and after a deep breath produce an energetic exhalation, clasping the nose of the victim's nose lips. When using the method "Mouth in the mouth" The nose of the patient is pinned with large and index fingers, deeply breathe air and, hermetically pressing his mouth to the mouth of the child, they are exhaled into the mouth of the victim, pre-sticking it with gauze or a nose handkerchief. Then the patient's mouth and nose are open, after which the patient's passive exhalation occurs. Artificial respiration with newborns is carried out with a frequency of 40 inhales in min, early children - 30, older children - 20.

When carrying out artificial lung ventilation hOLGERA NILSENE METHOD The child is placed on the stomach, pressed with their own hands on the patient's blades (exhale), then pull the hands of the victim (inhale). Artificial respiration method of Sylvester They are performed in the child's position on the back, the hands of the victim crossed on the chest and pressed them to the sternum (exhale), then the patient's hands straighten (inhale).

Indirect heart massage

The patient is placed on a solid surface, free from clothes, unbutton the belt. Straightened in elbow joints Hands pressed on the lower third of the baby's sternum (on two transverse fingers above the sword-shaped process). The squeezing is performed by the palm part of the hand, putting one palm on the other, the fingers of both hands are lifted. Newborn children indirect heart massage are carried out by two thumbs of both hands or index and middle fingers of one hand. Pressing on the sternum is carried out by rapid rhythmic jogs. The squeezing force should ensure the displacement of the sternum towards the spine in newborns for 1-2 cm, children of early age - 3-4 cm, older children - 4-5 cm. The frequency of pressure corresponds to the age frequency of heart rate.

Elemental heart resuscitation

Stages of pulmonary heart resuscitation;

Stage I - restoration of respiratory tract;

Stage II - artificial lung ventilation;

III Stage - Indirect Heart Massage.

If the pulmonary heart resuscitation performs one person, then after 15 presses on the chest, it produces 2 artificial inhales. If there are two pulmonary ventilation / heart massage of 1: 5.

The criteria for the effectiveness of pulmonary resuscitation are:

The appearance of the reaction of pupils for light (narrowing);

Restoration of ripples on sleepy, radiation, femoral arteries;

An increase in blood pressure;

The emergence of independent respiratory movements;

Restoration of the normal color of the skin and mucous membranes;

Return of consciousness.

Fainting

When fainting the child give horizontal position With a slightly lowered head and raised legs in order to improve the blood supply to the brain. Free from shocking clothes, unbutton collar, belt. Provide fresh air access, windows and doors open wide openings or bring the child to open air. Spray face cold water, pat on the cheeks. They give a sniff with a mock moistened with ammonia alcohol.

Collapse

Estimates for the provision of emergency assistance in collapse before the doctor coming include giving a child a horizontal position on the back with raised lower limbs, wrapped with a warm blanket, warming the heating.

Paroxysmal tachycardia

To remove the attack of paroxysmal tachycardia, techniques are used, causing irritation of the vagus nerve. The most efficient ways are the escape of the child at the height of the deep breath (Valsaw's sample), the impact on the sylocarotide zone, pressing on the eyeballs (the Reflex Ashner), artificial calling of vomiting.

Internal bleeding

Patient S. hemochpath and pulmonary bleeding Press the half-time position with lowered legs, prohibit moving, talk, fit. Frequent breathing out of clothes, provides a flow of fresh air, for which windows are widely opened. Child recommend swallowing small pieces of ice, drink cold water with small portions. Apply a bubble with ice on the chest.

For gastrointestinal bleeding Assign a strict bed mode, prohibit food and liquid. An ice bubble is put on the abdomen area. Permanent control of the frequency and filling of the pulse, level of blood pressure.

The urgent hospitalization is shown.

Outdoor bleeding

Child S. nose bleeding Press the half-off position. Prohibit blowing around. On the eve of the nose, a cotton ball, moistened with 3% hydrogen peroxide solution, or hemostatic sponge, is introduced. The wing of the nose is pressed to the nasal partition. On the head and the nose are placed ice or gauze moistened in cold water.

The main urgent event at external traumatic bleedingis a temporary stop of bleeding. Arterial bleeding from the vessels of the top and lower extremities Stop in two stages: first pressed the artery above the place of damage to the bone protrusion, then apply a standard rubber or improvised harness.

To relive the shoulder artery, the fists are placed in the armpit depression and press the hand to the body. Temporary stop of bleeding from the forearm arteries is achieved by laying the roller (packing bandage) in the elbow fold and the maximum bending of the hand in the elbow joint. With lesion femoral artery Press the fist on the upper third of the thighs in the region of the groove (tipparent) bundle. Pressing the arteries of the shin and foot is carried out by investing in the popliteal area of \u200b\u200bthe roller (bint packaging) and the maximum bending of the leg in the knee joint.

After pressing the arteries, the imposition of a hemostatic harness, which impose on top of clothing or towels, jacks, a piece of gauze. The harness is fed under the finiteness above the place of injury, strongly stretch and, without reducing tension, tighten around the limb, fixed. If the harness is imposed correctly, bleeding from the wound stops, the pulse on the radial artery or the back of the foot of the foot disappears distal departments The limbs are pale. It should be remembered that excessive tightening of the harness, especially on the shoulder, can cause paralysis of the peripheral sections of the limb due to damage to the nerve trunks. Under the harness put a note with the time of imposing a harness. After 20-30 minutes, the pressure of the harness can be loosen. Harness imposed on a soft gasket should not be on the limbs for more than 1 hour.

Arterial bleeding from the arteries of the brush and foot does not require a mandatory imposition of a harness. It is sufficiently tightly navigating a tight roller from sterile napkins (pack of sterile bandage) to the place of injury and give the limbs an elevated position. The harness is used only with extensive multiple injuries and disintegration of the brush and foot. Through the finger arteries are stopped by a tight grabbing.

Arterial bleeding in the scalp area (temporal artery), on the neck (carotid artery) and the torso (connectible and iliac artery) are stopped by tight wound tamponade. A tweezers or clamp wound tightly wrapped with napkins, on top of which you can attach an unsophisticated bandage from sterile packaging and to make it most tightly.

Venous and capillary bleeding are stopped by applying a tight gulling bandage. In case of damage to the major trunk veins, you can make a tight tamponade of the wound or impose a hemostatic harness.

Acute urinary delay

Emergency care for acute urine delay is the early removal of urine from bladder. Independent urination contributes to the sound of pouring water from the crane, irrigation of the genital organs with warm water. In the absence of contraindications to the pubic area, it is placed in a warm height or a baby sit in a warm bath. In the event of the ineffectiveness of these measures, resort to the catheterization of the bladder.

Hypertermia

During the maximum increase in the body temperature, the child should often and abundantly: give liquid in the form of fruit juices, horses, mineral waters. With increasing body temperature above 37 ° C, each degree requires additional injection of the fluid at the rate of 10 ml per 1 kg of body weight of the child. Cracks on lips are lubricated with vaseline or other oil. Careful care of the oral cavity.

With a "pale" type of fever, a church arises, the skin pale, the limbs are cold. The patient is primarily warming up, they are covered with a warm blanket, the heating pads apply, give warm drinks.

For the "red" type of fever, the feeling of heat, the skin is warm, wet, blush on the cheeks. In such cases, physical methods for increasing the heat transfer are used by the physical methods of a decrease in body temperature: the child is undressed, air baths are carried out, the skin is wiping with a semicircular solution or a solution of cutlery, the head of the head and liver is cooled with a bubble with ice or cold compress.

Overheating (thermal blow) It may occur in a child who is in a poor ventilated room with high air temperature and humidity, with intensive physical work in stuffed facilities. Protect overheating Warm clothing, non-compliance with drinking mode, overwork. In childhood children, the thermal blow may occur when wrapped in warm blankets, when you find a cot (or stroller) near the central heating battery or oven.

Signs of thermal impact depend on the presence and degree of hyperthermia. When overheating a light state satisfactory condition. The body temperature is not increased. Patients complain of headaches, weakness, dizziness, noise in the ears, thirst. Skin wet skin. Breathing and pulse are several rapidly, blood pressure within the normal range.

With a significant degree of overheating, it is disturbed by a strong headache, often arises nausea, vomiting. A short-term loss of consciousness is possible. Skin wet skin. Breathing and pulse are rapidly, blood pressure is increased. Temperature of the body reaches 39-40 ° C.

A severe overheating degree is characterized by an increase in body temperature up to 40 ° C and higher. Patients are excited, nonsense is possible, psychomotor excitement, contact with them is difficult. In childhood, breast-age often occurs diarrhea, vomiting, the features of the face, the features of the face are sharply deteriorating, convulsions are possible, a comatose state. A characteristic sign of severe overheating is the cessation of sweating, the skin is wet dry. Breathing is frequent, superficial. Possible respiratory stop. The pulse is sharply raised, blood pressure is reduced.

When signs appear heat strike The patient urgently endure in a cool place, provide access to fresh air. The child is stripped, give cold drink, the cold compress is put on the head. In more severe cases, the wrapping of sheets, moistened with cold water, pouring cool water, applying ice to the head and groin area, hospitalization.

Sunstroke It occurs in children, for a long time in the sun. Currently, they do not share the concepts of "thermal" and "sunny" blow, since in both cases there are changes due to the general overheating of the organism.

Emergency assistance in sunshine is similar to assistance rendered to patients with thermal impact. In severe cases, urgent hospitalization is shown.

Defeat by cold it is found in various climatic zones. This problem is especially relevant for the regions of the Far North and Siberia, however, cold injury can be observed in areas with a relatively high average annual temperature. The cold can have a common and local action on the body's body. The overall action of the cold leads to the development of general cooling (freezing), and the local action causes frostbite.

General cooling or freezing - This state of the human body, in which, under the influence of adverse external conditions, the body temperature is descended to + 35 ° C and below. At the same time, on the background of a decrease in body temperature (hypothermia), functional disorders are developing in the body with a sharp oppression of all life functions, up to full fading.

All victims independently of the degree of overall cooling should be hospitalized. It should be borne in mind that victims with a light freezing may refuse hospitalization, as they are inadequately assessed their state. The main principle of treatment with general cooling is warming. At the pre-hospital stage, first of all prevent further cooling of the victim. To do this, the child is immediately introduced into a warm room or into the car, remove wet clothes, wrapped with a blanket, shine, give hot sweet tea. In no case can you leave the victim on the street, rub with snow, drink alcoholic beverages. In the absence of signs of respiration and blood circulation, a whole complex of cardiovary and pulmonary resuscitation is carried out at the prehospital stage against the background of warming the victim.

Frostbite It occurs with local long-term exposure of low temperatures. Open parts of the body (nose, ears) and limbs are most often affected. Circulatory disorder arises, first the skin, and then driving tissues, necrosis develops. Depending on the severity of the lesion, four degrees of frostbite differ. I degree is characterized by the appearance of edema and hyperemia with a blue tint. With II degree, bubbles filled with light exudate are formed. III The degree of frostbite is characterized by the appearance of bubbles with hemorrhagic content. With IV degree frostbite, all skin layers are dying, soft fabrics and bones.

The affected child is introduced into the warm room, remove shoes, mittens. On the affected area of \u200b\u200bthe nose, the ear shells are imposed by a heat insulating aseptic bandage. The frostite limb is first rubbed with a dry cloth, then placed in a pelvis with warm (32-34 ° C) water. For 10 minutes, the temperature is adjusted to 40-45 ° C. If the pain occurring during heating quickly passes, the fingers take the usual view or slightly edema, the sensitivity is restored - the finiteness wipe dry, wipe the semicircular solution, wear cotton, and on top warm woolen socks or mittens. If heating is accompanied by amplifying pain, the fingers remain pale and cold, which indicates a deep degree of frostbite - the affected child is hospitalized.

Poisoning

First aid to children with acute poisoning is aimed at accelerated elimination toxic substances From the body. To this end, stimulate vomiting, washed the stomach and intestines, forcing diuresis. Stimulation of vomiting is carried out only in children in full consciousness. After receiving the maximum possible amount of water, irritating the rear wall of the throat with a finger or spoon. Stimulation of vomiting contributes to the use of a warm solution of the cook salt (1 tablespoon on a glass of water). The procedure is repeated to the complete disappearance of impurities and the appearance of pure water. Stomach washing is the main measure of removal of toxic substances and must be performed as early as possible. When taking inside of strong acids (sulfur, salt, nitrogen, oxal, acetic), washing the stomach is carried out with cold water using a probe, lubricated with vaseline or vegetable oil. With alkali poisoning (ammonia, ammonia, chlorine lime, etc.), the stomach is washed with cold water or a weak solution (1-2%) of acetic or citric acid through the probe, lubricated with vaseline or vegetable oil, after purification to the stomach cavity, enveloping agents are injected into the cavity. mucous heavens, milk) or sodium bicarbonate. For cleansing the intestines, salt laxative uses cleansing enemas. Frozing diuresis at the pre-hospital stage is achieved by appointing plenty of drink.

In order to change the metabolism of the poisoning substance in the body and reduce its toxicity, antidote therapy is used. As an antidote in poisoning with phosphorodorganic compounds (chlorofos, dichlofos, carbophos, etc.), atropine is used, with atropine poisoning (belladonna, belane, beautification) - Pilocarpine, in the case of copper poisoning and its compounds (copper sipop) - unitiol.

In the poisoning of inhalation toxic substances (gasoline, kerosene), carbon monoxide (carbon monoxide), the child is removed from the room, provide fresh air access, carry out hydroxygerapy.

Emergency assistance in poisoning to poisonous mushrooms implies washing the stomach and intestines with the introduction of the saline laxative, the suspension of the enterosorbent. In the case of poisoning, an atropine is additionally introduced.

Burning

For thermal skin burns It is necessary to stop the impact of the thermal agent. With the ignition of clothing, the fastest and efficient means of extinguishing is to pour the injured water or tarpaulin, blankets, etc. Clothes with damaged parts of the body are carefully removed (cut with scissors, without touching the wound surface). Tightly sticking to the burned skin of the clothing is neatly cut. The burned area is cooled with cold running water or use a bubble with ice. Open or cut bubbles should not. Contraindicated ointments, powders, oil solutions. Aseptic dry or wet-drying dressings are applied to the burn surface. In the absence of dressing material, the affected area of \u200b\u200bleather is wrapped with a clean cloth. The victims are hospitalized with deep burns.

For chemical skin burnscaused by acids alkalis, the most universal and most effective means of providing prefigure aid is a long-term washing of the burned area with an abundant amount of running water. Quickly remove clothing impregnated with a chemical agent, continuing to rinse the burned surface of the skin. Contact with water is contraindicated in burns caused by overeximation and organic aluminum compounds. When burns, burn wounds are washed with a weak solution of acetic or citric acid. If the damaging agent was acid, then a weak sodium bicarbonate solution is used for washing.

Electrotramma

First aid with electric shock is to eliminate the damaging current. Urgently turn off the chop, cut, refresh or discard the wires using items with a wooden handle. When the child is released from the effects of electric current, it is necessary to comply with their own safety, do not touch the injured body parts of the body open, it is necessary to use rubber gloves or wounded with dry rags, rubber shoes, located on a wooden coating or a car tire. In the absence of breathing and cardiac child, they immediately begin to perform artificial ventilation of light and indirect heart massage. A sterile bandage is applied to the electroplating wound.

Drowning

The affected child is removed from the water. The success of resuscitation measures largely depends on the correct and timely conduct. It is desirable that they start not on the shore, but on the water, during the towing of the child to the shore. Even a few artificial breaths spent during this period significantly increase the likelihood of subsequent revitalization of the drowned.

More advanced assistance to the victim can be provided in a boat (boat, boat) or on the shore. In the absence of a child of consciousness, but the preservation of breathing and cardiac activity is limited to the liberation of the victims of the shy and the use of ammonia alcohol. The absence of independent respiration and cardiac activity requires an immediate implementation of artificial ventilation of light and indirect heart massage. The oral cavity is purified from foam, mucus, sand, sludge. To remove the child's water that fell into the respiratory pathways put the stomach on the bent in knee joint The thigh providing help, the head is lowered down and, supporting the injured head with one hand, the other hand is slightly hit several times between the blades. Either the side surfaces of the chest (for 10-15 seconds) are compressed with sharp peasant movements (for 10-15 seconds), after which the child turns back to the back. These preparatory activities are carried out as quickly as possible, then proceed to the conduct of artificial respiration and indirect heart massage.

Bitches of poisonous snakes

With ukusakh poisonous snakes They squeeze the first blood drops from the wound, then cold is applied to the place of bite. It is necessary that the affected limb remains fixed, since the movements increase the lymphotok and accelerate the flow of poison to the overall circulation. The victim ensures peace, the affected limb is fixed with a tire or remedies. Do not catch the place of bite, slip it with any drugs, binting the affected limb above the place of bite, suck the poison, etc. The urgent hospitalization in the nearest hospital is shown.

Insect bites

When insect bite (bees, wasps, bumblebees), they are removed from the wound a sting of an insect with a tweezers (in its absence - fingers). The bite is wetted by a semicircle solution, the cold is applied. Medicinal therapy is carried out by appointment of a doctor.

CONTROL QUESTIONS

What is the help of a foreign body in nasal moves and respiratory tract?

What should be a prefigure assistance in the stenosis of the larynx?

What are the methods of artificial ventilation of the lungs?

What events need to be done when you stop the heart?

Determine the sequence of actions when performing pulmonary heart resuscitation.

What activities make it possible to bring a child from a faint?

What urgent help is in poisoning?

What events are carried out in acute urine delay?

What ways of temporary stopping of outdoor bleeding do you know?

What are there any ways to reduce body temperature?

What is the help of frostbiz?

What kind of prefigure help do with thermal burns?

How to help a child when electric crash?

What events need to be carried out when drowning?

What is the help of insect bite and poisonous snakes?

Getting into the situation when medical care is urgently needed, maybe everyone. Cases are different as the severity of the situation. It is the first assistance in urgent states that human life can save. It was this topic that we devoted our article. Of course, there may be a large number of such cases, we consider those that are most often found in medical practice.

Epileptic seizure

The most common appearance is observed in patients with epilepsy. It is distinguished by the loss of consciousness, the convulsive movements of the limbs, the patients have underscilateered symptoms, turning on time to which you can significantly help yourself. These include feeling of fear, irritation, rapid heartbeat, sweating.

With such as the seizure of epilepsy, it is as follows. The patient must be put on the side, prevent the tongue of the tongue with the help of a spoon or a girlfriend, if the vomiting of the foam began, to ensure that there is no asphyxia. If convulsions are observed, keep limbs.

Arrived to the place of doctors introduce intravenously magnesium sulfate with glucose, intramuscularly - "aminazine", then urgently hospitalized the patient.

Fainting

This state occurs with insufficient blood supply to the brain of the human head, is referred to as hypoxia in medicine.

The reasons may be mass, from the psychological response of the body to the sharp first aid in the urgent states of fainting is quite simple. A person without consciousness must be taken out on an open space, tilt the head down and keep in that position. And if possible, affect the car moistened with the ammonia, the respiratory tract.

After performing these events, a person comes to himself. They advise after fainting the silence and peace, as well as avoid stressful situations. As a rule, medical workers who arrived at the challenge do not hospitalize such patients. If a person came to himself and his condition stabilized, then he is prescribed to bed and monitoring of well-being.

Bleeding

These are special urgent states in which there is a significant loss of blood, which in some cases can lead to a fatal outcome.

Before prefigured assistance in urgent states with bleeding, it is important to understand its appearance. Distinguish venous and arterial loss of blood. If you are not sure about the correctness of your assumption, it is better to call an ambulance brigade and wait.

It is important to remember its own security, through blood you can get infected with diseases. The person who has you observe the loss of blood can be infected with HIV, hepatitis and other dangerous diseases. Therefore, before assistance, dismissed yourself with gloves.

In place of bleeding superimposed a tight bandage or harness. If the limb is damaged, then it is possible to align it.

If observed internal bleedingThe first assistance in urgent states is to apply the cold to this place. It will not be useful to use painkillers in order for a person to not lose consciousness and did not happen shock.

Bleedings are found not only in adults, urgent states in pediatrics are often observed. First aid for children in such states should be aimed at preventing shock and asphyxia. This is associated with a low pain threshold, therefore, if short-term respiratory stops are observed, the following is done. On the neck, below the caadiary, the puncture of the metal tube or infringement things is made. And immediately causes ambulance.

Comatous states

Coma is a complete loss of consciousness by a person who is characterized by the lack of reaction to external stimuli.

Causes are significantly different. It may be: strong alcohol poisoning, overdose of drugs, epilepsy, diabetes, injury and brain bruises and also signs of infectious diseases.

Coms are severe urgent states, medical care for which should be qualified. Based on the fact that the reasons are visually finding out, it will not be possible, the patient must urgently hospitalize. Already in the hospital, the doctor will appoint a complete examination of the patient. This is especially important if there are no information about diseases and possible reasons Cropping to whom.

There is an increased risk of brain edema and memory loss, so until the reasons for reasons are clarified. Such urgent states in pediatrics are less common. As a rule, in cases of diabetes and epilepsy. This simplifies the task of the doctor, parents will provide a child's medical card, and treatment will be started immediately.

Defeat current

The degree of damage to the current depends on many factors, this is an electrical discharge that struck a person and the duration of contact with the hearth.

The very first thing that needs to be done is if you witnessed the defeat of a person to the current, remove the hearth. It often happens that a person cannot release the electric wire, for this we use a wooden stick.

Before you arrive a carriage, first assistance will be provided for urgent states, you need to evaluate the person's condition. Check the pulse, breathing, inspect the affected areas, check the consciousness. If necessary, to independently make artificial respiration, indirect heart massage, handle the affected areas.

Poisoning

Occur when exposed to the body poisonous substances, They can be liquid, gaseous and dry. In case of poisoning, there is a strong vomiting, dizziness, diarrhea. Assistance in emergency conditions intoxication should be aimed at rapidly eliminating poisonous substances from the body, stopping their action and restoring the work of the digestive and respiration organs.

To do this, washing the stomach and intestines. And then - comprehensive therapy Outstorming nature. Remember that the timely appeal to medical care and first aid can save the human life.

In the people there is an opinion: "If it becomes bad for me somewhere on the street or in transport, any medical organization is obliged to provide me with free medical care." Is it true? Consider this situation in terms of legislation.

In accordance with applicable law medical assistance in emergency form turns out to besudden sharp diseases, states, exacerbation of chronic diseases Presenting a threat to the patient's life.

Medical assistance in emergency form to a citizenmedical worker and medical organization (regardless of the form of ownership, including a private medical clinic) exercising medical activities on the basis of a license urgently free.

Refusal In this case, it can be qualified under Article 124 of the Criminal Code of the Russian Federation "Non-appearance of assistance to a patient without valid reasons for a person who is obliged to provide it in accordance with the law or with a special rule" the health care worker is responsible, and not an organization.

In addition, the victim and / or his relatives, if the fault of the medical organization and specific perpetrators will be established by the court, has the right to demand the payment of damage due to the harm or death of the victim caused by the inactivity of these persons.

When providing medical care In emergency form, a citizen is not obliged to present polis Oms (paragraph 2 of Art. 11 of the Law of 21.11.2011 N 323-FZ; PP 1 of paragraph 2 of Art. 16 of the Law of 29.11.2010 N 326-FZ).

The main criterion for emergency medical care is the presence of life-threatening states.

The life-threatening state is harm to health, dangerous to life of a person who caused a disorder of the vital functions of the human body, which cannot be compensated by the body independently and usually ends with death.

It is under these states that medical organizations are obliged to provide medical care. Emergency medical care ("without explicit signs of the threat of a patient's life") in charge medical organizations Excluded. It is understood that emergency medical care should be provided in outpatient conditions or ambulance in the framework of the program guarantees of free medical care, i.e. Medical organizations involved in the implementation of this program.

Emergency assistance is in sudden acute diseases, states, exacerbation of chronic diseases, dangerous to the patient's life (in accidents, injuries, poisoning, pregnancy complications and other states and diseases). To date, it is worth focusing on a medical understanding of emergence of the situation, having a threat to the patient's life and urgency of actions.

Only a medical worker can determine the presence of a threat (i.e., a doctor or nurse, but not an administrator), so in such a situation the doctor must accept the patient outside the record.

In any case, the employee must cause an ambulance outfit.

If you have the opportunity to provide first aid (before the arrival of ambulance doctors), such assistance must be rendered.

Reasons for emergency medical care in emergency form (i.e. there is a threat to life) are:

a) violations of consciousness pose a threat to life;

b) respiratory disorders that pose a threat to life;

c) violations of the circulatory system representing a threat to life;

d) mental disorders accompanied by a patient's actions representing the immediate danger to him or other persons;

e) sudden pain syndrome representing a threat to life;

e) sudden violations of the function of a body or system of organs pose a threat to life;

c) the statement of death (except for hours of medical organizations providing medical assistance in outpatient conditions).

Urgent states are customary to call such pathophysiological changes in the human body, which lead to shopful deterioration Health and can threaten life with various external and internal aggression factors. The phase of the body's overall reaction begins to stimulate the hypothalamic-pituitary, and through it is a sympathetic adrenal system. Depending on the strength, duration and degree of exposure to the factor of aggression on the body, the response reaction can be maintained within compensatory capabilities, and with the imperfect reactivity of the body and the concomitant pathology of any functional systems becomes inadequate, leading to a breast of homeostasis.

The mechanism, or pathogenesis, urgent states in these conditions turns into a tanatogenesis (the physiological process of dying, named by the name of the ancient Greek God of the death of the Tanatos), when earlier useful hyperventilation leads to respiratory alkalosis and a decrease in cerebral blood flow, and the centralization of hemodynamics violates the rheological properties of blood and reduces it Volume.

The hemostatic reaction turns into a scattered intravascular coagulation with a dangerous thrombosis or unmanaged bleeding. Immune and inflammatory reactions are not protected, but contribute to the anaphylactic in the form of laryngo and bronchiolespace, shock, etc. Not only reserves of energy substances are consumed, but also burn structural proteins, lipoproteids, polysaccharides, reducing the functionality of organs and the body as a whole. The decompensation of acid-alkaline and electrolyte state occurs, and in connection with which enzymatic systems, tissue enzymes and other biologically active substances (BAV) are inactivated.

These interdependent and mutually interconnected disorders of the body's life functions can be represented as intertwined cycles of homoseostasis disturbances discussed in the monograph A.P. Zilbera "Clinical physiology in anesthesiology and resuscitation" (1984) within the system of intensive therapy of anesthesiology and resuscitation (ITAR). The first round - characterizes the violation of the regulation of vital functions, when not only the central regulatory mechanisms (nerve and hormonal), but also tissue (kinine systems, biologically active substances of the histamine type, serotonin, prostaglandins, CAMF systems), regulating blood supply and organ metabolism, Permeability of cell membranes, etc.

The second vicious circle - reflects the changes in the body's liquid media, when syndromes are developing, mandatory for critical states of any etiology: violation of the rheological properties of blood, hypovolemia, coagulopathy, changes in metabolism.

The third vicious circle - shows organ disorders, including: functional failure of the lungs (1), circulatory circulation (2), liver (3), brain (4), kidney (5), gastrointestinal tract (6). Each of the listed disorders can be expressed in varying degrees, but if specific pathology reached the level of critical state, the elements of all these disorders always exist, so any urgent state should be considered as a polyorgan deficiency requiring emergency medical care.

With outpatient dental interventions, the following urgent states distinguish:

• respiratory disorders due to disorders of external respiration and asphyxia;
• cardiovascular disorders, comprising fainting, collapse, arrhythmias, angina, hypertensive crisis, myocardial infarction, hypotension, vascular dystonia;
• comatous states in diabetes, increasing intracranial pressure (epilepsy), kidney damage; one"
• shock manifestations as a result of acute I pain reaction, injury, allergic reaction to medicines (anaphylactic shock), etc.

Assistance in emergency conditions develops from intensive relevant medical events. In the process of observing the condition of the patient, a number of clinical signs are possible:
! State of consciousness and psyche - The initial, the easiest changes in consciousness are manifested by the patient's inhibition, its indifference to the surrounding environment. The questions are responsible correctly, reasonably, but sluggish. Violation of orientation in time and space is not expressed, the answers to the asked questions gives a delay. In some cases, initial changes in psyche are manifested by speech and motor excitations, disobedience, aggressiveness, which is estimated as a stubborn state (discharge). If the patient is completely inspiring to the surrounding, does not answer questions, but the reflexes are preserved, - this indicates a suggestion, or disjection. The extreme degree of violation of consciousness is a coma (hibernation), when the complete loss of consciousness, sensitivity and active movements due to the loss of reflexes occurs.
! Patient position - It can be active, passive and forced. Passive position indicates the severity of the patient's condition, which is sedimulated, relaxed, slides towards the footage of the chair. Forced position is characteristic of respiratory complications, having shortness of shortness, cough, asphyxia.
! Facial expression - Determines general state Human: a suffer expression happens with severe pain reactions and mental experiences; pointed and inexpressive facial features speak of intoxication, uncomplicated blood loss, dehydration; Element, the swimming and pale face is characteristic of renal patients; A mask person testifies to the behavior of the brain, especially with combined damage to the jaws and heads.
! Skin Covers - Increased skin moisture is considered one of the reactions of adaptation and psycho-emotional voltage. Abundant sweating is characteristic of circulatory disorders (drop in blood pressure, temperature, etc.). Abundant cold sweat is an adverse symptom and is observed in fainting, collapse, asphyxia, terminal states. The determination of the turgora (elasticity) of the skin is important. Lowering the leather turgora is observed during dehydration in weakened and oncological patients. In some patients, there is a pale, with a gray tint of the skin, which indicates the circulatory disorders and intoxication of the body in chronic diseases of the cardiovascular system, parenchymal organs.

Peripheral cyanosis (acricyanosis) depends on the slowdown in the blood circulation and reducing oxygen utilization by tissues. In this case, the sinusiness is most noticeable at the tip of the nose, lips, ear sinks, finger nails. This type of synushia occurs in mitral vices and blood circulation disorders of cardiac origin by reducing cardiac output.

Cyanosis of central originUnlike peripheral, manifested by uniform body sinusiness as a result of a decrease in arterialization venous blood In the lungs, which is usually with severe forms of pneumosclerosis, lung emphysema, asphyxia. The growing cyanosis of any origin is prognostically unfavorable and requires emergency measures.

Swelling in tissues and interstitial spaces - As a rule, it is constant due to the appropriate pathology. The swelling of cardiac origin is manifested in the legs, renal - on the face, centuries, cachexic - everywhere, in all tissues and organism organs. Only only the swelling of allergic origin - swelling of quinte, which is distinguished by the attackness of manifestations on the skin of the face (eyelids, cheeks, lips, oral mucosa), as well as on hand. It can spread to the larynx, the trachea, the esophagus, which requires urgent medical events. The swelling of a certain anatomical region can be with phlebitis and thrombophlebitis, in particular, edema of the anterior facial vein, characterized by soreness and one-sided manifestation.

In addition to clinical manifestations of somatic disorders, their confirmation is required using laboratory studies and instrumental data, however, with an outpatient reception, these possibilities are limited, and we can only talk about the need to measure blood pressure, calculating the pulse rate, respiration, blood sugar analysis. Otherwise, much depends on the clarity of the actions, experience and intuition of the doctor.

Respiratory disorders - In the dental chair, sudden can only be with asphyxia. At the same time, from all types of asphyxes (dislocation, obtultational, wallotic, valve, aspiration) develops the concept of "board". Dentists are more likely to deal with aspiration asphyxes when saliva, blood, teeth fragments, sealing material and even small tools (root needle, pulpxtractor).

The symptoms of an acute disorder of external respiration are developing in several phases:
The 1st phase - the strengthening of respiratory functions at which the breath is lengthened and inhalation - inspiratory shortness of breath, anxiety, cyanosis, tachycardia;
The 2nd phase is a resignation of breathing with a sharp strengthening of exhalation - expiratory shortness of breath, acricyanosis, bradycardia, drop blood pressure, cold sweat;
3rd phase - Bradypna, loss of consciousness;
The 4th phase is apnea, Kous-Maulya, or atonal breathing.

By time, one phase replaces another depending on the reserve capacity of the body and emergency measures.

Emergency care is to urgently eliminate the causes of asphyxia, compensation for external respiration by inhalation of oxygen or auxiliary mechanical respiration using a manual device of RD 1, an AMBU bag (Fig. 42), anesthesia mask. In recent years, Kendall has created a convenient tube that can be used for emergency care. In addition, efficiently effective stimulation intravenous administration Respiratory Analeptics (2 ml of Cordiamine, 2.4% Euphilline solution, 10 ml). It is necessary to call "ambulance" or anesthesiologist, with the ineffectiveness of the activities carried out, tracheotomy or micro-tauchetoma is shown - piercing the thick needle of the trachea diaphragm between the folding and thyroid cartilage. The patient is transferred to the hospital. In disruption of external respiration for extractive reasons in patients with such accompanying pathology, such as stroke, miastic, hypertensive crisis, etc., urgent assistance should be aimed at preventing the edema of the lungs.

Cardiovascular disorders - Most often, fainting resulting from mental or nervous stress, as well as as a result of the manifestation of psycho-vegetative complications at the reception at the dentist. Sometimes after injection, anesthetic, accompanied by pain and proprioceptive irritation, suddenly arises a sharp pale of the patient's face cover, ringing in the ears, darkening in the eyes and loss of consciousness. At the same time, pupils remain narrowed, the corneal reflex is missing, the eyeballs are stationary or wandering, the pulse is weak, the breathing is superficial, systolic blood pressure within 70-50 mm RT. Art., Skin covers are cold, then covered. Such a state briefly (1-1.5 minutes), after which consciousness returns immediately, the patient notes retrograde amnesia.

Emergency care is in an urgent attachment to the patient's horizontal position. Smoothly throwing the back of the chair, freeing from clothes, shining and impellent breathing; Provide the influx of cool air by opening the window, window or turning on the fan on the dental installation. Next, moisten the tampon in the ammonia alcohol and squeeze the chest at the time of passive disguments, carefully bring the tampon to the nose. Then carry out the manual reflexology of the massage of the dots of the overall impact on the hands, the surbrov and at the base of the nose. If the faint is long, 2 ml of Cordiamine is administered intravenously on a physiological solution of 10 grams of syringe. In bradycardia - 0.1% a solution of atropine (0.6-0.8 ml) in the dilution of saline 1: 1.

Nepisiological and even dangerous should be considered a widespread reception of the rapid tilt of the head down and forward. On the contrary, it is necessary to ensure the influx of blood to the heart at the time of the centralization of blood circulation by the position of "legs at the level of the heart" so that there is a full-fledged cardiac output and was provided with brain-blooded blood flow.

Only after the persistent disappearance of the consequences of fainting and signs of circulatory disorders is possible to continue dental intervention. The main reason for the fainting should be considered a violation of bioenergy, when the insufficiency of the energy product process and the oxygen deficiency in psycho-emotional stress leads to the metabolic acidosis of tissues and circulatory disorder. This patient requires premedication before dental intervention.

Collapse - acute cardiovascular insufficiency due to blood loss or orthostatic reasons leading to the microcirculation disorder of the brain, myocardium and internal organs.

Clinically collapse is reminiscent of fainting, but develops gradually when on the background of pallor, tachycardia, sharp drops of hell up to 30 mm RT. Art. and the presence of superficial breathing loss of consciousness occurs with a delay.

Emergency care is the rapid increase vascular tone By intravenous administration of drugs: Cordiamin 2 ml on a physiological solution - 10 ml, after which the Meston (1% solution, 0.5-1 ml) or norepinephrine (0.2% solution, 0.5-1 ml) also in 10 ml The saline is slow. With the ineffectiveness of previous tools, a drop-free infusion of a 5% glucose solution is carried out (Fig. 43), polyglyukine with the addition of 100 mg of vitamin C and 100 mg of prednisone in 200 or 400 ml. The frequency of drip administration is 60-80 drops per minute under the control of blood pressure and pulse.

It is necessary to cause a resuscitation brigade or anesthesiologist responsible for the separation. The patient is translated into the hospital.

Arrhythmia - arises as a result of the reflex effect of the pain reaction coming from the field of the operating field, or as a result pharmacological action Anesthetics Against the background of metabolic acidosis due to stress factor.

Clinically arrhythmia is manifested by subjective unpleasant sensations in the field of heart, a feeling of trembles, anxiety, signs of circulatory disorder and heart failure (swelling of subcutaneous veins, cyanosis on the periphery of the body).

Emergency care is to terminate the intervention, giving a comfortable position. The patient must be given to drink water, take sedatives: tincture of valerian or mother-in-law, or validol under the tongue, or a 9 mg sider ("Per OS") in a liquid form. In the elimination of arrhythmia, it can be limited to this, when the disorder is increasing, it is necessary to cause a cardiological brigade before the arrival of which to ensure oxygen therapy, sedation and peace. During paroxysmal tachycardia, beta-adrelanoblasts are used in the form of a single dose of -5mg of the survey (anaprill) orally.

The arrhythmia is dangerous myocardial infarction, the clinic of which is brighter and corresponds to the acute heart attack of angina: anxiety, the feeling of fear is accompanied by pain in the heart area with irradiation for the left blade, in hand, and sometimes in the abdomen. Neither Validol, nor Nitroglycerin, nor even Promedol pain is removed.

Emergency care is to calm the patient, reducing pain syndrome, oxygenaterapy, reflexology with constant control of blood pressure and pulse, it is advisable to introduce a sadocent (10-20 mg intravenous), as well as a 2% solution of papaverine (2 ml) in combination with 1% dibazole (3 -4 ml). It is necessary to cause a specialized cardiological brigade and remove the ECG. The patient is transported to the therapeutic clinic or resuscitation department.

Hypertensive crisis - arises as a consequence of overwork, overanxcitation, pain and psycho-emotional voltage of the patient already suffering hypertensive disease.

It is clinically manifested by a sharp increase in hell up to 200 mm Hg. Art. And more, headache, noise in the ears, redness of the skin of the face, swelling of the subcutaneous veins, a feeling of heat, pouring then, breath. In severe forms, nausea, vomiting, violation, bradycardia, violation of consciousness, is joined, up to coma.

Emergency care is to properly diagnose, the imposition of harnesses on the limb, applying cold to the backbone, soothing the patient with the administration of sadocent (20 mg) in one syringe with barallganic (500 mg) in 10 ml of saline. The dibazole injection is then added 1% - 3 ml + papaverine 2% - 2 ml; It is possible to bleed up to 300-400 ml (leeches to the occipital region). If within 30-40 minutes the attack does not stop, resort to the introduction of gangli-blocking agents, but this is already the competence of a specialized cardiological brigade or "ambulance" doctors, which should be caused immediately after the occurrence of the crisis. The patient in all cases is subject to hospitalization in the clinic.

Vascular, neurocirculatory dystonia - refers to the exact opposite state of dental patients; It is characterized by general lethargy, weakness, dizziness, high sweating, the red dermographism of the skin is expressed.

With neurocirculatory dystonia hypotonic type, the functional activity of the cholinergic system and the relative insufficiency of the sympathetic system is observed, which causes the development of parasympathetic reactions in a patient with psycho-emotional stress.

Emergency assistance in this category of patients is reduced to the use of cholinolithics, which avoid circulatory disorders and bronchospasm. Against the background of the sedation, an intravenous administration of 0.1% of an atropine or metacine solution (from 0.3 to 1 ml) is recommended in the dilution of a saline solution of 1: 1.

Hypotension - It is characterized by a decrease in systolic pressure below 100 mm RT. Art., and diastolic - below 60 mm Hg. Art. Primary (essential) hypotension is manifested as a constitutional hereditary feature of the regulation of vascular tone and is regarded as a chronic disease in which lethargy, drowsiness, the tendency to ortostatic reactions and dizziness are typical symptoms.

Secondary arterial hypotension is observed in long-term diseases of the oncological nature, endocrine disorders (hypofunction thyroid gland), blood diseases, liver, kidney and with allergies. Clinical manifestations are similar and exacerbated by the emotional stress factor in front of dental intervention.

Emergency assistance in such states is the symptomatic therapy of the most pronounced functional disorders and the obligatory inclusion in therapeutic measures of the tranquilizer of benzodia-ditching series: diazepam (sidercane, relaignation, sybazon) at the rate of 0.2 mg / kg body weight of the patient in combination with atropine or metacin In an amount of 0.3-1 ml of 1% solution, depending on the initial heart rate and data of blood pressure.

Comatous states - stand out in a separate group of urgent states, since their manifestations are observed mainly in patients with concomitant diseases, which they always need to warn the dentist. Coma is the condition of the sharp braking of the highest nervous activity, accompanied by the loss of consciousness and violation of all analyzers. Who should be distinguished from the spin when the individual elements of consciousness and reactions to strong sound and light stimuli are preserved, and from the state of the stupor, or stupor, with the phenomena of catatonia, but without losing consciousness.

Distinguish to whom:
from alcohol intoxication;
due to the skull injury (subdural hematoma);
Due to the poisoning of non-splashing products, drugs, etc.;
due to infectious meningitis, encephalitis;
Uremic;
diabetic;
hypoglycemic;
hypoxic;
With epilepsy.

Significant information for estimating coma is the appearance of the patient during the inspection and determination of its condition. Cyanosis, a pronounced drawing of a venous system on a chest and stomach point to the hepatic hypertension or cirrhosis of the liver, that is, on the hepatic to whom. Hot dry skin can be with sepsis, severe infection, dehydration. The convulsions and rigidity of the occipital muscles, the mimic muscles confirm to whom due to an increase in intracranial pressure (injury, thrombosis, tumor, etc.).

In the diagnosis of coma, the smell assessment is important: diabetic acidosis as the reason for the coma is usually characterized by the smell of acetone from the mouth, the rented smell indicates liver coma, and the smell of urine is about kidney. With alcohol intoxication, the smell is typical.

Under a coma of unclear etiology, it is necessary to investigate the blood sugar content.

Emergency assistance in a coma is an urgent challenge "ambulance" or resuscitation brigade. Starting with constant oxygenation and relief of functional disorders - respiration, blood circulation, heart work and brain manifestations. In particular, in a hypoglycemic coma, it is necessary to immediately introduce intravenously 50-60 ml of 40% glucose solution, as it develops lightning and more dangerous in its consequences. The diagram of therapeutic measures at a coma is similar to the principles of ABC resuscitation.

Shock manifestations in outpatient dental practice arise, as a rule, in the form of an anaphylactic reaction to local anesthetic, antibiotic, sulfanimide drugs, enzymes and vitamins.

Anaphylactic shock - represents an allergic reaction of an immediate type, occurs immediately after the parenteral administration of allergen and manifests itself with a feeling of heat, itching in the scalp, limbs, dryness in the mouth, difficult to rapid breathing, redness of the face, replacing the pallor, dizziness, loss of consciousness, nausea and vomiting , convulsions, pressure drop, relaxation, up to the incontinence of urine, feces; The coma develops.

There are typical form, cardiac, astmoid, cerebral and abdominal variants of anaphylactic shock. For the flow, it is distinguished by lightning, heavy, moderate gravity and light shape.

Heavy and lightning forms, as a rule, end with a fatal outcome. With the form of moderate gravity and easy it is possible to identify the above clinical manifestations and treat.

Emergency assistance in shock manifestations corresponds to the resuscitation scheme: to give a horizontal position of the patient, to ensure the passability of the upper respiratory tract with the rotation of the patient's head on the side, stretch the tongue, clean the mouth from mucus and vomit, pull out the lower jaw forward, start to carry out an artificial breath.

Antihistamine drugs (2-3 ml of 2% supustine solution or 2.5% pipolfen solution) are introduced intravenously. A good effect gives the introduction of 3-5 ml of a 3% solution of prednisolone, 100-120 ml of 5% epsilon-aminocaproic acid. If there are signs of progressive bronchospasm, it is shown to introduce 10 ml of 2.4% of the solution of euphilline or 2 ml of 0.5% of the izadrin solution.

Heart glycosides (1-0.5 ml of 0.06% of the solution of Corgal Galcon in 10 ml of saline), as well as 2-4 ml of a 1% solution of the LaziCs are introduced to maintain cardiac activity. Such therapy is carried out in combination with mandatory oxygen therapy and respiratory compensation.

In the absence of an improvement in the patient's state, the administration of drugs should be repeated and go to the drip (from the one-time system) by the introduction of polyglyukin, saline with the addition of 2-3 ml of dexamethasone to the vial at a speed of up to 80 drops in 1 minute. According to indications spend cardiovole resuscitation. Patients undergoing anaphylactic shock should be hospitalized in a special branch due to the danger of late complications from the heart, kidney, gastrointestinal tract.

It is impossible to avoid such a formidable complication, but it should be prevented by careful analysis of the patient's anamnesis.

Basics of resuscitation of patients under dental polyclinic

When conducting dental intervention in patients, critical conditions may occur, accompanied by a violation of the organism's vital functions, which requires the implementation of the necessary resuscitation activities. Resuscitation, or revitalization of the body in a state clinical deathmust be performed by a doctor of any specialty. Its bases are included in the concept of ABC resuscitation, that is, a clear fulfillment of a certain sequence of emergency medical events and actions. To ensure the maximum effectiveness of the events, it is necessary to thoroughly know individual techniques for their implementation.

When carrying out artificial respiration, the doctor's assistance is located at the head of the patient. One hand he touches under the back surface of the neck, the other puts on the head of the patient so that you can push the nose in the nose and thumb and thumb. Having made a deep breath, the doctor presses his mouth to a lifting mouth of the victim and makes a sharp exhale, making sure chest patient.

Artificial breath can be carried out through the nose. Then you should leave the nose free, tightly closing the hand of the patient's mouth. From the hygienic considerations of the mouth (nose) of the patient should be covered with a handkerchief or a marlevary napkin. In recent years, special tubes with biological filters have appeared. Artificial respiration is better carried out through a U-shaped tube or an artificial respiratory machine (such as an ABU bag).

In the absence of a pulse at carotid arteries - continuing artificial respiration with a weak, threaded pulse, the presence of a wide pupil, not responding to light, and complete relaxation (that is, signs terminal state) - It is necessary to urgently provide blood circulation by outdoor heart massage. The doctor, being on the side of the patient, has a palm of one hand on the bottom third of the sternum (for two fingers above the sword-shaped process, at the attachment of ribs to the sternum). He holds the second hand on the first at right angles. Fingers do not have to touch the chest. An energetic push, allowing to shift the breast to the spine by 3-4 cm, carried out artificial systole. The systole efficiency control is carried out on a pulse wave on a sleepy or femoral artery. The doctor then relaxes his hands without tearing them from a sick breast, which should be horizontally on a tight surface below the doctor's belt. At the same time, one breath should have 5-6 massage compresses of the chest, and, consequently, the squeezes of the left ventricle.

Such actions continue until independent heart abbreviations and pulse on the carotid artery appear. After 5-10 minutes of the outer heart massage, if the patient does not come into consciousness, intravenously or under the tongue is administered with 1 ml of 0.1% of the adrenaline solution, an ice bubble is applied to the head and continue resuscitation measures before the arrival of a specialized brigade. Only resuscitation doctor solves the issue of termination of resuscitation in case of its ineffectiveness.

Cardiovary Resuscitation Principles

In all cases:
Give a horizontal position on the rigid surface (couch, floor), call to the aid of another medical worker or any person and cause an ambulance.
In the absence of consciousness:
Release shy clothes, throw off your head and push the bottom jaw. With a weakened breathing, give a pair of ammonic alcohol on the tampon, follow the oxygenation, controlling the sufficiency of breathing.
In the absence of breathing:
Provide an active blowing (through a napkin or handkerchief) of the air into light at least 12 times in 1 minute by the "mouth in the mouth" method, "mouth to the nose", through the air duct or hand respirator of the AMBU bag.
In the absence of a pulse at carotid arteries:
Continuing artificial respiration with a weak, threaded pulse, intravenously introduce 1 ml of 0.1% of the atropine solution from a syringe tube or 0.5 ml of 1% mesaton solution.
With the absence of pulse and breathing, the availability of a wide pupil that does not respond to light and complete relaxation, that is, signs of terminal state, urgently provide blood circulation by indirect heart massage.
When stopping a heart:
On a bare breast, the dual cross-cross-time hands are placed in the field of the lower third of the sternum and squeeze it, deflection by 3-4 cm. At the same time, it should have 5-6 massage compresses of the chest, and hence the squeezing of the left ventricle of the heart. Such actions continue until independent heart abbreviations and the pulse on the carotid artery appear.
After 5-10 minutes of the outer massage of the heart, if a person does not come into consciousness, 1 ml of 0.1% of the adrenaline solution is introduced intracardly and continue resuscitation measures before the arrival of a specialized brigade.

We offer practical dentists to use the following tested and new recommendations for the implementation of anesthesia under the conditions of dental clinics.

Premedication of patients with concomitant diseases

1. Patients with hypertensive disease with a moderate degree of psycho-emotional voltage sufficient is sufficiently premeditated by the stenquin inside at a dose of 0.3 mg / kg of body weight of the patient.
In the history, it is advisable to include bararalgin in a dose of 30 mg / kg in a liquid form from the ampoule.
With a pronounced degree of emotional voltage on the SCS, the premedication should be carried out by intravenous administration of sadocents in the same dose, and in the presence of hibs - to combine with a baralgin from the same calculation in one syringe.
With a pronounced degree of hysterical reaction in patients with hypertensive disease, premedication must be carried out
intravenous introduction of the following composition: Sedukene 0.3 mg / kg + lexier 0.5 mg / kg (or tram 50 mg) + 0.1% Atropine 0.6 ml. Such premedication is performed by anesthesiologist.
2. Patients with S. endocrine diseases (Easy and moderate degree of psycho-emotional voltage) Premedication is mandatory and carried out orally by a seashene tranquilizer at a dose of 0.3 mg / kg inwards in 30-40 minutes to local anesthesia and the operation of the dentist.
In patients with S. diabetes With a pronounced degree of psycho-emotional voltage, the premedication is carried out by intravenous administration of Seduksna 0.3 mg / kg and a Baralgin of 30 mg / kg in one syringe.
In patients with thyrotoxicosis, with a pronounced degree of psycho-emotional voltage, it is advisable to use in the premedication of beta-adrenobloclocloclator of the prison (propranolol, 5 ml of 0.1% R-ra) at a dose of 5 mg per reception in liquid form from the ampoule in combination with a 9-axle 0.3 mg / kg body weight patient.
With a pronounced degree of hysterical reaction in patients with endocrine diseases, the premedication is carried out by an anesthesiologist intravenous administration of Seduksiene, lexira, atropine in previously specified doses.
3. Evaluation of psycho-emotional voltage on SCC patients with allergic reactions Anamnesis focuses the dentist in the choice of anesthesia in operations under the conditions of dental clinic.
With a mild, the premedication of the phenazepam in a dose of 0.01 mg / kg inwards in tablets is 30-40 minutes to intervention.
With a moderate degree of psycho-emotional voltage, the premedication is also carried out orally with a phenasepam in a dose of 0.03 mg / kg in combination with a barg of 30 mg / kg or a beta-adrenoblor of -5 mg for one reception from the ampoule in liquid form.
If there is a pronounced degree of psycho-emotional voltage in this group of patients, the premedication is performed by anesthesiologist, or general anesthesia is carried out.
4. In pregnant women it is advisable to apply the following schemes of combined anesthesia: in patients without concomitant pathology, but having a high psycho-emotional voltage and a large amount of intervention - the use of sadocent (relainium) 0.1-0.2 mg / kg, and in the presence of concomitant pathology in combination With hypotension - Seduksen (Relanium) 0.1-0.2 mg / kg together with a barg of 20-30 mg / kg.
5. Patients over 60 years of age with a light and moderate degree of psycho-emotional voltage Premedication is performed by a dentist: prescribed inside the tranquilizer SIBAZA in a dose of 0.2 mg / kg of body weight of the patient 40 minutes before the operation.
With a moderate and pronounced degree of psycho-emotional voltage, the premedication is in combination of diazepam 0.2 mg / kg and a Baralgin of 30 mg / kg (inside).
In the presence of emotionally determined (paroxysmal) tachycardia, the premedication of diazepam (0.2 mg / kg) is shown in combination with a beta-adrenoblocker by an overwind (5 mg per one) in a liquid form from the ampoule (inside).

Modern technology of local anesthesia

1. With outpatient dental interventions on the upper jaw and in the frontal department on lower jaw
It is recommended to use infiltration anesthesia with drugs based on 4% artician with adrenaline at a concentration of 1: 100000 or 1: 200000.
2. For the anesthesia of the premolars on the lower jaw, it is better to use the blockade of the chiffer nerve and the cutting branch of the lower hole nerve intrarotrone in the modification of Malayeda with various amide local places containing a vasoconstrictor.
3. The anesthesia of the molars of the lower jaw is possible with the use of the blockade of the lower moon nerve in Egorov and GOU-Gates due to the safety, technical simplicity and the presence of individual anatomical landmarks.
4. To simplify the blockade of the blockade of the mandibular nerve on GOU-Gates, it is recommended to use the following manual reception: holding the syringe in the right hand, the index finger of the left hand is placed in the outer hearing pass or on the skin directly ahead of the lower border of the ear goat in the inter-earth clipping. Controlling on the sensations of the index finger of the left hand moving the head of the mumane process on the articular tuber during a wide opening of the mouth, the cervix is \u200b\u200bdetermined by the cervix for the mouse out and direct the needle to the point before the end of the index finger.
5. Improving the safety of intralyigative anesthesia is achieved by reducing the number of points of the inclination in the gum groove and the volume of the administered anesthetic. For anesthesia of a single-corner tooth, 1 feeding needles should be made and introduced a periodontal space of 0.06-0.12 ml of anesthetic solution, and for anesthesia of a two-or three-axis tooth -2-3 and 0.12-0.36 ml of solution.
6. Small amounts of inserted anesthetic and vasoconstrictor when using intraligent and intraseptal methods allow them to recommend them for anesthesia in individuals with cardiovascular, endocrine and other pathology.
7. In patients with contraindications to the use of a vasoconstrictor in the composition of the local substation solution, we recommend using a 3% mepivacain solution. To potentiation anesthesia, we recommend using drug preparation using benzodiazepine tranquilizers.
8. The most convenient and safest for infiltration and conductor anesthesia are foreign spring metal aspiration carpill syringes and a domestic plastic carpill syringe "IS-02 MFA", which have a ring focus for thumb.
9. It seems promising use of a computer syringe "Wand", which carries out accurate dosing and slow supply of anesthetic under constant pressure with automation of aspiration sample.
10. The diameter and length of the needle, as well as the amount of the anesthetic insertion, we recommend to determine for each method of anesthesia individually.

Introduction

The purpose of this abstract is the study of basic concepts to provide first aid, also consideration of a complex of first aid activities.
The subject of the study is urgent states, accidents, shock state.

Emergency condition

Emergency conditions are a set of symptoms (clinical signs) requiring first aid, emergency medical care, or hospitalizing the affected or patient. Not all states threaten life directly, but at the same time they require assistance in order to prevent significant and long-term impact on the physical or mental health of a person who has in such a state.

Types of urgent states:

ANAPHYLACTIC SHOCK

Bronchial asthma attack

Hyperventilation

Angina

Epileptic seizure

Hypoglycemia

Poisoning

A feature of urgent states are the need for accurate diagnosis in the minimum short time and, based on the alleged diagnosis, the identification of therapeutic tactics. These states may arise due to acute diseases and injuries of digestive organs, exacerbation of chronic diseases or as a result of complications.

The urgestibility of the state is determined:
First, the degree and rate of violation of the function of vital organs and systems, first of all:
hemodynamic impaired (sudden change in frequency, pulse rhythm, rapid decrease or increase in blood pressure, acute development of heart failure, etc.);
Violation of the central function nervous system (violation of the psycho-emotional sphere, convulsions, delirium, unconscious state, violation of cerebral circulation, etc.);
impairment of the respiratory function (acute change in frequency, respiratory rhythm, asphyxia, etc.);

Secondly,
The outcome of the urgent state or the disease ("to anticipate a danger means half to avoid it"). So, for example, the rise of blood pressure (especially against the background of its persistent increase) - a threat of stroke; Infectious hepatitis - acute yellow liver dystrophy, etc.;

Third, extreme concern and patient behavior:
directly threatening life pathological conditions;
directly not threatening life pathological conditions or diseases, but in which such a threat can become real at any time;
conditions in which the lack of modern medical care can entail persistent changes in the body;
conditions under which in the shortest possible time it is necessary to facilitate the suffering of the patient;
States requiring urgent medical intervention in the interests of others in connection with the behavior of the patient.

First aid for urgent states

The fainting is a sudden, short-term loss of consciousness, the coming due to the violation of the cerebral circulation.

The trimming state can continue from a few seconds to a few minutes. Usually a person himself after a while comes to feeling. Fund itself is not a disease, but rather a symptom of the disease.

First Assistance in Sync

1. If the respiratory tract is free, the victim breathes and his pulse (weak and rare) is tested, it must be put on the back and raise his legs.

2. Disseminate squeezing parts of clothing, such as collar and belt.

3. Put the wet towel on the forehead, or moisten it with cold water. This will lead to a narrowing of vessels and improve the blood supply of the brain.

4. With vomiting of the victim, it is necessary to translate into a safe position or at least turn the head of the side so that it does not choose the vomit's masses.

5 It must be remembered that fainting can be a manifestation of heavy, including acute diseaserequiring emergency. Therefore, the victim always needs to be inspected by his doctor.

6. Do not hurry to raise the victim after the consciousness returned to him. If the conditions allow that the affected can be filled with hot tea, after which it is to help lift and sit down. If the victim again feels a faint condition, it must be put on the back and raise his legs.

7. If the victim is unconscious for several minutes, most likely, this is not a faint and qualified medical care is necessary.

Bronchial asthma attack

Bronchial asthma is an allergic disease, the main manifestation of which is the attack of a suffocation due to a violation of the bronchi passability.

Bronchial asthma is expressed in the enclosures of choking, it is experiencing as a painful lack of air, although in reality it is based on the difficulty of exhalation. The reason for this is the inflammatory narrowing of the respiratory tract caused by allergens.

First aid in the attack bronchial asthma

1. To bring the victim to fresh air, unzipped the collar and weaken the belt. To be sat down with the tilt and focus on the chest. In such a position, the respiratory tract is opened.

2. If the victim has any drugs - help them use.

3. Immediately call ambulance, if a:

This is the first attack;

The attack did not stop after taking medication;

The victim has too hard breathing and it is difficult for him;

At the injured signs of extreme exhaustion.

Hyperventilation

Hyperventilation is redundant to the level of exchanging pulmonary ventilation, due to deep and (or) frequent breathing and leading to a decrease in carbon dioxide and an increase in blood oxygen.

Feeling strong excitement or panic, a person begins to breathe more often, which leads to a sharp decrease in the content of carbon dioxide in the blood. Hyperventilation occurs. The victim begins to feel even greater concern that leads to strengthening hyperventilation.

First aid for hyperventilation.

1. To bring a paper bag to the nose and the mouth of the victim and ask him to breathe by the air that he exhales into this package. At the same time, the victim exhales the air saturated with carbon dioxide, and again inhales its same.

Typically, after 3-5 minutes, the level of blood saturation, carbon dioxide comes back to normal. The respiratory center in the brain receives the relevant information about this and gives a signal: breathe slower and deeper. Soon the muscles of respiratory organs is relaxed, and the entire respiratory process comes back to normal.

2. If the cause of hyperventilation was the emotional arousal, it is necessary to calm the victim, to bring him a sense of confidence, to persuade the victim calmly sit down and relax.

Angina

Stenzardia (breast toad) is an attack of acute breast pain, due to the transient deficiency of coronary blood circulation, acute myocardial ischemia.

First aid for angina.

1. If the attack has evolved when exercise, It is necessary to stop the load, for example, to stop.

2. Posted by the victim half-swaying position by placing it under the head and shoulders, as well as under the knees of the pillow or rolled clothes.

3. If the victim had previously noted attacks of angina, to relieve which he used nitroglycerin, he can take it. For a faster absorption, nitroglycerin tablet must be placed under the tongue.

The victim should be warned that after taking nitroglycerin, there may be a feeling of cutting in the head and headache, sometimes dizziness, and, if you stand, a fainting condition. Therefore, the injured for some time should remain in a half-way position even after the pain passes.

In the event of the effectiveness of nitroglycerin, the attack of angina passes in 2-3 minutes.

If a few minutes after receiving the drug, the pain did not disappear, it can be reached again.

If, after receiving the third tablet, the affected pain does not pass and is delayed by more than 10-20 minutes, it is necessary to urgently cause ambulance, since the likelihood of infarction is possible.

Heart attack (myocardial infarction)

Heart attack (myocardial infarction) - necrosis (death) section of the heart muscle due to the violation of its blood supply, manifested in violation of cardiac activity.

First aid with heart attack.

1. If the victim in consciousness is to give him a half-sided position, laying under his head and shoulders, as well as under the knees of the pillow or rolled clothes.

2. Give aspirin's victim to the victim and ask for it.

3. Loosen the squeezing parts of the clothes, especially at the neck.

4. Immediately call an ambulance.

5. If the victim is unconscious, but breathes it in a safe position.

6. Control the breath and blood circulation, in case of a heart stop, immediately proceed to cardiovascular resuscitation.

Stroke - an acute circulatory breakdown in the head or spinal cord With the development of persistent symptoms of damage to the central nervous system.

First aid in stroke

1. Immediately cause qualified medical care.

2. If the victim is unconscious, check whether the respiratory tract is open, restore the airways permeability, if it is broken. If the victim is unconscious, but breathes - to translate it into a safe position on the side of damage (to the side where the pupil is expanded). In this case, a weakened or paralyzed part of the body will remain upstairs.

3. Be ready for a rapid deterioration of the condition and to conduct cardiovascular intensive care.

4. If the victim is in consciousness, put it on the back, laying something under the head.

5. The affected may be a microinsult, in which a slight disorder of speech, light turbidity of consciousness, light dizziness, muscular weakness are observed.

In this case, when first aid, it is necessary to try to protect the victim from falling, calm and support it and immediately call ambulance. Control DP - D - K and be ready to provide urgent help.

Epileptic seizure

Epilepsy is a chronic disease caused by the lesion of the brain, manifested by repeated convulsive or other seizures and accompanied by a variety of identity changes.

First aid with a small epileptic seizure

1. Eliminate the danger, to take the victim and calm it.

2. When the victim he woofs, tell him about the seizure, as it may be that his first fit and the victim does not know about illness.

3. If this is the first seizure - consult a doctor.

A large epileptic seizure is a sudden loss of consciousness, accompanied by strong convulsions (convulsions) of the body and limbs.

First aid with a large epileptic seizure

1. Noticing that someone is on the verge of a segment, it is necessary to try to make sure that the victim did not harm himself.

2. Free the place around the victim and put something soft under his head.

3. Disseminate clothes on the neck and chest of the victim.

4. Do not try to restrain the victim. If he is gritting his teeth, do not try to break the jaws. Do not try to shove something into the mouth of the victim, as this can lead to injury to teeth and the closure of the respiratory tract by their fragments.

5. After termination of the cramp, to translate the victim to a safe position.

6. Process all injuries received by the victim during the seaside.

7. After stopping the seizure of the victim, it is necessary to hospitalize in cases if:

The fit happened for the first time;

There was a series of seizures;

There is damage;

The victim was unconscious for more than 10 minutes.

Hypoglycemia

Hypoglycemia - reduced content Glucose in blood hypoglycemia can be in diabetes patient.

Diabetes is a disease in which the body does not quite produce a hormone insulin that regulates the volume of blood sugar.

The reaction is the consciousness of the confidentiality, the loss of consciousness is possible.

The respiratory tract is clean, free. Breathing is a rapid, superficial. Blood circulation is a rare pulse.

Other signs are weakness, drowsiness, dizziness. Feeling of hunger, fear, pallor of skin, abundant sweat. Summary and auditory hallucinations, muscle tension, trembling, cramps.

First aid for hypoglycemia

1. If the victim is conscious, give him a relaxed position (lying or sitting).

2. Give the victim sugar drink (Two tablespoons of sugar on a glass of water), a piece of sugar, chocolate or candy, canrakel or cookies. Saharo-substitute does not help.

3. Ensure peace until the state normalization is normal.

4. If the victim lost consciousness, translate it into a safe position, call an ambulance and control the state, be ready to start cardiopulmonary resuscitation.

Poisoning

Poisoning - intoxication of the body caused by the effects of the substances entering it from the outside.

The task of first aid is to prevent the further effect of the poison, in the acceleration of its elimination from the body, in the neutralization of the Poison residues and in supporting the activities of the affected organs and body systems.

To solve this problem, it is necessary:

1. To take care of yourself not to choose, otherwise assistance will be needed, and the victim will help to help.

2. Check the reaction, respiratory tract, breathing and blood circulation of the victim, if necessary, take appropriate measures.

5. Call an ambulance.

4. If possible, set the type of poison. If the victim is conscious, ask him about what happened. If unconscious is to try to find witnesses that happened, or packaging from poisoning substances or some other signs.

Accidents

Accident is an unforeseen event, an unexpected confluence of the circumstances, the entrusted corporal damage or death.

Typical examples are a car catastrophe (or entering the car), drop from height, hitting items in the breathing throat, drop items (bricks, icicles) on the head, electric shock. Risk factors may be non-compliance with safety, alcohol consumption.

An accident at production is the case of traumatic damage to the health of the victim, which occurred due to its labor activity, or during operation.

Types of accidents:

• Car accident
• Hit under the car
• Fire
• Hoore
• Drowning
• Fall
• Falling from height
• Fall in pit
• Electric shock
• Careless handling
• Careless handling of explosive materials
• Production injury
• Poisoning

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