stomach (simple, probe);
intestines (probe lavage – 500 ml / kg –
enema 30 l);
means (salt, oil, herbal);
(potassium chloride pituitrin, serotonin
load (oral, parenteral);
diuresis (urea, mannitol, sorbitol);
hyperventilation of the lungs.
laser hemotherapy) and pharmacological
5. Therapeutic hyper
or hypothermia (pyrogenal).
blood immune system activity
ultraviolet, magnetic, laser.
correction (T-activin, myelopid).
• plasma substituting
perfusion of the lymphatic system.
(spleen), allogeneic liver cells.
6. Physio- and
carried out in order to remove toxic
substances from the bloodstream, especially
in case of poisoning with substances that
excreted by the kidneys.
First compensate for water losses, then
start introducing large quantities
liquids with simultaneous use
diuretics (osmotic or saluretics).
Constant monitoring of the CVP is required,
5% glucose solution is administered intravenously
and isotonic sodium chloride solution,
Ringer’s solution – up to 3-5 liters per day. After
introducing 2 l of liquid apply lasix
at a dose of 20-40 mg. Hourly required
measurement of diuresis which should
be at least 300 ml / h, and towards the end
water load – 600 ml / h.
daily urine should equal
the amount of fluid injected. Spend
electrolyte control – potassium, sodium,
calcium and their correction. Against the background of the water
alkaline alkaline loads
4% solution recommended
intravenous sodium bicarbonate up to 1000 ml, since
alkaline urine reaction inhibits
reabsorption of poison in the kidneys.
to use the method: cardiovascular
failure, impaired function
toxic substances from the body using
membranes capable of retaining molecules,
protein bound, and skip
free molecules. Hemodialysis with
acute poisoning is used as
directly to detoxify the poison,
in renal failure,
resulting from poisoning.
method of purifying blood from toxic
substances by perfusion through various
sorbents (activated carbon,
synthetic resins). Used when
carried out by drainage
thoracic lymphatic duct with
to eliminate toxic substances with
lymph. Then reinfusion
peeled lymph. To remove toxins
from lymph apply a dialyzer from
“Artificial kidney” or various
based on the ability of the peritoneum having
pronounced vasculature, free
skip individual molecules and
large molecular weight protein compounds.
The method is accessible and simple. Osmotic
Sample pressure should
be higher than osmotic ability
blood and extracellular fluid.
puncture of the abdominal cavity and through the fistula
put drainage, which is introduced
drip dialyzer (for 20-30
min) and remove it by the principle of siphon.
The death of a person occurs as a result of
death of the body as a whole. In the process
dying emit stages: agony,
clinical death, brain death and
Agony is characterized by progressive
extinction of external signs
vital functions of the body (consciousness,
blood circulation, respiration, motor
With clinical death, pathological
changes in all organs and systems
are completely reversible.
Brain death is manifested by development
irreversible changes in the brain,
and in other organs and systems partially
or completely reversible.
Biological death is expressed
post-mortem changes in all organs
and systems that are permanent,
irreversible, cadaveric character.
Post-mortem changes have functional,
instrumental, biological and
• Lack of breathing, pulse, arterial
• Lack of reflex responses to
all kinds of irritants.
• Angiographic. Biological
• Maximum pupil dilatation.
• Pallor and / or cyanosis and / or marbling
(spotting) of the skin.
• Decrease in body temperature. Cadaverous
Instructions for determining the criteria and the procedure for determining the moment of death of a person, the termination of resuscitation.
A statement of the death of a person comes
with brain death or biological
death of a person (irreversible death
Biological death is established
based on the presence of cadaveric changes
(early symptoms, late symptoms).
The diagnosis of brain death is established
in health facilities having
necessary conditions for stating
Death of a person on the basis of death
brain is set according
with death statement
person based on a diagnosis of death
brain approved by order of the Ministry
Healthcare of the Russian Federation
from 20.12.2001/460/XNUMX? XNUMX “On approval of the Instructions
by stating a person’s death on
based on the diagnosis of brain death ”(order
registered by the Ministry of Justice
Russian Federation January 17, 2002?
III. The termination of resuscitation measures.
• when stating a person’s death on
the basis of brain death, including
against the backdrop of ineffective use
a full range of activities,
aimed at maintaining life;
• with the ineffectiveness of resuscitation
vital functions for 30
Resuscitation measures are not carried out.
• If there are signs of biological
• When a clinical condition occurs
reliably established incurable
diseases or incurable consequences
acute injury incompatible with life.
Note. This instruction is not
defines application failure conditions
resuscitation measures or their
termination in newborns and
children under 5 years old.
Forecast after CPR.
Favorable CPR outcome in conditions
the hospital is currently hesitating
from 22 to 57%, the frequency of discharge of survivors
5-29% of patients
50% go with a neurological deficit.
The outcome of CPR in the prehospital phase at
the order is lower (G. Baltopulos, 1999). Leading
complication in people who have had a condition
clinical death is development
• know how to do this;
Etiology. Mechanical or chemical
respiratory tract irritation.
Pathogenesis. The syndrome is based on striated reflex spasm.
muscle regulating work
Clinic. Against the background of relative
well-being, the victim suddenly
stridor respiration occurs, quickly
acute respiratory symptoms appear
insufficiency (ONE) I degree, during
a few minutes passing into ONE
II-III degree; this is accompanied by loss
cardiovascular system and development
coma. Death is coming
Urgent care. With full
a reasonable treatment method is
general curation of the patient with subsequent
tracheal intubation and ventilation.
Currently, in addition to muscle relaxants
no other drugs capable of fast
(within a few tens of seconds – 1 min)
relieve spasm striated
In the absence of the ability to conduct
immediate transfer of the patient to mechanical ventilation
using muscle relaxants shown
emergency conicotomy (see
section 20.4.3. Foreign bodies of the upper
respiratory tract). Tracheostomy in
given situation due to complexity and
intervention (3-5 min) not shown. After
elimination of laryngospasm and translation
a patient on mechanical ventilation
• inject adrenaline
– 1 mg intravenously (at a dilution of 1: 1000 or
1:10 000), if necessary, the introduction of this
doses are repeated every 3-5 minutes.
The dose is increased if the standard is not
gives effect. If there are no conditions for
intravenous administration, epinephrine
administered endotracheally at a dose of 2-2,5 mg;
– initial dose of 1 mg intravenously,
repeat every 3-5 minutes to a total dose
0,04 mg / kg (approximately 3 mg). Atropine
especially indicated if the cause of asystole is
there was vagotonia;
effective in rare cases – with
preservation of myocardial function.
Its effectiveness depends on time
carrying out. Electrical stimulation (external
or transesophageal) is effective in
or atropine, even before the development of asystole;
• sodium bicarbonate
shown only if asystole
arose against the background of acidosis (administered from
calculation of 1 mg / kg);
(aminophylline) is optional
an integral part of the treatment of asystole.
However, sometimes after drug administration
recovery is noted
hemodynamically effective rhythm.
Enter jet, 250 mg for 1-2 minutes.
It is indicated for asystole refractory to
adrenaline and atropine.
with asystole worse than with VF or VT.
But with the occurrence of asystole in
hospital (in the intensive
therapy) and fast
resuscitation is possible
Electromechanical Dissociation (EMD)
there may be sinusoid bradycardia,
atrioventricular block or
slow idiovent ricular rhythm.
If this does not palpate the pulse on
carotid arteries, condition determined
like EMD and the following events are held
Scheme 32.6. Algorithm
with electromechanical dissociation
• atropine – shown
with bradycardia accompanied by
arterial hypotension, ventricular
extrasystole and patient complaints on
chest pain and shortness of breath.
The initial dose is 0,5 mg intravenously.
The introduction of this dose is repeated every
effect. The total dose of atropine should not
exceed 0,04 mg / kg body weight;
shown in all cases significant
decrease in rhythm and arterial hypotension;
therapy. The cause of arterial hypotension
and brady cardia may be hypovolemia:
absolute (due to blood, plasma loss
or dehydration) and relative
(due to vasodilation – acute
myocardial infarction, shock, adrenal
vasodilators). Treatment is carried out in
compliance with general principles
vasoactive and inotropic agents. At
eliminated hypovolemia and ongoing
arterial hypotension shown
tone and giving a positive inotropic
and chronotropic effect. With sinus
bradycardia and moderate hypotension
preference is given to dopas-well (dopamine,
The asthmatic condition is determined
as an acute syndrome
arising attack of suffocation.
defined as extreme
severity of shortness of breath, accompanied by
a painful feeling of lack of air
fear of death.
Etiology. This condition may
develop acutely with upper diseases
respiratory tract (foreign bodies,
tumors of the larynx, trachea, bronchi, attack
bronchial asthma) and diseases
CVS (heart defects, AMI, pericarditis).
Pathogenesis due to obstruction
respiratory tract and diffusion
oxygen to the blood.
In the development of asthmatic conditions with
systems are mainly mucosal edema
shells of the bronchi as a result of accumulation
in it interstitial fluid and
compression of the small bronchi edematous and
In the development of bronchial obstruction
The following mechanisms are involved:
spasm of smooth muscles of bronchioles,
inflammatory and hypercrinia
swelling of the mucous membrane of the bronchi,
dyskinesia of the trachea and large bronchi,
expiratory collapse of the small bronchi,
sclerotic changes in the wall
Depending on the reasons that caused
asthmatic condition, secrete
cardiac asthma, asthmatic status
on the background of bronchial asthma and mixed
• Lightning fast. Death comes in
in a few minutes.
• Acute (fast). Death may come
within 10-30 minutes
• Subacute. Death may occur in
for several hours, days.
• Chronic. Characterized by
progressive right ventricular
In the clinical picture, first place
takes a sudden dyspnea
both at rest and after
insignificant physical activity.
By the nature of shortness of breath “quiet”, the number
breaths from 24 to 72 in 1 min. She can
be accompanied by painful, unproductive
coughing. More often complaints of coughing appear
already at the stage of pulmonary infarction;
cough time is accompanied by pain in
chest and bloody discharge
sputum (hemoptysis is not observed
more than 25-30% of patients). Wide
common belief that hemoptysis
is an integral sign of early
stage of pulmonary embolism, does not always correspond
the truth. EAT. Tareev (1951) in the first 3 days
hemoptysis was noted in 10-12%, P.M.
Zlochevsky (1978) met this syndrome
in 19% of patients. It should be emphasized that
hemoptysis is more common in 6–9
day of illness, and not for 1-2 days.
Hemoptysis due to hemorrhage
in the alveoli due to the gradient between
low pressure in the pulmonary arteries
distal to the embolus and normal – in
terminal branches of bronchial arteries.
Compensatory appears almost immediately
tachycardia, the pulse becomes threadlike
character, and every fourth
atrial fibrillation may occur
arrhythmia. Rapid fall occurs
HELL. Circulatory shock develops in
20-58% of patients and is usually associated with massive
pulmonary occlusion, which is considered one
from frequent signs of pulmonary embolism.
Depending on the location of the thrombus
pain may have a character
abdominal or mixed. At
arteries arise recurring
chest pain due to
irritation of the nervous apparatus,
embedded in the wall of the pulmonary artery.
In some cases, massive pulmonary embolism
sharp pain with wide radiation
resembles that of exfoliating
aortic aneurysm. Duration
pain may vary from a few
minutes to several hours. Sometimes
angina pain observed
character accompanied by ECG signs
myocardial ischemia due to a decrease
coronary blood flow due to
decrease in shock and minute volumes.
Of particular importance is the increase
Blood pressure in the cavities of the right heart, which violates
outflow of blood through the coronary veins. May
there are sharp pains in the right
hypochondrium combined with paresis
bowel, hiccups, irritation symptoms
acute peritoneal peritoneum
swelling of the liver with right ventricular
insufficiency or development of massive
heart attacks of the right lung.
• syncopal (as deep
fainting) with vomiting, cramps,
In addition, psychomotor
agitation, hemiparesis, polyneuritis,
A common symptom of pulmonary embolism is fever
body, usually from the first hours
diseases. In most patients
subfebrile temperature is noted
without chills, in a smaller part of patients –
febrile. Total duration
the febrile period is from 2
up to 12 days.
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