Hypernatremia treatment symptoms

1
Given with changes. From: Rose RD
Clinical Physiology of
Acid-Base and Electrolite Disorders, 3rd
ed. McGraw-Hill, 1989.

Hyponatremia
reflects excess water in the body,
due either to absolute increase
OOB, or sodium losses in excess of
water loss. Physiological ability
kidneys dilute urine to osmolality,
equal to 40 mOsm / kg H2O
(specific gravity 1,001), allows them to highlight
if necessary up to 10 l / day free
water.

In view of such a large compensatory
reserve, the cause of hyponatremia is almost
always a violation of dilution
kidney abilities (criterion of violation:
urine osmolality not less than 100 mOsm / kg
Н2О
or specific gravity not lower than 1,003). In rare
cases in the absence of violations of dilution
kidney abilities (osmolality of urine
may be lower than 100 mOsm / kg H2O),
hyponatremia is caused
primary polydipsia or reconfiguration
osmoreceptors;

for differential
diagnostics apply a test with restriction
water consumption. From a clinical point of view
vision for classifying hyponatremia
general content should be considered
sodium in the body (tab. 28-6). Hyponatremia,
developing with transurethral
prostate resection
discussed in chapter 33.

TABLE
28-6. Causes
hyponatremia

Kidney
sodium loss

Osmotic
diuresis (glucose, mannitol)

Renal
tubular acidosis

Extrarenal
sodium loss

Losses
into the “third space”

Normal
body sodium

Syndrome
inadequate secretion of antidiuretic
hormone

Collateral
drug action

Elevated
body sodium

Noncompetitive
potassium-sparing diuretics

Systemic
lupus erythematosus

Obstruction
urinary tract

Transfusion
long-lasting whole blood
store

Potassium
penicillin salt

Hyperkalemia
due to decreased renal excretion
potassium

(1)
pronounced decrease in speed
glomerular filtration;

(2)
decreased aldosterone activity or

(3)
violation of potassium secretion in the distal
departments of the nephron.

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glomerular filtration rate less
5 ml / min almost always occurs
hyperkalemia Against the backdrop of high potassium
load (alimentary, metabolic
or iatrogenic) hyperkalemia
may develop with less pronounced
impaired renal function. Besides
Moreover, uremia reduces activity
Na / K -3a-dependent
ATP-basics.

hyporenin aldosteronism
or renal tubular acidosis type IV)
usually combined with diabetes
and renal dysfunction; in such patients
increased ability
aldosterone secretion in response to
hyperkalemia. The disease is usually
asymptomatic, but with increasing
potassium intake and application
potassium-sparing diuretics develops
hyperkalemia.

Application
drugs affecting the system
renin-angiotensin-aldosterone, entails
there’s a risk of developing hyperkalemia,
especially with kidney failure.
Nonsteroidal anti-inflammatory
funds (except, possibly, sulindaka)
inhibit prostaglandin mediated
renin release. ACE inhibitors
inhibit angiotensin formation
II, which stimulates secretion
aldosterone.

Excretion
potassium through the kidneys may decrease due to
congenital or acquired disorder
its secretion in the distal nephron.
Similar violations occur even with
normal kidney function, they do not respond
treatment with mineralocorticoids. At
pseudohypoaldosteronism is noted
congenital resistance of the kidneys to
aldosterone.

Hyperkalemia
due to increased income
potassium in the body

В
normal increase in potassium intake in
the body is rarely accompanied
hyperkalemia –
with the exception of
those cases when iv is rapidly administered
a large number of it. However,
potassium load can cause
hyperkalemia in renal failure,
with insulin deficiency, as well as in patients,
receiving beta2-blockers.

Clinical
manifestations of hyperkalemia

Fig.
28-6. Electrocardiographic signs
hyperkalemia. As you increase
potassium concentration in plasma dynamics
electrocardiographic changes
looks like this: tall
pointed symmetrical tooth T,
often combined with shorter intervals
QT 
extension
QRS complex, PQ interval lengthening,
the disappearance of the P wave, a decrease in amplitude
R wave, depression (sometimes elevation) of the segment
ST 
sinusoidal complexes 
finally,
ventricular fibrillation or asystole

Calcium
(5-10 ml of 10% calcium gluconate solution
or 3-5 ml of a 10% solution of calcium chloride)
partially eliminates cardiotoxic
the effects of hyperkalemia and therefore
used in severe clinical
symptomatology. Calcium comes
fast but unfortunately wears transitory
character. In patients taking digoxin,
calcium is recommended for use with
caution as it promotes
the occurrence of glycoside intoxication.

RџSЂRё
metabolic acidosis infusion
sodium bicarbonate (usually 45 meq)
promotes the flow of potassium into cells
and within 15 minutes can lower it
plasma concentration. ( ^ -adrenomimetics
promote the movement of potassium into cells
and are used for acute hyperkalemia,
associated with massive blood transfusions
(chap. 29);

adrenaline in low doses (0,5-2
mcg / min) allows you to quickly reduce
plasma potassium concentration and, in addition to
also has a positive inotropic
act. Glucose-insulin infusion
mixtures (30-50 g of glucose and 10 units of insulin)
promotes the movement of potassium into cells,
but the maximum effect does not develop
immediately, and within 1 hour

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relatively safe renal function
furosemide is indicated, which increases
urinary potassium excretion. In severe
kidney dysfunction remove potassium from
organism is only possible with
ion exchange resins (e.g.
sodium polystyrenesulfonate inside or
in enema): 1 g of polystyrene sulfonate
sodium binds 1 meq K
and releases 1,5 meq of Na;
oral dose is 20 g
in 100 ml of a 20% solution of sorbitol.

Dialysis
indicated for severe or refractory
hyperkalemia. Hemodialysis significantly
faster and more effective than peritoneal,
reduces the concentration of potassium in the plasma.
Hemodialysis removes up to 50 meq
potassium in 1 h, peritoneal dialysis –
10-15 meq / h

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hyperkalemia planned surgery
set aside until potassium concentration
blood will not be reduced to normal.
Must also prevent her
re-raising. Spend thorough
ECG monitoring. Contraindicated
succinylcholine and any potassium-containing
infusion solutions (e.g., solution
Ringer with lactate).

To avoid
re-increasing concentration
potassium in plasma during surgery
need to prevent occurrence
metabolic and respiratory acidosis.
It is advisable to conduct mechanical ventilation
moderate hyperventilation. And finally
neuromuscular monitoring required
conduction because hyperkalemia
enhances the effect of muscle relaxants.

Consequences and complications

Among the most common possible complications of pathology, it is worth highlighting damage to the vessels that provide nutrition to the femoral head, as well as the development of avascular necrosis with subsequent destruction of bone tissue.

The whole process, as a rule, is accompanied by severe pain and the patient’s inability to move independently. The optimal solution to this problem is to perform an endoprosthetics operation (replacing a damaged hip joint with a prosthesis made of modern materials).

At the same time, a new replacement in shape and size fully corresponds to the damaged one, which ensures the full performance of all functions.

Of the external symptoms, attention should be paid to peeling of the skin and the formation of ulcerative wounds on its surface.

If the displacement of the head provoked damage to the obturator nerve, then the patient may experience abnormalities on the part of the muscles of the inner thigh. The sooner the hip dislocation is reduced, the faster its full patient performance will be restored.

Otherwise, the tissues cease to receive the necessary oxygen, which means that their necrosis (necrosis) begins to develop.

A hip or pelvic fracture occurred.

Treatment of hip dislocations consists in urgent reposition and short fixation, followed by mandatory functional therapy (physiotherapy and physiotherapy).

The consequences of this pathology can be very dangerous. Among them, the greatest health risks are:

  • violation of large vessels, which can cause necrosis of the femoral head, tissue destruction.
  • bruising of the sciatic nerve, in which there are sensory disturbances, motor disorders, severe pain
    ;
  • compression of the femoral vessels, as a result of which there is a violation of blood circulation in the legs;
  • violation of the obturator nerve, as a result of which muscle disorders occur.

As you know, as a result of dislocation, the joint capsule ruptures, which can lead to irreversible changes in the femoral head. This, in turn, becomes a serious reason for the development of coxarthrosis and degenerative changes in the structure of soft tissues.

The possibility of cure and the consequences depend on the degree of injury, the age of the injured and the neglect of the disease. However, the consequences of injury include:

  • circulatory disorders in the bones and pelvis, which leads to tissue necrosis, necrosis and destruction of the bone itself
  • non-fusion of debris and the formation of a false joint
  • the formation of pressure sores on the patient’s body, as well as vascular thrombosis as a result of the body being in the same position for a long time
  • pneumonia, again lack of movement, congestion in the lungs, which as a result can lead to death
  • illiterate surgery – hurt tendons, nerves, blood vessels
    postoperative disorders
  • rejection of dentures and its metal components
  • postoperative sepsis
  • arthrosis, atrophy of joints and limbs
Detonic  Blood transfusion from a vein to a buttock

With untimely or incorrect treatment of this pathology, serious complications can develop. This happens if the victim did not immediately consult a doctor or did not follow all his instructions.

Due to a prolonged improper position of the femur, the following consequences appear:

  • most often arthrosis develops – the destruction of cartilage in the joint;
  • with incorrect or untimely reposition, necrosis of the head of the bone develops;
  • due to dislocation, there may also be damage to nerves and blood vessels, joint ankylosis or the development of arthritis.

Hip dislocation is a rather serious injury. Only with timely access to a doctor, with the implementation of all his recommendations, it is possible to fully restore the functions of the composition.

Complications of hyponatremia are associated with damage to the central nervous system. These include:

  • cerebral edema;
  • encephalitis;
  • meningitis;
  • cerebral artery thrombosis;
  • subarachno >Hyponatremia
    with a low sodium content in the body

Progressive
loss of sodium and water in the end
lead to a decrease in extracellular volume
liquids. A decrease in BCC by 5-10% is
stimulus for neosmotic secretion
ADH. With a decrease in bcc gt; 10% incentive to
neosmotic secretion of ADH becomes
stronger than oppositely directed
incentive to suppress ADH secretion,
due to hyponatremia.

Maintenance
BCC has priority over maintaining
normal plasma osmolality. Losses
developmental fluids
hyponatremia, may be renal
or extrarenal origin. Kidney
loss of sodium and water is most often due to
thiazide diuretics; moreover
Na concentration
in urine may exceed 20 meq / l.

Extrarenal
losses usually occur through
gastrointestinal tract; concentration
Na
in urine does not exceed 10 meq / l. An exception
is hyponatremia occurring
when vomiting, when the concentration of Na
in urine sometimes exceeds 20 meq / l. This
the phenomenon is explained by bicarbonaturia,
associated with metabolic alkalosis
(chap.

Hyponatremia
with a high sodium content in
the body

For
patients with edema are characterized by an increase
total sodium in the body
and OOB. When excess water in the body
begins to exceed excess sodium then
hyponatremia occurs. Swelling develop
with heart and kidney failure,
cirrhosis of the liver and nephrotic syndrome.
Hyponatremia in these cases is due to
progressive dysregulation
free water by the kidneys, the degree of which
corresponds to the severity of the main
disease.

Hyponatremia
at normal sodium content in
the body

Hyponatremia
in the absence of edema and hypovolemia
observed with glucocorticoid
insufficiency, hypothyroidism, with
use of some medicinal
drugs (e.g., chlorpropamide and
cyclophosphamide), as well as with the syndrome
inadequate secretion of ADH (SNADG).
Adrenal Hyponatremia
failure may be due to
co-secretion of ADH along with secretion
corticotropinrilizing hormone.

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AIDS often causes hyponatremia,
due to adrenal gland damage
cytomegalovirus or mycobacterial
infection. The diagnosis of SNADG is after
exclude other causes of hyponatremia
and in the absence of edema, hypovolemia,
kidney, adrenal and
thyroid gland. SNADG is observed
with many malignant tumors,
diseases of the lungs and central nervous system.

Clinical
manifestations of hyponatremia

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hyponatremia neurological prevail
disorders due to overhydration
brain cells. The severity of the condition depends
on the rate of development of hypoosmolality
extracellular fluid. Mild and moderate
Hyponatremia when concentration
sodium in plasma gt; 125 meq / l, often
It is asymptomatic.

Early clinical
symptoms are usually non-specific and include
anorexia, nausea and weakness.
Progressive cerebral edema causes
drowsiness, impaired consciousness, cramps,
to whom and in the end death. Pronounced
neurological symptoms occur
with a decrease in sodium concentration in
plasma lt; 120 meq / l At
premenopausal women
hyponatremia risk
severe neurological disorders
significantly higher than men.

Slow
progressive and chronic
hyponatremia occurs with less
severe clinical symptoms.
As compensatory decrease
intracellular concentration dissolved
particles (mainly Na,
K
and amino acids) is gradually being restored
normal cell volume. Neurological
manifestations of chronic hyponatremia
more driven by changes
membrane potential
(due to the low concentration of Na
in extracellular fluid), not changes
cell volume.

Fig.
28-4. Algorithm for the treatment of hyponatremia. Una
– concentration of sodium in urine

Deficit
Na
= OOB x (desired [Na] – measured [Na]).

Too much
quick elimination of hyponatremia
causes demyelination of the brain bridge,
leading to severe irreversible
neurological disorders. Speed
hyponatremia correction should
correspond to the severity of the symptoms.
For mild symptoms should
increase the concentration of Na
in plasma at a rate not exceeding 0,5 meq / l / h,
with moderate – not higher than 1 meq / l / h, with
detailed clinical symptoms
– with a speed not exceeding 1,5 meq / l / h.

Example:
in a patient with a mass
body 80 kg marked drowsiness;
Na concentration
in plasma is 118 meq / l. Which
the amount of 0,9% NaCl solution is necessary
overfill to increase concentration
Na
in plasma up to 130 meq / l?

Deficit
Na
= OOB x (130 – 118).

So
how OOB in women is approximately
50% of the weight then

Deficit
Na
= 80 x 0,5 X (130 – 118) = 480 meq

0,9
% NaCl solution contains 154 meq / l Na,
therefore, the patient should enter 480
meq / 154 meq / l = 3,12 L of 0,9% NaCl solution. At
the introduction of Na
at a rate of 0,5 meq / l / h this amount
pour over 24 hours (130
ml / h).

We emphasize
that this calculation method does not take into account
concomitant deficiency of isotonic
liquid to be eliminated
infusion of isotonic solution.

Hyponatremia
can be quickly eliminated loopback
diuretics that cause water
diuresis; should be carried out at the same time
infusion of 0,9% NaCl solution to replenish
loss of sodium in urine. Even faster
hyponatremia correction is achieved
using hypertensive infusion
NaCl solution beta% NaCl).

Lower sodium concentration in
plasma carries a risk of
severe cerebral edema that during
operations is manifested by a decrease in MAC (i.e.
e. reducing the need for anesthetics),
and in the postoperative period –
psychomotor agitation, confusion
consciousness and drowsiness. With transurethral
prostate resection during
bladder lavage may
a significant amount is absorbed
water (up to 20 ml / min), which is associated with
danger of severe acute aquatic
poisoning (chap. 33).

Violations
sodium exchange

Volume
extracellular fluid is directly proportional
total sodium in the body,
accordingly, volume changes
extracellular fluid caused by
fluctuations in total sodium
in organism. Positive sodium balance
(i.e., excess sodium) increases volume
extracellular fluid while
negative balance (i.e.

Exchange
sodium is normal

Adult
people consume an average of 170 meq
sodium per day (1 g of sodium contains 43
meq of sodium ions, while 1 g of NaCl is 17
meq of sodium ions). There are kidney
and extrarenal sodium excretion pathways.
Leading role in the regulation of sodium metabolism
play kidneys that are able to change
its concentration in urine is from 1 meq / l to gt;
100 meq / l (chap. 31).

Regulation
sodium metabolism and extracellular volume
fluids

Exist
close interdependence between volume
extracellular fluid and total content
sodium, therefore, the mechanisms of their regulation
also paired. This regulation is ensured.
receptors responsive to change
the most important component of extracellular
liquids – “effective”
intravascular volume which in
reflects adequacy more
perfusion of renal capillaries than
real, measurable intravascular volume
liquids (plasma).

The structure of the hip joint

The organization of the hip joint is based on two key structures — the pelvic bones and the femur, which are connected by a multitude of fibers. Externally, the joint resembles a kind of bowl. Macroanatomically, the femoral head flows into the acetabulum, which is located on the surface of the pelvic formation. In this case, the femoral head is deepened into the cavity by more than half.

As in the structure of the remaining joints, the contact surface of the hip joint is covered with hyaline cartilage. Actually, the surface of the cavity is covered with connective tissue surrounded by synovial fluid. Such anatomical nuances allow the joint to perform multiple actions and movements in many directions. In addition, soft and fibrous tissues provide cushioning inside the joint itself, because it has to withstand the weight of the entire body.

However, despite the developed system of the articular apparatus, the latter has a number of weaknesses, among which is the not very good location of blood vessels and nerves in the soft tissues of the joint. Any excessive load is fraught with compression of arteries and nerves, which leads to undesirable consequences.

Features The structure of the hip joint provides a person with vital functions for survival – running, walking. Free movements are observed in various planes and directions. The joint structure provides bending and extension of individual parts of the lower extremities, however, the ligamentous apparatus slows down and restricts movements from excessive stretching.

The strongest and most powerful ligament is the ileo-femoral. Such it is not only in this joint, but also among all the ligaments of the whole organism. Its thickness reaches 1 cm. This fiber limits the joint flexion inward, that is, in the absence of a ligament, a person would be able to turn his leg inward, which would create extreme discomfort.

In addition to the ligaments, an important element of the joint – the articular bursa – provides the presence of synovial fluid. This phenomenon provides moderate friction between the surfaces of the joints, and the latter are difficult to pathological changes on their own.

In a child, the joint structure is distinguished by a lack of stability and integrity: their supporting apparatus is not ripe, and the skeletal system is partially replaced by cartilage in the first years of life. In general, the full articular mechanism of the thigh matures by 20 years. In adults, the hip joint stiffens and becomes more stable.

In old age, the frequency of injuries increases: their bony and ligamentous apparatus weakens due to involutional processes in the body and the layering of chronic diseases.

Isolated decrease in potassium secretion in the distal nephron

Calcium
found mainly in bones (98%), but
maintaining its normal extracellular
concentration is extremely important. Jonah
calcium is involved in almost everything
physiological processes including
muscle contraction, release
neurotransmitters and hormones, coagulation
blood and bone metabolism.
Therefore, calcium metabolism disorders
can lead to severe disorders
many physiological processes.

Exchange
calcium is normal

В
normal daily calcium intake
is 600-800 mg. Suction occurs
mainly in the proximal
small intestine. In the intestines also
calcium is secreted,
whose speed is constant and independent
from absorption. Usually up to 80% of consumed
calcium is excreted in the feces.

Concentration
calcium in plasma

В
normal plasma calcium concentration
is 8,5-10,5 mg / 100 ml (2,1-2,6 mmol / L).
Approximately 50% plasma calcium
is in free ionized
form, 40% bound to proteins (mainly
with albumin) and 10% – with anions (with citrate
and amino acids). Physiologically
active is free ionized
calcium, the concentration of which
([Ca2])
most important
in clinical practice.

В
normal [Ca2] is 4,5-5 mg / 100 ml (2,2-2,5 meq / l, or 1,1-1,25
mmol / l). Change in albumin concentration
in plasma affects total concentration
calcium, but not on concentration
ionized calcium: when changing
plasma albumin concentration per 1
g / 100 ml total calcium concentration
changes in the same direction by 0,8-1
mg / 100 ml.

Change
pH directly affects the degree
binding of calcium to proteins and thus
way to the concentration of ionized
calcium. Decrease in plasma pH for every
0,1 is accompanied by an increase in concentration
ionized calcium at 0,16 mg / 100 ml;
accordingly, with increasing plasma pH
for every 0,1 ionized concentration
calcium decreases by 0,16 mg / 100 ml.

Regulation
extracellular concentration of ionized
calcium

University Application
calcium into the extracellular fluid
occurs either upon absorption from
intestines, or as a result of resorption
from bone tissue; no more than 0,5-1% calcium
bones involved in the exchange with extracellular
liquid. Calcium May Leave
extracellular space due to: 1)
deposition in bones; 2) excretion with
urine

1)
mobilizes calcium from bones;

2)
stimulates calcium reabsorption in
distal renal tubules;

3)
indirectly increases absorption
calcium in the small intestine by accelerating
for the synthesis of 1,25-dihydroxycholecalciferol
in the kidneys.

В
the body there are several forms
vitamin D but maximum biological
possesses activity
1,25-dihydroxycholecalciferol. During
cholecalciferol metabolism (greater
part endogenous) turns into the liver
in 25-cholecalciferol which then in
kidney is converted to
1,25-dihydroxycholecalciferol.

Calcitonin
Is a polypeptide hormone that
produced by parafollicular
thyroid cells. Hypercalcemia
stimulates the secretion of calcitonin, and
hypocalcemia, on the contrary, depresses.
Calcitonin inhibits bone resorption
and stimulates renal excretion
calcium.

Varieties

1. Front dislocation. Such a subspecies, therefore, is divided into two more:

  • Hind, when the femoral head is pathologically located in front of the ilium wing;
  • Lower, when the femoral head is located near the pubis of the pelvis.

This class of injury is more common with falls or unsuccessful landings on the leg, turned outward during a collision with the surface.

2. Back dislocations:

  • Upper: the femoral head moves backward relative to the ilium;
  • Bottom: the head is moved posterior to the sciatic bone.

Rear dislocations occur against the background of excessive inward rotation. Hip joint dislocations also include congenital joint defects that developed as a result of impaired development of articular components during gestation.

First aid

First of all, at the sight of signs of a dislocation of the hip joint, witnesses need to call an ambulance crew, which can provide competent assistance to the victim, but simple medical care should be provided to prevent serious complications and undesirable consequences. Before trying to help a victim, the following rules should be kept in mind:

  • In no way can you fix the damaged joint yourself, as this can lead to a complication of the condition of the victim. Excess movements can provoke a rupture of ligaments or tendons;
  • Inaccurate manipulations can delay the rehabilitation period;
  • It is advisable to use any appropriate means at hand.

First aid procedure for hip dislocation:

  1. To reassure the victim and be close to him. Excessive panic or pathological anxiety worsens the quality of care;
  2. Provide the victim with painkillers such as analgin, baralgin or ketans;
  3. To immobilize the impaired limb, to ensure immobility of the leg. In ideal conditions, the Diterichs tire is designed for this, but in field situations, you can fix a limb using various tires or similar objects. The leg should be fixed in the position in which it was after an injury. It is important to remember that the tire can be built from surrounding objects: long sticks or plywood, branches. If there are no available means for performing fixation, you can tie the affected limb to a healthy one using the same clothes or bandages;
  4. To maintain the integrity of the skin, before fixation, wrap the limb with a soft cloth such as clothing or household items. At best, with a bandage;
  5. A cold wrapped in material should be applied to the affected joint, which will provide excess irritation on the surface of the skin. For this, ice is suitable. If not, cold bottles, beer can serve as cold. It is important to know that you can not apply any warming substances – this will only increase swelling;
  6. It is undesirable to transport the victim yourself: for this there is an ambulance. But in the case when there is no opportunity to call a team, it is best to transport the patient on an elongated solid surface such as doors or plywood.

Implementation of the reduction will not work even if there is a certain experience. It will be possible to eliminate the subluxation of the hip joint without anesthesia, but with a complete dislocation, anesthesia is indispensable. The fact is that the joints of the pelvis surround one of the most powerful and large muscles, which, due to trauma, are sharply tensed.

Before the arrival of doctors, you can help with pain and swelling – give an analgesic and apply a cold. The whole range of measures is determined by the condition of the victim. It is easier to calm an adult than a child. Therefore, children are offered painkillers such as “Nurofen” or paracetamol in the form of a syrup. If the damage was the result of an injury, then the lower body should be immobilized as much as possible.

Even if the second leg is in order, it is better to refrain from independent movement. The first steps after an injury can only be made with the agreement of a doctor. All immobilization manipulations are best done in a supine position. The leg is fixed as it was after the injury. It does not matter if the joint is damaged or artificial – the limb is immobilized anyway.

Of course, at the slightest suspicion of such complex damage, you should immediately consult a doctor, calling an ambulance team. After hospitalization under anesthesia, the doctor will perform a dislocation reduction.

In no case should you try to cope with this problem yourself, since one careless action can significantly aggravate the situation or even cause disability, but you need help until the doctors arrive:

  1. If you happen to be with a injured person, then before the arrival of specialists, you can give him pain medication (if possible intramuscularly) and fix the injured limb in a fixed position. You can use improvised materials in the form of sticks or reinforcement, pre-wrapped with a bandage.
  2. As an alternative fixation, you can stick the affected leg to a healthy one. The main thing is that during immobilization she was in the same position as immediately after the damage.
  3. It is possible to alleviate the condition of the victim with the help of a cold compress applied to the area of ​​the hip joint. In the form of a cooler, an ice bubble or an ordinary cloth soaked in cold water is suitable.
  4. After performing these manipulations, it remains to wait for the ambulance to arrive, because it is extremely undesirable to transport the victim in a car that is not equipped with everything necessary.

Rear is much more common

Any form of traumatic dislocation of the thigh is considered as an emergency condition requiring immediate reduction in a closed way in order to avoid the development of ischemic necrosis of the femoral head. Treatment should be carried out in a hospital under general anesthesia after the introduction of muscle relaxants. If the closed reposition is unsuccessful, the open is performed.

First aid for hip dislocation consists in the immobilization of the affected limb and the mandatory transportation to a medical facility. It is necessary to repair the joint within 24 hours!

If you suspect a dislocation of the femoral neck, an urgent call should be urgently called. It is not possible to reposition a dislocated joint on your own, since experience is required to assist. The muscles surrounding TBS are in a state of increased tone and will not allow the synovial surfaces to snap into place.

The ambulance doctor will make an anesthetic injection, fix the limb and deliver the patient to the nearest emergency room. If it is not possible to send a person to the hospital, they put him on a solid shield, inject narcotic analgesics and muscle relaxants. Then the hip dislocation is corrected, if the manipulations do not bring the desired result, repeated reposition is performed in the medical institution.

Cold is applied to the hip joint to avoid hematoma formation and severe swelling. Ice also relieves pain a bit. After this, you need to transport the patient to the hospital as soon as possible, where he will undergo a hip dislocation reduction under anesthesia, apply a plaster cast and perform an extremity extension.

In no case should you try to independently correct the dislocation! This can lead to very serious consequences from the complication of reduction of dislocation to rupture of ligaments, tendons, damage to the cartilage of the acetabulum. Any attempts to independently correct the dislocation lead to a lengthening of the rehabilitation period.

Next, it is necessary to ensure the immobilization (immobility) of the damaged limb. If there is a special tire (flexible or analogues of the Diterichs tire), it is necessary to fix the limb with the tire in the position in which it is located.

If there is no such tire, it is advisable to make its analogues from improvised materials – sticks, branches, any solid objects of the required size. Before applying the improvised tire, wrap it with bandage or clothing, or put clothing under the tire. You can also bandage the affected limb to a healthy elastic or ordinary bandage, or by any means, including the clothes of the victim.

A cold compress can be placed on the projection of the hip joint.

Self-transportation of the victim is highly undesirable. However, if there is no other way to deliver it to a healthcare institution, transportation must be on a solid surface.

Regardless of the degree of symptoms, it is necessary to consult a doctor, preferably calling an ambulance team, since it is contraindicated for the patient to move around.

If the patient is delivered to a medical institution independently, it should:

  • transport lying on your back
  • for severe pain, do general or local anesthesia
  • fix the diseased limb, tie to the splint of the entire leg, in extreme cases, tie the legs
  • carry the patient on a hard surface
  • if there is a bleeding wound, apply a tourniquet
  • psychologically support the patient

clinical picture

RџSЂRё
description of acid-base disorders
conditions and compensatory mechanisms
you must use the exact
terminology (tab. 30-1). Suffix oz
reflects the pathological process,
causing a change in arterial pH
blood. Violations that lead to
lower pH, called acidosis,
whereas
conditions that cause an increase
pH – alkalosis.

If the root cause
disturbance is a change in concentration
bicarbonate ([HCO3-]),
they are called metabolic. If
the root cause of violations is
change in PaCO2,
they are called respiratory. Secondary
compensatory reactions should be indicated
just like reactions without using a suffix
“Oz.” For example, you can say
“Metabolic acidosis with respiratory
compensation. ”

В
cases where there is only one
primary acid-base disturbance
state, it is called simple.
If there are two
or more primary process then they say
about mixed
violation of
acid-base condition.

Suffix
“-Emia” is used to characterize
total effect of all primary
pathological processes and compensatory
physiological reactions to arterial pH
blood. Since the pH of arterial blood
in an adult is normal
7,36-7,44, Acidemia means pH lt; 7,35,
alkalemia – pH gt; 7,45.

TABLE
30-1. Diagnostics
acid-base disorders

Detonic – a unique medicine that helps fight hypertension at all stages of its development.

Detonic for pressure normalization

The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.

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Perhaps you want to know about the new medication - Cardiol, which perfectly normalizes blood pressure. Cardiol capsules are an excellent tool for the prevention of many heart diseases, because they contain unique components. This drug is superior in its therapeutic properties to such drugs: Cardiline, Recardio, Detonic. If you want to know detailed information about Cardiol, go to the manufacturer’s website.There you will find answers to questions related to the use of this drug, customer reviews and doctors. You can also find out the Cardiol capsules in your country and the delivery conditions. Some people manage to get a 50% discount on the purchase of this drug (how to do this and buy pills for the treatment of hypertension for 39 euros is written on the official website of the manufacturer.)Cardiol capsules for heart
Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

Detonic