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Sometimes saving a child's life depends on our correct actions. Emergency conditions in children - how to provide first aid to a child correctly and in a timely manner? Emergency care for children in emergency conditions

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Specialty 02/34/01. Nursing basic training

“Emergencies in children. Rules and principles of first aid for clinical signs of these conditions, nursing activities and criteria for assessing their practical effectiveness"

Komsomolsk-on-Amur - 2015

1. Introduction

2. Emergency conditions in children

2.1 Hyperthermic syndrome

2.2 Convulsive syndrome

2.3 Laryngospasm

2.4 Acute obstructive laryngitis (croup)

2.5 Fainting

2.6 Anaphylactic shock

2.8 Flatulence

2.9 Nosebleeds in children

2.10 Mechanical asphyxia

2.11 Burn shock

2.12 Traumatic brain injury

2.13 Electrical injury

Conclusion

List of used literature

1. INTRODUCTION

The problem of emergency conditions in children occupies one of the central places among all sections of clinical pediatrics. The development of life-threatening conditions in childhood is due to many factors, including anatomical and physiological characteristics, imperfect neurohumoral regulation of body functions, as well as a burdened premorbid background. All this contributes to the formation of “stressed homeostasis” in the child and leads to a rapid breakdown of adaptive and compensatory capabilities when exposed to unfavorable factors.

Each pediatrician must have thorough knowledge and skills related to providing emergency care to a child with critical conditions, serious illnesses and accidents. Success in providing emergency care largely depends on correct diagnosis and selection of the necessary treatment measures. At the same time, determination, efficiency and the ability to organize the necessary assistance are required from the doctor and nurse in order to eliminate the threatening condition.

2. EMERGENCIES IN CHILDREN

2.1 HYPERTHERMIC SYNDROME

Hyperthermic syndrome is understood as an increase in body temperature above 39 °C, accompanied by hemodynamic and central nervous system disorders. It is most often observed in infectious diseases (acute respiratory diseases, pneumonia, influenza, scarlet fever, etc.), acute surgical diseases (appendicitis, peritonitis, osteomyelitis, etc.) due to the penetration of microorganisms and toxins into the child’s body.

A decisive role in the pathogenesis of hyperthermic syndrome is played by irritation of the hypothalamic region as the center of thermoregulation of the body. The ease of occurrence of hyperthermia in children is explained by several reasons: a relatively higher level of heat production per 1 kg of body weight than in adults, since the body surface in children is larger than the volume of tissues that provide heat production; greater dependence of body temperature on ambient temperature; underdeveloped sweating in premature babies, which limits evaporative heat loss.

Clinical picture. With a sudden increase in body temperature, a child experiences lethargy, chills, shortness of breath, refuses to eat, and asks to drink. Sweating increases. If the necessary therapy is not carried out in a timely manner, symptoms of central nervous system dysfunction appear: motor and speech agitation, hallucinations, clonic-tonic convulsions. The child loses consciousness, breathing is rapid and shallow. At the time of convulsions, asphyxia may occur, leading to death. Often, children with hyperthermic syndrome experience circulatory disorders: drop in blood pressure, tachycardia, spasm of peripheral vessels, etc.

For the clinical assessment of hyperthermic syndrome, it is necessary to take into account not only the value of body temperature, but also the duration of hyperthermia, and the effectiveness of antipyretic therapy. An unfavorable prognostic sign is hyperthermia above 40 C. Prolonged hyperthermia is also an unfavorable prognostic sign. The lack of response to antipyretic and vasodilator drugs also has a negative prognostic value.

Intensive care. It is carried out in two directions: the fight against hyperthermia and the correction of vital functions of the body.

1. To reduce body temperature, combined treatment should be carried out, using both pharmacological and physical methods of cooling the body.

2. Pharmacological methods include primarily the use of analgin, amidopyrine and acetyl-salicylic acid. Analgin is administered at the rate of 0.1 ml of a 50% solution per 1 year of life, amidopyrine is administered as a 4% solution at the rate of 1 ml/kg. Acetylsalicylic acid (in recent years, more often paracetamol) is prescribed in a dose of 0.05 - 0.1 g/kg (paracetamol 0.05 - 0.2 g/kg). In the treatment of hyperthermia, especially in cases of impaired peripheral circulation, vasodilating drugs are used, such as papaverine, dibazole, nicotinic acid, aminophylline, etc.

3. Physical cooling methods are used in the following sequence: opening the child; rubbing the skin with alcohol; applying ice to the head, groin and liver areas; blowing the patient with a fan; washing the stomach and colon with ice water through a tube. In addition, when performing infusion therapy, all solutions are administered cooled to 4 °C.

You should not lower your body temperature below 37.5 °C, since, as a rule, after this the temperature drops on its own.

Correction of violations of vital functions consists of the following components:

1. First of all, you should calm the child. For these purposes, midazolam is used at a dose of 0.2 mg/kg, diazepam at a dose of 0.3-0.4 mg/kg or a 20% solution of sodium hydroxybutyrate at a dose of 1 ml per year of the child’s life. The use of lytic mixtures, which include droperidol or aminazine in the form of a 2.5% solution of 0.1 ml per year of life and pipolfen in the same dose, is effective.

2. To maintain adrenal function and lower blood pressure, corticosteroids are used: hydrocortisone 3-5 mg/kg or prednisolone 1-2 mg/kg.

3. Correction of metabolic acidosis and water and electrolyte disorders, especially hyperkalemia. In the latter case, glucose infusion with insulin is used.

4. In the presence of respiratory disorders and heart failure, therapy should be aimed at eliminating these syndromes.

When treating hyperthermic syndrome, you should refrain from using vasopressors, atropine and calcium supplements.

2.2 CONVIVUS SYNDROME

Frequent clinical manifestation of central nervous system damage. In children, seizures occur especially often.

A number of endogenous and exogenous factors can lead to the occurrence of seizures: intoxication, infection, trauma, central nervous system diseases. Convulsive syndrome -- typical manifestation epilepsy, spasmophilia, toxoplasmosis, encephalitis, meningitis and other diseases. Often convulsions occur due to metabolic disorders (hypocalcemia, hypoglycemia, acidosis), endocrine pathology, hypovolemia (vomiting, diarrhea), overheating. In newborns, the causes of seizures can be asphyxia, hemolytic disease, and congenital defects of the central nervous system. Convulsions are often observed with the development of neurotoxicosis, which complicates various diseases in young children, in particular, such as combined respiratory viral infections: influenza, adenoviral, parainfluenza infection.

Clinical picture. Manifestations of convulsive syndrome are very diverse and differ in duration, time of occurrence, state of consciousness, frequency, prevalence, form of manifestation. The nature and type of seizures is greatly influenced by the type of pathological process, which can be the direct cause of their occurrence or play a provoking role.

With convulsive syndrome, the child suddenly loses contact with the environment, his gaze becomes wandering, then the eyeballs are fixed upward or to the side. The head is thrown back, the arms are bent at the hands and elbows, the legs are extended, the jaw is clenched. Possible tongue biting. Breathing and heart rate slow, possibly causing apnea.

Diagnosis. Important have a life history (course of childbirth), anamnesis of the disease. Additional research methods include electroencephalography, echoencephalography, fundus examination and, if indicated, computed tomography of the skull. Lumbar punctures are of great importance in the diagnosis of convulsive syndrome, which make it possible to establish the presence of intracranial hypertension, serous or purulent meningitis, subarachnoid hemorrhage or other diseases of the central nervous system.

Intensive care. They adhere to the following basic principles: correction and maintenance of basic vital functions of the body, anticonvulsant and dehydration therapy.

1. If a convulsive syndrome is accompanied by severe disturbances in breathing, blood circulation and water-electrolyte metabolism, which directly threaten the child’s life, intensive therapy should begin with the correction of these phenomena. It is carried out according to general rules and consists of ensuring free patency of the upper respiratory tract, oxygen therapy, and, if necessary, artificial ventilation, normalization of water-electrolyte metabolism and acid-base status.

2. Anticonvulsant therapy is carried out various drugs depending on the child’s condition and the doctor’s personal experience, but preference is given to drugs that cause the least respiratory depression:

Midazolam (dormicum) is a drug from the group of benzodiazepines that has a pronounced anticonvulsant, sedative and hypnotic effect. Administered intravenously at a dose of 0.2 mg/kg, intramuscularly at a dose of 0.3 mg/kg. When administered rectally through a thin cannula inserted into the ampoule of the rectum, the dose reaches 0.4 mg/kg, and the effect occurs within 7-10 minutes. The duration of action of the drug is about 2 hours, side effect minimal;

Diazepam (Seduxen, Relanium) is a safe remedy in emergency situations. It is administered intravenously at a dose of 0.3--0.5 mg/kg; subsequently, half the dose is administered intravenously, half intramuscularly;

Sodium hydroxybutyrate (GHB) has a good anticonvulsant, hypnotic, and antihypoxic effect. It is administered intravenously or intramuscularly in the form of a 20% solution at a dose of 50-70-100 mg/kg or 1 ml per year of the child’s life. It can be used intravenously in a 5% glucose solution to avoid recurrent seizures. The combined use of diazepam and sodium oxybutyrate in half dosages is very effective, when their anticonvulsant effect is potentiated and the period of action is extended;

Droperidol or aminazine with pipolfen are administered intramuscularly or intravenously at 2-3 mg/kg of each drug;

A quick and reliable effect is provided by the introduction of a 2% hexenal solution or a 1% sodium thiopental solution; administered intravenously slowly until the seizures stop. It should be borne in mind that these drugs can cause severe respiratory depression. Hexenal can be used intramuscularly in the form of a 10% solution at a dose of 10 mg/kg, which ensures long-term sleep;

If there is no effect from other drugs, you can use nitrous-oxygen anesthesia with the addition of traces of fluorotane;

Last resort against convulsive syndrome, especially in cases of manifestations of respiratory failure, is the use of long-term mechanical ventilation along with the use of muscle relaxants, the best of which in this case is Tracrium: it has virtually no effect on hemodynamics and its effect does not depend on the function of the patient’s liver and kidneys. The drug is used as a continuous infusion at a dose of about 0.5 mg/kg per hour;

In newborns and children infancy convulsions can be caused by hypocalcemia and hypoglycemia, therefore, as anticonvulsants in ex-juvantibus therapy, it is necessary to include a 20% glucose solution at 1 ml/kg and a 10% solution of calcium glucionate at 1 ml/kg.

3. Dehydration therapy is carried out according to general rules. Currently, it is believed that in case of convulsions one should not rush to prescribe dehydrating agents. It is advisable to begin dehydration with the introduction of magnesium sulfate in the form of a 25% solution intramuscularly at the rate of 1 ml per year of the child’s life. In severe cases, the drug is administered intravenously.

2.3 Laryngospasm

Laryngospasm in children is a sudden involuntary contraction of the muscles of the larynx. Causes complete closure of the glottis and occurs with inspiratory dyspnea. Sometimes it is combined with tracheospasm, when the smooth muscles of the posterior membranous part of the trachea simultaneously contract.

Occurs in children from 3 months of age. up to 3 years, usually at the end of winter or spring as a result of calcium depletion in the blood, which in turn is associated with a deficiency of vitamin D in the body.

Laryngospasm can develop against the background of bronchopneumonia, chorea, spasmophilia, with diseases of the larynx, pharynx, trachea, pleura, gall bladder, with sensitization of the body, for example due to infectious diseases, the introduction of certain medications into the nose (for example, adrenaline).

Laryngospasm develops suddenly, in children - usually during crying, laughing, coughing, or with fear. Noisy, whistling, difficult breathing appears, pallor or cyanosis of the skin is noted, auxiliary respiratory muscles are included in the breathing process, and the neck muscles tense. During an attack, the patient's head is usually thrown back, his mouth is wide open, cold sweat appears, and the pulse is thready.

A temporary cessation of breathing occurs, which is soon restored as a result of overstimulation of the respiratory center by carbon dioxide accumulated in the blood. In mild cases, the attack lasts several seconds and ends with an extended breath. Gradually, breathing returns to normal, and sometimes sleep occurs.

Attacks may recur several times a day, usually in daytime. In severe cases, the attack may be longer, the patient loses consciousness, generalized convulsions, foam at the mouth, involuntary urination and defecation, and weakened cardiac activity appear. With a prolonged attack, death from asphyxia is possible.

Features of care.

During an attack, the patient should be calmed down, provided with fresh air, given a drink of water and sniffed with ammonia, sprinkled with cold water on the face, patted the patient on the back, tickled the nose, asked to hold his breath, and artificially induce a gag reflex.

If there is a threat of asphyxia, they resort to tracheal intubation or tracheotomy.

The prognosis is usually favorable. The tendency to laryngospasms in children usually disappears with age.

If the attack does not stop, you need to do an enema of a 2% solution of chloral hydrate in doses:

up to 2 months of age. -- 10 ml.

from 3 to 5 months. -- 10-15 ml.

from 6 months up to 1 year - 15-20 ml.

from 1 year to 3 years - 20-25 ml.

You can inject intramuscularly a sterile solution of 25% magnesium sulfate, 0.2 ml. per 1 kg of child's weight.

Prevention.

Prevention is aimed at eliminating the cause of laryngospasms and timely treatment the underlying disease against which it usually occurs. Prescribe calcium supplements, vitamins, ultraviolet irradiation, recommend long stays in the fresh air, a dairy-vegetable diet, and feeding infants with mother's milk.

2.4 ACUTE OBSTRUCTIVE LARINGITIS (CROUP)

Croup, also known as viral croup or laryngotracheobronchitis, is a respiratory disease most common among children preschool age, most often between the ages of three months and three years. Symptoms of croup include inflammation of the larynx and upper airways, which leads to further narrowing of the airways.

Traditionally, a distinction is made between true croup, which occurs as a result of damage to the true vocal folds (diphtheria croup), and false croup, as a manifestation of stenosing laryngitis of a non-diphtheria nature (viral, spasmodic).

False croup, or acute stenosing laryngotracheitis, is an inflammation of the mucous membrane of the larynx, accompanied by spastic narrowing of the lumen of the larynx, which is characterized by the appearance of a rough “barking” cough, a hoarse or hoarse voice and shortness of breath, often of an inspiratory nature, caused by swelling of the subglottic space.

False croup affects children aged 6 months and older. up to 6 years (usually between the ages of 6 and 36 months). The boys:girls ratio is 1.5:1. The incidence is characterized by seasonality with a peak in late autumn - early winter.

The development of croup is associated with the anatomical and physiological features of the structure of the respiratory tract in children of this age, namely: a relatively narrow lumen of the larynx, a funnel-shaped shape of the larynx, loose fibrous connective and adipose tissue of the subglottic apparatus, which determines the tendency to develop edema, features of the innervation of the larynx and relative weakness respiratory muscles, which are associated with the occurrence of laryngospasm. It should be noted that swelling of the mucous membrane with an increase in its thickness by only 1 mm reduces the lumen of the larynx by half.

Main symptoms of croup:

Inspiratory shortness of breath (stridor) with the development of respiratory failure.

Breathing disorders due to narrowing of the lumen of the larynx most often occur at night, during sleep, due to changes in the conditions of lymph and blood circulation of the larynx, a decrease in the activity of the drainage mechanisms of the respiratory tract, frequency and depth breathing movements. In this regard, the croup is called a “night predator”.

Treatment of croup should be aimed at restoring airway patency by reducing or eliminating spasm and swelling of the laryngeal mucosa, freeing the lumen of the larynx from pathological secretions.

Patients are subject to hospitalization in a specialized or infectious diseases hospital, preferably in a department intensive care, however, treatment should begin already at prehospital stage.

The child should not be left alone; he must be calmed down and picked up, since forced breathing during anxiety and screaming increases the feeling of fear and the phenomenon of stenosis.

The room temperature should not exceed 18°C. Warm drinks (hot milk with soda or Borjomi), steam inhalations are recommended.

The basis of drug therapy false croup constitute glucocorticoid drugs. It is possible to use dexamethasone orally or parenterally, budesonide through a nebulizer, and prednisone in rectal suppositories. In order to thin and remove mucus from the respiratory tract, expectorants and mucolytic drugs are prescribed, administered primarily by inhalation.

2.5 syncope

Fainting is a sudden short-term loss of consciousness caused by acute oxygen deficiency of the brain (hypoxia). Some children and adolescents have a congenital or acquired tendency to faint due to individual characteristics reactivity of the nervous and cardiovascular systems.

The causes of fainting are varied. These include factors that cause reflex spasm (constriction) of brain vessels or difficulty in the absorption of oxygen by brain tissue. Fainting can be a consequence of taking certain medications (ganglionic blockers, etc.), one of the manifestations of hysteria (fainting is more common), many diseases of the nervous, endocrine, cardiovascular and other systems, brain injuries and other pathologies. Frills can cause sharp negative emotions caused by fear, sharp conflicts, extremely unpleasant sights, and other negative psycho-emotional effects.

Fainting in children and adolescents usually lasts from a few seconds to 15-30 minutes. If fainting lasts for a short time (from 1-2 seconds to 1-2 minutes), it is called mild. A more prolonged loss of consciousness is classified as syncope moderate severity or heavy.

Urgent Care when fainting

1. First of all, it is necessary to take measures to improve the blood supply to the victim’s brain. For this purpose, he is given a horizontal position with his head down and legs raised. In this case, it is necessary to free the child from restrictive clothing, unfasten the collar, loosen the belt, open the window or window, and ask all strangers to leave the room.

2. You should also sprinkle cold water on your face, neck, chest, and give them a sniff of some stimulating substance (ammonia or acetic acid), rub the body with alcohol or cologne (if they are not available, use a dry hand).

3. If, during prolonged fainting, cardiac arrest and breathing occur, immediately begin artificial ventilation of the lungs and closed cardiac massage.

4. During the recovery period, the victim is provided with conditions for maximum mental, emotional and physical peace, he is warmed with heating pads, and given hot sweet tea to drink.

For prolonged fainting, prescribe:

10% solution of caffeine-sodium benzoate 0.1 ml/year of life s.c. or

Cordiamine solution 0.1 ml/year of life s.c.

Hospitalization for a fainting state of functional origin is not indicated, but if there is a suspicion of organic cause, hospitalization in a specialized department is necessary.

2.6 ANAPHYLACTIC SHOCK

Anaphylactic shock is rare and very dangerous reaction to an allergen that has entered the human body. This condition develops very quickly, within a few minutes or hours, and can lead to serious consequences, including irreversible changes in internal organs and death.

Causes of anaphylactic shock

A state of shock occurs in the following cases:

When administering drugs orally, intramuscularly or intravenously;

After a child has been vaccinated;

As a reaction to a sample of an antibacterial drug;

For insect bites;

Very rarely - as an allergy to a food product.

Anaphylactic shock often develops in children who suffer from allergies or have a genetic predisposition to it.

There are two variants of the fulminant course of anaphylactic shock, depending on the leading clinical syndrome: acute respiratory failure and acute vascular failure.

At anaphylactic shock with leading respiratory failure syndrome, the child suddenly develops and develops weakness, a feeling of constriction in the chest with a feeling of lack of air, a painful cough, a throbbing headache, pain in the heart, and fear. There is severe pallor of the skin with cyanosis, foam at the mouth, difficult wheezing with dry wheezing when exhaling. Angioedema of the face and other parts of the body may develop. Subsequently, with the progression of respiratory failure and the addition of symptoms of acute adrenal insufficiency, death may occur.

Anaphylactic shock with the development of acute vascular insufficiency is also characterized by a sudden onset with the appearance of weakness, tinnitus, and heavy sweating. There is an increasing pallor of the skin, acrocyanosis, a progressive drop in blood pressure, a thready pulse, and heart sounds are sharply weakened. After a few minutes, loss of consciousness and convulsions are possible. Fatal outcome occurs with increasing symptoms of cardiovascular failure. Less commonly, anaphylactic shock occurs with the gradual development of clinical symptoms.

The complex of treatment measures must be absolutely urgent and carried out in a clear sequence.

Algorithm of action for providing emergency care for anaphylactic shock in children:

1. Stop administering the substance that caused anaphylaxis.

2. Place the child in a position with the foot end of the bed raised, cover him warmly, cover him with heating pads, turn his head to the side, give him humidified oxygen.

3. Inject the injection site “crosswise” with a 0.1% solution of adrenaline at the rate of 0.1 ml/year of life, diluted in 5 ml of isotonic sodium chloride solution. Apply a tourniquet above the allergen injection site (if possible) for 30 minutes without squeezing the arteries. When introducing an allergenic drug into the nose or eyes, it is necessary to rinse them with water and drip them with a 0.1% solution of adrenaline and a 1% solution of hydrocortisone

4. At the same time, inject 0.1% solution of adrenaline (0.1 ml/year of life) into any other part of the body every 10-15 minutes until the condition improves; if it progressively worsens, inject 0.2% solution of norepinephrine intravenously at 20 ml of 5-10% glucose solution.

5. Inject prednisolone (2-4 mg/kg) or hydrocortisone (10-15 mg/kg) intravenously, repeat if necessary after 1 hour.

6. When obstructive syndrome IV bolus 2.4% solution of aminophylline 3-4 mg/kg.

7. Inject intramuscularly a 2% solution of suprastin or a 2.5% solution of tavegil (0.1 ml/year of life).

8. For heart failure, 0.06% solution of corglycone (0.01 mg/kg) IV slowly in 10 ml of 10% glucose, Lasix (1-2 mg/kg) IM. Hospitalization is required even if life-threatening conditions disappear due to the possibility of secondary shock. In the hospital, continue the activities indicated above. If necessary, replenish the blood volume by drip injection of a 5% solution of glucose, polyglucin and rheopolyglucin; in the absence of stabilization of blood pressure, a 0.2% solution of norepinephrine (0.5-1 ml), 0.1% solution of mesatone (1- 2 ml), prednisolone (2-4 mg/kg). In severe cases, when breathing stops, the patient is transferred to mechanical ventilation.

After an attack of anaphylactic shock and first aid, treatment should be continued in a hospital setting for 12-14 days.

Vomiting occurs very often in children, especially at an early age. The causes of vomiting are very varied. And, although in some cases they can sometimes be determined by the nature of the vomit, vomiting, as a rule, characterizes conditions that urgently require the attention of a qualified physician.

Vomiting is the sudden emptying of the stomach through the mouth. Vomiting begins “on command” of the vomiting center, which is located in the medulla oblongata. It can be excited by impulses from the stomach, intestines, liver, kidneys, uterus, vestibular apparatus, as well as by irritation of higher nerve centers (for example, vomiting due to unpleasant odors). Vomiting can also occur as a result of the action of various toxic substances and medications on the vomiting center.

In most cases, vomiting is preceded by nausea, increased salivation, and rapid and deep breathing.

The mechanism of vomiting can be schematically described as follows: the diaphragm sequentially descends, the glottis closes (which prevents vomit from entering the respiratory tract), the lower part of the stomach spasms, and the upper part relaxes. Rapid contraction of the diaphragm and abdominal muscles causes the contents of the stomach to be expelled.

The causes of vomiting are varied. This infectious diseases, diseases of the gastrointestinal tract, surgical diseases, pathology of the central nervous system, etc. Depending on them, vomiting can be single or repeated, abundant or scanty, and appear at certain intervals. By the nature of the vomit (digested or undigested food, mucus, blood, bile), it is sometimes possible to determine the cause of vomiting.

It is also necessary to distinguish between vomiting and regurgitation. Regurgitation usually occurs without effort, tension of the abdominal muscles and diaphragm, and is the result of the stomach being full of food or air.

Vomiting occurs very often in children, especially at an early age. The particular danger of vomiting in children is determined by the fact that in young children the protective mechanisms are imperfect and vomit can enter the respiratory tract.

If a child experiences the following symptoms and vomiting, immediate medical attention is required.

Vomit contains red or brown blood;

Frequent repeated vomiting (more than four times in 2 hours) leads to rapid dehydration;

Vomiting, which is accompanied by high fever, significant lethargy of the child, semi-conscious or unconscious state;

Vomiting that occurs after a child falls, head injury;

Vomiting, which is accompanied by abdominal pain and lack of stool (peristalsis).

If a child vomits, you should provide him with vertical position bodies. It is advisable to find out the cause of vomiting as soon as possible.

If this phenomenon appears in an infant, it is necessary to check his nose for congestion. In some cases, food comes out due to the fact that the baby cannot breathe. If such situations arise, you need to immediately clean the child’s nose; this can be done with a medical bulb. In situations where the child’s vomiting continues for more than half an hour and does not calm down, the child should be hospitalized immediately.

In older children, when vomiting, you need to support the upper body, bring a basin, after the end of the attack, wipe the mouth and offer water, and if necessary, change clothes and bedding. If the child is very weak and it is difficult for him to be in a sitting position, then he can be laid down, but in this case his head is turned to the side. This is necessary to prevent vomit from entering the respiratory system.

If a child's vomiting is caused by poisoning medicines, chemicals, poor-quality food, and also in case of overeating, you need to rinse your stomach.

Gastric lavage is carried out several times in a row, until the water after rinsing becomes clean and does not contain any impurities.

2.8 Flatulence

emergency children laryngitis fainting

Flatulence is a condition characterized by excessive accumulation of gases in the intestines. Gases are released by bacteria when food ferments, and a child may also swallow air while eating or talking. Flatulence is not severe or dangerous disease, however, it often causes pain and discomfort in the child’s intestines.

The main symptoms of flatulence:

Stomach ache,

Strong rumbling

Belching;

Feeling of a bursting belly,

Increase in abdominal volume.

Normally, a child’s stomach and intestines contain about 0.5 liters of gases, which are formed as a result of the activity of microorganisms and are eliminated during bowel movements. With flatulence, the volume of gases produced can reach 1, 5 or more liters, the composition of gases also changes, which can cause belching, hiccups, pain, diarrhea or constipation.

Flatulence is also a common symptom of diseases such as:

Intestinal dysbiosis;

Diseases of the gastrointestinal tract (gastritis, pancreatitis, enteritis, colitis);

Acute intestinal infections;

Inflammatory processes in the intestines;

Frequent constipation;

Emergency care from a nurse for flatulence:

	JUSTIFICATION	DOSES OF MEDICINES
1. Lay the child on his back, free the lower half of the body	Relieving intestinal motility
2. Provide access to fresh air	Providing comfortable conditions
3. Perform a light abdominal massage clockwise	Normalization of peristalsis
4. If there is no effect from previous measures, install a gas outlet tube	Removing gases accumulated in the intestines
5.If there is no effect, administer the following drugs: activated carbon or "smecta" Intramuscularly cerukal (raglan) or prozerin Note: each subsequent drug should be administered if the previous one is ineffective	Are adsorbents Normalizes intestinal motility	Up to 1 year - 1 sachet per day, 1-2 years - 2 sachets per day, > 2 years - 2-3 sachets per day. (1 ml = 5 mg) 0.1 ml/year
6. Eliminate gas-forming foods from the diet: unleavened milk, carbonated drinks, vegetables, legumes, brown bread and others	Prevention of increased flatulence or recurrence

2.9 NOSELEED IN CHILDREN

Causes of nosebleeds: distinguish between local (trauma, adenoids, foreign body) and general (this is a sign of a general disease: scarlet fever, influenza, hemophilia, leukemia, thrombocytopenic purpura, liver disease, cardiovascular disease).

Providing nursing care:

1. In order to prevent aspiration, swallowing blood and bloody vomiting, sit the child with his head slightly lowered down.

3. To improve lung excursion, loosen tight clothing.

4. Provide access to fresh air to make breathing easier.

5. Create a calm environment.

6. To mechanically stop bleeding, press the wing of the nose to the nasal septum of the corresponding side.

7. Apply cold to the bridge of the nose, the back of the head, and a heating pad to the legs in order to reduce blood flow to the nasal cavity.

8. To ensure local stopping of bleeding, pack the corresponding nasal passage with a cotton swab (you can moisten it in a 3% solution of hydrogen peroxide, adrenaline solution, Vikasol, hypertonic solution, breast milk).

Note:

Hydrogen peroxide has a cauterizing effect;

Adrenaline has a vasoconstrictor effect;

Vikasol, hypertonic solution have a hemostatic effect;

Breast milk contains “hemostatic” vitamin K.

9. As prescribed by the doctor, administer hemostatic agents to the child:

10% calcium chloride solution or 10% calcium gluconate solution orally or intravenously;

Vikasol - 0.1 ml/year intramuscularly;

Strengthening drugs vascular wall: rutin, ascorbic acid.

10. Determine the cause of nosebleeds and try to eliminate it.

Nosebleeds are a symptom, not a diagnosis.

2.10 MECHANICAL ASPHIXIA

Asphyxia is a state of increasing suffocation caused by a severe lack of oxygen. Lack of oxygen and retention of carbon dioxide in the body lead to disruption of vital organs and systems, primarily the nervous, respiratory and cardiovascular systems. Mechanical asphyxia - develops as a result of the cessation or sharp limitation of air access to the lungs (for example, drowning, compression of the airways by a tumor, entry of a foreign body into the airways).

In the presence of obstructive syndrome, it is necessary to restore the patency of the airways, freeing them from mucus, blood, and vomit. Assistance begins with drainage in an inclined position of the body. To remove a foreign body from the glottis area, two techniques are used - a sharp push into the epigastric region in the direction of the diaphragm or compression of the lower parts of the chest. Small children are tilted forward, their heads are slightly thrown back, and with a blow of the palm the airways are cleared of a stuck foreign body. If there are no independent coordinated respiratory movements, begin artificial respiration using the “mouth to mouth” or “mouth to nose” method.

TO mechanical asphyxia include hanging and drowning.

2.11 BURN SHOCK

Household thermal and chemical burns occur more often in children than in adults due to their less experience and greater curiosity. For example, throwing hot liquids over oneself and touching hot metal objects predominate at the age of 1-3 years.

Due to the anatomical and functional immaturity of the child’s body pathological changes appear more sharply than in adults. The skin of children is thin and delicate, so a deep burn in them is caused by a thermal or chemical factor that will only cause a superficial burn in adults. Burn shock can occur in children with a lesion area of 5% and is more severe the younger the child’s age. In adults, burn shock develops when 15-20% of the body surface is affected.

Clinical manifestations:

The injured child is in a serious or extremely serious condition, but usually does not make any complaints, because he is indifferent to everything that is happening, apathetic (the victim’s gaze may seem absent, indifferent). The child may lose consciousness. With a slight shock, the child is characterized by restless behavior, he is excited, but on the contrary, he may be inhibited and lethargic. Characterized by a sudden and quite pronounced pallor of the skin and visible mucous membranes, the child’s skin takes on a grayish, earthy tint. A very typical manifestation of shock is cold, sticky sweat appearing on the skin. Typically, sweat appears on the face (particularly on upper lip) and on the palms, the affected child may experience numbness in the arms and legs. The pulse is weak and frequent (more than 100 beats per minute); The pulse is either barely palpable or not palpable at all. The breathing of a child in a state of shock is frequent, shallow and uneven. Body temperature drops slightly. There may be a feeling of general weakness. The affected child feels dizzy and thirsty. He experiences nausea and vomiting. The injured child may remain in a severe state of shock for several hours. If help is not provided at this time, the child may die.

The injured child must be given first aid:

1. Pain relief. At the scene of the incident, the doctor may suspect OS based on the patient’s behavior. If the patient (especially a child) screams and worries, this indicates either the erectile phase of burn shock (accompanied by pale skin) or the absence of shock (pink skin). Dyspnea and tachycardia (especially in children) can be psychogenic in nature in the absence of shock. In case of anxiety and screaming, hemodynamics are usually sufficient for absorption of drugs administered intramuscularly. Therefore, in such cases, help begins with an intramuscular (not subcutaneous!) injection of 1% promedol solution (0.1 ml per year of life, no more than 1.5 ml) + 0.25% seduxen solution ( 0.1 ml per year of life, no more than 2 ml) in one syringe (dose calculation, of course, only for pediatrics). Such an injection will not only ease the patient’s suffering, but will also allow him to be undressed for examination. burn wounds. Assessment of the area and depth of burns, as well as determination of blood pressure and heart rate confirm (or reject) the diagnosis of OS. If the patient has a torpid phase of OS (lethargy, hypotension), all medications are administered only intravenously.

Indications for hospitalization of patients with burn shock:

1. The area of burns is more than 10% at any age.

2. The area of burns is more than 5% in children under 3 years of age.

3. Burns 3 - 4 tbsp. any area.

4. Burn shock of any degree.

2.12 CRANIO BRAIN INJURY

Traumatic brain injury in children accounts for 30-40% of the total number of traumatic injuries. The mortality rate for isolated traumatic brain injury can reach 38-40%, and for combined traumatic brain injury - 70% or more.

Features of traumatic brain injury in children

1. Rapid development of general cerebral symptoms and depression of consciousness with possible improvement in a short time.

2. Fractures of the skull bones are often observed.

3. In children younger age white matter ruptures predominate, while in adults and children of older age groups, foci of contusion are more common.

Classification.

There are closed and open TBI. With a closed traumatic brain injury there is no damage to the aponeurosis, while with an open traumatic brain injury there is always damage to the aponeurosis.

Open TBI also includes a fracture of the base of the skull.

Regardless of the type, there are six clinical forms of TBI:

1. Concussion.

2. Mild brain contusion.

3. Brain contusion medium degree gravity.

4. Severe brain contusion.

5. Compression of the brain due to a bruise.

6. Compression of the brain without accompanying contusion.

Urgent Care.

The scope of therapeutic measures that are necessary at the prehospital stage depends on the degree of depression of consciousness and disruption of basic vital functions - breathing and circulation.

It should be emphasized that, regardless of the nature and severity of the injury, hypoxia, hypercapnia and arterial hypotension must be eliminated at the prehospital stage.

1. For mild TBI not accompanied by depression of consciousness, symptomatic therapy (pain relief, elimination of nausea and vomiting) followed by hospitalization of the patient in a hospital is indicated. The administration of sedatives at the prehospital stage is inappropriate in this case.

2. In patients with severe traumatic brain injury and impaired vital functions, urgent measures are required to ensure airway patency, adequate ventilation and normalization of hemodynamic parameters.

A. Ensuring airway patency.

If consciousness is depressed to the level of coma, tracheal intubation and transfer of the child to mechanical ventilation are indicated, regardless of the duration of transportation.

B. Ensure adequate ventilation and oxygenation.

In case of severe depression of consciousness (stupor, coma) and the presence of signs of inadequate spontaneous breathing, transfer of the child to mechanical ventilation in the mode of moderate hyperventilation is indicated.

B. Ensuring adequate hemodynamics.

The main task of the prehospital stage is to ensure normalization of the volume of circulating blood and stabilization of the main indicators reflecting the state of the cardiovascular system: heart rate, blood pressure, capillary refill time, hourly rate of diuresis, body temperature.

All efforts at the prehospital stage should be aimed at providing adequate infusion therapy and eliminating arterial hypotension, and not at eliminating intracranial hypertension, therefore the prescription of diuretics until hypovolemia is eliminated is strictly contraindicated.

The optimal solutions for infusion therapy for TBI at the prehospital stage are 0.9% sodium chloride solution and Ringer lactate.

Indications for hospitalization

1. Depression of consciousness (both at the time of examination and during the injury);

2. Presence of skull fractures;

3. Presence of focal neurological symptoms;

4. Alcohol intoxication, history of epilepsy;

5. Severe headache, vomiting, fever;

6. Convulsions;

7. Oto- and rhinoliquorhea.

2.13 ELECTRICAL INJURY

Electrical injury is damage caused by exposure of the body to high voltage electric current.

The most common causes: child contact with exposed electrical wires and insertion of metal objects into sockets.

Damage can be caused by:

Sources of direct and alternating current (high-voltage AC lines with a power of I - 1.75 kW, railway DC power lines with a power of 1.5 and 3.6 kW);

Static electricity discharges (lightning). More severe electric shocks occur when the child’s skin, clothes and shoes are wet.

The pathological effects of electric current depend on the line of its passage through the victim's body. The most common paths for current passage are: hand - hand, hand - head, hand - leg, leg - leg. Electrical injuries resulting from electric shock in 25% of cases result in the death of the victim.

When an electric current passes through the brain, instant death occurs. When current passes through the heart, various disorders heart rhythm up to ventricular fibrillation. Less severe lesions are characterized by disorders vascular tone. Tonic contractions of the muscles of the skeleton and blood vessels are accompanied by severe pain, leading to shock.

Electric current, in contact with the child’s body, also has a thermal effect, and 3rd degree burns occur at the point of contact. Direct current is less dangerous than alternating current. Alternating current, even at a voltage of 220 volts, can cause very serious damage to the body.

Before treating an electrical injury, be sure to stand on a dry surface, as moisture increases electrical conductivity. When the victim regains consciousness after artificial respiration, he should be given a large amount of liquid (tea, mineral water). The victim should be covered with a blanket and taken to the hospital as soon as possible. medical institution Characteristic feature Electrical burns are painless due to the destruction of sensory nerve endings.

Providing assistance with electrical injuries in children

1. Free the child from contact with the source of electric current.

2. Lay the child on a horizontal surface, free the chest from constricting clothing.

3. For stage 1 damage: give warm tea, oral analgin, sedatives in age-appropriate dosages.

4. Call the SME team and, with its assistance:

for stage 2 damage: administer a 50% analgin solution at a dose of 0.1 ml/year of life in combination with a 2.5% solution of pipolfen or a 2% solution of suprastin at a dose of 0.1 ml/year of life intramuscularly;

with 3 - 4 degrees of damage - complex cardiopulmonary resuscitation or mechanical ventilation accessible ways, indoor massage hearts.

In case of local manifestations of electrical injury, administer analgesics intramuscularly and apply an aseptic (ointment) bandage.

5. Hospitalization for 2 - 3 - 4 degrees of severity of electrical injury in intensive care unit. In the 1st degree, if the burn is more than 0.5% of the body surface or the injury is accompanied by charring, hospitalization in the surgical department.

CONCLUSION

The course work examines various emergency conditions in children, such as hyperthermic syndrome, convulsive syndrome, laryngospasm, fainting, acute obstructive laryngitis (croup), anaphylactic shock, vomiting, flatulence, nosebleed, mechanical asphyxia, burn shock, traumatic brain injury, electrical trauma, their symptoms and causes. Methods of providing emergency care to a child in the above conditions, complications that arise, and indications for hospitalization of a child after providing first emergency care are discussed in detail.

LIST OF REFERENCES USED

1.V.D.Tulchinskaya “Nursing care for childhood diseases” -2013

2. Rzyankina M.F., Molochny V.G. - “Local pediatrician” - 2005.

3. V.F. Uchaikin, V.P. Molochny “Emergency conditions in pediatrics” -2005

4. Petrushina A.D. "Emergency conditions in children" 2010

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Cardiac emergencies in children

These are very serious illnesses require a very quick response, because sometimes we are talking about minutes to save a child’s life:

Syncope (fainting) . This condition is familiar to everyone as loss of consciousness. And often its cause in a child is disturbances in the functioning of the cardiovascular system ( paroxysmal tachycardia, severe bradycardia, thromboembolism, aortic stenosis). In such cases, syncope may occur after cessation of physical activity, especially in a warm room. First aid in this condition before the doctor arrives is to provide an influx of fresh air, a cold compress on the forehead, and rubbing the earlobes. When the young patient regains consciousness, he must be given the medicine prescribed by the attending physician.
Tetralogy of Fallot . This is the name for a complex congenital heart defect with several developmental anomalies. Its main manifestations are the baby's shortness of breath from the first months and cyanosis of the skin. If the course of the defect is severe, then it is manifested by an attack of shortness of breath, convulsions, and short-term loss of consciousness. All young patients with tetralogy of Fallot urgently need surgical treatment. During an attack that begins with anxiety, you must immediately call an ambulance, try to calm the child down, provide him with an influx of fresh air, preferably inhalation of humidified oxygen. It is necessary to administer rheopolyglucin or aminophylline and glucose intravenously.
Aortic stenosis . With this cardiac disease, children from an early age experience shortness of breath, pale skin, and tachycardia. From the age of 5-7 years they complain of heart pain, dizziness and headaches. If fainting occurs during physical exertion (which is generally prohibited for such children), then the child must be provided with fresh air and urgently call a doctor. Treatment of aortic stenosis is surgical.
Hypertension . The disease very rarely manifests itself in childhood. But high blood pressure can be a sign of kidney disease or endocrine system disease. This means that childhood hypertension in most cases is secondary. And when a child is diagnosed with high blood pressure, it is worth putting him to bed, ensuring rest, and giving folk remedies to lower blood pressure. This is chokeberry or viburnum, a hot heating pad applied to the feet. After normalizing the pressure, it is necessary to undergo a thorough diagnosis and determine the cause of the increase in pressure in the child. Sometimes it is too much mental and physical stress, hormonal disorders in adolescence.

Emergency conditions in children in gastroenterology

Children sometimes experience esophageal burns when swallowing acids or alkalis. Their symptoms are anxiety, cough, black vomit in case of alkali poisoning, green vomit in case of hydrochloric acid burns. First aid in this case is to give the patient milk to drink. Even if the baby is bleeding, you should rinse the stomach with plenty of water. Next, you need to apply a neutralizing solution. For an acid burn, this is baking soda, chalk, magnesium. When alkaline - citric acid.

Often the reason for visiting a doctor is attacks of biliary dyskinesia. This is a manifestation dull ache in the right hypochondrium, with nausea, sometimes with vomiting. Antispasmodics are used to relieve pain. You can use no-shpu, mebeverine, spasmomen orally. Sedatives in the form of valerian and seduxen are also recommended.

When children develop hepatic colic, analgesics and antispasmodics are administered. For a long time pain syndrome Application of cold to the area of the right hypochondrium, intravenous administration of aminophylline, novocaine blockade will be effective.

Emergency conditions in children with acute intestinal infections

Most often, among intestinal diseases, it is infections that require emergency care. First, the sick person feels unwell, then the temperature rises, nausea occurs, and sometimes vomiting. The stool becomes frequent and pasty, even watery.

At the stage before hospitalization, you should rinse the stomach with a solution of soda or saline, do a cleansing enema, and prescribe a water-tea break with electrolytes for 6 hours. If the patient’s intoxication is too severe, then an isotonic solution of sodium chloride is administered and glucose-potassium droppers are placed. But this is already in a hospital setting.

Emergency conditions in children in neurology

Epilepsy is seizures that recur in a child with loss of consciousness.

It is urgent to ensure airway patency by holding a hard object between the patient’s teeth. It is also necessary to protect the child so that he does not hit his head on a hard surface. The use of benzodiazepines is required for early control of seizures. If such attacks are not occurring for the first time, then it is possible to use thiopental.

Acute paralysis of the respiratory muscles in children may be associated with damage to the respiratory center. A young patient with expected respiratory failure needs to be placed on assisted breathing.

Convulsive syndrome

This condition may be a nonspecific reaction of the brain to damaging factors. Among them are infections, fever, vaccination, intoxication of the body.

Seizures may be symptomatic due to brain tumors and cerebral palsy.

In epilepsy, seizures can be local or generalized. In this case, inhalation of humidified oxygen is necessary. To relieve such seizures, diazepam is usually administered intramuscularly. Its calculation is 0.1 ml per kilogram of the child’s body weight.

Emergency conditions in children with respiratory diseases

False croup is suffocation that occurs in a baby when the larynx narrows. Its cause is most often acute respiratory infections or allergies. The mucous membrane of the throat becomes inflamed and swollen, and attacks of suffocation most often occur in children in the evening, when a dry “barking” cough increases. Inhalation becomes noisy because it is difficult for the child to breathe, the child gets scared, cries, and blushes. First aid in this case is to calm the baby, turn him on in the bath hot water so that the child can breathe steam. Pulmicort or Benacort may be used. They will effectively eliminate inflammation.

Epiglotitis in a child is characterized by fever, severe sore throat, and severe dysphagia. First aid in this case consists of antipyretic therapy with paracetamol or ibuprofen, and then the young patient is hospitalized in a sitting position and antibacterial therapy is administered in the form of chloramphenicol intramuscularly.

Acute laryngotracheitis in children is accompanied by the development of acute respiratory failure and laryngeal stenosis. The attacks are characterized by shortness of breath and difficulty breathing air. Emergency care consists of reducing the edematous component of the larynx and inhaling a solution of naphazoline. The most convenient way to do this is to use a nebulizer. If this is not possible, then it is necessary to inject naphazoline into one nostril of the child in a sitting position.

Emergency conditions in children in traumatology

Traumatic brain injuries occur very often in children. They are accompanied by impaired consciousness, vomiting, nausea, and headaches. If such an injury compresses the baby’s brain, then there is a smoothness of the nasolabial fold, decreased reflexes, and bradycardia.

Emergency assistance in this case is to ensure rest, insert a probe into the stomach to prevent aspiration. If the child is unconscious, then he should be placed on his right side and a solution of droperidol or seduxen should be administered intramuscularly. The victim is hospitalized in a surgical hospital.

Sprains in children occur more often than other injuries. In such cases, it is necessary to apply ice and a tight bandage to the damaged area.

With fractures of the limbs, swelling spreads much faster than with sprains. A leg or arm may be deformed. First aid - applying a splint and fixing the limb. If the fracture is open, then it is necessary to apply an aseptic bandage to the wound.

With traumatic shock, the child may experience loss of consciousness. In this case, a 1% solution of promedol is administered at a dosage of 0.1 ml per year of life, and a 1% solution of diphenhydramine. Then the victim is provided with plenty of fluids.

Hyperthermic syndrome

This condition in children is characterized by a persistent increase in temperature above 38.5°C, despite the use of antipyretic drugs. In such cases, the child should be placed in a ventilated area and undressed. His skin must be wiped with 30% alcohol. Then he is injected with a lytic mixture.

If, during hyperthermic syndrome, agitation is strongly expressed or convulsions occur, then a 0.25% solution of droperidol is administered intramuscularly to the sick baby.

Hospitalization of the child is mandatory if there is no result from the measures taken. If there is an effect, then it is recommended to place the patient in a hospital if he has chronic diseases.

Especially for - Diana Rudenko

Lecture No. 26

Childhood diseases. Emergency conditions in children.

In childhood, many diseases are often accompanied by the development of severe intoxication with the emergence of conditions that threaten the child’s life and require emergency intensive care, so every doctor needs to know the principles of emergency care, regardless of his profile.

The largest complication of diabetes mellitus is coma.

Ketoacidotic coma.

It develops gradually over a period of 12-24 hours, sometimes over several days. Its development can be divided into 4 stages:

precomatose state
incipient coma
severe coma
terminal coma

Precomatose states are characterized by severe weakness, muscle hypotension, drowsiness, loss of appetite, nausea, vomiting, headaches, dizziness, abdominal pain. During this period, polydipsia and polyuria develop, sugar levels up to 15 μ/l or more. Severe glucosuria, aceturia, smell of acetone in the exhaled air.

With the onset of coma, severe drowsiness and stupor are noted, as well as decreased muscle tone and reflexes.

Severe coma is characterized by a soporous state (deep pathological sleep), but pain sensitivity, swallowing and pupillary reflexes are preserved, and tendon reflexes are reduced.

Terminal coma is characterized by total loss consciousness as a result of acidosis, breathing is noisy, deep with an extended exhalation: Kussmaul breathing. There is a strong smell of acetone in the exhaled air, the face is pale, the skin is dry and cold, the tone of the eyeballs is sharply reduced, the pupils are constricted, atony, areflexia. The body temperature is below normal, the tongue is dry, hyperemic, the pulse is small and frequent, blood pressure is reduced. Oligouria or even anuria occurs. Sometimes gastrointestinal bleeding occurs due to increased permeability of the vascular wall as a result of acidosis, as well as the presence of ulcers and changes in the blood system.

Depending on the prevalence of symptoms, there are options:

cardiovascular, when cardiac or vascular insufficiency
gastrointestinal, when there is a clinical picture of appendicitis, peritonitis.
renal, dysuric phenomena, hyperazotemia, proteinuria appear.
encephalopathic.

In the blood there is leukocytosis, an increase in ESR, sugar more than 18 mm/l, blood osmolarity is often increased, there is an increase in the content of residual nitrogen, urea, and cholesterolemia. Hypoxemia increases, reserve alkalinity of the blood decreases, the relative density of urine is high, acetonuria, glucosuria, proteinuria, cylindruria, microhematuria.

Hypoglycemic coma

The condition is caused by a decrease in blood sugar concentration with a further decrease in glucose utilization by brain tissue and brain hypoxia. The development of this condition can be caused by an overdose of exogenous insulin, insufficient intake of carbohydrates from food after the administration of insulin, significant physical activity, excessive production of endogenous insulin, insufficiency of the adrenal cortex, hypothyroidism, glucogen deficiency, insufficiency of the adrenal medulla.

Hypoglycemic coma develops in cases when the sugar level in premature infants is less than 1.1 mm/l (normally 1.6-4.0 mm/l) in full-term newborns less than 1.7 mm/l (normally 2.78 - 4.4 mm/l) for the rest less than 2.2 mm/l (normally 3.3-5.5 mm/l), however, the reaction to a hypoglycemic state may be different. Sometimes a serious condition is observed at higher numbers. As a result of a decrease in blood sugar during the treatment of diabetic coma, a hypoglycemic complex often occurs when the glucose level is higher than normal.

First of all, the brain suffers as a result of insufficient supply of glucose to the cells of the nervous system, the utilization of oxygen, carbohydrate and oxygen starvation brain is accompanied by the development of energy deficiency in nerve cells, damage to intracellular functional systems, irritation of structural elements of the brain, inhibition of protein and lipid resynthesis.

In nerve cells, the potassium content increases and the sodium content decreases, resulting in brain swelling. At the beginning of the development of hypoglycemic coma, activity predominates sympathetic division autonomic nervous system, as the coma deepens, the symptoms of vagotonia increase.

With severe and prolonged hypoglycemia, changes appear in the brain in the form of edema, swelling, congestion in the form of widespread petechiae, hemorrhages and degenerative changes in nerve cells. mask-like face, profuse cold sweat, the appearance of tonic and clonic convulsions, shallow breathing, muffled heart sounds.

A rapid pulse is replaced by a decrease in pulse; there may be other heart rhythm disturbances, blood pressure drops, dilation of the pupils is replaced by their narrowing, and the reaction to light is lost.

In the blood: leukocytosis, lymphocytosis. Sugar and acetone are not detected in the urine. Due to the development of morphological changes in nerve cells and the occurrence of cerebral edema, irreversible changes and death are possible.

Hyperosmolar coma

Often up to 2 years due to Down syndrome or delayed psychomotor development of another origin. High osmolarity can be caused by severe hyperglycemia (more than 55 mmol/l), increased content of sodium, urea, residual nitrogen, chlorides, and sometimes potassium. Level ketone bodies in the blood is within normal limits, therefore, ketonuria lags behind.

The lag in ketosis is explained by a sharp increase in glycemia, preventing the release of glycogen from the liver. As a result, the access of fats to the liver is hampered and the formation of ketone bodies is reduced. The acid-base status of the blood was not changed. Due to an increase in osmolarity, diuresis, vomiting and diarrhea, the blood volume decreases, and a picture of severe exicosis develops.

Coma develops gradually. IN clinical picture dehydration syndrome predominates: the skin is dry, hot, hyperthermia of the eyeballs, hypotension, tissue turgor is reduced, shallow breathing, there is no smell of acetone in the air emitted, the pulse is accelerated, polyuria. With the development of collaptoid conditions, anuria may occur, and signs of neurological disorders appear: nystagmus, muscle hypertension, convulsions.

In the blood: hyperleukocytosis, neutrophilia, increased red blood cells and hemoglobin, increased sugar, sodium, chlorides, residual nitrogen, urea. The concentration of ketone bodies and the acid-base state of the blood are within normal limits, ketonuria lags.

Hyperlactic acidotic coma

The development is facilitated by the presence of concomitant diseases; with insulin deficiency, acidosis, hypoxic conditions, the aerobic pathway of glycogen oxidation is inhibited and anaerobic glycolysis is activated, as a result of which the formation of pyruvic and lactic acid increases; in the clinic, a prodrome period and a wedge period are distinguished. manifestations.

Prodromal period: nausea, vomiting, dry skin and mucous membranes, oliguria, anuria, deep arrhythmic breathing of the Kussmaul type, pain in the heart region like angina pectoris, pain in muscles and bones, increased drowsiness, depression of consciousness, a collaptoid state develops.

In the blood: increased lactic acid content, severe decompensated acidosis, with moderate hyperglycemia, increased residual nitrogen and potassium.

Treatment

Treatment of diabetic coma

Patients require immediate hospitalization at the nearest hospital. Treatment should be comprehensive, pathogenetic, aimed at eliminating insulin deficiency, keto-acidosis, dehydration, cardiovascular failure, correction of CBS and metabolic disorders.

Elimination of insulin deficiency is achieved by administering insulin; before this, it is necessary to take blood for sugar, urine for sugar and acetone.

INSULIN: 0.1 IU per kilogram of body weight hourly intravenously or subcutaneously for glycemia When the sugar level drops to 11-13 mmol/l: 0.05 IU per kilogram of body weight, after 3 hours intramuscularly.

Simple short-acting insulins are administered ( see lecture diabetes mellitus). If before hospitalization the child received a daily dose of long-acting insulin, it is supplemented with simple insulin subcutaneously... every 4-6 hours, 4-6 units. Hypoglycemia may develop!

Day 2: short-acting insulin 5 injections, long-acting insulin - 2 weeks.

Fighting exicosis: intravenous administration of fluid with the first dose of insulin in a stream of 0.9% NaCl 5 ml/kg, then intravenously, drip, the first 6 hours: 1/3 0.9% NaCl, 1/3 Ringer's solution, 1/3 5 % glucose solution.

Then more glucose and potassium salts for every 1 unit of insulin there should be at least 4.0 grams of glucose. The most intensive fluid administration is carried out in the first 6 hours - 50% daily amount liquids, in the next 6 hours - 25% and for the remaining 12 hours another 25%. If 1-1.5 hours from the start of treatment arterial pressure does not tend to normalize, it is necessary to administer plasma and albumin at the rate of 10-20 ml/kg, then switch to saline solution. If low blood pressure persists, norepinephrine, mesaton, and small doses of dopamine are administered intravenously. To correct the acid-base state, 4% NaHCO3 solution.

Formula for calculation:

Base deficiency * 0.3 * body weight in kilograms

If there is a lag, a device is needed to determine base deficiency, but you can be guided by the clinical signs of acidosis:

Syndrome of impaired peripheral circulation: marbling of the skin, oliguria, hyperthermia, deep noisy breathing with the smell of acetone in the air released.

Body weight in kilograms * 4 ml.

During a diabetic coma, the body loses potassium (keto acidosis promotes the release of potassium from cells, and increased osmotic diuresis removes it in the urine). Result: early kalemic syndrome develops. Perhaps late kalemic syndrome, its occurrence is due to an increased supply of potassium into the cells under the influence of administered glucose and insulin (4-6 hours after the start of insulin treatment).

There is lethargy, adynamia, pallor, muscle hypotension, rapid breathing, and intestinal paresis. Hypokalemia is confirmed by ECG: flattening and inversion of the T wave, decreased ST segment, elevated QT interval. To prevent the occurrence of hypokalemia, it is necessary to prescribe potassium supplements after 4-6 hours under the control of its content in plasma and erythrocytes using a 1.1% KCl solution up to 10 ml/kg.

Cardiovascular drugs: strophanthin, korglykon in age-related doses. To prevent complications, 1 week of antibiotic therapy. During infusion therapy, a decrease in calcium often occurs - a convulsive syndrome may develop; for relief: intravenous 10% solution of calcium gluconate at the rate of 1 ml/1 year of life, but not more than 10 ml. 12 hours after the start of treatment, hypophosphatemia develops; it is recommended to prescribe phosphorus drugs: calcium glycerophosphate, ATP and others.

To improve metabolic processes: glutamic acid, ascorbic acid, B1, B6, B12. It is necessary to warm the child and provide humidified oxygen.

The child is not given food for the first day; after vomiting stops: sweet drinks in small portions (sweet tea, 5% glucose, vegetable and fruit juices). For the first three days, the carbohydrate diet must then be switched to a diet for patients with diabetes.

Hyperosmolar coma.

It is necessary to administer insulin and at the same time rehydrate. Monitoring blood sugar levels should be frequent because... as a result of a sharp decrease in sugar levels, and, accordingly, blood osmolarity, cerebral edema may develop.

Rehydration: 0.45% NaCl and 2.5% glucose solution in a 1:1 ratio. These hypotonic solutions are administered in an amount of 100-150 ml/kg; after normalization, the blood sugar level is switched to intravenous administration of 0.9% NaCl (isotonic).

Antibiotics + antipyretics + potassium preparations + cardiovascular drugs + humidified oxygen, if renal failure increases, hemodialysis is indicated.

Hyperlactic acidotic coma.

Treatment must be carried out under the control of the acid-base state of the blood.

4% NaHCO3
insulin for blood sugar control
low molecular weight plasma expanders
0.9% NaCl
5% glucose

After 2-3 hours from the start of treatment, Ringer's solution. To improve intracellular...???

Hypoglycemic coma.

To relieve a mild hypoglycemic condition, the child can be given a piece of sugar, honey, jam, sweet tea, compote (easily digestible carbohydrates), and can be repeated if necessary. If coma develops, immediately intravenously 20-40% glucose 20-50 ml in combination with 0.1% adrenaline at a dose of 0.1 ml/1 year of life, since adrenaline promotes the breakdown of glycogen and increases blood sugar.

If the child does not regain consciousness, repeat the glucose regimen; if there is no effect, intravenous drip of 5% glucose solution. Further, if there is no effect, intravenous or intramuscular glucocorticosteroids 2 mg/kg for prednisolone are necessary. If the child has not regained consciousness, glucagon 0.05 mg/kg. Consciousness returns after 5 to 20 minutes. If, after eliminating hypoglycemia, the patient does not regain consciousness, intravenous administration of glucose 5% should be continued, glucagon every 2 hours, glucocorticoids 4 times a day.

To eliminate edema and swelling of the brain, it is necessary to use diuretics: Lasix 3 mg/kg, mannitol 1 g/kg.

Relief of convulsive syndrome: droperidol, seduxen, GHB 100 mg/kg. To improve glucose metabolism: KKB, ascorbic acid. + cardiovascular drugs, + oxygen therapy, + symptomatic treatment

Neurotoxicosis

Neurotoxicosis is a hyperergic response of the body to an infectious agent, in which neurological disorders dominate against the background of progressive insufficiency of peripheral hemodynamics, respiratory disorders, metabolism and water-electrolyte balance.

Neurotoxicosis often develops with ARVI, influenza, adenovirus infection, parainfluenza, severe infectious diseases (pneumonia, sepsis), especially severe diseases under 3 years of age. Neurotoxicosis is one of the most severe forms encephalitic reactions. It is a combination of infectious and toxic damage CNS.

The main clinical manifestations: hyperthermia, convulsions, meningeal phenomena, which may later be complicated by somatic symptoms: cardiac, renal, acute adrenal insufficiency and others. Skin – red or white (vasospasm), hot. Neurological disorders: development of precoma, subsequently coma:

Midcerebral coma
Stem coma
Terminal coma

At the first stages of the development of neurotoxicosis, sympathicotonia predominates in the clinic, and then, along with profound neurological disorders, signs of circulatory failure. In the precomatous period of neurotoxicosis, two phases can be distinguished that can replace each other:

Eritative
Soporoznaya

Eritative phase: restlessness, excitability, hand tremor, accelerated pulse, tension and bulging of the large fontanelle, normal or hyperemic skin, body temperature 39-40 C, blood pressure slightly increased.

Soporous phase: more pronounced damage to the central nervous system, motor retardation, mask-like face. The child reacts only to strong stimuli, signs of microcirculation and acidosis are pronounced, and DIC syndrome may develop.

In moderate cerebral coma, consciousness is absent, the tone of the sympathetic autonomic nervous system is sharply expressed, muscle hypertonicity, hyperreflexia, body temperature is 40 C and above, marbling of the skin occurs, the pulse accelerates, tachypnea, and increased blood pressure. As a result, brain hypoxia occurs and swelling occurs, and convulsions develop. In brainstem coma, both parts of the autonomic nervous system are depressed; the sympathetic tone is replaced by vagotonia: the pulse slows down, blood pressure drops sharply, the pupils are constricted, with a weak reaction to light, the skin is pale with a marble pattern on the limbs and torso.

Terminal coma: respiratory depression, bradypnea, depression of cardiac activity, bradycardia, complete areflexia, cessation of convulsions, disappearance of the swallowing reflex.

Treatment.

Treatment is aimed at normalizing peripheral blood flow, eliminating hypoxia, relieving convulsive syndrome, combating edema and swelling of the brain, combating hyperthermia, correcting impaired metabolism, and eliminating life-threatening child syndrome.

In the eritative and soporotic phases, it is necessary to reduce the tone of the sympathetic autonomic nervous system, neurovegetative block - droperidol, single dose 0.5 mg/kg, seduxen 0.5 mg/kg, Na hydroxybutyrate 100 mg/kg. White hyperthermia persists: normalization of peripheral vascular tone - 2% papaverine solution or 0.5% dibazol solution 2 ml/year - vasodilator and antispasmodic effect. Euffilin has a pronounced antispasmodic and vasodilating effect; 2.4% 4-6 mg/kg is administered intravenously. If hyperthermia persists, antipyretics are prescribed per os: panadol, ibuprofen, single dose 10-15 mg/kg. Urgently: metamizole Na 50% 0.1 ml/1 year. With red hyperthermia, physical cooling can be used. Elimination of seizures: Ca gluconate 10% intravenously 1 ml/1 year. For heart failure, cardiac glycosides are used (strophanthin 0.05%, corglycon 0.06%, digoxin can be used). For the prevention of DIC syndrome, the following is used: chimes 0.5% solution intravenously up to 1 year, 0.1 ml; for children over one year old 0.5 ml; heparin, a single dose of which is 25-50 units/kg; To combat hypoxia, oxygen therapy is used; if there is no effect, ganglion blockers are prescribed, which interrupt the conduction nerve impulse, reduce blood pressure, dilate blood vessels (pentamine 2-4 mg/kg; benzohexonium 1-2 mg/kg; if convulsions continue, hexenal is prescribed intravenously. For diagnostic and therapeutic purposes, it is necessary to carry out lumbar puncture(only with parental consent). For neurotoxicosis, the use of glucocorticosteroids (prednisolone 2-10 ml/kg) is mandatory; diuretics are used for dehydration (Lasix 2-3 mg/kg, mannitol 1.0 g/kg). To reduce the activity of lysosomal enzymes, transsilol and contrical are prescribed intravenously at a dose of 500 units/kg. For acidosis, 4% NaHCO3 2-2.5 ml/kg is prescribed subcutaneously.

Anti-infective therapy: the amount of fluid should not be more than age-appropriate daily requirement in water, intravenously no more than the daily requirement or 2/3. You can use dextrans, derivatives of residual hydroxystarch, 10% glucose. Anti-infective therapy under the control of body weight dynamics and monitoring of diuresis (must be at least daily, depending on age). If diuresis is reduced, Lasix is prescribed 2-3 times a day. In the absence of the effect of neuroleptics, there is pastiness of the subcutaneous fat.

The scope of anti-infective therapy is limited.

Hyperthermic syndrome

An increase in body temperature is a normal physiological response of the body to infection. When the temperature rises to 38.5-39 C, immunological reactions intensify, the production of antibodies increases, the phagocytic activity of leukocytes increases, metabolism increases, and the antitoxic function of the liver improves. A pronounced infectious onset is only at temperatures above 38 C, but an increase in temperature can occur not only in response to an infection, but for example to disturbances in the ratio of sodium and potassium ions (during transfusion of saline solutions), irritation of the thermoregulation center (injuries to the base of the skull, tumors, intracranial hemorrhages ). IN clinical practice There are two types of thermostatic changes:

febrile conditions.
hyperthermic reaction

Feverish conditions.

They develop against the background of an undisturbed state of the thermoregulation centers and are a protective reaction of the body having more likely positive value, including the effect of high temperature on microorganisms and toxic and stimulating body resistance. Body temperature during febrile conditions is well reduced under the influence of antipyretics.

Hyperthermic reaction.

In all cases, it indicates a violation heat balance. In children, the mechanism of thermoregulation is imperfect, this is explained by the high rate of increase in the temperature reaction in children. A hyperthermic reaction is inappropriate for the body, since it leads to an excessive increase in metabolism, an increase in oxygen demand (increased oxygen delivery to tissues, compensatory increases in alveolar ventilation, that is, the work of the respiratory muscles increases, the load on the myocardium increases), increased metabolism, oxygen deficiency caused by the accumulation of a large amount of under-oxidized products, there is metabolic acidosis. Thus, hyperthermia in children changes homeostasis, increases intoxication, contributes to the appearance and intensification of cerebral edema, and the occurrence of seizures.

Hyperthermic syndrome is an increase in body temperature over 39C, with impaired thermoregulation, disorders of the central nervous system and cardiovascular system occur, which are expressed in impaired consciousness and the appearance of symptoms of cerebral edema. In a clinical setting, it is quite difficult to distinguish febrile states from a hyperthermic reaction, especially at a temperature of 38.5-39 C, at the beginning of its decline, although in each case the approach must be individual. If the child tolerates a temperature of 38.5 C well, it does not need to be reduced, and if neurological symptoms appear even at a lower temperature, therapy should be started.

Indications for therapy with antipyretics:

peripheral blood flow disorders
early clinical manifestations of nervous disorders
temperature increase over 2-3 hours over 38.5C

Application:

medicines
physical cooling
At the same time, the vital functions of the body are corrected.

Drug therapy: panadol 10-25 mg/kg, ibuprofen in the same dose, metamizole sodium 50% 0.1 ml/year, normalization of vascular tone: papaverine can be combined with dibazol, aminophylline (vasodilatation) if after 30-45 minutes the temperature does not decrease , the administration of antipyretics can be repeated, but in combination with neuroplegics: 2.5% pipolfen 2 mg/kg, lasts 4-6 hours.

Physical methods: increasing heat transfer, but they can be used only after antipyretics of vascular drugs (otherwise chills and fever will occur), cover the child’s head with a napkin with cold water. Cold in groin area armpits, blowing with a fan. Heat transfer can be enhanced by introducing droperidol, pentamine, or benzohexonium. Droperidol reduces skeletal muscle tone, lowers temperature, lowers blood pressure and has an antiemetic effect. Administer intravenously intramuscularly at 0.5 mg/kg/day.

In case of severe intoxication and persistent hyperthermia: prednisolone 2-3 mg/kg, oxygen therapy is required. You should not reduce your body temperature to less than 37.5, since after stopping the use of antipyretics and physical cooling, it begins to decrease on its own. In addition to the above methods, dehydration therapy is used, respiratory and heart failure is combated, and the underlying disease is necessarily treated.

Convulsive syndrome.

The most common syndrome in children. Cramps are continuous muscle contractions that appear suddenly in the form of attacks and last for varying periods of time. This is a clinical sign of central nervous system damage. In children, convulsive readiness is increased because they have insufficient myelination and immaturity of inhibitory mechanisms in the cerebral cortex. This contributes to the high hydrophilicity of the child’s brain and increased vascular permeability. Under the influence of toxins and infectious factors, the child develops cerebral edema, one of the manifestations of which is convulsive syndrome.

Causes: infections, intoxications, injuries, diseases of the central nervous system, spasmophilia, toxoplasmosis, encephalitis, metabolic disorders, disorders of the biliary system, sometimes after repeated vomiting, diarrhea, a violation of water-salt metabolism occurs. In newborns: asphyxia, birth trauma, hemolytic disease, congenital reorganization of the central nervous system.

Convulsions in infants: develop as a result of hypertension and cerebral edema, caused by hypoxia, hypercapnia, disorders of water-electrolyte metabolism, and the presence of meningoencephalitis. There are clonic and tonic seizures. Clonic convulsions are rapid muscle contractions following each other at short, uneven intervals of time; they are characterized by excitation of the cerebral cortex. Tonic cramps: prolonged muscle contraction that occurs slowly and lasts a long time, their appearance indicates excitement subcortical centers brain Convulsions – decreased metabolism and localization.?

Clinical picture.

The child loses contact with the external environment, the gaze wanders, the movements of the eyeballs are initially wandering, then they are fixed upward and to the side, the head is thrown back, the arms are bent at the elbows and wrists, breathing is slow, the pulse is reduced - this is the tonic phase, clonic-tonic convulsions, its duration does not more than 1 minute.

Clonic convulsions begin with twitching of the face, quickly move to the limbs and generalize, breathing is noisy, wheezing, foam on the lips, pale skin, tachycardia.

Treatment:

Elimination of hypoxia, treatment of respiratory and cardiovascular failure, anticonvulsant and dehydration therapy. Regardless of the type of convulsions: clearing the airways of mucus, supplying humidified oxygen, artificial ventilation is required.

Anticonvulsant therapy: individual, taking into account the reasons. You can use Seduxen intravenously slowly or intramuscularly. A good effect is given by 20% sodium hydroxybutyrate (GHB) 100 mg/kg intravenously or intramuscularly, phenobarbital intramuscularly or intravenously, 15% hexenal, intravenously or intramuscularly; barbiturate salts 1% give a faster effect - the “end of the needle” effect. Since breathing may stop, artificial ventilation is used.

It is necessary to remember: from the moment of administration of anticonvulsants to the development of the clinical effect, 5-20 minutes may pass (with the exception of hexenal); repeated administration can lead to accumulation and respiratory arrest.

In case of severe respiratory failure and hypoxia: the only remedy is transfer to mechanical ventilation while using muscle relaxants! Dehydration is required: concentrated plasma 10 ml/kg, 20% glucose 20-40 ml, mannitol 1 g/kg, Lasix 3-5 mg/kg. Glucocorticosteroids are of no small importance in the fight against cerebral edema: they thicken the vascular wall, have an anti-edematous effect, prednisolone 3 mg/kg, in order to reduce vascular permeability, ascorbic acid, calcium preparations. In all cases, for diagnostic and therapeutic purposes, a lumbar puncture is performed with the consent of the parents, additional symptomatic therapy (cardiac glycosides, ATP, CCB) and mandatory treatment of the underlying disease. If spasmophilia (decreased calcium) is used, anticonvulsants + calcium supplements are given for 2-3 days, then vitamin D is given.

Anaphylactic shock.

Type of allergic reaction immediate type occurs when an allergen is reintroduced into the body (antibiotics, vitamins, vaccines, gamma globulin, sulfonamides, X-ray contrast agents). Cases of anaphylactic shock have been described during skin testing and specific immunodiagnostics. Cold sickness stops in cold water.

Depending on the prevailing systems, there are:

typical forms
asphyxial variant
hemodynamic
abdominal
cerebral

Clinical picture.

It develops instantly immediately after exposure to specific allergens, severe weakness, nausea, chest pain, fear of death, severe pallor and acrocyanosis, cold sticky sweat, threadlike pulse, sharply reduced blood pressure, suffocation, convulsions, and the patient loses consciousness.

Typical form: arterial hypotension, disturbances of consciousness, breathing problems, convulsions.

Hemodynamic type: cardiovascular insufficiency comes to the fore, severe pain in the heart area, cardiac arrhythmia, muffled heart sounds, and a sharp decrease in blood pressure occur.

Asphyxial variant: acute respiratory failure, laryngeal edema, bronchospasm, edema of the mucous membranes of the bronchioles and lungs.

Cerebral type: excitement, loss of consciousness, convulsions.

Abdominal type: a picture of acute abdominal pain in the epigastric region.

Treatment: immediate cessation of allergen administration. If caused by an injection, apply a tourniquet above the injection and inject the injection site with a 0.1% solution of adrenaline or mezaton. It is necessary to lay the child down, prevent tongue retraction and aspiration of vomit, warm him up, provide access to fresh air, adrenaline every 15 minutes.

Infusion therapy: saline solution, furosemide, cardiac glycosides, necessarily glucocorticosteroids - prednisolone, relief of bronchospasm - intravenous aminophylline, relief of vascular collapse - cardiomine, caffeine. When seizures occur, mechanical ventilation, anticonvulsants - droperidol, etc., protease inhibitors - trasylol, contrical; antihistamines are prescribed only after hemodynamic recovery.

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Sometimes children experience emergency conditions, emergency medical care for which is not only desirable, but vital. Panic and fear for your child in these cases are bad helpers: tears, groans, sighs and other lamentations will not help the matter. You need to act, abstracting from personal experiences, clearly, coordinated, following a strictly prescribed algorithm.

If unforeseen circumstances arise related to the child’s health, he should always be examined by a doctor. But the doctor does not have wings, he cannot appear instantly. And the first 10 minutes often determine whether it will have this situation unpleasant consequences or you will quickly forget about this episode. Therefore, this chapter provides advice on how to provide first aid to a child: what needs to be done and in what order before the doctor arrives.

Features of emergency care for children with hyperthermia

Elevated temperature (hyperthermia) occurs in many diseases. It is necessary to distinguish between “red” and “white” hyperthermia.

“Red” bothers the child to a lesser extent; the skin is red, the hands and feet are warm to the touch. Children tolerate “white” worse; they become lethargic, the skin is pale, and the hands and feet are cold.

Dealing with “red” hyperthermia is much easier. When providing first aid, children are given paracetamol preparations such as Efferalgan, Panadol, Calpol, paracetamol, Cefekon suppositories and others with a similar effect. Nise and Nurofen syrups have a more pronounced anti-inflammatory effect.

Also, emergency care for children with hyperthermia includes physical cooling: the child should be undressed, a cold compress should be placed on the forehead, the body should be wiped with a sponge moistened with cool (20 degrees) water and vinegar (1 tablespoon of vinegar per 1 liter of water), and plenty of warm drinks should be given. The procedure can be repeated several times in a row until the temperature drops to 38 °C. Paracetamol is given to the child again after 5-6 hours.

For “white” hyperthermia, you also need to apply a cold compress to the forehead; you can give the child “No-shpu” or “Papaverine” and at the same time an antihistamine (“Tavegil”, “Suprastin”, “Fenistil”, “Fenkarol”, “Claritin”, "Zyrtec"), as well as antipyretics (paracetamol, etc.).

When providing assistance in such an emergency condition, you cannot dry children; on the contrary, you need to warm the child (heating pads to the arms and legs, put woolen socks on the child, give plenty of hot drinks) and wait until the legs become warm and the skin turns pink. Only after this can you carry out a vodka rubdown.

If the child remains pale and the temperature does not decrease, you should definitely call emergency help.

How to provide first aid to a child with false croup

Acute stenosing laryngotracheitis () most often develops suddenly, at night. The child goes to bed outwardly quite healthy, and at night completely unexpectedly wakes up excited. He develops a loud “barking” cough, hoarseness of voice, and difficulty breathing (inhalation is more difficult).

The cause of false croup can be viral infections (parainfluenza viruses, adenoviruses and others) or allergic lesions of the larynx. Emergency measures are carried out in the same way, regardless of the reason.

The algorithm for emergency care for children begins with calming the child. Then give him the warmed mineral water Borjomi or other alkaline heated water, it is very good to give the child at this moment a mixture of warm milk (2/3) and Borjomi (1/3).

If you have an inhaler (nebulizer) in the house, inhale Naphthyzin 0.05%: 1 ml of the drug per 1 ml of saline solution or warm water. If you have Naphthyzin 0.1%, then it is diluted in a proportion of 1 ml of the drug to 2 ml of water. Repeated inhalation can be carried out after 4-5 hours. If you don’t have an inhaler at home, drop Naphthyzin into your nose (2-3 drops in each nostril).

When providing emergency care to children, ventilate the room well, as cold air reduces swelling of the mucous membranes. It is more difficult for a child to breathe in a warm, stuffy room.

Antihistamines with a minimal drying effect, such as Zyrtec and Claritin, are indicated.

If it is not possible to quickly call an ambulance, all these measures to provide emergency care to children at the prehospital stage are carried out by parents. A doctor's examination in such a situation is mandatory.

Providing first aid to children with abdominal pain and poisoning

Stomach ache

For any abdominal pain that occurs for the first time, you should absolutely not give your child any medications, and under no circumstances should you place a heating pad on your stomach. At acute appendicitis and other acute diseases of the abdominal cavity, taking medications can suppress external symptoms, but the disease itself will progress. When providing emergency care, medications can be given to children only if there is an exacerbation of chronic diseases and only those that have already been prescribed by the attending physician. If a child experiences abdominal pain for the first time, he must be examined by a doctor, and as quickly as possible.

Drug poisoning

Almost every medicine in large doses is poison! Therefore, all medicines and household chemicals should be stored in places inaccessible to children, preferably even under lock and key. If the child does eat something that is not worth eating, try to induce vomiting and rinse the stomach with cold water (drink plenty of fluids). After this, for emergency medical care, it is advisable to give children some kind of enterosorbent (Polyphepan, Enterosgel, activated carbon, etc.).

It is safer to call an ambulance. Moreover, a seemingly harmless drug can cause severe poisoning.

Emergency care for children with injuries and bruises

Injuries are very common in young children. The baby is inherently curious, he constantly strives to learn something new, and dangers await him along this path. A child may run into furniture or fall from a bed, chair, or table. To prevent this from happening, try not to leave small children unattended. It is impossible to predict when a small child will first roll over, sit up, or begin to crawl. You can often hear from parents of children who have fallen from a bed or changing table: “He never rolled over before!” Children grow and develop, and if the baby did not do it yesterday or today, this does not mean that he will not be able to do it tomorrow. The child can only be left alone in a crib or playpen. When he begins to make attempts to sit up on his own, it is necessary to immediately lower the bottom of the crib. And of course, you need to be alert when the child begins to walk. What algorithm for providing emergency care to children should be followed for injuries?

After a long winter, we all love to get out into nature, outside the city. But mosquitoes and midges await us there. Their bites are especially dangerous for young children who have sensitive skin, and besides, they cannot protect themselves from these insects. Therefore, children need help.

Firstly, the room where the child sleeps must have mosquito nets on the windows and doors. Secondly, you can use fumigators with special tablets indoors. Thirdly, remember that insects fly into the light. Therefore, if you turn on the electricity in the evening, make sure that insects do not have access to the room where the child will sleep.

It's more difficult on the street. It is not advisable to use repellents (substances that repel insects) for young children. IN as a last resort some of them (those that are not contraindicated for children) can be applied to clothing. But if the child is nevertheless bitten by mosquitoes and itchy spots appear on the skin, then treat them with Fenistil gel, which reduces swelling and itching. When helping children, the use of ordinary soda solution(1 teaspoon in 1 glass of water), it also reduces itching.

Tick bites

The encephalitis tick is a carrier of two diseases: tick-borne encephalitis and tick-borne borreliosis (Lyme disease). Approximately every hundredth tick carries a virus, and every tenth tick carries Borrelia. To prevent ticks from ruining your vacation, it is advisable, when going out into nature, to dress in such a way that the tick cannot reach the skin. Ticks wake up at the end of April, and it is from this time that safety measures need to be taken. If a tick does bite a child, then during the first emergency medical care it is necessary to administer anti-tick gamma globulin to the victim in the first 48 hours after the bite. It is also advisable to examine the tick for the presence of Borrelia, so do not try to throw it away immediately, even if you removed it yourself, take it to the laboratory for examination. The fact is that anti-tick gamma globulin protects only against the tick-borne encephalitis virus. If the tick also contained Borrelia, then antibacterial therapy is prescribed, since Lyme disease takes a very long time and is quite severe. Can those rise
fever, joints and skin at the site of the bite become inflamed.

When returning from a walk, do not forget to inspect the child’s clothes and skin, because the tick could have gotten on him, but not yet attached.

To avoid having to resort to first aid for children, do not forget about vaccination. Vaccination against tick-borne encephalitis, which everyone remembers in the summer, can only be done from November to March, when all ticks are asleep. For the first time, the child is given 2 vaccinations with an interval of 1 month, and after a year the child is vaccinated once. This vaccination is given to children from the age of 4.

Don't forget: Proper first aid for pediatric emergencies can make a difference in how quickly your baby recovers.

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Doctor of Medical Sciences E.M. Malkova

EMERGENCY CARE FOR CHILDREN

PRINCIPLES OF PROVIDING EMERGENCY CARE FOR CHILDREN

Diagnosis and emergency care for life-threatening conditions in children.

A threatening condition is a condition in which there is decompensation of the vital functions of the child’s body (breathing, blood circulation, nervous system) or there is a danger of its occurrence.

Pre-hospital doctors and paramedics (clinics, ambulances) and on-duty medical staff of hospital admission departments provide assistance in threatening conditions. They, who provide first aid, have the following main tasks:

ü Diagnostics threatening condition.

ü Providing emergency assistance to stabilize the child’s condition.

ü Making a tactical decision about the need and place of hospitalization.

Diagnosis of threatening conditions in children comes down to identifying prognostically unfavorable symptoms, combining them into pathological syndromes, assessing their severity, and resolving issues about the urgency of treatment and tactical measures. The more severe the threatening condition, the more emergency medical care the patient needs.

History of the disease in emergency situation difficult to collect due to time constraints. First of all, they find out the information that makes it possible to determine the cause of the threatening condition, the severity of the situation and the factors influencing the prognosis. From the anamnesis it is important to get an answer to the questions: what circumstances preceded its onset; what was the initial deterioration in the child’s condition; how much time has passed since this moment? The more time has passed since the condition worsened, the less better prognosis and the more intensive the treatment measures should be.

In the life history, it is necessary to find out the presence of aggravating factors: complicated pregnancy and childbirth in the mother, encephalopathy, concomitant heart and kidney diseases, drug allergies, reactions to vaccinations, etc. It is necessary to take into account the social status of the family.

Initially, signs of decompensation of breathing, blood circulation and the degree of central nervous system depression are identified.

Inadequacy of breathing is indicated by its absence, bradypnoe or pathological types of breathing.

Central hemodynamics is reflected by the characteristics of the pulse during palpation and direct measurement of blood pressure. The pulse on the radial artery disappears when blood pressure is below 50-60 mm Hg. Art., on the carotid artery - below 30 mm Hg. Art. The more pronounced the hypoxia, the more likely tachycardia is replaced by bradycardia and arrhythmia. Impairment of peripheral blood flow is indicated by such prognostically unfavorable signs as marbling of the skin, cyanosis and hypostases.

In children older than one year, determining the degree of loss of consciousness is not difficult. When examining an infant, guidelines for assessing consciousness are concentration reactions to sound, visual stimuli and emotional response to positive and negative influences (mother, bottle of milk, slap on the cheeks, etc.). In case of loss of consciousness, pay attention to the width of the pupils and the presence of their reaction to light. Wide pupils that do not respond to light without a tendency to narrow are one of the symptoms of deep depression of the central nervous system. If consciousness is preserved, pay attention to how excited or inhibited the child is. When convulsions take into account their combination with respiratory disorders, the state of muscle tone (hypertension or hypotension) and the nature of the convulsive syndrome (predominance of the clonic or tonic component). The absence of muscle tone and the tonic component of seizures most often indicate brainstem disorders.

The main goal of emergency therapy at the prehospital stage and upon admission of a child to hospital is to provide a minimum sufficient amount of assistance, that is, those activities without which the lives of patients and victims remain at risk.

Errors in emergency care and their prevention

Errors in emergency care include incorrect actions or inactions of medical personnel that caused or could cause deterioration or death of the patient.

Conventionally, errors can be divided into diagnostic, therapeutic, tactical and deontological. Diagnostic errors are manifested in the fact that the main and concomitant diseases, as well as their complications, are established incorrectly or incompletely. In emergency pediatrics, diagnostic errors may be due to the severity of the child’s condition, unusual course common illness, lack of conditions, and most importantly - time for examination, dynamic observation and consultations with specialists.

The following factors can lead to an incorrect diagnosis:

ü Ignorance.

ü Insufficient examination due to:

Insufficient opportunities;

Lack of time;

Bad technique.

ü Errors in emergency treatment are manifested in the following:

Not assigned medicines and therapeutic procedures that are indicated;

The indicated medications or therapeutic procedures were applied incorrectly (untimely, incorrect dose, method, speed, frequency of administration or execution technique);

Contraindicated medications or medical procedures have been prescribed;

Irrational combinations of medications or therapeutic procedures, etc. were used.

The main reasons for errors in emergency treatment are subjective. The lack of necessary medicines, solutions, devices or instruments may have a certain significance. The most common errors in emergency treatment are: prescribing medications or therapeutic procedures without sufficient indications, polypharmacy, the use of medicinal “cocktails,” and excessively rapid intravenous infusion of potent drugs.

Tactical errors in the provision of emergency care are errors in determining the continuity of treatment, i.e. untimely or non-core transfer of the patient to specialists at the point of care or during hospitalization. Tactical errors usually follow from diagnostic ones and lead to therapeutic ones.

Deontological errors consist in the inability to find contact with a sick child, his parents and relatives, and underestimation of the importance of psychotherapeutic treatment methods in providing emergency care. Deontological errors remain one of the main causes of complaints about the quality of medical care.

In order to prevent errors, each time providing emergency care, you should consider:

The severity of the patient's condition;

The likelihood of life-threatening complications;

Main and concomitant diseases and their complications;

The immediate cause and mechanism of the emergency condition;

Age of the sick child;

Previous treatment and reaction to drugs in the past.

BASICS OF PROVIDING PRIMARY RESUSCITICAL CARE FOR CHILDREN

TERMINAL STATES

The main signs of clinical death:

Lack of breathing, heartbeat and consciousness;

Disappearance of the pulse in the carotid and other arteries;

Pale or grey-earthy skin color;

The pupils are wide and do not react to light.

Emergency measures in case of clinical death:

Reviving a child with signs of circulatory and respiratory arrest must begin immediately, from the first seconds of establishing this condition, extremely quickly and energetically, in strict sequence, without wasting time on finding out the reasons for its occurrence, auscultation and measuring blood pressure;

Record the time of clinical death and the moment of onset resuscitation measures;

Sound the alarm, call assistants and the resuscitation team;

If possible, find out how many minutes have passed since the expected moment of clinical death.

If it is known for sure that this period is more than 10 minutes or the victim has early signs biological death(symptoms of “cat’s eye” - after pressing on the eyeball, the pupil takes and retains a spindle-shaped horizontal shape and “melting ice” - clouding of the pupil), then the need for cardiopulmonary resuscitation is doubtful.

Resuscitation will only be effective if it is properly organized and life-sustaining measures are carried out in the classical sequence. In children under 8 years of age:

The first step A (Airways) is to establish airway patency.

The second step B (Breath) is to restore breathing.

The third step C (Circulation) is the restoration of blood circulation.

Sequence of resuscitation measures:

A (Airways)- restoration of airway patency:

1. Lay the patient on his back on a hard surface (table, floor, asphalt).

2. Mechanically clean the oral cavity and pharynx from mucus and vomit.

3. Slightly tilt your head back, straightening the airways (contraindicated if you suspect a cervical injury), place a soft cushion made of a towel or sheet under your neck.

A cervical vertebral fracture should be suspected in patients with head trauma or other injuries above the collarbones accompanied by loss of consciousness, or in patients whose spine has been subjected to unexpected stress due to diving, falling, or a motor vehicle accident.

4. Move the lower jaw forward and upward (the chin should occupy the highest position), which prevents the tongue from sticking to the back wall of the pharynx and facilitates air access.

B (Breath) -recovery breathing:

Start mechanical ventilation using expiratory methods “mouth to mouth” - in children over 1 year old, “mouth to nose” - in children under 1 year old.

C (Circulation) - restoration of blood circulation:

After the first 3-4 inhalations of air have been carried out, in the absence of a pulse in the carotid or femoral arteries, the resuscitator, along with continuing mechanical ventilation, must begin chest compressions.

The child's condition is re-evaluated 1 minute after the start of resuscitation and then every 2-3 minutes.

Criteria efficiency mechanical ventilation and indirect heart massage:

Assessment of chest movements: depth of breathing, uniform participation of the chest in breathing;

Checking the transmission of massaging movements of the chest by pulse on sleepy and radial arteries;

Increase in blood pressure to 50-70 mm Hg. Art.;

Reducing the degree of cyanosis of the skin and mucous membranes; - narrowing of previously dilated pupils and the appearance of a reaction to light; - resumption of spontaneous breaths and heart contractions.

Convulsive syndrome

Convulsions are sudden involuntary attacks of tonic-clonic contractions of skeletal muscles, often accompanied by loss of consciousness.

The most common causes of seizures in children:

1. Infectious:

Meningitis and meningoencephalitis;

Neurotoxicosis due to ARVI;

Febrile seizures.

2. Metabolic:

Hypoglycemic seizures;

Hypocalcemic seizures.

3. Hypoxic:

Affective-respiratory convulsions;

For hypoxic-ischemic encephalopathy;

With severe respiratory failure;

With severe circulatory failure; - in coma III of any etiology, etc.

4. Epileptic:

Idiopathic epilepsy.

5. Structural:

Against the background of various organic changes in the central nervous system (tumors, injuries, developmental abnormalities, etc.).

Epileptic seizure

Epilepsy- a chronic progressive disease, manifested by repeated paroxysmal disorders of consciousness and convulsions, as well as increasing emotional and mental changes.

The main clinical forms are: grand mal seizure and petit mal seizures. A grand mal seizure includes prodromal, tonic and clonic phases, and a post-ictal period.

Prodromal period - various clinical symptoms that appear several hours or days before the onset of seizures: motor restlessness, labile mood, increased irritability, sleep disturbances.

Attack The child begins with a cry (initial cry), followed by loss of consciousness (often to coma) and convulsions. The tonic phase of convulsions lasts 10-20 seconds and is characterized by tonic tension of the facial muscles, extensors of the limbs, and trunk muscles, while the jaws are tightly clenched, the eyeballs deviate upward and to the side. The complexion is pale at first and later becomes reddish-cyanotic. The pupils are wide and do not react to light. There is no breathing. The clonic phase lasts from 30 seconds to several minutes and is manifested by short flexion contractions of various muscle groups of the body. In both phases of the convulsive syndrome, biting of the tongue and lips may occur.

Subsequently, the convulsions gradually become less frequent, the muscles relax, breathing is restored, the patient is in stupor, motionless, reflexes are depressed, and often there is involuntary passage of urine and feces. After 15-30 minutes, sleep sets in or the child regains consciousness and does not completely remember the seizure.

Status epilepticus- a condition in which continuous repeated seizures are observed, and in the period between attacks there is no complete recovery of consciousness. It always represents an urgent state and is characterized by an increase in the depth of impaired consciousness with the formation of cerebral edema and the appearance of respiratory and hemodynamic disorders. The development of status epilepticus provokes cessation or irregularity anticonvulsant treatment, a sharp reduction in the dosage of antiepileptic drugs, as well as concomitant diseases, especially acute infections, intoxication, traumatic brain injuries, etc.

Urgent Care:

1. Lay the patient on a flat surface (the floor) and place a pillow or cushion under the head; turn your head to the side and provide access to fresh air.

2. Restore airway patency: clear the oral cavity and pharynx of mucus, insert a mouth dilator or spatula wrapped in a soft cloth to prevent biting the tongue, lips and damage to the teeth.

3. If convulsions continue for more than 3-5 minutes, as prescribed by a doctor inject a 0.5% solution of seduxen (Relanium) at a dose of 0.05 ml/kg (0.3 mg/kg) intramuscularly or into the muscles of the floor of the mouth.

Hospitalization after emergency care in a hospital with a neurological department, for status epilepticus in the intensive care unit. In the future, selection or correction of basic therapy for epilepsy is necessary.

Febrile seizures - convulsions that occur when body temperature rises above 38 0 C during an infectious disease (acute respiratory diseases, influenza, otitis media, pneumonia, etc.).

Typically observed in children under 5 years of age, the peak of the disease occurs in the first year of life. Most often, perinatal damage to the central nervous system predisposes to their occurrence.

Characteristic signs of febrile seizures:

Typically, convulsions are observed at a height of temperature and stop when it drops; they do not last long - from several seconds to several minutes;

Generalized tonic-clonic seizures are characteristic, accompanied by loss of consciousness; unilateral and partial seizures develop less frequently; there are no focal neurological disorders;

Anticonvulsants are rarely needed good effect provide antipyretics.

The differential diagnosis of febrile seizures in children is carried out, first of all, with convulsive syndrome due to meningitis and meningoencephalitis, which is characterized by an anamnesis typical of ARVI or other infectious disease, and the following clinical manifestations:

Meningeal symptoms, stiff neck;

Hyperesthesia - increased sensitivity to loud speech, light, touch, especially injections;

Early detection of focal symptoms (may be absent in meningitis): local convulsions, paresis, paralysis, sensitivity disorders, symptoms of damage to the cranial nerves (sagging corner of the mouth, smoothness of the nasolabial fold, strabismus, loss of hearing, vision), etc.;

Gradual development of coma.

In meningoencephalitis, the peak of a convulsive attack is usually not associated with hyperthermia; repeated administrations anticonvulsants.

Urgent Care:

1. Lay the patient down, turn his head to one side, provide access to fresh air; restore breathing: clear the mouth and throat of mucus.

2. As prescribed by the doctor, carry out simultaneous anticonvulsant and antipyretic therapy.

Hospitalization of a child with febrile convulsions due to an infectious disease in the infectious diseases department. After an attack of febrile convulsions, the child is prescribed phenobarbital 1-2 mg/kg per day orally for 1-3 months.

Affective-respiratory convulsions - attacks of apneic convulsions that occur when a child cries.

Typical for children aged 6 months to 3 years with increased neuro-reflex excitability.

Affective-respiratory convulsions are usually provoked by fear, anger, severe pain, joy, or force-feeding of a child. During crying or screaming, the breath is held while inhaling, and cyanosis of the skin and oral mucosa develops. Due to developing hypoxia, short-term loss of consciousness, tonic or clonic-tonic convulsions are possible.

Urgent Care:

1. Create a calm environment around the child.

2. Take measures to reflexively restore breathing:

Pat on the cheeks;

Spray your face with cold water;

Let the vapors of the ammonia solution (a swab moistened with ammonia) be inhaled from a distance of 10 cm.

Brain swelling

Cerebral edema is the most severe syndrome of nonspecific brain damage, clinically characterized by impaired consciousness and convulsive attacks. Edema refers to excess accumulation of fluid in the intercellular space. An increase in the volume of intracellular fluid is called brain swelling.

Brain swelling can occur when:

General infections;

Toxic and hypoxic conditions;

Acute neuro-infections;

Traumatic brain injuries;

Status epilepticus;

Cerebral circulation disorders;

Brain tumors;

Somatic diseases.

Characteristic clinical manifestations of cerebral edema:

General anxiety, “brain scream”, vomiting, muscle twitching, shuddering, which turns into convulsions, often of a tonic or tonic-clonic nature;

Impaired consciousness from stupor to stupor and coma, sometimes psychomotor agitation, delirium, hallucinations;

Meningism with the presence of positive symptoms of neck rigidity, Kernig, Brudzinsky, hyperesthesia to light, sounds, tactile influences;

Uncontrollable hyperthermia, often up to 38-40°C, associated with a violation of central thermoregulation;

Hemodynamic disorders: first an increase and then a decrease in blood pressure, collapse, bradycardia, respiratory failure;

- “stagnant disks” optic nerves» on the fundus (the boundaries are blurred, the disc protrudes mushroom-shaped into the vitreous body, there may be hemorrhages along the edge of the disc);

With computed tomography or magnetic resonance imaging - a decrease in the density of the brain matter, often in the periventricular zone.

The outcome of cerebral edema is:

1. Complete recovery.

2. Posthypoxic encephalopathy with disruption of higher cortical functions, mild intellectual-mnestic cerebral defect.

3. Decortication syndrome - the disappearance of acquired motor, speech, and mental skills. The appearance of extinct symptoms of oral automatism (sucking, grasping), mental retardation.

4. Decerebrate syndrome - persistent decerebrate muscle rigidity (extensor position of the limbs, thrown back head), strabismus, pathological reflexes and reflexes of oral automatism. Gross mental defect.

5. Lethal outcome.

Urgent Care:

1. Raise the head at an angle of 30°, sanitation of the upper respiratory tract, intubation and mechanical ventilation, oxygenation, drain urine with a catheter, followed by monitoring diuresis.

2. Decongestant and dehydration therapy as prescribed by a doctor.

3. Anticonvulsant therapy.

4. In order to relieve malignant hyperthermia:

5. Craniocerebral hypothermia (cold head);

Hospitalization in the intensive care unit.

Anaphylactic shock

Anaphylactic shock is an acutely developing, life-threatening pathological process caused by an immediate allergic reaction when an allergen is introduced into the body, characterized by severe disturbances of blood circulation, breathing, and central nervous system activity.

More often it develops in response to parenteral administration of drugs (penicillin, sulfonamides, X-ray contrast agents, serums, vaccines, protein preparations, etc.), as well as during provocative tests with pollen and less often with food allergens, with insect bites. It is characterized by rapid development - a few seconds or minutes after contact with the “causal” allergen.

There are two variants of the fulminant course of anaphylactic shock, depending on the leading clinical syndrome: acute respiratory failure and acute vascular failure.

In case of anaphylactic shock with a leading syndrome of respiratory failure, the child suddenly develops and develops weakness, a feeling of constriction in the chest with a feeling of lack of air, a painful cough, a throbbing headache, pain in the heart area, and fear. There is severe pallor of the skin with cyanosis, foam at the mouth, difficult wheezing with dry wheezing when exhaling. Angioedema of the face and other parts of the body may develop. Subsequently, with the progression of respiratory failure and the addition of symptoms of acute adrenal insufficiency, death may occur.

Anaphylactic shock with the development of acute vascular insufficiency is also characterized by a sudden onset with the appearance of weakness, tinnitus, and heavy sweating. There is an increasing pallor of the skin, acrocyanosis, a progressive drop in blood pressure, a thready pulse, and heart sounds are sharply weakened. After a few minutes, loss of consciousness and convulsions are possible. Death occurs with increasing symptoms of cardiovascular failure.

Less commonly, anaphylactic shock occurs with the gradual development of clinical symptoms.

The complex of treatment measures must be absolutely urgent and carried out in a clear sequence. At the beginning of treatment, it is advisable to administer all antishock drugs intramuscularly; if therapy is ineffective, puncture a vein.

Urgent Care:

1. Place the patient in a position with the leg end raised, turn his head to the side, extend the lower jaw to prevent tongue retraction, asphyxia and prevent aspiration of vomit. Provide fresh air or inhale oxygen.

2. It is necessary to stop further entry of the allergen into the body.

3. Immediately administer intramuscularly:

0.1% adrenaline solution at a dose of 0.05-0.1 ml/year of life (no more than 1.0 ml) and

3% solution of prednisolone at a dose of 5 mg/kg into the muscles of the floor of the mouth;

Monitoring of pulse, respiration and blood pressure is mandatory!

4. After completing the initial measures, provide access to the vein.

5. For bronchospasm and other breathing disorders:

Carry out oxygen therapy;

Remove accumulated secretions from the trachea and oral cavity;

If stridor breathing appears and there is no effect from complex therapy, immediate intubation is necessary, and in some cases, for health reasons, conicotomy.

6. If necessary, perform cardiopulmonary resuscitation.

Hospitalization in the intensive care unit after a set of emergency treatment measures.

Prevention of anaphylactic shock:

Accurately collected personal and family allergy history;

In patients with an allergic history, the “allergies” stamp is stamped on the medical history signal sheet and the medications listed are listed. causing allergies;

After antibiotic injections, it is necessary to observe the patient for 10-20 minutes;

The personnel of treatment rooms, surgical rooms, and first-aid posts must be specially trained to provide emergency medical care for drug-induced anaphylactic shock and the treatment of similar conditions.

In all treatment rooms, surgical and other rooms, and in first-aid posts, it is necessary to have a set of medications to provide emergency care for anaphylactic shock.

Quincke's edema

Quincke's edema - allergic reaction immediate type, manifested by angioedema spreading to the skin, subcutaneous tissue, and mucous membranes.

Quincke's edema occurs more often in response to drug or food antigens, insect bites; in some cases, the immediate cause may not be clear. Characterized by the sudden appearance of limited swelling in places with loose subcutaneous tissue, most often in the area of the lips, ears, neck, hands, and feet. Swelling can often reach significant sizes and deform the affected area. The immediate danger of this reaction is the frequent development of mechanical asphyxia due to swelling of the upper respiratory tract. With swelling of the larynx, the child experiences a barking cough, hoarseness, difficulty inhaling and, possibly, exhaling due to bronchospasm. If the tongue swells, speech becomes difficult, chewing and swallowing processes are disrupted.

Urgent Care:

1. Immediately stop the intake of the allergen.

2. Administer antihistamines IM or IV

3. Administer a 3% solution of prednisolone at a dose of 1-2 mg/kg IM or IV.

4. According to indications for increasing swelling of the larynx with obstructive respiratory failure, intubation or tracheostomy is performed.

Hospitalization in the somatic department.

Hives

Urticaria is an immediate-type allergic reaction, characterized by the rapid appearance of urticarial rashes on the skin and, less commonly, on the mucous membranes.

The causes of urticaria are the same as for Quincke's edema. The child develops a feeling of heat, itchy skin, and skin changes like “after a nettle burn.” The elements of urticaria - blisters and papules - can have a variety of shapes and sizes, often with their merging and the formation of giant elements. The color of the urticaria elements ranges from pale pink to red. The rashes are localized on any part of the body and mucous membranes, most often on the stomach, back, chest, and thighs. There may be general symptoms: fever, agitation, arthralgia, collapse.

Urgent Care:

1. Immediately stop the allergen.

2. Prescribe antihistamines orally or intramuscularly.

3. With widespread or giant urticaria with fever, administer a 3% solution of prednisolone 1-2 mg/kg IM or IV.

4. Carry out enterosorption with activated carbon at a dose of 1 g/kg per day.

Hospitalization to the somatic department is indicated if there is no effect from the therapy. Patients who were administered prednisolone at the prehospital stage due to the severity of their condition are also subject to hospitalization.

Fainting

Fainting(syncope) - a sudden short-term loss of consciousness with loss of muscle tone due to transient cerebrovascular accidents.

The most common causes of fainting in children:

1. Syncope due to disturbance nervous regulation vessels.

2. Cardiogenic syncope with:

Bradyarrhythmias (atrioventricular block P-III degree with Morgagni-Adams-Stokes attacks, weakness syndrome sinus node);

Tachyarrhythmias (paroxysmal tachycardia, including long QT syndrome, atrial fibrillation);

Mechanical obstruction of blood flow at the level of the heart or large vessels(aortic stenosis, hypertrophic subaortic stenosis, insufficiency aortic valves etc.).

3. Hypoglycemic syncope.

4. Cerebrovascular, etc.

Fainting may be preceded by a presyncope state (lipotymia): a feeling of discomfort, nausea, yawning, sweating, weakness in the legs, darkening in the eyes, flashing “spots” before the eyes, increasing dizziness, noise or ringing in the ears, numbness of the extremities. If the child manages to sit down or lie down, then the attack does not develop completely, but is limited to a state of stupor, yawning, and nausea.

Syncope is characterized by loss of consciousness - the child does not make contact. Muscle tone is sharply reduced, the face is pale, the pupils are dilated, the pulse is weak, blood pressure is reduced, heart sounds are muffled, the frequency and rhythm of heart contractions may be different, breathing is shallow. Profound syncope may (rarely) be accompanied by brief tonic convulsions. Restoration of consciousness occurs quickly in a horizontal position. In the post-syncope period, children report weakness, headache, pallor, and arterial hypotension.

The main signs of fainting are: suddenness of development; short duration (from a few seconds to 3-5 minutes); reversibility: rapid and complete restoration of consciousness - the child orients himself in his surroundings, remembers the circumstances preceding the loss of consciousness.

Children with vegetative-vascular dystonia in prepubertal and pubertal age are more likely to faint. Typical provoking situations: pain, fear of manipulation, the sight of blood, prolonged stay in a stuffy room, etc. Orthostatic syncope develops during the transition from a horizontal to a vertical position in children with insufficient compensatory mechanisms for regulating vascular tone. Sinocarotid syncope is provoked by sudden turns and tilts of the head, compression in the neck; based on increased sensitivity of the carotid sinuses and a reflex decrease in heart rate and/or blood pressure.

In each specific case, exclusion of other causes of sudden loss of consciousness is required. Deep fainting attacks accompanied by convulsions must be distinguished from epilepsy, which is characterized by loss of consciousness, hypersalivation, involuntary urination and/or defecation, and amnesia of the circumstances of the paroxysm. Changes in heart rate, blood pressure, and pulse are not typical.

For such cardiovascular diseases, such as aortic stenosis, hypertrophic cardiomyopathy, the occurrence of fainting during physical activity is especially typical. In the case of arrhythmogenic causes of syncope, the patient may experience “interruptions” of the heart rhythm. To exclude the cardiac origin of syncope, it is necessary in all cases to monitor the pulse rate and, if possible, urgently record an ECG.

You should think about the state of hypoglycemia if the attack was preceded by a long break in food intake (for example, in the morning) or the attack developed in a child after intense physical or emotional stress. In the post-syncope period, long-lasting drowsiness, muscle weakness, and headache are noteworthy. The diagnosis is confirmed when a reduced blood glucose level of less than 3.3 mmol/l is detected.

Urgent Care:

1. Lay the child horizontally, raising the foot end by 40-50°. Unfasten the collar, loosen the belt and other clothing items that put pressure on the body. Provide access to fresh air.

2. Use reflex effects:

Spray your face with water or pat your cheeks with a damp towel;

Allow the ammonia vapor to inhale.

3. When you come out of this state, give hot sweet tea to drink.

Hospitalization for a fainting state of functional origin is not indicated, but if there is a suspicion of an organic cause, hospitalization in a specialized department is necessary.

Collapse

Collapse is a life-threatening acute vascular failure, characterized by a sharp decrease in vascular tone, a decrease in circulating blood volume, signs of brain hypoxia and depression of vital functions.

The most common causes of collapse in children:

1. Severe course of acute infectious pathology (intestinal infection, influenza, ARVI, pneumonia, pyelonephritis, tonsillitis, etc.).

2. Acute adrenal insufficiency.

3. Overdose of antihypertensive drugs.

4. Acute blood loss.

5. Severe injury.

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

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

With vagotonic collapse, there is a significant expansion of arterioles and arteriovenous anastomoses, which is accompanied by the deposition of blood in the capillary bed. Clinically characteristic: lethargy, adynamia, decreased muscle tone, pronounced pallor of the skin with marbling, gray-cyanotic color, pronounced acrocyanosis, a sharp drop in blood pressure, weak pulse, often bradycardia, noisy and rapid breathing of the Kussmaul type, oliguria.

Paralytic collapse is caused by passive expansion of capillaries due to depletion of circulatory regulation mechanisms. This condition is characterized by: lack of consciousness with suppression of skin and bulbar reflexes, the appearance of blue-purple spots on the skin of the trunk and extremities, bradycardia, bradypnea with transition to periodic Cheyne-Stokes breathing, blood pressure drops to critical figures, threadlike pulse, anuria. In the absence of emergency assistance, death occurs.

Therapeutic measures must be started immediately!

Urgent Care:

1. Lay the child horizontally on his back with his head slightly thrown back, cover him with warm heating pads and provide an influx of fresh air.

2. Ensure free passage of the upper respiratory tract: conduct an inspection of the oral cavity, remove restrictive clothing.

According to indications, perform primary cardiopulmonary resuscitation. Hospitalization in the intensive care unit after emergency treatment.

Shock is an acutely developing, life-threatening pathological process characterized by a progressive decrease in tissue perfusion,