Posyndromic emergency care for children. Emergency conditions in pediatrics and emergency care. Indications for antipyretic therapy

A child’s body differs significantly from an adult in its functioning and imperfections. This is what makes him highly vulnerable and susceptible to the influence of various negative factors. Compared to adults, emergency conditions in children are much more common. A positive outcome depends entirely on the correct provision of first aid. In the article we will get acquainted with the most common emergency conditions and the first aid that the victim needs.

Concept of emergency conditions

In children, this is the presence of symptoms and signs that threaten the life of a small patient. In such a situation, immediate ambulance is required, the life of the little man will depend on its provision.

Helping children is based on the main principle: “Do no harm.” Quite often, parents (and this can happen to doctors too) make a mistake in choosing the dosage of a drug, combine medications incorrectly, or give medications, which later, in the hospital, make it difficult to make a correct diagnosis.

When children have medical emergencies, they need immediate medical attention because delay can be very costly.

Features of the body that predispose to the development of emergency conditions

Young children have some features in the structure and development of organ systems, which contribute to the fact that situations requiring urgent medical attention arise much more often.

1. If we consider the cardiovascular system, we can highlight the following features:

• In babies during the first two months of life, the right parts of the heart predominate, and the left ones have little compliance, which can contribute to the development of left ventricular failure.
• The duration of systole is long, which predisposes to heart failure.
• Uneven maturation of the conduction system and cardiac muscle, imperfect reflex regulation of the heart can lead to frequent disturbances in heart rhythm.
• The vessels have a well-developed muscular layer in the pulmonary circulation, which can cause the development of pulmonary hypertension.
• High permeability of the pulmonary capillaries predisposes to pulmonary edema, given that the pressure in the left atrium is 2 times less than in adults.
• Even with slight decreases in circulating blood volume, clinical symptoms of blood loss develop.
• The brain is abundantly supplied with blood, the blood-brain barrier is highly permeable, which facilitates the passage of toxins, poisons and viruses that circulate in the blood. And this can lead to brain damage.
• blood creates all the conditions for swelling of the brain and accumulation of fluid, which puts pressure on the brain tissue.

2. The respiratory system is also not perfect:

• The narrow larynx, trachea and bronchi, the poor development of elastic and muscle fibers in them, the softness of cartilage tissue, and an abundant blood supply create the prerequisites for the development of inflammatory diseases of the respiratory tract.
• Compensatory capabilities are sharply limited due to an increase in tidal volume and respiratory rate due to the special structure of the chest.
• The barrier functions of the bronchial epithelial tissue are poorly developed, the cough reflex is weak, which limits the protective function when an infection enters the child’s body.

3. The nervous system has the following features:

• The cerebral cortex is still poorly differentiated, it has little influence on the underlying parts of the nervous system, but the ascending reticular formation has a predominant tone, which contributes to diffuse cerebral reactions.
• High hippocampal activity predisposes to seizures.
• The tone of the sympathetic nervous system predominates, so children often have impaired peripheral circulation and are prone to hyperthermia and rapid breathing.

All these features contribute to the fact that emergency conditions in children are much more common than in adults and require serious medical care.

Symptoms requiring immediate medical attention

Most parents are very careful about the health of their little children and at the slightest deviation they cut off the pediatrician’s phone numbers, but most often the worries of mothers and fathers turn out to be in vain. However, any doctor can name several symptoms that indicate that a child urgently needs medical attention. These include:

Many mothers already intuitively feel when their baby is really in danger, and when it is possible not to panic, but to take the necessary measures themselves.

First aid for traumatic brain injuries

Young children fall quite often, but not every fall will result in a serious head injury. If a child falls from a small height, for example, from a sofa, then, most likely, it will not come to this, but a fall from a table already threatens with serious consequences.

Often parents themselves underestimate the abilities of their child and leave the baby unattended on the changing table. Sometimes a few minutes are enough, and the baby ends up on the floor. If a child hits his head, it is imperative to show him to a doctor. The main symptoms that indicate a traumatic brain injury are:

After a fall, a formation may form, the presence of which is indicated by the following signs:

• the nasolabial fold is smoothed;
• tendon reflexes decrease;
• bradycardia;
• tongue deviation.

Providing emergency assistance in this case must be carried out urgently, otherwise everything can end in disaster. It consists of the following:

1. Lay the victim down and keep him calm.
2. If breathing is impaired, an air duct must be inserted.
3. If there is no consciousness, the child must be placed on the right side.
4. Use a blower to suck out mucus from your mouth.
5. If severe overexcitation is observed, you can administer a 0.25% solution of droperidol at the rate of 0.2 ml per kilogram of weight.

After first aid is provided, children must be hospitalized without fail. If a child falls, you shouldn’t hope that everything will go away on its own; it’s better to be on the safe side.

Eye injury

When falling, quite often a child can stumble upon a sharp object and injure his eye. An eye injury can be end-to-end, when all layers are damaged, or non-through. To clarify the extent of damage and provide the necessary assistance, the child must be urgently sent to a specialized institution.

Minor eye injury can occur from foreign objects, which should also be removed by an ophthalmologist. A child can get it and this often happens during fires or after careless handling of chemicals. As an emergency, you need to rinse the eye under running water and drop Albucid, and then show the child to the doctor.

Providing assistance is mandatory, because untimely treatment or ignoring the problem altogether can result in blindness.

Help with poisoning

Kids are fans of constantly putting something in their mouth, so poisoning happens often. The reason may be:

It often happens that parents do not know what poisoned their baby, and he himself cannot yet say. Assistance in emergency conditions of this kind should be limited to the following:

1. If a toxic substance gets on your skin, you should rinse it well under running water and lubricate it with a rich cream or ointment.
2. If it gets into your eyes, rinse them, apply a sterile bandage and go to the doctor.
3. If carbon monoxide poisoning occurs, the victim should be taken to fresh air. If breathing stops, be sure to perform artificial respiration before the ambulance arrives.
4. If a toxic substance gets inside, you must first induce vomiting and rinse the stomach with a solution of potassium permanganate.

This should include first aid in case of emergency conditions in children if poisoning has occurred. All other procedures are carried out by a doctor in the hospital where the baby must be taken.

Burns

If you visit burn departments or centers, you can simply be horrified by the number of children who are there. Quite often the culprits in all this are the parents themselves. A pan of boiling water is carelessly left on the edge of the table, matches are within a child’s reach - and now disaster is just a stone’s throw away. The baby just needs to pull the edge of the container, and hot water pours over him from head to toe. The careless mother can only grab her head and rush to the hospital with her child.

After receiving a burn, it is necessary to immediately provide primary care for burns as follows:

• A bandage with furatsilin or novocaine should be applied to the injured surface.
• You can give a painkiller orally.
• If you have any anti-burn spray or gel at home, for example, “Panthenol”, “Livian”, then you need to treat the wound.

If the body area is large, then primary care for burns should be provided only in a hospital.

Injuries in children

Most children, due to their age, are very curious, they are constantly exploring something, and practically do not sit in one place. Getting various injuries is a trivial matter for them. Among the injuries, there are those that parents can handle, and sometimes they cannot do without an ambulance:

Fainting conditions

Diagnosis of emergency conditions in children should be at least a little familiar to parents so that they can seek the necessary medical help in a timely manner. For example, if the skin becomes too pale, cold sweats appear, and dizziness appears, this may be a symptom of impending fainting.

A child can lose consciousness for various reasons:

• severe pain;
• fright;
• exhaustion of the body;
• heat or sunstroke, which becomes especially important in the hot season;
• if you suddenly change the horizontal position to a vertical one;
• If a child hits their head, this can also cause loss of consciousness.

Parents should know what first aid should be provided to their child in such situations:

1. Splash your face with cold water.
2. You can bring a cotton swab moistened with ammonia to your nose.
3. Wipe the temples with ammonia.
4. The head must be on its side, because vomiting often occurs in this state.
5. In the absence of ammonia, you can rub the ears, fingertips, and the tip of the nose.
6. After the child returns to consciousness, give him a little rest and drink warm tea.

If it occurs for a reason unknown to you, you must urgently visit a doctor so as not to miss the development of a serious pathology.

Conclusion

From all that has been said, we can conclude that, compared to adults, emergency conditions occur much more often in children. First aid for babies should be provided immediately to prevent the development of serious complications. First of all, parents need to be attentive, because, to be honest, most often children become victims of the careless and irresponsible behavior of adults.

Take care of your children, all dangerous objects should be removed from their reach, then you won’t have to call an ambulance to save the baby.

Doctor of Medical Sciences EAT. 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 Diagnosis of a 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.

It is difficult to collect medical history in an emergency situation 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 favorable the 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 the provision of emergency care include incorrect actions or inaction of medical personnel that caused or could cause the deterioration of the patient’s condition or death.

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 can be caused by the severity of the child’s condition, the unusual course of a common disease, the lack of conditions, and most importantly, time for examination, follow-up and specialist consultations.

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:

Medications and therapeutic procedures that are indicated are not prescribed;

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

Contraindicated medications or therapeutic 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 the start of 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 of biological death (symptoms of “cat’s eye” - after pressing on the eyeball, the pupil takes on and retains a spindle-shaped horizontal shape and a “melting piece of ice” - clouding of the pupil), then the need for Cardiopulmonary resuscitation is questionable.

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 the pulse in the carotid 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, convulsions gradually become less frequent, 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 is provoked by the cessation or irregularity of 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; antipyretics have a good effect.

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 the seizure is usually not associated with hyperthermia, and repeated administration of anticonvulsants is often required.

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, breathing 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 optic discs” in 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, and 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 on exhalation. 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 that cause allergies are listed;

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 is an immediate allergic reaction, 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 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 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. For 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 a violation of the nervous regulation of blood vessels.

2. Cardiogenic syncope with:

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

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

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

Cardiovascular diseases such as aortic stenosis and hypertrophic cardiomyopathy are especially characterized by the occurrence of fainting during exercise. 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, attention is drawn to long-lasting drowsiness, muscle weakness, and headache. 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 fainting 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.

Treatment 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,

Pdf-img/38539692_133631651.pdf-1.jpg" alt=">EMERGENCY CONDITIONS IN CHILDREN">!}

Pdf-img/38539692_133631651.pdf-2.jpg" alt=">Emergency conditions - Changes in the human body that lead to a sharp deterioration in health,"> Неотложные состояния- Изменения в организме человека, которые приводят к резкому ухудшению здоровья, могут угрожать жизни и, следовательно, требуют экстренных лечебных мер!}

Pdf-img/38539692_133631651.pdf-3.jpg" alt="> PRIORITY OF THREATENING SYNDROMES AND SYMPTOMS"> ПРИОРИТЕТНОСТЬ УГРОЖАЮЩИХ СИНДРОМОВ И СИМПТОМОВ Вероятность летального исхода в течение… десятка минут нескольких часов экстренная, угрожающая жизни ситуация Клиническая смерть (несчастные случаи: Кардиогенный и Эпиглоттит, ОСЛТ электротравма, утопление и др.) некардиогенный альвеолярный отек легкого Острая асфиксия (инородное тело в гортани, трахее Шок любой этиологии СОБО СВПН (клапанный пневмоторакс) Первичный инфекционный Обширный ожог токсикоз Кровотечение из крупного артериального ствола Глубокая кома Острые отравления Эмболия легочной артерии Астматический статус III Сильные абдоминальный боли Анафилактический шок Тестикулярные боли ДКА Лихорадка у детей до 2 месяцев Геморрагическая сыпь Кровотечение из желудка и кишечника Сильная головная боль с рвотой Боли в грудной клетке Укусы насекомых и животных с повреждением мягких тканей!}

Pdf-img/38539692_133631651.pdf-4.jpg" alt="> Main tasks: 1. Diagnosis of a threatening condition 2. Providing emergency care, allowing"> Основные задачи: 1. Диагностика угрожающего состояния 2. Оказание неотложной помощи, позволяющей стабилизировать состояние ребенка 3. Принятие тактического решения о необходимости и месте госпитализации больного!}

Pdf-img/38539692_133631651.pdf-5.jpg" alt="> Task 1. The child is 1.5 years old. On examination:"> Задача 1. Ребенку 1, 5 года. При осмотре: состояние тяжелое, температура 39, 8 С, отмечаются влажный кашель, обильные слизисто-гнойные выделения из носа, яркая гиперемия задней стенки глотки, кожные покровы бледные, конечности цианотичные и холодные на ощупь, тахикардия до 150 в минуту, тахипное до 50 в минуту, при аускультации легких выслушиваются влажные крупно- и средне- пузырчатые хрипы с двух сторон. 1. Как следует расценить имеющийся симпотомокомплекс?!}

Pdf-img/38539692_133631651.pdf-6.jpg" alt=">Hyperthermic syndrome (“pale fever”) due to acute respiratory infection">!}

Pdf-img/38539692_133631651.pdf-7.jpg" alt="> Task 1. The doctor is called to the child 1, 5"> Задача 1. Врач вызван к ребенку 1, 5 лет. При осмотре: состояние тяжелое, температура 39, 8 С, отмечаются влажный кашель, обильные слизисто-гнойные выделения из носа, яркая гиперемия задней стенки глотки, кожные покровы бледные, конечности цианотичные и холодные на ощупь, тахикардия до 150 в минуту, тахипное до 50 в минуту, при аускультации легких выслушиваются влажные крупно- и средне- пузырчатые хрипы с двух сторон. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-8.jpg" alt="> Use of antipyretic drugs: oral or rectal paracetamol (10 -15 mg/kg) or"> Применение жаропонижающих препаратов: перорально или ректально парацетамол (10 -15 мг/кг) или ибупрофен (5 -10 мг/кг), парентерально метамизол (анальгин) Антигистаминные (супрастин, димедрол, дипразин) и сосудистые препараты (папаверин, дротаверин) в возрастной дозировке Физические методы нормализации температуры противопоказаны!!}

Pdf-img/38539692_133631651.pdf-9.jpg" alt="> Classification of fever Subfebrile (up to 37.9 *C) Febrile (38.0"> Классификация лихорадки Субфебрильная (до 37, 9 *С) Фебрильная (38, 0 -39, 0 *С) Гипертермическая (39, 1*С и выше)!}

Pdf-img/38539692_133631651.pdf-10.jpg" alt=">Clinical variants of fever “Red” (“pink”) fever “White” ("> Клинические варианты лихорадки «Красная» («розовая») лихорадка «Белая» («бледная») лихорадка!}

Pdf-img/38539692_133631651.pdf-11.jpg" alt="> Emergency care for “pink” fever Paracetamol 10 -15 mg/kg (up to"> Неотложная помощь при «розовой» лихорадке Парацетамол 10 -15 мг/кг (до 60 мг/мг/сут) внутрь или ректально Ибупрофен 5 -10 мг/кг Физические методы охлаждения При неэффективности – в/м литическая смесь (анальгин+супрастин) При неэффективности – см. «бледная» лихорадка!}

Pdf-img/38539692_133631651.pdf-12.jpg" alt="> Emergency care for “pale” fever IM lytic mixture: ü"> Неотложная помощь при «бледной» лихорадке в/м литическая смесь: ü 50% р-р метамизола натрия (анальгин) 0, 1 мл/год üР-р хлорпирамина (Супрастин) 0, 1 мл/год üР-р дротаверина (Но-шпа) 0, 1 мл/год!}

Pdf-img/38539692_133631651.pdf-13.jpg" alt="> Assessment of the effectiveness of antipyretic therapy For “pink” fever - a decrease in t by"> Оценка эффективности антипиретической терапии При «розовой» лихорадке – снижение t на 0, 5* за 30 минут При «бледной» лихорадке – переход в «розовую» и снижение t на 0, 5* за 30 минут!}

Pdf-img/38539692_133631651.pdf-14.jpg" alt="> Indications for emergency hospitalization Ineffective use of two or more regimens"> Показания к экстренной госпитализации Неэффективное использование двух и более схем терапии Неэффективное применение стартовой терапии при «бледной» лихорадке у детей первого года жизни Сочетание устойчивой лихорадки с прогностически неблагоприятными факторами риска!}

Pdf-img/38539692_133631651.pdf-15.jpg" alt="> Task 2. A 4-year-old child suddenly"> Задача 2. У ребенка 4 лет внезапно тошнота, рвота, боли в животе. Со слов матери за час до этого ребенок случайно выпил жидкость для мытья посуды. При осмотре: состояние тяжелое, возбужден, температура нормальная, кожные покровы бледные, тахикардия до 120 в минуту, АД повышено до 115/80 мм. рт. ст. , живот мягкий, болезненный в эпигастрии. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-16.jpg" alt=">Acute exogenous poisoning">!}

Pdf-img/38539692_133631651.pdf-17.jpg" alt="> Task 2. A 4-year-old child suddenly"> Задача 2. У ребенка 4 лет внезапно тошнота, рвота, боли в животе. Со слов матери за час до этого ребенок случайно выпил жидкость для мытья посуды. При осмотре: состояние тяжелое, возбужден, температура нормальная, кожные покровы бледные, тахикардия до 120 в минуту, АД повышено до 115/80 мм. рт. ст. , живот мягкий, болезненный в эпигастрии. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-18.jpg" alt="> keep the child in a supine position without a pillow if vomiting occurs"> удерживать ребенка в положении на спине без подушки, при возникновении рвоты - удерживать голову в боковом положении настойчиво предлагать выпить жидкость (воду, молоко, чай, сок) в привычном количестве, после каждого эпизода рвоты - повторный прием жидкости дать выпить растворенный в воде активированный уголь (1 таблетку на год жизни) госпитализация в токсикологическое отделение!}

Pdf-img/38539692_133631651.pdf-19.jpg" alt="> Task 2. A 4-year-old child suddenly"> Задача 2. У ребенка 4 лет внезапно тошнота, рвота, боли в животе. Со слов матери за час до этого ребенок случайно выпил жидкость для мытья посуды. При осмотре: состояние тяжелое, возбужден, температура нормальная, кожные покровы бледные, тахикардия до 120 в минуту, АД повышено до 115/80 мм. рт. ст. , живот мягкий, болезненный в эпигастрии. 3. Какова тактика дальнейшего лечения?!}

Pdf-img/38539692_133631651.pdf-20.jpg" alt="> Removing poison that has not entered the bloodstream from the stomach (inducing vomiting or"> Удаление яда, не поступившего в кровь из желудка (вызывание рвоты или промывание желудка), из кишечника (назначение слабительных средств, очистительная или сифонная клизма) Удаление яда, поступившего в кровь - форсированный диурез, экстракорпоральная детоксикация, перитонеальный диализ, заменное переливание крови. Антидотная терапия Посиндромная терапия!}

Pdf-img/38539692_133631651.pdf-21.jpg" alt="> Clinic of acute exogenous poisoning Latent period Toxigenic (resorptive) period"> Клиника острых экзогенных отравлений Латентный период Токсигенный (резорбтивный) период Соматогенный период (период поздних осложнений) Восстановительный период!}

Pdf-img/38539692_133631651.pdf-22.jpg" alt=">Emergency care for acute poisoning 1. Removal of the victim from the lesion"> Неотложная помощь при острых отравлениях 1. Удаление пострадавшего из очага поражения 2. Удаление невсосавшегося яда (с кожи, слизистых, из ЖКТ) 3. Удаление всосавшегося яда 4. Антидотная терапия 5. Симптоматическая терапия!}

Pdf-img/38539692_133631651.pdf-23.jpg" alt="> Removing poison from the gastrointestinal tract Inducing vomiting contraindications: üUnconscious state"> Удаления яда из ЖКТ Вызов рвоты противопоказания: üБессознательное состояние ребенка üПри проглатывании сильных кислот, щелочей, растворителей и др. повреждающих СО, пенящихся жидкостей Энтеросорбенты (уголь, полифепам и др.) Зондовое промывание желудка противопоказания üСудорожный синдром, декомпенсация кровообращения и дыхания üОтравление прижигающими средствами, если прошло более 2 часов üОтравление барбитуратами спустя 12 часов Очистительная клизма при находении яда в организме более 2 х часов!}

Pdf-img/38539692_133631651.pdf-24.jpg" alt="> ACUTE POISONING 1. Put the child to bed. 2."> ОСТРЫЕ ОТРАВЛЕНИЯ 1. Уложить ребенка в постель. 2. Если отмечаются явления угнетения или возбуждения ЦНС, потеря сознания, то детей старшего возраста фиксируют, а детей грудного и ясельного возраста пеленают. 3. Во избежание аспирации голову ребенка повернуть на бок. 4. Очистить полость рта от пищевых масс. 5. Наблюдение за больным должно быть постоянным. 6. При отравлении через рот детям старшего возраста, находящимся в сознании, контактным, дают выпить 1- 1, 5 стакана теплой питьевой воды с последующим вызыванием рвоты. Эту процедуру повторяют 3- 4 раза. Последнюю порцию воды дают с активированным углем (5 таблеток) и рвоту не вызывают. Детям младшего возраста (при сохранении акта глотания) для уменьшения концентрации токсического вещества в желудке дают питьевую воду с активированным углем (3 таблетки). 7. При попадании яда на кожу тело ребенка следует обмыть теплой водой. 8. При попадании токсического вещества на слизистую оболочку глаз их необходимо как можно быстрее промыть питьевой водой. Нельзя вызывать рвоту: у детей в сопоре и коме при отравлении кислотами или щелочами!}

Pdf-img/38539692_133631651.pdf-25.jpg" alt="> Task 3. During school, the child"> Задача 3. Во время занятий в школе ребенок 12 лет потерял сознание. Со слов одноклассников жаловался на головную боль и сонливость. При осмотре: отдергивает конечность и открывает глаза в ответ на боль, произносит нечленораздельные звуки. При осмотре отмечается сухость кожных покровов и запах ацетона изо рта. Школьный врач диагностировал гипергликемическую кому. 1. Какую оценку имеет уровень сознания ребенка по шкале Глазго?!}

Pdf-img/38539692_133631651.pdf-26.jpg" alt="> Criterion Points Motor reaction:"> Критерий Баллы Двигательная реакция: Выполняет инструкции 6 Защищает рукой область болевого раздражения 5 Отдергивает конечность в ответ на боль 4 Декортикационная ригидность (сгибание и приведение рук и 3 разгибание ног) Децеребрационная ригидность (разгибание, приведение и 2 внутренняя ротация рук и разгибание ног) Движения отсутствуют 1 Вербальная реакция: Участвует в беседе, речь нормальная; ориентация не нарушена 5 Участвует в беседе, но речь спутанная 4 Бессвязные слова 3 Нечленораздельные звуки 2 Реакция отсутствует 1 Открывание глаз: Спонтанное 4 На речь 3 На боль 2 Не открывает глаза 1 Сумма 8 из 15!}

Pdf-img/38539692_133631651.pdf-27.jpg" alt="> Task 3. During school"> Задача 3. Во время занятий в школе ребенок 12 лет потерял сознание. Со слов одноклассников жаловался на головную боль и сонливость. При осмотре: отдергивает конечность и открывает глаза в ответ на боль, произносит нечленораздельные звуки. При осмотре отчается сухость кожных покровов и запах ацетона изо рта. Школьный врач диагностировал гипергликемическую кому. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-28.jpg" alt="> restoration of free airway patency and prevention of aspiration of vomit"> восстановление свободной проходимости дыхательных путей и предупреждение аспирации рвотных масс обеспечение положения пациента, предупреждающего травматизацию при судорогах контроль жизненно важных показателей – пульса, дыхания, артериального давления при необходимости – проведение сердечно- легочной реанимации госпитализация в эндокринологическое отделение!}

Pdf-img/38539692_133631651.pdf-29.jpg" alt="> Task 4. A 1.5 year old child fell ill with an acute"> Задача 4. Ребенок 1, 5 лет заболел острой респираторной инфекцией два дня назад. На фоне подъема температуры тела до 39, 8 С возникли кратковременные клонико-тонические судороги. В анамнезе – перинатальное поражение ЦНС. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-30.jpg" alt=">Febrile convulsions due to infectious fever.">!}

Pdf-img/38539692_133631651.pdf-31.jpg" alt="> Task 4. A 1.5 year old child fell ill with an acute"> Задача 4. Ребенок 1, 5 лет заболел острой респираторной инфекцией два дня назад. На фоне подъема температуры тела до 39, 8 С возникли кратковременные клонико-тонические судороги. В анамнезе – перинатальное поражение ЦНС. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-32.jpg" alt="> ensuring airway patency and preventing tongue retraction prevention of injury"> обеспечения проходимости дыхательных путей и предупреждение западения языка профилактика травматизации освободить от тесной одежды, затрудняющей дыхание и обеспечить ему доступ свежего воздуха в/м введение диазепама 0, 05 мл/кг (0, 3 мг/кг) снижение температуры госпитализация в инфекционный стационар!}

Pdf-img/38539692_133631651.pdf-33.jpg" alt="> Task 5. A 2-year-old child fell ill acutely 24 hours"> Задача 5. Ребенок 2 лет заболел остро сутки назад: отмечалась повторная рвота, затем обильный жидкий стул 8 раз, лихорадка до 37, 7 С. При осмотре: кожные покровы и слизистые оболочки сухие, отмечаются акроцианоз, замедление расправления кожной складки до 2 секунд, Со слов матери объем мочи меньше обычного. Масса тела снижена на 8%. 1. Какая степень дегидратации у ребенка?!}

Pdf-img/38539692_133631651.pdf-34.jpg" alt="> I degree - loss of 4–5% of body weight (mild severity)"> I степень - потеря 4– 5% массы тела (лёгкая степень тяжести) II степень - потеря 6– 9% массы тела (средняя степень тяжести) III степень - потеря более 9% массы тела (тяжёлая степень)!}

Pdf-img/38539692_133631651.pdf-35.jpg" alt="> Task 5. A 2-year-old child fell ill acutely 24 hours"> Задача 5. Ребенок 2 лет заболел остро сутки назад: отмечалась повторная рвота, затем обильный жидкий стул 8 раз, лихорадка до 37, 7 С. При осмотре: кожные покровы и слизистые оболочки сухие, отмечаются акроцианоз, замедление расправления кожной складки до 2 секунд, Со слов матери объем мочи меньше обычного. Масса тела снижена на 8%. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-36.jpg" alt="> oral rehydration with glucose-saline solution (Rehydron) at the rate of 80 ml/kg for 6"> пероральная регидратация глюкозо-солевым раствором (регидрон) из расчета 80 мл/кг за 6 часов госпитализация в инфекционный стационар!}

Pdf-img/38539692_133631651.pdf-37.jpg" alt="> Problem 6. An 8-year-old child has"> Задача 6. У ребенка 8 лет во время лечения у стоматолога после проведения анестезии появились жалобы на головную боль, нарастающую слабость, заложенность носа, затруднение дыхания, боли в животе. При осмотре кожные покровы бледные, отмечаются элементы крапивницы, пульс слабого наполнения, 145 в минуту, систолическое давление 30 мм. рт. ст. , диастолическое не определяется. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-38.jpg" alt=">Anaphylactic shock.">!}

Pdf-img/38539692_133631651.pdf-39.jpg" alt="> Problem 6. An 8-year-old child has"> Задача 6. У ребенка 8 лет во время лечения у стоматолога после проведения анестезии появились жалобы на головную боль, нарастающую слабость, заложенность носа, затруднение дыхания, боли в животе. При осмотре кожные покровы бледные, отмечаются элементы крапивницы, пульс слабого наполнения, 145 в минуту, систолическое давление 30 мм. рт. ст. , диастолическое не определяется. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-40.jpg" alt="> ANAPHYLACTIC REACTIONS Emotional and involuntary motor restlessness, “fear of death”"> АНАФИЛАКТИЧЕСКИЕ РЕАКЦИИ Эмоциональное и непроизвольное двигательное беспокойство, «страх смерти» Внезапный кожный зуд, осиплость голоса, связанные с приемом пищи, лекарственных препаратов, укусом насекомых. Осложненный аллергологический анамнез. АНАФИЛАКТИЧЕСКАЯ РЕАКЦИЯ 1. Прекратить поступление аллергена в организм 2. Уложить ребенка горизонтально 3. Оценить окраску кожи и слизистых оболочек, распространенность цианоза 4. Измерить артериальное давление 5. Отметить характер одышки!}

Pdf-img/38539692_133631651.pdf-41.jpg" alt="> Crimson face, severe pallor of the skin, ashy cyanotic lips and nails"> Багровое лицо, резкая бледность кожи, пепельно – цианотичные губы и ногти Артериальная гипотония Тахикардия АНАФИЛАКТИЧЕСКИЙ ШОК 1. Адреналин 1: 1000 – 0, 01 мг/кг 2. Преднизолон – 5 мг/кг в/м в мышцы дна полости рта 3. Доступ к вене: глюкозо – солевой раствор 20 мл/кг/ч в/в 4. При отеке гортани – мероприятия по восстановлению ее проходимости. 5. Оксигенотерапия 6. Вызов реаниматолога!}

Pdf-img/38539692_133631651.pdf-42.jpg" alt="> Emergency measures for anaphylactic shock: laying the patient on his back with raised arms"> Неотложные мероприятия при анафилактическом шоке укладка больного на спине с приподнятыми ногами введение в/в, в/м или п/к раствора адреналина 1: 1000 - 0, 1 мл/кг, при необходимости - повторно через 10 -15 минут введение преднизолона в дозе 2 мг/кг (или другого глюкокортикоида), при необходимости - повторно через 10 -15 минут ингаляция сальбутамола, госпитализация в отделение реанимации!}

Pdf-img/38539692_133631651.pdf-43.jpg" alt="> Task 8 A 1.5 year old child has ARVI"> Задача 8 У ребенка 1, 5 лет на фоне ОРВИ ночью отмечено появление грубого «лающего» кашля, шумного дыхания, при крике – голос осиплый. Мальчик беспокоен, цианоз носогубного треугольника. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-44.jpg" alt="> Acute stenotic laryngotracheitis (larynx stenosis, “false” croup) against the background"> Острый стенозирующий ларинготрахеит (стеноз гортани, «ложный» круп) на фоне ОРВИ!}

Pdf-img/38539692_133631651.pdf-45.jpg" alt="> Laryngeal stenosis (croup syndrome) I degree"> Стеноз гортани (синдром крупа) I степень (компенсация) – грубый кашель, несколько затрудненное дыхание при бодрствовании, ДН – нет II степень (субкомпенсация) – беспокойство, шумное дыхание с участием вспомогательной мускулатуры уступчивых мест, инспираторная одышка, периоральный цианоз, «лающий кашель» III степень (декомпенсация) – усиление всех симптомов, резкая инспираторная одышка, исчезает кашель, бледность кожи, цианоз губ, акроцианоз, потливость, агрессивнос тахикардия IV степень (терминальная) – поверхностное дыхание, пульс слабый, иногда не определяется, тоны сердца глухие, резкая бледность кожи, может быть судороги, нарушение ритма дыхания. Асфиксия!}

Pdf-img/38539692_133631651.pdf-46.jpg" alt="> Task 8 A 1.5 year old child has ARVI"> Задача 8 У ребенка 1, 5 лет на фоне ОРВИ ночью отмечено появление грубого «лающего» кашля, шумного дыхания, при крике – голос осиплый. Мальчик беспокоен, цианоз носогубного треугольника. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-47.jpg" alt="> ACUTE STENOSING LARYNGOTRACHEITIS (OSLT) 1. Calm the child, limit negative"> ОСТРЫЙ СТЕНОЗИРУЮЩИЙ ЛАРИНГОТРАХЕИТ (ОСЛТ) 1. Успокоить ребенка, ограничить отрицательные эмоции 2. Теплое щелочное питьё 3. Паровые ингаляции с содой, создание эффекта «тропической атмосферы» 4. Ингаляции муколитических препаратов, β 2 - агонистов и ипротропиума бромида (беродуал, атровент), рацемического адреналина (разведение 1: 8) 5. Ингаляционные кортикостероиды (пульмикорт) 6. Отвлекающая терапия (горячие ванны общие или для рук и ног, компресс на область гортани) 7. Анемизирующие капли в нос 8. Антигистаминные препараты 9. При нарастающих явлениях стеноза – глюкокортикостероиды парентерально 10. Лечение основного заболевания!}

Pdf-img/38539692_133631651.pdf-48.jpg" alt=">Broncho-obstruction">!}

Pdf-img/38539692_133631651.pdf-49.jpg" alt=">Acute obstructive bronchitis dry cough wheezing expiratory shortness of breath"> Острый обструктивный бронхит сухой кашель свистящее дыхание экспираторная одышка сухие и влажные хрипы в легких Лечение: Ø Бронхолитики Ø Муколитические и отхаркивающие средства Ø Вибромассаж и постуральный дренаж!}

Pdf-img/38539692_133631651.pdf-50.jpg" alt=">Broncholytic therapy in children β 2 - short-acting agonists (salbutamol, phenterol)"> Бронхолитическая терапия у детей β 2 – агонисты короткого действия (сальбутамол, фентерол) Антихолинэргические препараты (ипратропиума бромид) Комбинированные (ипратропиума бромид+фенотерол=Беродуал)!}

Pdf-img/38539692_133631651.pdf-51.jpg" alt="> Berodual (inhalation via nebulizer) 0 -5 years: 1"> Беродуал (ингаляции через небулайзер) 0 -5 лет: 1 капля/кг массы 3 -4 раза в сутки 5 лет и старше: 2 капли/год жизни 3 -4 раза в сутки +2 -3 мл физ. раствора!}

Pdf-img/38539692_133631651.pdf-52.jpg" alt=">Budesonide (Pulmicort) suspension (250 mcg/ml, 500 mcg/ml) Children from 6 months: 0,"> Будесонид (Пульмикорт) суспензия (250 мкг/мл, 500 мкг/мл) Дети с 6 месяцев: 0, 25 -1 мг/сут 2 -3 ингаляции в сутки Доза зависит от тяжести БОС Ингаляция ГКС через 15 -20 мин. после ингаляции бронхолитика !При ОСЛТ – до 2 мг ингаляционно!!}

Pdf-img/38539692_133631651.pdf-53.jpg" alt=">Nebulizer inhalations for children PARI Junior. BOY S">!}

Pdf-img/38539692_133631651.pdf-54.jpg" alt="> Indications for hospitalization of children with BOS that developed against the background of ARVI:"> Показания для госпитализации детей с БОС, развившемся на фоне ОРВИ: Неэффективность проведения лечения в домашних условиях в течение 1 -3 часов Выраженная тяжесть состояния больного Дети из групп высокого риска осложнений По социальным показаниям При необходимости установления природы БОС и подбора средств терапии при впервые возникших приступах удушья!}

Pdf-img/38539692_133631651.pdf-55.jpg" alt="> ACUTE UPPER AIRWAY OBSTRUCTION INSPIRATIONAL DYSPHERENE, SIGNS"> ОСТРАЯ ОБСТРУКЦИЯ ВЕРХНИХ ДЫХАТЕЛЬНЫХ ПУТЕЙ ИНСПИРАТОРНАЯ ОДЫШКА, ПРИЗНАКИ УСИЛЕНИЯ РАБОТЫ ДЫХАНИЯ, ГИПОКСИИ ПРЕОБЛАДАЕТ НАРУШЕНИЕ ДЫХАНИЯ, СТЕНОЗ ВДП ПРЕОБЛАДАЕТ НАРУШЕНИЕ ГЛОТАНИЯ ВНЕЗАПНОЕ ПОСТЕПЕННОЕ НАЧАЛО ИНТОКСИКАЦИЯ, t>=38 С НАЧАЛО С ИНФЕКЦИОННОЙ ПРОДРОМОЙ САЛИВАЦИЯ, ВЫНУЖДЕННОЕ ПОЛОЖЕНИЕ АФОНИЯ ГОЛОВЫ, БОЛЬ ПРИ ГЛОТАНИИ РАНО, ФОН ЕСТЬ НЕТ ДН ПОЗДНЕЕ ЗДОРОВ ОТЯГОЩЕН ОСМОТР ЗЕВА РЫХЛЫЙ, ЗНАЧИТЕЛЬНЫЙ КАШЕЛЬ ГИПЕРЕМИРОВАН ОТЕК ЗЕВА И 1 -СТОРОННИЙ ОТЕК ОТЕК, ВЫБУХАНИЕ, ПОДЧЕЛЮСТНЫХ РАХИТ, АЛЛЕРГИЯ, МИНДАЛИН, НЕБНЫХ ГИПЕРЕМИЯ Л/У, СЕРЫЕ СПАЗМОФИЛИЯ, ПОВТОР ОСЛТ ДУЖЕК, ВЫБУХАНИЕ, ЗАДНЕЙ СТЕНКИ НАЛЕТЫ, «ПЕТУШИНЫЙ» ПРИСТУПА ГИПЕРЕМИЯ ГЛОТКИ НЕПРИЯТНЫЙ КРИК ЗАПАХ СЕРЫЙ НАЛЕТ НА ПЕРИТОНЗИ МИНДАЛИНАХ, ИНОРОДНОЕ t>=38, 5 С. ЛЯРНЫЙ ГЕПАТОСПЛЕНОМЕГА АЛЛЕРГИЧЕСКИЙ ОТЕЧНЫЙ ЯРКО- ТЕЛО, ВДП АБСЦЕСС ЛИЯ, СЫПЬ, ОТЕК ГОРТАНИ МАЛИНОВЫЙ ДИФТЕРИЯ ЛИМФАДЕНОПАТИЯ НАДГОРТАННИК ЛАРИНГОСПАЗМ ЗЕВА И ЗАГЛОТОЧНЫЙ ГОРТАНИ ЭПИГЛОТТИТ МОНОНУКЛЕОЗ АБСЦЕСС ГИСТАМИНОЛИТИК ПРОТИВОДИФТЕРИЙНАЯ ООТВЛЕКАЮЩАЯ СЫВОРОТКА, В/М ПРЕДНИЗОЛОН ТЕРАПИЯ ПЕНИЦИЛЛИН В/В 10% р-р Ca. Cl 2 0, 5 мл/кг ЛЕВОМИЦИТИН В/М 25 МГ/КГ. АБ ГРУППЫ ПЕНИЦИЛЛИНОВ. СЕДУКСЕН 0, 3 г/кг ИНФУЗИОННАЯ ТЕРАПИЯ В ПРИ ДН – НАЗОФАРИНГЕАЛЬНЫЙ ПОЛОЖЕНИИ СИДЯ ВОЗДУХОВОД!}

Pdf-img/38539692_133631651.pdf-56.jpg" alt=">ACUTE BRONCHIAL OBSTRUCTION SYNDROME IN YOUNG CHILDREN Child up to"> СИНДРОМ ОСТРОЙ БРОНХИАЛЬНОЙ ОБСТРУКЦИИ У ДЕТЕЙ РАННЕГО ВОЗРАСТА Ребенок до 3 лет (экспираторная одышка, признаки усиленной работы дыхания, гипоксии, аускультативно большое количество сухих и влажных разнокалиберных хрипов, эмфизема) Признаки ЗСН: чрезмерная тахикардия, Нет гепатомегалия, «влажное» легкое. Осложнения Гипероксидная проба+/- перинатального периода, в анамнезе длительная Исключайте «Сердечная кислородозависимость 5 -7 сут ОРВИ, кашель, Есть распространенные сухие кардит, токсикоз астма» детей и локализованные Кишша раннего возраста мелкопузырчат. хрипы Есть Вирусно- Диуретики: Нет бактериальный лазикс+верошпирон. К- эндобронхит препараты, Клинико- 1 -2 сут ОРВИ, распростр. функциональные Есть СГ-насыщение. мелкопузырчатые хрипы, признаки Оксигенотерапия 1 -й приступ СОБО гидроцефально- 1 -2 сут ОРВИ, распростр. RS, парагрипп? гипертензионного Нет Аэрозоль с антибиотиками, синдрома мелкопузырчатые хрипы, Бронхиолит муколитики, отхаркивающие повторные приступы СОБО средства, щелочное питье Нет Есть Симптоматический бронхиолоспазм Бронхиолит с УЗ-аэрозоль. Рибоварин реагиновым 20 мг/мл ОДН компонентом 6 -12 ч. Оксигенотерапия Оксигенотерапия, в/м лазикс 1 мг/кг. Терапия острого приступа БА Госпитализация в СО Эуфиллин 4 мг/кг в/в!}

Pdf-img/38539692_133631651.pdf-57.jpg" alt=">Obstruction of the airways by a foreign body">!}

Pdf-img/38539692_133631651.pdf-58.jpg" alt="> SUSPECTED ASPIRATION OF A FOREIGN BODY IN THE LARRYNX OR TRACHEA"> ПОДОЗРЕНИЕ НА АСПИРАЦИЮ ИНОРОДНОГО ТЕЛА ГОРТАНИ ИЛИ ТРАХЕИ У предварительно здорового ребенка во время еды или игры внезапное ухудшение состояния с приступом навязчивого кашля, рвота, затем разлитой цианоз, асфиксия и утрата сознания Инородное тело Осмотр ротоглотки не видно «Выдвинуть» нижнюю челюсть ребенка, провести 2 -3 пробных экспираторных вдоха Движение грудной клетки ребенка во время искусственного вдоха, дыхательные шумы аускультативно Удалить Конико- или инородное Нет Есть трахеотомия тело Применить прием механического «выбивания» инородного тела Осмотреть ротоглотку Инородное тело есть Инородного тела нет Удалить Продолжать искусственное инородное дыхание тело и интубировать трахею Мероприятия АВС реанимации. Срочная помощь реаниматолога!}

Pdf-img/38539692_133631651.pdf-59.jpg" alt="> For children over 1 year old, perform the Heimlich maneuver. Procedure:"> У детей старше 1 года выполняют прием Геймлиха Порядок действий: Встать за спиной ребенка (детей раннего возраста держат на коленях лицом от себя). Одну руку, сжатую в кулак, положить на живот между пупком и мечевидным отростком. Ладонь другой руки положить поверх кулака. Провести несколько резких толчков в эпигастральную область в направлении вверх к диафрагме (не сдавливая грудную клетку).!}

Pdf-img/38539692_133631651.pdf-60.jpg" alt="> The use of the Heimlich maneuver in infants is not recommended,"> Применение приема Геймлиха у грудных детей не рекомендуют, из-за опасности повреждения органов брюшной полости Порядок действий: 1. Ребенка кладут лицом вниз с несколько опущенным головным концом на предплечье 2. Средним и большим пальцами одной руки поддерживать рот ребенка приоткрытым 3. Производят до 5 ударов ладонью другой руки между лопаток. Нельзя пытаться извлечь инородное тело руками, так при этом можно протолкнуть его еще глубже!!}

Pdf-img/38539692_133631651.pdf-61.jpg" alt="> Prehospital resuscitation (Peter Safar's ABC) A (Air ways)"> Реанимация на догоспитальном этапе (Азбука Питера Сафара) А (Air ways) - восстановление проходимости дыхательных путей В (Breath) - обеспечение дыхания и оксигенации С (Circulation) - восстановление кровообращения!}

Pdf-img/38539692_133631651.pdf-62.jpg" alt="> Restoring airway patency, take the patient’s head back,"> Восстановление проходимости дыхательных путей голову больного отвести назад, открыть рот, осмотреть и салфеткой, намотанной на палец, очистить полость рта от инородных предметов Удалить изо рта и глотки слизь и слюну можно с помощью электроотсоса или резиновой груши. выпрямить дыхательные пути за счёт затылочного сгибания головы и подкладывания валика под плечи. приподнять нижнюю челюсть больного, при возможности - установить S-образный воздуховод.!}

Pdf-img/38539692_133631651.pdf-63.jpg" alt="> Providing respiration and oxygenation using non-apparatus expiratory ventilation method"> Обеспечение дыхания и оксигенации безаппаратная экспираторная вентиляция способом «изо рта в рот» или «изо рта в нос и рот» при возможности используется мешок Амбу!}

Pdf-img/38539692_133631651.pdf-64.jpg" alt=">Artificial ventilation using an Ambu bag">!}

Pdf-img/38539692_133631651.pdf-65.jpg" alt="> Restoring blood circulation, lay the patient on his back on a hard surface. closed"> Восстановление кровообращения уложить больного на спину на твердую поверхность. закрытый массаж сердца: § детям первых месяцев жизни - пальцами обеих рук, большие пальцы кладутся на нижнюю треть грудины, а остальные помещают на спину § Детям до 5 -7 лет - одной рукой, проксимальную часть ладони накладывают на нижнюю треть грудины § Детям старше 7 лет - проксимальными частями обеих кистей, сложенными крест накрест. Частота сжатий грудной клетки должна соответствовать частоте сердечных сокращений у ребенка определенного возраста - от 80 до 120 в минуту.!}

Pdf-img/38539692_133631651.pdf-66.jpg" alt=">CLOSED HEART MASSAGE IN CHILDREN Age Method Hand position Depth"> ЗАКРЫТЫЙ МАССАЖ СЕРДЦА У ДЕТЕЙ Возраст Метод Положение рук Глубина Частота, спасающего на груди вдавления в мин ребенка грудной клетки Концами двух пальцев На ширину одного пальца До 1 года 1 – 2 см 100 ниже сосковой линии Одной ладонью Нижняя треть 1 – 7 лет 2 – 3 см 80 – 100 грудины Кисти обеих рук Старше Нижняя треть 4 – 5 см 80 10 лет грудины!}

Pdf-img/38539692_133631651.pdf-67.jpg" alt="> CARDIO-PULMONARY RESUSCITATION Assess the clinical manifestations of TS"> СЕРДЕЧНО – ЛЕГОЧНАЯ РЕАНИМАЦИЯ Оцените клинические проявления ТС 1. Механически удалите из ротовой полости и глотки слизь и рвотные массы 2. Фиксируйте голову в строго сагиттальном положении и не А. Airways разгибайте (при подозрении на травму шейного отдела Очистка дыхательных путей позвоночника) или слегка запрокиньте ее и выпрямите и создание их свободной дыхательные пути проходимости 3. Выдвиньте вперед нижнюю челюсть ребенка 1. Провести 2 -3 искусственных вдоха («изо рта в рот» или «изо рта в рот и нос»), оцените движение грудной клетки (проведение и глубина дыхания). 2. При возможности перейдите на дыхание через маску с В. Breathing помощью мешка Амбу, системы Айра с добавлением Обеспечение дыхания кислорода. 3. ЧД искусственного дыхания-соответствует возрастной ЧД, глубина-движение грудной клетки, подобно возрастному глубокому вдоху. 4. Контроль – уменьшение степени цианоза С. Circulation 1. Оцените пульс, аускультативно ЧСС и АД Восстановление 2. При отсутствии пульса на бедренной или кровообращения сонной артерии начинайте ЗМС. (циркуляции) 3. Соотношение ЗМС: ИВЛ – 4: 1!}

Pdf-img/38539692_133631651.pdf-68.jpg" alt="> Basic support for vital functions">!}

Pdf-img/38539692_133631651.pdf-69.jpg" alt=">Basic support of vital functions in young children">!}

Pdf-img/38539692_133631651.pdf-71.jpg" alt="> POLYTRAUMA 1. Eliminate the effect of the traumatic agent 2. Assess the child’s condition,"> ПОЛИТРАВМА 1. Устранить действие травмирующего агента 2. Оценить состояние ребенка, осмотреть его 3. Привлекая помощника или самостоятельно вызвать скорую медицинскую помощь 4. Остановить наружное кровотечение, наложить повязки 5. Обеспечить проходимость дыхательных путей 6. Оценить состояние витальных функций 7. Оценить уровень сознания 8. Придать пострадавшему необходимое в зависимости от вида травмы положение 9. Измерить АД, пульс (при необходимости провести СЛР) 10. Контролировать состояние ребенка до прибытия скорой медицинской помощи.!}

Description="">

Pdf-img/38539692_133631651.pdf-73.jpg" alt="> ACUTE INFECTIOUS TOXICOSIS IN CHILDREN Neurotoxicosis is a severe form of encephalic reaction due to"> ОСТРЫЙ ИНФЕКЦИОННЫЙ ТОКСИКОЗ У ДЕТЕЙ Нейротоксикоз – тяжелая форма энцефалической реакции вследствие инфекционного и токсического повреждения ЦНС. 1. При гипертермическом синдроме - парацетамол 10 -15 мг/кг или ибупрофен (детям старше 3 месяцев) 5 -10 мг/кг внутрь, или 50% р-р анальгина в дозе 0, 1 -0, 2 мл/год жизни в/м или в/в. 2. При менингеальном синдроме – преднизолон 2 -3 мг/кг в/в или в/м. лазикс 1 -3 мг/кг в/в или в/м. 3. При судорогах – бензодиазепины (седуксен, реланиум, диазепам) в дозе 0, 2 -0, 5 мг/кг в/в медленно, лазикс 1 -3 мг/ в/в, преднизолон 2 -3 мг/кг в/в. 4. Эндотелиотропная терапия – L-лизина эсцинат у детей в возрасте 1 -5 лет 0, 22 мг/кг, 5 -10 лет – 0, 18 мг/кг, 10 -14 лет – 0, 15 мг/кг, старше 14 лет – 0, 12 мг/кг с 0, 9% р-ром натрия хлорида в/в медленно. 5. Госпитализация в ОИТ.!}

Pdf-img/38539692_133631651.pdf-74.jpg" alt="> ACUTE HEART FAILURE Emergency care should begin immediately,"> ОСТРАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ Неотложная помощь должна начинаться немедленно, чтобы избежать отека легких и угнетения дыхательного центра. 1. Вызвать скорую медицинскую помощь 2. Обеспечить полный покой в постели с приподнятым изголовьем. 3. Освободить от стесняющей одежды. 4. Респираторная терапия: при наличии умеренно выраженной одышки и акроцианоза – ингаляция 100% кислорода с темпом 10 - 12 л/мин. ; при резко выраженной одышке и цманозе, отсутствии или патологических типах дыхания – после предварительной премедикации 0, 1% метацина 0, 1 мл/год жизни (не более 0, 5 мл) в/в, кетамина 5 мг/кг в/в – интубация трахеи и перевода на ИВЛ. 5. Регуляция преднагрузки: 2% папаверин 1 мг/кг и 1% дибазол 0, 1 - 1 мл в/в; при асистолии – реанимационные мероприятия. 6. Срочная госпитализация в ОИТ.!}

Pdf-img/38539692_133631651.pdf-75.jpg" alt="> PULMONARY BLEEDING Cough with bright red frothy blood,"> ЛЕГОЧНОЕ КРОВОТЕЧЕНИЕ Кашель с ярко - красной пенистой кровью, вызванный глоточными и гортанными рефлексами при кровотечении из носа и верхних отделов пищеварительного тракта Подозрение на легочное кровотечение 1. Придать ребенку полусидячее положение 2. Успокоить ребенка 3. Не давать горячую пищу, чай 4. Оценить витальные признаки: Окраску кожи и слизистых оболочек Характер дыхания Пульс АД 5. Осмотрите полость рта и носоглотку (источник кровотечения), оцените характер теряемой крови 6. Обеспечьте свободную проходимость ВДП 7. Положить пузырь со льдом или холодной водой на грудь 8. Соберите анамнез!}

Pdf-img/38539692_133631651.pdf-76.jpg" alt="> NOSELEED 1. Calm the child 2. Give him"> НОСОВОЕ КРОВОТЕЧЕНИЕ 1. Успокоить ребенка 2. Придать ему сидячее или полусидячее положение, голову ребенка слегка наклонить вперед 3. В носовые ходы вставить марлевые тампоны, обильно смоченные 3% перекисью водорода. 4. Прижать крылья носа к носовой перегородке на 10 -15 минут 5. Холод на переносицу 6. Собрать анамнез при носовом кровотечении НЕЛЬЗЯ: Сморкаться Запрокидывать голову Тампонировать нос ватой!}

Pdf-img/38539692_133631651.pdf-77.jpg" alt="> LOSS OF CONSCIOUSNESS (DEPTH OF COMA) CHILD WITHOUT"> УТРАТА СОЗНАНИЯ (ГЛУБИНА КОМЫ) РЕБЕНОК БЕЗ ЦЕЛЕНАПРАВЛЕННАЯ РЕАКЦИЯ НА БОЛЬ СОЗНАНИЯ НЕТ ИЛИ ЕСТЬ НЕДИФФЕРЕНЦИРОВАНА ПРЕКОМА РЕФЛЕКСЫ С РОТОГЛОТКИ КОМА НЕТ ТЕРАПИИ НЕ ТРЕБУЕТ. ЕСТЬ ТАКТИКА В ЦЕНТРАЛЬНЫЕ НАРУШЕНИЯ ДЫХАНИЯ И ГЕМОДИНАМИКИ ЗАВИСИМОСТИ ОТ ПРИЧИНЫ ЕСТЬ НЕТ КОМА III ОЧИСТКА ВДП; КОМА I КОМА II ИВЛ МАСКОЙ 100% КИСЛОРОДОМ В ОКСИГЕНОТЕРАПИЯ; РЕЖИМЕ ГИПЕРВЕНТИЛЯЦИИ; ДОСТУП К ВЕНЕ; ТРОПИН 0, 1% 0, 1 МЛ/ГОД ЖИЗНИ; АТРОПИН 0, 1% 0, 1 МЛ/ГОД ЖИЗНИ; ДРУГАЯ ПОМОЩЬ В ИНТУБАЦИЯ ТРАХЕИ; ИНТУБАЦИЯ ТРАХЕИ ЧЕРЕЗ ЗАВИСИМОСТИ ОТ ПРИЧИНЫ ДОСТУП К ВЕНЕ; ИНТУБАЦИОННУЮ ТРУБКУ; КОМЫ; ДРУГАЯ ПОМОЩЬ В ЗАВИСИМОСТИ ОТ ДОСТУП К ВЕНЕ; ГОСПИТАЛИЗАЦИЯ В ПРИЧИНЫ КОМЫ; ИНФУЗИОННАЯ ТЕРАПИЯ 30 -40 ПОЛОЖЕНИИ НА БОКУ В ГОСПИТАЛИЗАЦИЯ В МЛ/КГ/ЧАС ДО СТАБИЛИЗАЦИИ АД; РЕАНИМАЦИОННОЕ ОТДЕЛЕНИЕ ЕСЛИ АД НЕ СТАБИЛИЗИРОВАНО- ВВЕДЕНИЕ АДРЕНОМИМЕТИКОВ В/В; ПРЕДНИЗОЛОН 3 МГ/КГ; ПРОБА НА ПЕРЕКЛАДЫВАНИЕ ДРУГАЯ ПОМОЩЬ В ЗАВИСИМОСТИ ОТ ПРИЧИНЫ КОМЫ СОСТОЯНИЕ СТАБИЛЬНО НЕ СТАБИЛЬНО БОЛЬНОЙ НЕ ТРАНСПОРТАБЕЛЕН, ПРОДОЛЖИТЬ МЕРОПРИЯТИЯ ПО ГОСПИТАЛИЗАЦИЯ В РЕАНИМАЦИОННОЕ ОТДЕЛЕНИЕ СТАБИЛИЗАЦИИ СОСТОЯНИЯ!}

Pdf-img/38539692_133631651.pdf-78.jpg" alt="> BURNS 1. Eliminate the damaging factor 2. Release"> ОЖОГИ 1. Устранить действие повреждающего фактора 2. Освободите поврежденный участок тела от одежды (разрезать). 3. Наложите на рану асептическую повязку 4. При химическом ожоге охладить обожженную часть тела под струей холодной воды (за исключением ожогов известью)или приложением холода. 5. Дать пострадавшему теплое питье. 6. Обеспечить покой. Запрещается Вскрывать ожоговые пузыри Срывать с пораженной поверхности части обгоревшей одежды Наносить на пораженные участки мази, жиры.!}

Pdf-img/38539692_133631651.pdf-79.jpg" alt="> INHALATION INJURY 1. It is necessary to ensure that the scene of the accident does not pose a danger. 2."> ИНГАЛЯЦИОННЫЕ ПОВРЕЖДЕНИЯ 1. Необходимо убедиться, что место происшествия не представляет опасности. 2. При необходимости следует использовать индивидуальные средства защиты. 3. Изолировать пострадавшего от воздействия газа или паров, для этого нужно вынести пострадавшего на свежий воздух. 4. Освободить пострадавшего от стесняющей дыхательные движения одежды (ремень, пояс и др.), вынести на свежий воздух. 5. Придать пострадавшему, находящему в сознании, полусидячее положение. 6. При отсутствии сознания необходимо придать пострадавшему устойчивое боковое положение, а при отсутствии дыхания надо приступить к проведению сердечно-легочной реанимации в объеме компрессий грудной клетки и искусственной вентиляции легких.!}

Pdf-img/38539692_133631651.pdf-80.jpg" alt="> OVERHEATING Eliminate exposure to heat by moving the child to a shaded or cool place"> ПЕРЕГРЕВАНИЕ Устранить воздействие тепла, переместив ребенка в тень или прохладное помещение Уложить в горизонтальное положение Освободить его от одежды Голову покрыть пеленкой, смоченной холодной водой Производить частое обмахивание При начальных проявлениях теплового удара и сохраненном сознании дать обильное питье глюкозо-солевым раствором не менее объема возрастной суточной потребности в воде. 1/2 ч. л. натрия хлорида (соль) 1/2 ч. л. натрия гидрокарбоната, 2 ст. л. сахара на 1 л воды!}

Pdf-img/38539692_133631651.pdf-81.jpg" alt="> FREEZING 1. Bring the child into a warm room 2."> ЗАМЕРЗАНИЕ 1. Внести ребенка в теплое помещение 2. Снять с него холодную, мокрую одежду и обувь 3. Уложить ребенка в теплую постель 4. Контролировать дыхание, пульс 5. Если ребенок в сознании напоить его теплым (не горячим) сладким чаем 6. Наложить на пораженную часть тела термоизолирующую ватно-марлевую повязку Нельзя оставлять ребенка на улице и растирать его снегом, спиртом! Нельзя прикладывать к пораженному участку грелку - согревание должно происходить постепенно! Нельзя погружать в горячую ванну!}

Pdf-img/38539692_133631651.pdf-82.jpg" alt="> ELECTRICAL INJURY Disconnect the electric current from the power supply, i.e."> ЭЛЕКТРОТРАВМА Отключите электрический ток из электросети, т. е. выключите рубильник (если возможно) Если Вы не можете этого сделать, встаньте на изолирующий материал: резиновый коврик, сухие газеты. Отдалите ребенка от источника электрического тока (пытайтесь отсоединить кабель от ребенка, а не руку ребенка), для этого используйте сухой предмет, который не проводит ток: деревянная палка, ручка веника, резиновые перчатки. Если рядом ничего подходящего нет, попытайтесь сделать преграду, насколько сможете, рукой, обвернув ее в сухую бумагу или одежду. Держитесь только за одежду ребенка, избегайте контакта с его кожей. Посмотрите, в сознании ли ребенок: Да Нет Успокоить ребенка Проверить есть ли Уложить удобно дыхание Проверить нет ли симптомов шока Да Нет Осмотрите участки, которые контактировали с источником Положить в ИВЛ электрического тока и землей - нет ли безопасную позицию там ожогов. Если вы их обнаружили, окажите первую помощь.!}

Pdf-img/38539692_133631651.pdf-83.jpg" alt="> DROWNING 1. Stop the flow of water into the respiratory tract."> УТОПЛЕНИЕ 1. Прекратить поступление воды в дыхательные пути. 2. Освободить полость рта и верхние дыхательные пути от воды, песка (ила, водорослей), воспользовавшись марлевым тампоном, носовым платком или другой мягкой тканью. 3. Создать дренажное положение для удаления воды – перегнуть пострадавшего ребенка через свое согнутое бедро лицом вниз и нанести удары ладонью между лопатками или приподнять, обхватив руками под эпигастральную область, надавливая на нижние отделы грудной клетки. Этим методом не пользуются, если остановка дыхания и сердечной деятельности имеет рефлекторный характер. 4. Приступить к проведению искусственного дыхания и по показаниям к комплексной сердечно-легочной реанимации по общим правилам при клинической смерти. Если самостоятельное дыхание и сердечная деятельность не восстанавливаются, то реанимацию продолжают 30 – 40 мин. 5. Если сознание у ребенка сохранено: снять мокрую одежду, растереть спиртом и тепло укутать; дать горячее питье;!}

Pdf-img/38539692_133631651.pdf-84.jpg" alt=">THANK YOU FOR YOUR ATTENTION">!}

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Student's independent work

On the topic: “Emergencies in pediatrics. First aid for children and childbirth outside the hospital"

Completed by: 1st year student, group 15

Bolotskikh Yu.

Plan

1. First aid for children. Emergency conditions in pediatrics

1.1 Anaphylactic shock

1.2 Hyperthermia

1.3 Diarrhea

1.4 Collapse

1.5 Laryngospasm

1.6 Flatulence

1.7 Stenosing laryngitis (“false croup”)

1.8 Seizures

1.9 Fainting

1.10 Acute poisoning in children

1.12 Nosebleed

1.13 Airway obstruction

2. Childbirth outside the hospital

Bibliography

1. First aid for children.Nemergency conditions in pediatrics

Every person must have thorough knowledge and skills regarding the provision of emergency pre-hospital medical care to a child in critical conditions, serious illnesses and accidents.

In children, the rapid development of life-threatening conditions is due to many factors, which include the anatomical and physiological characteristics of the child’s body, imperfect regulation of the functioning of its systems, and the presence of background diseases. After emergency care has been provided at the pre-hospital stage, without which the life of the sick child remains at risk, further treatment of the patient can be continued in the hospital.

Pediatric emergencies include:

· Anaphylactic shock

· Hyperthermia

· Collapse

· Laryngospasm

Flatulence

Stenosing laryngitis (“false croup”)

· Convulsions.

· Fainting

Acute poisoning in children

· Nose bleed.

· Obstruction of the respiratory tract.

Due to the anatomical and physiological characteristics of organs and systems, emergency conditions in children are characterized by a rapid, progressive course, often with an atypical clinical picture, which makes it difficult to correctly interpret symptoms. Most acute diseases in children require decisive, immediate action, both in terms of diagnosis and the choice of treatment tactics. It is the qualified actions of the doctor in emergency situations that are often decisive for their outcome.

1.1 Anaphylactic shock

This is a severe allergic reaction that develops rapidly (from a few minutes to 4 hours) after exposure to the allergen.

Causes: allergens may include antibiotics, especially penicillin, aspirin, novocaine, B vitamins, food products, stinging insect venom.

Clinic: manifested by loss of consciousness, shortness of breath, difficulty breathing, cyanosis (blueness) of the skin and cold sweat, blood pressure drops, palpitations occur, convulsions are observed, respiratory failure develops, including respiratory arrest.

First aid: At the first sign of shock, you should call for help. Before the ambulance arrives:

· immediately stop further entry of the allergen into the body, block its absorption. If the cause was an injection, apply a tourniquet above the injection site. If the cause is an insect bite (bee, wasp), remove the sting with tweezers. Apply ice to the bite site. If the allergen is administered orally, rinse the stomach.

· Place the child on his back with his head down and legs raised;

To prevent aspiration of vomit, turn your head to the side;

· unbutton tight clothing;

· warm the child (cover with a blanket);

· give a tablet of suprastin or tavegil.

1.2 Hyperthermia

This increase in body temperature above 37 0 C is the most common symptom of the disease in children.

Hyperthermia (fever) is a protective-compensatory reaction, due to which the body’s immune response to the disease is enhanced, as well as a symptom indicating the presence of a pathological process in the body. However, it must be remembered that, like most nonspecific protective reactions (pain, inflammation, shock), fever plays its protective adaptive role only to certain limits. With a progressive increase in temperature, there is a significant increase in the load on breathing and blood circulation (for every degree of temperature increase above 37°C, the respiratory rate increases by 4 breaths per minute, the pulse by 10 beats per minute), which leads to an increase in the supply of oxygen to the blood. But the increased amount of oxygen in the blood no longer provides the increasing tissue needs for it, hypoxia develops, from which the central nervous system primarily suffers and often develops febrile seizures. Most often, they are observed against a background of a temperature of 39-40°C, although the degree of hyperthermia at which these disorders occur is very variable and depends on the individual characteristics of the child’s body.

Types of hyperthermia

Causes: infection (viral bacterial), toxic, organic brain damage, etc.

First aid:

· Put the child to bed.

· Give plenty of fluids.

· At a temperature of 38.5°C and above, carry out physical cooling (remove clothes, rub the skin with a sponge moistened with water at room temperature, along large vessels). Do not use alcohol or alcohol-containing preparations. Give antipyretics (paracetamol, ibuprofen) at the rate of 10-15 mg/kg body weight. Aspirin and cefecone suppositories are not recommended for children to lower their temperature. up to 12 years

· After 20-30 minutes. repeat thermometry. If your condition is serious, call an ambulance.

1.3 Diarrhea

This is loose, watery stool. ( three or more times a day). Diarrhea can lead to dehydration and even death.

Causes. Diarrhea is common in young children who are fed cow's milk or formula.

Clinic. The stool is watery, sometimes with particles of undigested food, with an unpleasant odor, and may be green in color. If there is blood in the child's stool, it is dysentery. If the child is lethargic, lethargic or unconscious, has sunken eyes, cannot drink or drinks poorly, when taking a skin fold in the side of the abdomen it straightens out very slowly (more than 2 seconds), then the child is severely dehydrated and needs immediate hospitalization.

First aid.

· See a doctor immediately.

· Avoid dehydration, to do this, continue breastfeeding, if the child is breastfeeding, give the child liquids (water, compote), liquid food (for example, soup, rice water, yogurt-based drinks);

· you can prepare an ORS solution (sold in a pharmacy without a prescription) and give the child as much water as he wants.

1.4 Collapse

This is a severe form of acute vascular insufficiency.

Causes: Collapse is the result of significant blood loss or redistribution of blood in the vascular bed (most of the blood accumulates in the peripheral vessels and abdominal organs), resulting in a sharp drop in blood pressure.

Clinic:

Sudden deterioration of condition;

Paleness of the skin;

Cold clammy sweat;

Frequent thready pulse;

Low blood pressure.

First aid:

Call an ambulance.

Before the ambulance arrives:

· Place the child on a hard surface with the head down.

· Unbutton tight clothing.

· Provide access to fresh air.

1.5 Laryngospasm

Causes: most often occurs when a child is crying, screaming, or scared. Laryngospasm is one of the forms of obvious spasmophilia - a disease of children mainly of young age, characterized by a tendency to convulsions and increased neuromuscular excitability due to a decrease in the level of calcium in the body. Spasmophilia is always associated with rickets.

Clinic: manifests itself with a sonorous or hoarse breath and stopping breathing for a few seconds: at this moment the child first turns pale, then he develops cyanosis, he loses consciousness. The attack ends with a deep, sonorous “crow of a cock” breath, after which the child almost always cries, but after a few minutes he returns to normal and often falls asleep. In the most severe cases, death may result from sudden cardiac arrest.

Firsthelp:

· Place the child on a flat, hard surface.

· Unbutton tight clothing.

· Provide access to fresh air.

· Create a calm environment.

· Sprinkle the child's face and body with cold water, or cause irritation of the nasal mucosa (tickle with a cotton swab, blow into the nose, bring ammonia, or with a spatula, press on the root of the tongue with a spoon).

· In case of cardiac arrest, perform indirect cardiac massage.

1.6 Flatulence

This is bloating due to gases accumulated in the intestines.

Clinic: the child is crying, worried, the tummy is swollen, rumbling can be heard.

First aid:

· Lay the child on his back, free the lower half of the body.

· Provide access to fresh air.

· Perform a light abdominal massage in a clockwise direction.

· If there is no effect from previous measures, install a gas outlet tube.

· If there is no effect, give carbolene (activated carbon) or smecta.

· Eliminate gas-forming foods from the diet: fresh milk, carbonated drinks, vegetables, legumes, black bread.

1.7 Stenosing laryngitis(“false croup”)

This is an acute disease characterized by obstruction of the airways in the larynx and the development of respiratory failure.

Causes: develops as a result of stenosis in the glottis, swelling of the subglottic space, accumulation of sputum in the lumen of the larynx.

Kleeneka:

Rough "barking" cough;

Phenomena of respiratory failure (the child is restless, tosses around in bed, shortness of breath, difficulty breathing, cyanosis appear, auxiliary muscles are involved in the act of breathing: wings of the nose, intercostal muscles, diaphragm, etc.).

Firsthelp:

· Place the child with the head end elevated.

· Unbutton tight clothing.

· Provide access to fresh air

Create a calm environment

· Carry out distraction therapy (put mustard plasters on the calf muscles or conduct mustard foot baths).

· Carry out steam inhalations with the addition of soda and expectorant herbs (alternating them)

1.8 Convulsions

This is an involuntary muscle contraction that causes distortion of the shape of the body and limbs.

Causes: Febrile seizures occur with high fever in infants and young children. Afebrile seizures in infants most often result from birth trauma or brain damage. Rhythmic spasms of the limbs are characteristic symptoms of epilepsy.

Clinic. Cramps can be local (spread to individual muscle groups) and generalized (convulsive seizure).

Phases of a seizure

First aid

· Call an ambulance.

· Place the child on a flat, soft surface and remove any possible damaging objects.

· Unbutton tight clothing.

· Provide access to fresh air.

· Do not leave the child alone until the ambulance arrives.

1.9 Fainting

This is a manifestation of vascular insufficiency, which is accompanied by cerebral ischemia and is manifested by a short-term loss of consciousness.

First aid

· Call an ambulance.

· Place the child on a flat surface with his legs raised (or sit him down and sharply tilt his head down)

· Unbutton tight clothing

· Provide access to fresh air

· Spray the child’s face and body with cold water or give ammonia (acetic acid) a sniff.

1.10 Acute poisoning in children

This is a pathological process accompanied by a violation of the physiological functions of the body due to the ingress of one or more toxic substances from the environment. In most cases, acute poisoning occurs at home. They are associated with improper storage of medications and drug overdose. Poisoning with household chemicals, poisonous plants, and mushrooms is common; cases of substance abuse and suicidal poisoning are possible. Poisoning in children occurs mainly when poison is ingested. The entrance gates for toxic substances can be the skin, mucous membranes and respiratory tract.

Clinic. In childhood, acute poisoning is more severe than in adults. This is due to greater permeability of the skin, mucous membranes and blood-brain barrier, pronounced lability of water-electrolyte metabolism. Most poisons are absorbed within the first hour after administration, sometimes this process drags on for up to several days (for example, in case of poisoning with sleeping pills).

First aid.

· Call an ambulance.

· Before the ambulance arrives, try to find out what caused the poisoning.

· Any suspicion of acute poisoning is an indication for hospitalization of the child, regardless of the severity of his condition.

· If poison gets on your skin, rinse it immediately without rubbing with plenty of warm running water.

· If toxic substances come into contact with the eyes, the latter are washed copiously and for 10-20 minutes. water (preferably boiled) or saline, instill a local anesthetic (0.5 solution of novocaine, dicaine).

· If the child is conscious, in contact and has just swallowed poison (tablets, mushrooms, berries, roots, plant leaves, etc.), it is necessary to immediately induce vomiting by reflex irritation of the root of the tongue. Contraindications to reflex vomiting are coma, convulsions, a sharp weakening of the gag reflex, poisoning with acids and caustic alkalis, gasoline, kerosene, turpentine, phenol.

· Rinse the stomach. Do not rinse if poisoning occurs in late periods (after 2 hours) after poisoning with alkalis and corrosive poisons due to the high risk of perforation of the esophagus and stomach; convulsive syndrome due to possible aspiration of gastric contents.

· To remove poison from the intestines, give a cleansing enema.

· Give up to 10 tablets of activated carbon.

1.11 Vomit

Causes the appearance of vomiting: poisoning; intoxication; diseases of the gastrointestinal tract; diseases of the central nervous system.

First aid

· Provide access to fresh air (make breathing easier, eliminate unpleasant odors).

· Lay the child down with the head end elevated, head turned to the side (to prevent aspiration of vomit).

· Unbutton tight clothing.

· After vomiting, rinse your mouth with boiled water.

· Contact a healthcare professional as soon as possible.

1.12 Nose bleed

Causes. Nosebleeds can appear after an injury or be a sign of diseases: vitamin deficiency, liver, kidney, blood diseases, high blood pressure, endocrine disorders in girls.

Clinic. Based on location, nosebleeds are divided into anterior and posterior. Damage to the anterior sections of the nose is accompanied by blood leaking out; if the posterior sections are damaged, ingestion of blood can stimulate gastric or pulmonary bleeding. In cases of heavy bleeding, pallor, lethargy, dizziness, and tinnitus appear.

Firsthelp.

· Calm and sit the child down.

· Unbutton tight clothing.

· Suggest breathing deeply and evenly.

· In order to prevent blood from flowing into the oral cavity or pharynx, tilt your head forward and press the wing of your nose against the septum.

· A cotton swab moistened with a 3% solution of hydrogen peroxide can be inserted into the vestibule of the nose.

· If there is no effect, call an ambulance or take the child to the hospital.

emergency pediatrics hyperthermia syncope

1.13 Airway obstruction

Causes. Entry of objects into the respiratory tract during a sharp inhalation with a stream of air. The lumen of the trachea in a child of different ages is 0.5 - 1 - 1.5 cm. Therefore, almost any object can cause complete blockage (obstruction) of the trachea. Respiratory failure causes loss of consciousness very quickly and then circulatory arrest.

Clinic. In case of partial obstruction of the respiratory tract, a hoarse voice and cough suddenly appear. The child becomes restless and clutches his throat with his hands. Breathing is noisy, wheezing. With complete obstruction, the child cannot speak, cough, breathe, and grabs his throat with his hands. With complete airway obstruction, children cannot cry. Upon examination, blue discoloration appears on the lips, face, neck, and hands. Young children may not have the characteristic sign of obstruction (grabbing the neck).

First aid.

· Call an ambulance.

· If a child has signs of complete obstruction of the respiratory tract (does not breathe, does not cough, does not speak) and he is conscious, a series of blows to the back must be applied.

To do this, stand on the side and slightly behind the child;

Support his chest with one hand and tilt the child forward so that the foreign body can come out of the mouth;

Apply up to five sharp blows between the shoulder blades with the heel of the palm of the other hand.

· If five blows to the back do not relieve the obstruction, give five thrusts to the abdomen as follows:

Stand behind the victim and place both hands around his upper abdomen;

Tilt the victim forward;

Make a fist and place it between the navel and sternum;

Grab this hand with your other hand and sharply pull inward and upward;

Repeat up to five times.

· Alternate pressure on the stomach and blows between the shoulder blades until the airways are cleared.

If the airways are blocked in children under two to three years of age:

· Place the child on your arm, face down on your palm, so that the legs are located on opposite sides of your forearm and the axis of the body is tilted down. Use your hip to support the baby.

· Apply pats with the palm of your hand or several fingers between the shoulder blades until the airways are cleared.

2. Childbirth outside the hospital

Childbirth is the physiological process of expulsion of the fetus, membranes and placenta through the mother's birth canal. Childbirth outside the hospital most often occurs during premature pregnancy (from 22 to 37 weeks of pregnancy) or during full-term pregnancy in multiparous women. In such cases, they usually proceed rapidly.

During childbirth, there are 3 periods. Labor develops with precursors: irregular pain appears in the lower abdomen, mucus leaves.

In the first period, regular contractions occur (rhythmic contractions of the muscles of the uterus), pain of varying intensity appears, the uterus becomes dense and tense. The onset of labor is considered to be 4 contractions in 20 minutes or 8 contractions in 60 minutes. In preterm labor and childbirth in multiparous women, contractions are intense from the very beginning. As labor progresses well, the woman in labor loses amniotic fluid, which usually indicates sufficient or complete dilatation of the cervix. Towards the end of the first stage of labor, contractions become more frequent and stronger.

Then the second stage of labor begins, the woman in labor begins to push, and the baby is born.

Soon the afterbirth is born - this is the third stage of labor.

First aid.

· Call an ambulance.

· Help the woman in labor take a comfortable position (on her side or half-lying, half-sitting, leaning her back against a wall, a high headboard, a car seat, a bundle of blankets).

· Free the woman in labor from clothing below the waist; place the cleanest cloth or piece of clothing under it.

· Cover the woman in labor with a blanket or the warmest and cleanest items of clothing.

· Prepare:

Boiling water, boiled or clean water,

A weak (pale pink) solution of potassium permanganate - 3-4 crystals per 1 liter of water (it is advisable to strain this solution through gauze so that the remaining crystals do not injure the skin);

Alcohol or alcohol-containing liquid (vodka, cologne, eau de toilette); brilliant green, alcohol solution of iodine;

Sharp, clean scissors, immersed in boiling water for several minutes and then thoroughly wiped with alcohol (in the field, scissors can be replaced with a knife treated with an alcohol solution of iodine or alcohol);

Bandages and cotton wool;

Two strong threads about 20 cm long, dipped in alcohol (bandages can be used instead);

A small boiled syringe (“pear”), you can replace it with a pipette with a blunt end or a clean thin cocktail tube);

Disposable wipes;

Clean oilcloth or plastic film wiped with alcohol;

Clean diapers, sheets, pillowcases, pieces of fabric, clothes, etc.

· During contractions, massage the back in the area of ​​the sacrum, the inner surface of the thighs, the protrusions of the pelvic bones in the right and left iliac region - these techniques distract and help to endure pain more easily.

· Monitor your breathing; During a contraction, you should breathe shallowly with your mouth wide open, and breathe normally between contractions.

· Don’t forget to wet the woman’s face and give her mouth to rinse.

· As soon as the desire to push appears, the woman should be laid on her back and her legs spread apart.

· Wash your hands thoroughly with soap and treat with alcohol or iodine.

· Wash the woman in labor strictly from front to back - first with water, then with a weak solution of potassium permanganate and treat the perineum and inner thighs with iodine.

· The expansion of the opening of the rectum and the tension of the perineum during contractions allows us to judge that the baby’s head has dropped to the pelvic floor.

· During each attempt, ask the woman to breathe frequently and shallowly - “like a dog.”

· As soon as the baby's head is born, carefully pick it up with your left hand, and with your right hand begin to remove mucus from the nose and mouth. To do this, you can wipe the baby's face with a clean napkin, or suck out the mucus with a pear. In the absence of a syringe, you can use a blunt pipette or tube.

· Support the baby with your hands while the shoulders and the whole body are born. If there is an umbilical cord loop around the baby's neck, remove it through the head without waiting for the whole body to be born. When the baby is born whole, take him in your palm so that he lies tummy down, and his head is located slightly below the body (upside down). For the child to start breathing, massage his chest and back with your finger; You can lightly pat the back and soles of your feet.

· The umbilical cord should be cut 1-2 minutes after the baby is born. To do this, it is necessary, stepping back at least 10 cm from the child’s umbilical ring, to tightly tie the umbilical cord with alcohol-based threads or a sterile bandage in two places at a distance of 3 cm and cross it in the middle with scissors. It is better to treat the cut end of the umbilical cord connecting to the baby with an alcohol solution of iodine and wrap it in a sterile bandage.

· 5-20 minutes after the birth of the baby, the placenta should separate; You cannot speed up the process by pulling on the umbilical cord: it may break, which often causes bleeding.

· Dry the baby with a blotting motion and wrap it in a warm, clean cloth. make sure it doesn't get too cold.

· Collect the birth placenta in a plastic bag and deliver it to the maternity hospital along with the mother and the newborn.

Spsearch for literature used

1. WHO Pocket Guide “Providing hospital care for children”, WHO. 2nd edition. Publisher: Europe "WHO", 2005. (pp. 11-89)

2. ETAT. Emergency assessment for triage and treatment. WHO, 2012. 4th edition. Moscow: SpetsLit. (pp. 105-167)

3. Clinical protocols in neonatology. 1st edition. Bishkek: “Academy”, 2010. (pp. 43-86, 112-157)

4. Solving the problems of newborns: a guide for doctors, nurses, midwives. 1st edition. WHO, 2005 (pp. 8-115)

5. Ezhova N.V., Rusakova E.M., Rovina S.N., Pediatrics. Preclinical practice. 3rd edition. Minsk: Book House, 2004 (pp. 95-167)

6. Petrushina A.D., Malchenko L.A. Emergency conditions in children. 2nd edition. Minsk: “Medical Book”, 2001 (pp. 15-135)

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Providing pre-medical care to a child in a timely manner is a necessary condition for the qualification of a teacher. You cannot miss the first “golden hour”, when before the ambulance arrives you can create conditions to preserve the vitality of the child’s body or to stop the adverse effects on the injured area.

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First aid for a child in emergency conditions

Providing pre-medical care to a child in a timely manner is a necessary condition for the qualification of a teacher. You cannot miss the first “golden hour”, when before the ambulance arrives you can create conditions to preserve the vitality of the child’s body or to stop the adverse effects on the injured area.

Failure to provide assistance or leaving one in danger may result in criminal penalties:

Criminal Code of the Russian Federation, Article 124. Failure to provide assistance to a patient

1. Failure to provide assistance to a patient without good reason by a person obligated to provide it in accordance with the law or with a special rule, if this resulted in negligence in causingmoderate harm health of the patient, is punishable by a fine in the amount of up to forty thousand rubles, or in the amount of the wages or other income of the convicted person for a period of up to three months, or by compulsory labor for a term of up to three hundred sixty hours, or by corrective labor for a term of up to one year, or by arrest for a term of up to four months.

Criminal Code of the Russian Federation, Article 125. Leaving in danger

Known leaving without help a person who is in a condition dangerous to life or health and is deprived of the opportunity to take measures for self-preservation due to childhood, old age, illness or due to his helplessness, in cases where the culprit had the opportunity to help this person and was obliged to take care of him or himself put him in a condition dangerous to life or health, shall be punishable by a fine in the amount of up to eighty thousand rubles, or in the amount of the wages or other income of the convicted person for a period of up to six months, or by compulsory labor for a term of up to three hundred sixty hours, or by corrective labor for a term of up to one year, or forced labor for a term of up to one year, or arrest for a term of up to three months, or imprisonment for a term of up to one year.

FIRST AID

1. FAINTING.

If a child stays in a stuffy room for a long time, due to strong fear, anxiety, a sudden change in body position, or other situations, the child may lose consciousness.

First aid for fainting

• lay down without a pillow
• raise your legs a little
• unbutton your clothes
• open the window
• splash your face with cold water
• give a cotton swab with ammonia a whiff
• During an attack, monitor the child’s pulse, pay attention to its rhythm, and, if possible, measure the pressure. This data will help further determine the cause of fainting.

When the child regains consciousness, it is necessary to let him lie down until he completely feels well and for at least 5-10 minutes, drink strong sweet tea

1. BRUISED.

Rest and unloading of the injured limb are required. Apply a soft fixing bandage to the damaged joint and an ice pack on the first day. To reduce pain, you need to provide complete rest to the bruised part of the body and give it an elevated position.

1. BLEEDING.

Temporary methods of stopping bleeding depend on the type, location and intensity of bleeding. Blood may flow out in a stream ( arterial bleeding) or slowly accumulate in the wound ( venous bleeding). Capillary bleeding is associated with damage to smallcirculatory vessels . In this case, the entire wound surface bleeds. Typically, such bleeding is not accompanied by significant blood loss and is easy to stop. When providing first aid, it is enough to treat the wound with iodine tincture and apply a gauze bandage.

Sometimes the bleeding is so severe that you have to resort to applying a tourniquet. Any fabric can be used as a tourniquet. A tourniquet is applied above the wound site. A note with the exact time of application of the tourniquet is placed under the bandage (maximum time 30 minutes in winter, 1 hour in summer). It is impossible to hold the tourniquet for more than the prescribed time, as a sharp circulatory disorder and necrosis of the limb may occur. If the wound is on the neck, face, head and a tourniquet cannot be applied, then you should apply pressure with your palm to the area above the wound and urgently call a doctor.

For nasal If bleeding occurs, the child should be placed in a sitting or semi-sitting position, tilt his head slightly and place a cold compress on the bridge of his nose. You can tightly seal the nasal passages with cotton wool swabs moistened with a solution of hydrogen peroxide.

1. FOOD POISONING -drink plenty of warm boiled water (before the gag reflex). Put the child to bed.

1. CARBON MONOXIDE POISONING– access to fresh air.

1. THERMAL BURN

For any thermal burn: quickly remove clothing soaked in hot liquid. In this case, you should not tear off areas of skin that have stuck to the clothes, but you should carefully cut off the clothes with scissors. A sterile bandage should be applied to the burn site. If you don’t have any at hand, then clean materials at hand will do - a clean handkerchief, bed linen or underwear. If blisters have formed on the injured child’s body, they should never be pierced with a needle or cut off with scissors, as there is a possibility of infection in the wound.

1. ELECTRIC SHOCK

First aid for an electric shock victimshould always involve releasing it from the action of the current; to do this, turn off the switch (if you know where it is). If it is impossible to remove the current source, then it is necessary to follow precautions: do not touch the exposed parts of the victim’s body, but hold him only by his clothes, after putting on rubber gloves, if any, or dry woolen gloves, wrapping his hands in dry clothes or standing on an insulated object - a board, dry rags or put on rubber shoes; pull the victim away. You can use a dry wooden stick or other non-conductive objects to knock off the exposed wires.

If the victim is unconscious and has no heartbeat, it is necessary to immediately applyartificial respiration and indirect cardiac massage. The simplest and most effective method is artificial respiration through the mouth (mouth to mouth). To do this, the victim is placed on his back on a hard horizontal surface, with his head thrown back. Then the person providing assistance takes a deep breath and exhales through a special system (gauze or handkerchief) into the victim’s mouth. When blowing air into your mouth, you must pinch your nose to ensure a tight seal.

After two breaths, the helper kneels down next to the victim, places his left hand on the bottom of the chest (2 cm above the xiphoid process), the right hand on top in a cross-shaped position, the arms should be straight. The technique of cardiac massage involves rhythmic pressure on the chest to compress the heart muscle. 15 pressing movements are made on the chest without lifting the hands at a speed equal to 1 pressing per second. Pressure on the chest must be done in such a way that it drops a few centimeters.

A cat's eye indicates that a person is dead; dilated pupil - that the person is alive.

At the same time, it is urgent to call a doctor and an ambulance.

During chest compressions, rib fractures may occur.

1. FRACTURES

Rib fracture - the child takes a forced semi-sitting position, a tight pressure bandage is applied.

When a fracture occurs, a complete or partial disruption of the integrity of the bone occurs. Fractures are divided into open and closed:

At open fracturethe skin is damaged and the bone protrudes from the outside;

At closed fractureno damage to the skin.

Signs of a fracture:

Change in limb length;

Pain in the area of ​​injury;

Bruising in the area of ​​injury;

Swelling;

A crunch is heard;

Previously unusual mobility of the limb (fracture area).

The main actions when providing first aid are to create complete rest and immobility of the victim, prepare for immobilization (creating a fixed bandage);

Fracture of upper/lower limb

Immobility of the bones at the fracture site is achieved by applying special splints. You can use any available materials - sticks, pieces of plywood, strong cardboard, skis, reed stalks, umbrellas, rulers, etc.

Rules for applying splints:

Do not stretch your limbs;

When immobilizing, two nearby joints should be fixed - below and above the fracture (for the upper extremities) and all joints in case of injury to the lower extremities;

Be sure to place cotton wool, rags, clothes (whatever soft is available) under the tire;

The splint is attached to the limb tightly; loose fastening (looseness) is not allowed.

At collarbone fracturea scarf bandage is applied.

In case of a fracture of two collarbones, the “prisoner” pose (hands are tied behind the back).

1. FOREIGN BODIES

In the eye – do not allow your child to rub the injured eye, do not try to force open the injured eye, wash your hands before providing assistance.

See a doctor if: the eye is damaged or you are unable to remove the foreign body yourself. Gently pull down the lower eyelid and try to see the foreign body. If you see it, remove it with a corner of the cloth. If you do not see a foreign body, examine the upper eyelid. Remove the foreign body with a corner of a cloth or by rinsing the eye with boiled water. If you cannot see the foreign body or it cannot be removed, apply a sterile napkin, then a bandage over both eyes and consult a doctor.

In the nose – ask the child to blow his nose.

In the respiratory tract– throw the child over your knee, tap him on the back, and let him catch his breath.

From all of the above, each group should collect the following minimum set for emergency care:

• Sterile bandage;
• Vata;
• Zelenka;
• Hydrogen peroxide 3%;
• Iodine;
• Aseptic wipes;
• Tourniquet;
• Scissors;
• Mouth-to-mouth device;
• Gloves.

According to order 302-N “On substances..”, iodine is stored in a dark, cool place (as it is explosive). Potassium permanganate in powder form is classified as a narcotic drug and should not be stored in a preschool educational institution.

In conclusion, I would like to remind you once again that even seemingly minor domestic injuries must be taken seriously and, when providing assistance, certain rules must be followed to prevent various complications. You must always remember that the success of further treatment will depend on timely and correctly provided first aid at the scene of the incident.