Algorithm for providing emergency care for orthostatic collapse. Collapse is an emergency. The most common causes of collapse in children

COLLAPSE

This is a life-threatening acute vascular insufficiency, characterized by a sharp decrease in vascular tone, a decrease in circulating blood volume, signs of brain hypoxia and inhibition of vital body functions.

The most common causes of collapse in children: severe acute infectious pathology (intestinal infection, pneumonia, etc.); acute adrenal insufficiency; overdose of antihypertensive drugs; acute blood loss; serious 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

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

Vagotonic collapse

In this phase, a significant expansion of arterioles and arteriovenous anastomoses is noted, which is accompanied by the deposition of blood in the capillary bed. Clinically characteristic: lethargy, adynamia, decreased muscle tone, severe pallor of the skin with marbling, severe acrocyanosis, a sharp decrease in blood pressure. The pulse is usually weak, bradycardia is often noted, noisy and rapid breathing of the Kussmaul type, and oliguria may occur.

Paralytic collapse

It is caused by passive expansion of capillaries due to the depletion of blood circulation 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 torso and limbs, bradycardia, bradycardia with transition to periodic, blood pressure decreases to critical levels, thread-like pulse, anuria. In the absence of emergency assistance, death occurs.

Urgent Care

Treatment measures must be started immediately!

It is necessary to lay the child horizontally on his back with a slight
head thrown back, cover with warm heating pads, provide
fresh air flow.
Ensuring free patency of the upper respiratory tract
(perform an inspection of the oral cavity, remove restrictive clothing).

In case of symptoms of sympathotonic collapse, it is necessary to remove
spasm of peripheral vessels with intramuscular injection of antispasmodics (2% solution
papaverine thief 0.1 ml/year of life or drotaverine solution 0.1 ml/year
life).
In cases of vagotonic and paralytic collapse, it is necessary
we go:

Provide access to a peripheral vein and begin infusion therapy with rheopolyglucin solution or crystalloids (0.9% solution or Ringer's solution) at a rate of 20 ml/kg for 20-30 minutes;

Simultaneously administer corticosteroids in a single dose: hydro
cortisone 10-20 mg/kg IV or 5-10 mg/kg IV or
into the floor of the mouth, or 0.3-0.6 mg/kg i.v.

For intractable arterial hypotension, it is necessary to:
re-introduce a 0.9% solution intravenously or
Ringer's solution in a volume of 10 ml/kg in combination with a solution of re-
opolyglucin 10 ml/kg under control of blood pressure and diuresis;
prescribe a 1% solution of mezaton 0.1 ml/year of life intravenously
slowly or 0.2% norepinephrine solution 0.1 ml/year of life i.v.
drip (in 50 ml of 5% glucose solution) at a rate of 10-20 ka
drops per minute (in very severe cases - 20-30 drops per minute
chickpeas) under blood pressure control.

According to indications, primary cardiopulmonary resuscitation is performed, after which the patient is hospitalized in the intensive care unit after emergency measures are provided.

Fainting is a sudden, short-term loss of consciousness, which is manifested by loss of tone, weakening of cardiac and respiratory activity. Fainting, according to some data, is the mildest form of acute cerebrovascular insufficiency and is caused by anemia (anemia) of the brain.

Fainting is more common in women, in people of asthenic constitution, with a tendency to low blood pressure. The development of fainting is provoked by mental trauma, painful irritation, staying in a stuffy room, intoxication and infectious diseases, and a number of other reasons.

Mild fainting is characterized by the sudden onset of mild foggy consciousness, combined with dizziness, ringing in the ears, nausea, and yawning may occur. There is pallor of the skin, coldness of the skin of the hands and feet, drops of sweat are observed on the face, and the pupils may dilate. This attack usually lasts only a few seconds.

Ordinary fainting also begins with clouding of consciousness; later, a complete loss of consciousness may occur, with a sharp decrease in muscle tone, and therefore the sick person slowly subsides. The pulse is barely palpable, the pressure drops, and breathing is often shallow. Such an attack can usually last several tens of seconds, and is then followed by a complete and rapid restoration of consciousness. In this case, as a rule, amnesia does not occur.

Emergency care for fainting is as follows: the sick person should be laid on his back with his head slightly lowered, then unbutton the collar, provide access to fresh air for the patient, bring a cotton swab moistened with ammonia to the nose, and spray the face with cold water. For persistent fainting, it is recommended to inject subcutaneously one ml of caffeine solution or 2 ml of cordiamine solution. Hospitalization for fainting is usually not required.

Collapse is one of the forms of acute vascular insufficiency, often occurring as a result of infectious-toxic or only toxic damage to the center that regulates vascular tone, as a result of acute blood loss, anaphylactic (or allergic) complications. Sometimes this happens with an overdose of certain medications.

The mechanism of development of collapse is associated with a sudden drop in vascular tone, with a significant loss of circulating blood volume. This leads to a sharp decrease in arterial and venous pressure. In connection with this, a redistribution of blood in the body is observed - there is a lot of blood in the vessels of the abdominal cavity, and in the vessels of the brain. the heart and other important organs do not receive enough blood.

Help for collapse must be urgent. Detoxification therapy is carried out if the condition is caused by blood loss - help begins with stopping the bleeding in any available way. In addition, anti-inflammatory therapy is possible. The sick person is placed in a horizontal position, preferably with the leg end raised. The volume of circulating blood is replenished with available solutions (intravenously, drip), but solutions of polyglucin, venofundin, halofusin, which have an anti-shock effect, are recommended. It is also necessary to use drugs belonging to the group of pressor amines (increasing blood pressure) - mezatone, norepinephrine, it is also possible to use caffeine, cordiamine, sulfocamphocaine. If there is no effect, a solution of prednisolone - 60-90 mg - is administered intravenously, in a stream or drip. Next, to continue intensive care, the patient is taken to the nearest medical facility.

Collapse is called acute vascular insufficiency, which is characterized by a significant decrease in blood mass in the body, a drop in vascular tone, and disturbances in the functioning of the heart. In addition, the brain stops receiving the required amount of oxygen. Compared to fainting, collapse takes longer and differs in severity. Timely first aid in case of collapse is often the only chance to save a person’s life.

Causes

The causes of the collapse are:

significant blood loss due to rupture of an internal organ or serious injury;
infectious diseases (pneumonia, dysentery, viral hepatitis, typhoid, scarlet fever, anthrax);
puberty in girls;
a sharp change in body position for a bedridden patient;
food or drug poisoning;
heart rhythm disturbances: myocardial infarction, myocarditis, thromboembolism;
dehydration;
electric shock;
heatstroke;
exposure to ionizing radiation in high doses.

Symptoms

It is not difficult to determine collapse, since its signs are clearly expressed and cannot be confused with manifestations of another disease. Symptoms of collapse include:

sudden deterioration in a person’s well-being;
severe headache;
noise in ears;
darkening of the eyes;
weakness;
discomfort in the heart;
significant decrease in blood pressure;
paleness, cold sweat;
cyanosis of the skin of the extremities and nails;
sharpening of facial features;
frequent and shallow breathing;
decrease in body temperature;
thread-like pulse, which is often impossible to palpate;
in some cases, loss of consciousness.

First aid for collapse is to lay the patient with his back down on a hard, flat surface, bending his head slightly and raising his legs to ensure blood flow to the brain

First aid

The set of first aid measures for collapse is simple, but very important for saving the patient, because the delay of others can cost him his life. To provide emergency assistance you must:

lay the patient with his back down on a hard, flat surface, bending his head slightly and raising his legs to ensure blood flow to the brain;
unfasten all the buttons and belt on the victim’s clothing so that nothing is squeezing him anywhere;
immediately call an ambulance;
provide the patient with air flow by opening a window or balcony, and, if possible, inhale oxygen;
warm the victim with hot water bottles;
bring ammonia to the patient’s nose and let him smell it;
in the absence of ammonia, massage the earlobes, temples, dimples above the upper lip;
if collapse is caused by blood loss, bleeding should be stopped;
provide the patient with peace.
in the absence of external signs of life, artificial respiration and chest compressions should be performed.

It is important to remember that in case of collapse, before examining the patient by a doctor, it is prohibited:

give the victim popular heart medications, as they dilate blood vessels;
if a person is unconscious, give him water and any medications;
try to bring him to his senses with slaps.

Since minutes count for the patient, and the called team of doctors may not be there in time, every person should know how to provide first aid in case of collapse. This can save the victim's life.

Sincerely,

Acute vascular insufficiency in the form of collapse occurs when the ratio between the BCC and the capacity of the vascular bed changes. The main pathogenetic factors of collapse are a sharp drop in vascular tone (especially venous tone) and a decrease in blood volume. In contrast to fainting, the key element of collapse is a severe dysfunction of the vasomotor centers with a progressive decrease in the venous return of blood to the heart, a decrease in its (heart) work, and a deterioration in the blood supply to the brain.

Clinical picture: a sharp deterioration in general condition, pronounced pallor of the skin (sometimes a marbled coloration of the skin), dizziness, chills, cold sweat, a sharp decrease in blood pressure, rapid and weak pulse, frequent shallow breathing. Peripheral veins become empty, their walls collapse, which makes venipuncture difficult. Patients remain conscious, but are indifferent to what is happening.

Collapse can be a symptom of such severe pathological processes as acute myocardial infarction, shock (including anaphylactic - see above), internal or external bleeding, etc., which, of course, is important when choosing treatment tactics. Therefore, differential diagnostic techniques and pathogenetic treatment of a patient for collapse should be carried out in a specialized hospital. The task of a doctor engaged in outpatient dental practice is to take measures to hospitalize the patient as quickly as possible and provide emergency symptomatic care, the algorithm of which is presented in the diagram.

Emergency care algorithm for collapse

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Orthostatic collapse (or orthostatic hypotension) is caused by impaired functioning of the autonomic nervous system and is more often observed in individuals with weakened venous vascular tone. It is caused by a sudden transfer of the body from a horizontal to a vertical position or by standing for a long time. In this condition, the blood, under the force of its own gravity, descends to the legs and begins to flow in a smaller volume to the heart, which does not have time to react to the change in posture. This causes a decrease in systolic pressure of more than 20 mmHg. Art., and diastolic - by 10 mm Hg. Art. As a result of insufficient blood supply to the upper part of the body, the brain begins to suffer from hypoxia, and such oxygen starvation leads to the development of pre-syncope or fainting.

Orthostatic collapse can occur in people of different age groups. In our article we will tell you about the causes, symptoms, complications, emergency aid and treatment methods for this condition. This knowledge will help you respond in time to the first signs of orthostatic hypotension and correctly provide emergency first aid.

If a person often experiences dizziness when changing body position, and sometimes severe weakness, even fainting, then it is necessary to consult a doctor to find out the cause of this condition.

The main reasons for the development of orthostatic collapse are:

oxygen starvation of the brain;
untimely reaction of the heart and blood vessels to changes in body position;
a sharp decrease in blood pressure.

Such changes in the functioning of the body can be caused by many factors. Orthostatic hypotension is sometimes observed in healthy people. A sudden rise from bed after sleep (especially if the person is not fully awake), prolonged and motionless standing, prolonged space flights - such events can lead to a sharp decrease in blood pressure and cause pre-syncope or fainting of varying severity in people who do not suffer from heart disease , blood vessels or endocrine and nervous systems. In other cases, the orthostatic reaction is provoked by pathologies or adverse effects of various factors.

Orthostatic collapse can be caused by the following disorders:

primary neuropathies: Bradbury-Eggleston syndrome, Shy-Drager syndrome, Riley-Day syndrome, Parkinson's disease;
secondary neuropathies: autoimmune diseases, diabetes mellitus, post-infectious polyneuropathy, amyloidosis, alcoholism, porphyria, syringomyelia, paraneoplastic syndromes, tabes dorsalis, pernicious anemia, vitamin deficiencies, conditions after sympathectomy;
idiopathic factors, i.e. unknown causes;
taking medications: nitrates, dopaminergic drugs (used for hyperprolactinemia or Parkinson's disease), some antidepressants, barbiturates, Vincristine, Quinidine, etc.;
severe varicose veins;
myocardial infarction;
severe cardiomyopathy;
heart failure;
constrictive;
bleeding;
infectious diseases;
anemia;
disturbances in water and electrolyte balance leading to dehydration;
pheochromocytosis;
adrenal insufficiency;
long bed rest;
primary hyperaldosteronism;
binge eating.

Orthostatic collapse can be one of the signs of many cardiac pathologies. Its sudden appearance may indicate unrecognized PE or, and with aortic stenosis, constrictive pericarditis and severe orthostatic hypotension appears only when the body is quickly transferred to an upright position.

Symptoms

The clinical picture of orthostatic collapse can be different, and depending on the severity of its symptoms, three degrees of severity of this condition are distinguished:

I (mild) – rare pre-syncope without loss of consciousness;
II (moderate) – the appearance of episodic fainting during prolonged standing in a motionless position or after transferring the body to a vertical position;
III (severe) – frequent fainting, which occurs even in a half-sitting or sitting position or after a short period of standing in a motionless position.

Episodes of orthostatic hypotension in most patients proceed in the same way. Immediately after transferring the body to a vertical position or during a long stay in a standing position, the patient develops the following symptoms:

sudden and increasing general weakness;
“fog” or “clouding” before the eyes;
dizziness, accompanied by sensations of “falling through”, “premonition of fainting”, “falling in the elevator” or “loss of support”;
palpitations (in some cases).

If orthostatic collapse is caused by prolonged and immobile standing, patients often report the following sensations:

perspiration on the face;
chilliness;
"feeling";
nausea.

The clinical picture of mild orthostatic hypotension is limited only by these symptoms. They usually resolve on their own after straight-legged heel-to-toe walking, walking, or performing exercises to tense the muscles of the legs, thighs, and abdominals.

With moderate orthostatic hypotension, if the patient does not have time to lie down with his legs raised, the above symptoms culminate in fainting, during which involuntary urination may occur. Before loss of consciousness, which lasts no more than a few seconds, the patient experiences the following changes in state:

increasing pallor;
dampness of palms;
coldness of hands and feet;
cold sweat on the face and neck.

In moderate orthostatic hypotension, two types of changes in blood pressure and pulse are observed:

thread-like pulse and increasing bradycardia, accompanied by a decrease in systolic and diastolic pressure;
pronounced tachycardia, accompanied by a decrease in systolic and an increase in diastolic pressure.

Mild and moderate degrees of orthostatic collapse develop gradually: in about a few seconds. In most cases, the patient manages to take some measures in order to smooth out the fall: he bends his knees (as if squatting on the floor), manages to put his hand forward, etc.

With severe orthostatic hypotension, fainting is accompanied by convulsions, involuntary urination and becomes more sudden and prolonged (up to 5 minutes). The patient suddenly falls without any changes in movements. Falls can lead to a variety of injuries. In such patients, episodes of orthostatic collapse may occur over a long period of time (months or years), and this causes changes in gait. They walk with sweeping steps, with their knees bent and their heads hanging low.

According to the duration of the periods in which episodes of orthostatic collapse are observed, they are divided into:

subacute - several days or weeks (characteristic of orthostatic hypotension caused by transient disturbances in the functioning of the autonomic nervous system due to infectious diseases, intoxication or taking medications);
chronic – more than a month (characteristic of pathologies of the cardiovascular, nervous or endocrine systems);
chronic progressive - for years (characteristic of idiopathic orthostatic hypotension).

Complications

The main complications of orthostatic collapse are fainting and injuries that can be caused by a fall. In more severe cases, these conditions can be aggravated by the following pathologies:

stroke – caused by fluctuations in blood pressure;
worsening neurological diseases - caused by hypoxia of brain tissue;
dementia – caused by brain hypoxia.

Emergency care for orthostatic collapse

At the first signs of orthostatic collapse, you must:

Tilt the patient's head back.
If orthostatic collapse was caused by bleeding, then take all measures to stop it.
Call an ambulance.
Provide fresh air flow.
Cover the patient with warm heating pads.
Remove clothing that restricts breathing.
Sprinkle the patient's face and chest with cold water.
Bring a cotton swab moistened with ammonia to the patient’s nose.
Rub the limbs with a hard cloth or brush.
If possible, inject subcutaneously Cordiamine 1-2 ml or a solution of 10% Caffeine 1 ml.
After regaining consciousness, give the patient warm tea or coffee with sugar.

During orthostatic collapse, you should not give the patient vasodilators (No-Shpa, Papaverine, Valocordin, etc.) and try to bring him to his senses by hitting his cheeks.

Treatment

Mild and moderate orthostatic collapse can be eliminated and treated on an outpatient basis, and in severe cases of this condition, hospitalization is indicated for the patient. Further treatment tactics are determined individually after a detailed examination of the patient and assessment of the severity of the underlying disease causing a decrease in blood pressure.

Non-drug treatment

Correct selection of physical activity regimen.
Discontinuation of drugs that cause hypotension.
Therapeutic gymnastics: strengthening the abdominal muscles and lower extremities, exercises for spontaneous and rhythmic tension of the abdominal muscles and changing postures during prolonged standing.
Recommendations for slowly changing posture when standing up (especially for older people).
Optimal temperature in the room.
Changing the diet with the introduction of foods rich in potassium and increasing the amount of salt.
Sleeping with the head of the bed elevated.
Wearing compression garments or anti-gravity suits.

Drug therapy

The selection of drugs depends on the severity of orthostatic hypertension and the causes of its occurrence. The treatment regimen may include drugs from the following groups:

aderenomimetics;
beta blockers;
mineralcorticoids;
ergot alkaloids;
prostaglandin synthetase inhibitors;
dopamine agonists;
synthetic substitutes for somatostatin and vasopressin;
antidepressants;
adaptogens.

Surgery

Indications for the need for surgery are determined by the underlying cause of orthostatic hypotension or the need to ensure a rapid heart rate by implanting a pacemaker. In general, implementation interventions are guaranteed to have only limited effects.

Orthostatic collapse can bring significant inconvenience and risks of severe complications to the patient’s life. If this condition is detected, it is necessary to undergo a comprehensive examination to identify the cause of such a sharp decrease in blood pressure, and follow all treatment recommendations of the doctor. Our article will help you identify the symptoms of orthostatic hypotension in time and take the necessary measures to eliminate it. Remember that this condition can only be treated by a doctor!

To prevent recurrent episodes of orthostatic collapse, the patient can take the following measures:

Do not overeat and follow a diet with limited carbohydrates.
Do not get up abruptly from bed or chair.
Do gymnastics regularly and spend time outdoors.
Do not take medications that can cause a sharp drop in blood pressure without the advice of a specialist, and if symptoms of orthostatic collapse appear, immediately report them to your doctor.
See your doctor regularly for conditions that may cause orthostatic collapse.