6999 0
This is an acutely developing and life-threatening condition, which occurs as a result of severe trauma, is characterized by a critical decrease in blood flow in tissues (hypoperfusion) and is accompanied by clinically pronounced disturbances in the functioning of all organs and systems.
The leading factor in the pathogenesis of traumatic shock is pain (powerful pain impulses coming from the site of injury to the central nervous system). A complex of neuroendocrine changes during traumatic shock leads to the launch of all subsequent responses of the body.
Redistribution of blood. At the same time, the blood supply to the vessels of the skin, subcutaneous fat, and muscles increases with the formation of areas of stasis in them and the accumulation of red blood cells. Due to the movement of large volumes of blood to the periphery, relative hypovolemia is formed.
Relative hypovolemia leads to a decrease in venous return of blood to the right side of the heart, a decrease in cardiac output, and a decrease in blood pressure. A decrease in blood pressure leads to a compensatory increase in total peripheral resistance and impaired microcirculation. Impaired microcirculation and its progression are accompanied by hypoxia of organs and tissues and the development of acidosis.
Traumatic shock is often combined with internal or external bleeding. Which, naturally, leads to an absolute decrease in the volume of circulating blood. Despite the exceptional importance of blood loss in the pathogenesis of traumatic shock, traumatic and hemorrhagic shocks should not be identified. In case of severe mechanical damage, the pathological effects of blood loss are inevitably accompanied by the negative influence of neuropain impulses, endotoxemia and other factors, which makes the state of traumatic shock always more severe compared to “pure” blood loss in an equivalent volume.
One of the main pathogenetic factors that forms traumatic shock is toxemia. Its influence begins already 15-20 minutes from the moment of injury. The endothelium and, above all, the renal endothelium are exposed to toxic effects. In this connection, multiple organ failure develops quite quickly.
Diagnosis of traumatic shock is based on clinical data: systolic and diastolic blood pressure, pulse, skin color and moisture, and diuresis. In the absence of arrhythmia, the degree and severity of hemodynamic disturbances can be assessed using the shock index (Algovera).
With closed fractures, blood loss is:
. ankles - 300 ml;
. shoulder and lower leg - up to 500 ml;
. hips - up to 2 l;
. pelvic bones - up to 3 liters.
Depending on the value of systolic blood pressure, there are 4 degrees of severity of traumatic shock:
1. I degree - systolic pressure decreases to 90 mm Hg. Art.;
2. II degree of severity - up to 70 mm Hg. Art.;
3. III degree of severity - up to 50 mm Hg;
4. IV degree of severity - less than 50 mm Hg. Art.
Clinic
With shock degree, clinical manifestations may be scanty. The general condition is moderate. Blood pressure is slightly reduced or normal. Slight lethargy. Pale, cold skin. Positive “white spot” symptom. Heart rate increases to 100 per minute. Rapid breathing. Due to an increase in the content of catecholamines in the blood, there are signs of peripheral vasoconstriction (pale, sometimes “goosey” skin, muscle tremors, cold extremities). Signs of circulatory disorders appear: low central venous pressure, decreased cardiac output, tachycardia.In the third degree of traumatic shock, the condition of the patients is severe, consciousness is preserved, and lethargy is noted. The skin is pale, with an earthy tint (appears when pallor is combined with hypoxia), cold, often covered with cold, sticky sweat. Blood pressure was stably reduced to 70 mm Hg. Art. or less, pulse increased to 100-120 per minute, weak filling. There is shortness of breath and thirst. Diuresis is sharply reduced (oliguria). IV degree of traumatic shock is characterized by the extremely severe condition of the patients: severe adynamia, indifference, skin and mucous membranes are cold, pale gray, with an earthy tint and a marble pattern. Pointed facial features. Blood pressure is reduced to 50 mm Hg. Art. and less. CVP is close to zero or negative. Pulse is thread-like, more than 120 per minute. Anuria or oliguria is noted. In this case, the state of microcirculation is characterized by paresis of peripheral vessels, as well as disseminated intravascular coagulation syndrome. Clinically, this is manifested by increased tissue bleeding.
The clinical picture of traumatic shock reflects the specific features of individual types of injuries. Thus, with severe wounds and chest injuries, psychomotor agitation, fear of death, and hypertonicity of skeletal muscles are observed; a short-term rise in blood pressure is replaced by a rapid fall. In cases of traumatic brain injury, there is a pronounced tendency to arterial hypertension, masking the clinical picture of hypocirculation and traumatic shock. With intra-abdominal injuries, the course of traumatic shock is soon superimposed by symptoms of developing
Urgent Care
Treatment of traumatic shock should be comprehensive, pathogenetically substantiated, individual in accordance with the nature and location of the injury.Ensure patency of the upper respiratory tract using the triple Safar maneuver and assisted ventilation.
. Inhalation of 100% oxygen for 15-20 minutes, followed by a decrease in the oxygen concentration in the inhaled mixture to 50-60%.
. In the presence of tension pneumothorax, drainage of the pleural cavity.
. Stop bleeding by finger pressure, tight bandage, tourniquet, etc.
. Transport immobilization (should be performed as early and reliably as possible).
. Pain relief through the use of all types of local and regional anesthesia. For fractures of large bones, local anesthetics are used in the form of blockades of the immediate fracture zone, nerve trunks, and osteofascial sheaths.
. The following analgesic cocktails are administered parenterally (intravenously): atropine sulfate 0.1% solution 0.5 ml, sibazon 0.5% solution 1-2 ml, tramadol 5% solution 1-2 ml (but not more than 5 ml) or promedol 2 % solution 1 ml.
. Or atropine sulfate 0.1% solution 0.5 ml, sibazon 0.5% solution 1 ml, ketamine 1-2 ml (or at a dose of 0.5-1 mg/kg body weight), tramadol 5% solution 1-2 ml (but not more than 5 ml) or promedol 2% solution 1 ml.
It is possible to use other analgesics in equivalent doses.
The most important task in the treatment of traumatic shock is the fastest possible restoration of blood supply to tissues. With an undetectable level of blood pressure, jet transfusions into two veins (under pressure) are necessary in order to achieve a rise in systolic pressure to a level of at least 70 mm Hg within 10-15 minutes. Art. The infusion rate should be 200500 ml per 1 minute. Due to the significant expansion of the vascular space, it is necessary to administer large volumes of fluid, sometimes 3-4 times greater than the estimated blood loss. The rate of infusion is determined by the dynamics of blood pressure. The jet infusion should be carried out until the blood pressure steadily rises to 100 mm Hg. Art.
Table 8.5. Infusion therapy program during transportation of the victim
Glucocorticosteroids are administered intravenously at an initial dose of 120-150 mg of prednisolone and subsequently at a dose of at least 10 mg/kg. The dose can be increased to 25-30 mg/kg body weight. Treatment of heart failure may require the inclusion of dobutamine in the therapy at a dose of 5-7.5 mcg/kg/min or dopamine 5-10 mcg/kg/min, as well as drugs that improve myocardial metabolism, antihypoxants - Riboxin - 10-20 ml; cytochrome C - 10 mg, Actovegin 10-20 ml. If a terminal condition develops or it is impossible to provide emergency infusion therapy, dopamine is administered intravenously in 400 ml of a 5% glucose solution or any other solution at a rate of 8-10 drops per minute. In case of internal bleeding, conservative measures should not delay the evacuation of victims, since only emergency surgery can save their life.
The sequence of activities may vary depending on the prevalence of certain violations. The victim is transported to the hospital while intensive care continues.
Sakrut V.N., Kazakov V.N.
Significant types of injuries such as wounds, severe burns, concussions and others are quite often accompanied by such a serious condition of the body as traumatic shock, for which first aid is only as effective as how quickly it is provided. This complication itself occurs in combination with a sharp weakening of blood flow in the veins, capillaries and arteries. This, in turn, leads to serious blood loss and severe pain.
Traumatic shock: main phases and symptoms
With traumatic shock, its two main phases become relevant. Thus, the first phase is defined as the erectile phase; it occurs at the moment a person receives an injury with simultaneous sharp arousal noted in the nervous system. The second phase is defined as the torpid phase, and is accompanied by inhibition caused by general depression in the activity of the nervous system, including the activity of the kidneys, liver, lungs and heart. The second phase is characterized by a division into the following degrees:
- I degree of shock (mild). The victim's pallor and clarity of consciousness are noted; slight retardation, shortness of breath and decreased reflexes are possible. The increased heart rate reaches about 100 beats/min.
- II degree of shock (moderate severity). The victim is markedly lethargic and lethargic; the pulse is about 140 beats/min.
- III degree of shock (severe). The victim remains conscious, but at the same time he loses the ability to perceive the surrounding world. The color of the skin is earthy-gray; in addition, there is the presence of sticky sweat, cyanosis of the fingertips, nose and lips. The increased heart rate is about 160 beats/min.
- IV degree of shock (state of pre-agony or agony). The victim is unconscious and the pulse cannot be determined.
Traumatic shock: first aid
- First of all, traumatic shock involves, as the main first aid measure, the elimination of the causes that provoked it. Accordingly, first aid should focus on relieving pain or reducing it, stopping any bleeding that has occurred, and taking those measures that will improve respiratory and cardiac functions.
- To reduce the pain of the injured limb or the victim himself, a position is provided that will create optimal conditions for its reduction. The victim should also be given pain medication. As a last resort, in the absence of the latter, you can give a small amount of vodka or alcohol.
- Without stopping the bleeding, the fight against the state of shock will be ineffective; for this reason, this impact factor is eliminated as quickly as possible. In particular, traumatic shock and first aid for stopping bleeding involves applying a pressure bandage or tourniquet, etc.
- The next stage is to ensure transportation of the victim to the hospital. It is better if a resuscitation ambulance is used for this purpose, under the conditions of which the possibility of providing measures appropriate to the condition is determined. In any case, the victim is ensured maximum peace during transportation.
It is important to realize that the prevention of traumatic shock is easier than the consequences of its treatment. Be that as it may, first aid for traumatic shock involves compliance with the following five principles: reducing pain, providing fluids for oral administration, warming, ensuring peace and quiet, careful transportation (exclusively to a medical facility).
Actions that should be avoided during traumatic shock
- The victim should not be left alone.
- It is impossible to move the victim unless absolutely necessary. If this is still a necessary measure, then you need to act extremely carefully - this will prevent additional injury and deterioration of your general condition.
- Under no circumstances should you attempt to adjust or straighten the injured limb on your own - this may result in increased traumatic shock due to increased bleeding and pain.
- It is also impossible to apply a splint without first stopping the bleeding, because as a result it may intensify, which, accordingly, will aggravate the state of shock or may even lead to death.
The state of traumatic shock is a dangerous manifestation of complications after any type of injury.
First aid for a traumatic injury must be provided immediately, since this condition causes irreversible consequences in the body and often leads to the death of the victim.
In case of traumatic shock, urgent hospitalization is required, since medical intervention is necessary to relieve it.
Even with minor injuries, this condition occurs in 3% of victims. If the injuries are extensive and accompanied by severe external or internal bleeding, open or closed fractures, the rates reach 15%. At the same time, the percentage of deaths due to traumatic shock is very high, reaching more than half of all recorded cases.
Causes of occurrence and mechanisms of development
At the present stage, doctors associate the development of traumatic shock with two factors: extensive blood loss and severe pain.
Moreover, it is the loss of blood that primarily contributes to the development of this condition, since the theory of “painful” shock cannot explain why the disease does not occur, for example, in women in labor. Therefore, the hypovolemia hypothesis is taken as the basis for the occurrence of the disease.
According to this theory, the state of traumatic shock is caused by extensive loss of blood and plasma due to such injuries:
- Severe bruises accompanied by internal hemorrhages;
- Fractures;
- Ruptures of internal organs;
After stopping the bleeding, it is important to ensure relief of the pain syndrome. To do this, use any available ones.
Note!
If the victim is fainting, you should not put painkillers in his mouth!
A conscious person needs to ensure a free flow of air: remove or loosen the pressing elements of clothing.
If the patient is unconscious, he is carefully turned on his side and his tongue is fixed to prevent choking on vomit.
If the victim does not show signs of life, he needs to be given first aid: artificial respiration and cardiac massage.
Regardless of the time of year, after injury, the patient feels a feverish chill. Therefore, it is important to warm him up by covering him with any warm things.
One of the deadly conditions of the human body that requires immediate action is traumatic shock. Let's consider what traumatic shock is and what emergency care should be provided for this condition.
Definition and causes of traumatic shock
Traumatic shock is a syndrome that is a severe pathological condition that threatens life. It occurs as a result of severe injuries to various parts of the body and organs:
- pelvic bone fractures;
- traumatic brain injury;
- severe gunshot wounds;
- extensive;
- damage to internal organs due to abdominal trauma;
- severe blood loss;
- surgical interventions, etc.
Factors predisposing to the development of traumatic shock and aggravating its course are:
- hypothermia or overheating;
- intoxication;
- overwork;
- starvation.
Mechanism of development of traumatic shock
The main factors in the development of traumatic shock are:
- massive blood loss;
- severe pain syndrome;
- disruption of vital organs;
- mental stress caused by trauma.
Rapid and massive blood loss, as well as plasma loss, lead to a sharp reduction in circulating blood volume. As a result, blood pressure decreases, the delivery of oxygen and nutrients to tissues is disrupted, and tissue hypoxia develops.
As a result, toxic substances accumulate in tissues and metabolic acidosis develops. Lack of glucose and other nutrients leads to increased breakdown of fats and protein catabolism.
The brain, receiving signals about a lack of blood, stimulates the synthesis of hormones that cause peripheral vessels to constrict. As a result, blood flows away from the limbs, and there is enough of it for vital organs. But soon such a compensatory mechanism begins to malfunction.
Degrees (phases) of traumatic shock
There are two phases of traumatic shock, characterized by different symptoms.
Erectile phase
At this stage, the victim is in an excited and anxious state, experiences severe pain and signals it in all available ways: screaming, facial expressions, gestures, etc. At the same time, he can be aggressive and resist attempts to provide assistance and examination.
There is pallor of the skin, increased blood pressure, tachycardia, increased breathing, and trembling of the limbs. At this stage, the body is still able to compensate for the violations.
Torpid phase
In this phase, the victim becomes lethargic, apathetic, depressed, and experiences drowsiness. The pain does not subside, but he stops signaling about it. Blood pressure begins to decrease and heart rate increases. The pulse gradually weakens and then becomes undetectable.
There is marked pallor and dryness of the skin, cyanosis, which become obvious (thirst, nausea, etc.). The amount of urine decreases even with heavy drinking.
Emergency care for traumatic shock
The main stages of first aid for traumatic shock are as follows:
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)
Traumatic shock (T79.4)
general information
Short description
Traumatic shock- an acutely developing and life-threatening condition that occurs as a result of exposure to severe mechanical trauma on the body.
Traumatic shock is the first stage of a severe form of the acute period of a traumatic illness with a peculiar neuro-reflex and vascular reaction of the body, leading to profound disorders of blood circulation, breathing, metabolism, and the functions of the endocrine glands.
The triggering mechanisms of traumatic shock are pain and excessive (afferent) impulses, acute massive blood loss, trauma to vital organs, mental shock.
Protocol code: E-024 "Traumatic Shock"
Profile: emergency
Purpose of the stage: restoration of the function of all vital systems and organs
ICD-10 code(s):
T79.4 Traumatic shock
Excluded:
Shock (caused by):
Obstetric (O75.1)
Anaphylactic
NOS (T78.2)
Due to:
Pathological reaction to food (T78.0)
Adequately prescribed and correctly administered medicinal product (T88.6)
Serum reactions (T80.5)
Anesthesia (T88.2)
Caused by electric current (T75.4)
Non-traumatic NCD (R57.-)
Against lightning (T75.0)
Postoperative (T81.1)
Accompanying abortion, ectopic or molar pregnancy (O00-O07, O08.3)
T79.8 Other early complications of trauma
T79.9 Early complication of trauma, unspecified
Classification
According to the course of traumatic shock:
1. Primary - develops at the time of or immediately after injury.
2. Secondary - develops delayed, often several hours after injury.
Stages of traumatic shock:
1. Compensated - there are all signs of shock, with a sufficient level of blood pressure, the body is able to fight.
3. Refractory shock - all therapy is unsuccessful.
Severity of traumatic shock:
Shock 1st degree - SBP 100-90 mm Hg, pulse 90-100 per minute, satisfactory filling.
Shock 2 degrees - SBP 90-70 mm Hg, pulse 110-130 per minute, weak filling.
Shock 3 degrees - SBP 70-60 mm Hg, pulse 120-160 per minute, very weak filling (thread-like).
Shock 4 degrees - blood pressure is not determined, pulse is not determined.
Risk factors and groups
1. Rapid blood loss.
2. Overwork.
3. Cooling or overheating.
4. Fasting.
5. Repeated injuries (transportation).
6. Penetrating radiation and burns, that is, combined injuries with mutual aggravation.
Diagnostics
Diagnostic criteria: the presence of mechanical injury, clinical signs of blood loss, decreased blood pressure, tachycardia.
Characteristic symptoms of shock:
Cold, damp, pale cyanotic or marbled skin;
Sharply slowed blood flow of the nail bed;
Darkened consciousness;
Dyspnea;
Oliguria;
Tachycardia;
Decrease in blood and pulse pressure.
An objective clinical examination reveals
There are two phases in the development of traumatic shock.
Erectile stage occurs immediately after injury and is characterized by pronounced psychomotor agitation of the patient against the background of centralized blood circulation. The behavior of patients may be inappropriate; they rush about, scream, make erratic movements, are euphoric, disoriented, and resist examination and assistance. Getting in touch with them can sometimes be extremely difficult. Blood pressure may be normal or close to normal. There may be various breathing disorders, the nature of which is determined by the type of injury. This phase is short-lived and by the time assistance is provided it may change to a torpid one or stop.
For torpid phase characterized by blackouts, stupor and the development of a coma as an extreme degree of brain hypoxia caused by disturbances of the central circulation, decreased blood pressure, soft, rapid pulse, pale skin. At this prehospital stage, the emergency physician should rely on blood pressure levels and try to determine the amount of blood loss.
Determination of the volume of blood loss is based on the ratio of pulse rate to systolic blood pressure (S/SBP).
In case of shock 1 degree (blood loss 15-25% of the bcc - 1-1.2 l) SI = 1 (100/100).
In case of shock 2 degrees (blood loss 25-45% of the bcc - 1.5-2 l) SI = 1.5 (120/80).
In case of shock 3 degrees (blood loss more than 50% of the bcc - more than 2.5 l) SI = 2 (140/70).
When estimating the volume of blood loss, one can proceed from known data on the dependence of blood loss on the nature of the injury. Thus, with a fracture of the ankle in an adult, blood loss does not exceed 250 ml, with a fracture of the shoulder, blood loss ranges from 300 to 500 ml, of the lower leg - 300-350 ml, hips - 500-1000 ml, pelvis - 2500-3000 ml, with multiple fractures or In a combined injury, blood loss can reach 3000-4000 ml.
Taking into account the capabilities of the prehospital stage, it is possible to compare different degrees of shock and their inherent clinical signs.
Shock 1st degree(mild shock) is characterized by blood pressure 90-100/60 mm Hg. and pulse 90-100 beats/min. (SI=1), which can be satisfactorily filled. Usually the victim is somewhat inhibited, but easily makes contact and reacts to pain; the skin and visible mucous membranes are often pale, but sometimes have a normal color. Breathing is rapid, but in the absence of concomitant vomiting and aspiration of vomit, there is no respiratory failure. It occurs against the background of a closed fracture of the femur, a combined fracture of the femur and tibia, and a mild fracture of the pelvis with other similar skeletal injuries.
Shock 2 degrees(moderate shock) is accompanied by a decrease in blood pressure to 80-75 mm Hg, and the heart rate increases to 100-120 beats/min. (SI=1.5). Severe skin pallor, cyanosis, adynamia, and lethargy are observed. Occurs with multiple fractures of long tubular bones, multiple fractures of ribs, severe fractures of the pelvic bones, etc.
Shock 3 degrees(severe shock) is characterized by a decrease in blood pressure to 60 mm Hg. (but may be lower), the heart rate increases to 130-140 beats/min. Heart sounds become very muffled. The patient is deeply inhibited, indifferent to his surroundings, the skin is pale, with pronounced cyanosis and an earthy tint. Develops with multiple concomitant or combined trauma, damage to the skeleton, large muscle masses and internal organs, chest, skull and burns.
With further deterioration of the patient's condition, a terminal condition may develop - grade 4 shock.
List of main diagnostic measures:
1. Collection of complaints, medical history, general therapeutic.
2. Visual examination, general therapeutic.
3. Measurement of blood pressure in peripheral arteries.
4. Pulse examination.
5. Heart rate measurement.
6. Respiration rate measurement.
7. General therapeutic palpation.
8. General therapeutic percussion.
9. General therapeutic auscultation.
10. Registration, interpretation and description of the electrocardiogram.
11. Studies of the sensory and motor spheres in pathology of the central nervous system.
List of additional diagnostic measures:
1. Pulse oximetry.
Treatment abroad
Get treatment in Korea, Israel, Germany, USA
Get advice on medical tourism
Treatment
Tactics of medical care
Treatment algorithm for traumatic shock
General activities:
1. Assess the severity of the patient’s condition (it is necessary to focus on the patient’s complaints, level of consciousness, color and moisture of the skin, pattern of breathing and pulse, blood pressure level).
2. Provide measures aimed at stopping bleeding.
3. Interrupt shockogenic impulses (adequate pain relief).
4. Normalization of BCC.
5. Correction of metabolic disorders.
6. In other cases:
Lay the patient down with the leg end elevated by 10-45%, Trendelenburg position;
Ensure patency of the upper respiratory tract and oxygen access (if necessary, mechanical ventilation).
Specific events:
1. Stopping external bleeding at the prehospital stage is carried out using temporary methods (tight tamponade, application of a pressure bandage, digital pressure directly in the wound or distal to it, application of a tourniquet, etc.).
Continuing internal bleeding at the prehospital stage is almost impossible to stop, so the actions of the emergency physician should be aimed at the speedy, careful delivery of the patient to the hospital.
2. Pain relief:
Option 1 - intravenous administration of 0.5 ml of a 0.1% solution of atropine, 2 ml of a 1% solution of diphenhydramine (diphenhydramine), 2 ml of a 0.5% solution of diazepam (Relanium, Seduxen), then slowly 0.8-1 ml 5% ketamine solution (Calipsol).
In case of severe traumatic brain injury, do not administer ketamine!
2nd option - intravenous administration of 0.5 ml of 0.1% atropine solution, 2-3 ml of 0.5% diazepam solution (Relanium, Seduxen) and 2 ml of 0.005% fentanyl solution.
In case of shock accompanied by ARF, intravenously administer sodium hydroxybutyrate 80-100 mg/kg in combination with 2 ml of 0.005% fentanyl solution or 1 ml of 5% ketamine solution in 10-20 ml of isotonic solution of 0.9% sodium chloride or 5% glucose.
3. Transport immobilization.
4. Replenishment of blood loss.
For undetectable blood pressure, the infusion rate should be 250-500 ml per minute. A 6% solution of polyglucin is administered intravenously. If possible, preference is given to 10% or 6% solutions of hydroxyethyl starch (stabizol, refortan, HAES-steril). No more than 1 liter of such solutions can be poured at a time. Signs of the adequacy of infusion therapy are that after 5-7 minutes the first signs of detectable blood pressure appear, which in the next 15 minutes increase to a critical level (SBP 90 mm Hg).
For mild to moderate shock, preference is given to crystalloid solutions, the volume of which should be higher than the volume of lost blood, since they quickly leave the vascular bed. Introduce 0.9% sodium chloride solution, 5% glucose solution, polyionic solutions - disol, trisol, acesol.
10. * Oxygen
List of additional medications:
2. *Sodium bicarbonate 4% 200.0 ml, fl.
3. *Dopamine 200 mg per 400 ml
4. *Pentastarch (refortan) 500 ml, fl.
5. *Pentastarch (stabizol) 500 ml, fl.
* - drugs included in the list of essential (vital) medicines.
Information
Sources and literature
- Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
- 1. Clinical recommendations based on evidence-based medicine: Trans. from English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova. 2nd ed., rev. - M.: GEOTAR-MED, 2002. - 1248 p.: ill. 2. Guide for emergency physicians / Ed. V.A. Mikhailovich, A.G. Miroshnichenko - 3rd edition, revised and expanded - St. Petersburg: BINOM. Knowledge Laboratory, 2005.-704p. 3. Management tactics and emergency medical care in emergency conditions. Guide for doctors./ A.L. Vertkin - Astana, 2004.-392 p. 4. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development of clinical guidelines and diagnostic and treatment protocols taking into account modern requirements. Guidelines. Almaty, 2006, 44 p. 5. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 “On approval of the List of essential (vital) medicines.” 6. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 “On introducing amendments and additions to the order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854 “On approval of the Instructions for the formation of the List of essential (vital) medicines.”
Information
Head of the Department of Emergency and Emergency Medical Care, Internal Medicine No. 2, Kazakh National Medical University named after. S.D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.
Employees of the Department of Ambulance and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National Medical University named after. S.D. Asfendiyarova: candidate of medical sciences, associate professor Vodnev V.P.; candidate of medical sciences, associate professor Dyusembayev B.K.; Candidate of Medical Sciences, Associate Professor Akhmetova G.D.; candidate of medical sciences, associate professor Bedelbaeva G.G.; Almukhambetov M.K.; Lozhkin A.A.; Madenov N.N.
Head of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies - Candidate of Medical Sciences, Associate Professor Rakhimbaev R.S.
Employees of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya.; Volkova N.V.; Khairulin R.Z.; Sedenko V.A.
Attached files
Attention!
- By self-medicating, you can cause irreparable harm to your health.
- The information posted on the MedElement website and in the mobile applications "MedElement", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Guide" cannot and should not replace a face-to-face consultation with a doctor.
- Be sure to contact a medical facility if you have any illnesses or symptoms that concern you.
- The choice of medications and their dosage must be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and condition of the patient’s body.
- The MedElement website and mobile applications "MedElement", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Directory" are exclusively information and reference resources.