Cardiovascular insufficiency in children: causes, symptoms and treatment. Forms and clinical picture of acute vascular insufficiency in children and adults Acute vascular insufficiency in children emergency care

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 are: severe course of acute infectious pathology (intestinal infection,,, pneumonia,, etc.); acute adrenal insufficiency; overdose of antihypertensive drugs; acute blood loss; 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 (options) of collapse are conditionally distinguished: sympathotonic, vagotonic and paralytic.

Sympathotonic collapse

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

Vagotonic collapse

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

paralytic collapse

It is caused by passive expansion of capillaries due to the depletion of the mechanisms of regulation of blood circulation. This condition is characterized by: lack of consciousness with inhibition of skin and bulbar reflexes, the appearance of blue-purple spots on the skin of the trunk and extremities, bradycardia, bradypnoe with a transition to periodic, decreases to critical numbers, thready pulse, anuria. In the absence of emergency care, a fatal outcome occurs.

Urgent Care

Therapeutic measures must be started immediately!

  • It is necessary to lay the child horizontally on his back with slightly
    head thrown back, overlay with warm heating pads, provide with
    flow of fresh air.
  • Ensuring free patency of the upper respiratory tract
    (perform an audit of the oral cavity, remove tight clothing).
  • With the phenomena of sympathotonic collapse, it is necessary to remove
    spasm of peripheral vessels by intramuscular injection of antispasmodics (2% rast
    thief papaverine 0.1 ml / year of life or drotaverine solution 0.1 ml / year
    life).
  • With the phenomena of vagotonic and paralytic collapse, it is necessary
    walk:

Provide access to the peripheral vein and start infusion therapy with a solution of rheopolyglucin 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
in the bottom of the mouth, or 0.3-0.6 mg/kg IV.

  • With intractable arterial hypotension, it is necessary:
  • re-introduce intravenously 0.9% solution or
    Ringer's solution in a volume of 10 ml / kg in combination with a solution of re-
    opoliglucin 10 ml/kg under control, blood pressure and diuresis;
  • prescribe a 1% solution of mezaton 0.1 ml/year of life i/v bolus
    slowly or 0.2% solution of noradrenaline 0.1 ml/year of life IV
    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 the control of blood pressure.
  • According to indications, primary cardiopulmonary resuscitation is performed, after which the patient is hospitalized in the intensive care unit after emergency measures are rendered.

A severe form of vascular insufficiency, which is accompanied by a drop in vascular tone, a decrease in the volume of circulating blood in the body. Collapse is manifested by a pronounced decrease in arterial and venous pressure, the appearance of symptoms indicating cerebral hypoxia, inhibition of body functions important for life.

hypovolemia, (bleeding)

adrenal insufficiency

pain syndrome

infectious diseases

heart failure.

Clinical symptoms

Sudden worsening of the general condition: a sharp pallor with a marble skin pattern, cyanosis of the lips, cold sweat, a decrease in body temperature, consciousness is blurred or absent, breathing is frequent, shallow, tachycardia. Auscultatory - heart sounds are loud. The severity of the condition during collapse is due to the degree of decrease in blood pressure.

Emergency care at the prehospital stage (at home)

Give the patient with collapse a comfortable position, raise the lower limbs at an angle of 30 - 45 degrees.

Ensure free breathing (unbutton the belt, shirt collar, remove squeezing clothing)

Provide fresh air (open window)

Inhale a substance that irritates the upper respiratory tract (ammonia). Wipe face and chest with cold water.

Limbs rub or massage.

Introduce s / c cordiamine in a single dose of 0.1 ml / year of a child's life or 10% caffeine benzoate solution

0.1 ml/year of life.

A child who has developed a collapse must be overlaid with heating pads, covered with a blanket.

Emergency care for collapse at the hospital stage

Restore the volume of circulating blood by intravenous administration of infusion solutions: rheopolyglucin, polyglucin,

  • 0.9% isotonic sodium chloride solution up to 20 mg/kg, 5% glucose.
  • 3% Prednisolone 2-3 mg/kg IV or IM;

Adrenaline 0.1% solution of adrenaline s / c at a dose of 0.1 ml / year of life, In the absence of the effect of s / c, mezaton 1% - 0.1 ml / year of life is prescribed, or 0.2% solution of adrenaline / in, i / m, 1 ml of which is diluted in 250 ml of 5% glucose solution, injected intravenously 15-30 drops per minute under close control of blood pressure

Measures aimed at eliminating the underlying disease.

Algorithm for emergency care in anaphylactic shock.

Lay baby on back with head down and legs up:

Turn your head to the side to prevent aspiration of vomit:

Clear the mouth of the contents:

Provide fresh air:

Warm up:

Immediately stop further intake of the allergen:

  • - if the allergen was administered intravenously, stop the drip, but do not leave the vein (through it you will inject drugs in the future;)
  • - if the allergen is injected intramuscularly, apply a tourniquet proximal to the site of its introduction, apply cold.
  • - in case of food allergies, gastric lavage.
  • 7. Clear the airway and administer humidified oxygen.
  • 8. Initiate isotonic saline immediately.
  • 9. Control the pulse, breathing, blood pressure.
  • 10. Continue oxygen therapy.
  • 11. In case of severe hypotension, inject 0.1% adrenaline solution
  • 12. Use glucocorticoids: prednisolone at the rate of 1-5 mg/kg body weight or dexamethasone 12-20 mg/kg.
  • 13. Introduce eufillin 2.4% - 20 ml for bronchospasm (under the control of blood pressure).
  • 14. Enter antihistamines tavegil or suprastin 2-4 ml.
  • 15. Repeat the administration of all drugs every 10-15 minutes if there is no effect.
  • 16. Hospitalize in a specialized department

Emergency care algorithm for hyperthermia.

Put the child to bed.

Measure the child's body temperature:

  • a) if the child has a body temperature of 37.0-37.5ºC, prescribe plenty of fluids;
  • b) if the child has a body temperature of 37.5-38.0ºC:
    • - undress the child;
    • - carry out physical cooling: dilute alcohol 1:1, wipe the child's body, cover;
    • - apply a cold compress on the forehead;
  • c) if the child's body temperature is 38.0-38.5ºC
  • - give antipyretics: panadol, paracetamol, ibuprofen, etc.
  • d) if the child's body temperature is 38.5ºC or higher:
    • - enter the lytic mixture intramuscularly: analgin 0.1 ml/year, diphenhydramine 0.1 ml/year, papaverine 0.1 ml/year;
    • 5. Give oxygen therapy.
    • 6. Within 20-30 minutes from the start of the event, try to induce urination in the child.
    • 7. Measure body temperature after 20-30 minutes.
    • 8. Carry out a correction of ongoing activities, taking into account the indicators of repeated thermometry.

Algorithm for the provision of emergency care for convulsions.

Lay the child on a flat surface, remove possible damaging objects.

Loosen tight clothing.

Provide access to fresh air, if possible, give humidified oxygen.

Place a tissue knot or spatula wrapped with cotton or bandage between the molars.

Enter intramuscularly or intravenously drugs that suppress the excitability of the central nervous system and increase the resistance of the brain to hypoxia:

  • - Relanium (sibazon, bruzepam) - 0.1 ml / kg or
  • - droperidol 0.1-0.2 ml/kg for 1 year of life or
  • - 25% solution of magnesium sulfate 0.1-0.2 ml / kg or
  • - GHB 50-100mg/kg

Algorithm for the provision of emergency care for nosebleeds.

Nosebleeds can be traumatic or spontaneous. The first group includes bleeding accompanying injuries. “Symptomatic bleeding occurs against the background of other diseases: beriberi, cirrhosis of the liver, blood diseases, nephritis, hypertension, endocrine disorders in girls. By localization, nosebleeds are divided into anterior and posterior. Damage to the anterior parts of the nose is accompanied by outflow of blood, if the posterior parts of the nose are damaged, swallowing blood can stimulate gastric or pulmonary bleeding. In cases of heavy bleeding appear pallor, lethargy, dizziness, tinnitus.

Urgent Care:

Reassure the child, sit down with the head end lowered (prevention of aspiration, swallowing of blood).

Loosen tight clothing, ask the child to breathe evenly and deeply.

Provide access to fresh air.

Press the wing of the nose against the nasal septum of the corresponding side

Apply a cold compress on the bridge of the nose and on the back of the head for 30 minutes for reflex vasospasm.

Put heating pads on your feet or take hot foot baths.

Soak a tissue in 3% hydrogen peroxide solution or 0.1% adrenaline solution or 1% vikasol or 5% aminocaproic acid enter into the appropriate nasal passage.

If the bleeding does not stop, take a turunda 25-30 cm long, moisten it in a 3% solution of hydrogen peroxide or 5% aminocaproic acid, insert it into the corresponding nasal passage, plug it. Leave the turunda for 12-24 hours.

Give or inject intramuscularly vikasol, (calcium chloride, aminocaproic acid, dicynone, vitamin "C")

If the above measures are not effective, urgently hospitalize!

A condition in which there is a significant drop in blood pressure. Collapse - acute oxygen starvation, which extends to the cerebral cortex. This often results in death.

The collapse is divided into several types. The first type of collapse is associated with a pathological increase in the capacity of the venous bed. There is a decrease in venous return to the myocardium. Therefore, the name of the first type of collapse is angiogenic.

Hypovolemic collapse is associated with dehydration. In this case, the collapse is associated with massive blood loss and progresses in an upright position. In this case, urgent medical attention is needed.

Cardiogenic collapse is characterized by a lesion. There is myocardial dysfunction, in which there is a decline in blood circulation. That is, insufficient blood flow to the heart muscle.

A complication of cardiogenic collapse is heart failure. This is the most serious type of collapse. Frequent deaths.

Collapse is the most serious process in terms of severity of consequences. Unlike fainting. Therefore, there are changes in the cerebral cortex. Oxygen starvation can lead to the death of brain cells. And its further functioning is impossible.

What is the main etiology of collapse. Collapse develops in various situations. Moreover, this state of affairs is associated with a life-threatening condition. There are the following reasons for such conditions:

  • massive blood loss;
  • myocardial ischemia;
  • intoxication of the body;
  • infectious diseases;
  • stress;
  • damage to the endocrine system;
  • uncontrolled use of drugs

Collapse is not an independent disease. It is a consequence of pathological conditions. Which are most often massive blood loss,. Stress is less likely to cause collapse.

Damage to the endocrine system is also less likely to be a prerequisite for collapse. But the uncontrolled use of drugs can often provoke the development of collapse. Since some drugs have a lot of side effects. In this case, these disorders concern the brain.

Symptoms

The collapse is developing quite rapidly. There is a sudden drop in pressure. The general weakness of the body is characteristic. That is why urgent action needs to be taken.

There is also tinnitus during collapse. This condition has some symptoms:

  • loss of sharpness of vision;
  • dizziness;
  • feeling of fear;
  • temperature drop

There may be sweating. This produces cold sweat. The pallor of the skin is due precisely to the state of collapse. In this case, it is advisable to measure the pulse.

The pulse is quickened during collapse. It is felt directly on one hand. How does an attack happen? With collapse, the patient loses consciousness.

The pupils begin to dilate, the skin becomes cold. The patient does not respond to external stimuli. In this state, it is not advisable to try to help the patient without a medical presence.

Urgently need to call a doctor. Otherwise, the patient may die. Hospitalization required. What can you do?

In this case, it is necessary to give the patient a certain position. Usually given a horizontal position. With raised lower limbs. More details in the section: "Treatment".

What exactly are the objective signs of this condition? Most often, collapse is characterized by:

  • patient's lethargy;
  • earthy face;
  • body temperature is reduced;
  • shortness of breath;
  • pulse of weak filling and tension;
  • blood pressure 80-40 mm Hg. Art.

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Expert advice required!

Diagnostics

In the diagnosis of collapse, they resort to the direct diagnosis of this condition. This refers to the measurement of blood pressure. An indicator of blood pressure indicates a state of collapse.

It is also very advisable to measure the patient's pulse. At the same time, its increase, weak filling and tension are observed. Also a necessary technique in the diagnosis of collapse.

It is also necessary to take blood for analysis. This allows you to detect a decrease in the number of red blood cells. That is, a reduced level of blood cells also indicates this condition.

There is no time to conduct more detailed diagnostic measures. Most often, this condition requires urgent resuscitation measures. Otherwise, the patient may die.

If it is possible to get out of this state, then the diagnosis is the most complex. Includes the following activities:

  • laboratory research;
  • instrumental diagnostics;
  • blood chemistry;
  • measurement of blood pressure;
  • electrocardiogram

These are the most common diagnostic methods. They are used quite often. Since they allow you to identify the possibility of the occurrence of this condition.

Prevention

Infectious diseases need to be cured in time. This helps to prevent conditions such as collapse. The defeat of the cardiovascular system is also important to prevent.

In this case, it is necessary to see doctors more often. Especially if there are deviations in cardiac activity. Extensive intoxication also contributes to the development of this condition.

To prevent intoxication, it is necessary not to self-medicate, to take drugs only according to indications, to cure various infections in time.

In the prevention of collapse, it is important to prevent a state of stress. This refers to a strong emotional shock. Only certain sedative drugs will help to cope with stress.

If there is a serious endocrine pathology, then it is necessary to take hormonal drugs. Hormone therapy is aimed at replacing the necessary hormones. And that means the necessary therapy for this condition.

If there is a toxic factor. For example, in case of poisoning. The necessary measures must be taken immediately. Treat this condition. Otherwise, a severe course of poisoning will lead to the development of collapse.

Treatment

What should be done in the treatment of collapse. Treatment of this condition will be directed to the use of several techniques:

  • lay in a horizontal position with raised lower limbs;
  • warm the patient (cover with a blanket or warm with heating pads);
  • inject caffeine solution subcutaneously;
  • oxygen therapy;
  • enter prednisolone;
  • intravenously inject polyglucin

If there is a hemorrhagic collapse, then it is important to stop the bleeding, to administer hemostatic agents. Among the hemostatic drugs are used:

  • vikasol;
  • sodium etamsylate;
  • aminocaproic acid;
  • calcium chloride

If there is a cardiogenic collapse, then prescribe drugs aimed at treating myocardial infarction. It is also advisable to conduct detoxification therapy aimed at reducing the overall intoxication of the body.

When the heart stops working, it is necessary to apply electrical pacing. This allows the patient to return to life. And in some cases, this event does not bring the patient back to life.

In adults

Collapse in adults is quite difficult. In this case, there is a condition that requires urgent medical attention. The most common causes of this condition in adults are:

  • period of intoxication;
  • infections (chronic);
  • cardiac pathology;
  • massive blood loss;
  • severe stress

At any age, a person can break the state of severe stress. And this process is pathological. In this case, the cerebral cortex suffers. Brain hypoxia occurs.

Adults may experience cardiogenic collapse. as a result of heart disease. Usually, this pathology occurs more often in males. Women are also affected, but less so.

Intoxication can cause collapse. Alcohol intoxication may usually be present. Drug poisoning. Excessive alcohol consumption leads to various vascular disorders.

Massive blood loss is an unexpected condition. May require urgent medical attention. Hospitalization is mandatory.

In children

Collapse in children is a life-threatening acute vascular insufficiency. What is the main etiology of the disease in children? The main reasons for the collapse are:

  • severe course of the infectious process;
  • adrenal insufficiency;
  • overdose of antihypertensive drugs;
  • severe injury;
  • severe blood loss

Infectious process in children can take a more severe form. This is due to inadequate treatment or insufficient treatment. This condition may be due to the following infections:

  • intestinal infection;
  • flu;
  • acute respiratory viral disease;
  • pneumonia;
  • pyelonephritis

As you can see, any infection can cause this condition. However, it can be bacterial or viral. Depending on the pathogen.

What kind of help does a child need in this condition? The child needs first aid:

  • lay in a horizontal position;
  • ensure the patency of the airways;
  • overlay heating pads;
  • introduce a solution of papaverine, dibazol, no-shpy solution;
  • introduce hydrocortisone and prednisolone;

Provide cardiopulmonary resuscitation if indicated. Hospitalization in the intensive care unit is required. To prevent death.

Forecast

With a collapse, the prognosis is often unfavorable. Especially if first aid was not provided in a timely manner. There may be favorable forecasts.

Favorable prognosis, if help is provided on time and the patient is out of this state. At the same time, the work of the heart and respiratory system was restored. There may even be a full recovery.

The prognosis worsens with untimely, inadequate treatment of collapse. And also, when the patient is not hospitalized in time in the intensive care unit. What is one of the most necessary measures of assistance.

Exodus

Death is observed with untimely assistance. Recovery is possible in some cases. Much depends on the provision of first aid.

First aid can be provided by a paramedical worker. But at the same time, it is important to ensure the drug administration of drugs. This allows the functionality to be restored.

The outcome depends on the severity of the disease, as well as on the type of collapse. Cardiogenic collapse is associated with cardiac pathology. Therefore, it is advisable to conduct a certain therapeutic therapy. Most often, hypovolemic collapse ends unfavorably.

Lifespan

The length of life and its quality depends on many factors. At the same time, there is a speed and timeliness in the provision of assistance. With successful emergency care, life expectancy increases.

However, after even successfully completed assistance measures, it is necessary to control pressure. It is important to observe the daily routine and bed rest. This helps prolong the life of the patient.

Long-term rehabilitation is also necessary. But only under the supervision of a specialist. Self-medication can lead to a reduction in life expectancy. So follow these steps!

Acute circulatory failure can occur due to several reasons: a decrease in myocardial contractility (heart failure), a sharp decrease in vascular tone (collapse, acute adrenal insufficiency, acute blood loss or exsicosis). Acute circulatory failure may be the result of a combination of heart and vascular insufficiency, that is, mixed.

Restoration of cardiac activity is the main component of recovery from a state of clinical death. CPR includes chest compressions, mechanical ventilation, defibrillation, intravenous drug administration, and emergency management of metabolic acidosis.

The criteria for the effectiveness of a closed heart massage are the transfer of massaging movements in the form of a pulse to the ulnar artery, a decrease in the degree of cyanosis of the skin and mucous membranes. Constriction of the pupils can be expected only if atropine and epinephrine were not introduced during resuscitation.

ACUTE VASCULAR INSUFFICIENCY

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 are: severe course of acute infectious pathology (intestinal infection, influenza, SARS, pneumonia, pyelonephritis, tonsillitis, etc.); acute adrenal insufficiency; overdose of antihypertensive drugs; acute blood loss; 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 (options) of collapse are conditionally distinguished: sympathotonic, vagotonic and paralytic.

Sympathotonic collapse

He due to impaired peripheral circulation due to spasm of arterioles and centralization of blood circulation, compen-

satoric release of catecholamines. It is characterized by the excitation of the child, increased muscle tone; pallor and marbling of the skin, cold hands and feet; tachycardia, blood pressure normal and elevated. However, these symptoms are short-lived, and collapse is more often diagnosed in later phases.

Vagotonic collapse

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

paralytic collapse

It is caused by passive expansion of capillaries due to the depletion of the mechanisms of regulation of blood circulation. This condition is characterized by: lack of consciousness with inhibition of skin and bulbar reflexes, the appearance of blue-purple spots on the skin of the trunk and extremities, bradycardia, bradypnoe with the transition to Cheyne-Stokes periodic breathing, blood pressure decreases to critical numbers, thready pulse, anuria. In the absence of emergency care, a fatal outcome occurs.

Urgent Care

Therapeutic measures must be started immediately!

    It is necessary to lay the child horizontally on his back with his head slightly thrown back, overlay warm heating pads, and provide a flow of fresh air.

    Ensuring free patency of the upper respiratory tract (perform an audit of the oral cavity, remove tight clothing).

    With the phenomena of sympathotonic collapse, it is necessary to relieve spasm of peripheral vessels by intramuscular administration of antispasmodics (2% papaverine solution 0.1 ml/year of life or drotaverine solution 0.1 ml/year of life).

    With the phenomena of vagotonic and paralytic collapse, it is necessary:

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

■ simultaneous injection of corticosteroids in a single dose: hydrocortisone 10-20 mg/kg IV or prednisolone 5-10 mg/kg IV or in the floor of the mouth, or dexamethasone 0.3-0.6 mg/kg IV V.

With intractable arterial hypotension, it is necessary:

    re-introduce intravenously 0.9% sodium chloride solution or Ringer's solution in a volume of 10 ml/kg in combination with a solution of rheopolyglucin 10 ml/kg under the control of heart rate, blood pressure and diuresis;

    prescribe a 1% solution of mezaton 0.1 ml/year of life i.v. slowly or 0.2% solution of noradrenaline 0.1 ml/year of life i.v. drip (in 50 ml of 5% glucose solution) at a rate of 10-20 ka pel per minute (in very severe cases - 20-30 drops per minute) under the control of blood pressure.

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

SYNOPSIS (SYNCOPAL CONDITION)

This is a sudden short-term loss of consciousness with loss of muscle tone due to transient disorders of cerebral circulation.

Causes of fainting

    Violation of the nervous regulation of blood vessels: vasovagal, orthostatic, sinocarotid, reflex, situational, with hyperventilation syndrome.

    Cardiogenic syncope.

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

    Tachyarrhythmias (paroxysmal tachycardia, including with long QT interval 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.).

Hypoglycemia.

Cerebrovascular diseases, etc. Clinical picture

Fainting is more common in girls and girls 15-19 years old. A typical harbinger of fainting is dizziness, as well as a feeling of instability and unpleasant lightness.

The main signs of fainting: suddenness of development, short duration (from a few seconds to 3-5 minutes), reversibility, rapid and complete recovery of consciousness - the child is oriented in the environment, remembers the circumstances preceding the loss of consciousness.

During examination during fainting, the child reveals a sharply reduced muscle tone, pallor, dilated pupils, weak filling pulse, reduced blood pressure, muffled heart sounds; heart rate and rhythm may be different; shallow breathing. Although in most cases syncope has a functional etiology, in each case it is necessary to exclude organic pathology.

For aortic stenosis, hypertrophic cardiomyopathy, the occurrence of fainting during exercise is especially characteristic. In the case of arrhythmogenic causes of syncope, patients may notice “interruptions” in the heart rhythm. To exclude the cardiac origin of syncope, it is necessary in all cases to control the pulse rate and, if possible, urgently record an ECG.

The state of hypoglycemia should be considered if the attack was preceded by a long break in food intake (for example, in the morning) or the attack developed in a child after intense physical or emotional stress. In the post-syncope period, long-lasting drowsiness, muscle weakness, and headache are characteristic. The diagnosis is confirmed by detecting a reduced blood sugar level of less than 3.3 mmol / l or by ex juvantibus therapy.

First aid for fainting

    It is necessary to lay the child horizontally, raising the leg end by 40-50°, unfasten the collar, loosen the belt and other items of clothing that put pressure on the body; provide access to fresh air. You can use reflex effects: splash your face with water or pat your cheeks with a damp towel; give a breath of ammonia vapor. When leaving this state, you need to drink hot sweet tea.

    With prolonged fainting, it is necessary to introduce a 10% solution of caffeine-sodium benzoate 0.1 ml/year of life s/c or a solution of cordiamine 0.1 ml/year of life s/c. In case of severe arterial hypotension, a 1% solution of mezaton 0.1 ml / year of life is injected intravenously. In a hypoglycemic state, a 20-40% glucose solution is administered 2 ml/kg IV by jet. With severe bradycardia and an attack of Morgagni-Adams-Stokes, it is necessary to carry out primary resuscitation measures: indirect heart massage, inject a 0.1% solution of atropine 0.01 ml/kg intravenously. With psychogenic arousal, diazepam is administered at a dose of 0.3-0.5 mg/kg intramuscularly or intravenously.

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.

HEART FAILURE

To reduce the contractility of the myocardium, causing heart failure, lead to: acute cardiac decompensation with congenital heart defects, acute infectious myocardial dystrophy, infectious and infectious-allergic cardiitis, severe cardiac arrhythmias of various etiologies, less often - other reasons.

Depending on the severity of the process and the degree of decompensation, two main types of HF are distinguished: low cardiac output syndrome; congestive heart failure I- III degree.

Causes of low cardiac output syndrome

arrhythmic shock.

    Bradyarrhythmias (atrioventricular conduction disorders, sinoatrial and atrial blockades).

    Tachyarrhythmias (excessive tachycardia in toxicosis Kishsh, acute coronary insufficiency in young children; supraventricular paroxysmal tachycardia, atrial fibrillation and flutter, ventricular fibrillation, group ventricular extrasystoles).

    Cardiogenic shock against the background of acute focal (heart attack) or total myocardial hypoxia is more common in children with CHD (anomalies of coronary vessels discharge) with ARVI.

    Acute pericardial tamponade (myocardial injury or rupture, pericarditis, pneumopericardium, extracardiac cardiac tamponade in status asthmaticus) III- IV degree).

    End-stage CHF against the background of decompensation of heart defects, myocarditis of various origins.

Clinically, the syndrome of low cardiac output is manifested by a sharp decrease in blood pressure, pallor, anxiety (pain syndrome), frequent thready pulse, acrocyanosis, oliguria, disorientation and agitation. The ECG usually shows ST segment depression and a negative wave. T.

Congestive heart failure

The clinical picture consists of tachycardia and shortness of breath in a child at rest. Stagnation in the systemic circulation is manifested in an increase in the size of the liver, periorbital edema, swelling of the cervical veins and puffiness of the face, acrocyanosis, edema

lower limbs. With stagnation in a small circle, diffuse cyanosis, bronchospasm, crepitating and fine bubbling rales occur in the lower parts of the lungs. In young children, the presence of stagnation in both circles of blood circulation is typical. In more severe cases, widespread edema, deafness of heart tones, oliguria, and expansion of the boundaries of the heart are noted.

With the development of acute heart failure, it is necessary to call an intensive care team for urgent hospitalization. Begin oxygen therapy, enter furosemide intravenously 1-2 mg/kg. If there is no effect, treatment is carried out as with pulmonary edema.

HEART ARRHYTHMIAS

Paroxysmal tachycardia and complete atrioventricular blockade can cause cardiac disorders to the state of heart failure.

PAROXYSMAL TACHYCARDIAS

Paroxysmal tachycardia is an attack of a sudden increase in heart rate of more than 150-160 beats per minute in older children and more than 200 beats per minute in younger children. The duration of the attack can be from several minutes to several hours (less often - several days), with a sudden restoration of a normal heart rhythm. Rhythm disturbances are characterized by specific ECG manifestations.

The main causes of an attack of paroxysmal tachycardia: violations of the autonomic regulation of the heart rhythm; organic lesions of the heart; electrolyte disturbances, poisoning; psycho-emotional and physical stress.

Allocate paroxysmal tachycardia: supraventricular and ventricular. Supraventricular paroxysmal tachycardia is more often functional in nature and occurs as a result of changes in the autonomic regulation of cardiac activity. Ventricular paroxysmal tachycardia is less common and is usually caused by organic heart disease.

Clinical picture

Supraventricular paroxysmal tachycardia. A sudden onset is characteristic, the child feels a strong heartbeat, lack of air, dizziness, weakness, nausea, fear of death. Pallor of the skin, increased sweating, pollakiuria are noted. Heart sounds are loud, clapping, heart rate cannot be counted, jugular veins swell. There may be vomiting, which often stops the attack. HF (shortness of breath, hypotension, hepatomegaly, decreased diuresis) develops

Xia infrequently, mainly in children of the first months of life and with prolonged seizures. ECG signs of paroxysmal supraventricular tachycardia: a steady rhythm with a frequency of 150-200 per minute, an unchanged ventricular complex, the presence of an altered P wave

Ventricular and aroxysmal tachycardia. The beginning of the paroxysm subjectively the child does not catch; there is always a serious condition of the child (shock!); the cervical veins pulsate at a rate much lower than that of the arterial pulse. ECG signs of ventricular paroxysmal tachycardia: rhythm rate not more than 160 per minute, variability of R-R intervals, altered ventricular complex, absence of a tooth R.

Emergency care for an attack of supraventricular tachycardia

    Children under one year old are subject to immediate hospitalization.

    For children older than 3 years, assistance should begin with a reflex effect on the vagus nerve:

    Massage of the carotid sinuses alternately for 10-15 seconds, starting from the left one, as the vagus nerve is richer in endings (the carotid sinuses are located at the angle of the lower jaw at the level of the upper edge of the thyroid cartilage).

    Valsalva maneuver - straining at maximum inspiration while holding the breath for 30-40 s.

    Mechanical irritation of the pharynx is a provocation of the gag reflex.

    The Ashner test (pressure on the eyeballs) is not recommended due to methodological inconsistencies and the risk of developing retinal detachment.

Simultaneously with reflex tests, the following are prescribed orally: sedatives (diazepam */ 4 -1 tablet, tincture of valerian or motherwort, valocordin, etc. at a dose of 1-2 drops / year of life), panangin (potassium orotate) Ug-1 tablet in depending on age.

In the absence of the effect of the above therapy, after 60 minutes, antiarrhythmic drugs are prescribed sequentially (in the absence of an effect on the previous one) with an interval of 10-20 minutes: (ATP intravenously, aymalin).

Emergency care for an attack of ventricular paroxysmalnoah tachycardia

Provide access to the vein and inject slowly:

    10% solution of procainamide at a dose of 0.2 ml/kg together with 1% solution of mezaton at a dose of 0.1 ml/year of life or

    1% solution of lidocaine at a dose of 0.5-1 mg/kg per 20 ml of 5% glucose slowly!

Vagus tests and the introduction of cardiac glycosides are contraindicated!

Children with paroxysmal supraventricular tachycardia are hospitalized in the somatic department, with the addition of heart failure - in the intensive care unit; with ventricular tachycardia - in the intensive care unit.

COMPLETE AV BLOCK

This violation of the heart rhythm usually occurs with organic heart disease or poisoning with cardiotropic drugs. The heart rate decreases to 45-50 per minute or less.

Clinical picture

The growing weakness of the child, dizziness, and, finally, loss of consciousness with or without convulsions is characteristic. Attacks last from a few seconds to several minutes, often pass spontaneously, but sudden cardiac arrest is also possible. With a long course of the disease and recurrence of attacks, the child develops cardiomegaly and heart failure. If an attack is observed for the first time, then it can be suspected by a heart rate of 30-40 per minute, clapping the 1st tone at the top. You can finally verify the presence of AV blockade using an ECG.

Urgent Care

At the pre-hospital stage, to stop the attack, you need to lower the head in the horizontal position of the child below the body and start an indirect heart massage. A 0.1% solution of atropine is administered subcutaneously to infants and young children in a single dose of 0.005 ml / kg of body weight, older than 4 years - 0.05 ml per year of life (0.1 mg / kg). If it is possible to give the child a medicine inside, then put one tablet of izadrin under the tongue or ask to swallow U 2 -1 tablet of alupent. Inject glucocorticoids intravenously once 2 mg/kg. Hospitalization is required.

OTHER CAUSES OF HEART FAILURE

HYPERTENSIVE CRISIS

Hypertensive crisis - a sudden sharp rise in blood pressure, accompanied by clinical signs of encephalopathy or heart failure.

The disease is characterized by headache, nausea, vomiting, dizziness, blurred vision; shortness of breath, chest pain. Perhaps the development of a violation of consciousness, the development of coma, seizures, loss of neurological functions. The pulse is usually tense, bradycardia develops.

Urgent Care

With an increase in blood pressure to 170/110 mm Hg. in children under six years of age, or up to 180/120 mm Hg. in children older than six years, an immediate decrease in blood pressure is required before hospitalization.

In order to reduce blood pressure, nifedipine 0.5 mg/kg sublingually is prescribed, if necessary, the drug is repeated after 15 minutes. Perhaps the appointment of drotaverine and captopril. Drotaverin is prescribed for children from 1 to 6 years old, 40-120 mg in 2-3 doses, over 6 years old - 80-200 mg in 2-5 doses. Clonidine is prescribed orally 3-5 mcg/kg 3 times a day, s.c., i.m., or i.v.; furosemide is prescribed at a dose of 1-5 mg/kg IV. These drugs are used to quickly reduce pressure. Hospitalization is carried out depending on the cause of the increase in blood pressure in specialized departments or in intensive care.

dyspnea-cyanotic attack

This is an attack of hypoxia in a child with congenital heart disease of the blue type, most often with tetralogy of Fallot, associated with spasm of the output section of the right ventricle of the heart.

Attacks of hypoxia develop mainly in young children from 4-6 months to 3 years. Typically, seizures provoke psycho-emotional stress, increased physical activity, diseases accompanied by dehydration (fever, diarrhea), iron deficiency anemia, neuroreflex excitability syndrome with perinatal CNS damage, etc.

Clinical picture

A shortness of breath-cyanotic attack is characterized by a sudden onset: the child is restless, moaning, crying, while cyanosis and shortness of breath increase, takes a forced position - lies on its side with legs brought to the stomach or squats down. Auscultation of the heart determines tachycardia; systolic murmur of pulmonary stenosis is not heard. The duration of a hypoxic attack ranges from several minutes to several hours. In severe cases, convulsions, loss of consciousness up to coma and death are possible.

Urgent Care

    It is necessary to reassure the child, unfasten tight clothes, lay on the stomach in the knee-elbow position; inhalation of humidified oxygen through a mask.

    In a severe attack, it is necessary to provide access to a vein and enter:

    4% sodium bicarbonate solution at a dose of 4-5 ml/kg (150-200 mg/kg) IV slowly over 5 minutes; you can repeat the introduction of a half dose after 30 minutes and for the next 4 hours under the control of blood pH;

    1% solution of morphine or promedol at a dose of 0.1 ml / year of life s / c or / in (children over 2 years old in the absence of symptoms of respiratory depression);

    if there is no effect, a 0.1% solution of propranolol is administered very carefully at a dose of 0.1-0.2 ml / kg (0.05-0.1 mg / kg) in 10 ml of a 20% glucose solution IV slowly (at a speed 1 ml/min or 0.005 mg/min).

    With convulsions, a 20% solution of sodium oxybutyrate 0.25-0.5 ml / kg (50-100 mg / kg) is injected intravenously slowly!

    With the success of first aid measures, the patient can be left at home with the recommendation of the subsequent use of obzidan at a dose of 0.25-0.5 mg / kg per day.

Cardiac glycosides and diuretics are contraindicated! Hospitalization of children with shortness of breath and cyanotic attacks is indicated in case of ineffective therapy.

AGREED I APPROVE

Action algorithm

when providing emergency care for hyperthermia in a child,

Pink" hyperthermia

1. Uncover the baby, remove all obstacles for effective heat transfer.

2. Assign a plentiful drink (0.5 - 1 liter more than the age norm per day).

3.Use physical cooling methods:

Fan blowing;

Ice on the area of ​​large vessels or the head with a gap of 1 cm;

Wiping the body with a sponge moistened with cool (20 ° C) water with vinegar

(1 tablespoon of vinegar to 1 liter of water)

Enemas with boiled water 20°C;

In / in the introduction of chilled solutions, general cool baths with temperature

water 28° - 32°C.

4. Assign inside paracetamol (panadol, kalpol, tylinol, Efferalgan upsa, etc.) in a single dose:

From 1 to 3 years old - 200 mg.

From 3 to 7 years old - 200 - 300 mg.

After 4 - 6 hours, in the absence of a positive effect, it is possible to repeat

drug use.

Required medicines:

50% solution of analgin;

1% diphenhydramine solution;

0.2 paracetamol.

AGREED I APPROVE

Chief Physician of the Municipal Healthcare Institution "City Hospital" Director of the Secondary School No. 2

Locomotive city district

A.A. Zaripov _____________ M.A. Khakimov

"____" _______________ 2010 "____" _______________ 2010

Action algorithm

When providing emergency care to urticaria and Quincke's edema in children

1. Assign a water-tea break to the child for 12 hours.

2. Cleansing enema.

3. Enter a 2% solution of suprastin.

4. Assign histalong or zyrtec, or chemtin in doses:

up to 2 years - ¼ tablet;

2 - 7 years old - 1/3 tablet;

· 7 - 12 years - ½ tablet, 1 time per day.

5. Conduct enterosorption with activated charcoal at a dose of 1g/kg/day

From 1 - 3 years old - 15g;

From 3 to 7 years old - 20g.

6. In case of giant urticaria, inject 0.1% adrenaline solution at a dose of 0.1 - 0.2 ml s / c.

7. With the development of edema, hospitalization of the child in the ENT department is necessary.

Required medicines:

0.5 histalong;

2% suprastin solution

0.18% adrenaline hydrotartrate solution

· 0.25 activated carbon.

The nurse of preschool educational institution No. 3 L.N. Komanova was introduced

AGREED I APPROVE

Chief Physician of the Municipal Healthcare Institution "City Hospital" Director of the Secondary School No. 2

Locomotive city district

A.A. Zaripov _____________ M.A. Khakimov

"____" _______________ 2010 "____" _______________ 2010

Action algorithm

When providing emergency care for convulsive syndrome in children

1. Turn your head to the side;

2. Clean the oral cavity;

3. Constantly monitor the patency of the respiratory tract;

4. Provide access to fresh air;

5. Release from outerwear;

6. Introduction of an anticonvulsant drug:

0.5% solution of diazepam in / m or in the muscles of the oral cavity 0.1 ml / year of life, but not more than 2 ml once

7. In case of short-term effect or incomplete relief of seizures, re-introduce diazepam after 15-20 minutes.

8. Call an ambulance or resuscitation team;

9. When stopping seizures - hospitalization;

10. If parents refuse hospitalization, active monitoring.

Required medicines:

0.5% diazepam solution

The nurse of preschool educational institution No. 3 L.N. Komanova was introduced

AGREED I APPROVE

Chief Physician of the Municipal Healthcare Institution "City Hospital" Director of the Secondary School No. 2

Locomotive city district

A.A. Zaripov _____________ M.A. Khakimov

"____" _______________ 2010 "____" _______________ 2010

Action algorithm

When providing emergency care for hyperthermia in children

White" hyperthermia

1. Warm the child (warmers to the arms and legs);

2. Give inside a plentiful hot drink;

3. Inject lytic mixture IM: 50% solution of analgin 0.1 ml/year of life + 3% solution of thiamine bromide 0.1 ml/year of life + tavegil 0.1 ml/year of life. The lytic mixture can be repeated after 2 hours.

4. Inject one or two vasodilators intramuscularly:

NO-SHPA 0.1 - 0.2 ml / year of life;

2% solution of papaverine 0.1 ml/year of life;

1% dibazol solution 0.1 - 0.2 ml / year of life;

2.4% solution of eufillin 2 - 4 mg / kg.

· from 2 - 3 years - 30 - 60 mg;

From 3 to 7 years old - 30 - 901 mg.

1% solution of nicotinic acid 0.1 - 0.15 ml / year of life; nitroglycerin under the tongue up to 1 year - ¼ tablet, from 1 to 3 years - 1/3 tablet, over 3 years - ½ tablet.

Required medicines:

2.4% solution of aminophylline; 1% solution of nicotinic acid; nitroglycerine

50% analgin solution + 5% tavegil solution

2% papaverine solution, 1% dibazol solution.

The nurse of preschool educational institution No. 3 L.N. Komanova was introduced

AGREED I APPROVE

Chief Physician of the Municipal Healthcare Institution "City Hospital" Director of the Secondary School No. 2

Locomotive city district

A.A. Zaripov _____________ M.A. Khakimov

"____" _______________ 2010 "____" _______________ 2010

Action algorithm

in the provision of emergency care for collapse in children

1. Give the child a horizontal position with the head slightly bent in the dorsal direction.

2. Ensure free patency of the upper respiratory tract (remove restrictive details of clothing, conduct an audit of the oral cavity and nasopharynx).

3. Prescribe a 3% solution of prednisolone at a dose of 2-3 mg/kg IM.

From 1 - 3 years - 25 - 40 mg;

From 3 to 7 years old - 30 - 60 mgsh.

4. Prescribe 1% solution of mezaton 0.1 mg/year of life or 0.1 solution of adrenaline 0.1 ml/year of life IM.

Required medicines:

3% solution of prednisolone;

1% mezaton solution;

0.9% sodium chloride solution.

The nurse of preschool educational institution No. 3 L.N. Komanova was introduced