Symptoms of a cerebral coma. Coma: Neurological Examination of the Patient Educational Video of Degree of Consciousness and Glasgow Coma Scale
Etiology. Cerebral (cerebral) coma is observed in diseases of the brain: cerebral stroke, brain tumors, meningitis Clinical picture cerebral stroke develops with hemorrhages in the brain, thrombosis and embolism of the cerebral artery.
Rice. 11. Curve of Cheyne-Stokes respiration.
Clinic. Most often, a cerebral coma is associated with cerebral hemorrhage, which is usually not difficult to detect. As a rule, it develops in older people suffering from hypertension.
The patient is in an unconscious state, the face is red, the mouth is half-open, the lower lip droops, saliva flows from the mouth, the nasolabial fold is smoothed on one side. Pupils do not react to light. There is involuntary urination.
The pulse is tense, slow. When examining a patient, paralysis of the limbs of the right or left side is determined. The paralyzed limb, raised up, falls limply. The limbs on the other side of the body are passive and, being raised up and then released, also fall, but not so sharply and quickly. The difference can always be determined by checking the condition of the limbs on both sides. Muscle tone on the paralyzed side is markedly reduced. Smoothness of the nasolabial fold indicates paralysis facial nerve. The head may be tilted to the side. The gaze is directed there (in the direction of the focus of brain damage). Breathing is snoring (snoring) or Cheynstokes's (Fig. 11). The temperature is normal or subfebrile, sometimes rises to 38 ° and above. An increase in temperature may also be due to the accompanying inflammation of the lungs, which often complicates a cerebral stroke.
When listening to the heart, the deafness of tones draws attention, but an accent (amplification) of the second tone is noted on the aorta.
It should be remembered that a cerebral stroke may not be associated with a hemorrhage, but with the introduction of an embolus into the brain in case of heart defects and endocarditis. Then, when listening to the heart, murmurs indicating the presence of a defect are determined. An embolism in the brain is indicated by the young age of the patient and the pallor of the face.
The third type of stroke - thrombosis of the cerebral vessels - has that distinguishing feature that develops, as a rule, slowly, and not suddenly. The disease is characteristic of old age and is associated with atherosclerosis of cerebral vessels.
A picture of a cerebral coma can occur with a particular disease of the brain, for example, a tumor, meningo-encephalitis, etc.
The severity of the condition and prognosis in cerebral coma due to stroke depend on the caliber of the affected vessel, the massiveness of the hemorrhage, the recurrence of hemorrhages and complications. In cases of hemorrhage in the vital centers of the brain, death can occur soon after the stroke and even instantly, as, for example, with a hemorrhage in the medulla oblongata.
Treatment. When hemorrhage in the brain requires careful monitoring and care of the patient. In cases where a coma has occurred outside the home (at work or on the street), the patient with great care should be placed on a stretcher and taken to the hospital. If a call to the patient is made at home, then all therapeutic measures should be carried out only at home. Transportation of the patient from home is not permitted under any circumstances.
With the utmost care, the patient should be undressed and put to bed with a slightly raised head. Removable dentures must be removed from the mouth. The patient is completely at rest. It is advisable to put leeches on the mastoid processes (behind the ears), four on each side. An ice pack is placed on the head (preferably on the side opposite to the paralysis, that is, on the side where the hemorrhage occurred). Heating pads are applied to the legs. We must not forget that in the unconscious state of the patient, as well as due to loss of sensitivity, burns can occur. Therefore, the heating pad must be wrapped in a towel. If the patient does not have swallowing problems, it is necessary to give a laxative salt (10% solution of magnesium sulfate or sodium sulfate, one tablespoon one hour before the action). Just like foot warmers, this has a distracting effect.
With a massive or significant hemorrhage in the brain, the patient, without regaining consciousness, dies already in the first hours. However, it is difficult to establish the degree of severity of the condition and determine the prognosis. In all cases of cerebral coma, it is necessary to take all measures that will help restore the patient's viability. The longer the coma, the less favorable the prognosis. A few hours after the measures taken, the patient may regain consciousness. But it cannot be taken as a sign that the danger has passed. The patient should not be left without medical supervision and assistance. It is necessary to monitor the temperature, pulse and respiration. Cerebral hemorrhage may be accompanied by a rise in temperature. A prolonged increase in it should raise the suspicion of pneumonia that has joined. Therefore, even with a slight increase in temperature, treatment with penicillin should be started by intramuscular injections its 200,000-300,000 IU 4 times a day. Due to the fact that the patient cannot be turned, injections of penicillin should not be made into the buttock, but into the muscles of the thigh along its anterior or lateral surface. An increase in the pulse, its weakening and the appearance of arrhythmia indicate a drop in the activity of the cardiovascular system. In such cases, it is necessary to administer camphor, cordiamine or cardiazole 2 ml 3-4 times a day. A serious condition is indicated by the appearance of stertorous (snoring) "breathing.
Patients with cerebral coma often develop bedsores. The places of their formation are parts of the body on which the bed exerts pressure: the region of the sacrum, shoulder blades, heels, the lateral surface of the body on the side on which the patient lies. To prevent bedsores, you need to monitor the condition of the bed: it should be dry, sheets - without seams and folds that contribute to the formation of bedsores. Care must be taken to keep the patient's body dry. It is necessary to wipe the patient's body with alcohol (camphor, wine) or cologne. Particular attention should be paid to the paralyzed side and places where bedsores usually appear.
Careful care is also necessary for the oral cavity. Three times a day, the patient's mouth should be wiped with cotton wool wrapped around a stick and moistened with a solution of boric acid or a 2% soda solution. The tongue, cleaned of plaque, is smeared with glycerin.
In case of involuntary urination, a urinal should be installed between the legs of the patient. A large oilcloth is spread under the sheet. Even better, carefully hem it to the mattress so that wrinkles do not form. A wet sheet must be changed immediately, which must be done together: the patient is carefully turned on his side, the vacated part of the sheet is folded to the middle of the bed, the wet oilcloth is wiped dry, a dry sheet is spread in this place, the patient is carefully turned to the other side (in the direction of the newly spread sheet) and, lifting it slightly, remove the wet sheet. After wiping the wet oilcloth on the second half of the bed, they spread a sheet, straighten all the folds and lay the patient down.
In case of urinary retention in the area Bladder you can apply light pressure or apply a heating pad. If these measures fail to induce urination, it is necessary to catheterize with a soft rubber sterile catheter. This manipulation is performed under the strictest observance of the rules of asepsis.
It is necessary to ensure that in patients with a cerebral coma, the intestines function regularly, for which, with developed constipation, enemas are given. Instead of the usual cleansing enema of 4-5 glasses of warm water, it is better to resort to hypertonic and oil enemas. In the first case, a solution is prepared from 20-25 g of sodium chloride per 200 ml of water. Instead of table salt, you can take 25-30 g of magnesium sulfate for the same amount of water. For an oil enema take 100-150 ml vegetable oil. Sometimes after the application of a cleansing enema, urination also occurs.
Much attention should be paid to the nutrition of patients. Food must be liquid. It is necessary to feed the patient in small portions, 5-6 times a day, from a spoon, and even better from a drinker. With careless and hasty feeding, the patient may choke. In addition, there may be signs of swallowing disorders due to cerebral hemorrhage. The ingress of food into the respiratory tract can lead to the development of aspiration pneumonia, which is life-threatening for a seriously ill patient.
Hospitalization of the patient with a favorable course of the disease is allowed no earlier than after 2 weeks.
Director of LLC "Clinic of the Brain Institute", Doctor of Medical Sciences, Professor of the Department of Nervous Diseases and Anesthesiology-Resuscitation of the Ural State Medical Academy, Chairman of the Supervisory Board of ANO "Clinical Institute of the Brain".
Deputy chief physician for medical work, kmn, neurologist
Head of the Neurological Department, Neurologist
Primary cerebral coma is associated with a primary lesion of the central nervous system as a result of injury epileptic seizure, apoplexy, infectious and inflammatory lesions, tumor growth.
Clinical picture and symptoms
Symptoms in cerebral coma depend on the directly damaging factor. With subarachnoid hemorrhage and with traumatic injuries, gross focal neurological symptoms occur. Hemiplegia or tetraparesis may occur. Paralysis occurs throughout the striated skeletal muscles. In hemiplegia, the lesion occurs on the opposite side of the lesion. When the victim is in a coma, paralysis is manifested by the complete absence of any kind of sensitivity and reflexes.
Causes of cerebral coma
Cerebral coma occurs as a result of serious organic damage to the brain. In clinical practice, it is customary to distinguish several forms of cerebral coma. Apoplexy form - occurs due to subarachnoid or parenchymal bleeding in the brain tissue, as well as after an ischemic stroke with the formation of encephalomalacia zones. Post-traumatic form - as a result of trauma and coma associated with tumor growth.
Therapy
In the event of a cerebral coma, the victim necessarily needs a qualified medical care. Such a victim is urgently transferred to the intensive care unit and intensive care unit in order to continuously monitor the vital functions of the body. Cerebral coma is difficult to treat and correct, only experienced professionals can cope with this condition. The Clinical Institute of the Brain is equipped with an advanced intensive care unit and specializes in the treatment of all types of emergency conditions in neurology. Highly qualified specialists work on the basis of the center, ready to help the victim at any moment.
First aid
If you suspect a coma in a person, first call a specialized ambulance team. Check for the presence of vital body functions, namely respiratory and cardiovascular activity. Constantly monitor the condition of the victim until the arrival of doctors at the scene.
Complications in cerebral coma
Since cerebral coma is often associated with gross violations of brain structures, the consequences of such a coma are irreversible. If the victim manages to get out of a coma, then in most cases he remains disabled due to persistent paralysis of the skeletal muscles. Such a patient needs constant care.
Primary cerebral, or neurological (cerebral) coma is a group of comatose conditions, which are based on depression of the central nervous system in connection with a primary brain lesion, This group includes: apoplectic coma, epileptic coma, traumatic coma, coma with encephalitis, meningitis, brain tumors and its shells
Apoplexy coma Causes: Hemorrhage in the brain. Acute local ischemia of the brain with an outcome in a heart attack (with thrombosis or embolism of a large cerebral artery). Risk factors: Arterial hypertension (especially periods hypertensive crises). Atherosclerotic changes in the walls of cerebral vessels. People aged 45-60 are most susceptible
The leading pathogenetic factors of apoplexy coma are: ischemia and hypoxia of the brain (as a result of local or extensive circulatory disorders in it); a significant increase in the permeability of the walls of microvessels; rapidly growing edema of the substance of the brain. stroke is characterized by secondary circulatory disorders around the ischemic zone of the brain with rapidly increasing signs of loss of sensation and movement.
Manifestations of apoplexy coma - the patient suddenly loses consciousness; - his face (in typical cases) is purple; - visible vessels are dilated and noticeably pulsate; - pupils do not react to light; - tendon reflexes are reduced or absent (hyporeflexia), pathological reflexes are observed (Babinsky and others); - due to damage and irritation of the brain substance, respiratory disorders are intensively growing (it is noisy, hoarse); - impaired swallowing; - hypertensive reactions and bradycardia are noted.
With apoplexy coma as a result of ischemic stroke, the following are usually observed: - repeated episodes of rapidly passing dizziness; - unsteady gait; - speech disorders; - sensitivity disorders; - often fainting (these disorders are the result of transient circulatory disorders in the vessels of various regions of the brain with the development of its transient ischemia); - disorders of consciousness, up to its loss;
arterial hypotension; - bradycardia; - cardiac arrhythmias; - rare shallow breathing; - pale and cold skin and mucous membranes; - with prolonged ischemia (depending on the affected area of the brain), the following are detected: - hyporeflexia, - movement disorders, - sensitivity disorders.
Consequences of cerebral hemorrhage or ischemic stroke. Depend on: the scale and topography of damage, the degree of hypoxia and cerebral edema, the number of lesions, severity arterial hypertension, severity of atherosclerosis, age of the patient. Apoplexy coma is one of the most unfavorable flowing coma, fraught with death or disability of the patient.
First Aid Action: Call " ambulance” or a doctor (if the incident occurred in a hospital). Provide the patient with rest and bed rest. Release the patient from outerwear. Provide fresh air to the room. Free the patient's mouth from vomit (for repeated vomiting, turn your head to one side and remove the vomit from your mouth). For apoplexy coma, place an ice pack on the head or cold water. When convulsing, gently hold the head and limbs.
Epileptic coma Usually develops in patients with genuinous and symptomatic epilepsy in status epilepticus. In the pathogenesis of coma, hemodynamic, liquorodynamic and metabolic disorders in the brain play an important role. Manifestations: Onset is usually sudden In the interictal period, consciousness is not restored Body temperature rises to 39 degrees
The rhythm of breathing and cardiac activity are disturbed, vomiting of color appears coffee grounds Muscular hypotension increases, the severity and duration of convulsions decrease, breathing becomes superficial, and then periodic according to the Cheyne-Stokes type. Convulsions stop, muscle atony is observed, acidosis increases, cerebral edema. Respiratory arrest and death occur.
First aid actions Call an ambulance Before the emergency team arrives, lay the patient in a stable position Free the airways from vomit, mucus, foreign objects Do not let the tongue fall Free the patient from tight clothing Avoid possible injuries
Manifestations: A) Concussion Loss of consciousness lasting from several minutes to several hours Vomiting shortly after injury After recovery of consciousness, the patient complains of dizziness, tinnitus, headache, nausea, weakness, sleep disturbance, pain when moving the eyeballs Retrograde and anterograde amnesia With untimely diagnosis of a concussion or in its absence, the condition worsens and may develop into a coma.
B) Contusion of the GM and TBI, the loss of consciousness can last from several minutes (in mild cases) to several days or weeks mild degree: loss of consciousness does not exceed one hour, moderately pronounced headache, dizziness, nausea, repeated vomiting is possible. As a rule, there is also amnesia. Body temperature usually remains within normal limits, respiratory function is not impaired. However, even with a mild degree of brain contusion, fractures of the bones of the skull and an admixture of blood in the cerebrospinal fluid are possible. Data from special studies revealed signs of cerebral edema and petechial hemorrhages in the substance of the brain. moderate: The duration of loss of consciousness is an average of 46 hours.
The symptoms of a bruise are pronounced: there is a severe headache, repeated vomiting, pronounced changes in the heart rate (both slowing down and speeding up are possible), significant shortness of breath, fever. Possible mental disorders. Neurological symptoms are clearly manifested, pupil reactions, eyeball movements are disturbed, sensitivity and speech disorders are expressed. Along with fractures of the bones of the skull, hemorrhages under the lining of the brain are also often noted. CT scan with these bruises, it reveals hemorrhages in the substance of the brain of a small-focal nature or moderate soaking of the brain area in the bruised area with blood. severe degree: the duration of turning off consciousness can range from several hours to several weeks.
Severe brain damage corresponds to severe clinical manifestations that threaten vital functions: a sharp slowdown or a sharp increase in heart rate, a significant increase blood pressure, pronounced disturbances in the rhythm and frequency of breathing, motor excitation is often noted, body temperature is significantly increased, floating movements of the eyeballs, bilateral dilation or narrowing of the pupils, swallowing disorders, changes in muscle tone, inhibition of tendon reflexes are noted. Paralysis can be detected, convulsive seizures are less common. As a rule, there are fractures of the vault and base of the skull and massive hemorrhages under the lining of the brain.
First aid actions: Immediately call the rescue team Remove tight clothing, clear the upper respiratory tract If a skull fracture is suspected, it is better to fix the victim in the state in which he is Prevent tongue retraction If possible, apply cold to the head Stop bleeding, treat the wound follow appearance and breathing, pulse, blood pressure Limit the movement of the victim as much as possible
First aid: As with all emergencies, the following situations are possible with coma: - there is an anamnesis, previous diseases are known internal organs, in which a coma can develop; objective examination reveals characteristic symptoms this or that pathology: foci in strokes, traces of trauma, jaundice, etc. In these cases, the diagnosis of the cause of a coma usually does not cause difficulties; - a clinical situation in which there is no anamnesis, history of the disease, but have characteristic clinical symptoms or laboratory - instrumental data of a disease.
Medical assistance: 1. Mandatory immediate hospitalization in the intensive care unit, and in case of traumatic brain injury or subarachnoid hemorrhage - in the neurosurgical unit. Despite the mandatory hospitalization, emergency treatment for comas in all cases should be started immediately. 2. Restoration (or maintenance) of an adequate state of vital functions: a) breathing
Sanation respiratory tract to restore their patency, installation of an air duct or fixation of the tongue, artificial ventilation of the lungs with a mask or through an endotracheal tube, in rare cases - tracheo - or conicotomy; oxygen therapy (4-6 l / min through a nasal catheter or 60% through a mask, endotracheal tube); tracheal intubation in all cases should be preceded by premedication with a 0.1% solution of atropine at a dose of 0.5 ml (with the exception of poisoning with anticholinergic drugs); b) blood circulation - with a drop in blood pressure - drip injection of 0.9% sodium chloride solution, 5% glucose solution or 70 ml of dextran or ml of refortan with addition in case of inefficiency
Infusion therapy of pressor amines - dopamine, norepinephrine, - in case of coma on the background of arterial hypertension - correction of high blood pressure to values exceeding the "working" ones by mm Hg (in the absence of anamnestic information - not lower than / mm Hg): a) by lowering intracranial pressure b) by administering mg of magnesium sulfate as a bolus for 7-10 minutes or drip) c) with contraindications to magnesium by administering mg of bendazol (bolus 3-4 ml of 1% or 6-8 ml of 0.5% solution), d) with a slight increase in blood pressure, aminophylline is sufficient (10 ml of a 2.4% solution), - with arrhythmias - restoration of adequate heart rate.
3. Immobilization of the cervical spine for any suspicion of injury. 4. Providing the necessary conditions for treatment and control. The rule of three catheters (catheterization of a peripheral vein, bladder and placement of a gastric, preferably nasogastric, tube) when managing a coma prehospital stage not so categorical: in a coma medicines administered only parenterally (when taken orally, there is a high risk of aspiration) and preferably intravenously; obligatory installation of a catheter in a peripheral vein; infusions are carried out through it, and with stable hemodynamics and no need for detoxification
An indifferent solution is slowly dripped in, which provides a constant opportunity to inject medications; bladder catheterization should be carried out according to strict indications, since in prehospital care this manipulation is associated with the risk of septic complications, and during transportation it is difficult to provide the necessary degree of fixation; the introduction of a gastric tube with a preserved gag reflex without prior intubation of the trachea and its sealing with an inflated cuff is fraught with a coma with the possible development of aspiration of gastric contents (a potentially lethal complication, to prevent which a probe is installed).
5. The fight against intracranial hypertension, edema and swelling of the brain and meninges: side effects, especially in the absence of adequate control, at the prehospital stage, it can be used only for health reasons; b) in the absence of high blood osmolarity (available, for example, with hyperglycemia or hyperthermia) and in the absence of a threat of development or increased bleeding (observed, for example, with trauma, it is impossible to exclude the hemorrhagic nature of a stroke), dehydration is achieved by introducing an osmotic diuretic - mannitol in an amount 500 ml of 20% solution over minutes (1-2 g/kg);
To prevent a subsequent increase in intracranial pressure and an increase in cerebral edema (rebound syndrome), up to 40 mg of furosemide is administered after the completion of the mannitol infusion; c) the use of glucocorticoid hormones, which reduce vascular permeability and tissue edema around the brain lesion, is based on their proven effect in cases with the presence of perifocal inflammation; glucocorticoids are used with minimal concomitant mineralocorticoid activity, and therefore do not retain sodium and water; methylprednisolone has the greatest efficacy and safety, and dexamethasone (dose - 8 mg) can serve as a valid alternative.
6. Symptomatic therapy: a) normalization of body temperature - in case of hypothermia - warming the patient without the use of heating pads (burns are possible in the absence of consciousness) and intravenous administration heated solutions, high hyperthermia- hypothermia by physical methods (cold compresses on the head and large vessels, wiping with cold water or solutions of ethyl alcohol and table vinegar in water) and pharmacological agents (drugs from the group of analgesics - antipyretics); b) relief of seizures - the introduction of diazepam at a dose of 10 mg;
MDC 03.02 Disaster medicine
TICKET №__________
QUESTION: Anaphylactic shock. Forms. Urgent care.
STANDARD ANSWER
Anaphylactic shock
In the complex process observed in anaphylactic shock, one can distinguish three stages:
The first stage is immunological. It covers all changes in immune system arising from the moment the allergen enters the body; the formation of antibodies and / or sensitized lymphocytes and their combination with an allergen that has repeatedly entered or persists in the body;
The second stage is pathochemical, or the stage of formation of mediators. The stimulus for the emergence of the latter is the combination of the allergen with antibodies or sensitized lymphocytes at the end of the immunological stage;
The third stage is pathophysiological, or the stage of clinical manifestations. It is characterized by the pathogenic action of the formed mediators on the cells, organs and tissues of the body.
Urgent care
Adrenaline 0.5 mg intramuscularly
Pulse oximetry
oxygen inhalation
With little effect
Sodium chloride 0.9% - 500 ml intravenously drip
STANDARD ANSWERS FOR COMPREHENSIVE EXAM
PM.03. Providing medical care in emergency and extreme conditions
MDK 03.01 Fundamentals of resuscitation
MDC 03.02 Disaster medicine
TICKET №__________
QUESTION: Anaphylactic shock. Flow types. Urgent care.
STANDARD ANSWER
Anaphylactic shock- This is an immediate type of immune reaction that develops when an allergen is repeatedly introduced into the body and is accompanied by damage to its own tissues.
There are 5 types of flow
- from predominant lesion of the cardiovascular system.
The patient suddenly collapses, often with loss of consciousness. At the same time, other manifestations of an allergic reaction (skin rashes, bronchospasm) may be absent;
- from a predominant lesion of the respiratory system in the form of acute bronchospasm (asphyxic or asthmatic variant). This option is often combined with sneezing, coughing, a feeling of heat throughout the body, redness of the skin, hives, and heavy sweat. Be sure to join the vascular component (decrease in blood pressure, tachycardia).
- from predominant damage to the skin and mucous membranes. The patient experiences severe itching followed by the development of urticaria or angioedema. At the same time, symptoms of bronchospasm or vascular insufficiency may occur. Of particular danger is the angioedema of the larynx, which is manifested first by stridor breathing, and then by the development of asphyxia.
- with a predominant lesion of the central nervous system (cerebral variant). Neurological symptoms come to the fore - psychomotor agitation, fear, severe headache, loss of consciousness and convulsions resembling status epilepticus or cerebrovascular accident.
- from predominant lesion of the abdominal organs (abdominal). In these cases, the symptoms of an "acute abdomen" (sharp pain in the epigastric region, signs of peritoneal irritation) are characteristic, leading to an incorrect diagnosis of ulcer perforation or intestinal obstruction.
Urgent care
Stopping contact with the allergen
Give a position with a raised foot end
Adrenaline 0.5 mg intramuscularly
Pulse oximetry
oxygen inhalation
Vein catheterization or intraosseous access
Prednisolone 120 mg or Dexamethasone 16 mg IV
Sodium chloride 0.9% - 500 ml intravenously drip
With little effect
Epinephrine 0.5 mg intravenously or diluted with sodium chloride
0.9% - 250 ml intravenously drip 10 - 20 drops. in min. (after
placement of a second intravenous catheter)
Sodium chloride 0.9% - 500 ml intravenously drip
STANDARD ANSWERS FOR COMPREHENSIVE EXAM
PM.03. Providing medical care in emergency and extreme conditions
MDK 03.01 Fundamentals of resuscitation
MDC 03.02 Disaster medicine
TICKET №__________
QUESTION: Cerebral coma. Urgent care.
STANDARD ANSWER
Coma - pathological condition with an extreme degree of inhibition of brain activity, which is accompanied by loss of consciousness, lack of response to any external stimuli and disorders of various vital functions (impaired thermoregulation, respiration, slowing of the pulse, decreased vascular tone).
Causes of cerebral coma
The causes of this condition are primary or secondary toxic and traumatic factors. The most common reasons include:
Head and brain injuries
Strokes
Infectious lesions of the brain;
Brain damage due to lack of oxygen
Toxic damage caused by toxic substances, some drugs, drugs;
alcohol poisoning;
Symptoms of a cerebral coma
In the initial stages of a coma, a person seems to be just asleep, his eyes are closed, and the minimum possibility of movement remains. The victim can move in his sleep, swallow saliva, some reflexes are preserved. In addition, it is considered that initial stage a cerebral coma person may feel pain. At deeper stages of coma, there is an increasingly strong depression of the central nervous system and respiration, muscle atony, and disturbances in cardiac activity.
In a coma, only specialists can help. If there is a suspicion that a person has fallen into a coma, you should immediately call an ambulance. The only thing that can be done before the doctors arrive is to ensure that the victim can breathe. Since in a coma there is relaxation of the muscles, a decrease in the swallowing and respiratory reflex, it is necessary to check the victim’s pulse, turn him over on his stomach and, if possible, clear the airways
MDC 03.02 Disaster medicine
TICKET №__________
QUESTION: Hyperglycemic coma. Causes. clinical picture. Urgent care.
STANDARD ANSWER
As a rule, it complicates the course of mild or moderate diabetes mellitus, when insulin administration is stopped, its dose is insufficient, with unrecognized diabetes, against the background of physical and mental trauma, with gross violations of the diet.
Characteristic: a slow onset of a coma (the patient falls into a coma within a few hours) against the background of pain in the muscles and heart (like angina pectoris), the pulse is frequent, weak, blood pressure is lowered, dyspepsia, abdominal pain. Shortness of breath increases, to which Kussmaul's breathing joins, the exhaled air smells of acetone, collapse, oliguria, hypothermia develop. The skin becomes dry and cold, its marble-cyanotic tone decreases. The tongue is lined, the eyeballs are sunken, the pupils are constricted, the muscle tone is lowered.
2. Urgently call a doctor, laboratory assistant.
3. Give a stable side position.
4. Control of blood pressure, pulse, respiratory rate.
5. Portable fingertip blood sugar test
glucometer.
By doctor's prescription:
Glucometry
Vein catheterization
Sodium chloride 0.9% - 1000 ml intravenously by bolus during the first hour, then 500 ml per hour
Before intubation:
Atropine 0.5 - 1 mg IV
Midazolam 5 mg or Diazepam 10 mg IV - for coma
> 6 points on the GLASGOW Coma Scale
Sanitation of the upper respiratory tract
Tracheal intubation or laryngeal tube IVL/IVL
STANDARD ANSWERS FOR COMPREHENSIVE EXAM
PM.03. Providing medical care in emergency and extreme conditions
MDK 03.01 Fundamentals of resuscitation
MDC 03.02 Disaster medicine
TICKET №__________
QUESTION: Hypoglycemic coma. clinical picture. Urgent reasons for help.
STANDARD ANSWER
Most often occurs with an overdose of insulin, untimely food intake, large physical activity, fasting.
It is characterized by: an acute onset (within a few minutes), the patient before this is disturbed by a feeling of severe hunger, increasing weakness, sweating, trembling of the limb, sometimes severe headache, double vision. Usually there is a slight disturbance of consciousness, which is quickly stopped with the start of therapy. In the case of persistent hypoglycemia, a general motor excitation appears, turning into stupor and coma.
With a superficial coma, blood pressure is normal or slightly elevated, breathing is normal, there is no smell of acetone from the mouth. The skin is pale and moist.
With the deepening of the hypoglycemic coma, skin moisture disappears, breathing becomes more frequent and becomes shallow, tachycardia can turn into bradycardia, heart rhythm disturbances occur, and blood pressure decreases. Vomiting, hyperemia is noted.
The sugar level can decrease to 2.2 - 1 mmol / l, there is no glucosuria and ketonuria.
Nurse care steps:
1. Fix the time of onset of coma development.
2. Call a doctor and a laboratory assistant.
3. Give the patient a stable lateral position.
4. Inspect the oral cavity.
As prescribed by the doctor, inject 20-40-50 ml of 40% glucose solution intravenously.
STANDARD ANSWERS FOR COMPREHENSIVE EXAM
PM.03. Providing medical care in emergency and extreme conditions
MDK 03.01 Fundamentals of resuscitation
MDC 03.02 Disaster medicine
TICKET №__________
QUESTION: Renal coma. Causes. clinical picture. Urgent care.
STANDARD ANSWER
uremic coma is a complication of chronic renal failure (CKD - uremia). CKD is the end-stage (final) stage of progressive kidney disease. Chronic kidney failure become more complicated chronic glomerulonephritis, pyelonephritis, diabetic nephropathy, rheumatoid arthritis, gout - renal causes, long-term obstruction (blockage) urinary tract - postrenal, renal artery stenosis - prerenal.
Clinic. Coma develops gradually. There are 3 stages of coma development.
First stage- initial manifestations: poor appetite, nausea, vomiting, epigastric pain, smell of ammonia from the mouth, weakness, fatigue, chilliness, pruritus, insomnia, apathy.
Second stage- precoma. Patients are at first lethargic, sleepy, and then fall into stupor.
Third stage: coma. Miosis, Cheyne-Stokes or Kussmaul respiration are observed. Reflexes are reduced.