First aid for coma of unknown etiology. Emergency care for comatose states

, acute exogenous poisoning (alcohol, drug comas), metabolic comas (hyperosmolar, thyrotoxicosis), hypoxia (hanging, drowning)

Coma clinic

1. Lack of consciousness
2. Increase or decrease in the level of reflexes
3. Impairment or threat of impairment of the functions of vital organs (breathing: tongue retraction, respiratory arrest; heart: cardiac arrest)

Types of consciousness disorders:

• Obnibulation (stunning)
• Doubtfulness (drowsiness)
• Stupor (the patient is sleeping)

Degrees of coma

In a coma, verbal contact is lost

Coma 1st degree. Reaction to painful stimuli - with targeted movements; does not respond to verbal contact, sluggish reaction of pupils to light, there are corneal reflexes.

Coma 2nd degree. Reaction to painful stimuli - non-purposeful movements (chaotic), pathological types of breathing

Coma 3rd degree. Reaction to painful stimuli - changes in breathing, pulse, blood pressure, respiratory rates, absent corneal reflexes, arrhythmic breathing

Coma 4 degrees. There is no reaction to painful stimuli, mydriasis, spontaneous breathing is absent, blood pressure is sharply reduced

First aid for comas

1. Undifferentiated approach

• air duct, oxygen inhalation, mechanical ventilation
• when using Sol Magnii sulf. 25% 5-10 ml IV, IM (if breathing stops Sol. Calcii chloridi 10% - 10.0 IV) or others

If blood pressure is slightly increased, then use:

• Sol. Euphyllini 2.4% -5-7.0 - intravenously (if heart rate is not more than 100 per minute)
• For low blood pressure, use Sol. Dexamethazoni 8-20 mg. If ineffective - polyglucin - 50-100 ml IV in a stream, the rest by drip. If they are ineffective, Sol. Dofammi 4% 5.0 ml in saline solution intravenously
• If there is any suspicion, it is necessary to use a Shants collar
• Sol is used to combat intracranial hypertension and cerebral edema. Furosemidi 1% -4.0 and iv, Sol. Dexamethazoni 8 mg IV
• When body temperature is high, it is reduced
• With Relanium
• When vomiting, cerucal

2. Differentiated approach:

• : Sol Glucosi 40% 40-60 ml, but not more than 120 ml - IV after IV bolus administration of thiamine (2 ml), Sol. Dexamethazoni 4-8 mg - i.v.

Immediately carry out measures to maintain optical
low blood circulation and breathing.

Ensure airway patency (pain position
lie on your side, turn your head to the side, clear the oropharynx of mucus), on
oxygen therapy is started.

A gastric tube is inserted.

In case of cardiac and respiratory arrest, a complex of primary
cardiopulmonary resuscitation.

With severe arterial hypotension (hypovolemic
shock) provide access to the vein for infusion therapy
pi crystalloid solutions (0.9% sodium chloride solution, solution
Ringer's thief) at a rate of 20-40 ml/kg per hour under the control of heart rate, blood pressure and
diuresis;

With progressive respiratory failure (dyspnea, hy-
ventilation, cyanosis) perform tracheal intubation and transfer
patient on mechanical ventilation.

For the correction of hypoglycemia, which is highly likely in coma (also,
like therapy exjuvantibus if hypoglycemic coma is suspected)
carry out intravenous administration of a 20-40% glucose solution at a dose of 2 ml/kg.

To normalize body temperature during hypothermia (temperature
body temperature below 35 °C) warm the patient (close,
place heating pads on the extremities), with hyperthermia (temperature above
38.5 °C) antipyretic drugs are administered.

For seizures of non-metabolic origin, administer
anticonvulsants.

Patients are immediately hospitalized in the intensive care unit. The patient is transported in a horizontal position with the leg end raised; The baby's head should be turned to the side. During transportation, it is necessary to ensure the continuation of infusion therapy, oxygen therapy, mechanical ventilation, and prepare everything for CPR.

DIABETIC COMA

If patients with diabetes do not follow doctor's recommendations, diabetic comas may develop. Classification of diabetic comas

Ketoacidotic coma. It develops in 90% of diabetes cases
cheskogo com.

Hyperosmolar coma. It usually develops with additional
significant loss of fluid, except for polyuria. Pronounced exicosis with osu
If acidosis occurs, neurological symptoms appear early; sugar
sharply increased, blood pressure decreases early.

Lactic acidotic coma. Develops against the background of hypoxemia (according to
heart failure, anemia, pneumonia). In the clinical picture, first
muscle pain, pain in the area chest, patolo
gical types of breathing, tachycardia with minimal dehydration.

Hypoglycemic coma. It occurs when sugar levels drop
same 3 mmol/l as a result of irrational insulin therapy (diffe
rent with epilepsy). The clinical picture is due to neuroglycopenia
(headache, vomiting, behavioral disturbances, hallucinations, convulsions).
At the same time, hyperadrenalineemia causes anxiety,
pallor, sweat, tremor, hunger, tachycardia, increased blood pressure.

Differential diagnosis of diabetic comas To determine treatment tactics, it is necessary, first of all, to differentiate between ketoacidotic (diabetic) and hypoglycemic coma.

In addition to the characteristics related to the initial manifestations (skin condition, the presence of acetone odor from the mouth, blood pressure, diuresis, glycemic level), diabetic comas differ in the characteristics of respiration, tone of the eyeballs, pulse and laboratory parameters (ketonemia, blood pH, serum level of urea, lactate, sodium and potassium, plasma osmolarity).

Emergency care for ketoacidotic coma It is necessary to rinse the stomach with a 2-4% soda solution (100 ml/year), administer an enema with a 2-4% soda solution. Insulin is injected intravenously at a dose of 0.1 U/kg, followed by dose adjustment according to the glycemic level.

Treatment of coma P-III degrees must be carried out in the intensive care unit. If the journey to the hospital is more than one hour, a 0.9% sodium chloride solution of 10 ml/kg per hour is started at home or in an ambulance. Insulin is administered intravenously upon arrival at the hospital according to the schedule. When sugar drops to 14 mmol/l, 5% glucose is started to be administered in a ratio of 1:1 with 0.9% NaCl solution. Simultaneously with insulin

The administration of potassium supplements (3-5 mmol/kg per day) is also started. Taking vitamins B and C is indicated; oxygen therapy. Emergency care for hyperosmolar coma

Treatment begins with infusion therapy with 0.45% sodium chloride solution up to 1/4 of the daily volume over 6 hours. Starting doses of insulin are 2 times lower (0.05 U/kg), since patients are very sensitive to insulin, so a rapid decrease in glucose may cause swelling of the brain.

Emergency care for lactic acidotic coma Treatment begins with the elimination of acidosis by administering a 4% soda solution intravenously, and administering plasma in case of severe circulatory disorders.

Emergency care for hypoglycemic coma In case of severe hypoglycemia (the patient is unconscious), a solution of 20-40% glucose is administered intravenously. At the prehospital stage, glucagon can be used intramuscularly, subcutaneously, or intravenously: children under 10 years old - 0.5 mg, older - 1 mg. If there is no effect, prednisolone is administered. When seizures occur (i.e., when symptoms of cerebral edema appear), tracheal intubation is performed and mannitol is administered intravenously.

The main reason is a sharp intoxication of the body with ethyl alcohol and its breakdown products. Because of this, the functioning of all organs, including the brain, is inhibited. As a result of the fact that the body cannot cope and cannot process a large number of toxins, and an alcoholic coma occurs.

Not only heavy drinkers suffer from the toxic effects of ethanol on the body, but even people who drink little by little and holidays, is not insured against alcoholic coma. In case of severe alcohol poisoning, when the alcohol content in the blood reaches 3 ppm or more (after taking 500-1000 ml of strong alcohol), there is a danger of developing an alcoholic coma. But sometimes this condition occurs in cases of drinking smaller amounts of alcohol, only 300 - 500 ml, if it is drunk quickly.

What are the symptoms of alcoholic coma

A sign of an alcoholic coma can be an unconscious state, when a very drunk person cannot be brought to his senses in any way - ammonia, loud noises, blows to the cheeks do not affect him. He requires qualified emergency medical care, as the situation may worsen.

In total, there are 3 stages of alcoholic coma:

• Initial. It is characterized by loss of consciousness, but erratic movements of the arms and legs are possible. Sometimes involuntary spasms of the smooth muscles of the stomach occur, causing vomiting, and the bladder, leading to its involuntary emptying. The skin acquires a purple or bluish tint, the pupils constrict but react to light, breathing is hoarse and rapid due to increased secretion of mucus and saliva. Blood pressure is usually normal, but tachycardia is observed.
• Average. At this stage, excitement subsides, muscles become relaxed, blood pressure drops and the pulse weakens, the number of heart beats per minute decreases. The pupils stop responding to light, breathing is shallow, feces and urine pass involuntarily. If you experience these types of alcohol coma symptoms, you should make an emergency call for emergency help.


• Deep. When the deep stage of coma caused by alcohol intoxication sets in, breathing becomes rare, irregular, with pauses. The tissues experience oxygen starvation, which causes cyanosis on the face. The patient's skin turns pale, cyanosis is pronounced on the extremities, and the body becomes covered with sticky sweat. This happens due to slow cardiac activity: the pulse is thready, blood pressure is low.

When the blood supply to internal organs is disrupted, the kidneys suffer and changes occur in them. The urine may contain blood and may darken to a brown color. Against this background, acute renal failure develops, but death is most often associated with acute cardiac or respiratory failure.

Providing first aid for alcoholic coma

Often this pathology develops in the presence of others, for example, in a company. In this case, you should check how oriented the person is, whether he understands where he is, whether his pupils are narrowing, whether his muscles are twitching or convulsive movements are observed. Any signs of an alcoholic coma are a sufficient reason to call an ambulance.

Before the ambulance arrives, the victim should be induced to vomit and placed on his side, slightly tilted face down to avoid aspiration of vomit. After this, if the person is conscious, you need to take the sorbent - Activated carbon or any other. If after vomiting a person is still unconscious, you need to wrap a clean rag or bandage around your finger and clear the oral cavity of vomit and leave it lying on your side; this position prevents the tongue from blocking the respiratory tract.

If a person loses consciousness during a feast, he can sleep for about 6 hours and wake up on his own, if breathing and cardiac activity are not impaired. But if after 6 hours a person has not regained consciousness, hospitalization is urgently needed, since independent recovery from a coma provoked by alcohol is not always possible.

After sleep, a person who drank too much the night before will suffer from a hangover; dyspeptic disorders, diarrhea, nausea, and vomiting are possible. It is enough to create a calm environment, provide plenty of fluids, and in case of painful sensations, you can give a painkiller.

Important! First aid for alcoholic coma should be provided as early as possible to avoid irreversible changes in internal organs.

Consequences after an alcoholic coma

The consequences of an alcoholic coma are close to the state after a stroke, even if detoxification procedures were carried out on time and the person recovered. The consequences will linger for a long time even after the course of treatment. The most common complications that occur are:

• acute renal failure;
• memory loss;
• pneumonia.

Large amounts of alcohol always cause irreparable harm to health. After treatment of an alcoholic coma, the color of urine returns to normal within a few days, but blood may remain in it, soft tissues remain swollen for some time, and renal failure develops.

When an alcoholic coma occurs, a person usually falls, which leads to bruises and injuries, most often to the head. Large amounts of alcohol destroy the cells of the cerebral cortex. This leads to memory loss, in some cases even dementia, thus mental capacity people are declining.

One of dangerous consequences alcoholic coma - inflammation of the lungs, which develops from the aggressive effect of stomach contents on the delicate lung tissue when vomit enters the respiratory tract. If a bacterial infection is added to this, the consequences may be aggravated by serious lung diseases (pneumopleurisy, pneumonia, etc.).

Important! With timely treatment, a person who has drunk a large amount of alcohol comes out of an alcoholic coma after 2 - 4 hours with minimal consequences for his health.

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Traumatic brain injury - bruise or concussion of the brain, intracranial hemorrhage from damaged cerebral vessels or damage to brain tissue from fragments of skull bones. As a rule, it is accompanied by loss of consciousness, or the so-called cerebral coma.

Externally coma resembles deep sleep (Greek koma - deep sleep). But the problem is that it is almost impossible to wake up such a sleeper: he does not react to either strong sound or painful stimuli.

In what cases do we speak of loss of consciousness? If there is no reaction to what is happening. If there is no reaction to sound and pain stimuli.

The worst thing is that, depending on the depth of the coma, the tone of the hyoid muscles and soft palate sharply decreases. The tongue sticks to the back of the throat and stops air from entering the lungs.

Mechanical is coming asphyxia. In modern medicine this term means strangulation.

In a state of coma, the tongue will begin to play the role of a moving foreign body, with which the victim will periodically choke.

A sharply reduced tone of the soft palate and velum will cause them to vibrate during breathing and produce the sounds of snoring familiar to everyone. This is why coma is so often accompanied by snoring breathing with wheezing and wheezing of varying timbres when inhaling.

In this case, the entire facial muscles, neck muscles and most of the chest muscles, which are usually not involved in breathing, are involved in the act of inhalation. During each such inhalation, the mouth opens wide and the whole body tenses. A person becomes like a big fish thrown ashore.

This type of breathing is called stridorous(Latin stridor - hissing, whistling, hissing). It is these sounds that most often occur when air passes through a sharply narrowed lumen of the respiratory tract: be it a recessed tongue, laryngospasm (spasm of the glottis) or the entry of foreign bodies.

Another danger of a coma is the suppression of the cough and swallowing reflexes, which protect the airways from foreign bodies and saliva.

If a person in a coma lies on his back, then saliva, phlegm, blood from the nose and broken lips or from the sockets of knocked out teeth, as well as vomit, will certainly flow into the respiratory tract. Happening aspiration(Latin apiratio – inhalation) of the contents of the oral cavity into the lungs. Considering that vomiting is a mandatory symptom in cases of traumatic brain injury, aspiration of gastric contents will be inevitable. Many lives ended this way.

Remember! When lying on your back, the tongue sinks, which sticks so tightly to the back wall of the pharynx that it completely blocks the access of air to the lungs. For a person in a coma, lying on his back is extremely dangerous!

In what cases can a coma be assumed? If there is a loss of consciousness for more than 4 minutes, but the pulse in the carotid artery is preserved.

The victim may die within 1–2 minutes, and the “03” team will arrive at the scene in best case scenario only after 10–15 minutes.

Immediate actions to help in cases of coma:Make sure there is a pulse in the carotid artery. Turn the victim onto his stomach. Insert two fingers into the victim’s mouth and release the oral cavity, pressing on the root of the tongue.

Thus, you can not only clear the airways, but also verify the signs of life of the victim. Moreover, sharp pressure on the root of the tongue provokes the act of inhalation and a cough reflex. On the other hand, any careless touch to the tongue of the victim while lying on his back can lead to provocation of the gag reflex and death of the victim from aspiration of vomit.

After clearing the airways and provoking the gag reflex, leave the victim lying on his stomach, but be sure to place his arms along the body, turn his face in your direction so that you can control the pulse in the carotid artery and breathing pattern. To free the airways, it is unacceptable to turn only the victim’s head to one side, leaving him lying on his back. In this case, the contents of the oral cavity will continue to enter the respiratory tract, and the root of the tongue will not move away from back wall throats. Moreover, if the cervical spine is damaged, this incorrect action will cause displacement of the cervical vertebrae and lead to paralysis of the limbs and even death.

Only after the airway has been secured can further examination and assistance begin.

Remember! Turning the victim on his side is the first and most important step on the way to saving lives.

Now you should examine the victim more carefully and make a preliminary conclusion about the nature of the injuries received.

In what cases should we assume fractures of the limbs of a victim in a coma? If the position of the limb is unnatural (the heel or hand is turned out). With deformation and swelling of the limb. If bone fragments protrude from the wound (an indisputable sign open fracture bones).

Remember! In case of external bleeding, it is necessary to apply pressure bandages or hemostatic tourniquets to the limbs above the bleeding site as quickly as possible.

If you suspect fractures of the bones of the limbs, under no circumstances should you carry the victim even a few meters.

Remember! Until the 03 brigade arrives, the most reasonable thing is to leave the victim in place.

There is no need to explain that such actions will lead to additional displacement of bone fragments, tissue damage, increased bleeding and deepening of shock.

Only if there is a threat of fire, explosion or other danger should it be transported safely. As a stretcher, you can use a fragment of an advertising billboard or a piece of strong fabric (a tarpaulin cover, a tent, a raincoat or coat).

Remember! Before carrying the victim even a few meters or placing him on a stretcher, it is necessary to fix the injured limbs (immobilize) using any available means.

Scheme for providing assistance if the victim is unconscious

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What is a coma in humans?

Coma is a rather serious condition, which is characterized by rapidly developing depression of the central nervous system with deep loss of consciousness and lack of reactions to external influences. In this condition, the patient’s functioning of several body systems is disrupted: respiratory, cardiovascular and others.

One of the reasons for the development of coma is significant damage to brain tissue. This can occur due to tissue damage, for example, due to injuries or hemorrhages, as well as due to the presence of serious infectious pathologies, poisoning and other processes in the patient. First aid for coma and clinical death is very important, because it can save the patient’s life, but the first thing to do is to determine the type of coma and identify what triggered it.

Stages of coma

Coma, like many other pathologies in the human body, occurs in several stages:

• Prekoma. This condition is a precursor to true coma and can last from a couple of minutes to two hours. At this time, a person’s consciousness is confused, he is stunned, his condition changes sharply, then he becomes too lethargic, then a certain activity awakens, increased excitability. If reflexes are preserved, then coordination of movements may be impaired.

• Coma I degree. In this condition, all the patient’s reactions to external irritating factors are sharply inhibited, and contact with the patient is difficult. The muscle tone is increased, the patient is able to swallow only liquid food. Tendon reflexes are significantly increased. The reaction of the pupils to light is preserved; in rare cases, strabismus may be noticeable.
• Coma 2nd degree. This form is characterized by stupor, there is no contact with the patient. The pupils do not react to light, they are narrowed, and there are no reflexes to stimuli. Rare chaotic movements may also be noticed, limbs are tense or, conversely, relaxed, and others. Pathological breathing may be impaired if there is a 2nd degree coma. In rare cases, involuntary bowel and bladder emptying may occur.
• Coma 3rd degree. At this stage, the person is unconscious, there is no response to external stimuli. There is no reaction of the pupils to light. Muscle tone decreases and cramps may occur. Body temperature, blood pressure are low, breathing is impaired. First aid for coma in this state is very important, otherwise, if the condition is not stabilized, then this stage will turn into an extreme coma.
• Extreme coma (4th degree). In this state, pressure and temperature drop sharply, and all reflexes are completely absent. The patient's condition is maintained thanks to a ventilator and parenteral nutrition.

First aid for coma is very important, but it will be more useful if you immediately determine which type of coma the patient has, because there are several of them.

Diabetic coma

It most often occurs in patients suffering from diabetes. This coma can occur in patients with high level sugar (hyperglycemia) or low (hypoglycemia). This condition is caused by high levels of glucose in the blood. In diabetic coma, the smell of acetone appears from the mouth. If this type of coma is correctly diagnosed, then a person can be brought out of this state very quickly.

In this case, it is necessary to urgently measure the blood sugar level; if it is too high, then administer insulin, and if it is low, then allow the patient to take carbohydrates. And it is better to immediately seek help from a doctor who will observe the patient and be able to help him get out of this state without harm to his health.

Traumatic coma

Most often it occurs in patients who have suffered a traumatic brain injury, resulting in damage to the brain. It differs from other types of coma by severe vomiting in precoma. First aid for this type of coma involves taking urgent measures that will help improve blood circulation in the brain and restore its functions.

Meningeal coma

This type develops if there is intoxication of brain tissue, it can be triggered by the presence of meningococcal infection. The diagnosis can be clarified only after a lumbar puncture. In this condition, the patient has a severe headache, he cannot lift his outstretched leg, and if the head passively leans forward, then involuntary bending of the leg at the knee occurs.

Also a characteristic feature of this type of coma is a rash with areas of necrosis on the skin and mucous membranes. In this case, only qualified doctors can help the patient, so the first aid for him is calling an ambulance and hospitalization in the infectious diseases department.

Cerebral coma

It is typical for those patients who have brain diseases associated with the presence of tumors. A person in a coma feels:

• Severe headache accompanied by vomiting.
• Patients find it increasingly difficult to swallow food, they often choke, and have difficulty even drinking water.

If first aid is not provided at this time, a coma will develop. Also, these symptoms may indicate a coma caused by a brain abscess. The difference is that in the latter case it may be accompanied by inflammatory pathologies such as tonsillitis, otitis media or sinusitis. In this case, only a doctor can help, who will quickly determine what the problem is based on the signs and help the patient.

Hunger coma

This type occurs with grade 3 dystrophy, which develops as a result of prolonged fasting. This type is often found in young people who are on a diet. There is a deficiency of protein in the body; it performs many functions in the body, therefore, when there is not enough protein, almost all organs do not work correctly, and the functioning of the brain is inhibited.

If this condition develops, the following symptoms may be observed:

• Frequent fainting occurs.
• There is general weakness.
• Heart rate increases.
• A person in a coma feels unwell: body temperature and blood pressure are low, convulsions and even spontaneous urination occur.

In this case, you must consult a doctor, and under no circumstances should you give the patient food, because the body must recover gradually.

Epileptic coma

Often develops as a result of a severe seizure. Patients experience a characteristic dilation of the pupils, the skin turns pale, and all reflexes are suppressed. Signs of bite often appear on the tongue, and spontaneous emptying of the bladder and intestines is almost always observed.

Blood pressure and temperature decrease, pulse increases. If the condition worsens, the pulse becomes thread-like, breathing becomes deep from shallow. If first aid for a coma is not provided, the patient’s reflexes disappear, the pressure continues to decrease, and ultimately death occurs.

Alcohol poisoning often leads to alcoholic coma, it can end clinical death. Alcohol abuse can lead to organ dysfunction. Ethanol causes a serious blow to the functioning of the brain, it can even lead to the stoppage of the respiratory system.

There are several stages of alcoholic coma; emergency care for a coma of any stage is very important, but especially for the third. First aid in this case is to clear the airways of mucus and vomit. The patient is placed on his side and urgently called ambulance.

Hepatic coma

Improper functioning of the liver can cause the patient to develop a coma, in which case it is called hepatic coma. The cause can be pathologies of this organ of any origin. The physiological mechanism for the development of this type of coma is simple: the liver is the main filter of the human body. In cases where the functioning of the organ is disrupted, metabolic products that should have been neutralized in the liver penetrate into the bloodstream. They significantly affect brain cells, which can lead to the development of coma. This type is often accompanied by disturbances in the functioning of the heart, cerebral edema and general intoxication. Providing assistance for this type of coma means contacting a specialist as soon as possible; if this is not done, then in most cases this leads to the death of the patient.

First aid for coma

First aid for a comatose state is very important; any delay can lead to death. If there is a person in a coma in front of you, then the first thing you need to do is to briefly examine him. If he suddenly has a glucometer or insulin with him, this means that he is diabetic and, perhaps, he is in a diabetic coma, although a child should not have all this with him. The algorithm for providing coma care to adults and children is very similar.

• Urgently restore and maintain adequate breathing: sanitize the respiratory organs, connect a ventilator or perform a conicotomy, but this is in rare cases and only with the permission of a specialist.

• Peripheral vein catheterization.
• Restoring and maintaining adequate blood circulation: if the pressure is low, then a solution of sodium chloride and glucose is dripped intravenously, and if the pressure is higher than normal, then it is corrected with magnesium sulfate. The heart rhythm is normalized by defibrillation. The same applies to first aid for coma of unknown etiology.
• A catheter is installed in bladder so that the level of diuresis can be monitored.
• Insertion of a probe after tracheal intubation.

Emergency care for a coma is very important, so in no case should you become hysterical, but urgently call an ambulance and do everything possible to alleviate the patient’s condition. Timely assistance can save a person's life.

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1) Providing the patient with complete rest, with the upper body elevated. If transportation to a medical institution is necessary, transportation with all precautions is permissible no earlier than 10-12 days of illness;

2) put an ice pack on your head and a heating pad on your feet;

3) watch the tongue so that it does not fall back and thereby close the entrances to the pharynx and larynx;

4) if the patient can swallow, give him soothing drops (valerian, bromine);

6) monitor the intestines: in case of stool retention, cleansing enemas are necessary, and in case of prolonged unconsciousness - nutritional ones.

Coma (deep sleep) is an acutely developing pathological condition characterized by increasing depression nervous system with loss of consciousness, impaired response to external conditions, increasing disorder of breathing, blood circulation and other life support functions of the body. Often, instead of the term “coma,” the term “comatose state” is used.

Coma is not an independent disease; it occurs either as a complication of a number of diseases, accompanied by significant changes in the functioning conditions of the central nervous system, or with brain damage (for example, with severe traumatic brain injury).

Depending on the type of disorder in the body that disrupts the normal functioning of the central nervous system, various comas are possible, namely:

1) neuralgic coma, which is based on depression of the central nervous system due to brain damage. This includes apoplexy coma (with a stroke), traumatic coma (with traumatic brain injury), coma with brain tumors, etc.;

2) toxic coma, caused either by poisoning or internal intoxication due to renal failure (uremic coma), liver failure (hepatic coma);

3) coma caused by a lack of oxygen supply from the outside (suffocation), disruption of oxygen transport by the blood to the organs and tissues of the body during anemia, etc.;

4) coma caused by metabolism due to insufficient synthesis of hormones - their excess production or overdose of hormonal drugs;

5) coma caused by the body’s loss of water and energy substances (for example, a hungry coma).

Coma can develop suddenly (almost instantly), quickly (over a period of several minutes to 1-3 hours) and gradually over several hours or days.

Sudden development is most often observed in neurological coma. The patient loses consciousness and in the next few minutes all the signs of a deep coma are most often revealed. Various disorders of the rhythm and depth of breathing are noted - shallow and rare respiratory movements become deep and frequent, after reaching the maximum, breathing stops, then it resumes, etc. (this is Cheyne-Stokes breathing). Changes in blood pressure are observed with a tendency to decrease as the coma deepens. The functions of the pelvic organs (defecation and urination) are upset.

Typically, coma is characterized by degrees of severity, which, with the gradual development of coma, correspond to its stages.

Prekoma— disorder of consciousness is characterized by confusion, moderate stupor; Drowsiness or agitation is more common; purposeful movements are impaired, all reflexes are preserved.

Coma I degree - severe stupor, sleep (hibernation); the patient performs simple movements, can swallow water and liquid food, and turn independently; the reaction of the pupils to light is preserved; divergent strabismus and pendulum-like movements of the eyeballs are often noted.

Coma II degree– deep sleep, stoppage, contact with the patient is not achieved, rare movements are not coordinated, chaotic; breathing is impaired; involuntary urination and defecation are possible; the reaction of the pupils to light is sharply weakened; no skin reflexes; corneal and pharyngeal reflexes are preserved.

Coma III degree– consciousness, reaction to pain, corneal reflexes are absent; pharyngeal reflexes preserved; constriction of the pupils (miosis) is observed, the reaction of the pupils to light is absent; periodic convulsions, both individual and of the whole body, are possible; urination and defecation are involuntary; blood pressure is reduced; breathing is arrhythmic, often slow and shallow, body temperature is low.

Coma IV degree– complete absence of reflexes (areflexia); muscles become flabby, their elasticity disappears (muscle atony); there is a general cooling of the body (hypothermia); cessation of spontaneous breathing, sharp decrease in blood pressure.

Recovery from a comatose state under the influence of treatment is characterized by a gradual restoration of the functions of the central nervous system, usually in the reverse order of their inhibition. Corneal effects appear first, then pupillary effects. The restoration of consciousness goes through the stages of stupor, narrowed consciousness, and sometimes delirium and hallucinations are noted. Convulsive seizures followed by a twilight state are possible.

Coma, caused by changes in the central nervous system incompatible with life, ends in death. In stage IV coma, most patients die; in stage III coma, death cannot always be prevented.

First aid for all types of coma consists of taking measures to restore the patency of the upper respiratory tract, preventing asphyxia due to the retraction of the tongue and toileting the oral cavity and nasopharynx, especially during vomiting.

To do this, you need to lay the patient on his side (if vomiting - on his stomach), tilt his head back, push him forward and down at the same time lower jaw. Grasping it with your fingers, pull it out and then secure the tongue with a bandage.

After this, clear the mouth and pharynx from mucus, food debris or vomit using a damp cloth. If possible, oxygen inhalation is started, and if shallow breathing is rare or stops, artificial ventilation of the lungs is performed.

In case of poisoning with oral intake of poison (in case of poisoning with morphine, regardless of the route of entry), gastric lavage through a tube or gastric and intestinal lavage begin immediately.

The patient is transported to the car and to the medical facility on a stretcher (if there is no injury that requires transportation on a rigid board), on which the patient is placed carefully in a position on his side with his face turned down. To fix this position during transportation, the leg on which the patient lies is bent at the knee and pushed forward, which prevents the patient from turning onto his stomach; the arm of the same name is bent at the elbow and pushed back, which prevents the patient from tipping over backwards.

8.5. Asphyxia.

Asphyxia (choking)– an acute or subacute developing and life-threatening condition caused by insufficient gas exchange in the lungs, a sharp decrease in oxygen content in the body and the accumulation of carbon dioxide.

The immediate causes of asphyxia are mechanical obstacles to the passage of air through the respiratory tract, which arise: when the respiratory tract is compressed from the outside (for example, during suffocation); with significant narrowing caused by any pathological process (for example, tumor, inflammation or swelling of the larynx); when the tongue is retracted in a person who is in an unconscious state; with spasms of the glottis or bronchi of the lungs; when foreign bodies (for example, water) enter the respiratory tract; during aspiration of food and vomit; when the chest is compressed (by the earth, heavy objects, etc.); for chest and lung injuries.

Asphyxia can develop when a person stays in an atmosphere with insufficient oxygen and excess carbon dioxide, for example, when a person spends a long time in cramped enclosed spaces, in wells, mines, etc.

It is customary to distinguish several stages of development of asphyxia: first, second, third, fourth.

The first stage is characterized by increased activity of the respiratory and cardiovascular systems. There is an increase in heart rate and increased blood pressure. The flow of blood to tissues and organs from the blood depot increases. The body seems to be trying to enhance gas exchange in this way.

In the second stage, respiratory cycles slow down. There is a decrease in heart rate and blood pressure.

In the third stage, a temporary cessation of breathing often occurs, blood pressure drops sharply, heart rhythm is disturbed, the body's reactions to external irritation fade, and consciousness gradually fades away.

In the fourth (terminal) stage, rare convulsive “sighs” appear - agonal breathing, which usually lasts several minutes, sometimes much longer. Cramps, involuntary urination and defecation often occur. Death from asphyxia usually occurs due to paralysis of the respiratory center.

The total duration of asphyxia from its onset to death can vary widely: from 5–7 minutes with a sudden complete cessation of breathing to several hours or more (for example, when in a confined space).

With asphyxia, mental disorders are observed. Thus, when self-hanging after being brought out of unconsciousness, the victims experience memory impairment in the form of loss of the ability to retain and reproduce previously acquired knowledge (amnesia). In case of asphyxia caused by carbon monoxide poisoning with the development of coma, after recovery from the coma the victim develops a disorder resembling alcohol intoxication; At the same time, various memory impairments are observed. With asphyxia caused by a lack of oxygen, the assessment of time and space is impaired. Some victims experience lethargy, indifference or, conversely, agitation and irritability. Sudden loss of consciousness may occur.

In search and rescue operations, rescuers most often encounter mechanical asphyxia.

Mechanical asphyxia is understood as acute oxygen starvation, which occurs as a result of partial or complete cessation of air access to the respiratory tract and lungs, caused by various mechanical obstacles.

Depending on the nature of the mechanical factor, there are:

mechanical asphyxia from squeezing the neck - strangulation asphyxia (squeezing the neck with boards, logs, strangulation with a noose, strangulation with hands);

mechanical asphyxia from compression of the chest and abdomen - compression asphyxia;

mechanical asphyxia from closing the opening of the nose and mouth with soft objects, closing the airways with foreign bodies, liquids - obstructive asphyxia;

mechanical asphyxia from the closure of the respiratory tract with food masses and blood.

As a rule, mechanical asphyxia is acute and ends in death (if asphyxia is not interrupted) within 6-8 minutes. In severely weakened patients, for example, with heart disease, death can occur in the first minutes.

First medical aid for asphyxia is aimed at eliminating the cause that caused it and maintaining respiratory and cardiac activity (artificial ventilation and chest compressions) - resuscitation.

8.4. Renal colic.

Renal colic is manifested by severe paroxysmal pain with characteristic irradiation.

The occurrence of pain is associated with spasmodic contraction of the muscles of the ureters and convulsive contraction of the renal pelvis due to blockage of the ureters with stones and irritation of local nerve endings.

The main symptoms of renal colic are:

a) attacks of acute pain starting in the lower back and radiating down the ureter to the groin, to the bladder, in men and to the testicles, in women to the external labia; pain begins crampingly, often accompanied by bloating; their duration varies - from several minutes to several hours and even days;

b) nausea, vomiting, chills and fever up to 38-38.5 0;

c) at the height of attacks - cessation of urine flow into the bladder (anuria) in the presence of the urge to urinate;

d) the patient’s poor health; he is pale and covered in cold sweat; pulse is small and frequent; Fainting often occurs, less often - collapse.

When palpating the lumbar region, a sharp pain is detected; it intensifies with the slightest movements and turns.

First aid for renal colic:

a) providing the patient with rest and bed rest;

b) place heating pads on your waist and stomach;

c) inject atropine 0.1-1 ml subcutaneously;

d) inside (on the tongue) 1-2 drops of a 1% alcohol solution of nitroglycerin;

e) if there is no effect from atropine and nitroglycerin, morphine or pantopon is administered subcutaneously, and if there is an individual first aid kit, promedol.

The use of nitroglycerin when blood pressure drops is contraindicated.

f) drink plenty of water, tea, mineral water(Borjomi, Essentuki No. 20, etc.).

studopedia.ru

Classification

• Clear consciousness
• Darkened consciousness
• Stupor
• Sopor

Symptoms of impaired consciousness

Impaired consciousness	Leading signs	General signs
Clear consciousness
Darkened consciousness
Coma moderate	There is no consciousness.
Coma deep	There is no consciousness.
Coma beyond measure	There is no consciousness.

Color

skin.

Head position

Depth

coma

Anisocoria

(pupils of different sizes)

Hemodynamic disorders

Localization pathologyin the brain	Manifestations defeatscordially— vascularsystems

• x-ray of the skull,
• angiography,

Symptoms	Points
Opening your eyes
Spontaneous opening of eyes
Opening your eyes to sound
Motor disorders
Pathological flexion
Speech reactions
Free conversation
Pronunciation of individual phrases

degree of depression of consciousness:

Help with coma

• turn it on its side;
• call a medical team.

medsait.ru

HOW TO PROVIDE FIRST AID TO A VICTIM IN A COMA

Rules for identifying signs of coma

Remember! Pressing the area of ​​pulsation of the carotid artery is a painful point. If the victim does not react to your actions with a groan, words, or an attempt to remove your hand, then you can draw an unmistakable conclusion: she is unconscious. The presence of a pulse in the carotid artery: - it is alive.

Remember! Two reliable signs of coma:

1. Lack of consciousness.
2. The presence of a pulse in the carotid artery.

Rule one
You should not waste time calling out to the victim and determining consciousness by waiting for answers to the questions: “Are you all right? Is it possible to start providing assistance?, as well as pressing on various pain points and clapping your hands. Pressing on the neck in the area of ​​the carotid artery, while trying to determine the pulse on it, is a strong pain irritant.

Rule two
You should not waste time identifying signs of breathing. It is enough to attempt to determine the pulse in the carotid artery to conclude that coma has occurred. If, while determining the pulse on the carotid artery, the victim reacts with a glance, a groan or any other actions, then we can make an unmistakable conclusion that she is conscious.

In this case, you should stop further attempts to determine the pulse. If, in the presence of a pulse in the carotid artery, the victim does not respond to pressure, we can conclude that she is alive, but unconscious and in a state of coma.

What to do? If the victim has confirmed signs of coma?
Immediately turn her onto her stomach, otherwise she could choke on vomit or choke herself with her own tongue at any second.

Rules for performing a civil rescue turn

Rule one
Place the victim's hand closest to you behind her head. The victim's hand placed behind her head not only protects the cervical spine, but also greatly facilitates the rotation of the body. In a coma state, it is impossible to determine damage to the cervical spine. A hand placed behind the head protects the cervical spine from dangerous lateral displacements when turning onto the stomach.

Rule two
With one hand, grab the shoulder farthest from you, and with the other, grab the victim’s waist belt or thigh. The victim's hand placed behind her head not only protects the cervical spine, but also greatly facilitates the rotation of the body.

Rule three
Turn the victim onto her stomach with the cervical spine supported. Clean the mouth with your fingers or a napkin and press on the root of the tongue. When the victim's jaws are clenched, you should not try to unclench them. Tightly clenched teeth do not obstruct the passage of air.

Rule four
Apply cold to the head and leave in this position until the ambulance arrives. The use of cold significantly reduces the rate of development of cerebral edema and protects it from death.

Remember! First you need to turn the victim on her stomach and only then call an ambulance!

What to do? When did you suspect that the victim had overdosed on drugs or alcohol?
Place a cotton swab with ammonia and be sure to call an ambulance..

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Anatomical and functional features of the central nervous system

Being the central regulator of all processes occurring in the body, the brain operates in an active metabolic mode. Its weight is only 2% of body weight (about 1500 g). However, for the uninterrupted functioning of the brain, 14-15% of the total volume of circulating blood (700-800 ml) must flow into and out of the cranial cavity every minute. The brain uses 20% of all the oxygen the body consumes. It is metabolized only by glucose (75 mg per minute or 100 g per day).

So, the physiological functioning of brain tissue depends on adequate perfusion with its blood, the content of a sufficient amount of oxygen and glucose, the absence of toxic metabolites and the free outflow of blood from the cranial cavity.

A powerful autoregulation system ensures smooth functioning of the brain. Thus, even with significant blood loss, the perfusion of the central nervous system is not impaired. In these cases, a compensatory reaction of centralization of blood circulation with ischemia of less important organs and tissues is activated, aimed primarily at maintaining adequate blood supply to the brain. The body reacts to another pathological condition - hypoglycemia - by increasing blood flow to the brain and increasing the transport of glucose here. Hyperventilation (hypocapnia) reduces blood flow to the brain; hypoventilation (hypercapnia) and metabolic acidosis, on the contrary, increase blood flow, promoting the removal of “acidic” substances from tissues.

With significant damage to brain tissue, insufficient autoregulation or excessive manifestations of the compensatory reaction of the inflow and outflow of blood, the brain cannot voluntarily change its volume. The closed cavity of the skull becomes its trap. Thus, an increase in intracranial volume by only 5% (with hematomas, tumors, hyperhydration, liquor hypertension, etc.) disrupts the activity of the central nervous system with the patient losing consciousness. In another pathology, excessive growth of cerebral blood flow leads to overproduction of cerebrospinal fluid. The brain tissue is compressed between the blood and the cerebrospinal fluid, swelling develops, and functions are impaired.

Traumatic destruction of brain tissue, edema and swelling, increased intracranial pressure, impaired circulation of cerebrospinal fluid, circulatory disorders and other damaging mechanisms lead to hypoxia of CNS cells. It manifests itself primarily as a disturbance of consciousness.

Coma: symptoms, types, diagnosis

Coma is a complete suppression of consciousness with loss of pain sensitivity and reflexes, with general muscle relaxation and dysfunction of vital organs and systems of the body.

Classificationdegrees of impairment of consciousness (Bogolepov, 1982).

• Clear consciousness
• Darkened consciousness
• Stupor
• Sopor
• Coma: moderate, deep, extreme

Symptoms of impaired consciousness

Impaired consciousness	Leading signs	General signs
Clear consciousness	Cheerfulness, complete orientation in time and space and in one’s face.	Active attention, absolute language contact, thoughtful answers to questions, following all instructions. Free opening of eyes.
Darkened consciousness	Moderate drowsiness or euphoria, partial disorientation in time and space with complete orientation to one’s face.	The ability for active attention is reduced. Language contact is maintained, but obtaining an answer sometimes requires repeating questions. Commands are executed correctly, but somewhat slowly, especially complex ones.
	Deep drowsiness, disorientation in time and space, upon awakening, follows only simple commands.	The state of sleep predominates, sometimes in combination with motor excitement. Language contact is difficult. Unambiguous answers. The defensive reaction to pain is preserved. Control over the function of the pelvic organs is weakened.
	Pathological drowsiness, complete disorientation in time, space and in one’s face.	Opens eyes to painful stimuli, localizes pain with targeted actions to eliminate it. Reflexes of the cranial nerves and vital functions were preserved.
Coma moderate	There is no consciousness.	There is no reaction to external stimuli. Responds to painful stimuli with uncoordinated defensive movements. Pupillary and corneal reflexes are increased, abdominal reflexes are decreased. Reflexes of oral automatism and pathological reflexes from the feet appear. Sphincter control is impaired. Vital functions are preserved.
Coma deep	There is no consciousness.	The reaction to pronounced painful stimuli in the form of extension of the limbs is preserved. Suppression or absence of skin, tendon, corneal, pupillary reflexes. Rigidity or hypotonia of striated muscles. Respiratory and cardiovascular disorders.
Coma beyond measure	There is no consciousness.	Areflexia, bilateral fixed mydriasis, muscle atony, significant disturbances in breathing and cardiovascular activity. Hypotension (blood pressure below 60 mmHg)

Etiopathogenetic classification of comas

1. Comas of central origin (epileptic, traumatic, apoplexy).

2. Coma due to dysfunction of internal organs and endocrine glands (diabetic, hypoglycemic, thyrotoxic, myxedema, hypopituitary, hypocorticoid, hepatic, uremic, chlorpenic, anemic, alimentary-dystrophic).

3. Comas of infectious origin (pneumonia, malaria, neuroinfectious, etc.).

4. Comas with acute poisoning(alcohol and its substitutes, medications, carbon monoxide and etc.).

5. Comas that occur under the influence of physical factors (heat, cold, radiation, electric current).

Diagnosing the cause of coma can sometimes be quite difficult, since it is impossible to collect an anamnesis from the patient. Therefore, it is very important to ask the victim’s relatives and witnesses how this coma arose.

Anamnesis. It is necessary to find out the time of loss of consciousness, sudden or gradual deterioration of the condition, ask whether the patient did not fall or hit his head; or it wasn't high temperature, flu or jaundice. It is necessary to establish whether the victim did not have diabetes, hypertension, or epilepsy; Has he had similar cases of loss of consciousness or suicide attempts in the past? If the coma developed gradually, then what the patient complained about, whether he was vomiting, will be judged.

When examining the victim’s belongings, you can sometimes find medical documents, medicine packages, and remains of poisons. These findings may help in making a diagnosis.

In the absence of anamnestic data, it is important to identify individual symptoms on the basis of which the disease can be recognized.

Colorskin. Severe pallor is characteristic of massive blood loss, circulatory collapse, uremic coma, and blood diseases. Severe cyanosis is a sign of hypercapnic coma with insufficient external respiration function, asphyxia during hanging, drowning; after suffering an attack of convulsions. Facial hyperemia suggests poisoning with atropine and its derivatives, carbon monoxide, hyperglycemic coma and an infectious disease.

Head position. A head thrown back indicates meningitis, tetanus, hysteria; leaning to one side - most likely about a stroke. Hoarse breathing and a distorted mouth are characteristic of a stroke. Pathological types of breathing (Cheyne-Stokes, Biota) are observed with deep damage to the central nervous system. Deep noisy breathing (Kussmaul) indicates the accumulation of acids in the body (metabolic acidosis) of exogenous (in acute poisoning) or endogenous (diabetic ketoacidosis) origin. Hyperthermia and frequent deep breathing are characteristic signs of a coma of infectious origin. With this pathology, an increase in body temperature by 1 0C is accompanied by an increase in respiratory rate by 5-7 per minute.

In order to examine a patient in a coma, a medical professional must approach him from the back of the head. This position is dictated by the following points: firstly, the ability to immediately provide assistance to the victim if necessary (remove the lower jaw, free the tongue from biting, clear the oral cavity of vomit, perform artificial ventilation), and, secondly, the personal safety of the resuscitator, since an unconscious victim can injure him by pushing him with his hand or foot.

Simulation, and sometimes coma of hysterical origin, can be detected when trying to open the patient’s eyes. A person with completely absent consciousness does not strain his eyelids when opening them with his fingers. Conversely, even barely perceptible resistance when trying to raise them is a sign of preserved consciousness.

By pressing on the eyeballs, you can determine their tone. “Soft” eyeballs indicate hypovolemia (blood loss, hypohydration). They occur in patients with hyperglycemic coma and shock.

Depthcoma Diagnosed by the degree of inhibition of reflexes. Thus, a reaction to eyelash irritation indicates a superficial coma. The reaction to irritation of the sclera is preserved - moderate coma. Lack of pupillary response to light is a sign of deep coma.

The pupils can be of different sizes: constricted - in case of poisoning with sleeping pills, organophosphorus substances; very narrowed (like a poppy seed) - in case of drug poisoning; extended - for hypoxia, poisoning with antipsychotics and antihistamines; very expanded - when consuming atropine-containing substances.

Anisocoria(pupils of different sizes) — characteristic feature focal lesion of the central nervous system. Most often, this symptom occurs with traumatic brain injury with the presence of an intracranial hematoma. In such patients, a detailed examination of the face and scalp can reveal abrasions, a wound or subcutaneous hemorrhage. Sometimes there is a deviation of the eyeballs to the right or left - in the direction of brain damage.

The absence of knee, Achilles and abdominal wall reflexes indicates deep depression of the central nervous system. The pathological Babinski reflex indicates organic brain damage. Asymmetry of muscle tone is a sign of a space-occupying process in the cranial cavity (stroke, tumor, hemorrhage).

A detailed examination of other organs and systems helps in establishing a diagnosis. Thus, central nervous system failure may be caused by interruptions in the functioning of the heart due to disturbances in its conduction (Morgagni-Edams-Stokes syndrome). In turn, focal brain lesions cause disturbances in the functioning of the cardiovascular system.

Hemodynamic disordersdepending on the location of the pathology in the central nervous system

Localizationpathologyin the brain	Manifestationsdefeatscordially— vascularsystems
Lesions of the fronto-orbital zones	Bradycardia, complete atrioventricular block, atrial extrasystole
Excitation of midbrain structures	Extrasystole, atrioventricular block, ventricular fibrillation
Pathology of the medulla oblongata	Nodal and ventricular extrasystoles, atrial fibrillation
Damage to the hypothalamic region	Extrasystole, paroxysmal tachycardia, severe hypotension.
Lesions of the vascular-motor center	A sharp drop in vascular tone, hypotension, bradycardia, cardiac arrest.

Listening to a friction rub of the pericardium and pleura may indicate a uremic nature of the coma. Enlargement or reduction of the liver is characteristic of hepatic coma. An enlarged spleen is a sign of an infectious pathology, liver or blood disease.

In a hospital, the cause of coma can be diagnosed by laboratory tests of blood and cerebrospinal fluid. If a cerebral coma is suspected, the patient is given:

• x-ray of the skull,
• angiography,
• echoencephalography or computed tomography

To diagnose the depth of coma, use international classification (scale) of Glasgow (1974):

Symptoms	Points
Opening your eyes
Spontaneous opening of eyes
Opening your eyes to sound
Opening your eyes to painful stimuli
Lack of opening eyes to any stimuli
Motor disorders
Active movements performed as directed
Movements in the limbs directed to the site of painful irritation in order to eliminate it
Normal flexion movements
Pathological flexion
Only extension movements are preserved
All kinds of movements and reactions are absent
Speech reactions
Free conversation
Pronunciation of individual phrases
Pronunciation of individual phrases in response to painful stimuli
Unintelligible sounds in response to irritation or spontaneously
Lack of speech in response to irritation

Scoring allows you to determine degree of depression of consciousness:

Help with coma

Algorithm for providing first medical care for a patient in a comatose state:

• turn it on its side;
• lower slightly (by 15°) top part torso, so that the oral fissure is lower than the glottis;
• bring out the lower jaw and support it with your fingers;
• assess the patient’s breathing efficiency (color of the mucous membrane and skin, its humidity, depth and frequency of breathing, the presence of pathological noises during breathing, retraction of the jugular notch and intercostal spaces);
• if there is difficulty inhaling and the presence of gastric contents, blood, sputum in the oral cavity, it is necessary to ensure patency of the airways (remove foreign bodies and liquids);
• if breathing is ineffective, use artificial ventilation;
• palpate the pulse over the main and peripheral arteries;
• lift the patient’s upper eyelids and evaluate the reaction of the pupils to light;
• call a medical team.

In some patients, against the background of a coma, hyperreflexia is observed, hyperkinesis or convulsions occur.

For seizures you must:

Lay the patient on a flat surface, preventing injury from surrounding objects;

Prevent tongue biting by inserting a mouth retractor (a spatula, a wooden stick, a spoon handle, wrapped in cloth) between the molars;

Support the patient’s lower jaw and head, preventing injury and asphyxia;

Ensure oxygenation of the body by supplying oxygen through a mask or nasal catheter;

During the interictal period, catheterize the peripheral vein using a puncture method, where, as prescribed by the doctor, inject solutions of magnesium sulfate (5-10 ml of 25% solution), sibazon (2 ml of 0.5% solution);

Sugar 5 5

In case of coma, only specialists can provide assistance. If there is a suspicion that a person has fallen into a coma, it is necessary to immediately call an ambulance. The only thing that can be done before doctors arrive is to ensure that the victim is able to breathe. Since in a comatose state, muscles relax and the swallowing and breathing reflex decreases, the victim’s pulse must be checked, turned over on his stomach and, if possible, the airways cleared

MDK 03.02 Disaster Medicine

TICKET No.__________

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, or when it is not recognized diabetes mellitus, against the background of physical and mental trauma, in case of severe dietary violations.

Characteristic: a slow onset of a comatose state (the patient falls into a coma for several hours) against the background of pain in the muscles and heart (like angina), the pulse is frequent, weak, blood pressure is low, symptoms of dyspepsia, abdominal pain. Shortness of breath increases, which is joined by Kussmaul breathing, the exhaled air smells of acetone, collapse, oliguria, and hypothermia develop. The skin becomes dry and cold, marbled-cyanotic; its tightness decreases. The tongue is coated, the eyeballs are sunken, the pupils are constricted, and muscle tone is reduced.

2. Urgently call a doctor or laboratory assistant.

3. Give a stable lateral position.

4. Monitoring blood pressure, pulse, respiratory rate.

5. Determination of blood sugar levels using a portable finger
glucometer.

As prescribed by a doctor:

Glucometry

Vein catheterization

Sodium chloride 0.9% - 1000 ml IV stream during the first hour, then 500 ml per hour

Before intubation:

Atropine 0.5 - 1 mg IV

Midazolam 5 mg or Diazepam 10 mg intravenously - for coma

> 6 points on the GLASGOW Coma Scale

Sanitation of the upper respiratory tract

Tracheal intubation or use of a laryngeal tube for ventilation/IVL

ANSWER STANDARD FOR COMPREHENSIVE EXAMINATION

PM.03. Providing medical care in emergency and extreme conditions

MDK 03.01 Fundamentals of resuscitation

MDK 03.02 Disaster Medicine

TICKET No.__________

QUESTION: Hypoglycemic coma. Clinical picture. Urgent Causes 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 bothered by a feeling of severe hunger, increasing weakness, sweating, trembling of the limb, sometimes a severe headache, double vision. Usually a mild disturbance of consciousness occurs, which quickly resolves with the start of therapy. In the case of persistent hypoglycemia, general motor agitation appears, turning into stupor and coma.

In superficial coma, blood pressure is normal or slightly elevated, breathing is normal, and there is no smell of acetone from the mouth. The skin is pale and damp.

As the hypoglycemic coma deepens, skin moisture disappears, breathing quickens and becomes shallow, tachycardia can turn into bradycardia, and disturbances occur heart rate, Blood pressure decreases. Vomiting and hyperemia are noted.

The sugar level can drop to 2.2 - 1 mmol/l, there is no glucosuria or ketonuria.

Actions nurse for assistance:

1. Record the time of onset of coma development.

2. Call a doctor and laboratory assistant.

3. Place the patient in a stable lateral position.

4. Conduct an examination of the oral cavity.

As prescribed by the doctor, administer 20-40-50 ml of 40% glucose solution intravenously.

ANSWER STANDARD FOR COMPREHENSIVE EXAMINATION

PM.03. Providing medical care in emergency and extreme conditions

MDK 03.01 Fundamentals of resuscitation

MDK 03.02 Disaster Medicine

TICKET No.__________

QUESTION: Renal coma. Causes. Clinical picture. Urgent Care.

STANDARD ANSWER

Uremic coma is a complication of chronic renal failure (CRF - uremia). ESRD is the terminal (final) stage of progressive kidney disease. Chronic renal failure is complicated by chronic glomerulonephritis, pyelonephritis, diabetic nephropathy, rheumatoid polyarthritis, gout - renal reasons, 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, ammonia odor from the mouth, weakness, fatigue, chilliness, itching, 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.