Pathophysiology terminal conditions presentation. Terminal states. Types of terminal states. Restoring and maintaining airway patency

Slide presentation

Slide text: Kursk State Medical University Department of General Surgery Lecture Terminal and Shock Conditions in Surgery Lecturer: Professor, MD Tutov A.S.

Slide text: Types of terminal states Pre-agonal state Terminal pause (not always marked) Agony Clinical death

Slide text: Pre-agonal state Consciousness is depressed or absent. The skin is pale or cyanotic. Blood pressure decreases to zero. The pulse is stored in the carotid and femoral arteries. Breathing is bradyform. The severity of the condition is explained by increasing oxygen starvation and severe metabolic disorders.

Slide text: Terminal pause Terminal pause does not always happen. She is absent after vagotomy. Respiratory arrest, periods of asystole 1-15 sec.

Slide text: Agony The predecessor of death. The regulatory function of the higher parts of the brain ceases. Bulbar centers control the vital processes.

Slide text: Clinical death The activity of the heart and respiration stops, but there are still no irreversible changes in organs and systems. On average, the duration is no more than 5-6 minutes, depending on the ambient temperature, atm. pressure, etc.

Slide text: 3 types of circulatory arrest 1. Asystole - cessation of atrial and ventricular contractions (complete blockage, irritation of the vagus nerves, exhaustion, endocrine diseases, etc.). 2. Ventricular fibrillation - discoordination in the contraction of the myocardium. 3. Myocardial atony - loss of muscle tone (hypoxia, blood loss, shock).

Slide text: 3 types of cessation of respiratory activity Hypoxia. Hypercapnia. Hypocapnia is a respiratory alkalosis.

Slide text: Signs of Coma's clinical death are dilated pupils and lack of response to light. Apnea is a lack of breathing. Asystole is the absence of a pulse in the carotid arteries. Time factors play a huge role in this condition, therefore it is necessary to strive to perform an EEG, ECG, acid base balance is not necessary, but it is necessary to move on to resuscitation methods.

Slide number 10

Slide text: Air way open revitalization methods - restore airway patency. Breathe por victim - start ventilation. Circulation his blood - start a heart massage.

Slide number 11

Slide text: ABC rules 1. Unfold the cervical spine, remove the lower jaw (Fig. 23.24), free the oral cavity and pharynx, air duct - mechanical ventilation (Fig. 25.26). 2. a) external (external) - compression of the chest. b) blowing air into the lungs.

Slide number 12

Slide text: Methods for carrying out mechanical ventilation Ventilation through an S-shaped air duct. IVL through a gauze bandage (1-2 layers) or a handkerchief. IVL "mouth-to-mouth" 10-12 in 1 min (at the expense of 4-5). IVL "mouth-to-nose".

Slide number 13

Slide text: Ways to restore cardiac activity 1. Indirect cardiac massage. After 2-3 breaths - a blow with a fist in the area of ​​the heart and then massage between the sternum and the spine 1: 5 ratio of massage to mechanical ventilation.

Slide number 14

Slide text: 2. Drug stimulation. Repeats every 5 minutes. Adrenomimetics - adrenaline 1.0 0.1% + 10.0 physical solution intravenously, intravenously, until a clinical effect is obtained. Antiarrhythmic drugs - lidocaine 80-120 mg. Sodium bicarbonate 2 ml 1% per 1 kg. Magnesium sulfate 1-2 g in 100 ml of 5% glucose. Atropine 1.0 0.1% solution. Calcium chloride 10% - 10.0

Slide number 15

Slide text: 3. Electro-pulse therapy 200 J, 200-300, 360, 2500 V, 3500 V. Resuscitation benefits are not provided to patients with injuries incompatible with life, those in the terminal stage of incurable diseases, cancer patients with metastases.

Slide number 16

Slide text: Types of shock Hypovolemic (post-hemorrhagic, burn - these are varieties) shock. Cardiogenic shock. Vascular shock (septic and anaphylactic).

Slide number 17

Slide text: Clinical signs of shock cold, moist, pale cyanotic, or marbled skin; sharply slowed down blood flow to the nail bed; darkened consciousness; dipnea; oiguria; tchycardia; decrease in blood and pulse pressure.

Slide number 18

Slide text: Pathogenetic classification, main clinical symptoms and compensatory mechanisms of hypovolemic shock (according to G.A. Ryabov, 1979)

Slide number 19

Slide text: Shock control criteria Shock index is the ratio of heart rate to systolic pressure (P.G. Brusov, 1985). Normal value of SHI = 60/120 = 0.5 (blood loss 15-25% of the BCC) SHI = 1 (100/100) With shock II stage. (blood loss 25-45% of the BCC) SHI = 1.5 (120/80) (blood loss more than 50% of the BCC) SHI = ”(140/70)

Slide number 20

Slide text: Principles of treatment for hypovolemic shock Immediate control of bleeding, adequate pain relief. Catheterization of the subclavian vein and adequate fluid therapy. Relief of signs of acute respiratory failure. Constant supply of oxygen in the inhaled mixture in the amount of 35-45%. Relief of signs of acute heart failure. Bladder catheterization

Slide number 21

Slide text: The program of infusion therapy depending on blood loss (V.A.Klimansky, A.Y. Rudaev, 1984)

Slide number 22

Slide text: Principles of treatment of septic shock Elimination of signs of ARF and ACFS, transfer to mechanical ventilation according to indications. Normalization of indicators of central hemodynamics by using intravenous infusions of dextrans, crystalloids, glucose under the control of CVP and hourly urine output. Correction of the main indicators of acid-base balance and water-electrolyte balance. Preventive treatment of lung distress syndrome inevitable for this pathology. Antibacterial therapy (preferably bacteriostatic drugs). Relief of DIC - syndrome. Treatment of the allergic component of the disease by prescribing glucocorticoids. Remediation of the focus of infection. Symptomatic therapy.

Slide number 23

Slide text: ANAPHYLACTIC SHOCK Pathogenesis of anaphylactic shock Relative hypovolemia against the background of paresis of the microcirculation system. Laryngo- and bronchospasm. Increased permeability of cell membranes. Impaired sympathoadrenal response to endogenous coronary artery disease. Spastic contraction of the smooth muscles of the abdominal organs.

Slide number 24

Slide text: Principles of anaphylactic shock treatment Resuscitation measures if indicated. If possible, eliminate contact with the allergen, although this is not always possible. If this is not possible - a tourniquet above the injection site of the allergen or prick the injection site with a diluted solution of adrenaline. Intravenous infusion therapy under the control of CVP and hourly urine output. Slowly intravenously 1 ml 0.1% solution of adrenaline + 20.0 physical. solution (it is possible under the tongue). Relief of bronchospasm, slow intravenous administration of 5-10 ml of 2.4% aminophylline solution. The administration of glucocorticoids is shown as desensitizing drugs and stabilizers of cell membranes. When using prednisolone, the dose should be 90-120 mg. At the same time, hydrocortisone 125-250 mg is prescribed, which has the ability to retain sodium and water in the body.

Slide number 25

Slide text: Criteria for the successful treatment of shock BCC recovery and elimination of hypovolemia. Restoration of UOS, MOS. Elimination of microcirculation disorders.

2 slide

Types of terminal states Pre-agonal state Terminal pause (not always noted) Agony Clinical death

3 slide

Pre-agonal state Consciousness is depressed or absent. The skin is pale or cyanotic. Blood pressure decreases to zero. The pulse is preserved in the carotid and femoral arteries. Breathing is bradyform. The severity of the condition is explained by increasing oxygen starvation and severe metabolic disorders.

4 slide

Terminal pause There is not always a terminal pause. She is absent after vagotomy. Respiratory arrest, periods of asystole 1-15 sec.

5 slide

Agony The predecessor of death. The regulatory function of the higher parts of the brain ceases. Bulbar centers control the vital processes.

6 slide

Clinical death The activity of the heart and respiration ceases, but there are still no irreversible changes in organs and systems. On average, the duration is no more than 5-6 minutes, depending on the ambient temperature, atm. pressure, etc.

7 slide

3 types of circulatory arrest 1. Asystole - cessation of contractions of the atria and ventricles (complete blockade, irritation of the vagus nerves, exhaustion, endocrine diseases, etc.). 2. Ventricular fibrillation - discoordination in the contraction of the myocardium. 3. Myocardial atony - loss of muscle tone (hypoxia, blood loss, shock).

8 slide

3 types of cessation of respiratory activity Hypoxia. Hypercapnia. Hypocapnia is a respiratory alkalosis.

9 slide

Symptoms of Coma's clinical death are dilated pupils and lack of response to light. Apnea is a lack of breathing. Asystole is the absence of a pulse in the carotid arteries. Time factors play a huge role in this condition, therefore, it is necessary to strive to perform EEG, ECG, acid base balance is not necessary, but it is necessary to move on to resuscitation methods.

10 slide

Air way open revitalization methods - restore airway patency. Breathe por victim - start ventilation. Circulation his blood - start a heart massage.

11 slide

ABC rules 1. Unfold the cervical spine, remove the lower jaw (Fig. 23.24), free the oral cavity and pharynx, the air duct - mechanical ventilation (Fig. 25.26). 2. a) external (external) - compression of the chest. b) blowing air into the lungs.

12 slide

Ventilation methods IVL through the S-shaped air duct. IVL through a gauze bandage (1-2 layers) or a handkerchief. IVL "mouth-to-mouth" 10-12 in 1 min (at the expense of 4-5). IVL "mouth-to-nose".

13 slide

Ways to restore cardiac activity 1. Indirect cardiac massage. After 2-3 breaths - a blow with a fist in the area of ​​the heart and then massage between the sternum and the spine 1: 5 ratio of massage to mechanical ventilation.

14 slide

2. Drug stimulation. Repeats every 5 minutes. Adrenomimetics - adrenaline 1.0 0.1% + 10.0 physical solution intravenously, intravenously, until a clinical effect is obtained. Antiarrhythmic drugs - lidocaine 80-120 mg. Sodium bicarbonate 2 ml 1% per 1 kg. Magnesium sulfate 1-2 g in 100 ml of 5% glucose. Atropine 1.0 0.1% solution. Calcium chloride 10% - 10.0

15 slide

3. Electric pulse therapy 200J, 200-300, 360, 2500 V, 3500 V. Resuscitation benefits are not provided to patients with injuries incompatible with life, those in the terminal stage of incurable diseases, cancer patients with metastases.

16 slide

Types of shock Hypovolemic (post-hemorrhagic, burns are varieties) shock. Cardiogenic shock. Vascular shock (septic and anaphylactic).

17 slide

Clinical signs of shock Cold, moist, pale cyanotic, or marbled skin; sharply slowed down blood flow to the nail bed; darkened consciousness; dipnea; oiguria; tchycardia; decrease in blood and pulse pressure.

18 slide

Pathogenetic classification, main clinical symptoms and compensatory mechanisms of hypovolemic shock (according to G.A. Ryabov, 1979)

19 slide

Shock control criteria Shock index is the ratio of heart rate to systolic pressure (P.G. Brusov, 1985). Normal value of SHI = 60/120 = 0.5 (blood loss 15-25% of the BCC) SHI = 1 (100/100) (blood loss 25-45% of the BCC) SHI = 1.5 (120/80) (blood loss more than 50% of the BCC) SHI = ”(140/70)

20 slide

Principles of treatment for hypovolemic shock Immediate control of bleeding, adequate pain relief. Catheterization of the subclavian vein and adequate fluid therapy. Relief of signs of acute respiratory failure. Constant supply of oxygen in the inhaled mixture in the amount of 35-45%. Relief of signs of acute heart failure. Bladder catheterization

21 slide

The program of infusion therapy depending on blood loss (V.A.Klimansky, A.Ya. Rudaev, 1984)

22 slide

Principles of treatment of septic shock Elimination of signs of ARF and OSSN, transfer to mechanical ventilation according to indications. Normalization of indicators of central hemodynamics by using intravenous infusions of dextrans, crystalloids, glucose under the control of CVP and hourly urine output. Correction of the main indicators of acid-base balance and water-electrolyte balance. Preventive treatment of lung distress syndrome inevitable for this pathology. Antibacterial therapy (bacteriostatic drugs are better). Relief of DIC - syndrome. Treatment of the allergic component of the disease by prescribing glucocorticoids. Remediation of the focus of infection. Symptomatic therapy.

24 slide

Principles of anaphylactic shock treatment. Resuscitation measures, if indicated. If possible, eliminate contact with the allergen, although this is not always possible. If this is not possible - a tourniquet above the injection site of the allergen or prick the injection site with a diluted solution of adrenaline. Intravenous infusion therapy under the control of CVP and hourly urine output. Slowly intravenously 1 ml 0.1% solution of adrenaline + 20.0 physical. solution (it is possible under the tongue). Relief of bronchospasm, slow intravenous administration of 5-10 ml of 2.4% aminophylline solution. The administration of glucocorticoids is shown as desensitizing drugs and stabilizers of cell membranes. When using prednisolone, the dose should be 90-120 mg. At the same time, hydrocortisone 125-250 mg is prescribed, which has the ability to retain sodium and water in the body.

25 slide

Criteria for the successful treatment of shock BCC recovery and elimination of hypovolemia. Restoration of UOS, MOS. Elimination of microcirculation disorders.

"Terminal states"

OBZH teacher

MOU SOSH village Svyatoslavka

Samoilovsky district

Saratov region

Kulikova Tatiana Vasilievna

Slide 2

TERMINAL STATES

FIRST RESIDUAL AID

Slide 3

Combined lesson

The purpose of the lesson:

Teaching students how to provide emergency resuscitation care.

Lesson objectives.

Educational: Familiarization of students with the rules for providing first aid in extreme situations.

Educational: Raising awareness of the value of human life.

Practical: Formation of practical skills in the provision of emergency resuscitation care.

Slide 4

Terminal states and needed help

Predagonia, agony and clinical death are terminal, i.e. borderline states between life and biological death. Providing first resuscitation aid in these cases is the only way to save a person's life.

Slide 5

Predagonia

In pre-agony conditions, the following is observed:

• inhibition of the central nervous system,
• drop in blood pressure to 60 mm Hg. and lower, an increase and decrease in the filling of the pulse in the peripheral arteries,
• shortness of breath (rapid breathing - tachypnoe),
• discoloration of the skin - cyanosis (cyanosis). As a rule, consciousness is preserved, however, in some cases it is darkened or confused. The eye reflexes are vivid.

Slide 21

Slide 22

External heart massage

1. Maximum compression on the lower third of the sternum.

2. Depth of pressure 4-5 cm or about 30% of the anteroposterior chest size.

3. Technique: for adults - with two hands, for children under one year old - with the thumbs of both hands, for children 1-8 years old - with one hand; the shoulders should be directly over the clasped hands; keep your elbows straight.

Lesson topic:

Terminal state.

First resuscitation aid.

The purpose of the lesson:

• To acquaint students with the signs of a terminal state.

• Teach students to master the skills of receiving and providing

emergency resuscitation care.

Terminal states Are borderline states

organism between life and death, the last

stages of life.

SHOCK (5-6 hours) → PREAGONIA → TERMINAL PAUSE

→ AGONY → CLINICAL DEATH

(the last four links are developing

within a time not exceeding 8-9 minutes).

Clinical death is due to the cessation of cardiac activity.

Clinical death is characterized by five main signs of the main signs:

Lack of consciousness;

Lack of breathing;

Lack of pulse in the carotid or femoral arteries;

Dilated pupils;

Lack of pupil response to light.

The duration of clinical death is 4-5 minutes.

Resuscitation- this is the revival of a dying person, bringing him out of the state of clinical death, prevention of the occurrence of biological death.

The purpose of resuscitation:

saving a person's life as a social subject, a full-fledged member of society.

Resuscitation tasks:

Prevention of death, support for the restoration of brain functions;

Removal of the body from terminal states;

Prevention of their return (relapse);

Prevention or limitation of the number of possible complications;

Reducing the severity of their course.

First stages

intensive care

help .

Five questions are solved in sequential order:

Man is alive or dead;

Sick or healthy (but is, for example, intoxicated);

Is in a state of clinical death;

Whether he is in a state of severe shock preceding clinical death;

What kind of medical assistance does the victim need or cannot be treated at all?

1. Checking the condition of the cervical vertebrae.

2. The method of throwing back the head.

3. Immediate stopping of bleeding.

4. Checking the pulse, the state of the pupils.

5. Carrying out artificial ventilation of the lungs.

Correct placement of the victim.

IT IS NOT POSSIBLE TO CARRY OUT REANIMATION ON THE SOFA, ON THE BED - ALL MEASURES WILL BE INEFFECTIVE.

1.Checking the airway patency.

2. Technique of airway patency restoration.

3. Opening the victim's mouth.

1. Artificial ventilation of the lungs.

"MOUTH TO MOUTH", "MOUTH TO NOSE"

2.Painless artificial ventilation of the lungs.

3. External heart massage.

PRECARDINAL IMPACT

4. The ratio of resuscitation.

2: 15- with one rescuer

1: 5 - with two rescuers

1: 4 - in children

• Restorative, protective

• strict sequence of events;
• fast, accurate implementation;

Ensuring complete rest of the victim, his comfort;

Constant monitoring of the position of the body and the condition of the victim.

Bringing the victim into a recovery, protective position is carried out after his removal from the terminal state (the victim may be unconscious).

What issues are resolved at the diagnostic stage I of RP?

How to position the victim so that resuscitation

were the activities effective?

What are the main tasks of a ventilator rescuer?

Description of the presentation for individual slides:

1 slide

Slide Description:

Terminal states. First resuscitation aid. Completed by the teacher MBOU "OOSH s. Dubovka" Golodnov Alexey Vladimirovich

2 slide

Slide Description:

Terminal states are the borderline states of the organism between life and death, the last stages of life. At the same time, a characteristic five-link chain of events can be distinguished: shock, preagony, terminal pause, agony, clinical death (the last four links develop over a period of time not exceeding 8-9 minutes). Full revival is possible in all terminal states. In practical situations, most often you have to deal with the first resuscitation aid in case of clinical death. This help is of great importance, since immediately after clinical death, irreversible biological death occurs. Clinical death is characterized by five main signs: 1. Lack of consciousness. 2. Lack of breath. 3. Lack of pulse in the carotid or femoral arteries. 4. Dilatation of the pupils. 5. Lack of reaction of pupils to light.

3 slide

Slide Description:

Stages of the first resuscitation aid. Resuscitation is the revival of a dying person, bringing him out of the state of clinical death, prevention of the occurrence of biological death. The goal of resuscitation is to save the life of a person as a social subject, a full-fledged member of society. Resuscitation tasks: * prevention of death, support, restoration of brain functions; * removal of the body from terminal states; * prevention of their return (relapse); * prevention or limitation of the number of possible complications; * reducing the severity of their course.

4 slide

Slide Description:

There are five stages of the first resuscitation aid. 1.Diagnostic - decides five questions, whether a person is alive or dead; sick or healthy (being intoxicated); whether he is in a state of clinical death or in severe shock; what kind of medical assistance the victim needs or is not subject to treatment at all.

5 slide

Slide Description:

The stage is diagnostic. Determination of the state of consciousness, reaction to external influences (shake the shoulder, call out) Reaction available Reaction absent If necessary, position the victim more comfortably; exclude the possibility of airway blockage, provide first aid, call for help Check the condition of the cervical vertebrae. To exclude fractures, fracture-dislocations of the vertebrae, injuries to the neck, head. Free the airways; tilt your head back, push the lower jaw forward; remove foreign bodies if necessary. Call for help. Stop external bleeding. Summon ambulance... Check the victim's breathing by the sound, the feeling of air coming out, by the rise of the front wall of the chest during inhalation. Breathing is saved. Breathing is sharply weakened. Breathing is absent. Check for the presence of blood circulation: by the pulse on the carotid artery; according to the condition of the pupils. Carry out artificial ventilation of the lungs. Blood circulation is saved. There is no blood circulation. No blood circulation Carry out a full resuscitation cycle

6 slide

Slide Description:

The stages are preparatory and initial. Preparatory stage Initial stage Place the victim on a hard base (on the floor, on the ground, etc.) on his back (arms extended along the body) Throw back the victim's head Loosen the collar, belt. Free your bra. Mouth open Mouth closed Open the mouth using one of the following methods: - bilateral grip of the lower jaw, - anterior grip of the lower jaw, - lateral grip of the lower jaw. Check airway patency. Absent Retained Restore airway patency

7 slide

Slide Description:

8 slide

Slide Description:

Resuscitation stage. Artificial ventilation of the lungs External cardiac massage Using oral methods Precardinal blow before external cardiac massage at the beginning of each cycle ) breaths at the fastest pace, without pauses. Inspiratory volume - 400-500 ml. Inspiratory cycle: ventilator frequency - 8 in 1 minute; inspiration time no more than 1 s. Checking the effectiveness of the measures taken on the pulse on the carotid artery, the state of the pupils. With no effect. Cycles of external heart massage: frequency of impulses - 100 per 1 minute; depth of sternum deflection - 4-5 cm.Ratio of resuscitation (mechanical ventilation + external heart massage) With one rescuer - 2:15 With two rescuers - 1: 5 For children - 1: 4 In all cases, ensuring constant monitoring of the victim's condition, the effectiveness of resuscitation with adjustments

9 slide

Slide Description: