To emergency signs include: To emergency signs include



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To emergency signs include:

  • To emergency signs include:

  • - asphyxia

  • - Severe respiratory failure

  • - Central cyanosis

  • - Symptoms of shock (cold hands, capillary refill longer than 3 seconds, weak rapid pulse)

  • - coma

  • - seizures

  • - Signs of severe dehydration in children with diarrhea (sluggishness (lethargy), sunken eyes, a very slow unfolding



Priority signs suggest that the patient has a risk of death. These children urgently need to examine in more detail.

  • Priority signs suggest that the patient has a risk of death. These children urgently need to examine in more detail.

  • First, check the emergency signs, dividing the process into the following two stages:

  • Step 1. If there are problems with the airway or breathing, immediately begin treatment to restore respiratory function.

  • Step 2. Quickly check for the child of any of the following disorders: shock, impairment of consciousness, convulsions, diarrhea with severe dehydration.



- The age of two months

  • - The age of two months

  • - Respiratory distress

  • - Temperature: the child is very hot

  • - Trauma or other urgent surgical condition

  • - A child enrolled for a fixed direction from another health care facility

  • - Malnutrition: visible signs of severe malnutrition

  • - Pallor (severe)

  • - Pain (severe)

  • - The child is restless, irritable, or, on the contrary, inhibited

  • - poisoning

  • - Burns (large)

  • - Swelling of both feet





Respiratory failure - a condition of the body, which does not provide external breathing normal blood gases or maintain the price of excessive force (excessive energy costs.)

  • Respiratory failure - a condition of the body, which does not provide external breathing normal blood gases or maintain the price of excessive force (excessive energy costs.)













neurological

  • neurological

  • Restlessness, agitation

  • headache

  • disorientation

  • convulsions

  • cardiovascular

  • tachycardia

  • Hypertension or hypotension

  • Stethalgia

  • arrhythmias

  • pulmonary

  • tachypnea

  • deep breathing

  • The increase in inspiratory effort

  • skin

  • Cold, clammy, pale skin

  • Reduction of capillary refill



oxygen

  • oxygen

  • IVL

  • Constant high blood pressure (PAP)

  • Increased end-expiratory pressure

  • Mucolytics phlegm

  • xanthines

  • aminophylline

  • P2 antagonists

  • Izoetarin (Bronkosoi)

  • Metaproterenol (Alupent, Metaprel)

  • Terbutaline (Brethine)

  • Albuterol (Proventil, Ventolin)

  • sedation

  • Diazepam (Valium)

  • Lorazepam (Ativan)

  • Midazolam (Versed)

















I стадия:

  • I стадия:

  • тахикардия;

  • одышка в покое;

  • признаки застоя в большом круге кровообращения или в малом круге кровообращения;

  • сердечные тоны приглушены.

  • II стадия:

  • симптомы первой стадии;

  • олигурия;

  • периферические отеки;

  • возможен отек легких.

  • III стадия:

  • артериальная гипотензия;

  • сердечные тоны глухие;

  • расширение границ сердца;

  • признаки перегрузки малого круга кровообращения.





Cramps - the most frequent manifestation of CNS in children.

  • Cramps - the most frequent manifestation of CNS in children.

  • It is believed that up to two thirds of seizures in children occur in the first 3 years of life.



  • newborn;

  • 1 year;

  • an early age;

  • later in life.



infection;

  • infection;

  • intoxication;

  • injury;

  • central nervous system disease;

  • metabolic defects;

  • genetic predisposition, etc.







Febrile seizures occur mainly in diseases that occur with high temperature (over 38oS), -

  • Febrile seizures occur mainly in diseases that occur with high temperature (over 38oS), -

  • acute viral infection

  • flu

  • angina,

  • otitis,

  • bronchitis,

  • pneumonia, etc.



An increase in temperature, causing metabolic changes and circulatory disorders of the brain, increases availability of the brain to seizures.

  • An increase in temperature, causing metabolic changes and circulatory disorders of the brain, increases availability of the brain to seizures.

  • seizures occur in the first day of the temperature rise

  • manifested in the form of loss of consciousness with the general stress of the body and limbs twitching.

  • Some children may be the selection of foam from the mouth, and loss of bladder control.

  • Seizures are usually one-off

  • last for 3-5 minutes.

  • Repeated seizures are rare.

  • A few hours or minutes a child becomes restless, pressed against the mother's screams, and then the general excitement followed by convulsions



Dynamic monitoring of children undergoing isolated febrile seizures, showed that the risk of recurrent febrile seizure is 30%, and seizures are not associated with increasing temperature - 2-5%. If the baby was less than a year, the risk of recurrent seizures is increased to 50%.

  • Dynamic monitoring of children undergoing isolated febrile seizures, showed that the risk of recurrent febrile seizure is 30%, and seizures are not associated with increasing temperature - 2-5%. If the baby was less than a year, the risk of recurrent seizures is increased to 50%.



First aid for seizures

  • First aid for seizures

  • During the attack should:

  • stay calm, do not try to forcibly restrain the convulsive movements;

  • possible to lay on a flat surface and put a head on him something soft;

  • turn your head to the side lying sick to prevent zapadaniya tongue and saliva entering the respiratory tract, and in cases of vomiting gently turn the person on his side;

  • do not try to unclench his teeth;

  • do artificial respiration or cardiac massage.

  • Seizures stop on their own after a few minutes. After the attack to give people the opportunity to quietly recover and, if necessary, to sleep.



Paracetamol (daily dose of 20-30 mg per kg) every 4-5 hours.

  • Paracetamol (daily dose of 20-30 mg per kg) every 4-5 hours.

  • If they persist for more than 5 minutes or repeated, you must enter the diazepam (seduksen, Relanium, sibazon) 0.2-0.5 mg / kg rectally (in the rectum), after dissolving the appropriate dose of diazepam in 50 ml of water at room temperature.

  • If no effect, you can enter the repeat dose of diazepam. Severe toxic effects of diazepam are very rare.

  • In the presence of risk factors for recurrence of febrile seizures and epilepsy in the transition can be assigned to prophylactic treatment anticonvulsants.



partial seizures

  • partial seizures

  • Simple partial seizures without loss of consciousness

  • motor

  • sensory

  • standalone

  • mental

  • Complex partial seizures with impairment of consciousness

  • Partial seizures with subsequent generalization

  • generalized seizures

  • Absence (typical, atypical)

  • tonic

  • clonic

  • Tonic-clonic

  • myoclonic

  • atonic

  • infant spasms



Carbamazepine (Tegretol)

  • Carbamazepine (Tegretol)

  • When partsilnyh and tonic-clonic seizures

  • Side benefit: double vision, vomiting, ataxia, leukopenia

  • Ethosuximide (Zarontin)

  • when absences

  • Collaterally: rash, anorexia, leukopenia

  • Phenobarbital (Luminal)

  • When tonic-clonic and partial seizures

  • Collaterally: giperaktivnoct, sedation, nystagmus, ataxia

  • Phenytoin (Dilantin)

  • When tonic-kloiicheskih and partial seizures

  • Collaterally: rash, nystagmus, ataxia, anemia, polyneuropathy

  • Valproikovaya acid (Depakene, Depakote)

  • When tonic-clonic and partial seizures and absence seizures

  • Collaterally: hepatotoxicity, vomiting, anemia, thrombocytopenia



disease of young children characterized by a tendency to tonic and clonic-tonic seizures due to hypocalcemia.

  • disease of young children characterized by a tendency to tonic and clonic-tonic seizures due to hypocalcemia.



Chvostek (tapping your finger in the output section facialis to the zygomatic arch and into the corner of the lower jaw causes a rapid reduction of the facial muscles)

  • Chvostek (tapping your finger in the output section facialis to the zygomatic arch and into the corner of the lower jaw causes a rapid reduction of the facial muscles)

  • Trousseau (compression arm cuff sphygmomanometer or fingers causes muscle spasm brush - "hand obstetrician")

  • peroneal and ulnar phenomena (lead foot effleurage of the fibula head, bending the fingers when tapped on the outer condyle of the elbow).



manifested generalized tonic and clonic convulsions,

  • manifested generalized tonic and clonic convulsions,

  • karpopedapnym spasm ("hand obstetrician" and equinovarus position of the foot)

  • laringospazmom of attack as a light constriction of the glottis, or short-term, but its complete closure.



slow / injected a 10% solution of calcium gluconate or chloride - 0.3-0.5 ml / kg.

  • slow / injected a 10% solution of calcium gluconate or chloride - 0.3-0.5 ml / kg.

  • When injected seduksen clonic (0.5% solution - 0.1 ml / kg / m)

  • GHB (20% solution - 0.5 ml / kg), a / c,

  • Magnesium sulfate (25% solution - 0.2 ml / kg / m), at the same time introduce a 10% solution of calcium chloride / in.

  • And designate the 10% solution of calcium chloride to 1 teaspoon or dessert spoon or calcium gluconate 2-3 g 3 - 4 times a day. After 2-3 days of taking the drugs prescribed calcium protivorahitichestkoe treatment



Epilepsy - a chronic disease of the nervous system, manifested by epileptic seizures, which are the result of over a hyper-synchronous neuronal activity in the brain. The name of the disease "epilepsy" occurs from the Greek word - epilepsia, grasp meaning, master.

  • Epilepsy - a chronic disease of the nervous system, manifested by epileptic seizures, which are the result of over a hyper-synchronous neuronal activity in the brain. The name of the disease "epilepsy" occurs from the Greek word - epilepsia, grasp meaning, master.



Classification of epilepsy.

  • Classification of epilepsy.

  • By type of isolated attacks

  • 1) the generalized form

  • 2) The focal form.

  • Etiology:

  • 1) idiopathic,

  • 2) Symptomatic

  • 3) cryptogenic.







Valproate: Depakine, konvulsofin, Orphir, dipramal (dose 20-30mg/kg/sutki).

  • Valproate: Depakine, konvulsofin, Orphir, dipramal (dose 20-30mg/kg/sutki).

  • Iminostilbeny: finlepsin, carbamazepine, Timon, Tegretol (dose 10-20mg/kg/sut.).

  • Succinimides: suksilep, etosuksemid, piknolepsin (dose 15-20mg/kg/sut., Max 50 mg / kg / day.).

  • Benzodiazepines: clonazepam, antelepsin (dose 0.03-0.1 mg / kg / day., Max 0,3 mg / kg / day.).

  • Barbiturates: phenobarbital, benzonal, geksamedin (dose 2-4mg/kg/sut.).

  • Gidantoidy: phenytoin, phenytoin (dose of 5-7 mg / kg / day.).

  • 7. Some hormones (sinakten-depot ACTH).







Hypovolemic (Burn, adrenal, diabetic) decrease in the circulating liquid

  • Hypovolemic (Burn, adrenal, diabetic) decrease in the circulating liquid

  • cardiogenic

  • Violation of the pumping function of the heart

  • Distributive (septic, anaphylaxis, neurogenic) Improper volume of circulating fluid



septic shock

  • septic shock

  • Microorganisms into the circulation

  • anaphylactic shock

  • The result of a severe allergic reaction

  • neurogenic shock

  • The result of the loss of sympathetic tone



anxiety, fear;

  • anxiety, fear;

  • blue lips and nail boxes, paleness;

  • pain in the chest;

  • cold skin;

  • decreased urine output;

  • dizziness, weakness;

  • confusion, fainting or loss of consciousness deeper, nausea and vomiting;

  • numbness;

  • sweating, clammy skin, sharp pulse;

  • shallow breathing;

  • thirst.



Replacing lost fluids

  • Replacing lost fluids

  • whole blood

  • crystalloids

  • colloids

  • vasoconstrictors

  • Epinephrine (adrenaline)

  • Norepinephrine (Levophed)

  • Dopamine (Dopamine, Intrepid)

  • Metaraminol (Aramine)

  • Phenylephrine (Neo-synephrine)

  • ephedrine

  • vasodilators

  • Nitroprusside (Nipride)

  • Nitroglycerin (Nitrol, Tridil)

  • Hydralazine (Apresoline)

  • Labetalol (Normodyne, Trandate)

  • inotropes

  • dopamine

  • Dobutamine (Dobutrex) amrinone (Inocor)

  • epinephrine

  • Norepinephrine (Levophed) Digoxin (Lanoxin)



Result of the reaction of immediate hypersensitivity immunoglobulin-E (IgE)-dependent or IgE independent

  • Result of the reaction of immediate hypersensitivity immunoglobulin-E (IgE)-dependent or IgE independent

  • ETIOLOGY

  • Food and food additives

  • medications

  • Elements of the environment

  • The elements of wildlife

  • PATHOPHYSIOLOGY

  • Activation of the immune system

  • Stem cell degranulation

  • Activation of biochemical mediators - peripheral vasodilation

  • Increased permeability of the capillaries

  • Smooth muscle contraction



Reduction of circulating volume

  • Reduction of circulating volume

  • bronchospasm

  • laryngeal edema

  • Reduced oxygen

  • Decrease in venous return

  • The decrease in stroke volume

  • Decrease in cardiac output

  • Reducing the supply of cells with oxygen

  • Violation of cell metabolism



hypotension

  • hypotension

  • tachycardia

  • sneezing

  • Erythema and rash

  • angioedema

  • fear

  • blackout



Eliminate the effect of antigen

  • Eliminate the effect of antigen

  • intubation

  • Ventilation or black mask oxygen

  • epinephrine

  • aminophylline

  • Diphenhydramine (Benadryl)

  • corticosteroids

  • Liquids - colloids, crystalloids

  • Positive inotropes - dopamine, dobutamine (Dobutrex)





Shock - is the ultimate state of the vital functions of the body, manifested by the complex pathological changes of the physiological systems (central nervous system, with-we circulation, respiration and metabolism).

  • Shock - is the ultimate state of the vital functions of the body, manifested by the complex pathological changes of the physiological systems (central nervous system, with-we circulation, respiration and metabolism).



Collapse - developing acute vascular insufficiency, characterized by falling vascular tone and a sharp decrease in the bcc

  • Collapse - developing acute vascular insufficiency, characterized by falling vascular tone and a sharp decrease in the bcc



Syncope - a sudden loss of consciousness of short duration, which is based on short-term reduction / cessation of cerebral blood flow. Syncope occurs frequently in collapse.

  • Syncope - a sudden loss of consciousness of short duration, which is based on short-term reduction / cessation of cerebral blood flow. Syncope occurs frequently in collapse.









Common symptoms are:

  • Common symptoms are:

  • Anxiety, fear

  • Dizziness, weakness

  • impaired consciousness

  • Stethalgia

  • Cooling of the skin, numbness

  • Profuse sweating, skin moisture

  • Cyanosis of the lips, nail boxes, paleness

  • Frequent thready pulse

  • tachypnea

  • oliguria

  • Nausea / vomiting

  • excessive thirst



Instrumental studies:

  • Instrumental studies:

  • ECG, radiographic examination (AIZ, GR, pelvis)

  • Measurement of blood pressure, heart rate, IOC, BCC, NPV

  • The Index of shock (ISH) by Algoveru: ISH = HR / ADsist:



Laboratory studies:

  • Laboratory studies:

  • Blood on Ht, amylase, group compatibility

  • Some of the 20 required indicators:

  • albumin

  • AP

  • ALT, AST, total direct and b / w

  • Urea, uric acid, creatinine, blood

  • total protein

  • Ca, chloride, CO2

  • K, Na serum








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