Extreme conditions

Extreme conditions are conditions characterized by excessive stress or exhaustion of the body's adaptation mechanisms with disruption of the regulation of the function of vital organs.

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How do extreme conditions develop?

Extreme conditions are based on the shutdown of afferent regulation of the body's function by the central nervous system. When minimal interoreceptive impulses of afferent regulation remain, aimed at implementing only elementary forms of breathing and blood circulation. Clinically, extreme conditions are manifested by coma, shock, sudden cessation of breathing and cardiac activity.

Extreme conditions may develop primarily, as a rule, suddenly under the influence of extreme irritants: trauma, blood loss, exposure to allergic factors, toxic substances, acute circulatory disorders, etc., which manifest themselves as shock. Secondary extreme conditions are caused by decompensation of the function of vital organs in chronic diseases of the heart, lungs, endocrine glands, liver, kidneys, brain and are accompanied by the development of coma.

The pathogenesis of extreme conditions is very complex and polymorphic, as it depends on the underlying disease that caused decompensation of the function of vital organs. But the common thing is the development of hypovolemia and tissue hypoxia, primarily the brain.

Sudden respiratory and cardiac arrest is treated as a reversible terminal condition and requires replacement therapy and resuscitation.

The causes of respiratory and cardiac arrest are very diverse: asphyxia by foreign bodies, bronchospastic processes, electric shock, poisoning, trauma and blood loss, shock, strokes and heart attacks, drug overdoses, allergic reactions, etc. Terminal conditions can develop in any conditions: at work, on the street, on vacation, in a medical facility, on the operating table, etc. The urgency of resuscitation measures is important, before the arrival of a specialized ambulance team or a resuscitator from a clinic;

But ethical and organizational questions often arise. First of all, the question arises - has death occurred? After all, sudden loss of consciousness is not a sign of death, it can occur both in coma and in fainting. The first obvious signs are formed after 10 seconds: no chest excursions (apnea), no pulse in the carotid artery (asystole), no consciousness (coma). Not all signs develop at once: with primary respiratory arrest, cardiac activity continues for another 3-4 minutes; with primary cardiac arrest, complete respiratory depression occurs by the end of the first minute; paralytic dilation of the pupil also appears by the end of the first minute. You should not wait for their full appearance, but immediately begin resuscitation complex in the presence of one sign.

Fainting

The main pathogenetic moment of their development is a short-term spasm of the cerebral vessels, causing fainting or redistribution of blood with a sharp change in position, causing the development of orthostatic collapse.

It can develop during psycho-emotional stress, for example, during some disasters or life situations, during a long stay in a stuffy and humid room, etc. But at the same time, the vital activity and regulation of body functions are not disrupted. It is based on a neuro-reflex stress reaction in the form of a short-term angiospasm of the cerebral vessels. At the same time, clinically extreme conditions are accompanied by sudden pallor, a feeling of lack of air, ringing in the ears, floating of surrounding objects, a decrease in pulse and breathing, pupils are dilated, blood pressure does not drop below 90 mm Hg.

Consciousness is not completely lost, the patient hears and perceives everything, but becomes indifferent and, as they figuratively put it: "It floats and floats away, I want peace and quiet." With severe stress, persistent situational amnesia can develop. Due to the preserved sensations, the patient never falls, he slowly settles "along the wall" or with support.

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Providing assistance:

1. provide access to air - remove people around, open windows (doors), unbutton the top buttons, loosen the tie, etc.;
2. if the patient is in a sitting position, tilt the head down and press it to the knees;
3. if the patient is lying down, turn him onto his back, the head should be in a horizontal position, raise the legs so that they are higher than the head;
4. give irritating substances to sniff (ammonia).

Collapse

This is a sudden, short-term loss of consciousness that occurs with a sharp change in position, as a result of redistribution of blood, which is why it is also defined by the term "orthostatic collapse". All other concepts of "collapse" are outdated, and no one recognizes them.

Extreme conditions in the form of collapse develop in the elderly and children with a sharp change in position from sitting to standing, from lying to sitting. Clinically manifested by a sudden loss of consciousness with a decrease in blood pressure below 90 mm Hg. The skin is pale, with a bluish tint. Breathing is preserved and may be somewhat rapid.

The pulse is rapid and weak. Blood pressure is low, sometimes below 60 mm Hg. The veins are collapsed. But the body's vital functions are preserved. Providing assistance:

Give a lying position, wrap up, raise legs. It is advisable to administer cordiamine, strophanthin, euphyllin or bemegride. Functional recovery usually occurs in 2-3 minutes.

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