Extreme conditions

Extreme conditions are conditions characterized by excessive stress or exhaustion of the mechanisms of adaptation of the organism with a violation of the regulation of the function of vital organs.

[1], [2], [3], [4]

How do extreme states develop?

At the heart of extreme conditions lies the disabling of afferent regulation of the body's function by the central nervous system. When there are minimal interoreceptive impulses of afferent regulation aimed at the realization of only elementary forms of respiration and circulation. Clinically extreme conditions are manifested by coma, shock, sudden stopping of breathing and cardiac activity.

Extreme conditions can develop primarily, as a rule, suddenly when exposed to extreme stimuli: trauma, blood loss, exposure to allergic factors, toxic substances, acute circulatory disorders, etc., which are manifested by shock. Secondary extremal conditions are caused by decompensation of the function of vital organs in chronic heart, lung, endocrine glands, liver, kidney, brain and are accompanied by the development of coma.

The pathogenesis of extreme conditions is very complex and differs polymorphism, as it depends on the underlying disease that caused the decompensation of the function of vital organs. But the general is the development of hypovolemia and hypoxia of tissues, primarily the brain.

Sudden stopping of breathing and cardiac activity is treated as a reversible terminal condition and requires replacement therapy and resuscitation.

The causes of stopping breathing and cardiac activity are very diverse: asphyxiation with foreign bodies, bronchospastic processes, electric shock, poisoning, trauma and blood loss, shock, strokes and heart attacks, drug overdoses, allergic reactions, etc. Terminal states can develop in any conditions: at work , on the street, on vacation, in a medical institution, on the operating table, etc. An urgent need for resuscitation before the arrival of a specialized ambulance or resuscitator clinic;

But often there are questions of an ethical and organizational nature. First of all, the question arises - was death? After a sudden loss of consciousness is not a sign of the onset of death, it can be either coma or fainting. The first obvious signs are formed after 10 seconds: absence of chest excursions (apnea), lack of pulse on the carotid artery (asystole), lack of consciousness (coma). Not all signs develop at once: at primary stop of breath heart activity proceeds 3-4 more minutes; at the primary stop of the heart, complete respiratory depression occurs at the end of the first minute; paralytic dilatation of the pupil, also appears at the end of the first minute. Wait for their full appearance should not, and immediately begin a resuscitation complex in the presence of a single sign.

Fainting

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

It can develop at psychoemotional stresses, for example, during some catastrophes or life situations, with a long stay in a stuffy and humid room, etc. But this does not affect the vital functions and regulation of body functions. The basis is a neuro-reflex stress reaction in the form of a short-term angiospasm of cerebral vessels. Moreover, clinically extreme conditions are accompanied by sudden blanching, a feeling of lack of air, ringing in the ears, swimming of surrounding objects, loss of pulse and respiration, pupils dilated, BP does not drop below 90 mm Hg. Art.

Consciousness is not completely lost, the patient hears and perceives everything, but becomes indifferent and, according to their figurative expression: "It swims and floats away, I want peace and quiet." With severe stress, persistent situational amnesia can develop. Because of the saved sensations, the patient never falls, he slowly settles "on the wall" or with a support.

[5], [6]

Giving help:

1. provide air access - remove the surrounding, open the windows (doors), unbutton the upper buttons, loosen the tie, etc .;
2. if the patient is in a sitting position - tilt his head down and press him to his knees;
3. if the patient lies - turn on the back, the head should be in a horizontal position, raise the legs, so that they are above the head;
4. give sniffing irritating substances (ammonia).

Collapse

This is a sudden short-term loss of consciousness, which occurs when the position changes sharply, as a result of the redistribution of blood, so 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 sudden change in position from sitting to standing, from recumbent sitting. Clinically manifested sudden loss of consciousness with a decrease in blood pressure less than 90 mm Hg. Art. Skin covers are pale, with a cyanotic shade. Breathing is preserved and can be somewhat increased.

Pulse is frequent, weak filling. Arterial pressure is lowered, sometimes it is less than 60 mm Hg. Art. The veins slept together. But the vital activity of the body is preserved. Giving help:

To put a lying position, to wrap up, to raise legs. It is advisable to administer cordiamine, strophanthin, euphyllin or bemegrid. Usually functional recovery occurs after 2-3 minutes.

[7], [8],