Main first aid other diseases and traumatesexclusive care for infectious diseases First aid for: Other diseases and injuries Emergency care for infectious diseases 22257 0 for infectious diseases, the emergency doctor must establish a nosological diagnosis or syndrome that requires emergency benefits, determine the indications and deliver the patient to the hospital with simultaneous urgent etiotropic, pathogenetic and specific therapy. Having established the diagnosis of an infectious disease, the emergency doctor is obliged to choose the best option for medical evacuation tactics – urgent hospitalization through an ambulance call, hospitalization by ambulance, home treatment by specialists of the territorial outpatient clinic.
A call to the infectious patient is registered in sanitary-and-epidemiological institution (SES of epidura). Urgent hospitalization by calling an ambulance is subject to: a) patients who require resuscitation measures already at the pre-hospital stage (infectious and toxic shock, hypovolemic shock); b) patients with pronounced toxicosis, organ failure, severe concomitant pathology, who need to carry out certain medical measures before transportation; C) patients with the threat of developing critical conditions. Urgent hospitalization of such patients (in the absence of epidemiological contraindications) can be performed by ambulance.
Infectious and toxic shock the Cause of infectious and toxic shock can be meningococcal sepsis, severe flu with pronounced toxicosis, as well as other acute infections with an unfavorable course of the disease. Infectious-toxic shock successively passes the stages of compensation, subcompensation and decompensation. Diagnostic signs of sub-and decompensated shock are clear and consist in a decrease in blood PRESSURE, tachyarrhythmia, tachypnea, oliguria and anuria, the development of hypothermia against the background of a disorder of consciousness and a progressive deterioration of the General condition. Early diagnosis of the compensated stage of shock is a difficult task, which allows for rational therapy to stop its development and prevent the occurrence of life-threatening disorders.
Signs of compensated shock (grade I shock) are hyperthermia, agitation, motor restlessness, mental disorders of various severity, hyperventilation, shortness of breath. Arterial hypotension in the development of shock should be considered an unfavorable clinical sign indicating far-reaching metabolic disorders. In subcompensated shock (grade II shock), agitation and motor restlessness are replaced by lethargy and depression, hyperemia of the skin-pallor and cyanosis, body temperature begins to fall. The decrease in blood PRESSURE reaches a critical level (from 100 to 70 mm Hg), which, taking into account the initial indicators in accordance with possible concomitant cardiovascular pathology, leads to oliguria. Decompensated shock (grade III shock) is characterized by a drop in blood PRESSURE below the critical level (70 mmHg). art.), hypothermia, anuria, disappearing peripheral pulse, loss of consciousness, decreased peripheral reflexes.
The development of infectious toxic shock in meningococcal infection is preceded by meningococcal sepsis, and in influenza-specific influenza intoxication and bacterial complications against the background of severe concomitant diseases. Meningococcal sepsis Infectious and toxic shock in meningitis is preceded by the occurrence and development of meningococcal sepsis, a constant pronounced sign of which is a specific exanthema. A few hours after the onset of the disease, a petechial rash of irregular stellate shape appears on the limbs, then on the buttocks and trunk, which becomes generalized within a few hours with mergers of individual petechiae into large hemorrhages and even into extensive blue-purple spots with areas of necrosis.
The brighter the rash, the more intense the meningococcemia. Hemorrhages affect the mucous membranes and parenchyma of internal organs. To avoid diagnostic errors, the presence of hemorrhagic rashes against the background of the corresponding General disorders of the body should be interpreted as meningococcal sepsis. An erroneous diagnosis of hemorrhagic diathesis of a different etiology is incomparably more dangerous than an overdiagnosis of meningococcal sepsis.
Progressive meningococcal infection is characterized by a pronounced meningeal syndrome, as well as psychomotor agitation of the patient. Patients with an uncomplicated form of meningitis can be hospitalized by ambulance, with a complicated form require emergency hospitalization by an ambulance team with urgent medical measures, some of which can be performed before its arrival. Emergency treatment of meningococcal infection,
Regardless of the severity of clinical manifestations, all patients with meningitis should be administered intramuscularly sodium levomycetin-succinate – 25 mg per 1 kg of weight intramuscularly or intravenously at home. Other treatment measures are carried out strictly differentiated in accordance with the form of meningococcal infection.
If the course of meningitis is uncomplicated, you can limit yourself to intramuscular administration of 60 mg of prednisone and 2 ml of 1% furosemide solution. With hyperthermia, convulsions, psychomotor agitation, the dose of furosemide (lasix) should be increased 2-4 times and prednisone-1.5-2 times, intramuscularly enter a lytic mixture consisting of: 1.0 ml of 2% promedol solution, 2.0 ml of 5% analgin solution, 1.0 ml of 1% diphenhydramine solution, and 2.0-4.0 ml of 0.5% seduxen solution intravenously or intramuscularly. Toxic shock requires transporting the patient to the hospital under the cover of intravenous drip-feed poliglyukina (reopoliglyukina) with the addition of corticosteroids at doses in shock I degree -prednisolone 2.5 mg per 1 kg of mass, or dexason 0.2-0.3 mg per 1 kg of mass, or hydrocortisone 10-20 mg per 1 kg of mass; when the shock of II degree – prednisolone 10-15 mg per 1 kg of weight, or dexasone 0.5-1.0 mg per 1 kg of mass, or hydrocortisone 30-40 mg per 1 kg of weight. Patients with grade III shock are given a jet infusion of plasma substitutes, including reopoliglyukin (polyglucin) up to 400-500 ml and 5% albumin solution up to 200.0 ml.
If there is no effect, enter 5 ml (200 mg) of dopamine per 200 ml of 10% glucose solution. Dopamine is administered dropwise until blood pressure stabilizes at 100 mm Hg. Excitement and convulsions in shock can be stopped by intravenous administration of 2.0-4.0 ml of 0.5% seduxen solution or 20 ml of 20% sodium oxybutyrate solution. Transportation to the hospital is carried out by the medical team of the SMP with all the necessary emergency medical measures carried out on the way according to the indications.