Standard for assisting with pulmonary edema
- Remove the 12-14-channel ECG, ask for advice if the ECG is not normal
* The ECG should be removed within 5 minutes of arrival at the call.
- Remove the ECG repeatedly if the pain continues and the first ECG was normal
* Note the change in the ST segment. reduction of ST - ischemia, ST rise - possible myocardial infarction
- Symmetry of pulse on both forearms
- Monitoring of oxygen saturation with blood (pulse oximetry)
- Participation of auxiliary respiratory muscles, BH, detection of noise in auscultation of the lungs
HELP WITH HEART PATHOLOGY
- Peace, semi-sitting position of the patient
- With pains in the heart - give chew 250 mg of acetylsalicylic acid (ASA)
* if there is no allergy to ASA
* if a patient with asthma suffers ASA
OXYGENOTHERAPY WITH (POSITIVE PRESSURE AT THE END OF EXPOSURE) PEEP
- Start to give oxygen through the PEEP valve, if
* there are signs of heart failure, and
* BH more than 20 per minute or
* Significant participation of ancillary respiratory musculature
- Before starting the procedure, find out that the patient does not suffer from asthma or COPD.
- Nitrospray, if the blood pressure is above 100 mm and the heart rate is more than 50 per minute
- Introduction of fractional morphine (2-4 mg) IV or Oxicon (3-5) mg IV
- the introduction of the above doses can be repeated after 2-3 minutes.
- the action of the medication is sufficient if the intensity of pain is reduced to 0-3 points by VASHB.
- For example, metoprolol is divided into 2 mg IV slowly.
* with a sinus rhythm, the heart rate should be more than 70 per minute, with atrial fibrillation (AF) - more than 90 per minute.
- Find out from the asthmatist the tolerability of β-blockers (whether there are seizures when taking these drugs)
- The action of the medication is sufficient, if the heart rate with sinus rhythm is 60 per minute, and with AF, it is about 90.
- It is indicated if the pain is not stopped after nitrosprae or if the ECG shows obvious signs of ischemia.
- Introduction using a syringe pump according to the algorithm or after consulting a physician (see 60.51)
- Contraindication - stenosis of the aortic valve, relative contraindication - infarction of the right ventricle.
- Control of blood pressure every 5 minutes
* The blood pressure should be not less than 100/60 mm.
- After consulting a doctor, you can enter 2.5-5 mg diazepam IV for a sedation.
* May help reduce blood pressure and depression of consciousness or breathing
HELP WITH DISORDERS OF CIRCULATION
- Catheterization of a vein with an adapter in the form of a tee.
- Infusion of Ringer's solution
* If the systolic blood pressure is less than 90 mm. and heart rate more than 60 per minute and there are no signs of pulmonary edema, enter 300 ml of Ringer's solution in 10 minutes.
- Request for advice on further action
- Characteristic pain in the chest, the ECG shows a decrease in ST or a change in the T wave. There is no rise in the ST segment.
- Enoxaparin (Clexane) 0.6 mg / kg IV.
- The blood pressure is raised, the pulse is increased, the extremities are warm to the touch.
- The introduction of a β-blocker (eg, Metoprolol) is divided into 2 mg in 2-3 minutes to a total dose of 10 mg.
- If blood pressure remains high, nitroglycerin infusion is added.
- The blood pressure does not need to be reduced by more than 30% and it should not fall below 100/60 mm.
- Low blood pressure (less than 90/60 mm), pulse quickening or normal, limbs cold
- Enter the Ringer injections at the rate of 10 ml / kg
- Start Dopamine infusion if there is no result from the administration of Ringer's
- The blood pressure is low or normal, heart rate is less than 45 per minute, the temperature of the limbs is normal or reduced.
- Atropine 0.1 mg / 10 kg of weight in / in.
* Administration can be repeated up to a total dose of 3 mg
- Think whether there is a need for an electrocardiostimulation
- Pulse on the radial artery is not palpable, heart rate is more than 150 per minute
- Electrical cardioversion (see 50.40) is performed after consultation with a physician
Normal or elevated blood pressure
- Rhythm is correct, heart rate is more than 150 per minute
- Enter Adenosine according to the algorithm for paroxysmal supraventricular tachycardia (see 60.20)
- Normal or elevated blood pressure, dyspnea, normal or swollen cervical veins, cold extremities
- Helps with both pulmonary edema (see 30.52).
- Low blood pressure, frequent pulse, cold, moist skin. This condition is often complicated by pulmonary edema.
- Start an infusion of dopamine or epinephrine (see 60.31 and 60.23).
- Think about the possibility of giving oxygen through the PEEP valve.
Request for consultation
- Have a doctor of the NSR or a doctor on duty at a polyclinic or hospital in your region according to instructions
- To determine the tactics of assistance
- The medical level team should be able to recognize by ECG signs of ischemia, heart attack and life-threatening rhythm disturbances.
* The tactics of providing assistance are specified in case of detection of an ischemia or myocardial infarction on the ECG
- At the slightest doubt when interpreting the ECG and always before you start TLT, you should get a doctor's consultation.
- The patient can not be hospitalized, if all, the conditions listed below are taken into account.
- There is a stable angina, an attack of pain does not differ from those that occurred earlier.
- The attack is stopped by no more than three doses of nitrosprey. No pain at the moment.
- Indicators of vital organs are normal.
- ECG does not reveal signs of ischemia.
- The patient is informed how to act in case of resumption of pain.
Transportation and place of hospitalization
- The basic principle: the patient should be taken to the hospital of the final treatment site if possible.
- The place of hospitalization is determined by regional standards.
- If the medical level team can not arrive on time in a timely manner, the basic level team begins transportation on its own as soon as possible.
- Without the waiting time for the team of the medical level, the standard time of call is not more than ten minutes.
- Always, if the patient has a change in the ECG, indicating a myocardial infarction
- If pain persists and there are disturbances in the function of life support
30.56 Balloon angioplasty 704
- Consider the possibility of balloon angioplasty if
* in your region this is done
* the patient has contraindications to trobolysis
- If you are taking the patient to balloon angioplasty, give the patient ASA and enter 30 mg of kleksana IV.
* In addition, you can inject a patient with RhoPro and / or Plavix, if this is agreed in your area.
* The ECG changes that indicate myocardial infarction should be ascertained by the doctor
More than 3 hours after the onset of pain
- Consider the possibility of balloon angioplasty
- Thrombolysis is not performed if the doctor has not decided otherwise
Less than 3 hours from the onset of pain
- Consider the possibility of balloon angioplasty, if this intervention can be done
* sooner than an hour later, and thrombolysis - later
* less than 90 minutes after arrival to the patient
- Consider the possibility of balloon angioplasty, if thrombolysis is not effective
* the patient remains in pain
* on the ECG, the ST rise did not decrease by more than 50%
* in the presence of cardiogenic shock
YOUR = visual analog pain scale
PEEP = positive end-expiratory pressure
ASA = acetylsalicylic acid
Heart rate = heart rate
Blood pressure = blood pressure
BH = respiratory rate