Diseases of the respiratory system, emergency conditions, first aid. Emergency care for children with conditions associated with damage to the respiratory system. External causes of bronchial asthma

Without the supply of oxygen to the blood, a person cannot live. Any respiratory failure is dangerous symptom indicating a life-threatening condition. Emergency measures for respiratory distress can save a person's life, so you need to know the principles of first aid for acute respiratory failure.

Healthy lungs - normal breathing

Causes of respiratory disorders

The free flow of air into the lungs is an unconditioned reflex - a person breathes without thinking. Like the beating of the heart, rhythmic breathing is one of the most important functions that ensure the vital activity of the body (on average, about 15-20 respiratory episodes inhale-exhale per minute). Deterioration or cessation of gas exchange may occur against the background of the following factors:

• mechanical obstruction in the throat (food, sunken tongue);
• water ingress (drowning);
• trauma in the neck or head;
• tumor in the lungs or thyroid gland;
• brain cancer affecting the respiratory center;
• poisoning (carbon monoxide, neurotoxic organic poisons);
• severe brain infections;
• coma with a pronounced violation of metabolic processes.

Most often, respiratory failure is manifested by various variants of disorders, which can suggest the presence of a life-threatening condition. It is important to start providing assistance in time to prevent the complete cessation of respiratory function.

Degrees of respiratory disorders

There are 3 degrees of acute respiratory failure:

1. Tachypnea (against the background of a feeling of lack of air, the number of respiratory movements increases to 30 per minute, blood pressure rises and anxiety appears with anxiety);
2. Cyanosis with tachypnea and tachycardia (severe lack of oxygen leads to bluish discoloration of the skin, respiratory rate increases to 40 per minute, heart rate accelerates sharply, fear and panic arise);
3. Coma with lack of respiration and pulse (gonal state).

It is optimal to provide assistance when the respiratory failure is limited to tachypnea. Significantly worse at 2-3 degrees, when rapidly growing problems lead to a complete cessation of vital functions.

Respiratory failure - first aid

Any variant of frequent breathing in a person at rest should be a reason for a careful assessment of the situation - the suspicion of a life-threatening condition that has arisen requires an immediate call to an ambulance. Prior to the arrival of the resuscitation or emergency medical team, the following steps must be performed:

• ensuring free airway patency (free your mouth from foreign objects, turn your head to the side to prevent tongue retraction, give the body a stable lateral position);
• create an influx of fresh air, which is especially important in stuffy office spaces;
• free the upper body of a person from tight clothing (remove the tie, unfasten the buttons).

A stable lateral position will prevent dangerous complications before the arrival of emergency help

Real and effective help can only be provided by a doctor who arrived on an emergency call. The only life-saving option for 2-3 degrees of respiratory failure is tracheal intubation with forced air supply through the tube directly into the lungs. In parallel, the doctor will carry out all other measures to restore vital functions that have arisen against the background of

A brief review of the main clinical symptoms.

Bronchitis is an inflammation of the bronchial mucosa that occurs as a result of infection or the action of allergens. According to the course of the disease, acute and chronic are distinguished. Acute bronchitis is usually preceded by disease of the upper respiratory tract.

At the beginning of the disease, the patient's state of health worsens, the body temperature rises, hoarseness, pain and soreness in the throat and behind the sternum appear, then a dry, painful cough. After a few days, expectoration becomes easier, sputum is excreted in large quantities.

With untimely treatment and insufficient care, acute bronchitis can turn into chronic, complicated by pneumonia, rheumatism, otitis, acute nephritis.

Treatment and care. The patient is prescribed bed rest and treatment with antibiotics or sulfa drugs.

The room is often ventilated, with sweating - they change clothes regularly. To dilute sputum and facilitate coughing, the patient is given decoctions of coltsfoot, plantain, marshmallow root, licorice, hot milk with soda or mineral water. Alkaline inhalations, warming compresses at night, rubbing with camphor oil followed by wrapping, mustard plasters and jars are useful. The patient's food should be high-calorie, easily digestible, non-spicy.

Focal pneumonia (bronchopneumonia) is characterized by inflammation of the lungs with damage to the pulmonary vesicles (alveoli) and surrounding tissues, covering a small area of ​​the lung. The causative agents are various microbes and viruses. Respiratory vesicles of the lungs with focal pneumonia are filled with liquid mucopurulent contents. More often it develops as a complication of other diseases such as influenza, bronchitis, less often as a primary disease.

The disease begins with a cold. Cough gradually increases, and after 1-2 weeks after the onset of the disease appears quite easily

Respiratory diseases

The main signs of respiratory diseases include cough, sputum production, hemoptysis, pain, shortness of breath, pulmonary bleeding.

Cough is a reflex protective act, consisting of involuntary forced expiratory movements, due to irritation mainly of the mucous membrane of the respiratory tract.

Cough is distinguished: 1) by duration - paroxysmal, periodic, continuous, short; 2) in terms of timbre - barking, hoarse, silent. 3) depending on sputum - wet (with sputum), dry (without sputum).

Sputum is a discharge from the mucous membranes of the respiratory tract that accompanies coughing and is thrown out (mucous, serous, purulent, bloody, mixed.)

Hemoptysis is the discharge of blood from the respiratory tract in the form of streaks with sputum or individual spitting of blood.

Pulmonary bleeding - the release of blood from the respiratory tract in large quantities.

Shortness of breath - a disorder in the frequency, rhythm and depth of breathing, accompanied by a feeling of lack of air. Shortness of breath is an adaptive reaction of the body with increased physical stress or painful lesions of the body.

Choking is a pronounced shortness of breath, accompanied by a lack of oxygen in the body and the accumulation carbon dioxide.

Asthma is suffocation that occurs in attacks (bronchial, cardiac.)

Pneumonia is an acute or chronic disease characterized by inflammation of the parenchyma and (or) interstitial lung tissue. Most acute pneumonias are parenchymal and are divided into croupous (lobar) and focal (lobular).

Etiology, pathogenesis: bacteria affect the lung tissue (pneumo-, staphylo- and streptococci, sometimes E. coli), viruses, mycoplasmas, fungi, physical and chemical factors, allergic reactions. The causative agent penetrates through the bronchogenic, hematogenous and lymphogenous routes.

Symptoms and course - depend on the pathogen, the nature and phase of the course, complications.

Croupous pneumonia usually begins acutely: chills, temperature up to 39-40C, pain when breathing on the affected side, "rusty" or purulent viscous sputum with an admixture of blood appear. The patient's condition is severe, the skin of the face is hyperemic or cyanotic. Breathing is rapid, shallow, the chest lags behind in the act of breathing on the side of the affected lung.

Focal pneumonia, or bronchopneumonia, occurs as a complication of acute or chronic inflammation of the upper respiratory tract and bronchi in patients with congestive lungs, severe, debilitating diseases in the postoperative period. The disease begins with chills, the temperature rises to 38-38.5 C, cough appears, dry or with mucopurulent sputum, weakness, shortness of breath.

Chronic pneumonia is characterized by cough with sputum for many months, years, shortness of breath at the beginning during physical exertion, then at rest.

Complication - exudative pleurisy, lung abscess, spontaneous pneumothorax, nephritis, hepatitis, pericarditis, endocarditis, meningitis.

Treatment: stationary, bed rest is indicated, a mechanically chemically sparing diet with salt restriction. Prescribe antibiotics (penicillin, ampicillin, gentamicin, kefzol, etc.), sulfonamides (biseptol, sulfadimezin, sulfalene, etc.), broncho- and mucolytics (eufillin, bromhexine, theofedrin), antipyretics (analgin, aspirin), vitamins, if necessary, cardiovascular drugs, humidified oxygen.

Bronchial asthma is a disease of an infectious-allergic nature. Bronchial asthma is manifested by spasm of the bronchi, swelling of their mucous membrane, accumulation of viscous sputum in them. All this leads to respiratory disorders of varying severity. During the course of the disease, exacerbations are periodically noted, in which a person has asthma attacks.

Signs:

The patient feels tightness in the chest, he develops a dry, painful, obsessive cough.

The patient's breathing is difficult, the exhalation is lengthened

When breathing, dry whistling and buzzing rales are heard

The skin of the face becomes cyanotic, moist

pulse quickens

The patient during an attack sits down, rests on the bed with his hands or gets up, resting his hands on the table. This position makes breathing easier. since additional respiratory muscles of the shoulder girdle and neck are included in the work.

Giving help:

1. Reassure the patient, free him from tight clothing. It is necessary to ensure the supply of fresh air.

2. Give 1 tablet of diphenhydramine, 1 tablet of aminophylline, 1 tablet of no-shpy.

3. The patient should inhale salbutamol, or Asthmopent, or Alupent, or Berotek from a pocket inhaler, making no more than 3 breaths of one of the listed drugs with an interval of 15 minutes.

4. Take a hot foot bath.

5. Give the patient a large amount of liquid to thin the sputum and better discharge it: alkaline drink (Borjomi, soda drink), decoction or infusion of expectorant herbs (marshmallow root, thermopsis herb). The volume of liquid should be at least 1-1.5 liters. Solutions should be given warm.

The first sign of the end of the attack is the beginning of sputum discharge and a decrease in the sensation of suffocation.

Hemoptysis and pulmonary hemorrhage. Hemoptysis - the release of blood from the respiratory tract with sputum in the form of streaks or individual spitting, should inspire concern, since one cannot be sure that it will not turn into life-threatening pulmonary bleeding - the release of blood from the respiratory tract in large quantities. To provide medical care, it is necessary to distinguish pulmonary bleeding from gastric. When bleeding from the lungs, blood appears during coughing, it is scarlet, frothy, alkaline. Gastric bleeding appears after previous nausea and is accompanied by vomiting, the blood is mixed with food, has a darkish tint and an acid reaction. With pulmonary bleeding, the patient should be given emergency care. He is given a sitting position with an inclination forward, physical and emotional anxiety is eliminated, an ice pack is applied to his chest. Then, agents that increase blood coagulation are administered: 10% calcium chloride solution - 10 ml intravenously, 1% vikasol solution - 1-2 ml intramuscularly, 5% aminocaproic acid solution - up to 100 ml intravenously drip, single-group blood is transfused - 10-100 ml. Food and drink are given cold, swallowing pieces of ice is recommended.

Care of patients with respiratory diseases. Proper care for respiratory diseases significantly affects the outcome of the disease and prevents complications. It is necessary to pay special attention to the seriously ill, the elderly and children, who are most likely to have complications. In patients with severe pneumonia, lung abscess during an attack of bronchial asthma, acute cardiovascular insufficiency may develop, in these cases it is especially necessary to monitor the respiratory rate. If shortness of breath occurs, the patient must be lifted, freed from tight clothing, and fresh air must be provided. With a dry cough that irritates the respiratory tract, patients are given warm milk with baking soda (1/4 teaspoon per glass or half with mineral water), jars and mustard plasters bring them considerable relief. With a strong separation of sputum, the patient must use a spittoon, he must be taught the rules of disinfestation, it is necessary to help find a condition in which sputum is most completely and freely discharged. If the patient is feverish, the body temperature is regularly measured and recorded, during chills they are warmed with heating pads, give plenty of warm drink. If you sweat heavily, change your underwear frequently. Patients with bronchial asthma are explained the rules for using an individual inhaler.

The body temperature of a healthy person is relatively constant. The human body temperature ranges from 36.4-36.7 0 C with possible daily fluctuations of 0.1-0.6 0 C. In the rectum, vagina, oral cavity, the temperature is 0.4 0 C higher than in in the armpit, in newborns in the inguinal fold it reaches 37.2 0 C. Thermometry - body temperature measurement - is carried out with a medical mercury thermometer. Its scale is designed for a temperature range from 34 to 42 0 C with a price of one division of 0.1 0 C. Body temperature is usually measured in the armpit (in children, sometimes in the inguinal fold), rectum, and vagina. Before measuring body temperature, the axillary area is wiped dry and the thermometer is tightly clamped in it for 7-10 minutes. Thermometry is carried out twice a day: in the morning and in the evening. If necessary, this is done every 2-3 hours. Keep thermometers in a special glass with a disinfectant solution.

Measures of influence on blood circulation.

Action	Performing a procedure
The compress is a medical multilayer bandage. Cold compress	Cold compresses take away heat at the site of application, cause vasoconstriction, which reduces blood supply, reduces acute inflammation. Shown on the first day after injuries of soft tissues, ligaments, periosteum, with local inflammation, nosebleeds.	consists of a soft cloth folded into several layers, soaked in cold water and slightly wrung out. They use two compresses - one is applied to a sore spot, the other is prepared by immersing in cold water. The compress is changed after 2-3 minutes.
Lotion	Lotions are prescribed for bruises and acute inflammatory diseases of the skin and mucous membranes. Performing the procedure: a piece of cloth, folded in several layers, is moistened with an infusion of medicinal herbs.	One of the cold compress options. The lotion is applied for a few minutes, and then it is changed. The duration of the procedure is up to 40 minutes.
hot compress	Under its influence, vasodilation occurs, which promotes blood flow and leads to resorption, relieving muscle spasms. Assign to reduce headaches with migraine, pain in muscles and joints. Do not use in acute inflammatory and suppurative diseases, especially in the abdominal cavity.	Immerse the fabric folded in several layers in hot water (60-70 0 C) and wring out. Place the wrung out tissue on the affected area. Cover the fabric with oilcloth, and cotton wool on top. You can use a heating pad or woolen cloth instead of cotton. When cooling, change the compress.
Warm compress	Delays heat transfer and evaporation at the application site. Between the skin and the superimposed on a non-moist tissue, water vapor accumulates, heated to body temperature. A warm compress produces a uniform and long-term expansion of blood vessels, increasing blood flow and thereby reducing venous stasis, inflammation and swelling of tissues, as well as pain. It is prescribed for inflammatory diseases of the larynx, joints, pleura and seals after injections, sprains, bruises.	Soak a piece of soft cloth, folded several times, in water at room temperature, wring it out slightly and apply it to the affected area. Cover this layer with oilcloth or wax paper of such a size that it completely covers the wetted fabric. Put another layer of cotton on the oilcloth larger area. Fix all 3 layers with a few turns of the bandage. If the bandage was applied correctly, then after removing it, the fabric remains moist and warm.
Medicinal compresses	They are used in the same way as a warming compress, only the prescribed drug is used instead of water - alcohol, Vishnevsky ointment, etc.
ice pack	Cold reduces pain, tissue swelling, bleeding from small vessels.	Prepare ice in the refrigerator or bring it from outside. Break the ice into small pieces and place them in a rubber bubble, spreading them evenly across the bottom. After filling with ice, the bubble must be flat, otherwise it does not fit snugly against the body. Place a folded towel over the affected area and place an ice pack on top. The cold should be kept for no more than 20 minutes, then removed and repeated after 10 minutes. In total, cold is applied for 2 hours.
mustard plasters	Used to improve blood circulation in the area of ​​application and for deep heating.	Immerse the mustard plaster in a bowl of warm water to soak. Place a layer of fabric, gauze on the area where mustard plasters are applied, and lay mustard plasters on top of it. Place a towel over them and cover the patient. Keep mustard plasters for 15 minutes. If there is an effect, then in the area where mustard plasters are applied, the skin should turn red. At the beginning of the procedure, a burning sensation appears, which is replaced by a feeling of warmth. If redness appears that extends beyond the mustard plaster, finish the procedure in order to avoid burns. After removing mustard plasters, wipe the skin with a dry soft cloth, then lubricate with sunflower oil and dress the patient warmly. With increased skin sensitivity to mustard in adults and children, the composition can be used instead of mustard plasters: 1 tbsp. false dry mustard, 1 tbsp. spoon of honey, 1 tbsp. spoon of sunflower oil, 1 tbsp. a spoonful of vodka. Move everything, make a cake from the resulting mass and wrap it in a cloth. Fix the composition in the right place and you can keep it for several hours (preferably all night). With this, there is no burning sensation, warming up occurs slowly, but for a long time.
Medical banks	Banks are used for the same purpose as mustard plasters. Banks can not be placed on the spine, sternum, heart, mammary glands.	Make the patient comfortable. Prepare: 10 cans, a metal stick with cotton wool wound around its end, alcohol, matches, petroleum jelly. Dip a cotton swab in alcohol and light the cotton wool. Quickly insert burning cotton into the jar, without touching the edges, for 1-2 seconds. The jar itself should not get hot. When the cotton wool inside the jar burns, the air is displaced, a vacuum is created, and due to this, the jar sticks to the skin. Having placed all the cans evenly on the surface of the back, cover the patient with a light blanket. Banks should be kept for 10-15 minutes. If there is an effect, then bruises appear in the area of ​​​​the installed cans. If the jars do not fall off on their own, then press the skin next to the jar to allow air to flow. After the procedure, warmly wrap the person.
	Fill 2/3 of the volume of the heater with water heated to 60 0 C. Expel the air from the heater by squeezing it at the neck and screw the plug. The heating pad should be flat after filling. Check the heating pad for leaks by turning it upside down. Wrap in a towel. Attach to the right place for 20 m. After 5 minutes, take an interest in the patient's feelings.

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The disease is based on bronchospasm, mucus hypersecretion and swelling of the bronchial mucosa. Asthmatic status is an extremely severe manifestation of the disease and is characterized by severe bronchial obstruction, acid-base disorders, pulmonary insufficiency, accompanied by arterial hypoxemia, and far

In advanced cases - hypercapnia, hypertension of the pulmonary circulation with right ventricular failure, resistance to a- and d-adrenergic receptor stimulants to the usual doses of corticosteroid hormonal drugs. With inadequate therapy, status asthmaticus is characterized by a severe progressive course and can be fatal.
Factors contributing to the onset and progression of bronchial asthma are allergens of various origins (drugs, nutritional factors, cosmetics, plant pollen, etc.), exacerbation, focal infection, inadequate treatment with antibacterial and bronchodilator drugs, physical and emotional overvoltage. Refractory to treatment and the development of asthmatic status are facilitated by an exacerbation of the infectious process, the abolition or misuse of glucocorticoid-1-1st hormonal drugs, long-term use of α- and 3-adrenergic receptor stimulants, neglect of information about the presence of polyvalent allergies.
The main manifestation of the disease is asthma attacks lasting from several minutes to several hours, and in especially severe cases - up to several days.
Clinical picture
An asthma attack occurs due to bronchospasm, hyper-secretion of mucus and swelling of the bronchial mucosa. Asthma syndrome can occur suddenly, but in some cases, choking occurs gradually. During the period of precursors, rhinorrhea, paroxysmal cough, difficulty in expectoration of sputum, skin itching in the chest area, drowsiness, lethargy, yawning are observed; during the height of the attack - shortness of breath, suffocation with difficulty exhaling, painful cough with difficult to separate viscous sputum, a feeling of compression of the chest. There are shortness of breath of the expiratory type, bradypnea with a respiratory rate of 8-14 per 1 min; exhalation is difficult, long, convulsive, inhalation is short; noisy breathing, accompanied by wheezing, heard at a distance, the disappearance of the pause between exhalation and inhalation. Characterized by pallor, cyanosis or a grayish tint of the skin, puffiness of the face, perspiration, a pained expression; the consciousness is clear, but the patient has difficulty answering questions because of shortness of breath. There is a forced, usually sitting, position of the patient with an inclination of the body-1. EMERGENCY CONDITIONS IN DISEASES OF THE RESPIRATORY organ
Emergency conditions in respiratory diseases are associated with the development of acute pulmonary insufficiency.
According to the etiology and pathogenesis, acute pulmonary insufficiency is divided mainly into three groups:
1) acute pulmonary insufficiency due to obstruction of the distal sections of the bronchial tree (status asthma, oronchiolitis, etc.);
2) acute pulmonary insufficiency due to a sharp decrease in the respiratory surface of the lungs (acute pneumonia, pulmonary embolism, spontaneous pneumothorax, lung atelectasis, exudative pleurisy);
3) respiratory disorders due to obstruction of the upper respiratory tract, trachea and large bronchi (diphtheria of the larynx, Quincke's edema, burns of the upper respiratory tract, foreign bodies of the trachea and bronchi).
When carrying out intensive therapy, the identification and elimination of the cause of acute pulmonary insufficiency, the fight against hypoxemia, and the elimination of cardiovascular disorders are of particular importance.
/./. Emergency conditions associated with obstruction of the distal bronchial tree
Bronchial asthma, status asthmaticus
The disease is based on bronchospasm, mucus hypersecretion and swelling of the bronchial mucosa. Asthmatic status is an extremely severe manifestation of the disease and is characterized by severe bronchial obstruction, acid-base disorders, pulmonary insufficiency, accompanied by arterial hypoxemia, and far

in advanced cases - hypercapnia, hypertension of the pulmonary circulation with right ventricular failure, resistance to a- and d-adrenergic receptor stimulators to the usual doses of corticosteroid hormonal drugs. With inadequate therapy, status asthmaticus is characterized by a severe progressive course and can be fatal.
Factors contributing to the onset and progression of bronchial asthma are allergens of various origins (drugs, nutritional factors, cosmetics, plant pollen, etc.), exacerbation, focal infection, inadequate treatment with antibacterial and bronchodilator drugs, physical and emotional overvoltage. Refractory to treatment and the development of asthmatic status are facilitated by an exacerbation of the infectious process, the abolition or misuse of glucocorticoid-1-1st hormonal drugs, long-term use of α- and 3-adrenergic receptor stimulants, neglect of information about the presence of polyvalent allergies.
The main manifestation of the disease is asthma attacks lasting from several minutes to several hours, and in especially severe cases - up to several days.
Clinical picture
An asthma attack occurs due to bronchospasm, hyper-secretion of mucus and swelling of the bronchial mucosa. Asthma syndrome can occur suddenly, but in some cases, choking occurs gradually. During the period of precursors, rhinorrhea, paroxysmal cough, difficulty in expectoration of sputum, skin itching in the chest area, drowsiness, lethargy, yawning are observed; during the height of the attack - shortness of breath, suffocation with difficulty exhaling, painful cough with difficult to separate viscous sputum, a feeling of compression of the chest. There are shortness of breath of the expiratory type, bradypnea with a respiratory rate of 8-14 per 1 min; exhalation is difficult, long, convulsive, inhalation is short; noisy breathing, accompanied by wheezing, heard at a distance, the disappearance of the pause between exhalation and inhalation. Characterized by pallor, cyanosis or a grayish tint of the skin, puffiness of the face, perspiration, a pained expression; the consciousness is clear, but the patient has difficulty answering questions because of shortness of breath. There is a forced, usually sitting, position of the patient with an inclination of the torso

Vishcha forward, fixing the shoulder girdle, focusing on the upper limbs; chest in the position of maximum inspiration; accessory muscles are involved in the act of breathing. Disturbs cough with viscous, thick, difficult to separate mucus or mucopurulent sputum; towards the end of the attack, the cough intensifies, the amount of sputum increases, it becomes less viscous. Tachycardia, weak filling of the pulse, a decrease in size or the disappearance of absolute cardiac dullness, a weakening of heart sounds, a muffled i tone over the apex of the heart, and an accent of the II tone over the pulmonary artery are determined.
With a prolonged attack, signs of right ventricular failure appear - swelling of the cervical veins, enlargement and tenderness of the liver. Above the lungs, a tympanic or boxed shade of percussion sound is determined, the lower borders of the lungs are lowered, the mobility of the lower pulmonary edge is limited; auscultatory - weakening of respiratory sounds, a variety of dry rales, mainly on exhalation.
If it is impossible to stop the attack, an asthmatic condition develops, in which 3 stages are distinguished: sub-compensation, decompensation and coma.
In the stage of subcompensation, the patient's condition is severe: severe expiratory dyspnea (bradypnea), cyanosis, tachycardia, increased blood pressure. Clinically and radiographically determined acute swelling of the lungs, absolute cardiac dullness is absent. Consciousness is preserved. There are clinical signs of dehydration, an increase in hematocrit up to 50%.
Severe pulmonary insufficiency, disturbances in the acid-base state and blood gas composition are noted: pH 7.20-7.30, base deficiency is 4-5 mmol / l, carbon dioxide tension in arterial or capillary blood (Pa^o) is above 50 mm Hg . st, oxygen tension (Rad) - below 70 mm Hg. st, resistance is observed
to bronchodilators.
In the stage of decompensation, breathing is frequent and shallow. Consciousness is confused. The pulse is frequent, weak filling. Mucus does not come out. Breathing noises weaken, wheezing may not be heard (a picture of the so-called "silent lung"). Significant dehydration, a decrease in circulating blood volume, an increase in hematocrit up to 50-60% are noted. Severe pulmonary insufficiency develops, mixed decompensated acidosis, severe hypoxemia (pH

7.25-7.10; P^co above 60 mm Hg. Art., deficiency of bases more than 5 mmol / l, Ryd below 60 mm Hg. Art.).
The coma stage is characterized by loss of consciousness, decreased muscle tone, and the absence of reflexes. Severe cyanosis develops. Respiration is frequent and shallow or of the Cheyne-Stokes type. The pulse is frequent, weak filling, various rhythm disturbances are noted. Auscultatory - a picture of "silent lung". Hypoxemia and acid-base disorders reach extreme severity: pH 7.10 and below, Pa (^ above 70 mm Hg, Rad below 50 mm Hg. On the electrocardiogram, signs of overload of the right heart, as well as various arrhythmia and conduction disturbances that usually occur at the stage of decompensated asthmatic status: polytopic extrasystoles, paroxysms of atrial fibrillation, migration of the pacemaker, blockade of the right bundle branch block, impaired atrioventricular conduction.
X-ray at the time of the attack, there is a picture of acute emphysema of the lungs: increased transparency of the lung fields, low standing of the diaphragm and its low mobility. The lung pattern is reinforced, the shadows of the roots are enlarged. Radiological signs of acute and subacute cor pulmonale are determined. During the period of asthmatic status, especially its decompensated stage, diffuse shading is found in the lower parts of the lungs due to hypoventilation, as well as atelectasis of the segments and lobes of the lungs.
In the peripheral blood, eosinophilia, lymphocytosis are determined; with an infectious-allergic form of bronchial asthma, there may be neutrophilic leukocytosis and an increase in ESR.
There is an increase in a- and g-globulins, histamine content. acetylcholine, the phenomenon of blood hypercoagulation; a significant increase in the blood of immunoglobulin E.
Eosinophils, Charcot-Leiden crystals, Kurschmann spirals are found in sputum.
A study of the function of external respiration during an attack reveals signs of acute pulmonary distention: a decrease in lung capacity (VC), a significant increase in residual volume (00) and functional residual lung capacity (FRC); there is a decrease in maximum ventilation (MVL), forced expiratory volume in the first second (Tiffno test) and expiratory power.

sky, immunopathological, neuropsychic, dyshormonal (glucocorticoid insufficiency of the adrenal cortex). So, with an infection-dependent variant of the course of bronchial asthma, antibiotic therapy should be used in the complex of therapeutic measures (including urgent ones); in the atopic variant, termination of contact with the allergen and the use of antihistamines, inhalation of intal are mandatory; the predominance of the immunopathological component and glucocorticoid insufficiency of the adrenal cortex dictate the need for the use of corticosteroid hormonal drugs; in the neuropsychic variant of the course of bronchial asthma, it is advisable to use sedatives (Table 1).
With a mild attack of bronchial asthma, the introduction of bronchodilator drugs by inhalation or orally is indicated. It is advisable to use sympathomimetic agents with a predominant 3- and ^-stimulating effect:
isoprenaline, isadrin, novodrin, euspiran, isuprel, alyudrin are inhaled using pocket inhalers in the form of a 0.5-1% solution or a stationary device; dose per inhalation 0.1-0.2 ml;
alupent (asthmopent, orciprenaline) is used in the form of inhalations of 0.75 mg;
ventolin (salbutamol) is used in tablets of 0.002 g per dose, inhalations (1 ml of a 0.5% solution when using a stationary inhaler or 0.1 mg-1-2 breaths when using a pocket inhaler);
terbutaline (brikanil) is effective in tablets of 0.0025 g or inhalations of 0.25 mg using a metered-dose aerosol inhaler; berotek is prescribed in inhalations of 0.2 mg; ipradol is used in tablets of 0.5 mg or inhalation of 0.2 mg. .
Inhalations of sympathomimetic drugs can be used no more than 3-4 times a day; their uncontrolled use can lead to the development of therapy-resistant seizures and even death of the patient. This is due to the fact that status asthmaticus is characterized by a deep blockade of bronchial beta-adrenergic receptors, and the sympathetic drugs used further aggravate the blockade of these receptors. In addition, massive uncontrolled use of sympathomimetics can cause ventricular fibrillation. This complication seems to be associated with

significant increase in mortality in patients with asthma, noted in recent years.
Drugs that thin sputum and promote its release are used:
expectorants of reflex action (decoction of marshmallow root, infusion of thermopsis herb, ipecac root), as well as direct action on the mucous membrane of the respiratory tract (ammonia-anise drops, potassium iodide, ammonium chloride, etc.);
mucolytic agents - acetylcysteine ​​in inhalations, 3 ml of a 20% solution, mucosolvin 0.4-2 ml per inhalation, bromhexine (bisolvone) inside 1100.008-0.016 g and in inhalations;
proteolytic enzymes (trypsin, chymotrypsin 5-10 mg in 2 ml of isotonic sodium chloride solution, chymopsin 25-30 mg in 5 ml of isotonic sodium chloride solution or distilled water in inhalations).
Proteolytic enzymes and mucolytics should be used with caution due to the possibility of increasing bronchospasm.

Plentiful hot drinking, circular jars, mustard plasters, mustard foot baths, steam inhalation, chest massage are shown.
If these measures are insufficient, epinephrine (0.1% -0.3-0.5 ml) or ephedrine (5% -1 ml) should be injected subcutaneously.
In cases where there are contraindications to the administration of these drugs (arterial hypertension, atherosclerotic coronary sclerosis, thyrotoxicosis, diabetes mellitus, pregnancy), drugs of the theophylline group (myolytics)-eufillin (aminophylline, syntophyllin, diaphyllin) can be used orally, in candles, intravenously by stream or drip in the form of a 2.4 "/o solution-10-20 ml, inhalation (2.4% solution-I-2 ml). Myolytics, along with the elimination of bronchospasm, also cause dilation of the vessels of the small circle of blood addressed 5-:i; aminofillin is the drug of choice for an attack of mixed asthma (cardiac and bronchial).
Sometimes the introduction of anticholinergics is quite effective (0.1 "about a solution of atropine-1 ml, 0.2% solution of platinfillin - 1 ml subcutaneously).

1 aol i c a
The scheme of treatment of patients with bronchitis
flax asthma in the exacerbation phase

depending on clinical
atogenetic variants
currents

(G. B. Fedoseev,

/
Clickico-pathogenetic

options

predominance of glucose

the predominance of immunopathological
predominance of violation
coid insufficiency

atonic form

logical component
nervous system
adrenal cortex
infectious-allergic form

1. Treatment of acute or exacerbation of a chronic inflammatory process in the respiratory organs (antibacterial therapy, sanitation of the bronchi, surgical sanitation of "foci of infection)
1. Termination of contact with the allergen 2. Nonspecific hyposensitization 3. Intal

1 Corticosteroid-nys preparations 2. Cytostatic agents (b-mercaptopurine, imurac, delagpl)
1. Hippo-suggestive therapy 2. Electrosleep 3. Novocaine blockades
1. Corticosteroid drugs?. Etimizol 3. Sanitation of foci of infection, antibacterial
2. Desensitizing therapy 3. Restoration of bronchial patency (bronchodilators, expectorants and mucolytics)
4. Antihistamines b. Bronchodilators 6. Increasing non-specific resistance

3. Bronchodilators
4. Sedative mean "d-stya 5. Bronchodilators 6. Increasing the leisurely personal resistance of the organism
4. Bronchodilators 5. Increase in nonspecific resistance-CT;I of the Organism
nose treatment, barotherapy, etc.)

5. Normalization of functional co-

standing nervous system

It is advisable to use combined preparations: theofedrine, anthastman, solutan, efatin, etc., since the maximum bronchodilatory effect is achieved by combining several drugs with different mechanisms of action.
Moderate and severe attacks of bronchial asthma should first of all try to stop using the list of drugs listed above.
If there is no effect, intravenous drip administration of a complex solution containing various l-z the mechanism of action of bronchodilators, cardiac drugs, for example: 2.4% solution of euphyllin-10-i5 ml; 5% solution of ephedrine-1 ml; 0.1% solution of adrenaline-0.5-1 ml; 0.06% solution of corglycone or 0.05% solution
"lucose OR from ^toni-
thief strophanthin-0.5 ml; 5% solution - - - rlf\f\o
chesky solution of sodium chloride-200-300 ml.
nokat
In cases where the administration of sympathomimetics is contraindicated, or an attack of bronchial asthma is combined with angina pectoris, a mixture of nitrous oxide (50%) and oxygen (50%) can be used at an injection rate of 8-12 liters per minute or anesthesia with halothane, chloral hydrate (0.5 -2.0 r) in the form of an enema. When anesthesia with nitrous oxide or halothane, the use of adrenaline is contraindicated.
Antihistamines (diphenhydramine, pipolfen, supra-stii, tavegil, etc.) are indicated for the atonic form of bronchial asthma; with an infectious-allergic form, their use is limited, since they cause thickening of sputum.
In cases of a combination of bronchial asthma with arterial hypertension, it is advisable to administer ganglionic blockers: pentamine, benzohexonium.
In the 1st stage of asthmatic status, oxygen therapy, the elimination of violations of the CBS, the fight against dehydration, the introduction of bronchodilators, cardiac glycosides, glucocorticoid hormonal drugs, and broad-spectrum antibiotics are carried out. Drugs are administered by infusion and inhalation routes.
In the All-Russian Research Institute of Pulmonology of the Ministry of Health of the USSR, the following complex solution is used for long-term infusion: isotonic sodium chloride solution - 1.5 l, reopoliglyukin - 400 ml, 5% sodium bicarbonate solution - 250 ml, 5% albumin solution - 250 ml, eufillin - 240-480 mg, 0.06% solution of corglicon or 0.05% solution of strophanthin -1 ml, hydrocortisone 200-300 mg or prednisolone 30-60 mg, 2.5% solution of pipolfen-1 ml, heparin- 5000 units The solution is administered intravenously drip for 3 hours. An effective remedy for

severe asthmatic status is the intravenous administration of prednisolone at a dose of up to 3 mg per 1 kg of body weight per day. The dose of the drug can be 1000 mg or more per day. It should be noted that some doctors often use glucocorticoids hesitantly and in small doses in order to stop asthmatic status.
The initial dose should be 90-120 mg prednisone equivalent, and subsequent doses - 60-90 mg every 4 hours. After improvement, the dose of hormones can be reduced fairly quickly (every 1-2 days by 30% of the last daily dose). At the same time, they switch from intravenous administration to oral administration of drugs. Too rapid reduction in the dose of glucocorticoids can provoke the development of a new asthmatic attack.
Usually, patients with status asthmaticus need rehydration. Diuretic drugs (preferably veroshpiron) are used only in the presence of right ventricular failure 11B and stage III.
It is advisable to combine infusion therapy with inhalation: aminofillin, hydrocortisone, alkaline solutions, antibiotics, antiseptics, proteolytic enzymes with good tolerance of the latter.
In connection with the overstrain of the respiratory muscles in the treatment of status asthmaticus, auxiliary artificial lung ventilation (ALVL) is performed - several sessions a day for 20-30 minutes.
The bronchial tree is sanitized through a nasotracheal catheter using heated physiological saline, 3% sodium bicarbonate solution, and mucolytic enzymes. To reduce bronchospasm, edema of the bronchial mucosa and eliminate the inflammatory process, antiseptics (furatsilin, furagin soluble), hydrocortisone (300-500 mg), aminofillin (240-480 mg), antibiotics are injected into the bronchial tree.
Percussion and vibration chest massage is performed. With the ineffectiveness of these measures (transition of asthmatic status in stages II and III), bronchological sanitation is indicated - sputum removal under conditions of anesthesia, muscle relaxation and mechanical ventilation (ALV). Treatment is carried out by a therapist (pulmonologist) together with a resuscitator.
The indication for washing the bronchial tree (la-oage) is the lack of effect from conventional treatments, persistent or increasing hypoxia and hypercapnia.

When carrying out lavage, a deep washing of the bronchi with solutions of sodium bicarbonate, furainlin is carried out, followed by aspiration of the washing water with an electric suction. During the procedure, up to 500-600 ml of solution is injected, during the aspiration of which mucous and purulent casts of sputum are removed. To prevent increased bronchospasm during lavage, you can use halothane inhalation. Before extubation, when spontaneous breathing is restored, 15 mg (0.5 ml of a 3% solution) of prednisolone with 2 ml of a 2.4% solution of aminophylline is injected into the trachea. After awakening, shortness of breath usually subsides and the patient's condition improves.
If the patient comes under supervision in P and II! stages of asthmatic status, all preparatory (before intubation and PVL) activities are reduced in time and limited to a minimum: correction of CBS, the introduction of cardiac drugs, glucocorticoid hormonal drugs (the dose of which increases to 120-200 mg or more, and up to 1000 mg per day), VIVL.

In MPP (military infirmary). In addition to physical examination, the following diagnostic measures are carried out: spirometry and pneumotachometry, ECG registration. examination of peripheral blood, sputum.
A complex of therapeutic measures: creating an environment of rest, providing a comfortable (usually sitting) position of the patient with support for hands; inhalation of bronchodilator sympathomimetic agents (euspiran, alupent, salbutamol, etc.); theofedrin or antastman inside; hot drink, hot bath for hands and feet; oxygen therapy with humidified oxygen.
If these measures are insufficient, subcutaneous injection of 0.1% adrenaline solution - 0.3-0.5-1 ml or 5% ephedrine solution - 1 ml, 0.1% atropine solution - 0.5-1 ml.
If there is no effect, intravenous administration of eufillin 2.4% solution-10 ml (slowly, .-.y ^: ie drip), can be combined with corglycon 0.06% - 1.0 ml or strofantin 0.05% -0.5 ml. 5 "/ () glucose solution or isotonic sodium chloride solution - 200-300 ml. Adrenaline 0.1% - 1 ml, ephedrine 5% -1 ml, hydrocortisone-100 mg or prednisone can also be added to the solution for infusion

;IOH - 30-60 mg. Intramuscular injection of diphenhydramine - 1% solution-1 ml.
Evacuation to the hospital in a sitting position in an ambulance, accompanied by a doctor or paramedic.
In medb and hospital. In the presence of status asthmaticus, treatment is carried out in the intensive care unit or intensive care unit, where patients should go directly, bypassing the emergency department.
Diagnostic measures: ECG registration, examination of peripheral blood, sputum, fluoroscopy, chest radiography, examination of blood serum proteins, acute phase reactions, circulating blood volume, hematocrit, CBS, blood gases. With the improvement of the patient's condition - spirography, pneumotachometry.
The whole complex of therapeutic measures is carried out, including infusion therapy with sufficient administration of liquid for rehydration, aminophylline, glucocorticoid hormonal preparations, corglycon (strophanthin). KOS is corrected, inhalation therapy with aminofillin, hydrocortisone, alkaline solutions, antibiotics, antiseptics, proteolytic enzymes is carried out. With an exacerbation of the inflammatory process in the lungs - the introduction of antibiotics intramuscularly, endobronchially. Sanitation of the bronchial tree is carried out with the introduction of drugs endobronchially. Obligatory oxygen therapy.
If signs of respiratory depression appear (decrease, rhythm disturbance), asphyxia, intravenous and intramuscular administration of cordiamine 4-5 ml, urgent intubation, transfer of the patient to controlled breathing. Treatment is carried out by a resuscitator and a therapist and is aimed at eliminating hypoxia, acidosis, restoring bronchial patency, fighting infection (infusion therapy, washing the bronchial tree, removing sputum, etc.) - all activities are carried out under artificial ventilation of the lungs.
Acute bronchiolitis (chilling of the lungs)
The disease is characterized by damage to the smallest bronchi - bronchioles, associated with prolonged exposure to cold air. The inflammatory process in the first phase of the disease occurs in the upper respiratory tract (pharyngitis, laryngitis). In the future, the bronchi are affected, down to the smallest and smallest branches.

Clinical picture
In the phase of the peak of the disease, weakness, chest pain, cyanosis, shortness of breath, more often of an inspiratory nature, appear, body temperature rises to 39-40 ° C. During percussion, a tympanic shade of sound is determined, and the mobility of the lower edge of both lungs is limited. On auscultation, dry whistling rales and small bubbling wet rales are heard over all lung fields. There are tachycardia, expansion of the boundaries of the heart, mainly to the right. The electrocardiogram is characterized by acute overload of the right atrium and right ventricle. When examining the function of external respiration, a decrease in bronchial patency is noted. With the progression of the process, signs of oxygen starvation of the brain join: excitement, clouding of consciousness. In severe cases, there may be fatal outcome with symptoms of acute cor pulmonale.

Among the therapeutic measures, warming the patient is of paramount importance (hyperthermal wraps, mustard plasters, hot drinks, hyperthermic baths). Assign strict bed rest, oxygen inhalation. Bronchodilators are used: eufillin 2.4% -10 ml IV slowly, atropine 0.1% to 1 ml subcutaneously. To stop right ventricular failure, 0.5 ml of a 0.05% solution of strophanthin or 1 ml of a 0.06% solution of corglicon per 20 ml of a 40% solution of glucose is injected slowly intravenously. In case of vascular insufficiency, 1-2 ml of a 25% solution of cordiamine, 1-2 ml of a 10% solution of sulfocamphocaine, 1 ml of a 20% solution of caffeine, and 0.1-0.5 ml of a 0.1% solution of adrenaline or 0.5 -1.0 ml of 5% ephedrine solution. Antibiotics are used to treat infectious complications.
The volume of medical measures in units and military medical institutions
First aid consists in warming, providing fresh air, urgent evacuation of the patient to the WFP.
In MPP (military infirmary). The doctor introduces a s / c solution of cordiamine and caffeine, an i / v solution of aminophylline, continues measures to warm the patient.

Evacuation to the hospital by ambulance in a sitting or lying position, accompanied by a doctor or paramedic.
In medb and hospital. Diagnostic measures: ECG registration, chest x-ray, complete blood count; with the improvement of the patient's condition, spirography, pneumotachometry, blood gases are examined. The regime is strictly bed. Oxygen therapy. The whole complex of measures is carried out in order to eliminate the phenomena of bronchiolospasm, cardiovascular insufficiency. Antibiotics, glucocorticoids are prescribed.
1.2. Emergency conditions associated with a sharp decrease in the respiratory surface of the lungs
This form of respiratory failure occurs in many diseases and complications: severe pneumonia, exudative pleurisy, thromboembolism of the pulmonary artery, its branches or a large number of its small branches, spontaneous pneumothorax, lung atelectasis.
The most formidable condition requiring emergency care is thromboembolism of the pulmonary artery trunk, its branches and small branches. The cause of this complication is phlebothrombosis or thrombophlebitis of the deep veins of the extremities, pelvic veins and veins of the skull, as well as cardiovascular diseases, in which blood clots form in the right heart. The sudden exclusion of a significant lung surface from the breathing process determines the severity of the course and the prognosis of this complication. The clinical picture, tactics of emergency therapy for pulmonary embolism are given in the 1st part of the manual.
The commonality of the pathophysiological mechanisms of emergency conditions in this group causes in some cases a similar clinical picture.
All patients with this condition are characterized by severe shortness of breath, cyanosis, chest pain. Therefore, the issues of differential diagnosis of diseases of this group are of paramount importance for the correct provision of emergency care (Table 2).
Acute pneumonia
Acute pneumonia is a lung disease of an infectious nature, caused by various pathogens, accompanied by damage to the bronchi and respiratory department.

Patients with severe and extremely severe forms of croupous, confluent focal and influenza pneumonia need urgent measures and intensive care.
Clinical picture
Croupous pneumonia is manifested by chills (sometimes terrific), severe headache, rapid fever, cough - dry or with scanty mucous sputum (viscous, glassy), often with streaks of blood or a characteristic rusty color, intense pain in the chest, aggravated by deep breathing and cough, sometimes radiating to the abdomen or shoulder girdle, shortness of breath.
Objective signs: flushing of the cheeks, often one-sided, according to the side of the lesion, cyanosis of the lips, herpes on the lips, wings of the nose; tachycardia, lowering blood pressure; frequent shallow breathing, sometimes delirium, agitation.
During the period of resolution of pneumonia and a critical drop in temperature, collapse phenomena can be observed: sharp cyanosis (gray), coldness of the extremities, frequent and small pulse, drop in blood pressure, collapse of the veins, increased shortness of breath, intermittent breathing, blackout of consciousness.
Physical examination data depend on the prevalence, localization and phase of the process. In the first days of the disease over the affected lobe, the percussion sound has a tympanic tone, breathing is weakened. In the future, dullness increases, bronchial breathing appears, crepitus, pleural friction noise can be heard.
In the stage of resolution, intense dullness is replaced by a pulmonary sound, breathing becomes hard, moist rales are heard.
X-ray signs: at the beginning of the disease, a weak, non-intense darkening; by the third day it becomes homogeneous, intense, occupies a share, a segment or several segments.
With late or ineffective treatment, inflammatory changes can capture several lobes. Involvement in the process of the pleura is characteristic, an expanded shadow of the lung root on the side of the lesion is noted.
Laboratory data: leukocytosis with neutrophilic shift to the left to young forms, eosinopenia. lymphopenia, increased ESR, C-reactive protein,

fibrinogen, sialic acids, lactate dehydrogenase activity (especially the third fraction), changes in blood protein fractions due to an increase in a (- and ag-globulins.
Despite the fact that in recent years croupous pneumonia has lost some of its "classic" signs, nevertheless, the criteria for its diagnosis should be considered: acute onset of the disease with high fever and severe intoxication, cough with "rusty" sputum and chest pain, the presence of a shortening of the pulmonary sound, altered breathing and crepitus or wet rales, homogeneous intense darkening with a reaction of the lung root and pericostal pleura, detection of pneumococcus in bacteriological examination of sputum, neutrophilic leukocytosis with a shift to the left, eosinopenia, increased ESR, positive acute phase reactions. In all forms of acute pneumonia, respiratory function is disturbed more often by a mixed type with a decrease in VC and indicators characterizing bronchial patency.
Focal pneumonias are severe in those cases, especially if they are caused by pathogenic hemolytic staphylococcus aureus. There is a high fever (sometimes remitting, with chills and sweats), chest pain, cough with purulent bloody sputum. Characterized by severe intoxication, earthy skin tone and mucous membranes, cyanosis, shortness of breath. The severity of intoxication and the severity of the condition of patients sometimes do not correspond to the meager data on percussion and auscultation of the lungs. The X-ray picture is changeable. Numerous focal shadings are found, less often confluent shadows, capturing a segment or several segments; characterized by early abscess formation. In the blood, a high neutrophilic leukocytosis, a pronounced increase in ESR are determined.
Influenza pneumonia occurs when the flu is severe. Its distinguishing features are severe shortness of breath, dry cough with scanty bloody sputum, pain behind the sternum. Patients show symptoms characteristic of influenza (hyperemia and puffiness of the face, injection of conjunctival and scleral vessels, hyperemia of the soft palate, rhinitis, tracheitis), as well as signs of intoxication, vascular and autonomic disorders (headache, body aches, adynamia, bradycardia, inclination to collapse). With pronounced vascular disorders, hemorrhagic pulmonary edema or hemorrhagic confluent pneumonia sometimes occurs, which is characterized by an extremely severe course and the rapid development of liver failure. The condition worsens sharply:

barking shortness of breath, severe cyanosis, bloody foamy sputum appears, hypoxemic coma develops.
Physical data in influenza pneumonia are varied and variable. A characteristic radiological sign is the lesion of the interstitial tissue in the form of an enhanced and taut pattern. In peripheral blood, unlike other pneumonias, the leukopenia often comes to light.
Electrocardiographic changes in pneumonia are not specific. With extensive damage to the lung tissue against the background of tachycardia, signs of hypertrophy and overload of the right heart, violations of myocardial repolarization (changes in the S-T segment, negative T in // I III standard leads) are recorded.
The study of the acid-base state and gas composition of the blood reveals respiratory alkalosis or metabolic acidosis, hypoxemia of varying severity.
The main criteria for isolating extremely severe forms of pneumonia: pronounced intoxication, accompanied by complications from the central nervous system (acute psychosis, soporous conditions with respiratory disorders, meningitis, etc.); acute severe and recurrent vascular and cardiovascular insufficiency (severe collapse, cardiac asthma, pre-edema and pulmonary edema), pronounced pulmonary insufficiency with acid-base disturbances and hypoxemia (with total pneumonia, widespread draining processes against the background of bronchial asthma, obstructive bronchitis, emphysema, etc.); massive and multiple destructive processes in staphylococcal pneumonia with severe purulent intoxication.
The main criteria for the isolation of severe forms of pneumonia: severe intoxication, accompanied by hyperthermia, weakness and other manifestations; acute vascular insufficiency (orthostatic collapses), an increase in chronic circulatory insufficiency; the expressed pulmonary insufficiency (pr^ widespread pneumonia); destructive processes in the lungs with staphylococcal pneumonia; infectious-allergic complications from various organs and systems (infectious-allergic myocarditis, para- and metapneumonic pleurisy with large effusion, mediastinal displacement, etc.).

Complex of urgent measures
Detoxification therapy: polyglucin (rheopoliglyukin), hemodez, isotonic sodium chloride solution, 5% glucose solution intravenously in the amount of 300-400 ml "per infusion; in case of pneumonia occurring with encephalopathy, it is advisable to use agents that reduce intracranial pressure (mannitol 15% solution - 200 ml intravenously drip or 20% glucose solution - 50 ml intravenous drip - up to 200 ml per day); in acute staphylococcal pneumonia, accompanied by purulent intoxication and proteolysis, it is necessary to use protease inhibitors: counter-. (trasylol) 25,000-50,000 IU intravenously drip in 300-500 ml of isotonic sodium chloride solution; antipyretics (acetylsalicylic acid 0.5-1.0 g orally 3-4 times a day, analgin 50% solution - 1 ml inside -muscular, amidopyrine).
Treatment of acute pulmonary heart includes elimination of hypoxemia, correction of the acid-base state, restoration of the drainage-evacuation function of the bronchi.
Elimination of hypoxemia is achieved by inhalation of humidified (heated) oxygen using masks, oropharyngeal and nasal catheters. Pure oxygen or 40-60% mixture of it with air is given; sessions are held for 20-30 minutes every 1-2 hours. If it is possible to determine the partial pressure of 02 in arterial or capillary blood (Pa ^),. then it is advisable to give oxygen in such quantity and at such intervals that Pa ^ is 80-100 mm Hg. Art. It is advisable to short-term increase Rad up to 200 mm Hg. Art. in order to eliminate tissue hypoxia. Where possible, hyperbaric oxygen therapy is performed.
To correct the acid-base state, intravenous administration of sodium bicarbonate (50-100 ml of a 3-5% solution or 50-100 ml of an 8.4% solution), trisamine (THAM) in the form of a 3.66% solution is used. The amount of solution is determined by the formula
K \u003d B X E,
where K is the amount of a 3.66% solution of trisamine, ml; B-deficiency of bases, mmol/l; E - body weight of the patient, kg.
The introduction of bicarbonate and trisamine is carried out under the control of KOS indicators.

Restoration of the drainage-evacuation function of the bronchi is achieved by the use of drugs that eliminate bronchospasm (myolytics, sympatholytics, anticholinergics, etc.), the use of enzyme preparations (trypsin, chymotrypsin, ribonuclease, etc.) in the form of inhalations and endobronchial sanitation, as well as the appointment expectorants - (infusion of thermopsis herb, decoction of marshmallow root, 3% solution of potassium iodide).
Bronchial sanitation is indicated in cases where the severity of the condition is due to bronchial obstruction, as well as with concomitant purulent bronchitis, abscess formation. Bronchological sanitation is carried out in specialized pulmonological departments and includes postural drainage, therapeutic bronchoscopy with aspiration of the contents, bronchial lavage and intrabronchial administration of antibiotics, proteolytic and mucolytic drugs, antiseptics, bronchodilators (see restoration of bronchial drainage function in status asthmaticus).
Respiratory depression, which usually occurs when the central nervous system is affected (hypoxic coma, cerebral edema), requires the immediate administration of respiratory analeptics (1% lobelin solution 0.3-0.5 ml intravenously or intramuscularly, 0.5-1 ml cytiton intramuscularly or intravenously) and artificial ventilation of the lungs by the mouth-to-mouth method or using a manual device. In the future, tracheal intubation and long-term artificial lung ventilation may be required.
In acute vascular insufficiency, analeptics should be used (camphor - 20% oil solution 2 ml subcutaneously; corazol-10% solution 1 ml intravenously slowly or intramuscularly; cordiamine 25% 2 ml intravenously slowly or intramuscularly; caffeine-20% solution-1-2 ml subcutaneously), vasoconstrictors (mezaton 0.3-0.5 ml of 1% solution subcutaneously or in 40 ml of 5-40% glucose solution intravenously by stream or 1 ml of 1% solution in 250 ml of 5% glucose solution intravenously drip; norepinephrine 1 ml of 0.2% solution in 200 ml of 5% glucose solution intravenously at a rate of 40-60 drops per minute).
Acute heart failure (left ventricular and right ventricular) is stopped by intravenous administration of cardiac glycosides (strophanthin 0.05% solution - 0.5 ml or corglicon 0.06% solution - 1 ml intravenously). It is advisable to use diuretics (lasix, furosemide 20-40-60 mg-2-4-6 ml of a 1% solution).

With significant stagnation and increased pressure in the pulmonary artery system and normal or elevated blood pressure, the use of ganglion blockers is indicated (pentamin 5% solution -1 ml intramuscularly; benzohexonium 2.5% solution -1 ml subcutaneously, intramuscularly or intravenously slowly).
Glucocorticoid hormonal preparations are prescribed for acute vascular insufficiency, hemorrhagic edema "of the lungs, a picture of acute cor pulmonale. They can be used in large doses (250 mg of hydrocortisone, 90-120 mg or more of prednisolone 1-2 times a day intravenously) for a short period of time (2 -3 days) It should be remembered that these drugs in massive pneumonia and in high doses contribute to the occurrence of destructive processes in the lungs and they should be canceled immediately after liquidation of life-threatening events.
Antibacterial therapy of patients with severe and extremely severe forms of acute pneumonia should be carried out with csr- "oro onset of the disease (before the isolation and identification of the pathogen). In these cases, one should focus on the epidemiological history and features of the clinical picture of the disease.
With croupous pneumonia, benzylpenicillin is effective (5,000,000 units or more per day with a six-time injection).
If acute staphylococcal pneumonia is suspected, it is advisable to combine large doses of benzylpenicillin (10,000,000-20,000,000 IU intramuscularly and intravenously in combination with semi-synthetic drugs - metncillin 4-8 g per day intramuscularly; oxacillin 2-6 g per day intramuscularly, orally; carbenicillin 4 -8 g per day intramuscularly, intravenously). In cases of extremely severe course, the daily dose of benzylpenicillin can be increased to 20,000,000-40,000,000 units, and methicillin, oxacillin up to 10-12 g. Cephalosporins (ceporin, keflin, kef-zol), which are used parenterally (intramuscularly, intravenously) at a dose of 2-8 g per day.
It is advisable to treat influenza viral and viral-bacterial pneumonia with a combination of semi-synthetic penicillins with broad-spectrum drugs. In cases of extremely severe forms of influenza pneumonia, the following set of therapeutic measures recommended by the Leningrad Research Institute of Influenza can be used:

gamma globulin-3 ml intramuscularly, and in its absence, antistaphylococcal hyperimmune plasma: intravenous drip hemodez (polyglucin or isotonic sodium chloride solution) 200 ml with the addition of serum polyglobulin (3-6 ml), corglicon (0.06% -1 ml ) or strophanthin (0.05% -1 ml), cocarboxylase (100 mg), hydrocortisone (250 mg), olemorphoclin (250,000 IU) or morphocycline (150,000 IU), lasix (20 mg), ascorbic acid (5% - 5 -10 ml), mezaton (1% -1 ml); tseporin 1 g 4 times a day intramuscularly (or methicillin, oxacillin); cordiamine 2 ml 3-4 times a day; expectorant mixture 8 times a day; oxygen (moistened).
Ampicillin (2-6-10 g per day intramuscularly, intravenously, orally), carbencillin (4-8 g or more per day intramuscularly, intravenously), ampiox (2-4 g per day intravenously, intramuscularly) have a wide spectrum of action , which can be used for staphylococcal and viral-bacterial infections.
If an anaerobic infection is suspected, high doses of lincomycin (up to 2 g per day intramuscularly, intravenously, orally) or chloramphenicol (2-4 g orally, intramuscularly) should be prescribed.
In all cases of extremely severe pneumonia of unknown etiology, preference should be given to semi-synthetic penicillins and cephalosporins.
In case of intolerance to antibiotics, it is advisable to parenteral administration of sulfanilamide preparations (5-10% solution of norsulfazole 10-20 ml intravenously 2-3 times a day, 10-20% solution of etazol-5-10 ml intravenously 2-3 times a day), the use of nitrofuran derivatives (furagin, furazolin, furadonin inside 0.1-0.15 g 4 times a day).
The volume of medical measures in units and military medical institutions
In MPP (military infirmary). A set of diagnostic measures: examination of peripheral blood, sputum bacterioscopy, registration of EC.G, spirometry and pneumotachometry.
Therapeutic measures: oxygen therapy; the introduction of cardiovascular analeptics (corazol, cordiamine, camphor); with vascular collapse - mezaton, norepinephrine; antibacterial therapy (introduction of large doses of benzylpenicillin, semi-synthetic penicillins, cephalosporins); .reception

expectorants; in the presence of concomitant broncho-spastic syndrome, bronchodilators (theofedrin, antastman inside; alupent, isadrin in inhalations, aminofillin inside and intravenously).
In extremely severe forms of pneumonia, intravenous administration of detoxifying fluids with the addition of cardiovascular agents, antibiotics, glucocorticoid hormonal drugs.
Evacuation to the hospital (omedb) is carried out by special transport, lying on a stretcher with the upper half of the body elevated (in case of collapse - in a horizontal position), accompanied by a doctor who is ready to assist on the way.
In medb and hospital. Patients with extremely severe acute pneumonia require intensive care in intensive care units. In severe pneumonia, patients should be in the intensive care units of the therapeutic and infectious diseases departments.
Diagnostic measures: examination of peripheral blood, acute phase reactions, sputum bacterioscopy, chest X-ray, registration of EK.G, examination of the acid-base state and blood gases; with the improvement of the condition, spirography is performed.
The whole range of therapeutic measures is carried out: disintoxication therapy, massive antibacterial therapy, correction of the acid-base state, if necessary, bronchological sanitation, and in case of acute pulmonary heart and hypoxemic coma, artificial ventilation of the lungs.
Spontaneous pneumothorax
Spontaneous pneumothorax - accumulation of air in the pleural cavity, not associated with traumatic injury to the chest or therapeutic effects - develops in diseases that occur with destruction of the lung tissue (tuberculosis, bronchiectasis, abscess, pulmonary gangrene, tumor diseases, echinococcal cyst, bullous emphysema, air lung cyst). Sometimes pneumothorax occurs in young men (20-40 years old) without visible pathology of the lungs - the so-called idiopathic spontaneous pneumothorax. Its causes are ruptures of pleural adhesions during inspiration, tears of the pleura of a healthy lung, ruptures of single subpleurally located emphysematous vesicles, Provoking factors contributing to the formation

spontaneous pneumothorax, are sudden movements or during coughing, forced
voltage
respiratory breathing.
Clinical picture
Reflex and pain effects associated with irritation of the pleural sheets, as well as respiratory and circulatory disorders due to the collapse of the lung tissue and mediastinal displacement determine the clinical picture. The severity of clinical manifestations depends on the amount of air accumulated in the pleural cavity and the speed of its entry. The presence of hemopneumothorax aggravates the picture of the disease due to internal bleeding.
There are closed, open and valvular pneumothorax. Subjective sensations: sudden pain in the chest, radiating to the neck, arm, sometimes to the epigastric region, accompanied by a strong painful dry cough; the severity of symptoms varies from moderate pain with deep inspiration and shortness of breath during exercise to severe pain and suffocation.
Objective signs: restless behavior of the patient, forced position, most often sitting, pallor and cyanosis of the skin, swelling of the cervical veins, shortness of breath of the inspiratory type (tachypnea), signs of collapse (fainting, cold sweat, frequent thready pulse, drop in blood pressure and etc.); expansion of the chest on the side of the lesion, there is also smoothness of the intercostal spaces, a decrease in respiratory excursions; weakening or absence of voice trembling, tympanic or box percussion sound on the side of the lesion, disappearance of splenic or hepatic dullness, displacement of the liver or spleen downward; weakening of breathing, sometimes a symptom of amphora-metal breathing; with the formation of pleural exudate or hemopneumothorax - symptoms of effusion in the lower sections with a horizontal upper border, "splash noise", a symptom of a "falling drop".
X-ray signs: a pronounced homogeneous zone of enlightenment, devoid of a bronchovascular pattern; collapsed lung (with complete pneumothorax, a semicircular or polycyclic shadow of the lung is adjacent to the mediastinum); shift of the mediastinum towards a healthy lung; flattening and low location of the dome of the diaphragm on the side of the affected

nia; horizontal fluid level (with pneumothorax complication by pleurisy or hemopneumothorax).
Imaging and angiopulmonography help differentiate spontaneous pneumothorax from a large bulla or giant cyst. With spontaneous pneumothorax, the main trunks of the pulmonary artery can be traced against the background of the shadow of a collapsed lung, and with cystic changes, the vascular branches are determined in the wall of the cyst against the background of a gas bubble.
An electrocardiographic study reveals signs of pulmonary hypertension and overload of the right heart.
Laboratory and others special methods diagnostics: a study of peripheral blood usually does not reveal pathology; with hemopneumothorax, a decrease in hemoglobin, a decrease in the number of red blood cells.
Diagnostic puncture of the pleura reveals free gas. Manometric determination of intrapleural pressure allows you to establish the form of pneumothorax: with closed pneumothorax, negative pressure, with open pneumothorax, equal to atmospheric pressure, and with valve - positive.
The study of pleural exudate makes it possible to differentiate idiopathic spontaneous pneumothorax from pathological, which is a complication of other lung diseases (serous nature of the fluid in tuberculosis, purulent or putrefactive in an abscess, tumor cells in the punctate with carcinomatosis, etc.). The study of the function of external respiration reveals a decrease in ventilation parameters, hypoxemia of varying severity.
Bronchoscopy is performed in cases where it is necessary to differentiate spontaneous pneumothorax from obstructive atelectasis. Thoracoscopy is indicated for chronic pneumothorax in order to identify pleural adhesions, fistulous passages, emphysematous bullae.
Complex of urgent measures
Rest, semi-sitting position of the patient. The introduction of narcotic drugs, analgesics: morphine 1% -1 ml subcutaneously; omnopon 2% -1 ml subcutaneously, promedol 2% -1 ml subcutaneously; analgin 50% -1 ml intramuscularly or amidopyrine 4% - 2.5-5 ml intramuscularly; talamonal 1-2 ml in 20 ml of 40% glucose solution, administered slowly intravenously.
Antitussives: codeine 0.015-0.03 g or dionine 0.015-0.03 g.

The introduction of analeptics, vasoconstrictors, cardiac glycosides: Cordiamin 1-2 ml subcutaneously, intramuscularly, intravenously; corazole 10%-1 ml subcutaneously, intravenously, caffeine 20%-2 ml subcutaneously; mezaton 1% -1 ml subcutaneously or in a vein 0.3-0.5 ml of 1% solution in 40 ml of 5-40% glucose solution; - strophanthin 0.05% -0.5 ml or corglicon 0.06% - 1 ml intravenous drip. Oxygen therapy.
The listed complex of urgent measures is usually sufficient for closed pneumothorax with a slight collapse of the lung and the latter's tendency to rapidly expand.
Severe respiratory and circulatory disorders, especially with tension valvular pneumothorax (increasing dyspnea, cyanosis, swelling of the jugular veins, a sharp shift in the mediastinum) are an indication for pleural puncture and air aspiration.
Aspiration methods have a number of modifications: a) passive aspiration of air from the pleural cavity using a needle with a diameter of 1-1.5 mm, which is inserted into the II-III intercostal space along the midclavicular line or into the II intercostal space along the anterior axillary line (the needle is connected to a two-bottle a system filled with an antiseptic liquid and acting like a valve drainage);
b) aspiration using an apparatus for applying artificial pneumothorax; "
c) the most universal method is the drainage of the pleural cavity with constant aspiration of air through the drainage.
The volume of medical measures in units and military medical institutions
In MPP (military infirmary). Diagnostic measures: examination of the patient, examination of peripheral blood.
Therapeutic measures: creating a resting environment, giving the patient a semi-sitting position, oxygen therapy, eliminating the pain syndrome (administration of drugs, analgesics), the use of antitussives (dionine, codeine). In the presence of collapse, the introduction of analeptics, cardiovascular drugs. In acute pulmonary and heart failure (severe shortness of breath, cyanosis, swelling of the cervical veins); pleural puncture with aspiration of air or transfer of a tense (valvular) pneumothorax into an open one is shown.

After carrying out these measures, evacuation to the hospital (omedb) is carried out by special transport, on a stretcher, preferably in a semi-sitting position, accompanied by a doctor.
In medb and hospital. Diagnostic measures: fluoroscopy, radiography, and, if necessary, chest tomography; examination of peripheral blood, ECG registration, determination of blood gases.
Treatment is carried out in the intensive care unit, intensive care unit or surgical department. Transportation is carried out directly to these departments, bypassing the emergency room.
Therapeutic measures: obligatory oxygen therapy; if necessary, repeated measures aimed at combating collapse, pain syndrome. In the case of a closed or partial pneumothorax, pleural puncture is not indicated (can only be performed for diagnostic purposes). The severe condition of the patient, the presence of acute cor pulmonale requires mandatory puncture of the pleura and removal of air from the pleural cavity (by active aspiration of air through drainage).
Lung atelectasis
Atelectasis is a condition of the lung tissue in which the alveoli lose their airiness and collapse. There are congenital and acquired lung atelectasis. Acquired atelectasis of the lungs are divided in turn into obstructive and compression.
Obstructive atelectasis occurs with complete obstruction of the bronchus, caused by a variety of reasons: bronchogenic cancer, inflammatory swelling of the walls, inspiration of foreign bodies, blood, mucus. In the blocked section of the lung, the air is absorbed, intra-alveolar pressure drops and the corresponding section of the lung is reduced in volume.
Compression atelectasis occurs when the lung is compressed by nearby organs. With total atelectasis, the mediastinum and trachea move towards the affected lung, and the diaphragm is pulled up. Blood sweats into the lumen of the alveoli, thereby creating prerequisites for the development of an inflammatory or suppurative process.
Clinical picture
With the acute development of atelectasis with the capture of large areas of the lung, symptoms of severe respiratory failure appear.

Sufficiency (sudden shortness of breath or choking, cyanosis, chest pain). The patient is covered with profuse sweat, there is a strong cough. The affected side of the chest lags behind when breathing, the amplitude of respiratory excursions decreases. The retraction of the chest area on the corresponding side is determined, the intercostal spaces are somewhat narrowed and retracted, and over the healthy lung they are smoothed. Percussion sound over the area of ​​atelectasis is shortened, vocal trembling is increased, the heart and mediastinum are displaced to the affected side. Above the affected area, respiratory sounds are sharply weakened or absent, bronchial breathing, unvoiced moist rales or crepitus are heard. The diagnosis is confirmed by x-ray examination, which reveals intense homogeneous darkening of the lung lobe with a decrease in its size, an increase in the level of standing of the diaphragm, and sometimes vicarious emphysema of unaffected areas of the lung. With compression atelectasis, a shadow of the formation is revealed, which puts pressure on the lung.
Prolonged collapse of the lung leads to the development connective tissue, induration of the lung, the development of bronchiectasis, sometimes abscess formation. Acute atelectasis of the lung must be differentiated from extensive pneumonia, pleurisy, pneumothorax, and progressive pulmonary thrombosis (see Table 2).
Complex of urgent measures
The main therapeutic measure for obstructive atelectasis is the restoration of the patency of the bronchial tract. To do this, use various bronchodilator drugs used to treat bronchial asthma. For this purpose, bronchoscopy is performed and foreign bodies are removed or aspirated blood or vomit, sputum and mucus are sucked off. The stimulation of the cough reflex also contributes to the removal of secretions from the respiratory tract. Improving the patency of the bronchial tree in many cases can be achieved by the appointment of breathing exercises or a periodic change in body position.
To accelerate the evacuation of a viscous secret from the bronchi, proteolytic enzymes are used (5-10 mg of trypsin or chymotrypsin in 2-5 ml of isotonic sodium chloride solution), sputum is aspirated 1-2 minutes after the drug is administered through a bronchoscope. Sometimes the spreading of the lung

There is a short-term increase in intrapulmonary pressure during inspiration during assisted ventilation. The procedure is performed using special respirators such as RO-5 or RO-6.
In all cases, hospital examination and treatment are indicated.
The volume of medical measures in units and military medical institutions
In MPP (military infirmary). Rest, semi-sitting position. Inhalation of oxygen. With severe pain subcutaneously 1-2 ml 1 "" about promedol or omnopon. Emergency evacuation to medb or hospital.
In medb and hospital. Diagnostic measures: fluoroscopy, radiography, and, if necessary, chest tomography; examination of peripheral blood, ECG recording, with improvement in condition, bronchoscopy, spirography are performed and blood gases are determined. The complex of therapeutic measures in full.
Exudative pleurisy
Pleurisy is an inflammatory process of the pleura of an infectious-allergic etiology. There are dry fibrinous and exudative pleurisy.
Exudative pleurisy of various etiologies in cases of large accumulation of fluid in the pleural cavity, when the lung is compressed and loses airiness, leads to the development of pulmonary insufficiency.
Clinical picture
The disease begins gradually or acutely high temperature, severe stabbing pains in the chest, excruciating dry cough. During the examination, the forced position of the patient on the sore side, shortness of breath, cyanosis, lagging of the chest during breathing on the side of the lesion are noted. Palpation of the chest is determined by the weakening of voice trembling on the affected side. Percussion over the corresponding half of the chest reveals dullness of percussion sound. The upper limit of bluntness goes along the oblique line of Damuazo.

The area occupied by the exudate is usually in the form of a triangle with the apex at the posterior axillary line. The boundaries of dullness almost do not shift with a change in body position. Between the spine and the ascending line of dullness, the Garland triangle with a tympanic sound is determined, and on the healthy side, the Rauchfus-Grokko triangle with dullness of the percussion sound. With a high standing of the fluid, a shift of the mediastinal organs to the healthy side is noted. According to percussion, one can approximately judge the amount of exudate: with dullness reaching the IV rib, the fluid content is about 1500 ml, up to the III rib - 2000 ml, up to the collarbone - 3000 ml. During auscultation in the zone of dullness, breathing is weakened, in the region of the Garland triangle, with a bronchial tinge. In the upper zone of dullness, a pleural friction rub can be heard, which usually appears at the beginning and during resorption of the exudate. X-ray reveals a dense homogeneous shadow with an oblique upper border and a shift of the mediastinum towards a healthy lung. Examination of the respiratory function reveals its violation according to the restrictive type of varying severity, the appearance of hypoxemia and violations of the CBS is possible. The differential diagnosis with rapidly increasing and significant effusion is carried out with lobar pneumonia, lung atelectasis and spontaneous pneumothorax (see Table 2).
Complex of urgent measures
With sharp, excruciating pain that prevents proper breathing, narcotic analgesics are administered subcutaneously or, less often, intravenously (1 ml of 1% morphine solution, 2% omnopon solution, or 2% promedol solution), usually in combination with antihistamines to prevent nausea and vomiting ( 1-2 ml of 1% diphenhydramine solution, 2% solution, suprastin thief or 2.5% pipolfen solution). In addition, the use of these drugs suppresses coughing. A pronounced antitussive effect is exerted by dionin (0.01 g each), glaucin (0.05 g each) 2-3 times a day.
With the development of cardiovascular insufficiency, camphor, cordiamin, strophanthin are used. Oxygen therapy is carried out.
Severe disorders of pulmonary ventilation and hemodynamics due to mediastinal displacement with massive exudates are a direct indication for urgent pleural
puncture dates.

Evacuation of the exudate should be carried out slowly (at least 30 minutes), in an amount not exceeding 500-1000 ml, because of the risk of developing shock with a sharp reverse displacement of the mediastinal organs and the occurrence of pulmonary edema.
Antibacterial therapy is carried out depending on the etiology of pleurisy. In all cases, anti-allergic, desensitizing agents should be used: sodium salicylate, acetylsalicylic acid or amidopyrine, calcium chloride.
Given the hyperergic nature of the inflammatory process, glucocorticoid hormonal preparations should be used, first hydrocortisone (125-250 mg intramuscularly twice a day), and then prednisolone (5-10 mg 4-6 times a day). Glucocorticoids must be combined with antibacterial agents.
The volume of medical measures in units and military medical institutions
In MPP (military infirmary). Rest, semi-sitting position of the patient, inhalation of oxygen. With severe pain, subcutaneously 1-2 ml of a 1% solution of promedol or omnopon. With a rapid increase in shortness of breath, cyanosis, puncture of the pleural cavity and evacuation of 500-700 ml of fluid. Evacuation to the omedb or hospital by ambulance, accompanied by a paramedic or doctor.
In medb and hospital. Diagnostic measures: fluoroscopy, radiography, chest tomography, peripheral blood examination, ECG registration. With the improvement of the condition, spirography is performed and blood gases are determined. Treatment is carried out in the intensive care unit. Therapeutic measures: oxygen therapy, measures aimed at combating collapse, pain syndrome. Puncture of the pleural cavity. Antibacterial therapy.
1.3. Respiratory disorders due to obstruction of the upper respiratory tract and large bronchi
With a sharp narrowing of the airways - larynx, trachea, bronchi - stenotic breathing develops, characterized by inspiratory shortness of breath (difficulty inhaling). The degree of respiratory disorders depends on the caliber of the affected airways, on the duration of the lumen closure

hey, bronchi. Acute respiratory disorders can occur due to significant swelling of the mucous membrane of the pharynx and larynx, which is noted with Quincke's edema, thermal or chemical burns, laryngeal diphtheria, and also when foreign bodies enter the respiratory tract. In case of violations caused by eliminated factors (spasm of the smooth muscles of the bronchi, swelling of the mucous membrane of the bronchi, foreign bodies), the patency of the airways can be restored after therapeutic measures. With persistent violations of bronchial patency, there is a violation of pulmonary ventilation in the corresponding zone of the lung with the development of atelectasis.
If a patient with obturation of the upper respiratory tract is threatened by asphyxia, then there is a need for a tracheostomy.
The tracheostomy technique consists of the following main elements. The patient is laid on his back with his head slightly thrown back. To do this, a small roller is placed under the shoulder blades. An incision is made along the midline of the neck from the thyroid cartilage almost to the jugular notch. The skin and subcutaneous tissue are dissected. The anterior jugular vein is retracted to the side. Then the superficial and middle fascia of the neck are dissected. The sternohyoid and sternothyroid muscles are pulled apart with hooks. The thyroid gland located in the fascial membrane is found. If it is necessary to perform an upper tracheostomy, the ligament connecting the thyroid gland with the cricoid cartilage is cut with a transverse incision, and the isthmus of the gland is carefully pulled down with a blunt hook. After a thorough stop of bleeding with a pointed scalpel, the second ring of the trachea is crossed, and then two more of its rings.
A tracheostomy tube is inserted into the wound of the trachea, expanding it with two sharp hooks or a special expander. Layers above and below the tube are sutured.
In conditions of respiratory failure, upper tracheostomy has some advantages. It can be performed more quickly because there are fewer blood vessels along the incision. With a lower tracheostomy, it is necessary to bandage the venous plexus and, in addition, due to the deep location of the trachea, the tracheostomy tube often falls out of its lumen.
Sometimes there is a need for an immediate tracheostomy. A cuffed tracheostomy tube can be used for this purpose. After dissection of soft tissues and retraction of the isthmus thyroid gland production

dissection of the tracheal rings. When a tracheostomy tube is inserted, the cuff is immediately inflated to prevent blood from entering the trachea from the wound. Tracheobronchial contents (blood, sputum) are aspirated through the tracheostomy.
The effectiveness of tracheostomy in patients with acute pulmonary insufficiency largely depends on the timeliness of its use.
Quincke's edema
Acute stenosis of the larynx and bronchospasm with acrocyanosis, barking cough and a small amount of dry rales in the lungs in some cases is due to angioedema. The cause of acute laryngeal edema and bronchospasm is, as a rule, the repeated entry of antigen into the airways of sensitized patients.
Clinical picture
The disease develops very quickly and sharply. Most often, against the background of urticarial rash, hyperemia of the skin and, in some cases, slight hypotension, edema of the skin, subcutaneous tissue, and mucous membranes develops without a clear delimitation from unchanged tissues. Edema spreads, as a rule, in the area of ​​the lips, cheeks, eyelids, scalp. The most dangerous is acute swelling of the tongue and larynx.
An allergic reaction sometimes proceeds so quickly that the medical staff finds the patient already in the stage of acute pulmonary insufficiency or even asphyxia.
In this condition, not only inhalation is difficult, but also exhalation. Air, passing through the sharply narrowed larynx, creates a noise resembling the sound of a saw - stridor breathing. The patient is extremely frightened and restless, rushing about. The skin of the face is cyanotic and hyperemic, the extremities are cold, the intercostal spaces, the supraclavicular spaces, the jugular fossa, and the epigastric region are retracted during inspiration. Neck veins swollen, tachycardia. Arterial pressure decreases. Stridor breath sounds are heard over the lungs. With a further increase in hypoxia, coma and convulsive syndrome develop.
The diagnosis is based on the presence of rashes on the skin, oral mucosa, allergies in the anamnesis of most patients.

new chest; if the patient's condition allows, then the state of the ventilation function of the lungs is determined. Medical measures are carried out in full.
Inspiration of foreign bodies
Acute stenosis of the upper respiratory tract can occur in some cases when foreign bodies enter. The severity of clinical manifestations depends on the size of the foreign body and the level of obturation. If a foreign body completely or largely closes the lumen of the larynx, asphyxia develops almost instantly and death occurs. In some cases, a foreign body, without obstructing the passage of air, causes acute inflammation with subsequent development of stenosis of the upper respiratory tract. An extremely serious complication is the inhalation of water into the respiratory tract during gastric lavage without prior tracheal intubation in patients with a coma.
Clinical picture
The main symptoms are an attack of suffocation, accompanied by stridor breathing, painful cough, hemoptysis. Physical examination reveals signs of lung atelectasis - dullness of percussion sound in the corresponding lobe of the lung, a sharp weakening of breathing, voice trembling.
An X-ray image is determined corresponding to the level of bronchial obstruction (intense homogeneous darkening of the lung lobe with a decrease in its size, an increase in the level of the diaphragm). The ventilation capacity is impaired, the volume and capacity of the lungs decrease, and bronchial patency decreases.
Complex of urgent measures
Immediate hospitalization of the patient to remove a foreign body in a hospital setting. When symptoms of asphyxia appear, a tracheostomy is performed (the tracheostomy technique is described above).
Endogenous pathological products (vomit, blood clots) that have entered the trachea and bronchi are removed by suction through a catheter inserted into the trachea through the nose, using special suction or a large syringe. To prevent inflammatory complications caused by in-
Complex of urgent measures
Urgent termination of contact with the allergen and hospitalization of the patient in the otorhinolaryngological department. Tracheostomy with the threat of asphyxia. Glucocorticoids: 2-3 ml of a 3% solution of prednisolone or 1-2 ml of a 0.4% solution of dexamethasone intravenously in saline.
With a decrease in blood pressure and signs of asphyxia, subcutaneous adrenaline 0.1% -1 ml, cardiac glycosides; use inhalation of adrenaline with ephedrine.
Antihistamines: 2-3 ml of 1% diphenhydramine solution; 2-3 ml of 2.5% pipolfen solution; 2-4 ml of a 5% solution of ascorbic acid, 10 ml of a 10% solution of calcium chloride intravenously.
Symptomatic therapy: 4-6 ml of a 1% solution of furosemide or 1-2 ml of a 5% solution of ethacrynic acid (uregit) in 10-20 ml of physiological sodium chloride solution intravenously; 30-60 g of mannitol in 200-400 ml of bidistilled water intravenously.
The volume of medical measures in parts. it military medical institutions.
At the scene of the incident (at home, at work), the patient should be freed from tight clothing, given sedatives, stop contact with the allergen (immediate withdrawal of the drug that caused the allergy, an ice pack at the site of an insect bite or drug antigen injection), provide free air access .
In MPP (military infirmary). Immediately injected subcutaneously 0.5-1.0 ml of a 0.1% solution of adrenaline, 2.0 ml of a 1% solution of diphenhydramine. Oxygen inhalations are given.
In the case of an injection of a drug or an insect bite that caused an allergy, epinephrine is injected at the injection site. 10 ml of a 10% calcium chloride solution should be slowly injected intravenously or calcium gluconate, 120-150 mg prednisolone. Transportation to the hospital in a lying or sitting position, accompanied by a doctor.
If necessary, a tracheostomy is performed on the MPP, vascular analeptics and cardiac glycosides are introduced. In medb and hospital. The cause of the allergic reaction is clarified (examination of duodenal contents for giardia, opisthorchiasis, feces for cysts of giardia), studies of peripheral blood, urine, ECT, fluoroscopy of the organ

infection and trauma of the larynx or trachea when foreign bodies get into them, antibiotic therapy is prescribed. In all cases, it is necessary to introduce agents into the lumen of the bronchial tree that eliminate bronchospasm and mucus hypersecretion.
The volume of medical measures in units and military medical institutions
In MPP (military infirmary). Diagnostic measures: blood test, electrocardiogram registration.
Therapeutic measures: in case of asphyxia, a tracheostomy is indicated. Immediate evacuation to the hospital by ambulance, accompanied by a doctor.
In medb and hospital. Diagnostic measures: blood and urine tests, X-ray examination of the chest organs. Bronchoscopy.
Medical measures are carried out in full. Medical treatment is carried out in full the above activities.
1.4. Acute cor pulmonale
Pulmonary insufficiency in urgent lung diseases often leads to the development of acute cor pulmonale - acute hypertension of the pulmonary circulation with dilatation of the right heart.
Clinical picture
Subjective manifestations and objective signs are different depending on the cause that caused acute cor pulmonale (pulmonary embolism, spontaneous pneumothorax, pneumomediastinum, severe asthma attack, widespread pneumonia, massive lung atelectasis). The most characteristic and typical are the following: pain behind the sternum, sharp or dull, prolonged, not stopped by taking nitroglycerin and, unlike pain during myocardial infarction immediately associated with shortness of breath and cyanosis (pulmogenic angina pectoris of Kutch); shortness of breath of the inspiratory or expiratory type of varying severity; cyanosis of the skin ("warm", "gray" cyanosis) of hypoxic origin (with right ventricular failure, there may be acrocyanosis); tachycardia; swelling of the neck

venous veins, their pulsation during inhalation and exhalation: epithelial (-.traldad pools ^ ^ ^ I, increased pulsation in the II and III intercostal spaces on the left; "^ I ^ T ^ Tl tone on the pulmonary artery; systolic, and sometimes diastolic murmur on pulmonary artery, gallop rhythm.With decompensation of the cor pulmonale, edema in the legs, ascites, hydrothorax, enlargement and tenderness of the liver appear.
Characteristic radiological signs are: a bulge of the cone of the pulmonary artery, an increase in the roots of the lungs (in contrast to the pattern of "congestive hilus" in left ventricular failure, they do not appear blurred, but with clear contours of the vessels); a significant expansion of the central basal vessels with a poor vascular pattern on the periphery (an increase in the width of the right pulmonary artery at the level of the intermediate bronchus to 1.5 cm or more indicates an increase in pressure in the pulmonary circulation); expansion of the heart to the right (a sign of dilatation of the right atrium and the onset of decompensation of the cor pulmonale).
The electrocardiographic picture is characterized by the presence of S waves in 1 hour Q-B III leads (SiQui syndrome), an increase in the Riii wave, low or negative T waves in leads Vi-z, ///, aVF, Hx widening; elevation of the ST segment in leads l^i-h, ///, aVF, aVR with its decrease in leads ^5-6, 1, H, aVR (of particular importance is the rise of STin with decreases in ST [!), Shift of the transient zones in ^4-5, complete or partial blockade of the right leg of the bundle of His, the appearance of "P-pulmonale", acute cardiac arrhythmias in the form of atrial fibrillation and flutter, paroxysmal tachycardia, atrioventricular blockade.
Complex of urgent measures
Urgent measures are carried out taking into account the underlying disease and specific mechanisms for the development of acute pulmonary heart. So, with status asthmaticus, the main measures should be aimed at restoring bronchial patency; tension pneumothorax, massive hydrothorax require the removal of air, fluid from the pleural cavity; with severe widespread pneumonia, early active antibiotic therapy, the fight against toxemia, with pulmonary embolism, removing the patient from the collaptoid state, early use of anticoagulant and thrombolytic agents (see relevant sections).

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Acute pneumonia

Acute pneumonia - common disease organism with predominant involvement in the inflammatory process of the respiratory section of the lungs. This is a very common disease with a fairly high mortality (predominantly among elderly and senile patients). Etiologically acute pneumonia can be associated with bacteria (pneumococcus, staphylococcus, streptococcus, Friedlander, etc.), viruses, mycoplasma, rickettsiae, as well as exposure to chemical and physical factors.

In their pathogenesis, a significant role is played by a violation of the immunological reactivity of the body, the drainage and protective function of the airways; in some cases, the exogenous (pathogenic pathogen) is of paramount importance, in others, the endogenous (activation of the endogenous microflora against the background of a decrease in the reactivity of the macroorganism) pathways of the disease. There are lobar, focal and interstitial pneumonia.

Croupous pneumonia

It's spicy infection, characterized by the defeat of one (sometimes more) lobe of the lung or its significant part by fibrinous inflammatory process and kind of cyclical. The causative agent is pathogenic pneumococcus. In typical cases, the disease begins acutely with chills (in 80%), a rapid increase in temperature - up to 39-40 ° C, chest pain during breathing, headache, less often - vomiting. With the defeat of the basal pleura, the pain is localized in the epigastric (less often - in the iliac) region.

A cough is also an early sign, at first with viscous mucus-purulent sputum that is hard to cough up, then it becomes red or rusty. An objective examination of the patient often takes a forced position (often on the sore side), the face is hyperemic (more significantly on the sore side), there are often herpetic eruptions on the lips, the mucous membranes are cyanotic, and the sclera are icteric. Breathing is superficial, up to 30-40 per minute.

The pulse is speeded up - up to 110-120 beats / min, sometimes arrhythmic (extrasystole); blood pressure is often low. The boundaries of relative cardiac dullness can be expanded in diameter, the tones are muffled, at the apex there is often a systolic murmur. On the ECG - signs of overload of the right heart, the displacement of the ST segment, changes in the T wave; rhythm and conduction disturbances occur.

Physical changes in the respiratory system depend on the location and extent of the lesion, as well as on the phase of the pathological process. On the first day of the disease, a shortening of the percussion sound with a tympanic shade is determined above the affected area, breathing is weakened with increased expiration, crepitus is often heard, and moist (finely bubbling) rales are heard in a limited area.

In the following days, the percussion sound becomes dull, breathing becomes bronchial with a large number of moist rales, pleural friction noise is often determined, bronchophony is increased. At the stage of resolution of the disease, breathing becomes hard (and later - vesicular), final crepitus appears, the number of moist rales decreases, dullness becomes less intense, bronchophony normalizes.

Atypical lobar pneumonia proceeds as follows:

• in children it begins acutely, but without chills, the general condition is severe due to severe intoxication; often abdominal pain, similar to an attack of appendicitis;
• in old people it is characterized by a general severe condition with a moderate rise in temperature and poor physical data;
• alcoholics have a severe course with delirium (up to a picture of delirium tremens);
• in patients with apical localization - a severe course with very poor physical data.

Complications: exudative pleurisy, abscess formation, carditis (endo-, perimyocarditis), purulent meningitis, glomerulonephritis, collapse or toxic shock, pulmonary edema.

Differential diagnosis is carried out with focal (confluent) pneumonia, Friedlander's pneumonia, exudative pleurisy, tuberculous lobar pneumonia.

Urgent care: 1) with severe pain - 2-4 ml of a 50% solution of analgin or 5 ml of baralgin with 1 ml of a 1% solution of diphenhydramine intramuscularly; 2) subcutaneously or intravenously, 2 ml of cordiamine or 2 ml of a 10% solution of sulfocamphocaine; in severe condition - 0.5 ml of a 0.05% solution of strophanthin or 1 ml of a 0.06% solution of corglycon intravenously; 3) oxygen therapy; 4) with a sharp decrease in blood pressure - intravenously drip 200-400 ml of polyglucin and 100-200 ml of hydrocortisone (or 60-120 mg of prednisolone, or 4-8 mg of dexamethasone).

The patient must be urgently delivered (lying, on a stretcher) to the pulmonology department. If hospitalization is not possible, antibiotic therapy should be started (under the supervision of a local doctor). With croupous pneumonia, antibiotics of the penicillin series are most effective (before administration, an allergic history should be clarified, intradermal test sensitivity to penicillin).

Friedlander's pneumonia

The causative agent is Klebsiela. It mainly affects elderly men suffering from alcoholism or some debilitating chronic disease. It begins acutely with chills, pain in the side and cough. Fever is constant or remittent, may be absent in the elderly. The sputum is viscous, often stained with blood. Physical data are often poor (weakened breathing, a moderate amount of moist rales), the course of the disease is severe. The prognosis is serious, mortality is high.

The method of treatment is the same as for croupous pneumonia, but it should be borne in mind that sulfa drugs and penicillin preparations for Friedlander's pneumonia are ineffective; it is necessary to use broad-spectrum antibiotics (tseporin, kanamycin, etc.).

Focal pneumonias are less severe and rarely require urgent measures.

Acute bronchiolitis

It occurs in children, the elderly and debilitated people. The pathological process is based on inflammation of the mucous membrane of the bronchioles with swelling and necrosis, blockage of the lumen of the bronchioles with inflammatory exudate, which disrupts ventilation of the lungs. The onset of the disease may be preceded by acute tracheobronchitis. Patients are agitated, occupy a semi-sitting position in bed, the face is puffy, cyanosis with a grayish tinge, acrocyanosis is noted.

Shortness of breath up to 40 breaths per minute. Breathing is superficial, cough is rare, with mucopurulent sputum that is difficult to expectorate. Percussion - pulmonary sound with a tympanic tinge, restriction of lung excursion. Against the background of hard breathing, wet and dry whistling rales are heard. Respiratory failure is often accompanied by cardiac failure (due to increased pressure in the pulmonary circulation).

The heart is enlarged, the tones are muffled, the emphasis of the second tone is on the pulmonary artery. Tachycardia - 100-140 beats / min. There is an increase in the liver, there are swelling on the legs. The course of the disease is severe. If within 2-3 days it is not possible to improve the drainage function of the bronchi, the prognosis is extremely unfavorable (lethal outcome occurs with the progression of acute pulmonary heart failure).

Urgent care: 1) strict bed rest; 2) oxygen therapy (40% mixture of oxygen with air); 3) 0.25-0.5 ml of a 0.05% solution of strophanthin mixed with 10 ml of a 5% glucose solution intravenously slowly (as well as corglycon, digoxin); 4) 10 ml of a 2.4% solution of aminophylline intravenously slowly on glucose (or drip); 5) expectorants (terpinhydrate, inhalations of 2% sodium bicarbonate solution, trypsin, etc.); 6) antibiotics (penicillin, tseporin); 7) prednisolone at a dose of 30-60 mg intravenously; 8) diuretics (furasemide, uregit); 9) emergency hospitalization in a therapeutic (pulmonological) department.

Bronchial asthma

Bronchial asthma is a chronic, recurrent disease of an allergic or infectious-allergic nature, clinically manifested by asthma attacks. Among the population of cities in developed countries, the incidence is 1-2% or more. The pathogenesis of bronchial asthma is based on allergic reactions of immediate and delayed types. In the antigen-antibody reaction, active substances are released - serotonin, histamine, bradykinin, etc., dysimmunoglobulinemia develops (the content of IE increases and decreases - IA and IG). During an asthma attack, bronchospasm, hypersecretion and swelling of the bronchial mucosa occur.

The clinic of an attack of bronchial asthma is quite typical: choking often occurs suddenly, at night (sometimes it is preceded by coughing, sneezing, runny nose); the patient takes a forced sitting position. The chest is in the inspiratory position; attention is drawn to the difficulty of exhalation, noisy, wheezing, often - cyanosis of the lips, cheeks, nose tip. Sputum at the beginning of the attack is separated with difficulty, in appearance - thick, viscous, light. With percussion of the chest - a box sound, the mobility of the lower edges of the lungs is limited.

During auscultation, against the background of weakened breathing, wheezing is determined both on inhalation and, especially, on exhalation. The heart sounds are muffled, the pulse is frequent. BP often rises. On the ECG during an attack: an enlarged, pointed, widened P wave in II and III standard leads. The duration of the attack is different: from several minutes to several hours. The end of the attack is marked by the appearance a large number sputum, restoration of breathing, a decrease in the number of wheezing and signs of emphysema.

However, in some cases, the attack is not stopped and goes into an asthmatic state. This is a state of suffocation, which is caused by a persistent and prolonged violation of bronchial patency, which is not amenable to conventional methods of treatment for a long time (more than a day). The main causes of an attack are swelling of the mucous membrane of the bronchioles, thickening of sputum and a violation of its excretion; of secondary importance is the spasm of the smooth muscles of the bronchi. Exacerbation of chronic bronchitis, the abolition of glucocorticoid hormones, the use of hypnotics, the unsystematic use of sympathomimetic agents can contribute to the emergence of an asthmatic state.

An essential point is the occurrence of a deep blockade of beta-adrenergic structures of the smooth muscles of the bronchi and blockage of their lumen with viscous sputum. As a result, gas and metabolic acidosis, hypovolemia, and an increase in the concentration of sodium in the blood develop. This occurs against the background of resistance of adrenoreactive lung structures to sympathomimetics.

According to the severity, 3 stages of asthmatic status are distinguished:

I stage- the stage of formed resistance to sympathomimetics (the stage of the absence of ventilation disorders or the stage of compensation). Patients are conscious; observed expiratory dyspnea, tachypnea up to 40 min, acrocyanosis, sweating, moderate tachycardia; BP may be slightly elevated. Hard breathing is heard above the lungs, against which scattered dry rales are determined (in a relatively small amount). The amount of sputum is reduced. This stage is reversible, but death can occur due to repeated use of sympathomimetic agents.

II stage- stage of decompensation (stage of progressive ventilation disorders). Consciousness is preserved. Patients are excited or. on the contrary, they are apathetic. Severe cyanosis of the skin and mucous membranes, swollen veins, puffy face. Breathing is noisy, with the participation of auxiliary muscles, severe shortness of breath. The lungs are emphysematous. against the background of sharply weakened breathing, a small amount of dry rales is heard; there are areas where breathing is not heard at all. This stage is prognostically very dangerous and requires the immediate initiation of intensive care.

III stage- stage of hypercapnic and hypoxic coma. Characterized by disorientation, delirium, lethargy, etc. eventually complete loss of consciousness. Coma often develops slowly, less often - quickly. Breathing is superficial, sharply weakened. The prognosis is very difficult.

All patients with status asthmaticus need immediate hospitalization in the intensive care unit (lying down, on a stretcher with a raised head end).

An attack of bronchial asthma should be differentiated from a bronchospastic variant of cardiac asthma, which often develops in older people, patients with CIHD or myocardial infarction (especially against the background of chronic bronchitis).

Urgent treatment measures include:

• measures aimed at relieving bronchospasm (beta-adrenergic stimulants, aminophylline);
• the use of decongestants (glucocorticoid hormones, inhibitors of proteolytic enzymes);
• sanitation of the tracheobronchial tree (with asthmatic status);
• oxygen therapy and ventilation;
• metabolic correction.

To stop an attack of bronchial asthma, inhalations of sympathomimetics are currently most often used. Salbugamol (ventolin) is a B2-adrenergic receptor stimulant of the bronchi, does not cause tachycardia and hypertension. For the relief of an attack, 1-2 breaths of the drug are usually sufficient. Berotek (fenoterol) has a powerful bronchodilator effect, its action is quite selective. Sometimes it can cause muscle tremors.

Widely used and alupent or asthmapent (ortsiprenalin), causing a good bronchodilatory effect (3-4 breaths of 0.75 mg, as well as subcutaneously intramuscularly 1-2 ml of a 0.05% solution or intravenously 1 ml of a 0.05% solution slowly , in breeding). It should be borne in mind that the drug can cause tachycardia, as well as a paradoxical increase in bronchospasm against the background of the use of other adrenomimetic agents. Isoprenaline (isopropylnorepinephrine, isoproterenol, isuprel, euspiran, novodrin, isadrin) stimulates B1- and B2-adrenergic receptors.

Along with a pronounced bronchospastic effect, it causes tachycardia (arrhythmias may develop against the background of hypoxia). Adrenaline, which stimulates not only B-receptors, but also a-receptors, is rarely used because of the risk of side effects (hypertension, tachycardia, arrhythmias): in the absence of contraindications, 03-05 ml of a 0.1% solution is injected subcutaneously. Eufillin has a reliable bronchodilator effect. which is administered intravenously in 10 ml of a 2.4% solution mixed with 10 ml of a 40% glucose solution for 3-5 minutes.

Patients with a stopped attack of bronchial asthma with a previously established diagnosis are not subject to emergency hospitalization, but those with a primary attack should be hospitalized.

Emergency treatment of patients with status asthmaticus begins (and continues during transportation) with intravenous drip injection of 15-20 ml of a 2.4% solution of aminophylline and 60-90 mg of prednisolone mixed with 500 ml of a 5% glucose solution. In the absence of contraindications, 5 thousand units are administered. heparin (in the future, the daily dose is 20 thousand units). Therapy with prednisolone continues in the hospital (daily dose can reach 10 mg/kg).

Oxygen therapy is used from the very beginning of providing assistance to patients with asthmatic status (with the help of KI-3, KI-4 devices or through any device for inhalation anesthesia, oxygen is supplied in an equal mixture with air with positive pressure at the end of expiration). In case of respiratory depression, a transition is necessary. to assisted ventilation. A direct indication for the transition to mechanical ventilation at the prehospital stage is asthmatic status III degree - hypercapnic and hypoxemic coma.

At the prehospital stage, it is preferable to carry out mechanical ventilation manually using devices such as RDA or DP-10 (AMBU bag), while the respiratory rate gradually decreases to 12-16 per minute. It should be remembered that mechanical ventilation in such patients may be complicated by tension pneumothorax.

All patients with status asthmaticus need urgent hospitalization in the intensive care unit and resuscitation, for which intensive care teams or specialized SP teams are used.

B.G. Apanasenko, A.N. Nagnibed

One of the most important lung function is the saturation of red blood cells with oxygen, the release of carbon dioxide. The frequency and rhythm of breathing is regulated by the respiratory center, the cerebral cortex, fluctuations in acid-base balance, the biochemical and clinical composition of the blood, the state of cardio-vascular system, respiratory organs, degree of intoxication.

Main symptoms lung pathology are the frequency, rhythm, depth of breathing. The color of the skin and mucous membranes, shortness of breath, suffocation, cough, hemoptysis, bleeding, chest pain when breathing, sputum features.

At healthy human breathing is even, rhythmic, with a frequency of 16-18 per minute. In men, the type of breathing is abdominal, in women - chest, 2-4 breaths more than in men.

In healthy people, increased breathing (tachypnea) is observed in a standing position, during emotional and physical stress; deceleration (bradypnea) - in the supine position, in athletes, trained people.

Breathing is monitored unnoticed by the patient. With visual difficulty, the hand is placed on the epigastric region, counting only breaths.

Dyspnea- a subjective feeling of lack of air, accompanied by an increase in the frequency, depth of breathing.

There are inspiratory, expiratory, mixed dyspnea.

inspiratory shortness of breath is observed with mechanical compression of the larynx, large bronchi, accompanied by a noisy labored breath. With expiratory, on the contrary, it is difficult, exhalation is lengthened, which is associated with a narrowing of the lumen of the small bronchi and bronchioles, due to muscle contraction.

mixed shortness of breath is manifested by difficulty in inhaling and exhaling.

Under suffocation understand sudden pronounced shortness of breath with a deep inhalation and exhalation, increased breathing, a painful feeling of lack of air, a feeling of tightness in the chest.

Asthma- acutely developing suffocation. Distinguish between bronchial and cardiac asthma.

For bronchial asthma is characterized by: cough initially dry, then with scanty, glassy sputum, accompanied by whistling and buzzing wheezing audible at a distance, suffocation with a predominance of the expiratory component, cyanosis (cyanosis) of the skin, a forced position of the body, in which the patient leans his hands on the edge of the bed, the window sill etc.

Giving help: create emotional and physical peace; give an elevated position; release the patient from restrictive clothing, provide access to fresh air; if possible, give oxygen, use aerosol inhalations, put jars, mustard plasters, make hot mustard baths.

Methodology using the inhaler: turn the can upside down, remove the protective cap, shake well, take the mouthpiece down in your hand, clasp it with your lips, take a deep breath, simultaneously press the bottom of the can to the maximum, hold your breath for a few seconds, then remove the mouthpiece, take a slow exhale, and put on the protective cap. The number of doses is determined by the doctor and adjusted according to the effectiveness of the procedure.

Cough is a protective, unconditioned reflex aimed at removing foreign bodies, mucus, blood, sputum from the bronchi, upper respiratory tract through a sudden, sharp exhalation with a closed glottis. dock cough follows only with pleurisy (inflammation of the pleura), rib fractures, peritonitis (acute inflammation of the peritoneum), in the postoperative period.

By the nature of the cough it is possible to judge a possible pathology. With acute respiratory diseases, pharyngitis (inflammation of the pharynx), pleurisy. The initial stages of tracheitis (inflammation of the trachea), bronchitis (inflammation of the bronchi) cough is dry, painful. As the disease progresses, it becomes wet.

The composition of sputum its appearance largely reflects the pathomorphological changes occurring in the focus of inflammation. When analyzing it is paid attention to the volume, color, number of layers, smell, the presence of blood, impurities. Find out the relationship of sputum discharge with the position of the body in bed.

Phlegm happens serous, mucous, purulent, putrid.

For tuberculosis coughing without or with a small amount of sputum mixed with blood (hemoptysis) is characteristic. At lung abscess, bronchiectasis sputum contains pus with an admixture of blood, increased cough, increased sputum volume in a position on a healthy side. At lobar pneumonia cough, deep breath accompanied by chest pain, rusty sputum.

Spit sputum is necessary in a dark glass spittoon with a screw cap.

Methodology collection of sputum for laboratory research: in the morning, before breakfast, after brushing your teeth, rinsing your mouth, breathing deeply and coughing, sputum in the amount of 15-20 ml is collected in a sterile glass jar or spittoon with a tight-fitting lid.

IN depending on the delivered the purpose of sputum is sent to the laboratory for examination for general analysis (the number of leukocytes, erythrocytes, epithelial cells, etc.); tumor cells, Mycobacterium tuberculosis, flora; sensitivity to antibiotics.

Bleeding manifest as hemoptysis and significant blood loss. Each of them, regardless of magnitude, is a formidable prognostic symptom. Observed with pulmonary embolism (pulmonary infarction), tumors, bronchiectasis, lung abscess, tuberculosis.

For pulmonary hemorrhage the previous cough, frothy, scarlet sputum, alkaline reaction, complaints, characteristic pathologies of the lungs, chest pain, cyanosis (bluish tint) of the skin are characteristic.

Regardless of the severity diseases it is necessary: ​​to calm the patient, to give a sitting or semi-sitting position, to prevent active movements, to put an ice pack on the chest, to give food in a cold form, to stop coughing. For pain in the chest, give painkillers, Seek medical attention.

At high fever, especially accompanied by chills, you should lift the patient, put a pillow under his back, raise the head of the bed, warm, wrap, overlay heating pads, drink hot tea, coffee. For hyperpyrexia, apply a cold compress to the head. In case of profuse sweat, wipe with a towel, change underwear and bed linen, exercise constant control over breathing, pressure.

At lung pathology chest pains appear at the height of inhalation and exhalation, accompanied by coughing.

oxygen therapy– the use of an oxygen-air mixture for the treatment of patients in a ratio of 1: 1 by inhalation and non-inhalation methods.

At inhalation method oxygen enters the respiratory tract from an oxygen bag, an oxygen cylinder, through a centralized supply through a mask, nasal catheters. Only humidified oxygen is inhaled. Oxygen tents and oxygen barotherapy (inhalation of oxygen under high pressure) are also used.

Using oxygen bag the mask is wrapped with 2-3 layers of wet gauze, applied to the patient's mouth, the faucet is opened, offering to inhale oxygen through the mouth, exhale through the nose. As oxygen decreases, the pillow is folded, starting from the corner opposite the mask, thereby maintaining the pressure required for inhalation. At the end of the procedure, the mask is wiped with 3% hydrogen peroxide or 70 0 alcohol.

At non-inhalation method oxygen is administered subcutaneously or through the digestive tract.

Mechanism of action: elimination of hypoxia (oxygen starvation), reflex and local effects on organs and tissues.

Before oxygen barotherapy it is necessary to consult an otolaryngologist in order to exclude the pathology of the tympanic membrane.

Nasal catheter insertion technique: a sterile catheter is lubricated with petroleum jelly, inserted through the lower nasal passage into the pharynx, connected to an oxygen source, fixed to the cheek, temple of the patient with adhesive tape, open the dosimeter valve, served at a rate of 2-3 l / min.

IN cylinder oxygen stored at a pressure of 150 atmospheres, which requires strict adherence to safety regulations. In accordance with labor protection, the cylinder is painted blue, has a stamp indicating its number, weight, year of manufacture, period technical certification.

Balloon it should be set in a metal nest, secured with straps or chain; be at a distance of at least 1 m from heating devices and 5 m from open sources of fire; protected from direct sunlight.

Fill up with oxygen another container should only be passed through a reducer with a pressure gauge designed for the pressure in this container.

To avoid fire, it is forbidden to lubricate the cylinder fitting with oil, use a greasy cream. Do not stand against the nozzle outlet; operate a cylinder with an expired technical examination, damage to the body, color, valve.