Topic number 14. Stroke, myocardial infarction. epileptic fit. Providing PMP.

Subject Meaning:

A medical worker must be proficient in express diagnostics of conditions requiring emergency first aid, respect the patient’s rights when providing emergency care; own modern technologies for providing first aid in emergency situations; interact with first aid teams; prepare the patient for transport.

A medical worker should be able to provide first aid for acute myocardial infarction, stroke, epileptic seizure. Further treatment and recovery of the patient depends on the correct provision of first aid.

Knowledge and skills in the implementation of first aid algorithms will help future pharmacists master general and professional competencies and effectively apply them in emergency situations, help them understand the significance of their future profession, and show a steady interest in it.

Based on theoretical knowledge and practical skills, the student must

know :

· Legal liability in case of refusal to provide emergency first aid.

The rights of the patient in the provision of emergency care.

Basic principles of first aid.

Signs of a heart attack, stroke, epileptic seizure.

be able to:

· Possess express diagnostics of conditions requiring emergency first aid.

Respect the rights of the patient when providing him with emergency care.

· Be proficient in modern technologies for providing first aid in emergency situations.

· Collaborate with first aid teams.

· Prepare the patient for transport.

· Monitor and care for victims during transportation, depending on the nature of the damaging factors.

Provide PHC for heart attack, stroke, epileptic seizure.

The student must master the general competencies

OK 1. Understand the essence and social significance of your future profession, show a steady interest in it.

OK 3. Make decisions in standard and non-standard situations and be responsible for them.

OK 4. Search and use the information necessary for the effective performance of professional tasks, professional and personal development.

OK 6. Work in a team and team, communicate effectively with colleagues, management, consumers.

OK 11. Be ready to take on moral obligations in relation to nature, society and man.

OK 12. Provide first aid in case of emergency.

The student must master professional competencies

PC 1.7. Provide first aid.

Topic study plan:

Control of the initial level of knowledge.

1. Name the causes, symptoms of myocardial infarction, PMP.

2. Name the causes, symptoms of stroke, PMP.

3. Name the causes, symptoms of an epileptic seizure, PMP.

Topic content

Acute myocardial infarction is an acute disease caused by the development of foci of necrosis in the heart muscle as a result of a violation of its blood supply, which occurs due to thrombosis of the coronary artery or its sharp narrowing by an atherosclerotic plaque.

With myocardial infarction, necrosis of part of the heart muscle develops. The focus of necrosis can be large in magnitude (large-focal myocardial infarction) or these foci are small (small-focal myocardial infarction). If the focus of necrosis affects the entire thickness of the wall of the ventricle, then such a heart attack is called transmural. The outcome of a heart attack is scarring of the focus of necrosis – the so-called post-infarction cardiosclerosis.

Symptoms of myocardial infarction: – prolonged pain attack in the region of the heart and behind the sternum. The pain occurs suddenly and quickly reaches a high degree of “dagger” pain, it can radiate to the left arm, shoulder blade, lower jaw, interscapular space. With myocardial infarction, the pain is much more intense and is not stopped by taking nitroglycerin. This variant of the onset of a heart attack is typical.

However, there are atypical variants. Pain can be localized in the epigastric region, accompanied by nausea and vomiting. This variant of the onset of the disease is called “gastralgic status”.

The disease can begin with an asthma attack (an attack of cardiac asthma) – the so-called asthmatic status. With this variant of the onset of myocardial infarction, pain in the region of the heart may be absent. More rare atypical variants of the onset of myocardial infarction are arrhythmic (the disease begins with an acutely developed heart rhythm disturbance) and apoplectiform (similar to a violation of cerebral circulation).

During an attack of pain or suffocation, the patient experiences fear of death, pallor, cold sweat appears on his forehead. There is a decrease in blood pressure, the pulse is small, frequent, sometimes arrhythmic.

On the second day, the body temperature rises to subfebrile (and even febrile) and remains elevated for no more than 3-5 days. On the ECG, characteristic changes in the QRS complex and the T wave appear.

In the acute period of myocardial infarction, serious complications can occur: cardiogenic shock, left ventricular failure, rhythm and conduction disturbances.

Cardiogenic shock is a sharp drop in blood pressure due to a sharp decrease in the contractile function of the heart.

There are so-called peripheral signs: cold, pale skin with moderate cyanosis, covered with cold, sticky sweat, lethargy, confusion, or even temporary loss of consciousness. A constant sign of cardiogenic shock is oligo- or anuria. The pulse is quickened, small filling, sometimes not determined.

Left ventricular failure in myocardial infarction is manifested by an attack of cardiac asthma and pulmonary edema.

PMP for myocardial infarction:

1) relief of pain attack;

2) anticoagulant and fibrinolytic therapy;

3) prevention and relief of cardiac arrhythmias;

The pain attack is stopped by the introduction of narcotic analgesics (morphine, promedol), but neuroleptanalgesia is more effective (droperidol is a neurolytic agent and fentanyl is an anesthetic drug).

Anticoagulant and fibrinolytic therapy is carried out to stop the onset of thrombosis in the coronary artery, prevent new thrombosis and prevent thromboembolic complications. Fibrinolysin is administered intravenously in combination with heparin for 3-7 days, and then the patient is transferred to receive indirect anticoagulants. Heparin is administered under the control of blood clotting.

To combat cardiogenic shock, peripheral vasodilators (sodium nitroprusside or nitroglycerin intravenously drip) are used in combination with dopamine, which improve the contractile function of the unaffected myocardium.

First of all, the patient must be comfortably laid on the bed and unfasten clothing that makes it difficult to breathe, give a sufficient supply of fresh air. Remove dentures, vomit from the mouth. The head, shoulders should lie on the pillow so that there is no flexion of the neck and deterioration of blood flow through the vertebral arteries. With the development of a stroke, the first minutes and hours of the disease are the most expensive, it is at this time that medical care can be most effective.

A patient with a stroke is transported only in the supine position.

Stroke is an acute violation of cerebral circulation, characterized by a sudden (within minutes, hours) onset of focal and/or cerebral neurological symptoms that persist for more than 24 hours or lead to the death of the patient in a shorter period of time due to cerebrovascular pathology.

A stroke can present with cerebral and focal neurological symptoms.

General cerebral symptoms of a stroke: impaired consciousness, stupor, drowsiness or, conversely, arousal, there may be a short-term loss of consciousness for several minutes. Severe headache accompanied by nausea or vomiting. Sometimes there is dizziness. The person may feel disoriented in time and space. Vegetative symptoms are possible: a feeling of heat, sweating, palpitations, dry mouth.

Against the background of cerebral symptoms of a stroke, focal symptoms of brain damage appear. If a part of the brain provides the function of movement, then weakness develops in the arm or leg, up to paralysis. Loss of strength in the limbs may be accompanied by a decrease in sensitivity in them, impaired speech, vision. Similar focal symptoms of a stroke are mainly associated with damage to the area of u200bu200bthe brain supplied by the carotid artery.

There is weakness in the muscles, impaired speech and pronunciation of words, a decrease in vision in one eye and pulsations of the carotid artery in the neck on the side of the lesion are characteristic. Sometimes there is unsteadiness of gait, loss of balance, indomitable vomiting, dizziness, especially in cases where the vessels that supply blood to the brain areas responsible for coordinating movements and a sense of body position in space are affected. There is a “spotted ischemia” of the cerebellum, occipital lobes and deep structures and the brain stem. There are bouts of dizziness in any direction when objects revolve around a person. Against this background, there may be visual and oculomotor disorders (strabismus, double vision, decreased visual fields), unsteadiness and instability, deterioration of speech, movements and sensitivity.

PMP:

1. The patient must be laid on the bed and unbuttoned clothes, give a sufficient supply of fresh air.

2. The head should be covered with ice packs, heating pads should be placed at the feet. Absolute rest is needed.

3. If swallowing is preserved, give sedatives (valerian tincture, bromides), drugs that lower blood pressure (dibazole, papaverine).

4. It is necessary to monitor breathing, prevent retraction of the tongue, remove mucus and vomit from the oral cavity.

5. It is possible to move and transport to the hospital only after the conclusion of the doctor about the transportability of the patient.

epileptic seizure

Symptoms: the patient suddenly loses consciousness. The look is wandering, the eyeballs first “float”, and then are fixed upward or to the side. The head is thrown back, the arms are bent at the hands and elbows, the legs are extended, the jaws are convulsively closed. Breathing and pulse slow down, biting of the tongue, apnea is possible. The patient’s face first turns pale, then becomes purplish-blue. The tonic phase of convulsions lasts no more than a minute. The second phase of the seizure is characterized by clonic convulsions, in which flexion and extension of the muscles of the arms and legs alternate quickly, twitching of the muscles of the face, neck, torso (the patient “beats”). Often there is involuntary urination. Foamy saliva comes out of the mouth. The total duration of the seizure is 2-3 minutes, then the muscles of the limbs and torso relax. Consciousness remains confused for a while, then sleep usually follows. Waking up, the patient does not remember what happened, complains of weakness, muscle pain, weakness, headache.

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