Syncope (medicine)

Syncope, also known as fainting, is a light form of circulatory collapse, short loss of consciousness , caused by
a decrease in blood flow to brain

Causes: strong emotions, fear, sight of blood, pain, prolonged motionless vertical position of the body,
rapid change of horizontal position to vertical one, stay in stuffy/ hot room, overwork, infectious diseases,
internal bleeding (especially gastrointestinal), heart disease (myocarditis , endocarditis, cardiac defects).

Clinical picture: weakness, headache, nausea, sometimes vomiting, ringing in the ears, darkening in the
eyes, short-term loss of consciousness. Skin and lips are pale, limbs are cold, often there is an abundant cold
sweat. Muscle tone is reduced. Pupils are narrowed, do not respond to light. Shallow breath,bradypnoe. Slow
pulse, weak. Blood pressure is low.
Fainting usually lasts 10-20 minutes.

First aid: put the victim in a horizontal position with slightly raised legs to provide good cerebral
circulation. Release breast and neck to from the embarrassing clothing. Ensure the flow of fresh air or take the
victim out of a stuffy room. Sprinkle the face with cold water or wipe it with a damp towel, pat on the cheeks,
give a breath of vapors of ammonia or vinegar, grind the body and limbs of the child, cover with heaters. If
syncope is long, administer a 10% solution of cordiamine or a solution of caffeine subcutaneously or
intramuscularly.

Question number 2: Collapse

Collapse is a more severe form of acute vascular insufficiency. It differs from syncope with greater duration
and gravity of the phenomena. The tone of the entire circulatory system decreases sharply, which leads to
decrease in blood pressure and a violation of cardiac activity.

Causes: extensive blood loss, a blow to the stomach, a sudden change in the position of the body. Often
the collapse is a complication of any disease (scarlet fever, typhus, cardiovascular disease, food poisoning,
acute pancreatitis, pneumonia, etc.).

Clinical picture: the patient is pale, motionless, has a cold sweat, Cyanosis of the extremities and nail
phalanges. Shallow breathing, filiform pulse, sometimes not palpable. The body temperature decreases in 1-2
degrees, the blood pressure is very low or not determined. Consciousness is obscured, in severe cases it is
absent. If at this time the patient is not provided emergency care, then the above mentioned phenomena are
accompanied by convulsions, cardiac weakness, involuntary incontinence of urine and feces, the patient dies.

First aid: elimination of the cause of the collapse (stop the traumatizing agent, blood loss, etc.) and
cardiovascular insufficiency. The patient is placed in a position with a raised legs (to provide a rush of blood to
the brain), put tight bandages on the limbs (self-transfusion of blood) and immediately call ambulance. It is
important to provide the patient with fresh air. If the patient in collapse has a terminal condition, it is necessary
to proceed to artificial respiration and indirect cardiac massage.

Shock is the response of the body, which develops from the overexcitation of the central nervous system
by painful stimuli.
 Causes: severe stroke, myocardial infarction, perforated gastric ulcer, pancreatitis attack, etc., after
transfusion of non-group blood, serum administration and large blood loss. The shock is a much more difficult
condition than collapse.

Clinical picture: patient is apathetic, indifferent, almost does not complain of pain. The skin is pale, the
face is covered with cold sweat, there is a rare shallow breathing, a small frequent pulse, low blood pressure.
During initial stages of shock, consciousness is present. The listed symptoms can be expressed in varying
degrees depending on the stage of the shock.

First aid:
• eliminate traumatic factors;
• stop the bleeding;
• immobilization in case of fractures;
• control the breathing and heart work; do artificial respiration and indirect heart massage if necessary;
• call an ambulance;
• provide the victim with peace and warmth.
• give smell of ammonia, use warmers, give tod drink hot tea, coffee, alcohol, vodka, analgin, amidopyrine.

Anaphylaxis is a serious allergic reaction

Cause: allergen (drugs, food, etc.)

Clinical picture: a sudden decrease in blood pressure, accompanied by loss of consciousness.

First aid: stop injection of the drug (apply a tourniquet above the injection site or bite). At the injection or
bite site, administer 0.5 ml of a 0.1% solution of epinephrine (subcutaneously or intramuscularly, and the same
dose in another part) should be injected; apply a cold. Administer hormones of the adrenal cortex
(prednisolone, dexazone, hydrocortisone). There are special anti-shock kits. Human life depends on the
elimination of the manifestations of shock. . If the shock is evolved in nature, it is necessary to lay down the
affected, avoid the aspiration of vomit. Warm and wrap the victim, start artificial ventilation in case of clinical
death.

Question number 4: Heart failure. Myocardial infarction

Acute heart failure is one of the most severe circulatory disorders.

Causes: prolonged oxygen starvation (hypoxia), blood loss, respiratory distress, traumatic shock, hypertension,
heart disease (mitral stenosis), myocardial infarction, poisoning by toxic substances.

In acute heart failure, the heart loses its contractility, so it can not pump the blood flowing to it, the so-
called cardiac output sharply decreases. As a result, blood stagnation occurs. If the heart's left ventricle is
predominant, the blood stagnates mainly in the lungs (in pulmonary circulation). If predominant right
ventricular failure, the blood stagnates in systemic circulation - there are swellings, the liver is enlarged, the
speed of blood flow and the supply of oxygen to various organs and tissues decrease.

First aid:
• strengthen the contractility of the heart, take strophanthin, korglikon;
• in case of acute heart failure associated with angina pectoris – give nitroglycerin a tablet under the tongue;
• reduce the stagnation of blood in the lungs – take euphyllin.
 • if the blood pressure is low slightly – put the victim in elevated position;
• rapid hospitalization of the patient.

Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow stops to a part of
the heart causing damage to the heart muscle.

Causes: violation of blood supply of the heart as a result of atherosclerosis of venous vessels, their spasm or
clogging of blood clots.
Clinical picture: a circulatory disorder in the cardiac muscle is manifested by an attack of angina (angina
pectoris) in the form ofstrong pain behind the sternum.

First aid:
• stop the pain syndrome by morphine, promedol and other pain-relievings;
• use preparations that extend the coronary vessels (nitroglycerin, validol);
•profound rest;
• no active movements;
• reanimation, delivery to hospital.

Pulmonary edema is a stagnation of the fluid in the pulmonary alveoli and in the lung tissue. This is not
an independent disease, but a serious complication of other diseases.

Causes: stagnation of blood in the lungs, caused by heart failure in heart defects, hypertension, myocardial
infarction, with acute inflammation of the kidneys.

Clinical picture: choking, loud wheezing, bubbling breath, the discharge of foamy pink phlegm, a sharp pallor
of the skin with a cyanotic shade, the pulse is frequent, weak.
To prevent edema, it is necessary to turn the ill patient from side to side several times a day.

 First aid:
• restore airway patency to eliminate suffocation
• reduce blood filling in the pulmonary vessels - apply tourniquets to the limbs. Check the presence of a pulse
on the artery below the tourniquet;
• use a variety of medications - diuretics, reducing blood pressure;
• put the victim in a semi-sitting position;
• a tablet of nitroglycerin under the tongue;
• put mustards to your hands and feet;
• put dry jars on the back.

Question number 6: Stroke (cerebral hemorrhage).

A stroke is when poor blood flow to the brain results in cell death. Acute circulatory disturbances in the
brain and spinal cord. There are two main types of stroke: ischemic, due to lack of blood flow, and
hemorrhagic, due to bleeding.

Causes: hypertensive crisis and atherosclerosis of cerebral vessels, severe mental trauma, severe physical
exhaustion, prolonged work under the sun with uncovered head.

Clinical picture: sudden loss of consciousness, skin is pale, then face hyperemia (redness), increased
sweating, cyanotic lips, tongue deflected to the side, with loss of consciousness, there may be tongue lagging,
neck pulsation, muscle tone is lowered;
 Paralysis on the side opposite the focal point of the hemorrhage, the foot is turned outward, the eyeballs
are turned to the affected side, the pulse is rare, tense, the arterial blood pressure is high, the breathing is
frequent, raucous, convulsions, vomiting, involuntary urination, defecation.

First aid:
• physical and mental rest;
• Unbutton clothing, give a sufficient supply of fresh air;
• horizontal position with raised head and upper torso. Cold on the head, at the feet - warmers;
• control of breathing, pulse, blood pressure;
• Prevention of tongue twisting;
• if swallowing is possible- take soothing agents and means that reduce blood pressure;
• the most careful transportation to the hospital;

Question number 7: Epilepsy. A hysterical fit.

Epilepsy is a chronic neuromuscular disease accompanied by bouts.
Causes: heredity, birth trauma, birth asphyxia, severe infections, craniocerebral trauma, alcoholism, drug
addiction.

Clinical picture: sudden loss of consciousness with tonic, and then clonic convulsions, a sharp turn of the head
to the side and the release of foamy fluid from the mouth. In the first seconds of the attack, the patient falls,
often getting injured. There is a fine facial complexion, the pupils do not react to light. During a fit, involuntary
urination occurs. The duration of the fit is 1-3 min. After, the patient falls asleep and does not remember what
happened to him.

First aid:
• Do not hold the patient at the moment of seizure;
• Turn to the side with a raised head;
• Put something soft under the head;
• Dissolve clothing;
• for the purpose of preventing the bite of the tongue, insert a folded handkerchief;
• apply a cold compress on the forehead.
 Epileptic seizure and stroke should be distinguished from a hysterical fit

A hysterical fit is a pathological reaction to an unbearable or unacceptable situation, for whatever reason.

Causes: acute and chronic neurological and mental diseases, lesions of the central nervous system, severe
infections, trauma, stress. Most often found in children and young women.

Clinical picture: Movement disorders: trembling of hands, inability to walk; Violation of sensitivity:
blindness, deafness, loss of taste and smell, a violation of sensitivity in the form of stockings, gloves, hysterical
pain in various organs; Vegetative disorders: hysterical coma, feeling of obstruction of the esophagus, refusal
of food and even at the sight of food-hysterical vomiting, hiccups, sensation of lack of air, aphonia (lack of
voice); Mental disorders: hysterical psychosis, fears, hallucinations, depression.Первая помощь:

First aid:
• Remove "spectators";
• open windows, air out the room;
• unfasten the tight clothes;
• not show fussiness and special participation;
• say a stern voice: "get up, calm down, the attack has passed"
• give a sniff of ammonia;
• Give a drink of 15-20 drops of tincture of valerian to half a cup of water or a tablet of Validol under the
tongue.

Question 8: Sudden birth

Despite the wide network of maternity hospitals and careful medical examination of pregnant women,
sometimes it is necessary to render first aid to women giving birth at home, by train, by plane. When helping,
you should carefully wash your hands and sterilize scissors or a knife, prepare sterile bandage or put strong
thread, ribbon in alcohol (alcohol solution of iodine), debride umbilical cord. If a child is born in asphyxiation,
a rubber pear can be used to draw amniotic fluid from the nasal passages and from the mouth.

First aid:
• the newborn is laid on a clean, ironed hot sheet (diaper).
• after stopping the pulsation of the cord, twice, at a distance of 5 and 10 cm from the baby's navel, tie with a
string, ribbon or strip of bandage, and then cut the cord between the ligatures.
• the end of the umbilical cord should be treated with an antiseptic solution and fixed with a sterile bandage,
fixing it with a string to the umbilical cord.
• if the child does not breathe, it is necessary to start artificial respiration by mouth-to-mouth principle, having
sucked water from the nose and mouth of the child with a rubber pear.
• deliver the mother and the child to the maternity hospital as soon as possible.
• after the labour within the first hour, the afterbirth (placenta) with the remains of the umbilical cord should
leave the birth canal. Show the afterbirth to the doctor, who will determine the completeness of the placenta
retreat. The rest part of placenta may cause bleeding.
• the perineum should be covered with a clean diaper or a piece of tissue.