The asthmatic state is the attack of asthma,
which lasts more than 6–10 hours and resistant to sympatomimetics and
methylxantins. It is characterized by total bronchoobstruction on a background
of refraction of b2-adrenoreceptors
with progress of hypoxia, hypercapnia, decompensative acidosis, dehydration and
development of acute cardiac insufficiency of a right-heart type. In the
process of development of the asthmatic state three stages are selected:
relative indemnification, decompensation and hypoxemic comma.
Diagnostic criteria of asthmatic status
1.
Protracted attack of bronchial asthma, which
is not cured during 6 hears
and
anymore.
2.
Resistens to sympatomimetics.
3. Violation of drainage
function of bronchial tubes.
4. Development hypoxemia - РаО2 - 60
ml Hg, hypercarpnia - РаСО2 60 ml Hg.
Clinic.
I stage of the asthmatic status (relative compensation).
Forced sitting position, leaning against
hands, tachypnoe with the considerably prolonged inspiration, attack cough with
much amount of viscid phlegm which is badly deleted. Skinis pale, cyanosys of
lips, nasolips triangle, acro- or general cyanosys. A thorax is emphysematous,
the excursion is limited, above lungs
percussion box sound. Plenty of the
distance wheezes in comparisone with little amount of dry wheezes, the loosened breathing in lungs.
The border of heart is not determined, are low, systolic murmur on an apex,
tachycardia. A liver is enlarged, sickly. Arterial pressure is decreased.
Help on prehospital stage
1.
Do not use of
symdatomimetics!
2.
To provide access of fresh air.
3.
To release from squeezing clothes.
4.
Oxygentherapy: moistened air through a mask.
5. 2,4
% solution of Euphyllini in dose of a 5 mg/kg of mass of intravenously
streamly on a 15 –20 ml of isotonic
solution of sodium chloride.
6.
2 % solution of No-spani a 1 mg/кг
mass on dose intramuscular.
7.
3 % solution of Prednisoloni 2-3 mg/kg
of the masses (Hydrocortisonі 10-15 mg/kg) intramuscular or intravenously
streamly.
8.
Urgent hospitalization.
Help on a hospital stage
1.
Do not use sympatomimetics!
2.
To provide access of fresh air.
3.
Oxygentherapy
optimum 40 % by the moistened oxygen constantly.
4. 3
% solution of Prednisoloni in dose 2-3 mg/kg of
the mass intravenously streamly on a 5-10 ml of isotonic
solution of sodium chloride.
5. 2
% solution of No-spani 1 mg/kg of mass on dose intramuscular or intravenously
streamly slowly.
6. Solution
of Corgliconi 0,06 % or Strophantini 0,05 % 0,1 ml per the year of life, but not more than 0,3-0,4 ml on a
5-10 ml isotonic solution of sodium chloride
intravenously streamly.
7. Cocarboxylazae
50-100 mg, 5 % solution of sodium ascorbinati 2,0-5,0 ml, Panangini 0,5 ml per
year of life of intravenously streamly in separate syringe .
8. 2,4
% solution of Euphyllini 7-10 mg/kg of
mass on a 200 ml of isotonic solution of sodium chloride intravenously
with a next continuous tranfusion on Euphyllinization
by intravenously infusion of 2,4 % solution of Euphyllini at a speed of 0,7
mg/kg/hour on isotonic solution of
sodium chloride, but not more than 24
mg/kg/day for the children upto 9 years and 20 mg/kg/day for children senior than
9 years.
9. Heparini
200-300 U/day on 4 intravenous stream injection every 6 hours.
10.
Reopoliglucini 150-200 ml
intravenously in drops.
11.
In default of effect in 2 hours o
repeate intravenous stream injection of Prednisolone 2-3 mg/kg of the masses or Hydrocortisoni 10-15 mg/kg
of mass.
12.
Alkaline drink: mineral water, 1 %
solution of soda, milk with a soda. Intravenous
injection of 4 % solution of sodium bicarbonatis only under the control
of acid – alkaline equilibrium indexes.
13.
Absence of effect after the repeated
injection of glucocorticoids testifies to transition
of the asthmatic state in the ІІ stage.
Clinic of the ІІ stage of
the asthmatic status (decompensations). Child
in consciousness, excited or apathetical. General cyanosis of skin and mucus, a
person is puffy, the veins of neck are swelling. Breathing is encreased, noisy
with the prolonged inspiration and acute downing in of interribs intervals,
supraclavicular and epigastrial areas, jugular pit with a limited excursion of
thorax. Percussion: bandbox sound. Breathing is sharply loosened with single
unsounding dry wheezes, in the lower areas of lungs breathing is not listened,
syndrome of “mute lungs”. Таhycardia, pulse of the weak filling,
unrhythmical. The tones of heart are not determined, tones are deaf. Arterial
pressure is reduced. A liver is enlarged, sickly.
Help on prehospital stage
1.
To provide access of fresh air.
2.
Oxygentherapy: moistened air through a mask.
3.
2,4 % solution of Euphyllini in dose
of a 5 mg/kg of mass intravenously
streamly on a 15-20 ml of isotonic
solution of sodium chloride.
4.
3 % solution of Prednisoloni in dose
of a 3-5 mg/kg of mass or
Hydrocortisoni 15-25 mg/kg
of mass intramuscular or intravenously
streamly.
5.
Urgent hospitalization.
Help on hospital stage
1.
To provide access of fresh air.
2.
Oxygentherapy:
optimum 40 % of the moistened oxygen constantly
through a mask.
3.
3 % solution of Prednisoloni in dose
of 3-5 mg/kg of mass or
Hydrocortisoni 15-25 mg/kg
of mass of intravenously streamly with
the
repeated introduction after 1,5-2 hours in default of effect.
4.
2 % solution of No-spani 1 mg/kg of
mass in dose intramuscular or
intravenously streamly
slowly.
5.
Solution of Corgliconi 0,06 % or
Strophantini 0,05 % in dose 0,1 ml per
the year of life, but not more than 0,3-0,4 ml
intravenously streamly on a
5-10 ml of
isotonic solution of sodium
chloride.
6.
Cocarboxylazae 50-100 mg, panangini
0,5 ml per year of life, 5 %
solution of sodium
ascorbinati 2,0-5,0 ml intravenously streamly in
separate syringes.
7.
2,4 % solution of Euphyllini 7-10
mg/kg of mass on a 200 ml of isotonic
solution of sodium chloride of intravenously in drops. If
Euphyllini was
already entered at treatment of I stage of the
asthmatic status, continue
Euphyllinization at a speed
of 0,7 mg/kg/hour on isotonic solution of
sodium chloride 50 ml/ hour.
8.
Heparini 200-300 Units/kg/days,
divided in 4 injections, every 6 hours
intravenously streamly.
9.
In default of effect after the
repeated introduction of glucocorticoids
urgent intubation with
bronchoscopy sanation and after that- artificial
ventilation.
10.
On artificial ventilation Euphyllinization
must be continued, repeat
introductions of
Prednisoloni every 1,5-2 hours in dose
of 6-10 mg/kg
of mass.
11.
Mucolitic drugs endotrachially with
the following lavagge of bronchial
tubes with bronchoscopy.
12.
Intravenously 4 % solution of sodium
bycarbonatis only under the
control of indexes acid – alkaline
equilibrium.
13.
Haemosorbtion, plazmopheresis.
It is not recommended to enter:
1.Antihistaminic drugs – Suprastini,Tavegili,
Claritini.
2.Sedative drugs – Seduxeni, Sodium oxytirati , Aminasini.
3.Drugs with ephedrini –
Solutani, Broncholitini.
4.Unselective b2- -adrenomimetics -
Astmopent, Alupent, Izadrin.
5.Prolonged b2- -adrenomimetics –
Salmeterol, Seretid.
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