Assessment of the severity of the condition of patients in the provision of emergency therapeutic and surgical medical care at the prehospital stage.

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LIST OF ABBREVIATIONS

AV malformation — arteriovenous malformation BP — blood pressure

HIV — human immunodeficiency virus ICP — intracranial pressure

DBP — diastolic blood pressure

PAWP — pulmonary artery wedge pressure DKA — diabetic ketoacidosis

DN — respiratory failure

Gastrointestinal tract — gastrointestinal tract ZMS — closed cardiac massage

IVL — artificial lung ventilation

INR — international normalized relations AKI — acute renal failure

ARVI — acute respiratory viral infection ICU — intensive care unit

ICU — intensive care ward MOF — multiple organ failure

RDS — respiratory distress syndrome RO — intensive care unit

SBP — systolic blood pressure

CPR — cardiopulmonary resuscitation SMOD — multiorgan dysfunction syndrome SOPL — acute lung injury syndrome

AIDS — acquired immunodeficiency syndrome SIRS — systemic inflammatory response syndrome CVS — cardiovascular system

PE — pulmonary embolism

UFSHO — Original simplified physiological disorders rating scale HR — heart rate

RR — respiratory rate

CNS — central nervous system CRP — C-reactive protein CSF — cerebrospinal fluid

GOS — Glasgow outcome scale GCS — Glasgow coma scale

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A-a-DO2 — alveolar-arterial oxygen tension gradient ALT — alanine aminotransferase

AST — aspartate aminotransferase

BIPAP — biphasic positive airway pressure — ventilation of the lungs with two phases of positive pressure

BUN — blood urea nitrogen

FiO2 — inspiratory oxygen fraction ICU — intensive care unit

PaO2 — partial oxygen tension of arterial blood PEEP — positive end-expiratory pressure

PT — prothrombin time

PTT — partial thromboplastin time

SpO2 — oxygen saturation of capillary blood

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INTRODUCTION

When providing care to sick and injured people at the prehospital stage, timeliness, adequacy, efficiency and continuity between all rescue structures are of great importance. In some cases, to provide effective assistance, special means may be required to extract injured from the rubble or mangled technical equipment. The first minutes after damage and accident are of great importance. At these moments, the surrounding people, rescuers and medical workers nearby provide first aid. Precisely first aid, and not any other help. Naturally, a resuscitator or surgeon will provide such assistance much more effectively than just a rescuer who has completed courses or training in providing first aid to injured. Rescuers must provide such assistance in strict accordance with the knowledge they have acquired in providing first aid, which is clearly regulated by Federal Law of November 21, 2011, № 323-FZ.

In this case, assessing the severity of the condition of patients and injured, correct diagnosis of pathological changes and traumatic injuries is of great importance. It is the initial examination of patients that is crucial in providing first aid and all subsequent measures. When providing first aid, it is necessary to identify all possible dangers for both yourself and the victim, and quickly call an emergency medical team (EMS) to the scene of the incident. Before the ambulance arrives, the victim should be protected from the continuation of dangerous influences, using available means to stop bleeding from wounds, immobilize limb fractures, clear the airways of foreign bodies, and give the patient the most comfortable body position depending on the identified injuries. In cases of cardiac arrest or respiratory arrest, patients should undergo cardiopulmonary resuscitation until the arrival of emergency medical services or the appearance of signs of biological death according to the approved rules.

Terms and definitions

Patient is an individual who is receiving medical care or who has applied for medical care, regardless of the presence or absence of a disease.

A victim is an individual who has received damage from various types of energy.

The severity of the patient's condition is determined by the risk of complications and death: the higher the risk, the more severe the patient's condition.

Assessing the severity of a condition is the process of identifying signs of decompensation of vital functions according to generally accepted criteria (scales): breathing, blood circulation, functioning of the central nervous system.

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A threatening (urgent) condition is a condition in which there is decompensation of the vital functions of the body (respiration, circulation, nervous system) or there is an immediate danger of its occurrence.

Types of assistance at the prehospital stage

First aid is provided by the injured themselves in the form of self and mutual assistance, or by all people surrounding the victim: rescuers, special units, firefighters, police, transport services, students of all educational institutions, volunteers and paramedics, paramedics, nurses and doctors of all specialties, if they do not have the necessary medicines and medical equipment.

Providing first aid is regulated by order of the Ministry of Healthcare and Social Development of May 4, 2012, № 477n “On approval of the List of conditions for which first aid is provided and the List of measures for providing first aid”.

Medical care is provided by people who have nursing or medical education with valid specialist certificates or accreditation if they have the necessary medicines and medical equipment in the amount of approved emergency medical equipment or emergency equipment (Appendix).

Medical care by specialized teams is provided by a team of specialist doctors who have a medical education with valid specialist certificates or have received accreditation in a specially equipped vehicle equipped with everything necessary to provide specialized care outside the hospital (an intensive care unit, an operating room on a vehicle, an airplane, a boat, etc.).

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1. ASSESSMENT OF THE SEVERITY

OF THE CONDITION OF PATIENTS AND INJURED

The stages of assessing the severity of the condition of patients and injured are applied to any patient and injured when providing first aid or medical care at the prehospital level.

General assessment of the condition of patients and injured

It is carried out during the first examination of the patient by a rescuer, paramedics or a doctor. a person threatening his life, for carrying out effective medical measures and timely delivery to an emergency hospital.

It is performed with the patient sitting or lying down, depending on the general condition.

The assessment sequence is based on the principles of “Safar alphabet”:

A — Airways — airway patency. B — Breating — breathing.

C — Circulation — blood circulation.

D — Disability — legal capacity (neurological status).

E — Exposure — appearance (temperature, skin, mucous membranes, presence of injuries, etc.).

The assessment method is visual (exclusively by examining the patient).

It is carried out according to the rule of examining three main body systems: a) appearance:

–assessment of consciousness;

–skin coloring;

–damage to the skin;

–deformation of skeletal bones and pathological mobility;

–flabbiness or muscle tension, cramps;

–active or passive movements of the limbs;

–stability when standing and walking;

–impaired sensitivity of the skin, pain sensitivity;

–disturbances of the sense organs — hearing, vision, taste, smell;

–skin temperature or rectal temperature;

b) breathing:

–whether there is breathing;

–whether the airways are passable;

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