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

c)preservation of muscle tone;

d)inhibition of tendon reflexes;

e)loss of control over pelvic functions.

Please indicate the error (1).

41.The following symptoms correspond to the state of atonic coma: a) inability to wake up;

b) areflexia;

c) pathological respiratory rhythms with periods of apnea; d) maintaining defensive movements;

e) loss of control over pelvic functions.

Please indicate the error (1).

42.Irritable meninges syndrome can occur under the following circum-

stances:

a) subarachnoid hemorrhage;

b) ischemic disorders of cerebral circulation; c) viral or bacterial meningitis;

d) certain forms of viral encephalitis.

Please indicate the correct answer (1).

43.If a patient has a deep coma, the severity of his condition should be assessed as:

a) satisfactory;

b) moderate severity; c) heavy;

d) extremely severe; d) terminal.

Please indicate the correct answer (1).

44.If a patient has an atonic coma, his condition should be assessed as:

a)satisfactory;

b)moderate severity;

c)heavy;

d)extremely severe; е) terminal.

Please indicate the correct answer (1).

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45.If the patient has deep stupor or stupor, his condition should be assessed as:

a) satisfactory;

b) moderate severity; c) heavy;

d) extremely severe; е) terminal.

Please indicate the correct answer (1).

46.Specify objective methods for assessing the severity of pain:

a)visual analogue scale;

b)assessment of pain intensity in points;

c)are absent.

Please indicate the error (1).

47.Signs of severe dehydration include: a) thirst;

b) dry skin;

c) arterial hypotension; d) oliguria;

е) swelling.

Please indicate the error (1).

48.Signs of overhydration include:

a)increase in body weight;

b)swelling;

c)increase in central venous pressure;

d)decrease in central venous pressure; е) shortness of breath.

Please indicate the correct answer (1).

49. Severe dehydration corresponds to fluid loss:

a)5–10 %;

b)more than 10 %;

c)5–6 %;

d)2–4 %.

Please indicate the correct answer (1).

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50. A decrease in blood volume during hypovolemic shock entails changes such as:

a)drop in cardiac output;

b)reflex decrease in heart rate;

c)decrease in filling pressure of the right heart;

d)decrease in central venous pressure;

e)decrease in systemic blood pressure.

Please indicate the correct answer (1).

Answers

4.2.TASKS FOR MONITORING THE LEVEL OF KNOWLEDGE

1.How many clinical signs are assessed in the Glasgow coma scale?

2.What clinical signs are assessed in the Glasgow coma scale?

3.What is the minimum (unfavorable) possible score on the Lung damage scale (1988)?

4.What is acute respiratory failure?

5.What is an early symptom of ARF?

6.How does the early symptom of ARF manifest itself subjectively?

7.How should a ventilation ARF be assessed according to severity, if PaСO2 < 50 mmHg?

8. How should ventilation ARF be assessed by severity if PaСO2 = 51–

69mmHg?

9.How should a ventilation ARF be assessed according to severity if PaСO2 > 70 mmHg?

10.Name the clinical manifestation of decompensation of ventilation ARF, which will develop at PaСO2 = 90–140 mm Hg.

11.How should the severity of parenchymal ARF be assessed if PaСO2 = 60–

79mmHg (SpO2 = 90–94 %)?

12.How should the severity of parenchymal ARF be assessed if PaСO2 = 40–

59mmHg (SpO2 = 76–89 %)?

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13. How should the severity of parenchymal ARF be assessed if PaСO2 <

<40 mmHg (SpO2 ≤ 75 %)?

14.Name the clinical manifestation of decompensation of parenchymal ARF, which will develop in stage III ARF. PaO2 39–30 mmHg.

15.The patient is conscious, complains of a feeling of lack of air, is restless, and asthenic. The skin is pale, moist, slight acrocyanosis of visible mucous membranes. RR up to 30 per minute, heart rate up to 110 per minute, blood pressure is normal or slightly increased, PaO2 decreases to 70 mm Hg, PaСO2 is reduced due to compensatory shortness of breath. What stage of ARF corresponds to the given clinical picture?

16.The patient complains of severe suffocation, possible development of psychomotor agitation, impaired consciousness, delirium, and hallucinations. The skin is moist, cyanotic, often combined with hyperemia. RR 30–40 per minute, heart rate 120–140 per minute, often arrhythmia, hypertension is recorded, PaO2 decreases to 60 mmHg, PaCO2 rises to 50 mmHg. What stage of ARF corresponds to the given clinical picture?

17.Consciousness is clouded or absent, convulsive syndrome may develop due to brain hypoxia, spotty cyanosis is observed, hypoxic pupil dilation with lack of reaction to light. As the process progresses, tachypnea (RR > 40 per minute) turns into bradypnea (RR < 8 per minute). Hypotension, tachyarrhythmias are observed, PaO2 decreases to 50 mmHg and below, PaCO2 rises to 90 mmHg and higher. What stage of ARF corresponds to the given clinical picture?

18.What scale is currently used in most countries to first assess the severity of injury when a patient with polytrauma is admitted to the hospital?

19.What is the ISS score for injured with severe life-threatening injuries?

20.In what anatomical areas of the human body does the Hannover polytrauma severity scale (PTS) determine the assessment of damage?

21.How many assessment parameters does the Mainz emergency rating

scale use?

22.List the assessed parameters of the Mainz emergency condition rating

scale?

23.What is the gradation of levels of parameter deviation in the Mainz emergency condition assessment scale?

24.What number of points corresponds to the minimum score on the Mainz emergency rating scale?

25.What number of points corresponds to the maximum score on the Mainz emergency rating scale?

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26.Define sepsis (adopted in 2017 by the European Society of Intensive Care Medicine and Society of Critical Care Medicine).

27.When should a patient be assessed for sepsis using the expanded SOFA

score?

28.When is it appropriate to make a diagnosis of sepsis?

29.Define septic shock (adopted in 2017 by the European Society of Intensive Care Medicine and Society of Critical Care Medicine). How does mortality change with the development of septic shock compared to sepsis?

31.Under what criteria does the probability of in-hospital death exceed 40 %?

32.Specify the criteria for systemic inflammatory response syndrome according to the SIRS/SIRS scale.

33.How many indicators are used in the Rating scale for the condition of sick and injured (2019)?

34.What indicators are used in the Rating scale for the condition of sick and injured (2019)? Name them.

35.Is it possible to use the Rating scale for the condition of sick and injured (2019) in the absence of a pulse oximeter?

36.What gradation of conditions is determined by the Rating scale for the condition of patients and injured (2019)?

37.What condition will correspond to the sum of points 5 on the Rating scale for the condition of sick and injured (2019)?

38.What should be the sum of points on the Rating scale for the condition of sick and injured (2019) to determine the condition as severe?

39.What is the maximum value of the sum of points in the Rating scale for the condition of sick and injured (2019)?

40.How is the clock drawing test to assess the mental state of the patient carried out? Outline the procedure.

41.How are errors assessed when performing the clock drawing test to assess the mental state of a patient?

42.In what range can the results of the clock drawing test to assess a patient’s mental state vary?

43.What do 18 points of the clock drawing test to assess a patient’s mental state correspond to?

Answers

1.Three.

2.Eye opening, verbal response, motor response.

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3.3.

4.Acute respiratory (respiratory) failure (ARF) — a rapidly increasing (development time of several minutes/days) severe pathological condition of the patient, caused by a mismatch of the external respiration system with the metabolic needs of the body to maintain normal partial tension of oxygen and carbon dioxide in the arterial blood, or it is achieved through increased work of the respiratory and circulatory systems, which leads to a decrease and subsequent depletion of the body’s functional capabilities.

5.Dyspnea.

6.An early symptom of ARF is subjectively manifested by a feeling of lack of air or difficulty breathing, while the frequency, rhythm and depth of breathing change, accompanied by an increase in the work of the respiratory muscles.

7.Grade I (moderate).

8.Grade II (pronounced).

9.Grade III (severe).

10.Hypercapnic coma.

11.Grade I (moderate).

12.Grade II (pronounced).

13.Grade III (severe).

14.Hypoxemic coma.

15.Stage I of ARF.

16.Stage II of ARF.

17.Stage III of ARF.

18.On the AIS scale.

19.ISS scale indicators are more than 30 points.

20.Skull, chest, abdomen, pelvis, limbs.

21.Seven.

22.Glasgow scale score, heart rate, respiratory rate, heart rate, pain, blood pressure, SpO2.

23.Physiological value (norm), moderate deviation, significant deviation, lifethreatening deviation.

24.8 points.

25.28 points.

26.Sepsis is a life-threatening organ dysfunction caused by a disregulatory response of the host body to infection.

27.If there are ≥ 2 points on qSOFA or suspicion of sepsis remains.

28.If there are ≥ 2 points on the expanded SOFA scale.

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29.Septic shock is a subtype of sepsis, which is based on impaired circulation, and pathological changes in cells and metabolism are profound enough to significantly increase mortality.

30.Increases significantly: 40 versus 10 %.

31.Persistent arterial hypotension requiring the use of vasopressors to maintain mean arterial pressure ≥ 65 mmHg, lactate level > 2 mmol/L, despite adequate fluid therapy.

32.Body temperature more than 38 or less than 36 °С; HR greater than 90 bpm; tachypnea, or NPV greater than 20 respiratory movements per minute, or PaCO2 less than 32 mmHg; white blood cells greater than 12 000 cells/mm3, or less than 4 000 cells/mm3, or more than 10 % of immature neutrophil forms.

33.Five.

34.Glasgow consciousness scale, pulse rate, blood pressure, capillary refill test, respiratory rate and/or pulse oximetry.

35.Perhaps.

36.Satisfactory, moderate, severe, critical, agonal.

37.Satisfactory.

38.11–15 points.

39.25.

40.The patient is given a blank sheet of unlined paper and a pencil. Instructions are given: please draw a round clock with numbers on the dial so that the clock hands show fifteen minutes to two. The patient must independently draw a circle, put all 12 numbers in the correct places and draw arrows pointing to the correct positions.

41.Errors are quantified on a 10-point scale.

42.Results of the clock drawing test to assess the mental state of the patient can vary from 0 to 18 points.

43.18 points correspond to the highest cognitive abilities.

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