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Файл:Emergency medical care at the prehospital stage. Assessment of the severity of the condition of patients. Study aid
.pdf
SECONDARY VOCATIONAL EDUCATION
____________________________________________________________________
Federal State Budgetary Educational Institution
of Higher Education «Samara State Medical University»
of the Ministry of Healthcare of the Russian Federation
E.P. Izmailov, I.G. Trukhanova, A.V. Tsybin
EMERGENCY MEDICAL CARE
AT THE PREHOSPITAL STAGE.
ASSESSMENT OF THE SEVERITY
OF THE CONDITION OF PATIENTS
Study aid
Recommended by the Educational and Methodological Department
of the publishing house as a study aid for use in the learning process
in educational institutions of secondary vocational education
in the specialties “Medical”, “Nursing”
Moskow
IPR Media
2024
UDC 616
BBK 53.0/57.8
I-99
The author's team of the Department of Anesthesiology,
resuscitation and emergency medical care IPO of the Samara State Medical
University of the Ministry of Healthcare of the Russian Federation consisting of:
Izmailov E.P. — MD, Associate Professor, Professor of the Department;
Trukhanova I.G. — MD, Professor, Head of the Department;
Tsybin A.V. — Assistant of the Department
Reviewers:
Kunafin M.S. — MD, Professor, Head of the Department of Emergency medicine
and disaster medicine with courses in thermal trauma and transfusiology of IDPO
Bashkir State Medical University of the Ministry of Healthcare of the Russian Federation;
Ershov I.V. — MD, Professor, Head of the Department of Anesthesiology
and reanimatology of the Orenburg State Medical University
of the Ministry of Healthcare of the Russian Federation
Izmailov, Evgeny Petrovich.
I-99 Emergency medical care at the prehospital stage. Assessment of the severi-
ty of the condition of patients : study aid / E.P. Izmailov, I.G. Trukhanova,
A.V. Tsybin ; Samara State Medical University. — Moskow : IPR Media,
2024. — 141 p. — Text : electronic.
ISBN 978-5-4497-2703-9
The study aid outlines the issues of assessing the condition of patients and
injured in the provision of emergency medical care at the prehospital stage. The
stages of assessing the severity of the condition of patients and injured according
to the body systems are described, the main clinical symptoms of urgent diseases and traumatic injuries are considered. The scales for assessing the severity of
the condition of patients and injured are given.
The study aid was prepared in accordance with the requirements of the
Federal State Educational Standard for Secondary Vocational Education.
The study aid was created for students of the specialties “Medical”, “Nurs-
ing”, studying the disciplines “Emergency medical care at the prehospital stage”,
“First medical care in emergency conditions”, “Provision of pre-medical medical care in emergency and extreme conditions”.
Educational electronic publication
ISBN 978-5-4497-2703-9 © Izmailov E.P., Trukhanova I.G.,
Tsybin A.V., 2024
© Samara State Medical University, 2024
© LLC Company “IPR Media”, 2024
Educational publication
Izmailov Evgeny Petrovich
Inna Georgievna Trukhanova
Tsybin Alexander Viktorovich
Editor Yu.V. Semenova
Technical editor, computer layout Е.V. Savenkova
Cover by Ya.A. Kirsanov, S.S. Siziumova, photobank Freepik
Signed for use 06.02.2024. Data volume 6 Mb.
LLC Company “IPR Media”
8 800 555 22 35 (toll-free within Russia)
E-mail: sale@iprmedia.ru
4
CONTENTS
LIST OF ABBREVIATIONS ..................................................................................... 6
INTRODUCTION ....................................................................................................... 8
1. SEVERITY ASSESSMENT STEPS FOR SICK AND INJURED ................... 11
2. PATIENT SYSTEM STUDIES TO ASSESS
THE GENERAL CONDITION OF THE PATIENT
AND PRELIMINARY DIAGNOSIS ....................................................................... 14
2.1. General patient study in terms of his physique
and anthropometric parameters ............................................................................... 14
2.2. Examination of skin and subcutaneous tissue of the patient ............................ 18
2.3. Peripheral lymph node study ............................................................................ 24
2.4. Study of patient's motor activity ...................................................................... 26
2.5. Examination of nervous system condition,
skin consciousness and sensitivity .......................................................................... 30
2.6. Examination of the state of the senses — vision, taste, hearing ...................... 40
2.7. Endocrine system study .................................................................................... 44
2.8. Bone system examination ................................................................................. 54
2.9. Respiratory system examination ...................................................................... 81
2.10. Cardiovascular system examination ............................................................... 89
2.11. Digestive system examination ........................................................................ 90
2.12. Urinary system organs examination ............................................................. 107
3. GENERAL HEALTH SCALES FOR SICK AND INJURED ....................... 110
3.1. Glasgow scale ................................................................................................. 110
3.2. Diagnosis of acute respiratory failure (ARF) ................................................. 111
3.3. Damage severity scale (ISS) .......................................................................... 112
3.4. Hanover polytrauma severity scale (PTS)...................................................... 114
3.5. Mainz emergency assessment scale ............................................................... 114
3.6. Cincinnati stroke prehospital score scale (CPSS) .......................................... 117
3.7. CCBO/SIRS systemic inflammatory response syndrome scale ..................... 117
3.8. qSOFA sepsis criteria ..................................................................................... 118
3.9. qSOFA septic shock criteria ........................................................................... 118
5
3.10. Assessment scale of the condition of sick and injured................................. 119
3.11. Clock drawing test to assess the mental state of the patient ........................ 121
KNOWLEDGE MONITORING MATERIALS .................................................. 122
Test tasks ............................................................................................................... 122
Questions and objectives ....................................................................................... 133
BIBLIOGRAPHY ................................................................................................... 138
6
LIST OF ABBREVIATIONS
AB-malformation — arteriovenous malformation
BP — blood pressure
HIV — human immunodeficiency virus
GERD — gastroesophageal reflux disease
DBP — diastolic blood pressure
DKA — diabetic ketoacidosis
DN — respiratory failure
GI — gastrointestinal tract
ZMS — closed heart massage
Mechanical ventilation — artificial ventilation of the lungs
BMI — body mass index
IR — Robinson index
CT — computed tomography
INR — international normalized relations
MRI — magnetic resonance imaging
ODN — acute respiratory failure
ONMC — cerebrovascular accident
OPN — acute renal failure
ARVI — acute respiratory viral infection
ICU — intensive care and intensive care unit
FEV — forced expiratory volume in the first second
CCC — circulating blood volume
CRR — oculocephalic reflex
PIT — intensive care unit
VED — multiple organ failure
PSV — peak expiratory rate
RDS — respiratory distress syndrome
RO — resuscitation department
SBP — systolic blood pressure
SGM — concussion
NSR — emergency medical service
AIDS — acquired human immunodeficiency syndrome
CVD — systemic inflammatory response syndrome
CCC — cardiovascular system
PE — pulmonary embolism
7
COPD — chronic obstructive pulmonary disease
CRF — chronic renal failure
TBI — traumatic brain injury
HR — heart rate
BD — respiratory rate
HPC — central venous pressure
CNS — central nervous system
ShH — Glasgow com scale
EEG — electroencephalography
A-a-DO2 — alveolar-arterial gradient by oxygen voltage
ALT — alanine aminotransferase
AST — aspartate aminotransferase
BIPAP — biphasic positive airway pressure — ventilation with two phases of
positive pressure
BUN — blood urea nitrogen
FiO2 — oxygen fraction on inhalation
PaO2 — partial tension of arterial blood oxygen
PEEP — positive end-expiratory pressure
PT — prothrombin time
PTT — partial thromboplastin time
SpO2 — oxygen saturation of capillary blood
8
INTRODUCTION
When providing assistance to patients and injured at the prehospital stage,
timeliness, adequacy, efficiency and continuity between all rescue structures are of
great importance. In some cases, special means may be required to recover injured
from debris or mangled equipment to provide effective assistance. The first minutes
after damage and accident are of great importance. At these moments, people around,
rescuers and medical workers nearby provide first aid. It is first aid, not any other.
Naturally, a resuscitation doctor or surgeon will provide such care much more effectively than just a rescuer who has completed courses or first aid training for injured.
Rescuers must carry out such assistance in strict accordance with their knowledge of
first aid, which is clearly regulated by the Federal Law of November 21, 2011,
№ 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation”.
At the same time, it is of great importance to assess the severity of the condition of patients and injured, correct diagnosis of pathological changes and traumatic
injuries. It is the initial examination of patients that is crucial in the provision of first
aid and all subsequent activities. When providing first aid, it is necessary to determine all possible dangers both for yourself and for the victim, quickly call the emergency medical team (NSR) to the scene. Before the arrival of the NSR, the victim
should be protected from the continuation of dangerous effects by improvised means
to stop bleeding from wounds, immobilize limb fractures, free the respiratory tract
from foreign bodies, give the patient the most comfortable body position for him, depending on the revealed injuries. In cases of cardiac arrest or respiratory arrest, patients should undergo cardiopulmonary resuscitation before the arrival of the NSR or
the appearance of signs of biological death according to the approved rules.
Mastering the materials of the textbook will allow you to acquire the necessary
knowledge and skills in the skillful use of scales for assessing the condition of patients and injured in clinical practice at the prehospital stage.
As a result of mastering the discipline “Emergency medical care at the prehospital stage”, students must:
1) know:
etiology and pathogenesis of emergencies;
basic vital parameters;
features of emergency diagnostics;
algorithm of the paramedic's action in case of emergency conditions at the
prehospital stage in accordance with the standards of emergency medical care;
9
principles of emergency medical care for terminal conditions at the prehospi-
tal stage;
principles of pharmacotherapy in emergency conditions at the prehospital
stage;
rules, principles and types of transportation of patients to a medical and pre-
ventive institution;
rules for filling out medical documentation;
basic sanitary and hygienic and anti-epidemic measures carried out in the
provision of emergency medical care at the prehospital stage;
2) be able to:
conduct a patient examination in emergency conditions at the prehospital
stage;
determine the severity of the patient's condition;
single out the leading syndrome;
perform differential diagnostics;
work with portable diagnostic and resuscitation equipment;
provide syndrome emergency medical care;
evaluate the effectiveness of emergency medical care;
carry out cardiopulmonary resuscitation;
monitor the main parameters of vital activity;
carry out pharmacotherapy at the prehospital stage;
determine the indications for hospitalization and transport the patient;
monitor at all stages of prehospital care;
organize the work of the emergency medical care team for patients;
train patients in self and mutual care;
provide emergency medical care for various types of damage;
3) have practical experience:
conducting a clinical examination in emergency conditions at the prehospital
stage;
determining the severity of the patient's condition and the existing leading
syndrome;
differential diagnosis of diseases;
work with portable diagnostic and resuscitation equipment;
provision of syndromic emergency medical care;
determination of indications for hospitalization and transportation of the
patient;
providing emergency medical care for various types of damage.
10
Terms and definitions
A patient is an individual who receives medical care or who has sought medical care regardless of the presence or absence of the disease.
The 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.
Assessment of the severity of the condition is the process of detecting signs
of decompensation of vital functions according to generally accepted criteria (scales):
respiration, circulation, functioning of the CNS.
A threatening (emergency) condition is a condition in which there is decompensation of 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 order of self and mutual
assistance or by all people around the victim: rescuers, special units, firefighters, police transport services, students and 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.
The provision of first aid is regulated by order of the Ministry of Health and
Social Development of May 4, 2012, № 477n “On the approval of the List of conditions in which first aid is provided and the List of first aid measures”.
Medical assistance is provided by people with nursing or medical education,
with valid certificates of specialists or with accreditation received if they have the
necessary medicines and medical equipment in the amount of approved stacking of
NSR machines or emergency stacking.
Medical assistance by specialized teams is provided by a team of specialist
doctors with medical education, with valid certificates of specialists or with accreditation received in a specially equipped vehicle equipped with everything necessary to
provide specialized assistance outside the hospital (reanimobile, operating room on
the vehicle, aircraft, boat, etc.).
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