Добавил:
ivanov666
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Emergency medical care at the prehospital stage. Assessment of the severity of the condition of patients. Study aid
.pdf
131
c) preservation of muscle tone;
d) inhibition of tendon reflexes;
e) loss of control over pelvic functions.
Specify the wrong answer (1).
41. The following symptoms correspond to the state of atonic coma:
a) non-excitability;
b) areflexia;
c) pathological respiratory rhythms with apnea periods;
d) preservation of protective movements;
e) loss of control over pelvic functions.
Specify the wrong answer (1).
42. Irritated meninges syndrome can be observed under the following cir-
cumstances:
a) subarachnoid hemorrhage;
b) ischemic cerebral circulation disorders;
c) viral or bacterial meningitis;
d) individual forms of viral encephalitis.
Please enter the correct answer (1).
43. If the patient has a deep coma, the severity of his condition should be
regarded as:
a) satisfactory;
b) moderate severity;
c) heavy;
d) extremely heavy;
e) terminal.
Please enter the correct answer (1).
44. If the patient has an atonic coma, his condition should be regarded as:
a) satisfactory;
b) moderate severity;
c) heavy;
d) extremely heavy;
e) terminal.
Please enter the correct answer (1).
132
45. If the patient has a deep stun or sopor, his condition should be regard-
ed as:
a) satisfactory;
b) moderate severity;
c) heavy;
d) extremely heavy;
e) terminal.
Please enter the correct answer (1).
46. Specify objective methods for assessing the severity of pain syndrome:
a) visual analog scale;
b) assessment of pain syndrome intensity in points;
c) are absent.
Specify the wrong answer (1).
47. Signs of severe dehydration include:
a) thirst;
b) dry skin;
c) arterial hypotension;
d) oligurium;
e) edema.
Specify the wrong answer (1).
48. Signs of hyperhydration include:
a) weight gain;
b) edema;
c) increase of HPC;
d) HPC reduction;
e) shortness of breath.
Please enter 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 enter the correct answer (1).
133
50. Reduction of BCC in hypovolemic shock entails changes such as:
a) falling cardiac output;
b) reflex reduction of HR;
c) reducing the filling pressure of the right heart;
d) reduction of HPC;
e) reduction of systemic BP.
Please enter the correct answer (1).
Answers
1. d
2. d
3. b
4. а
5. d
6. c
7. d
8. d
9. d
10. c
11. c
12. e
13. d
14. b
15. d
16. b
17. c
18. d
19. c
20. e
21. c
22. а
23. d
24. d
25. d
26. c
27. а
28. b
29. c
30. c
31. d
32. а
33. а
34. b
35. а
36. c
37. e
38. а
39. b
40. c
41. d
42. b
43. d
44. e
45. c
46. с
47. e
48. d
49. b
50. b
QUESTIONS AND OBJECTIVES
1. How many clinical signs are evaluated in ShH?
2. What clinical signs are evaluated in ShH?
3. What is the minimum (unfavorable) possible score in the lung injury scale
(1988)?
4. What is ODN?
5. What is an early symptom of ODN?
6. How is the early symptom of ODN subjectively manifested?
7. How should the ventilation ODN be rated by severity if the PaCO2 is <
< 50 mmHg?
8. How should the ventilation ODN be rated by severity if PaCO2 = 51–
69 mmHg?
9. How should the ventilation ODN be rated by severity if PaCO2 > 70 mmHg?
10. What is the clinical manifestation of decompensation of ventilation ODN,
which will develop at PaCO2 = 90–140 mmHg?
11. How to consider the severity of parenchymal ODN if PaO2 = 60–79 mmHg
(SpO2 = 90–94 %)?
12. How to consider the severity of parenchymal ODN if PaO2 = 40–59 mmHg
(SpO2 = 76–89 %)?
13. The severity of parenchymal ODN should be considered if the PaO2 <
< 40 mmHg (SpO2 ≤ 75 %)?
134
14. Name the clinical manifestation of decompensation of parenchymal ODN,
which will develop in stage III of ODN. PaO2 39–30 mmHg.
15. The patient is conscious, complains about the feeling of lack of air, worried, asthenic. The skin is pale, moist, a small acrocyanosis of visible mucous membranes. Heart rate up to 30 per minute, heart rate up to 110 bpm, BP is normal or
slightly increased, PaO2 decreases to 70 mmHg, PaCO2 reduced due to compensatory
shortness of breath. What stage of ODN corresponds to the given clinical picture?
16. The patient complains of pronounced suffocation, the development of psychomotor arousal, impaired consciousness, delirium, hallucinations is possible. The
skin is wet, cyanotic, often in combination with hyperemia. HR 30–40 per minute,
HR 120–140 bpm, often arrhythmia, hypertension is recorded, PaO2 decreases to
60 mmHg, PaCO2 rises to 50 mmHg. What stage of ODN corresponds to the given
clinical picture?
17. Consciousness is darkened or absent, the development of convulsive
syndrome due to brain hypoxia is possible, there is spotted cyanosis, hypoxic dilation
of the pupil with no reaction to light. When the process progresses, tachypnea
(HP > 40 per minute) changes to bradypnea (HP < 8 per minute). Hypotension, tachyarrhythmia, PaO2 decreases to 50 mmHg and below, PaCO2 increases to 90 mmHg
and above. What stage of ODN corresponds to the given clinical picture?
18. On what scale does most countries currently initially assess the severity of
damage when a victim with polytrauma is admitted to the hospital?
19. What is the ISS score of injured who have a severe injury with a risk
to life?
20. In which anatomical areas of the human body does the Hanover polytrauma
severity scale (PTS) assess damage?
21. How many estimated parameters does the Mainz emergency assessment
scale use?
22. List the estimated parameters of the Mainz emergency assessment scale.
23. What is the gradation of parameter deviation levels in the Mainz emergency assessment scale?
24. What is the minimum score on the Mainz emergency assessment scale?
25. What is the maximum score on the Mainz emergency assessment scale?
26. Define sepsis (adopted in 2017 by the European Society of Intensive Care
Medicine and the Society of Critical Care Medicine).
27. When should the patient be looked at and the likelihood of sepsis assessed
on an expanded SOFA scale?
28. When is it eligible to make a diagnosis of “sepsis”?
135
29. Define septic shock (adopted in 2017 European Society of Intensive Care
Medicine и Society of Critical Care Medicine).
30. How does mortality change when septic shock develops compared
to sepsis?
31. In the presence of what criteria does the probability of in-hospital death exceed 40 %?
32. Specify the criteria for systemic inflammatory response syndrome on the
CCBO/SIRS scale.
33. How many indicators are used in the assessment scale of the condition of
patients and injured (2019)?
34. What indicators are used in the assessment scale of the condition of patients
and injured (2019)?
35. Is it possible to use the assessment scale of the condition of patients and injured (2019) in the absence of a pulse oximeter?
36. What gradation of conditions is determined by the assessment scale of the
condition of patients and injured (2019)?
37. What condition will correspond to the sum of points 5 on the assessment
scale of the condition of patients and injured (2019)?
38. What should be the sum of the scores on the assessment scale of the condition of patients and injured (2019) in order to determine the condition as serious?
39. What is the maximum value of the sum of points in the assessment scale of
the condition of patients and injured (2019)?
40. How is the clock drawing test done to assess the mental state of the patient?
Outline the procedure.
41. How are errors assessed when performing a clock drawing test to assess
a patient's mental state?
42. In what range can the results of the clock drawing test vary to assess the
mental state of the patient?
43. What does the 18 points of the clock drawing test correspond to to assess
the mental state of the patient?
Answers
1. Three.
2. Eye opening, verbal response, motor response.
3. 3.
4. Acute respiratory (respiratory) failure (ODN) is a rapidly increasing (development time of several minutes/days) serious pathological condition of the patient,
136
due to the inconsistency of the external breathing 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 due to increased work of the respiratory and circulatory
systems, which leads to a decrease and subsequent depletion of the body's functional
capabilities.
5. Shortness of breath.
6. An early symptom of ODN is subjectively manifested by a feeling of lack of
air or difficulty breathing, while the frequency, rhythm and depth of breathing, accompanied by an increase in the work of the respiratory muscles, change.
7. Grade I (moderate).
8. Grade II (expressed).
9. Grade III (severe).
10. Hypercapnic coma.
11. Grade I (moderate).
12. Grade II (expressed).
13. Grade III (severe).
14. Hypoxemic coma.
15. Stage I ODN.
16. Stage II ODN.
17. Stage III ODN.
18. On the AIS scale.
19. ISS scale scores are greater than 30 points.
20. Skull, chest, abdomen, pelvis, limbs.
21. Seven.
22. Glasgow score, HR, HR, heart rate, pain, BP, SpO2.
23. Physiological value (norm), moderate deviation, significant deviation, lifethreatening deviation.
24. 8 points.
25. 28 points.
26. Sepsis — a life-threatening organ dysfunction caused by the host's dysregulatory response to infection.
27. If there are 2 or more qSOFA scores or if sepsis is still suspected.
28. If there are 2 or more points on the expanded SOFA scale.
29. Septic shock — a subspecies of sepsis, which is based on impaired circulation, and pathological changes in cells and metabolism are deep enough to significantly increase mortality.
30. It increases significantly: 40 against 10 %.
137
31. Persistent hypotension requiring vasopressors to maintain mean BP ≥
≥ 65 mmHg, lactate level > 2 mmol/L, despite adequate infusion 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, pulse rate, BP, capillary filling test, respiratory
rate and/or pulse oximetry.
35. Maybe.
36. Satisfactory, moderate, severe, critical, agonal.
37. Satisfactory.
38. 11–15 points.
39. 25.
40. The patient is provided with a clean sheet of unlined paper and a pencil. Instructions are given: please draw a round clock with numbers on the dial so that the
hands of the clock show without fifteen two. The patient must draw a circle on his
own, put all 12 numbers in the right places and draw arrows pointing to the right positions.
41. Errors are quantified on a 10-point scale.
42. The results of the clock drawing test to assess the mental state of the patient
can range from 0 to 18 points.
43. The 18 points correspond to the highest cognitive abilities.
138
BIBLIOGRAPHY
1. Alexandrovich, Yu.S. Assessment and prognostic scales in the medicine
of critical conditions / Yu.S. Alexandrovich, V.I. Gordeev. — Saint Petersburg : Sotis. — 2007. — 140 p.
2. Tests through the eyes of resuscitator Yu.Yu. Sapichev / edited by
A.M. Ovezov. — 5th edition. — Moscow : MEDpress-inform, 2019. — 224 p.
3. Anesthesiology : national leadership / edited by A.A. Bunyatyan, V.M. Mizikova. — Moscow : GEOTAR-Media, 2011. — 1104 p.
4. Anesthesiology / edited by M.S. Vetsheva, A.R. Aitkenhead, G. Smith. —
Moscow : Reed Elsiver, 2010. — 848 p.
5. Diagnostics in anesthesiology and intensive care : guide for doctors / edited
by V.A. Koryachkin, V.L. Emanuel, V.I. Strashnov. — Saint Petersburg : SpetsLit,
2011. — 414 p.
6. Intensive care : national leadership : in 2 volumes / edited by B.R. Gelfand,
A.I. Saltanov. — Moscow : GEOTAR-Media, 2011. — 960 p.
7. Intensive care : national guide / Federation of Anesthesiologists and Resuscitators ; Russian Association of Specialists in Surgical Infections ; edited by B.R. Gelfand, I.B. Zabolotsky. — 2nd edition, rev. and additional. — Moscow : GEOTARMedia, 2019. — 923 p.
8. Intensive care / translation from English by P.L. Marino. — Moscow :
GEOTAR-Media, 2010. — 786 p.
9. Morgan, J.E. Clinical Anesthesiology / J.E. Morgan, S.M. Magid. — Moscow : BINOM, 2011. — 457 p.
10. Cardiology : national leadership / Russian Cardiological Society ; edited by
Academician of the Russian Academy of Sciences E.V. Shlyakhto. — 2nd edition,
rev. and additional. — Moscow : GEOTAR-Media, 2019. — 815 p.
11. Vyalov, S.S. Cardiology: polyclinic care / S.S. Vyalov. — 2nd edition, rev.
and additional. — Moscow : Smart Doctor, 2019. — 224 p.
12. Kuznik, B.I. Cellular and molecular mechanisms of regulation of the hemostasis system in normal and pathology / B.I. Kuznik. — Chita : Express Publishing
House, 2010. — 832 p.
13. Kutyreva, Yu.G. Comatose states. Intensive therapy of comatose conditions : textbook / Yu.G. Kutyreva, I.G. Trukhanova. — Samara : Tactical Studio,
2013. — 176 p.
14. Computed tomography in emergency medicine / edited by S. Mirsadre,
C. Mankad, E. Chalmers. — Moscow : BINOM, 2013. — 239 p.
139
15. Borschoff, D.S. Critical situations in anesthesiology : practical guidance /
D.S. Borschoff ; edited by M.S. Danilov, K.M. Lebedinsky. — Moscow : GEOTARMedia, 2019. — 79 p.
16. Lectures on traumatic brain injury : textbook / edited by V.V. Krylov. —
Moscow : Medicine, 2010. — 320 p.
17. Lichterman, L.B. Concussion: treatment tactics and outcomes / L.B. Lichterman, A.D. Kravchuk, M.M. Filatova // Analyses of clinical and experimental neurology. — 2008. — Vol. 2. — № 1. — P. 12–21.
18. Makarevich, S.V. Spondylodez with a universal fixator of the thoracic
and lumbar spine : a manual for doctors / S.V. Makarevich. — Minsk : UNIPAK,
2001. — 80 p.
19. Krylov, V.V. Neuroreanimation : practical guide / V.V. Krylov, S.S. Petrikov. — Moscow : GEOTAR-Media, 2010. — 176 p.
20. Emergency care in a therapeutic clinic : textbook / edited by A.V. Gordienko. — Saint Petersburg : SpetsLit, 2017. — 229 p.
21. Trufanov, G.E. Emergency ultrasound diagnostics : textbook / G.E. Trufanov, V.V. Ryazanov, V.M. Cheremisin. — Saint Petersburg : ELBI-SpB, 2014. —
159 p.
22. General and emergency surgery : guidance / edited by S. Paterson-Brown. —
Moscow : GEOTAR-Media, 2010. — 378 p.
23. Izmailov, E.P. Providing first aid to patients and injured in domestic conditions : textbook / E.P. Izmailov, I.G. Trukhanova, A.V. Tsybin. — Samara : Publishing house SamGMU, 2019. — 118 p.
24. Goryachev, A.S. Fundamentals of mechanical ventilation / A.S. Goryachev,
I.A. Savin. — Moscow : MD, 2012. — 254 p.
25. Acute abdominal pathology / edited by D. Kline, L.G. Stead. — Moscow :
BINOM, 2013. — 291 p.
26. Izmailov, E.P. Acute surgical abdominal diseases in the practice of providing emergency medical care at the prehospital stage : textbook / E.P. Izmailov,
I.G. Trukhanova, L.V. Pyscheva. — Samara : Publishing house SamGMU, 2019. —
146 p.
27. Otorhinolaryngology : national leadership / Russian Society of Otorhinolaryngologists ; editor-in-chief V.T. Palchun. — Moscow : GEOTAR-Media,
2020. — 1012 p.
28. Practical cardioanesthesiology / edited by F.A. Hensley. — 5th edition. —
Moscow : MIA, 2017. — 1083 p.
140
29. Emergency medical services : national guidance / Association of Medical
Societies on Quality ; edited by S.F. Bagnenko, M.Sh. Khubutia, A.G. Miroshnichenko. — Moscow : GEOTAR-Media, 2018. — 886 p.
30. Handbook of emergency conditions / translation from English by P. Ramrakh, C. Moore. — Moscow : GEOTAR-Media, 2010. — 762 p.
31. Skaletta, T. Emergency injury. Spine / T. Skaletta, D. Scheider ; edited by
Academician of the Russian Academy of Sciences S.P. Mironov. — 2nd edition. — Moscow : MIA, 2006. — P. 165–199.
32. Matsas, A. Ultrasound in intensive care and anesthesiology / A. Matsas. —
Moscow : MEDpress-inform, 2019. — 128 p.
33. Volkov, V.S. Emergency diagnosis and treatment in emergency cardiology :
guide for physicians / V.S. Volkov. — Moscow : MIA, 2010. — 333 p.
34. Bykov, Yu.V. Electroconvulsive therapy in the practice of an anesthesiologist : scientific and practical manual / Yu.V. Bykov. — Moscow : RIOR : INFRA-M,
2020. — 221 p.
35. Balk, R. Pathogenesis and management of multiple organ dysfunction or
failure in severe sepsis and septic shock / R. Balk // Crit Care Clin. — 2000. —
№ 16. — P. 337–352.
36. The mortality index for neonatal transportation score: a new mortality prediction model for retrieved neonates / S.J. Broughton, A. Berry, S. Jacobe [et al.] //
Pediatrics. — 2004. — № 4. — P. 424–428.
37. The pediatric risk of hospital admission score: a second-generation severity-of-illness score for pediatric emergency patients / J.M. Chamberlain, M. Kantilal,
K.M. Patel [et al.] // Pediatrics. — 2005. — № 2. — P. 388–395.
38. Ferrara, A. Neonatal stabilization score. A quantitative method of auditing
medical care in transported newborns weighing less than 1 000 G at birth / A. Ferrara,
Y. Atakent // Medical Care. — 1986. — № 24. — P. 179–187.
39. Gray, J.E. Neonatal therapeutic intervention scoring system: a therapybased severity-of-illness index / J.E. Gray, D.K. Ricahardson // Pediatrics. —
1992. — № 90. — P. 561–567.
40. Hennes, H.J. Beurteilung des notfallpatienten mit dem Mainz emergency
evaluation score MEES / H.J. Hennes, T. Reinhardt, W. Dick // Notfallmedizin. —
1992. — № 18. — P. 130–136.
41. Hren, T. Does the Mainz emergency evaluation scoring (MEES) in combination with capnometry (MEESc) help in the prediction of outcome in major trauma /
T. Hren, S. Grmec, M. Golub // Critical Care. — 2004. — № 8. — P. 139.
Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]