Collapse

Description:

Collapse — the acute vascular insufficiency which is characterized by sharp decrease in the ABP owing to falling of a vascular tone, reduction of cordial emission or as a result of acute reduction of volume of the circulating blood. The collapse is followed by a hypoxia of all fabrics and bodies, decrease in a metabolism, oppression of the vital functions of an organism.

Collapse symptoms:

The clinical picture of a collapse has the features depending on its reason, but on the main manifestations it is similar at collapses of various origin. Patients complain of the arisen and quickly progressing weakness, dizziness, a chill, sight easing, a sonitus, sometimes feeling of melancholy and fear. Consciousness of the patient is kept, but in most cases he is indifferent to surrounding. Skin is sharply pale, the face of earthy color, is covered with a cold clammy sweat, at a cardiogenic collapse cyanosis is quite often noted. Body temperature is reduced. Shallow breathing, is speeded up. Pulse is small, soft, speeded up.

By the ABP it is lowered: systolic — to 80 — 60, diastolic — to 40 mm of mercury. below (at persons with the previous hypertensia the picture of a collapse can be observed at higher rates of the ABP). Practically in all cases the pachemia, an oliguria, quickly accruing azotemia are noted. When deepening a collapse at the patient consciousness is darkened (or progress) disturbances of a cordial rhythm often join; pupils extend, reflexes disappear. If effective treatment is not carried out, there comes death.

The cardiogenic collapse is usually combined with heart arrhythmia, a fluid lungs or signs of acute right ventricular insufficiency (for example, at a thromboembolism of pulmonary arteries), proceeds hard. The orthostatic collapse arises only at vertical position of a body and is quickly stopped after transfer of the patient in a prone position.

The infectious collapse most often develops in time of critical decrease in body temperature; at the same time humidity of skin, as a rule, of all body (the got wet linen), the expressed hypotonia of muscles, pulse soft is noted.

The toxic collapse, especially at poisonings, is combined quite often with nausea, vomiting, a diarrhea, symptoms of dehydration of an organism and an acute renal failure.

Diagnosis of a collapse is based in a characteristic clinical picture. Researches ABP in dynamics, and at a possibility also of the volume of the circulating blood, a hematocrit give an idea of its character and weight. The differential diagnosis at disorders of consciousness is carried out with a faint which differs in short duration of a loss of consciousness. It is necessary to consider that the collapse can be a component of a picture of shock at which there are deeper hemodynamic disturbances.

Collapse reasons:

Among the diverse reasons of its emergence by the most frequent are a heart trouble and vessels, especially acute (a myocardial infarction, myocarditis, a thrombembolia  of pulmonary arteries, etc.), acute blood loss and плазмопотеря (for example, at extensive burns), heavy intoxication at various poisonings and infectious diseases, disturbances of regulation of a vascular tone at shock of various origin, and also at a number of diseases of TsNS and endocrine system, at overdose of neuroleptics, ganglioblokator, sympatholytics.

Treatment of the Collapse:

Medical events have to be held urgently and intensively. Patients with the collapse which arose in extra hospital conditions have to be urgently brought in a hospital accompanied by an ambulance crew (if it did not give full effective on-site assistance) or the medics owning technology of resuscitation.

In all cases of the patient stack in horizontal position with a little raised lower extremities, cover with a blanket, subcutaneously enter 2 ml of 10% of solution caffeine-sodium benzoate. At an infectious collapse this therapy sometimes happens sufficient, at orthostatic — is always effective, but if the ABP does not tend to increase, it is necessary, as well as at collapses of other origin, performing the etiological and more developed pathogenetic therapy. Etiological treatment assumes a bleeding stop at a hemorrhagic collapse, removal of toxic substances from an organism and specific antidotal therapy at poisonings, thrombolytic therapy At an acute myocardial infarction and at a thromboembolism of pulmonary arteries, stopping of a paroxysm of a ciliary arrhythmia or other disturbances of a heart rhythm, etc.

Pathogenetic therapy includes intravenous administration of blood at a hemorrhagic collapse, plasma and blood-substituting liquids — at a pachemia at patients with toxic, infectious and any hypovolemic collapse, introduction of hypertonic salt solution of sodium chloride at a collapse against the background of pernicious vomiting and a diarrhea, and also at patients with adrenal insufficiency, along with administration of hormones of adrenal glands. If necessary it is urgent to raise the ABP intravenously kapelno enter noradrenaline or angiotensin; slower, but also more long effect injections of a phenylephine hydrochloride, Phethanolum give. In all cases oxygen therapy is shown.