Postresuscitatic syndrome
Contents:
Description:
The postresuscitatic disease is the disease arising at patients after holding successful resuscitation actions for an occasion of clinical death. The problem becomes more and more urgent because of increase in number of cases of successful resuscitation (revival) in patients. And resuscitation at which it is possible to recover not only adequate blood circulation and independent breath, but also full function of a brain (consciousness, physical activity, sensitivity) is considered successful. Usually resuscitation is successful on average in 15% of cases of all resuscitation, and in hospital conditions - is approximately twice more often that depends on equipment of hospital and time of the beginning of resuscitation actions (the earlier resuscitation actions are begun, the outcome is more favorable).
Symptoms of the Postresuscitatic syndrome:
Displays of a disease depend on a current stage. In a postresuscitatic disease allocate five main stages: 1-in the first 6-8 hours after successful resuscitation there comes the phase of instability of level of arterial pressure (arterial pressure often falls and does not provide a normal blood stream in fabrics - cyanosis of mucous membranes, extremities remains, puffiness of skin can appear) and independent breath - it is oppressed and becomes rare. It leads to a bigger increase of a hypoxia, it becomes the damaging element for system of a blood coagulation with emission of a large number of anticoagulative factors (it is possible to determine it by a laboratory method). For this reason heavy bleedings can be observed. Often in this stage sudden cardiac standstills and life-threatening disturbances of a heart rhythm are observed (they are revealed usually at constant monitor electrocardiographic control for such patients). 2stadiya-relative stabilization of the main functions of an organism when the level of a hypoxia does not increase that it is possible to determine in the laboratory way by the level of acid-base balance of blood and by explicit improvement of health of the patient. Also high danger of bleedings remains. Usually the amount of the urine emitted by the patient is always reduced. This phase lasts until the end of the first days of the postresuscitation period. The 3rd phase - damages of bodies - at preservation of a hypoxia appear signs of insufficient work of lungs (an asthma in the form of increase in frequency of dykhaniye), hearts (an asthma in a pose lying, big heart rate), kidneys (hypostases, accumulation in blood of products of disintegration - urea, creatinine, the high content of potassium), other bodies (there can be psychoses, bleedings). 4 phase - immunity disturbance - develop for 3-5 days and is characterized by development of various inflammatory processes - from pneumonia to sepsis. It is connected with damage of the immune status by a high hypoxia. The 5th phase - an outcome - depends on a current of the previous phases and can be favorable and adverse that connect with extent of defeat of fabrics, bodies and systems of an organism.
Reasons of the Postresuscitatic syndrome:
The main reason of a postresuscitatic disease it is considered to be deep or is long the existing hypoxia - the decrease in content of oxygen in fabrics and bodies leading to heavy pathological changes in them (from disturbance of separate functions before change of structure of fabrics and bodies).
Treatment of the Postresuscitatic syndrome:
Maintaining the patient in the initial postresuscitatic stage submits to the purposes formulated for a stage of long maintenance of life of a complex of cardiopulmonary resuscitation. An important point is simultaneity of holding diagnostic and medical actions. Diagnostic actions are supplemented with dynamic monitoring of the integrative indicators and parameters reflecting a condition of the main life support systems. For assessment of a condition of TsNS use clinical assessment of the neurologic status on the standard scales (a scale a lump of Glasgow), considering probability of medicamentous oppression of consciousness the drugs used when performing cardiopulmonary resuscitation. Existence at the patient of level of consciousness less than 8 points (a moderate coma) demonstrates heavy injury of a brain. In case of diagnosis of an ultraboundary coma (less than 3 points) damage of TsNS should be considered irreversible.
