Collapse

Collapse is one of the forms of acute vascular insufficiency, characterized by a sharp drop in vascular tone or a rapid decrease in the mass of circulating blood, which leads to a decrease in the venous influx to the heart, a drop in arterial and venous pressure, brain hypoxia, and inhibition of vital functions of the body.

Causes: acute infections (abdominal and typhus, meningoencephalitis, pneumonia, etc.), acute blood loss, diseases of the endocrine and nervous system (tumors, syringomyelia, etc.), exogenous intoxications (carbon monoxide poisoning, organophosphorus compounds, etc.), spinal And peridural anesthesia, orthostatic redistribution of blood (overdose of certain drugs - ganglioblokatorov, insulin, hypotensive drugs, etc.), acute diseases of the abdominal cavity (peritonitis, etc.). Collapse may be a complication of acute disruption of the contractile function of the myocardium, united by the concept of "small cardiac output syndrome" that occurs in the acute period of myocardial infarction, with a pronounced tachycardia, deep bradycardia, sinus node function disorders,

There are differences between the concepts of "collapse" and "shock." Shock, in contrast to the collapse, calls the reaction of the body to an extremely strong, especially painful, irritation accompanied by more severe disorders of vital functions of the nervous and endocrine systems, circulation, respiration, metabolic processes, and often the excretory function of the kidneys (see Shock).

Symptoms. For the most part, suddenly feelings of general weakness develop, dizziness, the patient complains of chilliness, chills, thirst; Body temperature decreased. The facial features are pointed, the extremities are cold, the skin and mucous membranes are pale with a cyanotic shade, the forehead, the whiskey, sometimes the entire body is covered with cold sweat, a small and weak pulse, usually rapid, veins asleep, blood pressure lowered. The heart is not dilated, its tones are deaf, sometimes arrythmic, breathing shallow, rapid, but, despite the shortness of breath, the patient does not suffocate, lies with a low head. Diuresis is reduced. Consciousness is preserved or darkened, the patient is indifferent to the surrounding patient, the pupils' reaction to light is weak, there are tremors in the fingers, sometimes convulsions. The volume of circulating blood is always reduced, decompensated metabolic acidosis is often determined, hematocrit is elevated. Differential diagnosis is performed with syncope, in which functional impairment is much weaker, normal blood pressure, and also with heart failure, different from orthopnea collapse, increased circulating blood volume, normal blood pressure.

Treatment is urgent. Depending on the cause - the stop of bleeding, the removal of toxic substances from the body, the use of specific antidotes, the elimination of hypoxia, etc. The patient is warmed, stacked with raised legs. Transfusion of blood substitutes (polyglucin, haemodez, reopolyglucin, saline solutions) is performed and only according to strict indications - blood components. Injection intravenously with prednisolone (60-90 mg), with insufficient effect add 1 2 ml of 1% mezatone solution or drip 1 ml of 0.2% solution of noradrenaline (with hemorrhagic collapse, vasopressor preparations are used only after recovery of blood volume), 1 -2 ml of cordiamine, 1-2 ml of 10% caffeine solution, 2 ml of 10% solution of sulfocamphocaine. With acidosis, IV solutions of sodium hydrogencarbonate (50-100 ml), 8.4% solution or 100-200 ml 4.5% solution are injected. With the syndrome of small cardiac output, antiarrhythmic drugs are used (if it is caused by arrhythmia), dopamine (drip iv 25-100-200 mg in a 5% solution of glucose or isotonic sodium chloride solution), emergency electrocardiostimulation, etc.

The prognosis is determined by the cause of collapse and the degree of vascular disorders.