COLLAPSE

COLLAPSE - acute vascular insufficiency, characterized by a sharp decrease in blood pressure due to a drop in vascular tone, a decrease in cardiac output, or as a result of an acute decrease in the volume of circulating blood. Collapse is accompanied by hypoxia of all tissues and organs, a decrease in metabolism, suppression of vital body functions.

Among the various causes of its occurrence are the most frequent heart and vascular diseases, especially acute ( myocardial infarction , myocarditis , pulmonary artery thromboembolism , etc.), acute blood loss and plasma loss (for example, with extensive burns), severe intoxication with various poisoning and infectious diseases, Disturbances in the regulation of vascular tone in the shock of various origins, as well as in a number of diseases of the central nervous system and the endocrine system, with an overdose of antipsychotics, ganglion blockers, sympatholytics.

The clinical picture of collapse has features that depend on its cause, but it is similar in basic manifestations to collapses of various origins. Patients complain of arisen and rapidly progressing weakness, dizziness , chilliness , blurred vision, tinnitus, sometimes a sense of anguish and fear. Consciousness of the patient is preserved, but in most cases he is indifferent to the environment. The skin is sharply pale, the face is earthy in color, covered with cold sticky sweat, with cardiogenic collapse, cyanosis is often noted. Body temperature decreased. Breathing shallow, rapid. Pulse is small, mild, rapid.

BP reduced: systolic - up to 80 - 60, diastolic - up to 40 mm Hg. Art. And lower (in persons with previous hypertension, the collapse pattern may be observed at higher BP indices). Almost in all cases, there is a thickening of the blood, oliguria, rapidly growing azotemia . With deepening of the collapse, the patient is obscured, often the heart rhythm disturbances (or progresses) are added; Pupils dilate, reflexes disappear. If there is no effective treatment, then death occurs.

Cardiogenic collapse is usually combined with cardiac arrhythmia, pulmonary edema or signs of acute right ventricular failure (for example, with thromboembolism of the pulmonary arteries), it is difficult. Orthostatic collapse occurs only in the vertical position of the body and is quickly arrested after the patient has been transferred to the prone position.

Infectious collapse most often develops during a critical drop in body temperature; At the same time, the skin's moisture is usually noted, as a rule, the whole body (soaked underwear), pronounced muscle hypotension, soft pulse .

Toxic collapse, especially when poisoning, is often combined with nausea, vomiting, diarrhea, signs of dehydration and acute renal failure.

The diagnosis of collapse is based on a characteristic clinical picture. Studies of blood pressure in the dynamics, and if possible also the volume of circulating blood, hematocrit give an idea of ​​its nature and severity. Differential diagnosis in disorders of consciousness is carried out with a faint, which is characterized by a briefness of loss of consciousness. It should be borne in mind that collapse can be an integral part of the shock pattern, in which deeper hemodynamic disturbances occur.

Medical measures should be carried out urgently and intensively. Patients with a collapse that has arisen in out-of-hospital conditions should be rushed to the hospital immediately, accompanied by an ambulance (if it is not provided with full effective on-the-spot assistance) or medical personnel who possess the technique of resuscitation.

In all cases, the patient is placed in a horizontal position with slightly raised lower limbs, covered with a blanket, subcutaneously injected with 2 ml of a 10% solution of caffeine-benzoate sodium. With infectious collapse, this therapy is sometimes sufficient, with orthostatic - it is always effective, but if the blood pressure does not tend to increase, it is necessary, as with the collapse of another origin, to carry out etiological and more extensive pathogenetic therapy. Etiological treatment involves stopping bleeding during hemorrhagic collapse, removal of toxic substances from the body and specific antidote therapy for poisoning, thrombolytic therapy. In acute myocardial infarction and pulmonary embolism, paroxysm of atrial fibrillation or other heart rhythm disturbances, etc.,

Pathogenetic therapy includes intravenous blood injection during hemorrhagic collapse, plasma and blood-substituting fluids - with blood thickening in patients with toxic, infectious and any hypovolemic collapse, the introduction of a hypertonic sodium chloride solution in a collapse on the background of indomitable vomiting and diarrhea, as well as in patients with adrenal insufficiency , Along with the introduction of adrenal hormones. If necessary, urgently increase blood pressure intravenously drip norepinephrine or angiotensin; A slower, but longer-lasting effect is produced by injections of mezaton, fetanol. In all cases, oxygen therapy is indicated.

Forecast. Rapid elimination of the cause that caused collapse leads to a complete recovery of hemodynamics. In those cases when the underlying disease is irreversible and therapeutic measures are ineffective, vascular disorders progress, causing irreversible changes in the central nervous system and death.