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Hello, today is Thursday, December 15th. What's new? Quite a lot in fact, even though the title says otherwise. Last week our beloved cat, who was only 8 months old, almost died. The baby vomited, aspiration of vomit and pulmonary edema occurred. At first they thought it was heart failure, but, well, it turned out okay. The cat spent the night under oxygen, he was injected with furosemide to remove fluid from the lungs, and the swelling eventually subsided. We are currently being treated with antibiotics, but they make him sick, today is the last day of the course, so...

How not to treat acute respiratory infections in children

No room for error. How not to treat acute respiratory infections in children. Acute respiratory diseases are the most common infectious pathology of childhood. Often, parents begin treatment on their own, and the doctor is faced with “neglected” processes. To prevent parents from creating a threat to the health of their children, let’s talk about the typical mistakes they make when treating acute respiratory infections in children...

Vomiting is a reflex, most often spontaneous act, which leads to the eruption of the contents of the intestines and stomach through the oral cavity. In most cases, vomiting is a reaction of the body's defense due to the presence of irritating and (or) toxic substances.

There are often cases when, observing vomiting, a person does not know the simple principles of first aid and has absolutely no idea how to help the patient. Initially, it is necessary to sit the patient comfortably, covering the chest with oilcloth or a towel, bring a basin, a clean tray, or place a bucket to the mouth. If the patient is excessively weak and is unable to sit, then position his head so that it is lower than his body, turn it on his side so that he does not choke on vomit, and only then bring the basin or tray to his mouth. Also, in order not to contaminate the pillow, place a folded diaper, a towel or any other material. During vomiting, you must be near the patient.

If the patient is unconscious, then he should be positioned strictly on his side. An oral dilator should be inserted into the mouth to prevent aspiration of vomit. After vomiting, the container with vomit should be immediately removed from the room, rinsed and wiped the patient's mouth. If the patient is very weak, then after each eruption of vomiting, the oral cavity should be wiped with gauze moistened with water or a disinfectant solution. To help stop vomiting, give the patient a piece of ice, a few mint drops, 5 ml of a 0.5% novocaine solution and a sip of cooled water. If the vomiting does not stop and the patient’s condition gradually worsens, then you should immediately call an ambulance.

Aspiration of gastric contents. First aid for aspiration of gastric contents.

1. To the first group of factors predisposing to aspiration of gastric contents. include: an increase in the volume of gastric contents or an increase in intragastric pressure, observed with pyloric obstruction or ascites. Factors that allow the reflux of stomach contents into the pharynx or that provoke this reflux constitute the second group. These include hiatal hernia, as well as the introduction of a gastroscope. The third group of predisposing factors includes dysfunction of the pharynx, which occurs, for example, during coma or local anesthesia and allows the movement of liquid gastric contents into the trachea. Prevention is critical; Among patients with confirmed aspiration, the mortality rate reaches 50%. Careful care of patients at risk for this complication is important. For example, insertion of a nasogastric tube does not always allow effective evacuation of gastric contents, but can lead to functional failure of the gastroesophageal junction, as well as provoke vomiting during its insertion. When caring for a patient who is in a semi-comatose state, he should be placed in a “lying on his side” position with his head slightly lowered, and when feeding through a nasogastric tube, the patient’s head should be raised. If swallowing is impaired or consciousness is darkened, it is sometimes necessary to insert an endotracheal tube with a cuff into the patient.

2. Often the diagnosis is aspiration diagnosed only by exclusion, but sometimes medical personnel may witness vomiting and aspiration in a patient; or bile is found as an impurity in the tracheal secretion or as spots on the pillow. Aspiration may pose an immediate threat to the patient's life; depending on the nature and amount, it can cause partial or complete obstruction of the airways; signs of asphyxia in this case are convulsive respiratory movements or apnea. Immediate removal of the aspirate by all available methods is crucial; You should clear the throat with your finger, lower the patient's head, suck out the aspirate, or perform direct laryngoscopy.

3. Another variant of the clinical picture is progressive respiratory depression and hemodynamic instability during the first 24 hours. Chemical irritation from acidic gastric contents, especially if its pH is less than 2.5, leads to inflammation and edema. Frequent hypovolemia requires correction with intravenous fluid administration. Expiratory wheezing indicates small-caliber bronchial obstruction. Treatment consists of intravenous aminophylline and inhaled orciprenaline. Conflicting data on the effectiveness of corticosteroids for aspiration do not allow their widespread use to be recommended; however, the indication for steroids may be increased airway resistance resistant to other drugs.

4. Signs of ongoing respiratory dysfunction are tachypnea, tachycardia, hypoxia when inhaling air with a high oxygen content, as well as the alternation of hypercapnia with hypocapnia that often occurs after aspiration. During treatment, the need for endotracheal intubation and mechanical ventilation may arise.

5. Immediate reaction to aspiration. even in the absence of infection, there may be fever, leukocytosis and increased sputum viscosity. Pulmonary infection most often develops within 2-14 days after aspiration. An infectious complication can be recognized by deterioration of the patient’s condition, detection of the pathogen in a smear or bacteriological examination of sputum and/or blood, pleural fluid, as well as the appearance or increase in previously existing infiltrates on a chest x-ray. The choice of antibiotic depends on the pathogen detected during bacteriological examination and determination of its sensitivity. If necessary, antibiotic therapy is started before results are obtained so that the prescribed drugs are effective against community-acquired anaerobic pathogens, and also act against pathogens of hospital-acquired aerobic and anaerobic infections. Prophylactic antibiotics are prescribed only in case of aspiration of gastric masses that obviously contain a large number of pathogenic microorganisms.

6. Even in the absence of signs of infection during aspiration of gastric contents observation of the patient should continue for 3-4 weeks, since sometimes a pulmonary infection can develop more than 2 weeks after the episode of aspiration.

Vomit

Vomiting protects the body from toxins. During vomiting, the stomach ejects contents that are evacuated through the mouth and nose. The brain controls all this. Women and children vomit more often than men.

Blood in vomit

Children usually vomit due to infections, nasopharyngeal diseases, emotional distress or pain. The mechanisms of the emergence and inhibition of gag reflexes in childhood are not yet mature enough. If a child vomits too often, he should be seen by a doctor. After all, the reason may be acute intestinal obstruction, peritonitis, appendicitis, bleeding and other far from harmless things.

Nausea precedes vomiting; after vomiting, some relief occurs.

If a person has appendicitis, in addition to vomiting, he is bothered by pain in the right lower abdomen. The pain gradually moves from top to bottom. With pancreatitis, the girdle pain is concentrated on the left. Vomiting in these diseases does not bring relief.

With injuries and diseases of the brain, vomiting occurs for no apparent reason. The person loses consciousness and experiences a headache. For example, with a brain tumor, a person begins to feel dizzy, his speech and gait change.

When a doctor tries to find the cause of vomiting, he begins to study the vomit. Blood in the vomit indicates bleeding in the throat, esophagus, or upper stomach. If the blood reacts with gastric juice, it turns brown. If the vomit contains blood the color of “coffee grounds,” this means that bleeding has opened in the duodenum or stomach. If a person vomits with foam and blood, this indicates that bleeding has opened in the lungs.

Vomit may contain bile, pus, worms, feces and foreign bodies. To make an accurate diagnosis, you need to know exactly what preceded the vomiting and study the vomit.

How to cure vomiting?

In order to get rid of vomiting, you need to know exactly what caused it. The timing of vomiting is of great importance. Pregnant women, people with brain diseases and alcoholics vomit in the morning. After eating, those who suffer from ulcers or gastritis vomit.

When studying vomit, not only the composition is important, but also the smell. A sour smell indicates that there is increased acid formation in the gastrointestinal tract. This happens with ulcers. If food stagnates in a person’s stomach, it will smell like something rotten. With intestinal obstruction, the vomit smells like feces. In diabetics, vomit smells like acetone; in people with kidney failure, it smells like ammonia.

In addition to farrowing the patient and examining the vomit, the doctor conducts a clinical and biochemical blood test, fibrogastroduodenoscopy, X-ray of the digestive tract, ECG, computed tomography and ultrasound.

No one can cure vomiting by itself. It is necessary to eliminate the cause of its occurrence. Symptomatic treatment is carried out with tranquilizers, antipsychotics and antihistamines.

People have their own methods of treating vomiting. Usually people are treated with herbs that have a calming and antispasmodic effect. These include mint, valerian, dill and chamomile. Lemon water and green tea help many people.

Until the vomiting stops, you can’t eat anything. After the cause of vomiting has been established and you feel a little better, you can eat rice porridge without sugar, salt and oil. Tea with crackers is also suitable.

Vomiting can cause dehydration and rupture the stomach, esophagus and throat. If vomit enters the respiratory tract, aspiration pneumonia may occur. If a person vomits frequently, stomach acid can eat away tooth enamel, and this, in turn, can lead to the development of caries. These are all the worst complications that vomiting can lead to. In fact, this happens extremely rarely.

If you experience frequent vomiting, you should contact a gastroenterologist, gynecologist, cardiologist, psychotherapist, dermatologist, neurologist, pulmonologist, endocrinologist or urologist.

Vomit bags

Previously, when a person felt sick in transport, he needed to take a regular food bag with him. Such bags are not very convenient; they can tear and release the contents. Today, pharmacies sell a huge number of vomit bags.

Care Bags are hygienic disposable bags that do not leak liquid. These bags have special inner liners that turn the vomit into a gel. They also have laces that tighten themselves. There is practically no smell from the bags and nothing spills.

If a person feels nauseous from time to time, he can buy vomit bags and keep them with him all the time, for example, in a bag or pocket. It is convenient to recycle and use such bags, so you shouldn’t skimp and use regular food bags.

Aspiration of vomit

When foreign bodies (food, vomit, pellets, nails, etc.) enter the respiratory tract, aspiration may occur. Large foreign bodies completely close the airways and the person dies. If something small gets in, a painful cough begins and noisy breathing appears. Most often, an object that gets into the throat can be coughed out or dissolved. But sometimes, in severe cases, bronchitis, pneumonia, broncholitis, abscesses and even death occur.

Children are much more likely than adults to choke on something. Starting from intrauterine development, the child begins to choke. Sometimes amniotic fluid enters the respiratory tract, this happens when the umbilical cord is torsed or if the mother has a heart defect. During breastfeeding, milk can also enter the respiratory tract if the baby has a impaired swallowing reflex, coughs or screams.

If foreign bodies do not want to come out on their own, you need to call an ambulance and remove them with a bronchoscope. There are situations when foreign bodies have to be removed surgically.

Aspiration of vomit occurs when a person vomits and does not take the correct position. In order to prevent vomit from getting into the respiratory tract, you need to get on all fours and, without tilting your head too much, allow the gag reflex to do its cleansing work.

Asphyxia by vomit

Asphyxia is suffocation in which oxygen starvation occurs. If a person has asphyxia, it is necessary to give him mouth-to-mouth artificial respiration. With the help of forced air injection, you can save a person before the ambulance arrives.

Asphyxia can be non-violent: with bronchial asthma, allergic edema of the larynx, and violent: when a person drowns or is deliberately strangled by squeezing the neck.

If a person decides to hang himself, he will experience strangulation mechanical asphyxia. Under the weight of the suspended body, a noose is tightened around the neck, which not only breaks the cervical vertebrae, but also leads to suffocation.

When a foreign body prevents breathing, obstructive asphyxia occurs. With such asphyxia, death can occur due to acute oxygen deficiency or due to reflex cardiac arrest.

Asphyxia by vomit can lead to death if the person is intoxicated.

E.S. Apetova, V.S. Salmova

Department of Propaedeutics of Childhood Diseases, Russian State Medical University.

A universal clinical symptom complex of troubles in the upper gastrointestinal tract in newborns and children of the first year of life is the syndrome of vomiting and regurgitation. This syndrome occurs in approximately 86% of children in the first six months of life.

Vomiting is a complex neuro-reflex act, which has both a pathological significance and a protective, compensatory nature and is aimed at maintaining homeostasis and removing harmful substances from the body. Vomiting is usually preceded by nausea - an unpleasant, painless, subjective sensation, accompanied by vegetative-vascular reactions: paleness, weakness, dizziness, sweating, salivation. Vomiting is a complex reflex act, during which the involuntary ejection of stomach contents occurs through the esophagus, pharynx and mouth, while the pylorus contracts and the fundus of the stomach relaxes, the esophagus expands and shortens, a strong contraction of the diaphragm and abdominal muscles occurs, the glottis closes, the soft palate rises . Emptying of the stomach occurs due to repeated jerky contractions of the abdominal muscles, diaphragm, and stomach.

In infants, especially premature ones, vomit is often expelled through the mouth and nose, which is due to imperfect coordination of the components of the vomiting mechanism. This creates a real threat of aspiration of vomit, the occurrence of aspiration pneumonia, and asphyxia.

Regurgitation is a type of vomiting in children of the first year of life, they occur without abdominal tension, are carried out as a result of passive reflux of gastric contents into the pharynx and oral cavity, and the child’s well-being is not disturbed.

The frequency of regurgitation and vomiting in infants is explained by anatomical and physiological characteristics.

Anatomical and physiological features of the cardioesophageal transition.

It is known that in infants the esophagus is relatively short, its abdominal part is located 2 vertebrae higher than in adults and lies at the level of 8-9 degrees. vertebra. Poor development of the mucous membrane, muscles of the esophagus and the cardiac part of the stomach contributes to the insufficient expression of the angle of His, formed by the abdominal part of the esophagus and the adjacent wall of the fundus of the stomach. There is poor development of circular muscle fibers of the cardia of the stomach. As a result, the Gubarev valve, formed by a fold of the mucous membrane that protrudes into the cavity of the esophagus and prevents the return of food from the stomach, is almost not expressed. The same applies to the loop of Willis - a group of muscle fibers of the internal oblique muscle layer of the stomach, which does not completely cover the cardiac part of the stomach. As a result, the cardiac sphincter of the stomach in children is functionally defective, which can contribute to regurgitation of stomach contents into the esophagus. The lack of tight coverage of the esophagus by the legs of the diaphragm, impaired innervation with increased intragastric pressure, as well as the horizontal position of the stomach, high tone of the pyloric sphincter and physiological insufficiency of the cardia contribute to the ease of regurgitation and vomiting. Regurgitation and vomiting are much more common in children born prematurely.

In creating an antireflux mechanism (ARM), the lower esophageal sphincter (LES) is important (in addition to the diaphragmatic-esophageal ligament, Gubarev's fold, crura of the diaphragm, acute angle of His, and the length of the abdominal part of the esophagus). The LES is a separate morphofunctional formation, which is a muscular thickening formed by the muscles of the esophagus, has a special innervation, blood supply, and specific autonomous motor activity. The LES becomes most pronounced by the age of 1-3 years of life, and before this age all the anatomical structures that cause APM are weakly expressed.

The antireflux mechanism, in addition to anatomical structures, is determined by certain functions. “Esophageal clearance” is the ability for self-cleaning through propulsive contractions due to primary (autonomous) and secondary (during swallowing) peristalsis of the esophagus. Damage to the esophageal mucosa by aggressive reflux contents depends on the clearance time, the alkalizing effect of saliva and the tissue resistance of the esophageal mucosa.

Regulation of motor function of the esophagus and stomach

Regulation of gastric motility is carried out by nervous and humoral mechanisms. Irritation of the vagus nerve increases the motor activity of the stomach, increases the frequency and strength of contractions, the speed of propagation of the peristaltic wave, accelerates its emptying, while the tone of the sphincters of the upper digestive tract decreases. This nerve also decreases the tone of the stomach when food enters it, a component of the swallowing reflex. Irritation of the sympathetic nerves inhibits motor activity stimulated by the parasympathetic nerves and increases sphincter tone.

Reflex regulation of gastric motility occurs when receptors in the oral cavity, esophagus, stomach, duodenum, small and large intestine are irritated. The afferent nerves involved in the act of vomiting are the vagus, glossopharyngeal and other nerves, the efferent nerves are the vagus and sympathetic nerves innervating the intestines, stomach and esophagus, as well as branches innervating the diaphragm and abdominal wall.

The cholinergic system contains an important mediator - the neurotransmitter - acetylcholine, which stimulates cholinergic neurons and two types of receptors: muscarinic (M) and nicotinic (N). The release of acetylcholine occurs when the cholinergic system is activated; in addition, the sympathetic nervous system and the opiate system are involved in its release. There are sympathetic postsynaptic fibers that block the activity of cholinergic neurons and enkephalinergic fibers that also block the release of acetylcholine. The localization density of cholinergic receptors in the gastrointestinal tract is not the same: the largest number of M-cholinergic receptors is in the stomach, then in descending order. Therefore, atropine-like substances have an antispasmodic effect on the antrum of the stomach 3-10 times stronger than on the underlying sections of the gastrointestinal tract.

In the implementation of the motor function of the esophagus and stomach, external innervation is of dominant importance, and internal innervation is weak (Table 1).

Table 1.

Neural regulation of motor function of the gastrointestinal tract

Aspiration is the penetration into the respiratory tract by inhalation of various foreign bodies of an organic (pieces of food, peas, nuts, vomit) or inorganic nature (balls, nuts, nails, removable dentures not removed before the start of anesthesia, etc.), pus . blood. Clinical manifestations of aspiration depend on the nature of the aspirated bodies, their size, degree of solubility and infection. Aspiration of large foreign bodies that completely block the airway leads to instant death; with aspiration of small foreign bodies, noisy breathing, painful cough, etc. appear. Sometimes the foreign body is coughed up, dissolved or encysted. In some cases, bronchitis occurs as a complication of aspiration. bronchiolitis, tracheobronchitis, atelectasis and bronchiectasis, as well as pneumonia. abscesses.

Aspiration is much more common in children than in adults. Aspiration of amniotic fluid occurs due to oxygen starvation of the fetus due to maternal heart defects or torsion and compression of the umbilical cord. In newborns and small children, milk aspiration occurs during feeding as a result of a violation of the swallowing reflex, with malformations of the gastrointestinal tract; Aspiration of films during diphtheria, food during laughter, coughing, screaming, etc. is possible.

Treatment: urgent hospitalization to remove foreign bodies using a bronchoscope (see Bronchoscopy); if this method is unsuccessful, surgical intervention is indicated. See also Asphyxia.

Aspiration (from Latin apiratio - inflation) - penetration into the respiratory tract during breathing of various foreign bodies: liquids, food particles, pieces of tissue, blood, various microorganisms, substances, etc. Aspiration of food debris, mucus, saliva, etc. In patients with a weakened swallowing reflex, it is observed with general weakness, status typhosus, damage to the central nervous system, aspiration of vomit most often occurs in people with darkened consciousness. Aspiration of blood occurs when there is bleeding in the nose, mouth, respiratory tract, as well as the esophagus and stomach. Blood entering the larynx can also enter the respiratory tract. Of particular importance is the aspiration of mucus into the airways during anesthesia.

The consequences of aspiration depend on the consistency of the aspirated masses, their infection and the depth of penetration into the respiratory tract. Aspiration of large quantities of liquid and semi-liquid masses, as well as large foreign bodies, leads to death due to suffocation. When a small amount of these masses is aspirated, they penetrate into the respiratory tract and are expectorated, dissolved, or cause inflammatory processes of varying localization, degree and nature and damage in the respiratory tract or lung tissue - laryngotracheitis, bronchitis, bronchiolitis, pneumonia and their complications in the form of suppuration and gangrene. .

Vomit (aspiration, asphyxia)

As a result of vomiting, the body protects itself from possible toxins. According to statistics, vomiting most often occurs in children and women, and the gag reflex is controlled by the brain.

Vomiting blood

Vomiting in children most often occurs as a result of diseases of the nasopharynx, infections, severe pain and psychological distress. In childhood, the reflexes of inhibition and vomiting are still poorly formed. If a child vomits regularly, he should be seen by a doctor immediately. In fact, the reason may lie in serious diseases, including appendicitis, peritonitis, intestinal obstruction, bleeding and much more.

After vomiting occurs, the child should feel temporarily better.

If there is appendicitis, then vomiting causes pain in the lower abdomen on the right. Over time, the pain begins to move upward. If the patient has pancreatitis, then pain occurs in the left side, and vomiting is not able to bring relief.

If vomiting begins for no apparent reason, it may be due to illness or brain injury. This often results in headaches. If a tumor is present, gait and speech may change, and you may feel dizzy. The vomit may contain feces, helminths, foreign bodies, bile - in this case, an analysis of the vomit is carried out to make an accurate diagnosis.

Treatment of vomiting (nausea). Should vomiting be treated?

To cope with the gag reflex, be sure to determine why it occurred. The period when vomiting began is considered equally important. In the morning, vomiting worries people with brain diseases, after drinking alcohol the day before, and in pregnant women. After eating, vomiting begins in patients with gastritis and ulcers.

When studying vomit, it is necessary to pay attention not only to its contents, but also to the smell. If you feel acid, this indicates the presence of increased acidity in the gastrointestinal tract. A similar condition can occur with an ulcer. If food stagnates in the stomach, the vomit will smell rotten. If there is an intestinal obstruction, the vomit will smell like feces. In patients with kidney failure, vomit smells like ammonia, and in diabetic patients, it smells like acetone.

Vomiting itself does not require treatment; it is necessary to deal with the cause that caused it and the urge to vomit will disappear on its own. You can cope with the symptoms using antihistamines, antipsychotics and tranquilizers.

There are also folk methods for treating vomiting; for this, herbs that have an antispasmodic and sedative effect are used. These are chamomile, dill, valerian and mint, you can also drink green tea and water with lemon juice. You should not eat until the vomiting stops completely. After identifying this reaction of the body and completely stopping vomiting, you can eat rice porridge without adding oil, salt and sugar, you can also drink tea with crackers.

Vomiting may cause dehydration, rupture of the pharynx, esophagus and stomach. If vomit ends up in the respiratory tract, the patient may develop aspiration pneumonia. With frequent vomiting, tooth enamel is corroded by gastric juice, which contributes to numerous caries. In fact, such serious complications caused by vomiting are very rare. If vomiting is a frequent concern, then you should visit a urologist, endocrinologist, pulmonologist, neurologist, dermatologist, psychotherapist, cardiologist, gynecologist and gastroenterologist.

Aspiration of vomit

If foreign objects end up in the respiratory tract (balls, vomit, food), a person may experience aspiration. The airways are completely blocked by a foreign object, which can result in death. When small objects come into contact, a debilitating cough begins, and noise occurs during breathing. Many objects found in the respiratory tract can be dissolved or coughed up. If the case is serious, the patient may experience an abscess, broncholitis, pneumonia, bronchitis and even death.

Most often, foreign objects get stuck in the respiratory tract of children. While still in the womb, the baby moves intensely. It may happen that amniotic fluid ends up in the respiratory tract, this can happen if the woman has a heart defect or the umbilical cord is twisted. If you breastfeed your baby, there is a chance that he may choke on his mother's milk; if there are problems with the swallowing reflex, he begins to cry and cough.

If the foreign object cannot come out on its own, then it is necessary to urgently call an ambulance so that the doctor can get it out. In some cases, surgery may be necessary to remove the foreign object. Aspiration by vomit can occur if the person is in an incorrect position when vomiting begins. It is necessary to tilt your head forward while vomiting; such a simple position will prevent vomit from entering the lungs, preventing negative consequences.

Asphyxia by vomit

Nausea and vomiting

Nausea and vomiting - these unpleasant phenomena are probably familiar to everyone. Most often they occur as a protective reaction of the body to food intoxication, but they can also be a symptom of various, including quite serious, diseases.

Nausea

Nausea represents the impending desire to vomit. As a rule, nausea is felt in the throat or in the epigastric region.

In most cases, nausea accompanies and precedes vomiting, but there are conditions when nausea occurs on its own.

Nausea may be accompanied by drooling, pale face, general weakness, and dizziness. decreased blood pressure, sometimes fainting.

Diseases and conditions that may be accompanied by nausea:

Nausea can accompany diseases that cause increased intracranial pressure (brain tumor, traumatic brain injury, meningitis).

Nausea can also appear in healthy people as a reaction to changes in some external conditions:

• when driving rough;
• when working in an inclined position;
• as a reaction to unpleasant odors (or even memories of them).

Vomit

Vomiting is the increased expulsion of gastrointestinal contents through the mouth.

There are some gender and age patterns in the appearance of vomiting:

• This symptom occurs more often in children and adolescents than in adults;
• women are more susceptible to vomiting than men.

Causes of vomiting

Vomiting is often observed with the following pathologies:

1. Diseases of the gastrointestinal tract. Vomiting develops with various diseases of the stomach (with gastritis, pyloric stenosis, prolonged spasm of the pylorus, with peptic ulcers, stomach cancer, with ingestion of poor quality food). There are some patterns in the appearance of vomiting, depending on the disease that causes this symptom and the location of the pathology. For example, with chronic gastritis, vomiting occurs on an empty stomach, accompanied by the release of a large amount of mucus. In acute gastritis, ulcers and cancer of the cardial part of the stomach, vomiting occurs 10-15 minutes after eating. If the pathological process is located in the body of the stomach, then vomiting appears 2-3 hours after eating. Peptic ulcer of the pylorus and duodenum is manifested by vomiting 4-6 hours after eating. Often, vomiting during a peptic ulcer occurs at the height of a painful attack; after vomiting, the abdominal pain decreases or completely disappears. Vomiting of food eaten the day before is characteristic of pyloric stenosis.
2. In acute infections accompanied by hyperthermia, vomiting may occur. The mechanism of vomiting is exposure to toxic products that circulate in the blood and poison the body (intoxication).
3. Diseases of the pancreas, liver, bile ducts. Vomiting in these pathologies not only does not bring relief, but only aggravates the patient’s condition. If bile is mixed with vomit, then it acquires a bitter taste. Vomiting can also develop with appendicitis, intestinal obstruction, peritonitis, and bleeding of the gastrointestinal tract. Vomiting coffee grounds is a symptom of stomach bleeding.
4. Diseases of the central nervous system, accompanied by increased intracranial pressure, and damage to the inner ear apparatus (cerebral edema, brain tumor, Meniere's disease, acute labyrinthitis).
5. Hormonal changes that occur during pregnancy often lead to vomiting. This condition is called toxicosis of pregnancy (early gestosis in pregnant women).
6. Endocrine diseases accompanied by severe metabolic disorders (decompensated diabetes mellitus, adrenal insufficiency).
7. Vomiting can occur with a sharp increase in blood pressure (during a hypertensive crisis), with acute infarction of the posterior wall of the left ventricle, with congestive heart failure.
8. Taking some medications may cause nausea and vomiting. For example, when taking expectorants, nausea is an integral indicator of a correctly selected, effective dose of the drug.
9. Vomiting can be a symptom of emotional distress. As a rule, with mental disorders there is no pain syndrome, there are no visible disturbances associated with food intake, and there are no other symptoms of gastrointestinal pathology (belching, flatulence, diarrhea or constipation). But with a detailed questioning of the patient, with careful observation of his behavior, it is possible to establish additional symptoms of a mental disorder.

But vomiting is not necessarily a sign of any disease. This is the most important protective mechanism that protects the human body from toxic substances entering it.

If you have eaten a poor-quality product or drunk an excessive amount of alcohol, the body gets rid of these substances through vomiting. Vomiting once or several times is not dangerous, and you should not try to hold it back. On the contrary, in such cases it is necessary to help the body get rid of poisons. As a rule, after the body cleanses the stomach of toxic substances, the general condition improves and vomiting stops.

But there are times when uncontrollable vomiting or vomiting occurs like a fountain, and the patient simply cannot cope with it, loses a significant amount of fluid and important electrolytes with the vomit, then it is necessary to stop the vomiting with the help of medications.

Although vomiting is a protective mechanism, it can be dangerous and lead to the development of various complications.

Complications that vomiting can lead to

Treatment of nausea and vomiting

First of all, it is necessary to find out what exactly caused the vomiting. After all, sometimes just prescribing antiemetics may not be enough. In particular:

As a symptomatic treatment of vomiting, dopamine and serotonin receptor blockers (cerucal, metoclopramide) have the best effect. These drugs help with almost all types of vomiting, with the exception of psychogenic or vestibular vomiting.

For psychogenic vomiting, preference is given to prescribing small doses of antipsychotics (etaperazine).

For vestibular vomiting (caused by pathology of the inner ear), antihistamines (promethazine hydrochloride) are used.

Diagnosis of diseases

Transaminase activity in patients with angina

We studied the activity of glutamic-pyruvic (GPT) and glutamic-oxaloacetic (GSTA) transaminases in 30 patients with angina (8 - seriously ill, 14 - moderately ill, 6 - mildly ill). Activity of the mentioned enzymes

Allergens that cause food allergies

With our diet, allergens can be milk, eggs, fish, citrus fruits, flour; less common allergens are meat, especially pork and horse meat, cereals (rye, wheat, buckwheat and oatmeal, corn, rice), legumes, fruits (gooseberries, pears, oranges, bananas

Allergy tests in the diagnosis of atopic diseases

With the discovery of reagins as IgE, it became possible to detect sensitization using in vitro methods. Clinical diagnosis of atopic diseases is permissible only in specialized laboratories. Skin tests carried out as

Amnioscopy during pregnancy

This method was first proposed by Saling for the purpose of detecting meconium in amniotic fluid when the amniotic sac is intact. The presence of the latter could be judged by the green color of the water visible through the bubble. Subsequently, the scope of application of this method expanded, and it began to be used to diagnose hemolytic disease in the intrauterine fetus.

Amniocentesis, study of the properties of amniotic fluid

In order to establish the condition of the intrauterine fetus in case of isoserological incompatibility of the blood of the mother and the fetus, the method of amniocentesis has recently begun to be used. It allows, based on the study of the physical and chemical properties of amniotic fluid, to obtain more reliable information about the condition of the fetus compared to other methods.

Arterial curve analysis in children

The arterial curve indicates the change in the volume of the arteries resulting from changes in the pressure of blood flowing to them. The change in pressure is studied using an adapter based on the principle of a piezoelectric microphone, and the curve is usually recorded using an electrocardiograph

Vein curve analysis in children

Recording and analysis of the venous curve was, before the spread of the ECG, one of the most useful and, from many points of view, expedient methods. Currently, recording of the venous curve is almost never used as an independent method of examination, but for comparison in phonocardiography

Analysis of feces in a child, laboratory diagnostics

Stool examination is of much greater clinical importance in children than in adults. The condition of feces is the main indicator of the health of children, especially in infancy and young age. Changes in the composition of stool are often the first sign of an incipient disease.

Analysis of clinical data of rheumatism using the method of long-term observations

An analysis of clinical studies, based mainly on long-term dynamic observations of patients and “suspicious” rheumatism, showed that out of 510 children and adolescents, 274 (53.7%) were sent to the clinic or to a cardio-rheumatology clinic with a diagnosis of rheumatic lesions

Blood test, red blood cells in blood

The erythrocyte curve is similar to the hemoglobin curve, with the significant difference that after the 14th day the erythrocyte curve decreases significantly less than the hemoglobin curve

Urinalysis in the diagnosis of kidney disease

Brown-red coloration of diapers in newborns or infants is often a sign not of hematuria, but of high density urine associated with a febrile illness or excisosis. It can also be caused by urochrome, precipitated urates (“brick sediment”). Colorants from food products

Urinalysis, answers to pressing questions

Specific gravity of urine is the ratio of the mass of a certain volume of urine to the mass of the same volume of water. The value of this indicator depends on the number and weight of urine components. Glucose and protein affect the specific gravity of urine, since they themselves have a significant

Analysis of the results of clinical and phonocardiographic examination of patients with angina

Clinical assessment of muffledness (decrease in amplitude) of the first tone is difficult because its genesis is complex and is not explained in the same way by all researchers. Everyone agrees that the main component that determines

Aspiration

Intestinal myiasis- entomosis from the group of myiases, characterized by enteritis, diarrhea, abdominal pain, vomiting. Aspiration pneumonia is an inflammation of the lungs that occurs when various substances are inhaled or passively ingested into the lungs in a massive volume, most often in practice - vomit. Inflammation occurs through the specific properties of substances that cause strong inflammatory reactions.

Cholera- acute intestinal sapronotic infection caused by bacteria of the species Vibrio cholerae. It is characterized by a fecal-oral mechanism of infection, damage to the small intestine, watery diarrhea, vomiting, rapid loss of fluid and electrolytes by the body with the development of varying degrees of dehydration up to hypovolemic shock and death. Humanity has suffered from devastating cholera outbreaks from time to time throughout history. Hippocrates and Galen also wrote about this disease, and numerous information indicates that the disease was known in ancient times and on the Gangetic plains. More than 150 serogroups are known Vibrio cholerae; they are divided into those that are agglutinated by standard cholera serum O1 and those that are not agglutinated by standard cholera serum O1. The World Health Organization estimated in 2010 that there were between 3 and 5 million cases of cholera worldwide and 100,000 to 130,000 deaths. These diseases occurred mainly in developing countries. In the early 1980s, the death rate was estimated to exceed 3 million per year. The symptoms of the disease are not caused by Vibrio cholerae itself, but by the cholera toxin it produces. The incubation period lasts from several hours to 5 days, usually 24-48 hours. The severity of the disease varies - from erased, subclinical forms to severe conditions with severe dehydration and death within 24-48 hours. If cholera is suspected, patients are urgently hospitalized in a special department. With timely and adequate treatment, favorable. Working capacity is fully restored within approximately 30 days. In the absence of adequate medical care, the likelihood of rapid death is high.

Aspiration- an acoustic effect during the pronunciation of a sound that occurs if the ligaments begin to vibrate a significant period of time after the end of consonantal articulation.

Abortion- artificial termination of pregnancy. According to modern medical standards, abortion is usually performed up to 20 weeks of pregnancy or, if the gestational age is unknown, when the fetus weighs up to 400 g. Abortions are divided into safe and unsafe. A safe abortion is one that is performed by a qualified professional using approved and recommended methods and in an appropriate medical facility. An abortion is considered unsafe if it is performed by a person without medical education or training, in unsanitary conditions, or if it is performed by the woman herself. In the modern world, the permissibility of abortion and its limits is a hotly debated issue, including religious, ethical, medical, social and legal aspects. In some countries, this problem has become so acute that it has caused division and fierce confrontation in society. Induced abortion can be medical or criminal. A significant part of the debate surrounding the issue of abortion is the question of whether abortion affects mental health. Most scientific publications and WHO recommendations for obstetricians and gynecologists present the opinion that the vast majority of women endure abortion without mental consequences. A number of studies indicate that the percentage of mental illness among women who have had an abortion is significantly higher compared to women of the same age who have given birth or who have not become pregnant. In pagan antiquity, termination of pregnancy was considered quite an ordinary occurrence. This was due to the idea that a newborn was considered a person only after the rite of sublatio, when the father, raising the baby above his head in the temple, recognized him as a new member of his family. According to WHO, approximately 46 million induced abortions are performed annually in the world, which is 22% of the number of observed pregnancies. Denisov B.P. Sakevich V.I. Will Russia move from abortion to family planning?

Medical abortion can be performed for up to 42 days of amenorrhea if intrauterine pregnancy is detected. The most effective is medical abortion for up to 4 weeks, when the fertilized egg is still weakly attached to the uterus, and hormonal changes in the female body are not so pronounced.

Apomorphine- medicine. It is a semi-synthetic alkaloid obtained from morphine when exposed to hydrochloric acid. In this case, the oxygen bridge characteristic of morphine alkaloids is removed and, as a result of molecular rearrangement, a new four-cyclic compound is formed. Apomorphine retains some of the pharmacological properties of morphine. It has weak analgesic activity and has a depressant effect on the respiratory center. The influence of apomorphine is especially pronounced on the chemoreceptor trigger zone of the medulla oblongata, the stimulation of which causes its strong emetic effect. White, slightly grayish or slightly yellowish crystalline powder, odorless. It turns green in air and light. Difficult to dissolve in water and alcohol. Metabolized in the liver to form glucuronides. It is excreted by the kidneys in the form of metabolites, mainly paired compounds, 4% - unchanged. Chronic alcoholism. The need to quickly remove toxic substances and poor quality food from the stomach. Hypersensitivity, peptic ulcer of the stomach and duodenum, risk of gastrointestinal bleeding; angina pectoris, cardiosclerosis, cerebral atherosclerosis; arterial hypotension; open forms of tuberculosis with cavities and a tendency to pulmonary bleeding; condition after stomach burns with acids and alkalis; pregnancy, old age; poisoning with opiates and anxiolytics. As an emetic, apomorphine hydrochloride is used when it is necessary to quickly remove toxic substances and poor-quality food products from the stomach, especially when it is impossible to perform gastric lavage. The action occurs a few minutes after the subcutaneous injection. Administer 0.002-0.005 g under the skin for adults, and 0.001-0.003 g for children. Apomorphine should be used with caution; Some patients may develop collapse and experience visual hallucinations, and people with traumatic encephalopathy may have neurological disorders. Allergic reactions are possible. Release forms: powder; 1% solution in ampoules of 1 ml in packages of 5 or 10 ampoules.

For use in alcoholism, the powder is packaged in pharmacies of specialized medical institutions in gelatin capsules of 10; 20; thirty; 40; 60 and 80 mg with the addition of ascorbic acid to increase the stability of the drug to a total powder weight of 200 mg. Storage: List A. William Burroughs, in his books Naked Lunch and The Soft Machine, describes the possibility of apomorphine treating opiate addiction.

Vomit- reflex eruption of stomach contents through the mouth. Vomiting is mainly caused by contraction of the abdominal muscles; in this case, the outlet part of the stomach closes tightly, the body of the stomach relaxes, the entrance to the stomach opens, the esophagus and oral cavity expand. This entire reflex act is regulated by the vomiting center located in the medulla oblongata. Vomiting is usually preceded by nausea, involuntary swallowing movements, rapid breathing, and increased secretion of saliva and tears. Vomit usually consists of food debris, gastric juice, and mucus; may contain bile and other impurities.

Potassium antimonyl tartrate- a complex compound of antimony oxide and potassium tartrate. When heated to 100°, it dehydrates. It is obtained by the action of antimony oxide Sb2O3 on an aqueous solution of potassium hydrogen tartrate. It is used in medicine, veterinary medicine, homeopathy, as an emetic and expectorant, in analytical chemistry for the determination of phosphates, and as a mordant in calico printing.

Zooplankton- part of the plankton, represented by animals that cannot resist currents and are transported along with water masses. Zooplankton traditionally also includes fairly large heterotrophic protists - unicellular and colonial. Representatives of most types of the animal kingdom are found in zooplankton. In most bodies of water, the most numerous group of zooplankton are small crustaceans.

Carbon detonation- combustion of carbon in an explosive manner in the degenerate core of stars, an analogue of a helium flash.

Swarming- or the nuptial flight of insects - a more or less prolonged flight of insect imagoes, undertaken with the special purpose of copulation in the air.

Death when a corpse is found with its head down?

Well, a corpse is already a corpse.

I don’t know, but if you think about it, vomit in this position cannot get into the respiratory tract, because when vomiting, the main thing is to take the right position.

Pulmonary edema is a pathological condition in which transudate accumulates in the interstitium or alveoli of the lungs. This condition is life-threatening for the animal and requires immediate attention to the clinic.

There may be several reasons for the development of pulmonary edema:

1)cardiogenic

2) non-cardiogenic: infectious diseases, severe systemic diseases, respiratory tract obstruction, gas poisoning, aspiration, with pancreatitis, renal failure, sepsis, etc.

Why is this pathology so dangerous for the animal? In a state where the lung tissue contains liquid instead of air, the body begins to suffer from a lack of oxygen. Such hypoxia entails disruption of the functioning of vital organs - kidneys, liver, heart muscle and brain.

Pulmonary edema is manifested by the following symptoms:

1) tachypnea

2) abdominal or thoraco-abdominal breathing

3) cyanosis of the mucous membranes; sometimes, especially in cats with a pink nose and light hair on the ears, bluish skin can be detected.

4) The animal begins to breathe with its mouth open, takes a forced pose with its elbows apart, and in critical situations lies on its side

5) In advanced conditions, even without additional equipment, you can find that the animal is breathing with wheezing

6) Cough with fluid

If one of these signs is detected, you must immediately bring the animal to the clinic. Upon arrival at the veterinary clinic, you must inform the reception staff/doctors that the animal is in serious condition.

An X-ray is required at the clinic.

All animals diagnosed with pulmonary edema are strongly recommended to remain in the intensive care unit at the veterinary clinic, as this condition requires constant monitoring, oxygen therapy and intensive decongestant therapy. If pulmonary edema leads to terminal respiratory failure or in the absence of positive dynamics of therapy, a mechanical ventilation device is used.

Kerosene is a product of oil refining, and its main areas of application have always been far from medicine. In any medical reference book you can find an indication of its unconditional harmfulness to the human body:

“Kerosene has psychotropic, hepatotoxic, nephrotoxic, pneumotoxic effects. Poisoning can occur both from inhalation of vapors and from ingestion. Symptoms: When ingested, the smell of kerosene from the mouth, pain and burning in the mouth and stomach, nausea, sometimes vomiting, and diarrhea are noted. In severe cases, yellowing of the skin and enlarged liver are noted. The development of convulsive syndrome and acute psychosis is possible. When aspiration of toxic substances occurs against the background of vomiting, chest pain, shortness of breath, cough, bloody sputum, and blue discoloration of the skin occur. When inhaling vapors, dizziness, headache, agitation, followed by depression, are noted. In severe cases - convulsive syndrome and coma, development of pulmonary edema with possible death."

Although in alternative medicine kerosene is used to treat sore throat:

". Angina

Sore throat is an acute general infectious disease with the most pronounced local inflammatory process in the tonsil area. The palatine tonsils are most often affected. Sore throat is more often observed in spring and autumn.

Treatment methods:

10 drops of kerosene are diluted in 50 grams of warm water. Gargle with the resulting solution after meals every day for a week. Then a break is taken for 1 - 2 weeks.

Using kerosene as a compress: a cloth is soaked in heated kerosene, then wrung out and wrapped around the neck. A scarf or woolen fabric is placed on top. Keep the compress on for as long as possible.

Kerosene lubrication is also used to treat sore throat. To do this, you need to wrap cotton wool on a thin long stick and dip it in purified kerosene. Inflamed tonsils are lubricated with kerosene every half hour. In the case of an advanced form of tonsillitis, when abscesses have already formed on the tonsils, it is strongly not recommended to lubricate them with kerosene.

Rinsing with a weak solution of purified kerosene is often used. For this purpose, you need to dissolve half a tablespoon of tea soda in a glass of warm boiled water. 1 tablespoon of kerosene is added to the resulting solution. The course of such treatment is 6–8 days, the frequency of rinsing is 4–12 times a day. "

P.S. Treating a sore throat with kerosene for a couple of weeks is DANGEROUS! The infectious inflammatory process can progress and descend into the lower respiratory tract.

The entry of distillation products into the body through the mouth causes irritation of the mucous membranes of the upper part of the gastrointestinal tract. When large quantities of these products are ingested, symptoms resemble those caused by inhalation. Quite often, regurgitation or vomiting leads to aspiration of oil distillation products into the trachea. Due to the low surface tension of these substances, even small amounts can spread widely throughout the lungs and cause pulmonary edema and pneumonia. Lung damage may also develop as a result of absorption of ingested petroleum products from the gastrointestinal tract. However, kerosene is at least 100 times more toxic when it enters the body intratracheally than when it enters the body orally.

When treating patients with poisoning by petroleum distillation products, the possibility of their aspiration into the lungs should be avoided. If the patient has a cough, then aspiration has probably already occurred.

If large quantities of these substances are swallowed, gastric lavage is indicated. In patients who are able to assess their condition, vomiting can be induced; in this case, the patient's head should be below his hips. In other cases it should. perform gastric lavage, but only after inserting an endotracheal tube with an inflatable cuff. You can give the patient a saline laxative. Victims of kerosene poisoning should be hospitalized for at least 24 hours to monitor their condition.

If symptoms or signs of lung irritation appear, the patient should be given oxygen. Steroids appear to be ineffective and contraindicated.

Prophylactic use of antibiotics is not indicated. Symptomatic treatment for central nervous system depression or seizures may be necessary.

When I was poisoned with clonidine, I experienced severe dizziness to the point of loss of consciousness, low blood pressure, blackout, sleepiness, and after I was given several droppers and washed for several hours, cartoons began. That is, something like a drug dream, very beautiful, bright colors, animation. I was lucky that I only drank orange juice with clonidine. He drank, got behind the wheel and went to the club to party. An hour later I got carried away, and my intuition told me that the girls were harassing me. I drove home on autopilot myself, called an ambulance myself, and gave them my diagnosis myself. If the girls had made a cocktail of clonidine and vodka, the outcome could have been fatal.

After 12 hours, I escaped from the ambulance and rested at home. Only droppers help. Hurry up. It's been three days, let's hope your dad is alive. And ready for exploits.

Treatment of shock must meet the requirements of emergency therapy, i.e., it is necessary to immediately use drugs that give an effect immediately after their administration. Delay in treating such a patient can lead to the development of severe microcirculation disorders, the appearance of irreversible changes in tissues and be a direct cause of death. Since a decrease in vascular tone and a decrease in blood flow to the heart play an important role in the mechanism of shock development, therapeutic measures should primarily be aimed at increasing venous and arterial tone and increasing the volume of fluid in the bloodstream.

First of all, the patient is placed horizontally, that is, without a high pillow, and oxygen therapy is provided. The head should be turned to the side to avoid aspiration of vomit in case of vomiting; Taking medications by mouth is naturally contraindicated. In case of shock, only intravenous infusion of drugs can be of benefit, since a disorder of tissue circulation impairs the absorption of drugs administered subcutaneously or intramuscularly, as well as taken orally. Rapid infusion of fluids that increase the volume of circulating blood is indicated: colloid and saline solutions in order to increase blood pressure to 100 mm Hg. Art. Isotonic sodium chloride solution is quite suitable as initial emergency treatment, but if very large volumes are transfused, pulmonary edema may develop. In the absence of signs of heart failure, the first portion of the solution is administered as a stream. If shock is caused by acute blood loss, if possible, blood is transfused or blood substitutes are administered.

In case of cardiogenic shock, due to the risk of pulmonary edema, preference is given to cardiotonic and vasopressor drugs - pressor amines and digitalis preparations. For anaphylactic shock and shock resistant to fluid administration, therapy with pressor amines is also indicated.

Norepinephrine acts not only on blood vessels, but also on the heart - it strengthens and speeds up heart contractions. Norepinephrine is administered intravenously at a rate of 1-8 mcg/kg/min. In the absence of a dispenser, proceed as follows: pour 150 - 200 ml of a 5% glucose solution or an isotonic sodium chloride solution with 1-2 ml of a 0.2% norepinephrine solution into the dropper and set the clamp so that the injection rate is 16 -20 drops per minute. Monitoring blood pressure every 10 - 15 minutes, if necessary, double the rate of administration. If stopping the drug administration for 2 - 3 minutes does not cause a repeated drop in pressure, you can finish the infusion while continuing to monitor the pressure.

Dopamine has selective vascular effects. It causes vasoconstriction of the skin and muscles, but dilates the blood vessels of the kidneys and internal organs. Dopamine is administered intravenously at an initial rate of 200 mcg/min. In the absence of a dispenser, the following scheme can be used: 200 mg of dopamine is diluted in 400 ml of saline, the initial rate of administration is 10 drops per minute, if there is no effect, the rate of administration is gradually increased to 30 drops per minute under the control of blood pressure and diuresis.

Since shock can be caused by various causes, along with the administration of fluids and vasoconstrictors, measures are needed to prevent further exposure to these causative factors and the development of pathogenetic mechanisms of collapse. For tachyarrhythmias, the treatment of choice is electrical pulse therapy; for bradycardia, electrical stimulation of the heart. In hemorrhagic shock, measures aimed at stopping bleeding come to the fore. In the case of obstructive shock, pathogenetic treatment is thrombolysis for pulmonary embolism, drainage of the pleural cavity for tension pneumothorax, pericardiocentesis for cardiac tamponade. Pericardial puncture may be complicated by myocardial damage with the development of hemopericardium and fatal rhythm disturbances, therefore

Foreign bodies entering the respiratory tract during deep inspiration can cause suffocation. In infants, when feeding them in a horizontal position or when vomiting, objects of aspiration can be food masses or a pacifier; in preschoolers and schoolchildren, these are usually buttons, beads, pins, small nails, peas, seeds, and nuts.

Any small object that is in the mouth while laughing, crying when scared, or with a deep breath can get into the larynx and trachea. Painful phenomena vary depending on the size, nature, shape of the foreign body and the location of its retention. A foreign body causes blockage of the respiratory tract, irritation of the mucous membrane, resulting in swelling and spasms.

Symptoms indicating a foreign body entering the respiratory tract:

sudden development of an attack of suffocation in a child who played with small objects or choked while eating;

cyanosis of the lips and face;

severe, recurring bouts of coughing.

Foreign bodies of large volume, especially with uneven edges, stop in the larynx, often between the vocal cords, less often under them.

Characteristic signs for foreign bodies in the larynx are as follows:

difficulty breathing, periodic attacks of asphyxia;

painful convulsive cough;

soreness in the larynx;

normal or low-grade fever;

absence of catarrhal phenomena in the pharynx;

with a foreign body with sharp edges - pain in the larynx and pharynx and blood in the sputum.

If a foreign body overcomes natural reflexes, it can get stuck either in the trachea or in the bronchi. In the trachea, a foreign body, in addition to difficulty breathing, causes periodic severe attacks of whooping cough, leading to suffocation. The face becomes cyanotic, sputum is released, sometimes mixed with blood. The voice is hoarse. The child is extremely restless. During breathing, the soft tissues of the epigastric region are retracted.

A moving foreign body in the trachea is identified by a squelching sound. Small foreign bodies, especially those with a smooth surface and round shape, can enter the bronchi and cause the formation of atelectasis, prolonged purulent bronchi, and cause chronic pneumonia. With any prolonged bronchitis or chronic pneumonia, it is necessary to remember that their source may be a foreign body in the bronchi, and carefully examine the patient in this regard.

An X-ray examination can only detect a contrast-enhanced foreign body. Suspicion for aspiration is caused by acute localized swelling of the lungs distal to the foreign body. For non-contrast foreign bodies in the bronchi, tomography makes it possible to clarify their location, position and shape.

If it is known that the foreign body that has entered does not have sharp edges, then you should first of all lift the child by the legs and try to remove the foreign body from the respiratory tract by tapping the Back. Sometimes it works. If this method is ineffective, it is necessary to urgently take the child to a surgical or otolaryngological department to remove the foreign body from the respiratory tract using a laryngoscope or bronchoscope. In severe cases accompanied by asphyxia, it is necessary to resort to tracheotomy.

The most common causes of death in alcoholics:

- bleeding from esophageal varices - vomiting blood

- pulmonary embolism - loss of consciousness, blueness of the upper half of the body

- heart attacks - classic - severe chest pain, shortness of breath, foam at the mouth

- severe arrhythmias with a hangover - the heart feels like it’s going to jump out

- strokes - the face is distorted, one side of the body is paralyzed

Aspiration is much more common in children than in adults. Aspiration of amniotic fluid occurs due to oxygen starvation during maternal or torsion and compression. In young children, milk aspiration occurs during feeding as a result of a violation of the swallowing reflex, in the gastrointestinal tract; Aspiration of films during diphtheria, food during laughter, coughing, screaming, etc. is possible.

Treatment: urgent hospitalization to remove foreign bodies using (see); if this method is unsuccessful, surgical intervention is indicated. See also .

Aspiration (from Latin apiratio - inflation) - penetration into the respiratory tract during breathing of various foreign bodies: liquids, food particles, pieces of tissue, blood, various microorganisms, substances, etc. Aspiration of food debris, mucus, saliva, etc. In patients with a weakened swallowing reflex, it is observed with general weakness, status typhosus, damage to the central nervous system, aspiration of vomit most often occurs in people with darkened consciousness. Aspiration of blood occurs when there is bleeding in the nose, mouth, respiratory tract, as well as the esophagus and stomach. Blood entering the larynx can also enter the respiratory tract. Of particular importance is the aspiration of mucus into the airways during anesthesia.

The consequences of aspiration depend on the consistency of the aspirated masses, their infection and the depth of penetration into the respiratory tract. Aspiration of large quantities of liquid and semi-liquid masses, as well as large foreign bodies, leads to death due to suffocation. When a small amount of these masses is aspirated, they penetrate into the respiratory tract and are expectorated, dissolved, or cause inflammatory processes of varying localization, degree and nature and damage in the respiratory tract or lung tissue - laryngotracheitis, bronchitis, bronchiolitis, pneumonia and their complications in the form of suppuration and gangrene. .

February 22, 2007 from 8:30 to 12:00 in the morgue of the regional bureau of forensic medical examination in clear weather and electric lighting based on the direction of the Department of Internal Affairs of the Moscow District Department of Internal Affairs of Ryazan, police lieutenant A.D. Vakuikin. by me, Ivanova M.P. student of the Ryazan State Medical University, fifth year, medical faculty, group No. 1, an autopsy was performed on the corpse of Ipatko P.A. Born in 1954 to determine the cause of death, how long ago the death occurred, the presence of bodily injuries on the corpse, and the presence of alcohol in the blood.

The autopsy was attended by fifth-year students of the Ryazan State Medical University, Faculty of Medicine, Group No., mortuary attendant Lagutin.

Circumstances of the case.

From the direction: “...the corpse of E.D. Ipatko. Born in 1954, discovered on 02/21/07 on the street. Kalyaeva, 111...no money or valuables were found.”

External research.

Removed from the corpse: a black jacket with a gray fur collar and a large blue check lining;

black, sports, wool blend hat with red embroidery

"Reebok" inscription;

black felt boots;

dark blue jeans;

dark blue sweatpants with white embroidered lettering

Adidas;

wool blend purple machine knitted sweater with red

stripes on the collar;

machine-knitted wool blend brown sweater;

machine knit gray wool blend sweater;

black, cotton, army-style shirt;

half-woolen sock, black;

half-woolen sock, brown;

dark blue cotton panties.

All clothes are worn and dirty.

The corpse of a man appears to be 50-55 years old, of average (normosthenic) build, satisfactory nutrition, body length 167 cm. The corpse is cold to the touch. Rigor mortis is well expressed in all muscle groups studied. Cadaveric spots are pale purple, abundant, diffuse, located on the back and front surfaces of the body, and do not turn pale when pressed. Against their background, multiple pinpoint and small-spotted hemorrhages of a dark red color with a bluish tint are determined. The skin of the scalp, face, neck, torso and limbs is without visible damage. The face is puffy, bluish. The eyes are closed, the mucous membranes of the eyelids are pale, with multiple pinpoint dark red hemorrhages. The corneas are cloudy, the pupils are equal in size, with a diameter of about 0.4 cm. The bones and cartilage of the facial part of the skull are intact to the touch. The nasal passages and external auditory canals are free. The mouth is half-open, the transitional border of the lips is pink-bluish. On the upper and lower jaws, most of the teeth are missing, their sockets are smoothed. The neck is proportionate to the body. The chest is symmetrical, the stomach is sunken. The genitals are formed correctly according to the male type. The testicles are lowered into the scrotum. The anus is closed, the skin around it is not stained.

Internal research.

Soft tissues of the neck, chest and abdomen without hemorrhages. The thickness of the subcutaneous fat layer of the anterior chest wall is 1 cm, the abdomen is 1.5 cm. The organs in the serous cavities are located correctly; there are no foreign contents in the abdominal or thoracic cavities. The intestinal loops are moderately distended. The vermiform appendix is ​​12 cm long, the diameter of its base is about 1.5 cm. There are traces of cloudy, whitish urine in the bladder. Its mucous membrane is pale gray. The parietal peritoneum is thin, smooth, without hemorrhages. The parietal pleura is rough, pale gray, without hemorrhages. The tongue is covered with a whitish coating, the papillae of the mucous membrane are clearly visible. The muscles of the tongue on the section are grayish-brown, without hemorrhages or scars. The lobes of the thyroid gland are symmetrical, measuring 4.8 * 2.5 * 1.5 cm each, the isthmus is clearly visible. The tissue of the gland on the section is light brown, finely granular in structure. The aorta and its large branches with single, small, dense, yellowish plaques. The inner lining of the vessels is light yellow. The lumen of the esophagus is freely passable, its mucous membrane is bluish, full-blooded, with longitudinal folding. The hyoid bone and cartilage of the larynx are intact, the surrounding soft tissues are without hemorrhages. The entrance to the larynx is free.

In the lumen of the trachea and large bronchi, a clear liquid is found with an admixture of small, loose, whitish cylindrical bodies about 0.7 cm long, about 0.2 cm thick, resembling boiled vermicelli in appearance. The mucous membrane of the respiratory tract is pale gray. The pulmonary pleura is thin, pale gray, without hemorrhages. On the surface of the right lung between the upper and middle lobes there are single, pinpoint dark red hemorrhages (Tardier spots). The lung tissue is uniformly swollen, dark red on the cut surface, and a large amount of foamy, dark red liquid flows from the cut surface.

The adrenal glands are leaf-shaped, with a grayish-yellow cortex and a brownish-gray medulla. The right kidney weighs 150 g, its dimensions are 12 * 6.5 * 3 cm, the left kidney weighs 160 g, dimensions - 11 * 7 * 4 cm. The kidney capsules are thin, smooth, easily removed, exposing smooth surfaces. The kidney tissue is grayish-brown when cut, the boundaries between the layers are clear. The calyces and pelvis are free. Their mucous membranes are pale gray, without hemorrhages. The spleen weighs 40 g, its dimensions are 9.5 * 5 * 1 cm. Its tissue is red-brown when cut, without scraping. The capsule is thin and wrinkled.

The stomach contains about 300 ml of transparent whitish liquid with an admixture of small, loose, whitish cylindrical bodies about 0.7 cm long, about 0.2 cm thick, resembling boiled vermicelli in appearance. The gastric mucosa is pale gray, the folds are smoothed, the entrance and exit are freely passable. The pancreas is 18 cm long, its head is 4 cm wide, its body is 2 cm, its thickness is 1.2 cm. The bile ducts are freely passable. The gallbladder contains about 15 ml of liquid, yellow-green bile, its mucous membrane is velvety. Liver 1300g, Glissonian capsule thin, smooth. The tissue of the organ on the section is light brown, full-blooded. The contents and mucous membrane of the intestine correspond to its anatomical sections.

Traces of a clear, yellowish liquid were found in the cardiac sac. Heart – 350g, its cavities contain liquid dark red blood. The valves are thin, elastic, without overlaps or ulcerations. The heart muscle on the section is grayish-brown with areas of uneven blood supply. The thickness of the myocardium of the wall of the left ventricle is 1.2 cm, the right one is 0.2 cm, the septum is 1.0 cm. Coronary arteries with small, isolated, yellowish plaques, narrowing the lumen by less than one third. The sternum, collarbones, ribs, spine and pelvic bones are intact. The bones of the limbs are intact to the touch.

Soft tissues of the scalp without hemorrhages. The dura mater is tightly fused with the bones of the skull, its sinuses are full of blood. The pia mater is full-blooded, edematous, the sulci of the brain are narrowed, the convolutions are flattened, the hemispheres are symmetrical. Brain tissue on a section with a clear pattern of the structure of gray and white matter, moist, shiny, sticks to the knife. The ventricles are distended and filled with clear, colorless liquid. The choroid plexuses are swollen. The vessels at the base of the brain have a thin, elastic wall; the inner lining of the arteries is grayish-yellowish. The bones of the vault and base of the skull are intact. The thickness of the frontal bone is 0.5 cm, the occipital bone is 0.7 cm.

For a forensic chemical study, blood and urine were taken to determine ethyl alcohol, as well as the wall of the bladder to determine narcotic substances.

For forensic biological research, blood was taken to determine group affiliation.

For forensic histological examination, pieces of internal organs were taken: brain, lungs, heart, liver, kidneys, spleen, bifurcation lymph node.

The blood was taken and sent to the laboratory of the Republican Regional Clinical Hospital for ELISA.

Forensic medical diagnosis.

Main: asphyxia from the closure of the respiratory tract with vomit: in the lumen of the trachea and large bronchi there is vomit, Tardieu spots under the pulmonary pleura, mucous membranes of the eyelids with multiple pinpoint dark red hemorrhages, the lungs are evenly distended,

Complications: pulmonary edema, cerebral edema-swelling,

Concomitant: mild atherosclerosis of the aorta and coronary arteries.

Court medical expert

Conclusion.

The death of E.D. Ipatko, born in 1954, was due to asphyxia from the closure of the respiratory tract with vomit.

When examining the corpse, no bodily injuries were found.

Court medical expert

Aspiration of food masses into the respiratory tract is observed in persons who were unconscious as a result of vomiting, during resuscitation measures, or when performing artificial respiration techniques or chest compressions incorrectly.

The detection of food masses in the respiratory tract does not in itself indicate death from aspiration asphyxia. Food masses can enter the respiratory tract during the agonal period or even during rotting of the corpse. Absolute proof of intravital aspiration can be the detection of particles of gastric contents not only in the trachea and large bronchi, but also in small bronchi, bronchioles and alveoli.

Macroscopically, the lungs are swollen, there are bumps on the surface, and on cuts, when pressed, particles of food mass are released from the small bronchi and alveoli.

Histological examination of lung tissue reveals pronounced generalized bronchospasm, undigested muscle fibers, starch particles, plant cells in the lumen of small bronchi and alveoli. As a rule, 3 pieces are taken for research from each lobe of the lung: hilar, central, peripheral.

Death from aspiration of blood occurs in persons who are unconscious due to a head injury, damage to the soft tissues of the face, or cut or stab injuries to the neck. In this case, histological examination of lung tissue is important to verify the diagnosis. At the same time, a number of changes characteristic of this type of death are revealed. The bronchi and bronchioles are dilated, full of blood, a small amount of blood is also detected in the alveoli, fibrin threads and single leukocytes can be found in the mass of red blood cells. Generalized bronchospasm is noted.

When assessing the microscopic picture, it is necessary to take into account that the presence of blood in the alveoli is not necessarily associated with its aspiration, but can be the result of hemorrhages into the pulmonary parenchyma due to a variety of reasons. Therefore, during diagnosis, a thorough examination of the lumen of the bronchi at various levels is of particular importance. In addition, blood can be found in the sinus of the sphenoid bone, where it penetrates as a result of a sharp increase in pressure in the nasal cavity.

CLOSURE OF THE AIRWAY WITH A FOREIGN BODY

This variant of mechanical asphyxia has recently been found very often in persons in a state of alcoholic intoxication of varying degrees. In such cases, the airways are closed by a large piece of poorly chewed food (a piece of meat, bread, lard, etc.), due to a decrease in the reflex sensitivity of the mucous membrane of the nasopharynx and oropharynx, as well as a violation of the act of swallowing due to the development of inhibitory processes in the bulbar regions brain stem. Therefore, death occurs unexpectedly and quickly while eating in a dining room, restaurant, or at home.

In children, a wide variety of small objects that the child puts in his mouth (buttons, beads, beans, nuts, pills, chips and much more) can get into the respiratory tract.

Diagnosis of this type of mechanical asphyxia is not difficult and is based on the detection of a foreign body in the larynx, trachea, bronchi, tightly or partially obstructing their lumen in combination with signs of rapid death. In this case, the opening of the lumen of the larynx or trachea is performed on the spot, before the organ complex is removed. The foreign body, its size, location in the respiratory tract, and the degree of closure of the lumen must be described in detail. Describe the condition of the mucous membrane of the respiratory tract, in particular, swelling, congestion, damage. If death did not occur immediately, all signs of inflammation are revealed at the site of fixation of the foreign body. When a foreign body remains in the trachea or bronchus for a long time, bedsores form.

DROWNING AND DEATH IN WATER

Drowning is a process characterized by a combination of pathophysiological reactions and the penetration of water or other liquids into the respiratory tract and lungs.

Traditionally, drowning is understood as the fact that a body is completely immersed in water. However, in real life this is not at all required for drowning; It is enough to immerse only the head or even the face. Therefore, cases of drowning in small streams and ponds, barrels, bathtubs and even puddles are quite possible. Such cases are considered as special cases of obstructive asphyxia (the cause of death is aspiration of fluid and its closure of the airways).

Currently, there are four main types of drowning, differing from each other both in thanatogenesis and in morphological manifestations.

Types of drowning:

1. Aspiration type(true drowning).

2. Reflex(syncope) type.

3. Spastic(asphyxial) type.

4. Mixed type(a combination of aspiration type with asphyxial, aspiration and reflex, asphyxial and reflex is possible).

Aspiration type

By true (aspiration) drowning we mean this type of drowning, when water penetrates deeply and fills the respiratory tract and alveoli in large quantities, sometimes reaching the volume of circulating blood. The volume of inspired water depends on its temperature (warm water is inspired in greater quantities), on the intensity of respiratory movements, the vital capacity of the lungs, and the reflex sensitivity of the upper respiratory tract.

Diagnosis of true drowning

1.Persistent pinkish-white fine bubble foam, resembling cotton wool, at the openings of the mouth and nose, as well as in the lumen of the respiratory tract (S.V. Krushevsky’s sign). The mechanism of its formation is explained by the mixing of mucus, surfactant, water and air during intense respiratory movements. Because The foam is based on mucus; it is characterized by sufficient elasticity and does not burst when touched. When pressing on the chest, its synchronous mobility is noted. The presence of foam is noted in the first 2-3 days after death. Microscopic examination of foam bubbles can often reveal foreign inclusions: sand, small algae, etc.

Detection of foam at the openings of the nose, mouth and in the respiratory tract is a valuable sign indicating active respiratory movements during the process of drowning .