IX Международная студенческая научная конференция Студенческий научный форум - 2017


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Regional Clinical Hospital is one of the largest in the region and a leading medical institution in the city. One of the most important functions of the admission department of the hospital is the organization of the therapeutic process for patients admitted to the hospital for emergency indications. Over the month the admission department of RCH receives about 1200 patients. Every tenth patient arrives on the emergency indications.

We have 237 patients with urgent medical records were analyzed. They were divided into five major groups of urgent pathologies: Injuries (34%) - 93 people; Diseases of the cardiovascular system (27%) - 74 people (including 30 patients with heart disease - angina pectoris, myocardial infarction, and 44 patients with hypertensive crisis); Diabetes (21%) - 50 people; Pulmonary disease (18%) - 20 people.

Appointment of drugs starts from the moment of admission. Patients with heart disease (angina pectoris (including unstable angina), acute myocardial infarction, post-myocardial infarction, hypertension in the "small" circle of blood circulation, peripheral artery spasm) prescribe the drug "Iso-Mic". Tablets Iso-Mic10 and Iso-Mic 20 for oral administration contain the active ingredient Isosorbide dinitrate. The tablet should be swallowed with a small amount of drinking water. Adults are usually receive 10-20 mg isosorbide dinitrate 2-3 times daily or 10 mg isosorbide dinitrate 4-5 times a day.

In patients with angina pectoris and arrhythmias, sinus tachycardia, ventricular and supraventricular arrhythmias, atrial tachyarrhythmia, atrial flutter, ventricular premature beats, arrhythmias on the background of mitral valve prolapse used drug Metoprolol - beta-blocker. Orally in an average dosage of 50 mg 2-3 times a day. In the acute phase of myocardial infarction immediately after hospitalization (while continuously monitoring hemodynamics: ECG, heart rate, blood pressure) administered bolus IV 5 mg, repeat every 2 min to a total dose of 15 mg.

Patients with hypertension in a state of crisis in the admission department get Nifedipine - blocker of slow calcium channels. The drug is also used in angina; hypertension; spasm of the coronary arteries; hypertension in the "small" circle of blood circulation. Administered orally, sublingually. The maximum daily dose - 40 mg, the maximum single dose - 30 mg. Sublingual: for hypertensive crisis - 10 mg every 30 minutes (total dose of 40 mg) under the careful control of blood pressure and heart rate. After receiving the patient is recommended to rest for 30-60 minutes.

For patients with coronary artery disease - angina pectoris, myocardial infarction, unstable angina pectoris and post-infarction - nitroglycerin is prescribed. Mostly sublingually (tablet, capsule held under the tongue until complete resorption without swallowing) – 0.5-1 mg per reception. If necessary in order to achieve a more rapid effect, the capsule should be immediately crushed teeth; repeated intake of the capsule can be each 30-40 minutes. Usually antianginal effect is manifested within 0.5-2 min; 75% of the patients noted an improvement in the first 3 minutes and another 15% - within 4-5 min. In the absence of anti-anginal action within the first 5 minutes, take another 0.5 mg of nitroglycerin. Duration of action after sublingual administration – about 45 minutes.

A group of patients requiring pain relief (including injury, neuralgia, myalgia, arthralgia, biliary colic, intestinal colic, renal colic, myositis, tuberculosis, etc.), receives the drug "Renalgan" - a combined drug, providing analgesic and antispasmodic effect. "Renalgan" is administered 2-5 ml IM. If necessary, repeat administration after 6-8 hours. The maximum daily dose should not exceed 10 ml.

The drug Analgin is also used. IV or IM: adults - 250-500 mg 3 times a day. The maximum single dose - 1 g, daily - 2 g. Injectable solution should have a body temperature. Dosages greater than 1 g should be administered IV.

In order to relieve pain antispasmodic drugs is also used: "No-spa" (active ingredient Drotaverinum) - treatment of spasm of smooth muscles of internal organs (renal colic, biliary colic, intestinal colic, biliary dyskinesia and gallbladder, cholecystitis), gastric ulcer and duodenal ulcer. Administered orally - 40-80 mg 3 times a day; IM - 40-80 mg 1-3 times a day. For treatment of hepatic and renal colic - IV slowly, 40-80 mg.

Patients arriving in a state of hypoglycemic coma (including diabetics with an overdose of insulin), carbohydrate deficient nutrition, dehydration (vomiting, diarrhea, post-operative period), drug intoxication receive "Glucose" (active substance Dextrose) - IV bolus - 10-50 and 10 mL of 5% or 10% solutions. In adults with normal metabolism daily dose of dextrose should not exceed 6.4 g / kg, i.e. about 250-450 g (with a decrease in metabolic rate daily dose is decreased to a 200-300 g). Administering dextrose to a patient with diabetes should be under control of its content in the blood and urine.

Patients with diseases of bronchopulmonary system (chronic obstructive pulmonary disease, asthma, emphysema, and other diseases that occur with bronchospasm), receive a drug "Nebutamol" (active ingredient Salbutamol). The drug is administered by inhalation, 0.1 mg of salbutamol. If the attack is not stopped within 5-10 minutes after the first inhalation, inhalation can be repeated. With prolonged use of salbutamol, use 1-2 inhalations (0.1 mg) 3-4 times a day at intervals of not less than 3 hours.

Thus, the provision of medical care to patients with urgent pathology starts since the arrival of the patient to the admission department of the hospital and includes drug first aid. Considering the diversity of modern pharmaceutical preparations, it is necessary to choose the most optimal medical therapy individually for every patient.

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