Filling up the call card of an accident with a fatal one. The procedure for registration of death cases at the prehospital stage

Location. The body of a man (woman) is on the floor (on the bed) in the supine position (stomach) with his head to the window (feet to the door), arms along the body. Unconscious.

2. Anamnesis. FIO (if known) was discovered in this state by the son (neighbor) FIO at 00 h 00 min. Relatives (neighbors) carried out resuscitation measures (if any) in the amount of: (list what and when). According to the son (neighbor), he suffered - (list chronic diseases). Treated - (specify medications). Indicate the date and time of the last request for medical care, if any within the last 7-10 days.

3. Objectively. Skin pale (grayish, deathly pale, cyanotic), cold (warm) to the touch. (The skin of the face, hands becomes noticeably cold after 1.5-2 hours. Skin areas covered with clothes remain warm up to 6-8 hours.)
The presence of dirt on the skin and clothing. The skin around the mouth is contaminated with vomit (blood).

cadaveric spots in the region of the sacrum and shoulder blades in the stage - hypostasis- completely disappear when pressed (after 2-4 hours) or diffusion– fade, but do not completely disappear (after 14-20 hours) or imbibitions- do not turn pale when pressed (after 20-24 hours)

Rigor mortis For example, it is weakly expressed in the muscles of the face. There are no signs of rigor mortis in other muscle groups. (Rigor mortis develops after 2-4 hours, starting with the muscles of the face, hands, and persists for 2-3 days.)

Respiratory movements no. Auscultatory: breath sounds are not heard.

Pulse on the main arteries is absent. Heart sounds are not heard.

Pupils dilated, unresponsive to light. Corneal reflex missing.
Beloglazov's symptom(symptom of "cat's pupil") positive or not detected (positive from 10-15 minutes of biological death, unstable, disappears after 50-120 minutes.)
Larcher spots(4-5 hours after the onset of death, horizontal stripes or brownish areas of a triangular shape are formed on the sclera in the region of the corners of the eyes) are not expressed (pronounced). Visible damage to the body not detected (discovered; further - description).

D.S. The death of a citizen (full name) was ascertained at 00 hours 00 minutes.
or D.S. Declaration of death (00 h 00 min).

(The ascertaining time should differ from the arrival time by 10-12 minutes).

Territorial data Polyclinic N, name of ATC. In case of crime or child death, it is obligatory to indicate the name and rank of the arrived police officer (senior group).

Acute coronary syndrome with ST elevation, uncomplicated

I21 Acute myocardial infarction

I21.9 Acute myocardial infarction, unspecified
I22 Recurrent myocardial infarction

TYPICAL COMPLAINTS

- Intense pain behind the sternum and in the region of the heart of a pressing or squeezing nature (the intensity is more pronounced than with a normal attack of angina pectoris).

- The attack is unusually long, more than 15 minutes.

- Possible irradiation to the left or right hand, neck, lower jaw, under the left shoulder blade, in the epigastric region.

- The patient is agitated, restless, notes the fear of death.

- Sublingual nitrates are ineffective or do not completely eliminate pain, or pain returns within a short time;

-- For any variant, the following symptoms are also characteristic: pallor of the skin, hyperhidrosis (sometimes "cold sweat" on the forehead), severe general weakness, feeling of lack of air.

Lack of a typical clinical picture cannot serve as proof of the absence of myocardial infarction.

CLINICAL OPTIONS OF MYOCARDIAL INFARCTION

painful

Anginal pain, independent of posture and body position, movement and breathing, resistant to nitrates. The pain has a pressing, suffocating, burning or tearing character with localization behind the sternum, in the entire anterior chest wall with possible irradiation to the shoulders, neck, arms, back, epigastric region. It is characterized by a combination with hyperhidrosis, severe general weakness, pallor of the skin, agitation, motor restlessness.

Abdominal

The combination of epigastric pain with dyspeptic symptoms: nausea, vomiting, hiccups, belching, severe abdominal distension, pain may radiate to the back, tension abdominal wall and pain on palpation in the epigastrium.

Atypical pain

The pain syndrome has atypical localization (for example, only in the areas of irradiation: throat and mandible, shoulders, arms, etc.).

Asthmatic

An attack of shortness of breath (a feeling of lack of air is the equivalent of angina pectoris), which is a manifestation of acute heart failure (cardiac asthma or pulmonary edema).

arrhythmic

Rhythm disturbances predominate.

Cerebrovascular

Signs of violation cerebral circulation: fainting, dizziness, nausea, vomiting, focal neurological symptoms are possible.

Asymptomatic (asymptomatic)

The most difficult variant to recognize, often diagnosed retrospectively according to ECG data.

ECG CRITERIA FOR MYOCARDIAL INFARCTION:

Acute injury: arcuate elevation of the ST segment with a bulge upward, merging with a positive T wave or turning into a negative T wave (an arcuate depression of the ST segment with a bulge down is possible).

Small focal necrosis: the appearance in the dynamics of a negative symmetrical T wave.

Large focal or transmural necrosis: the appearance of a pathological Q wave and a decrease in the amplitude of the R wave or the disappearance of the R wave and the formation of QS.

An indirect sign of myocardial infarction, which does not allow to determine the phase and depth of the process: there is an acute blockade of the legs of the bundle of His (usually the left one). If there is anginal pain or its equivalent, the diagnosis is: ACS, for the first time revealed blockade of the left leg of the bundle of His. Help as in ACS with ST elevation.

N.B. In the presence of a complete blockade of the left leg of the bundle of His, if there is no clinical manifestations(anginal pain and its equivalents), if there is no archival ECG and information from the anamnesis confirming the prescription of the blockade, the patient is offered hospitalization with a diagnosis of: for the first time revealed blockade of LNPH of indeterminate prescription. At the same time, assistance is provided as with unstable angina pectoris.

HELP:
ECG (EKP).

ACETYLSALICYLIC ACID(Aspirin) 125-250 mg chewed with water.
For pain:
NITROGLYCERINE 0.4 mg spray or

ISOSORBIDE DINITRATE(Izoket-spray) 1-2 doses spray in the mouth; vein catheterization.
morphine up to 10 mg IV, fractionally
When transporting for emergency primary PCI:

clopidogrel(Plavix) 600 mg or
TICAGRELOR 180 mg orally.
If it is impossible to be hospitalized within 90 minutes with the possibility of emergency PCI and the duration from the onset of symptoms is not more than 3 hours with a large area of ​​ischemia and a low risk of bleeding (age less than 65 years), subject to immediate TLT:
clopidogrel(Plavix) 300 mg orally, patients over 75 years of age - 75 mg;

SODIUM HEPARIN 60 IU/kg IV, no more than 4000 IU or
ENOXAPARIN SODIUM 1 mg/kg subcutaneously.
Tactics
Hospitalization in a hospital with the possibility of emergency percutaneous intervention as soon as possible by the first team that arrived at the patient. Transportation lying on a stretcher.
In case of refusal of hospitalization - an asset at "03" after 2 hours, in case of repeated refusal - an asset in a medical facility or OKMP.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Instructions for filling out a call card

INTRODUCTION

The "call card" was compiled in accordance with the form No. 110 / y "Call card for an ambulance", approved by order of the Ministry of Health and Social Development of Russia dated 02.12.2009. No. 942 "On approval of statistical tools of the station (department), emergency hospital", taking into account the requirements of orders for the Station and data processing at KAFU.

"Call card" is a legal medical document, common for all brigades of the Ambulance Station to fulfill calls coming to the Station.

The "Call Card" is filled out for each call in a neat and legible handwriting. In case of re-filling of the Challenge Card (rewriting), an explanation is attached to it indicating its reasons.

"Call card" has front and back sides.

PARTI.

The procedure for filling out the front side of the "Call Card".

The health worker for receiving and transferring calls (PPV) of the station prints out the incoming call on the front side of the call card. After printing the call card, the medical worker at the station’s PPV passes the “Call Card” to the medical worker responsible for the team sent to carry out this order.

When printed out at the station, the "Call Card" automatically indicates:

order number;

Date of receipt of the call to the Station;

Substation number;

Brigade number;

Time of registration (reception) of a call to "03";

Call transfer time to the station;

Brigade call transfer time

Call address: settlement, district, street, house, building, apartment, entrance, floor, entrance code (intercom), phone number from which the call was made;

Reason for the call, note (additional information relevant to the prompt search for the patient, as well as clarifying the reason)

The name of the institution or organization from which the call came;

Who called the ambulance

Full Name medical worker who accepted the call;

Surname, name, patronymic of the medical worker who sent the call to the brigade;

Surname and age of the patient (injured);

Type of call (primary, repeated, active, call to yourself, repeated by technical reason, re-treatment, double, gravity);

Place of call.

The composition of the brigade

If the brigade receives a call outside the station (by radio, by telephone, by communicator, on the way), the medical worker responsible for the brigade fills in these positions manually.

1. ATTRACT NUMBER

The position has 6 cells.

The work order number is automatically assigned to the call when it is registered.

1. CALL DATE

The "Call Card" contains the calendar date of registration of the call at the Station. The position has 6 cells:

two cells - number, two cells - month, two cells - year.

Correct entry: 160514.

1. TEAM NUMBER

The number of one of the active teams of the substation is recorded in the "Call Card". When filling in this position manually, the brigade number must be written in the form in which it was entered into KAFU when the brigade was placed on the line

1. CALL RECEPTION TIME AT STATION

The line contains the time when the call was received by the dispatch service of the Station. Attention ! This string cannot be filled with zeros alone. If the marked point in time for this or other time positions corresponds to midnight, then it is indicated as "2400".

1. TIME TO TRANSFER CALL TO TEAM

The line records the time the call was transferred to the brigade. Attention ! This string cannot be filled with zeros alone.

1. ARRIVAL TIME OF THE TEAM AT THE CALL PLACE

The line records the time of arrival of the brigade at the place of the call. This position is filled in by the brigade manually, using Arabic numerals. The time is recorded, which is reported to the crew by the employees of the Station's dispatch service when the crew confirms their arrival at the place of the call, or the time of the change in the status of the crew via the communicator.

If it is impossible to timely fix the time of arrival at the place of the call (lack of a communicator, telephone, walkie-talkie, the patient’s serious condition, an emergency situation at the place of the call, etc.), after the end of the provision of medical care to the patient (injured), the actual time of arrival of the brigade is entered in the “Call Card” to the place of the call. At the same time, a note is made in the notes: “actual time of arrival” and the reason for the impossibility of a timely “callback” is indicated.

Attention! This line can be filled with only zeros for the following call results: "address not found", "call canceled", "call not completed due to technical reasons";

if this position is filled at the end of the call service, the dispatcher makes a note in the KAFU database that there is no timely “callback” about the arrival of the brigade to the call and its reason.

1. HOSPITALIZATION REQUEST TIME

(start time of transport)

The line records the time of the request for a place for hospitalization. This position is filled in by the brigade manually, using Arabic numerals. The time is recorded, which is reported to the crew by the employees of the Station's dispatch service when requesting a place for hospitalization.

If it is impossible to timely fix the time of the start of transportation of the patient (injured), the actual time of the start of transportation is entered in the Call Card.

Attention!

1. ARRIVAL TIME TO HOSPITAL

The line records the time of the actual delivery of the patient (injured) to the hospital (injury center, sanatorium, etc.). This position is filled in by the brigade manually, using Arabic numerals. The time of change of the brigade state is recorded by the communicator.

If it is impossible to timely fix the time of arrival at the hospital, the actual time of arrival at the hospital (injury center, sanatorium, etc.) is entered in the "Call Card" and the reason for the impossibility of timely "callback" is indicated.

Attention! This line is filled in with only zeros in the absence of hospitalization of the patient (injured) in a hospital (injury center, sanatorium, maternity hospital etc.)

1. CALL END TIME

The time is recorded, which is reported to the brigade by the employees of the Station's dispatching service when the brigade "rings back" about the completion of servicing the patient, or the time of the change in the state of the brigade via the communicator.

1. TIME TO RETURN THE TEAM TO THE STATION

The line records the time of arrival of the brigade at the station (in case the brigade returns to the substation).

Attention! This line is filled with only zeros:

- if the team did not return to the station;

- if in the process of making a call an ambulance broke down (the end time of the call is considered to be the time of the brigade's call back with a message about the further impossibility of making the call).

1. CALL TIME

The line includes the time spent by the brigade on the call. It represents the difference between the time the team received the call and the time the team “called back” about the end of the call service (if the team received the next call without returning to the station) or the time the team returned to the station and is indicated in the time format (hour: min)

1. FULL NAME

the patient (injured) is recorded by the brigade without abbreviations, legibly in Russian letters and is entered by the dispatcher into the KAFU database also completely without any abbreviations.

Attention!

If the surname, name, patronymic of the patient (injured) are unknown, then this line is written "Unknown (th)")

The line is not filled in when performing a special task force, duty, or in case of unsuccessful calls with codes from 01 to 07.

1. FLOOR sick (injured)

Values: 1 - male, 2 - female.

Attention! The line is not filled:

- for any unsuccessful departure by code from 01 to 07

- when performing a brigade of special forces or on duty.

1. AGE OF THE PATIENT(injured)

The full number of years, months (for children up to a year) or days (for children up to a month) is recorded, indicating the units of measurement.

Attention! The string is filled with zeros:

- for any unsuccessful call by code from 01 to 07

- when performing a brigade of special forces or on duty .

1. DATE OF BIRTH

The calendar date of birth of the patient (injured) is recorded in Arabic numerals in the "Call Card".

There are 6 cells for this position:

Two cells - a number, two cells - a month, two cells - a year.

Correct entry: 190138.

Attention! This string is filled with only zeros

- if it is impossible to set the date of birth

- when performing a special task force, on duty or on unsuccessful calls with codes from 01 to 07.

1. PLACE OF REGISTRATION OF THE SICK (INJECTED)

In this position, the place of permanent registration of the patient (injured) is indicated by underlining the desired position. At the same time, the code of the place of permanent registration is entered into the adjacent cell: 1 - St. Petersburg, 2 - Leningrad region, 3 - another region, 4 - another state, 5 - not established.

1. PLACE OF CALL

The code of the call place where the patient (injured) is located.

Attention!

1. In all cases of applying for medical help when performing a scheduled duty, an additional outfit is issued for each patient (injured)
2. The position can be filled with zeros:

- only when performing a special task force;

- if the code is represented by a single digit, then the first cell is filled with zero.

1. Place of call after entering the code, then duplicated by text.

For example : the call came to the street - the correct entry is "01", street.

1. PLACE (method) OF RECEIVING A CALL BY THE TEAM

The place where the brigade received the call is indicated.

The line is filled in in strict accordance with the codifier.

Attention! This position cannot be filled with zeros.

The place (method) of receiving a call after entering the code is duplicated in text.

For example : call received on the phone - the correct entry is "2", the phone.

The medical worker responsible for the team after the end of the provision of medical care to the patient (injured) fills in the specified data:

1. CALL TYPE

Specifies the type of call.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! The position can be filled with zeros only when performing a special task force or duty.

For example : (first, repeat, asset, on yourself, repeat for technical reasons, repeat. reverse, double) the correct entry is "2".

20. CAUSE OF THE ACCIDENT

The cause of the accident is indicated when coding the diagnosis relating to traumatic injuries or acute poisoning.

There are 2 cells for this position.

The line is filled in in strict accordance with the codifier.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! The position is filled with zeros

-

- at any exit to a call that is not associated with traumatic injuries or poisoning of the patient.

The reason for the incident after entering the code is then duplicated in text.

1. ACCIDENT SITE

The location of the incident is given when coding the diagnosis for traumatic injuries or acute poisoning.

There are 2 cells for this position.

The line is filled in strict accordance with the codifier

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! The position is filled with zeros

- when performing a special task force or on duty;

- at any exit to a call that is not associated with traumatic injuries or poisoning. The scene of the incident after entering the code is duplicated with the corresponding text.

1. LONG TIME OF THE DISEASE

The duration of the disease is indicated when coding the established diagnosis of myocardial infarction and stroke.

There is 1 cell for this position.

The line is filled in in strict accordance with the codifier.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! The position is filled with zeros for any call that is not related to myocardial infarction or stroke.

1. CHARACTER OF ACUTE MYOCARDIAL INFARCTION

The nature of the acute myocardial infarction is indicated when coding the established diagnosis of acute myocardial infarction.

There is 1 cell for this position.

The line is filled in in strict accordance with the codifier.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! The position is filled with zeros for any call that is not related to acute myocardial infarction.

1. SIGNS OF ALCOHOL DRUNK

The presence or absence of suspicions of alcohol intoxication of the patient (victim) is indicated.

There is 1 cell for this position.

The line is filled strictly in accordance with the codifier.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention!

1. SOCIAL STATUS OF THE SICK (INJECTED)

There is 1 cell for this position.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! This line is filled with zero when:

- unsuccessful departure - codes from 01 to 07;

- when performing a special task force or on duty.

1. PARTICIPANT OF THE GREAT PATRIOTIC WAR AND COMBAT ACTIONS

There is 1 cell for this position.

The line is filled in in strict accordance with the codifier.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! This line is filled with zero:

- in case of unsuccessful departure - codes from 01 to 07;

- when performing a special task force or on duty.

Attention! This line is filled with zero when:

- unsuccessful departure - codes from 01 to 07;

- when performing a special task force or on duty.

1. CALL RESULT

The result of the call is recorded.

There are 2 cells for this position.

Filling in this line is carried out in strict accordance with the codifier.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! The string cannot be filled with zeros. Entering the code is duplicated by text.

1. METHOD OF TRANSPORTATION TO THE VEHICLE

This position is filled in the case of transporting a patient (injured) to an ambulance during hospitalization, delivery to a trauma center, sanatorium, etc.

There is 1 cell for this position.

This position is filled in strict accordance with the codifier.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention! This line is filled with zero when:

- unsuccessful departure - codes from 01 to 10;

- when performing a special task force or on duty;

Entering the code is duplicated by text.

1. MILEAGE

Records the integer number of kilometers traveled on the call.

There are 3 cells for this position. If the number of kilometers is represented by a two-digit or one-digit number, the first cell or the first two cells are filled with zeros.

1. URGENT ACTIONS

For this position, 14 cells are allocated (each cell is designated by a letter of the Russian alphabet).

When carrying out urgent measures (main types of emergency medical care) indicated in the codifier, the corresponding cell is crossed out. If urgent measures were not taken, the cells remain empty.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

1. THERAPEUTIC AND DIAGNOSTIC MEASURES

For this position, 25 cells are allocated (each cell is designated by a letter of the Russian alphabet).

When carrying out treatment and diagnostic measures (the main types of emergency medical care) indicated in the codifier, the corresponding cell is crossed out. If treatment and diagnostic measures were not taken, the cells remain empty.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention!* codifier "AND" use in the case of using inhalation of oxygen or an oxygen-air mixture with the patient's spontaneous breathing.

1. CERTIFICATION

1. HOSPITALIZATION IN A PSYCHIATRIC HOSPITAL

This line is filled in only by psychiatric teams in accordance with the current legislation of the Russian Federation in the field of protecting the health of citizens of the Russian Federation.

*Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision"

1. RESTRAINTS

This line is filled in only by psychiatric teams in accordance with the current legislation of the Russian Federation in the field of protecting the health of citizens of the Russian Federation.

1. CONSENT FOR PSYCHIATRIC EXAMINATION/ HOSPITALIZATION

This line is filled in only by psychiatric teams in accordance with the current legislation of the Russian Federation in the field of protecting the health of citizens of the Russian Federation.

1. DISABILITY BY MENTAL ILLNESS

This line is filled in only by psychiatric teams in accordance with the current legislation of the Russian Federation in the field of protecting the health of citizens of the Russian Federation.

1. SEEKING PSYCHIATRIC CARE

This line is filled in only by psychiatric teams in accordance with the current legislation of the Russian Federation in the field of protecting the health of citizens of the Russian Federation.

1. DISPENSARY SUPERVISION IN PND

This line is filled in only by psychiatric teams in accordance with the current legislation of the Russian Federation in the field of protecting the health of citizens of the Russian Federation.

1. WHERE IS THE SICK (INJURED) DELIVERED

This position is filled in cases when the brigade transports the patient (injured).

The place where the patient (injured) was delivered (hospital, sanatorium, trauma center, mortuary, etc.) is indicated, indicating the number of the medical institution.

1. ACCOMPANYING THE SICK (INJECTED)

When accompanying a patient, an accompanying person is indicated. If during the transportation of the sick (injured) there was no escort, a record is made: "Unaccompanied"

1. SURNAME OF THE DOCTOR WHO RECEIVED THE PATIENT (INJECTED)

The name of the doctor to whom the patient (injured) was transferred after being delivered to the hospital (sanatorium, emergency room, etc.) is indicated.

The doctor who received the patient (injured) in a hospital (sanatorium, emergency room, etc.) confirms the fact of admission with his signature in the call card.

1. TIME FOR DELIVERY OF THE SICK (INJECTED)

The time at which the patient (injured) was transferred to the doctor of the hospital (sanatorium, emergency room, etc.) is indicated.

1. TERRITORIAL POLYCLINIC (DISPENSER)

The number of the territorial polyclinic (dispensary) in which the patient (injured) is observed (or assigned) is indicated.

1. SUBJECT TO ACTIVE OBSERVATION

In case of need for dynamic monitoring of a sick victim, the number of the outpatient clinic (polyclinic, consultation, dispensary, etc.) to which the active call is transmitted is indicated. When an active call is transferred directly by the team, the name of the person who accepted this call is entered into the call card. Attention! During outpatient clinic hours, the active call is transferred directly by the team.

In cases where the ambulance team leaves the asset at "03", a corresponding entry is made and the time for which an active visit to the patient (injured) by the ambulance team is scheduled.

1. CONSENT TO MEDICAL INTERVENTION

In cases of obtaining informed voluntary consent to medical intervention, taking into account the risk possible complications after the last name, first name, patronymic and signature of the patient (his legal representative), the last name, first name, patronymic of the official medical worker who provided the information and received consent to medical intervention is put

1. REJECTION OF MEDICAL INTERVENTION

In cases where the patient (injured) refuses medical intervention or requests to stop medical intervention, after the last name, first name, patronymic and signature of the patient (his legal representative), the last name, first name, patronymic of the official medical worker who received the refusal of medical intervention and explained possible consequences and complications of refusal and put his signature.

48. REFUSAL OF TRANSPORTATION FOR HOSPITALIZATION TO HOSPITAL

In cases where a patient (injured) refuses to be transported for hospitalization to a hospital, the date and time of the refusal are indicated, after the last name, first name, patronymic and signature of the patient (his legal representative), the last name, first name, patronymic of the official medical worker who received the refusal to be transported for hospitalization in hospital and explaining to the patient the possible consequences of refusal, and his signature is put.

* Explanation to paragraphs. 48 - 49. Medical intervention is any action of a medical worker for the purpose of diagnosing and treating a patient, including the collection of complaints and anamnesis. Only his legal representative can refuse medical intervention in the event of a patient's incapacity. For children, parents are legal representatives. At the same time, ambulance workers are not given the right to demand documentary evidence of legal representation.

1. NOTE, DESCRIPTION

The position is intended for entering an updated address, a description of signs, clothing and personal belongings of the victim, if necessary, as well as entering other necessary information about the call.

1. COMPOSITION OF THE TEAM

Surname I.O. is indicated. members of the brigade - medical personnel and the driver. The entry is made legibly in Russian letters.

51. DIAGNOSIS BASIC

Only the main diagnosis is to be coded .

There are 3 cells for this position.

The line is filled in in strict accordance with the codifier. All cells of this line are subject to filling. The code is filled in after the entry in the line of the established diagnosis.

When filling out, it is necessary to use the codes provided for by the AISS S&NMP System.

Attention!

- The position is filled with zeros only when performing a special task force or duty

Attention!

When ascertaining death in victims as a result of traumatic injury or poisoning is mandatory to indicate location and cause of the accident.

PARTII

PROCEDURE FOR FILLING IN THE BACK SIDE OF THE CHALLENGE CARD

COMPLAINTS: I find out the main, or leading, complaints, establish their nature in detail. Then find out and describe the general complaints. Describe changes in the general state.

ANAMNESIS: brief history of present illness and information from life history relevant to diagnosis this disease.

When questioning, you need to get accurate answers to the following questions: when the disease began; how it started; how it went; what studies were conducted and their results, what treatment was carried out and what is its effectiveness, etc.

Epidemiological history - in all febrile patients. Gynecological history - in women of childbearing age with abdominal pain and / or a decrease in blood pressure, fainting. Allergic history - before prescribing any medication.

OBJECTIVELY.

General state- satisfactory, moderate, heavy, terminal.

Consciousness may be: clear, confused, stupor, coma (1-3). In addition to the classification of impaired consciousness generally accepted in Russia, it is necessary to use an assessment of consciousness using the GLASGOW COMA scale:

Position can be active, passive, forced (describe).

The skin can be: dry, wet; by color - pink, icteric, cyanotic, pale, hyperemic, etc.; the rash may be urticarial, vesicular, papular, hemorrhagic, etc.; in addition, changes in skin color and a rash can be total and local. bedsores, The lymph nodes, edema - yes, no (if there is, indicate the location). Temperature (indicated by a number).

Respiratory organs NPV(figure / in 1 min.). Shortness of breath may be absent or be expiratory, inspiratory and mixed, as well as objective and subjective. Breathing can be: rhythmic or arrhythmic (Grock, Cheyne-Stokes, Biot, etc.); superficial or deep (large Kusmaul breathing).

Auscultatory breathing can be vesicular, hard, bronchial, puerile, stenotic and also absent (right, left, total, in departments).

Wheezing may be absent or be dry (whistling and/or buzzing) and moist (finely, medium and large bubbling, voiced or unvoiced) totally or in certain departments. The presence of crepitus, pleural friction noise, etc.

Percussion sound can be pulmonary, box, tympanic, dull or blunt totally or over certain departments.

Cough may be absent or dry, incl. "barking" or wet, while sputum may be absent or mucous, purulent, "rusty", bloody, foamy, etc.

Circulatory organs: Pulse (figure / in 1 min.), the rhythm may be correct or incorrect, the filling may be satisfactory, weak, different, in addition, there may be no bullets.

Heart rate (figure / in 1 min.). Heart sounds when listening to them can be sonorous, muffled, deaf, and also different in sonority.

The murmur may be absent or be systolic and/or diastolic, auscultated over a certain point or totally, and also conducted to the carotid arteries, to the axillary region, etc.

Digestive organs. The tongue may be wet, dry; clean or coated with plaque (color of plaque and its localization); with bite marks, etc.

The shape of the abdomen can be retracted, swollen, totally or locally, the shape can be correct, and also correspond to a certain gestational age. In addition, there may be hernial protrusions and scars on the abdomen. On palpation, the abdomen can be soft or tense, totally or locally, as well as painful, totally or locally. In this case, various pathological symptoms may be absent or revealed (according to the authors).

The liver may not be palpable, protrude from under the edge of the costal arch. It has certain percussion dimensions.

Vomiting may be absent or may be ingested food, "coffee grounds", bile, etc. The stool can be formed or liquid, have pathological impurities, be frequent or rare, and also be absent for a certain time. There is a change in the color of feces.

Nervous system: in addition to the level of consciousness, the assessment of which is given at the very beginning of the description of the call card, the following are described: the patient's behavior (calm, excited, disoriented, etc.), his accessibility to contact, as well as the intelligibility of speech, the size of the pupils, their reaction to light, the presence and type of nystagmus, focal and meningeal symptoms, if any.

genitourinary system: It is necessary to evaluate diuresis, note dysuric disorders, the presence or absence of blood in the urine, the height of the bottom Bladder with urinary retention, etc.

Additional research methods and their results, local status in local pathological processes, therapeutic and tactical measures and their results, consumption of medicines and materials.

All indicators contained in the stencil of the call card are mandatory for identification and description, regardless of the nosological form. To enter the necessary information not included in the stencil, the Supplement column is used.

Upon completion of filling out the descriptive part of the call card, the date and number of the order are indicated. The card is certified by the personal signature of the medical worker responsible for the team.

The card is also signed (with full name indicated) by the responsible person who checked the call card.

Rules for determining the moment of death of a person, including the criteria and procedure for determining the death of a person (approved by Decree of the Government of the Russian Federation of September 20, 2012 No. 950) The moment of death of a person is the moment of death of his brain or his biological death (irreversible death of a person). Biological death is established on the basis of the presence of early and (or) late cadaveric changes. The diagnosis of brain death is established in health care facilities that have the necessary conditions to determine brain death.

Statement of death and examination of the corpse To ascertain death, orienting and reliable, or absolute, signs of death are used. The orienting signs of death include: § Passive, immobile position of the body, § Pallor of the skin, § Absence of consciousness, § Absence of breathing, § Absence of pulse and heartbeats, § Absence of sensitivity to pain and olfactory stimuli, § Absence of pupillary reaction to light, § Absence corneal reflex. § The fact of death is also indicated by injuries incompatible with life, visible upon examination of the corpse.

Statement of death and examination of the corpse eyeball from the sides, § Drying of the cornea and sclera, § Cadaverous spots, § Rigor mortis, § Decrease in body temperature below +20 ° C, § The presence of late cadaveric changes.

Reliable signs of death Beloglazov's sign ("cat pupil" phenomenon, "cat's eye" phenomenon) - when the eyeball is squeezed from the sides, the pupil takes the form of a narrow vertically running slit or oval. § This symptom is observed 10-15 minutes after the onset of death and ceases to be detected 40-60 minutes after death (according to some sources - after 90 minutes).

Reliable signs of the death of Magnus (Magnus-Richardson) test - one of the "life tests", an "ancient" orienting sign of the onset of death, when, when pulling a finger with a thread or applying a pressure bandage in a living person, the finger below the place of compression acquires a red-bluish color, and the color of the finger does not change in the corpse. The Magnus test is positive when the color of the finger does not change. R. Magnus (1490–1558) - Dutch physiologist and pharmacologist. B. W. Richardson (1828–1896), English physician.

Statement of death and examination of the corpse Early cadaveric changes: – Cooling of the corpse, – Cadaverous spots, – Rigor mortis, – Drying out, – Autolysis. Late cadaveric changes: – Decay, – Mummification, – Fat wax, – Peat tanning.

Early cadaveric changes The cooling of the corpse is determined by feeling the parts of the body of the corpse that are open and covered by clothing and by thermometry. At the onset of death, cooling is primarily noted on the exposed parts of the body: Ø after 1 hour, coldness of the hands is felt, Ø after 2-3 hours - the skin of the face. It is believed that the body temperature drops by an average of 1 o C per hour, and after 6 hours - by 1 o C every 1.5 - 2 hours.

Early cadaveric changes Cadaverous spots - occur 1.5 - 4 hours after death on the lower parts of the body. Cadaveric spots are usually purple in color. Often, against the background of cadaveric spots, pale areas of the skin stand out well - prints from the pressure of parts of clothing or any objects on which the corpse lay. Upon death as a result of poisoning with poisons, the color of cadaveric spots changes: Ø pinkish-red in case of carbon monoxide poisoning, Ø grayish-brown in case of poisoning with methemoglobin-forming poisons (bertolet salt, nitrites, etc.).

Stages of development of cadaveric spots - - - The first stage - the stage of hypostasis - is detected 1.5 - 4 hours after the onset of death. In the stage of hypostasis, the color of cadaveric spots completely disappears when pressed with a finger, and a few seconds after the pressure is stopped, the color is restored. The second stage - diffusion - is formed 10 - 12 hours after the onset of death. Cadaverous spots during this period do not disappear with pressure, but turn pale and slowly restore their original color after the pressure stops. The third stage - hypostatic imbibition - begins to develop by the end of the 1st day after the onset of death, continuing to grow in the following hours. Cadaveric spots at this stage do not disappear and do not turn pale when pressed, but retain their original color, do not move when the position of the corpse changes.

Description of cadaveric spots When describing cadaveric spots, indicate their localization, prevalence (solid, spilled, focal), color, change in color intensity when pressed (completely disappear, turn pale, do not change), as well as the time required to restore the cadaveric spot (in seconds) . A variant of the description of cadaveric spots: “Cadaveric spots of light purple color, spilled, located on the posterolateral surfaces of the body, completely disappear when pressed, restore their color after 10 seconds.”

rigor mortis rigor mortis begins 2 to 4 hours after death. The full development of rigor mortis in all muscle groups is achieved by the end of the 1st day. More often, the development of rigor mortis occurs in a descending type, i.e., rigor mortis first undergoes chewing muscles, then the muscles of the neck, chest, upper limbs, abdomen and finally lower extremities. The resolution of rigor mortis (at room temperature) usually occurs by the beginning of the 3rd day.

Description of rigor mortis When describing rigor mortis, it should be indicated in which muscle groups it is determined. With the development of rigor mortis in a descending type, it is first detected in the masticatory muscles, then spreads to the muscles of the neck, chest, upper limbs, abdomen, and finally the lower limbs. The entry in the call card that “rigor mortis is not expressed” is incorrect and does not indicate the absence of rigor mortis, but its weak severity and, therefore, requires an indication in which muscle groups it is detected.

Cadaverous Drying Cadaverous drying is associated with the evaporation of moisture from the surface of the body. Signs of desiccation of the corpse are determined: - when examining the eyes (clouding of the cornea; yellowish-brown areas on the conjunctiva - Larche's spots), - on the transitional border of the lips (dark red dense stripe), - on the glans penis, the anterior surface of the scrotum (dark red dense areas), on the mucous membrane of the female genital organs.

Cadaverous DRYING Drying starts from the cornea and the whites of the eyes; with open or half-open eyes, it is visually detected no earlier than 2-3 hours later. Especially clearly these changes are determined in the case when the eyes are half-open. When the eyelids are moved apart, a triangular clouding of a grayish-yellowish color becomes clearly visible against the background of a transparent and shiny albuginea; the base of the triangle is the iris, the apex is the outer corners of the eyes. These opacities are called Larcher spots.

Scheme of interviewing eyewitnesses Personality of the patient - full name, gender, age Time of appearance of the first signs of deterioration - time from the onset of deterioration Signs of violations - a brief description of the existing violations (including pain, loss of consciousness, vomiting, fever, change in pulse, breathing, swallowing, paralysis, convulsions, etc.) Circumstances and unusual situations that immediately preceded this violation - severe or prolonged exercise stress, alcohol abuse, stressful situations, overheating, trauma, bodily injury; diseases suffered at home (it is desirable to clarify the diagnosis), etc. Change in state from the moment of illness to the onset of death - short description the speed of development and the sequence of disorders that have arisen - a sudden or gradual onset, etc. Therapeutic measures taken from the moment of the disease to the examination - a list of the drugs taken (therapeutic measures used) and the degree of their effectiveness cardiovascular diseases, neurological diseases etc. The names of the drugs used.

Statement of death Anamnestic data, information received from relatives and friends, from eyewitnesses, the results of the examination of the corpse must be carefully documented. The description of the data of the examination of the corpse ends with an indication of the fact and time of ascertaining biological death: “Biological death was declared at 17:15”. The time of ascertaining death cannot coincide with the time of arrival on the call.

Defects in the description of the statement of death Anamnestic data are indicated interspersed with objective data; Incorrect description of objective data; At the same time, reliable signs of biological death are indicated that are inconsistent in time; After describing the objective data, the fact of ascertaining biological death is not reflected; The time of ascertaining biological death is not indicated. Specified time confirmation of biological death coincides with the time of arrival on the call.

Examples of defects in the description of the statement of death “The body of an elderly woman lies on the sofa with her feet to the door, her head to the window. The skin is pale, cool to the touch. According to her daughter, she suffered from coronary artery disease, hypertension, lost consciousness an hour ago, stopped breathing. Cardiac activity is absent, blood pressure is 0/0, the pulse on the main arteries is not determined. Breathing movements are absent, breathing is not auscultated. Rigor mortis is not expressed. Cadaverous spots in sloping places, do not disappear with pressure. The pupils are wide, uniform, there is no reaction to light. Beloglazov's symptom is positive. Pronounced Larcher spots. Time of death 14:00 Time of ascertainment 15:10

FRAGMENT OF THE DESCRIPTION OF A CORSE with a prescription of death less than one and a half hours A variant of the description of objective data when ascertaining death: “The body of a woman, who looks like 80 years old, lies in a room on a bed on her back. The skin is pale. Consciousness, spontaneous breathing, pulse on carotid arteries missing. Heart sounds are not heard. BP is not determined. The pupils are wide, do not react to light. There are no corneal reflexes. Beloglazov's symptom is positive. Total atony, areflexia. No visible damage was found on external examination. ECG: asystole. At 12 o'clock. 28 min. declared biological death.

FRAGMENT OF THE DESCRIPTION OF A CORSE with a limitation of the onset of death of more than two hours A variant of the description of objective data when ascertaining death: “The body of a man who looks 70 years old lies in a room on the floor on his back. Consciousness, spontaneous breathing, pulse on the carotid arteries are absent. Heart sounds are not heard. The skin is pale. Cadaverous spots on the back of the body, diffuse, pale purple, with indistinct contours, disappear when pressed and are completely restored after 30 seconds. Rigor mortis of chewing muscles. The eyes are half-open, the pupils are wide, there is no photoreaction, Larcher's spots are noted. No visible damage was found on external examination. At 10 o'clock. 15 minutes. Biological death declared.

Rules for the termination of resuscitation measures (Approved by the Government Decree Russian Federation dated September 20, 2012 No. 950) Resuscitation measures are terminated when they are recognized as absolutely unpersistent, namely: Ø when a person’s death is declared on the basis of brain death; Ø with the ineffectiveness of resuscitation measures aimed at restoring vital functions within 30 minutes; Ø in the absence of a heartbeat in a newborn after 10 minutes from the start of resuscitation measures in full (artificial lung ventilation, heart massage, medicines). Information about the time of termination of resuscitation and (or) ascertainment of death is entered in the medical documents of the deceased person.

Termination of resuscitation CPR should be stopped only in cases when, using all available methods, there are no signs of their effectiveness within 30 minutes. At the same time, it should be borne in mind that it is necessary to start counting the time not from the beginning of CPR, but from the moment when it ceased to be effective, that is, after 30 minutes of the absence of electrical activity of the heart.

Other defects in the issuance of call cards with the result “death at the ambulance brigade” Unreasonably complete examination during terminal state Inconsistent description of cardiopulmonary resuscitation Delayed start of cardiopulmonary resuscitation (for example: "cardiac arrest at 22:40" , and then: "at 22:42 the patient is transferred to the floor, CPR started") No time of start of cardiopulmonary resuscitation resuscitation (there is often a record: “resuscitation measures started immediately”) The time of registration of asystole is not indicated.

Other defects in the design of call cards with the result “death at the ambulance team” The dilution of drugs is not indicated when describing the therapy and cardiopulmonary resuscitation; In case of an unsuccessful attempt of orotracheal intubation in patients with no breathing, the procedure specified in Appendix 19 "Algorithms" (p. 226) is violated (or not described): before re-attempting tracheal intubation, mask ventilation with 100% oxygen should be performed for 1 - 1 , 5 minutes. When conducting hardware mechanical ventilation (or VVL), their parameters are not indicated; Manipulations are coded but not described; The section on consent to medical intervention is incorrectly drawn up.

Codes of defects that can be used in case of an incomplete description of medical and resuscitation measures Ø 3. clinical guidelines on the provision of medical care: Ø 3. 2. 1. not affecting the state of health; Ø 3. 2. 3. leading to a deterioration in health or creating a risk of progression of an existing disease, or creating a risk of a new disease; Ø 3. 2. 5. resulting in death. In the latter case, the call is not subject to payment and a fine is imposed in the amount of 300% of the per capita funding standard - 43,140 rubles.

When misfortune visits the house and a loved one passes away, nothing can make up for this loss, and the pain of loss will resonate in the hearts of relatives for a long time to come. And yet, someone close to you will have to organize the funeral, starting from the first minutes after the loss. It is this period that is the basis for the correct observance of all the necessary formalities and, as a result, the quick and timely execution of documents.

Relatives of the deceased should take the following actions:

• call the police;
• invite representatives of medical institutions (polyclinics, ambulance);
• transport the body to the morgue;
• draw up all the necessary documents in this case.

Calling the police

The first and most important action in the first minutes after the misfortune. Calling police officers is carried out by numbers: 02 (from the city) and 112 (from mobile phone). After the duty officer has accepted your application, without waiting for the arrival of the operational group, prepare the passport of the deceased, as well as the passport of one of the relatives. Police officers will conduct a visual inspection of the body and the premises in which it is located, and draw up a protocol. As a rule, these actions on the part of the task force are enough. However, there are situations when law enforcement officers issue a referral for a forensic medical examination:

• sudden death;
• death that occurred on the street;
• police officers suspected the violent nature of the death.

These actions are lawful and comply with the order of the Moscow Health Committee No. 300 dated July 12, 2007 "On improving the information support, registration and analysis of mortality in Moscow." If there is no need to organize a forensic medical examination, the police officers will simply leave you a copy of the protocol. Also, representatives of law enforcement agencies can offer the services of their own ritual agent. To agree to them or not is your choice, we only note that in case of a positive decision, this will require additional expenses from you in the form of payment for recommendations.

Calling representatives of medical institutions

The next step after inviting the task force. You can call medical representatives both at the same time after the application is made to law enforcement agencies, and after the departure of the police officers. To ascertain death, it is necessary to call an employee of the clinic serving this address. However, if the death occurred between 8:30 pm and 8:00 am on weekdays and between 4:00 pm and 8:00 am on weekends, you should use the services of ambulance personnel. To invite a representative of the polyclinic, contact the reception. If necessary, call ambulance, call 03 (from a landline) or 112 (from a cell phone).

An important point: in case of suspicion of a violent death, the police will call a specialized service that transports bodies to the morgue and there will be no need to go to a medical facility.

To certify death by representatives medical institutions it is also necessary to prepare a passport of the deceased, a medical policy, an outpatient card (if it is on hand), as well as a passport of one of the relatives. On your call, the duty or district doctor, the head nurse, the head of the therapeutic department should come. If it is possible to deliver the health worker yourself, then this will significantly speed up the process. After examining the body, a representative of the medical facility will leave you a death certificate.

An employee of a polyclinic can offer the services of a certain ritual agency. It will also cost a little more due to the inclusion in the cost of organizing the funeral of the so-called bonuses for this person.

Transportation of the body to the morgue

The service is provided free of charge if the body of the deceased is transported to the premises territorially assigned to this address: Mitinsky, Troekurovsky, Khovansky, Lublinsky, Nikolo-Arkhangelsky morgues. If you want to transport the deceased to another mortuary, you must obtain the approval of the administration of the institution, and the organization of the transportation of the body of the deceased will be carried out at your expense.

Paperwork

After all the measures taken, the person who organizes the funeral will need to contact the clinic, which is territorially assigned to the address of the deceased. It will be necessary to prepare the following documents: personal passport, passport of the deceased, as well as his medical card(if she is on hand), medical policy. It would be good if you additionally have papers that can somehow shed light on the cause of death. The employee of the medical institution to whom you applied will issue a medical certificate of death or write out a referral for examination.

Offers "City Service-Ritual"

All of the above concerns fall on the shoulders of the relatives of the deceased just in the most difficult period - in the first days after the death of a loved one. We understand how hard it is to focus in this moment and think rationally to do this kind of work. That is why the employees of the city ritual service "City Service-Ritual" are ready to offer their assistance in preparing and organizing the funeral. This includes:

• reasonable prices for the whole complex of funeral services;
• transportation of the body to the morgues of Moscow;
• registration of all medical and official documents;
• preparation of documents for receiving state benefits;
• paperwork for a cemetery or crematorium;
• organization of the funeral of the deceased in the temple;
• selection of a site for a memorial meal and other services.

We will support you by providing the full range of funeral services at the proper level, delicately and without a hitch!

DOSAGES FOR EMERGENCY DRUGS (The most complete list to help the physician) ADRENALIN (epinephrine) 0.1% solution (1 mg / ml). 0.01 mg/kg. In the absence of information about body weight, it is possible to use a dose of 0.1 ml of a 0.1% solution per year of life. In / in drip 0.5-1 mcg / kg / min, depending on the desired effect (with severe bradycardia, ventricular asystole). Preparation of the "mother" solution: 1 ml of 0.1% epinephrine is diluted in 200 ml of 0.9% sodium chloride solution or 5% glucose solution. Dilution: 1 ml of a 0.1% solution per 9 ml of a 0.9% sodium chloride solution (1 ml of a solution = 0.1 mg of the drug: 0.1 ml / kg or 1 ml / year of life at the indicated dilution). You can repeat the introduction every 3-5 minutes. With intratracheal administration, the usual doses are doubled, and the drug is diluted in 2-3 ml of a 0.9% sodium chloride solution. ACTIVATED CHARCOAL - 1 g/10 kg. AMBEN (Aminomethylbenzoic acid) 1% 5 ml. 50-100 mg (5-10 ml) IV. Contraindicated in children under 14 years of age. AMINOCAPRONIC ACID 5% solution (50 mg/ml). 100 mg/kg (2 ml/kg) at 1 hour, then 33 mg/kg/hour IV; 300-400 ml inside during the day. AMINAZINE (Chlorpromazine) 2.5% solution (25 mg/ml). 0.25 - 1 mg/kg AMINOSTIGMIN 0.1% solution (1 mg/ml). 0.01 mg/kg IV or IM (in case of poisoning with anticholinergics). ANALGIN (metamisole sodium) 50% solution (500 mg/ml). Children under 1 year at the rate of 0.01 ml / kg, older than 1 year 0.1 ml / year (10 mg / kg) of life. ANEXAT (Flumazenil) 0.01% solution (0.1 mg/ml). 0.01 mg/kg ARDUAN (Pepicuronium bromide) 0.4% solution (4 mg/ml). 0.08 mg/kg ASCORBIC ACID 5% (50 mg/ml). 0.1-0.3 ml per year of life. Children up to a year - 0.5 ml, older than a year - 1-2 ml of a 5% solution diluted with a 20% glucose solution. ATROVENT (Ipratropium bromide) 0.025%, inhalation, children - 1 dose (20 mcg) ATROPINE SULPHATE, 0.1% (10 mg / ml) 0.02 mg / kg (or 0.1 ml / kg body weight when diluted 10 times) or 0.05-0.1 ml / year of life (for bradycardia and in the complex of treatment for asystole). Dilution: 1 ml of a 0.1% solution per 9 ml of a 0.9% sodium chloride solution (0.1 mg of the drug will be in 1 ml of the solution). In the absence of information about body weight, it is possible to use a dose of 0.1 ml of a 0.1% solution per year of life (with a specified dilution of 1 ml / year). You can repeat the injection every 3-5 minutes until a total dose of 0.04 mg / kg is reached. In the absence of venous access - 0.1 ml / year into the muscles of the bottom of the mouth. ATP (Trifosadenine) 0.3% solution (3mg/ml). 0.1 mg/kg. Adults: 6 mg (2 ml of 0.3% solution) as an IV bolus. Children: 50 mcg/kg IV bolus. ACYZOL 6% solution (60 mg/ml). 0.1 ml per year of life. (for carbon monoxide poisoning) BERODUAL (Fenoterol + ipratropium bromide) metered aerosol (in 1 dose of fenoterol 50 mcg and ipratropium bromide 20 mcg) 1-2 inhalations 2-3 times a day; solution for inhalation through a nebulizer (in 1 ml - 0.5 mg of fenoterol and 0.25 mg of ipratropium bromide): children under 6 years old up to 50 mcg / kg of fenoterol. Children under 6 years old - 10 cap. (= 0.5 ml) per appointment, children 6-12 years old - 20 drops. for 3 times a day. BETALOC (Metoprolol) 0.1% solution (1 mg/ml). With supraventricular tachycardia: 5 mg (5 ml) intravenously, the rate of administration is 1-2 mg per minute. The total dose is 10-15 mg. The interval between repeated doses is 5 minutes. The maximum dose is 20 mg. In case of myocardial infarction or if it is suspected: 5 mg (5 ml) intravenously, the rate of administration is 1-2 mg per minute. The total dose is 10-15 mg. The interval between repeated doses is 2 minutes. The maximum dose is 15 mg. VASELINE OIL 1 ml/kg VERAPAMIL 0.25% solution (2.5 mg/ml). 0.1 mg/kg (maximum dose 10 mg). 2-4 years - 0.8 ml; 5-7 years - 1 ml; 8-10 years - 1.5 ml; older than 10 years - 2 ml. VITAMIN B1 (Thiamin) 5% solution (50 mg/ml) 0.1 ml per year of life. VITAMIN B6 (Pyridoxine) 5% solution (50 mg/ml) 0.1 ml per year of life. VOLUVEN (Hydroxyethyl starch) 10-15 ml/kg HALOPERIDOL 0.5% solution (5 mg/ml). 0.025 mg/kg. HEPARIN SODIUM 5 IU/ml. 75 IU/kg of weight (not more than 4000 IU) HYDROCORTISONE 2.5% emulsion (25 mg/ml). Children: 8-25 mg/kg IV. GLYCINE 0.1 (100 mg). older than 3 years - 1 tablet. GLUCOSE (Dextrose) 5-10% (50-100 mg/ml). 10-20 mg/kg IV drip. GLUCOSE (Dextrose) 20-40% solution (200-400 mg/ml). 0.2 ml / kg to 5 ml / kg - an average of 2 ml / kg - in / in a stream (elimination of hypoglycemia). HES (Hydroxyethyl Starches) 10-15 mg/kg. DEXAMETHASONE 0.4% solution (4 mg / ml) at a dose of 0.3 - 0.7 mg / kg. On average 0.6 mg/kg. DESPHERAL (Deferoxamine) 0.5 vial (500 mg/ml). 15 mg / kg intravenously or intramuscularly (for poisoning with iron-containing drugs). DEFIBRILLATION 4 J/kg. The force of pressure on the electrodes during the discharge is 5 kg (3 kg for infants). DIBAZOL (Bendazol) 1% solution (10 mg/ml). 0.1 ml/year of life. DIGOXIN 0.025% solution (250 mcg / ml), children: 25-75 mcg (0.1-0.3 ml of a 0.025% solution) (with paroxysmal tachycardia). DIMEDROL (Diphenhydramine) 1% solution (10 mg / ml), 0.05 ml / kg IV or IM, but not more than 0.5 ml for children under 1 year old and 1 ml for children over 1 year old. DICYNONE (Etamsylate) 12.5% ​​solution (125 mg/ml), 12.5 mg/kg (0.1 ml/kg). The maximum dose for children is 500 mg. DOPAMINE 4% solution (40 mg / ml), 2-20 mcg / kg / min, depending on the desired effect. Preparation of the "mother" solution: 0.5 ml of 4% dopamine is diluted in 200 ml of 0.9% sodium chloride solution or 5% glucose solution (100 μg / 1 ml, 5 μg / 1 drop). DORMIKUM (Midazolam) 0.5% solution (5 mg/ml). Adults: 0.1-0.15 mg/kg, children: 0.15-0.2 mg/kg. DROPERIDOL 0.25% solution (2.5 mg/ml). Older than 3 years - 0.1 mg / kg. IBUPROFEN in a single dose of 5-10 mg/kg. ISOPTIN (Verapamil) 0.25% solution (2.5 mg / ml), at the age of 1 month - 0.5 - 0.75 mg (0.2-0.3 ml); up to 1 year - 0.75-1 mg (0.3 - 0.4 ml); 1-5 years - 1-1.25 (0.4-0.5 ml); 5-10 years - 2.5-3.75 mg (1 - 1.5 ml); over 10 years old - 3.75-5 mg (1.5 - 2 ml). Adults for the purpose of stopping nagel. tachycardia, isoptin is administered as a bolus without dilution (1-2 ml of a 0.25% solution in 1-2 minutes). IONOSTERIL 10 ml/kg CALCIUM GLUCONATE 10% solution (100 mg/ml), 0.2 ml/kg (20 mg/kg). The maximum dose is 50 ml. CALCIUM CHLORIDE 10% solution (100 mg / ml), 1 ml / year of life. KAPOTEN (Captopril) older than 5 years - 0.1-1 mg / kg of body weight. CARBOXIM 15% solution (150 mg/ml). 0.1 ml/year of life. (cholinesterase reactivator) KETAMINE 5% solution (50 mg/ml). 0.5-1 mg/kg IV, 6-8 mg/kg IM. CLEXANE (Enoxaparin sodium) syringes containing 0.2, 0.4, 0.6, 0.8 and 1 ml. 0.1 ml = 10 mg = 100 anti-Xa units. 1 mg/kg body weight. In case of unstable angina pectoris, it is injected s / c every 12 hours, it is used together with acetylsalicylic acid. With AMI, 0.3 ml of the drug is injected intravenously, then, within 15 minutes, the main dose s / c (no more than 100 mg). CONVULEX (Sodium Valproate) 10% solution (100 mg/ml). With convulsive s-me: 15 mg / kg for 5 minutes / in. Children: over 10 years old - 15 mg / kg, up to 10 years old - 20 mg / kg. Average daily dose: 20 mg/kg in adults (including elderly patients) CORDARON (Amiodarone) 5% solution (50 mg/ml). Children: 5 mg/kg of body weight CORINPHAR (Nifedipine) from 5 years old - 0.25-0.5 mg/kg. SODIUM CAFFEINE-BENZOATE 20% solution (200 mg/kg). 1-5 mg/kg. Up to a year - 0.1 ml; 2-4 years - 0.5 ml; 5-10 years - 0.6-0.75 ml; older than 10 years - 1 ml. CRYSTALOIDS 130-140 ml/kg/day. LASIX (Furosemide) 1% solution (10 mg/kg). 1-2 mg/kg. LEVOMICETIN SUCCINATE (chloramphenicol) intramuscularly in a single dose of 50 mg/kg (80-100 mg/kg/day, but not more than 2 g/day). LIDOCAINE 2% solution (20 mg / ml), at a dose of 0.5-1 mg / kg (with stable ventricular fibrillation). LIDOCAINE 10% spray 1-2 doses. LISTENONE (suxamethonium chloride) IV 2 mg/kg. LORAZEPAM (Ativan) 0.4% solution (4 mg / ml), adults: single or double administration of 4 mg (1 ml of a 0.4% solution) intravenously at a rate of 2 mg per minute; children: 0.05 mg/kg IV. MAGNESIUM SULFATE 25% solution (250 mg/kg). 1 ml/year of life. 50 mg/kg. 13 ml of 25% magnesium sulfate + 250 ml of sodium chloride - in / in drip: 2 drops / kg per minute. MANNIT (Mannitol) 1.5-6.5 ml/kg. MEZATON (Phenylephrine) 1% solution (10 mg/ml), 2-10 mcg/kg. Preparation of the "mother" solution: 1 ml of 1% solution (10 mg) is diluted in 100 ml of 0.9% sodium chloride solution or 5% glucose solution (1 ml = 100 μg, 1 drop = 5 μg). S / c, / m: 0.1 ml / year (but not more than 1 ml). MEXIDOL (Ethylmethylhydroxypyridine succinate) 5% solution (50 mg/ml). 0.1 ml per year of life. METALYSE (Tenecteplase) vials 5 mg = 1 unit. It is administered intravenously as a bolus (for 5-10 seconds) depending on the patient's weight: less than 60 kg - 6000 IU (30 mg) + 6 ml of water for injection; 60-70 kg - 7000 IU (35 mg) + 7 ml of water for injection; 70-80 kg - 8000 IU (40 mg) + 8 ml of water for injection; 80-90 kg - 9000 IU (45 mg) + 9 ml of water for injection; more than 90 kg - 10,000 IU (50 mg) + 10 ml of water for injection. Thrombolysis. METHOCLOPRAMIDE (cerucal) (children over 2 years old) 0.5% solution (5 mg/ml), single dose 0.1-0.2 mg/kg; no more than 0.5 mg / kg per day. Morphine 1% solution (10 mg/ml), for children older than 2 years, a single dose of 0.1-0.2 mg/kg IV or IM. Adults with ACS are given 1 ml intravenously in fractions of 0.3-0.4 ml. NALOXONE 0.4% - 1 ml (4 mg/ml). 0.01-0.02 mg/kg intravenously. SODIUM HYDROCARBONATE 4% solution (40 mg / ml), 1-2 ml / kg IV slowly (with acidosis). SODIUM OXYBUTYRATE (sodium oxybate) 20% solution (200 mg/ml), 80-100 mg/kg (0.3-0.5 ml/kg 20% ​​solution). SODIUM CHLORIDE 0.9% solution is administered as a bolus at a dose of 20 ml/kg for 20 minutes (with symptoms of decompensated shock: with systolic blood pressure less than the lower limit of the age norm). NAPHTHIZINE (naphazolin) 0.05% solution (500 mcg / ml), 0.2 ml for children of the first year of life, adding 0.1 ml for each subsequent year, but not more than 0.5 ml, dilute with distilled water at the rate of 1 ml per year of life, but not more than 5 ml. Diluted naphazoline is injected with a syringe (without a needle) intranasally: into one nostril of a child in a sitting position with his head thrown back. The appearance of a cough indicates the ingress of the solution into the larynx. NIVALIN (Galantamine) 0.1% solution (1 mg/ml). Up to 5 years - 1-2 mg / kg, over 5 years - 2-5 mg / kg. NICOTIC ACID 1% solution (10 mg/ml), 0.05 ml/kg (for hyperthermia in older children). NITROMINT (Nitroglycerin) 180 dose vial (0.4 mg = 1 dose). Under the tongue 1-2 doses. Can be repeated after 5-10 minutes. NOVOCAINE (Procaine) 0.5% solution, 1 ml/kg, but not more than 100 ml during local anesthesia . 10-20 mg/kg. NOVOCAINAMIDE (Procainamide) 10% solution 10 mg/kg. Up to 1 year - 1 ml; 2-4 years - 2-3 ml; 5-7 years - 3-4 ml; 8-10 years - 4-5 ml; older than 10 years - 4-5 ml. NORADRENALINE (Norepinephrine) 0.2% (2 mg/ml) 0.05-0.5 mcg/kg/min. NO-SHPA (Drotaverine) 2% solution (20 mg/ml), 0.1-0.2 ml/year of life. OXYTOCIN 5 IU/1ml. Children 8-12 years old: 0.4-0.6 ml; over 12 years old: 1 ml. PANANGIN (potassium and magnesium asparaginate) 10 ml ampoules; 1 ml per year of life, but not more than 10 ml. PAPAVERINE 2% solution (20 mg/kg), children: 0.1-0.2 ml/year of life. PARACETAMOL in a single dose of 10-15 mg/kg. PERLINGANITE (Nitroglycerin) 0.1% - 10 ml (1 mg / ml). 1-10 mg/hour. 10 ml of a 0.1% solution is diluted with 250 ml of saline. solution (= 0.04 mg / ml) and administered drip. 1 mg / hour - 7 drops / min; 2 mg / hour - 13 drops / min; 3 mg / hour - 20 drops / min; 4 mg / hour - 27 drops / min; 5 mg / hour - 33 drops / min; 6 mg / hour - 40 drops / min; 7 mg / hour - 47 drops / min; 8 mg / hour - 53 drops / min; 9 mg / hour - 60 drops / min; 10 mg / hour - 67 drops / min. PIPOLFEN 2.5% solution (25 mg / ml), children under 1 year old at a dose of 0.01 ml / kg, older than 1 year 0.1 ml / year of life, but not more than 1 ml. PLATIFILLIN 0.2% solution (2 mg/ml). 0.1 ml per year of life. POLYGLUKIN, REFORTAN are administered at a dose of 10 ml/kg (if a double dose of crystalloid solutions is ineffective). POLIFEPAN 1 teaspoon for 1 year of life. PREDNISOLONE 2.5-3% solution (25-30 mg/ml), 2-10 mg/kg (average 3-5 mg/kg) IM or IV per 10 ml of 20-40% solution glucose depending on the severity of the condition. PROMEDOL (trimeperidine) 2% solution (20 mg / ml), not prescribed for up to a year; 0.1-0.2 mg/kg, 0.1 ml/year. PROPOFOL 1% solution (10 mg/ml). Introduction to anesthesia: Adults up to 55 years old 1.5-2.5 mg / kg. Adults over 55 and debilitated patients 1 mg/kg. Children over 8 years of age 2 mg/kg. Children under 8 years of age 2-4 mg/kg. Propofol is not prescribed for children under 3 years of age. Maintaining the required depth of anesthesia: Adults up to 55 years of age 4-12 mg / kg / hour. Adults over 55 years of age, debilitated patients, no more than 4 mg / kg / hour. Children from 3 to 16 years old 9-15 mg / kg / hour. The dose is selected individually. Anesthesia is maintained by administration of propofol via continuous infusion or repeated bolus injections. PULMICORT (Budesonide) 1-2 mg. PUROLASE (Prourokinase recombinant) bottles of 2 million IU. Thrombolysis: IV 2 million IU bolus + 4 million IU infusion over 60 minutes. REGIDRON (Oralit) 1 sachet per 1 liter of water. 50 ml/kg. RELANIUM (Diazepam) 0.5% solution (5 mg/ml), 0.3-0.5 mg/kg; 0.05-0.1 ml/kg IV in glucose solution, IM. (Maximum dose up to 5 years - 1 ml, over 5 years - 2 ml). The total dose for repeated administration should not exceed 4 ml. Rectally administered in a double dose. RHEOPOLIGLUKIN at a dose of 10 ml/kg until blood pressure stabilizes. RIBOXIN (inosine) 2% solution (20 mg/ml). 1 ml/year of life i.v. SALBUTAMOL dosed aerosol 1-2 doses 3-4 times a day. inhalation through a nebulizer 1.25-2.5 mg 3-4 times a day; inside at a dose of 3-8 mg / day. SPAZMALIN (Metamizol sodium + pitophenone + fenpiverinium bromide) 0.1 ml per year of life. STEROFUNDIN 10 ml/kg. SULFACIL SODIUM 20% (200 mg/ml). 1-2 drops (10-20 mg). SUPRASTIN (Chloropyramine) 2% solution (20 mg/ml). 0.1 ml/year of life. The maximum dose is 1 ml. TAVEGIL (clemastine) 0.1% solution (1 mg / ml), children under 1 year old at a dose of 0.01 ml / kg, older than 1 year 0.1 ml / year of life, but not more than 1 ml. TISERCIN (Levomepromazine) over 12 years old - 25-75 mg. SODIUM THIOPENTAL 1-2 mg/kg. TRAMAL (tramadol) 5% solution (50 mg/ml), 2-3 mg/kg IV or IM. TRANEXAMIC ACID 10-15 mg/kg intravenously drip, jet slowly (1 ml per minute) ACTIVATED CHARCOAL tab. by 0.25. 1 g per 10 kg. UNITHIOL (Dimercaprol) 5% solution (50 mg/ml). 0.1 ml/kg (1 ml/10 kg) FENTANYL 0.005% solution (50 µg/ml). 1-4 mcg/kg. FUROSEMIDE 1% solution (10 mg/ml), 1-2 mg/kg (in some cases up to 5 mg/kg) iv or IM. CHLOROPROTHIXEN Older than 6 years - 0.5-2 mg/kg. CHLOSOL (Acesol) 10-15 ml/kg. CERAXON (citicoline) 12.5% ​​solution (125 mg/ml). With stroke and TBI in the acute period, 1000 mg (8 ml of 12.5% ​​solution) IV every 12 hours. The intravenous dose is administered over 3-5 minutes. It can be administered intramuscularly, but repeated injections should avoid repeated injections in the same place. Children (according to some reports) from 50-100 mg (0.5 - 1 ml of syrup) 2-3 times a day inside. CERUCAL (Metoclopramide) 0.5% solution (5 mg/ml). 0.1 mg / kg (maximum dose for children - 2 ml) CEFTRIAXONE 1.0 bottle. 100 mg / kg (maximum - 2.0). CYCLODOL (trihexyphenidyl) 0.1 mg/year of life orally (for neuroleptic poisoning). CIPROFLOXACIN 5-10 mg/kg. EBRANTYL (Urapidil) 0.5% (5 mg/ml). In / in a stream slowly: 10-50 mg (2-10 ml of 0.5% solution) + 10 ml of physical. solution. Infusomat: 100 mg (20 ml of 0.5% solution) + 30 ml of saline. solution. In / in the system: 250 mg (50 ml of 0.5% solution) + 500 ml of physical. solution (1 mg \u003d 44 drops \u003d 2.2 ml of the finished solution). The initial rate is 2 mg per minute. Maintenance dose 9 mg/hour. Eleutherococcus, tincture, 1 cap/year of life orally. ENAP (Enalaprilat) older than 5 years - 0.2 mg/kg SODIUM ETAMSILATE 12.5% ​​solution (125 mg/ml), 12.5 mg/kg (0.1 ml/kg). The maximum dose for children is 500 mg (4 ml of 12.5% ​​solution). Adults - 2-10 mg / kg. EUFILLIN (Aminophylline) 2.4% solution (24 mg / ml), in a single dose of 4-5 mg / kg (0.1-0.2 ml / kg) 0.5-1 ml / year of life (but no more than 10 ml IV). _____________________ mg = milligram = 0.001 (one thousandth of a gram) µg = microgram = 0.000001 (one thousandth of a milligram)