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 dose 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 (naphazoline) 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)
Instructions for filling out a call card
INTRODUCTION
The "Call Card" was compiled in accordance with Form No. 110 / y "Call Card for 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
Surname, name, patronymic of the 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, asset, self-call, repeated for a technical reason, repeated appeal, 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.
- ATTRACT NUMBER
The position has 6 cells.
The work order number is automatically assigned to the call when it is registered.
- 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.
- 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
- CALL ACCEPTANCE 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".
- 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.
- ARRIVAL TIME OF THE TEAM AT THE CALL SITE
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 team by the employees of the Station's dispatch service when the team confirms the arrival at the place of the call, or the time of the change in the state of the team 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, a serious condition of the patient, 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.
- 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!
- 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 with only zeros in the absence of hospitalization of the patient (injured) in a hospital (injury center, sanatorium, maternity hospital, etc.)
- CALL END TIME
The time is recorded, which is reported to the brigade by the employees of the Station's dispatch 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.
- 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 car broke down (the end time of the call is considered to be the time when the brigade “calls back” with a message about the further impossibility of making a call).
- 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 (in case 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)
- 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.
- 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.
- 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 .
- 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.
- 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.
- PLACE OF CALL
The code of the call place where the patient (injured) is located.
Attention!
- In all cases of applying for medical help when performing a scheduled duty, an additional outfit is issued for each patient (injured)
- 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.
- 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.
- 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:
- 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.
| 01 | (RTI): a person who was in a car and was injured as a result of a transport accident |
| 02 | Linked to rail |
| 03 | Connected with metro |
| 04 | Linked to another mode of transport |
| 05 | Fall on a flat surface |
| 06 | Ice-related fall |
| 07 | falling icicle |
| 08 | Falling from height |
| 09 | Fall related to household items (chair, bed, sofa, etc.) |
| 10 | Drowning in the bathroom |
| 11 | Drowning in the pool |
| 12 | Drowning in open water |
| 13 | Hanging |
| 14 | self harm |
| 15 | Penetration of foreign bodies through the natural openings of the body |
| 16 | electrical injury |
| 17 | Fire |
| 18 | Contact with hot and incandescent substances |
| 19 | Exposure to high temperatures |
| 20 | Exposure to low temperatures |
| 21 | Exposure to sunlight |
| 22 | A bite of an insect |
| 23 | Biting or hitting a dog |
| 24 | Biting or hitting other animals |
| 25 | Poisoning with intent to commit suicide |
| 26 | accidental poisoning |
| 27 | Explosion |
| 28 | The impact of the forces of nature (hurricane, earthquake, flood) |
| 29 | Self-harm from a firearm (including careless handling) |
| 30 | Knife wound |
| 31 | Gunshot wound |
| 32 | Damage from the explosion of firecrackers, fireworks |
| 33 | attack, fight |
| 34 | Public unrest |
| 35 | Military actions |
| 36 | Terrorist act |
| 37 | Consequences of therapeutic and surgical interventions |
| 38 | Other reasons |
| 40 | Crash: Pedestrian injured in traffic accident |
| 41 | Crash: cyclist injured in traffic accident |
| 42 | Crash: motorcyclist injured in traffic accident |
| 43 | Accident: a person who was in a truck and was injured as a result of a transport accident |
| 44 | Crash: a person on the bus who was injured in a traffic accident |
| 45 | Accident: a person who was in other vehicles and was injured as a result of a transport accident |
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.
- ACCIDENT LOCATION
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.
- 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.
- 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.
- 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!
- 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.
- 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.
- 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.
| 01 | There is no patient on site, incl. taken away to the ambulance (except for ambulance crews) |
| 02 | fake call |
| 03 | Address not found |
| 04 | Served by another brigade "03", served by a polyclinic doctor |
| 05 | Refusal to check |
| 06 | Call canceled |
| 07 | Call failed for technical reasons |
| 08 | Practically healthy |
| 10 | Statement of death |
| 11 | Death at the SMP brigade |
| 12 | Death in an SMP car |
| 13 | Delivered to hospital |
| 14 | Left in place |
| 15 | Refusal of hospitalization |
| 16 | Delivered to the sanatorium |
| 17 | Delivered to emergency room |
| 18 | Delivered to sobering-up station |
| 19 | Delivered home (from a medical institution) |
| 20 | Transferred to another brigade |
| 21 | Transportation of the patient on "03" |
| 22 | Transportation of the patient outside the branch |
| 23 | Doing duty |
| 24 | Execution of a special task force |
| 25 | Left in place + asset to the clinic |
| 26 | Left in place + asset on "03" |
| 27 | Refusal of hospitalization + asset to the clinic |
| 28 | Refusal of hospitalization + asset on "03" |
| 29 | Left the brigade "03" |
| 30 | Left in place + OKMP asset |
| 31 | Refusal of hospitalization + OKMP asset |
| 32 | Left on the spot + the evacuation department team was called for transportation to the hospital |
| 33 | Stillbirth |
Attention! The string cannot be filled with zeros. Entering the code is duplicated by text.
- 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.
- 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 double or single digit number, the first cell or the first two cells are filled with zeros.
- 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.
- 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.
| BUT | Injection |
| B | dressing |
| AT | ECG |
| G | Immobilization |
| D | Infusion therapy |
| E | The use of narcotic analgesics |
| AND | Oxygen inhalation* |
| W | Gastric lavage through a tube |
| And | Childbirth allowance |
| To | Nebulizer Application |
| L | The use of neuroprotectors (glycine, mexidol, simaks) |
| M | Cardiomonitoring |
| H | ECHO |
| O | The use of anti-epidemic styling |
| P. | ECG transmission by telephone (EKP) |
| R | Lumbar puncture |
| FROM | The use of antiplatelet agents (trental, aspirin, etc.) |
| T | Anticoagulant therapy (heparin, clexane) |
| At | thrombolysis |
| F | The use of tablets and sprays |
| X | Infusion with a syringe pump |
| C | Using the transport incubator |
| W | Pulse oximetry |
| SCH | Glucometry |
Attention!* codifier "AND" use in the case of using inhalation of oxygen or an oxygen-air mixture with the patient's spontaneous breathing.
- CERTIFICATION
- 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"
- 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.
- 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.
- DISABILITY DUE TO 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.
- 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.
- 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.
- 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.
- ACCOMPANYING THE SICK (INJECTED)
When accompanying a patient, an accompanying person is indicated. If during the transportation of the patient (injured) there was no escort, a record is made: "Unaccompanied"
- 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.
- 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.
- TERRITORIAL POLYCLINIC (DISPENSER)
The number of the territorial polyclinic (dispensary) in which the patient (injured) is observed (or assigned) is indicated.
- 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.
- CONSENT TO MEDICAL INTERVENTION
In cases of obtaining informed voluntary consent to medical intervention, taking into account the risk of 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
- REJECTION OF MEDICAL INTERVENTION
In cases where the patient (injured) refuses medical intervention or demands 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 the possible consequences and complications 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.
- 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.
- 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: a brief history of the present disease and information from the anamnesis of life relevant to the diagnosis of 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, severe, 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:
| Index | Characteristic | Points |
| Speech reaction | Correct speech | 5 |
| slurred speech | 4 | |
| Articulate speech (a separate set of words) | 3 | |
| Slurred speech (incomprehensible sounds) | 2 | |
| Lack of speech production | 1 | |
| motor response | On command or at the request, performs motor tasks | 6 |
| Pain localization reaction | 5 | |
| Removing the limb from the source of irritation | 4 | |
| Abnormal flexion (decortic rigidity) | 3 | |
| Abnormal extension (decerebrate rigidity) | 2 | |
| Lack of response to pain | 1 | |
| eye opening | Arbitrary | 4 |
| At the request, on a call | 3 | |
| For pain irritation | 2 | |
| Lack of response | 1 | |
| Correlation with the Russian classification | Coma | 8 points and below |
| Sopor | 9-12 | |
| Stun | 13-14 | |
| clear mind | 15 |
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, lymph nodes, edema - yes, no (if any, 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 it may be dry (whistling and/or buzzing) and wet (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 bladder bottom 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 establishing 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 institutions that have the necessary conditions for ascertaining 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, § Lack of sensitivity to pain and olfactory stimuli, § Absence of pupillary response 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 Reliable signs of death include: § Sign of Beloglazov (phenomenon of the "cat pupil", the phenomenon of "cat's eye" - a change in the shape of the pupil when the eyeball is squeezed 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 squeezed from the sides of the eyeball, 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-cyanotic 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, that is, rigor mortis first undergoes masticatory muscles, then the muscles of the neck, chest, upper limbs, abdomen, and finally the lower limbs. 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 it 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 drying of the corpse are determined: - when examining the eyes (clouding of the cornea; yellowish-brown areas on the conjunctiva - Larche 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 - heavy or prolonged physical exertion, alcohol abuse, stressful situations, overheating, injuries, bodily injuries; illnesses suffered at home (it is desirable to clarify the diagnosis), etc. Change in state from the moment of illness to the onset of death - a brief description of the rate of development and the sequence of disorders that occurred - sudden or gradual onset, etc. Treatment measures carried out from the moment of illness to the examination - enumeration of medications taken (therapeutic measures used) and their degree of effectiveness Chronic ailments that existed before the given disease, prescribed medications - diabetes, cardiovascular diseases, neurological diseases, etc. 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. The specified time of ascertaining biological death coincides with the time of arrival to 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. Respiratory 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
A FRAGMENT OF 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 80 years old, lies in a room on a bed on her back. The skin is pale. Consciousness, spontaneous breathing, pulse on the carotid arteries are absent. 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 prescription 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 Decree of the Government of the Russian Federation dated September 20, 2012 No. 950) Resuscitation measures are terminated by recognizing them as absolutely non-persistent, namely: Ø upon ascertaining the death of a person 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, administration of drugs). 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 design of call cards with the result “death at the ambulance team” Unreasonably complete examination in the terminal state of the patient Inconsistent description of cardiopulmonary resuscitation Delayed start of cardiopulmonary resuscitation (for example: “cardiac arrest at 22:40”, and then: “ at 22:42 the patient was transferred to the floor, CPR was started") The time of the start of cardiopulmonary resuscitation is not indicated (the entry: "resuscitation immediately started immediately") The time of registration of asystole is not indicated.
Other defects in the issuance of call cards with the result “death at the ambulance team” 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 incomplete description of medical and resuscitation measures Ø 3. recommendations on the provision of medical care: Ø 3. 2. 1. did not affect 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.
Brigade calls in connection with criminal situations, suicides and attempts to them make up a significant number of cases among all ambulance trips. The provision of medical care in such cases has some peculiarities and requires special training of medical personnel due to difficult working conditions and responsibility to the bodies of inquiry and investigation.
The Ministry of Health approved an instruction on the procedure for providing medical care in criminal cases, suicides and attempted suicides. The instruction regulates the work of mobile teams and the dispatch service that receives and transmits these calls. The article will consider the work of these two links.
The tow truck of the operational department of the station is the first to receive a call about a criminal case by calling “03”. Usually this is a medical worker with a secondary education. To issue a call, he fills out an ambulance card and immediately transfers it to the senior dispatcher of the operations department. The medical evacuator is obliged to accurately and legibly fill out the call card. When speaking with a subscriber, he should combine brevity with politeness and attentiveness. In all doubtful cases and to resolve the issues that have arisen, the evacuator switches the subscriber to the panel of the doctor on duty "03". The senior dispatcher, having received a call from a tow truck and having determined the substation closest to the scene, sends it to the brigade control dispatcher. The medical evacuator and both dispatchers are located in adjacent rooms, so the transfer of the call takes a minimum of time.
The dispatcher of the crews already on the phone transfers the call for direct execution to the dispatcher of the substation, who sends the crew.
Simultaneously with the transfer of the call to the substation, the dispatcher of the direction notifies the duty inspector of the city's Main Department of Internal Affairs by telephone and marks the time of transmission and the name of the person who received the signal in the call card. The police inspector on duty sends a task force to the address given to him. Such a multi-stage approach in receiving and transmitting calls from a medical evacuator to a substation dispatcher exists only at non-category stations that perform 2 million or more trips per year. In other cities, the reception and transmission of information is carried out by one or more persons, depending on the staffing table. The dispatching service, receiving and transmitting such calls, must treat their execution with attention and responsibility. Incorrect recording of the address or other information may lead to delays in the arrival of the brigade and the provision of medical assistance to the victim. The brigade, arriving at the scene, usually already finds the task force that has begun the investigation. In this case, the functions of the brigade are reduced only to helping the victim.
When servicing calls in connection with criminal situations, there should be operational interaction between medical personnel and police representatives. The operational group is obliged to assist medical workers in providing assistance to the victim (remove strangers from the premises or select another one, help in carrying the victim, in collecting the necessary information, etc.).
Usually operational workers know their duties well and are prepared to work with our teams.
Medical personnel are strictly forbidden to enter into disputes with operational workers on issues not related to medical work. In turn, to ensure successful medical care to the victim, the operational group carries out all the necessary organizational measures at the scene. Possible "conflicts" between the ambulance and operational services are resolved jointly by the senior doctor on duty "03" and the duty inspector of the city police department.
If the task force is late, the ambulance team takes measures to preserve material evidence and possible traces of the crime. To do this, outsiders are removed from the scene, they are not allowed to rearrange furniture, shift objects, remove or destroy various papers, sweep floors, close or open doors, windows, etc. Special attention should be paid to the safety of weapons, traces of blood, notes, bottles and other items that are material evidence.
Along with urgent administrative measures, the team must immediately ensure the provision of medical care to the victim, carry out the necessary medical manipulations. However, this may lead to the partial destruction of material evidence and traces of the crime.
Consider 2 cases
First example
The brigade arrived at the scene and found the body. The doctor, and in his absence, one of the paramedical workers ascertains death. At the same time, they try to keep the situation and possible traces of the crime unchanged at the scene. By agreement with the police and the senior doctor on duty "03", the victim's corpse can be left on the spot for further investigative actions. This is the simplest example, but even in this case, transportation may be required, for example, if the corpse is on the street or in a public place. Having received permission from the police for evacuation, the brigade, according to the instructions of the senior doctor on duty, takes the body to one of the forensic morgues.
Second example
The brigade finds the victim with signs of life. Requires the provision of emergency medical care in full, including resuscitation. In this case, medical workers independently determine the procedure for providing assistance. In order to preserve possible traces of the crime and material evidence, it is difficult to provide assistance at the scene. The victim is transferred to another room, to an ambulance or simply to another place where medical personnel can work freely. It happens that operational workers, trying to obtain information important for the investigation from the victim, ask the medical staff to delay hospitalization. Doctors must understand that even a few words spoken by the dying can be of great help in solving the crime. However, in this case, the actions of all interested services are primarily aimed at providing medical assistance to the victim. Clarification of the circumstances of the incident, the persons involved in it and other issues of an investigative nature is possible only with the permission of medical workers, after rendering assistance to the victim and taking into account his condition.
Weapons or other objects of crime of evidentiary value may be found at the scene of the incident. The medical staff takes measures to preserve them, and hand over the firearms against receipt to the operational workers. If the weapon is clamped in the hand of the deceased, then it is left until the arrival of the task force. The loops used for hanging or strangulation are not untied, but cut above or below the knot, keeping it intact (knot tying may be an individual feature of the offender and is material evidence).
Some calls about poisoning with unknown poisons may be criminal. When performing them, medical personnel should handle vials left in place with extreme caution. It should be borne in mind that even a slight inhalation of vapors of a potent poison can cause serious poisoning. Sometimes the smell of the air exhaled by the victim is enough to determine the poison. For example, in case of poisoning with hydrocyanic acid salts and nitrobenzene, the exhaled air smells of bitter almonds. The smell of thiophos, karbofos, acetone or alcohol emanating from the victim indicates poisoning with these poisons.
One of the controversial issues is the issuance of conclusions on the cause of death. Ambulance medical workers should be aware that the ambulance station does not have the right to issue forensic and expert opinions.
The duty of the ambulance crews is only to ascertain the death of the victim. The bodies of inquiry receive all the information necessary for the investigation after a forensic autopsy. The hypothetical statements of our staff about the cause and timing of death may misorient the investigation and lead to the development of erroneous versions. Statement of death, interaction with representatives of the police or the prosecutor's office - the competence of the doctor, and in his absence - the responsible paramedic.
When performing the next (linear) call, the ambulance team may encounter a case of sudden death, where, judging by the situation, violent actions can be assumed.
The criminal nature of death can be indicated by the data of the external examination of the corpse: the presence of traumatic injuries, mechanical asphyxia, signs of poisoning in the form of traces of vomiting, injections, chemical burns around the mouth, face, neck. In this case, it is necessary to notify the senior doctor on duty "03" and act according to his instructions. Such information from the doctor on duty is needed to resolve the issue of transporting the corpse. In criminal or suspicious cases, the corpse is removed from the scene only with the permission of the police, with the exception of cases of death on the streets, in public places, in public transport, when delay in removing the corpse may impede the work of transport or institutions. If there are no representatives of the police or the prosecutor's office, then the ambulance workers must remember the position of the corpse, write down the car numbers (in case of a traffic accident), the names and addresses of eyewitnesses and other data.
Documents, money and valuables of the deceased in the morgue are accepted by the collector, which is documented. The doctor, in the presence of the collector, examines the corpse and registers all documents and valuables found in the ambulance call card. They also act in relation to patients with a clouded consciousness or persons who are in a state of intoxication.
All information on the provision of medical care in criminal cases is "closed" and medical personnel do not have the right to disclose the content of the incident, the number of victims and other data. Information is transmitted only to the administration of the ambulance station and the investigating authorities. Unfortunately, sometimes medical professionals tell strangers about incidents. The results are the spread of exaggerated rumors.
Responsibilities of Field Personnel When Called for Hanging or Attempted Hanging
The provision of medical care for hanging or strangulation has its own characteristics. If, having arrived on a call, the brigade discovers a corpse, then the actions of the medical worker are reduced to releasing the corpse from the loop, for which they cut the rope above or below the knot. At the same time, one of the medical workers must hold the corpse so that if it falls to the floor, post-mortem injuries do not occur, which can complicate the investigation. Let's consider a case. The team comes to the victim, already removed from the noose. Due to the short-term, being in a state of asphyxia, the victim retained vital functions - cardiac activity and respiration. However, short-term hypoxia of the brain manages to cause the death of the cells of the cerebral cortex that are most sensitive to oxygen starvation. The higher parts of the central nervous system are switched off. The victim has confusion or lack of it, a sharp motor excitation. Seizures and seizures may occur. These patients are dangerous for their unexpected and unreasonable actions. Their appearance is quite characteristic: the face is hyperemic, the eyeballs protrude from their sockets, their gaze is meaningless, their consciousness is confused. Often the victim screams, and this cry is not like a human, but resembles the roar of a wild animal. Possible motor excitation, causing bodily harm to yourself and others. Such a victim can jump out of the window, from the stairwell, fall off the stretcher. The medical worker has to tie him up, fix him to a stretcher and carry him into the car in this state. These actions may cause criticism from relatives or others who do not understand the behavior of medical workers. For this reason, conflicts and complaints are possible. Working with such victims is associated with a large expenditure of physical and mental strength, a great emotional burden, and requires maximum tact and attention from the physician.
The actions of the ambulance team in suicidal attempts
Calls for suicide attempts include calls for all types of attempted suicide by taking poisonous or hypnotic drugs, opening veins, stabbing, gunshot wounds, self-hanging, falling from a height, trying to throw yourself under a city or railway transport, carbon monoxide or industrial poisoning. gas, etc. A suicide attempt is usually made by persons with mental disorders (with clouding of consciousness, severe depression, for delusional motives), often in a state of alcohol or drug intoxication, sometimes with a demonstrative purpose.
In these patients, external examination of the skin can reveal old scars from previous suicide attempts, traces of injections on the limbs.
Medical assistance in all these cases will be symptomatic, however, all calls for a suicide attempt have one thing in common - the mandatory hospitalization of victims in a specialized hospital.
When transporting such patients, they need strict supervision to avoid repeated suicidal attempts (patients can tear off the bandages, try to jump out of the car, injure medical workers, etc.).
Be aware of the mandatory hospitalization for rape. The victim must be hospitalized in the clothes that she was wearing during the rape. Gynecological examination in an ambulance is not carried out.
When providing medical care, attention should be paid to the following: in case of poisoning with poisons and sleeping pills, it is necessary to rinse the victim's stomach through a tube, regardless of whether the poison was taken or there was only an attempt to take it.
In this case, relatives try to persuade medical workers to leave the victim at home, since the poisonous substance was not taken. Ambulance crews should not go along with such requests. You cannot be sure that a person left in a conflict situation will not take the poison again or will not commit any violence against himself or others. The very fact of a suicide attempt obliges us to consider this person as a patient in need of special treatment. This is a very important moment in our work, as the team is responsible for the life and health of the patient left at home.
In conclusion, it must be said that no instruction or article can provide for the whole variety of life cases. The ambulance team must act according to the circumstances, taking into account the prevailing situation, consulting in all doubtful cases with the senior doctor "03".
One of the areas of work that ambulance employees have to deal with is the statement of death, while a call card is compiled in all cases. We will tell you how to issue a call card and declare death in different cases
One of the areas of work that ambulance employees have to deal with is the statement of death, while a call card is compiled in all cases.
We will tell you how to issue a call card and state death in different cases. A detailed description of the actions of health workers, "cheat sheet" for download.
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From the article you will learn:
Regulations on the declaration of death in the call card
One of the areas of work that ambulance employees have to deal with is the statement of death, while a call card is compiled in all cases.
We will understand the features of the current legislation to determine the fact of death, as well as how an ambulance call card is drawn up, a statement of death in a medical institution, what signs health workers are guided by, stating the death of a patient.
The death of the patient is confirmed by a health worker - a doctor or paramedic, i.e. a person with special medical education. If biological death has occurred, a call card is compiled at the patient's home, while the moment of death is recognized as the moment of death of his brain or the time of irreversible consequences for the patient's life.
Statement of death card for calling a cheat sheet for an ambulance (regulations of actions):
- First of all, the death of the patient is reported to the senior doctor (before the arrival of the team or in its presence).
- If death is suspected as a result of criminal attacks, violent acts, as well as as a result of suicide, health workers should report this to the police.
- A statement of death, a call card is drawn up in all cases. In the card, the physician describes the estimated time of death of the patient, its approximate causes, the patient's last complaints (according to witnesses) and other circumstances of death known to him.
- If death occurred in the presence of physicians, the description of the call card to ascertain death should include data on the provision of medical care to the patient, the circumstances in which it was provided.
- An obstetric history is included in the death card in the event of the death of a child under the age of 1 year. At the same time, the place and date of his birth, weight and height, data on known diseases are indicated.
- If the patient underwent resuscitation, it is necessary to indicate their volume and duration.
When ascertaining death, the health worker must determine the presence of injuries on the body (injuries, strangulation furrow), the position in which the body is located, the color of the skin, the presence of cadaveric spots and other important signs.
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