Loss of consciousness - Causes, symptoms and treatment. MF.
Mar 29, 2018
Loss of consciousness, a condition in which the functioning of central nervous activity is impaired. The person falls, is without movements( exception is convulsions with epileptic seizures), does not perceive the surrounding, does not respond to questions, does not respond to external stimuli( loud voice, claps, lungs slaps, chips, cold, heat).
Short-term loss of consciousness from a few minutes to half an hour, in medicine has the term - "syncopal condition".
Heavier and more prolonged states are divided by severity into coma of different degrees.
Causes of loss of consciousness:
1. Insufficiency of blood flow to the brain.
2. Lack of oxygen in the blood
3. metabolic disorder, that is, brain nutrition.
4. impairment, for some reason, of impulses transmission by axons of the brain or the occurrence of pathological discharges in neurons of the brain.
Now we will sort out in order.
Inadequacy of blood flow to the brain can occur:
1. As a result of an increased reaction of the autonomic nervous system to various psychological situations such as anxiety, fright, fatigue, there is a sharp expansion of the peripheral vessels, blood rushes due to lower resistance down,and oxygen in the brain.
2. Due to cardiac causes, when the fraction of cardiac output sharply decreases, that is, the amount of blood ejected into the systole by the left ventricle of the heart. This condition is typical for acute myocardial infarction. Heart rhythm disturbances, such as atrial fibrillation( chaotic, ventricular-independent atrial contraction), atrioventricular blockages of nerve impulses between the atrium and ventricle, weakness syndrome of the sinus node( central nerve connection regulating the rhythm of the heart).As a result of these pathologies, irregularities are formed, entire complexes of cardiac contractions disappear, the flow of blood becomes irregular, which also leads to hypoxia of the brain. With significant stenosis of the aortic valve of the heart, syncopal conditions are also possible due to the difficulty of ejection of blood into the aorta.
Just in this section I want to make a reservation that the incomplete blockades of the legs of the bundle of Giss( nerve fibers in the ventricles of the heart) frequently encountered on cardiograms do not lead to attacks with loss of consciousness and in general in most cases do not have any symptomatology and diagnostic value if they exista long time.
3. Orthostatic syncope occurs in people with low blood pressure, when taking inadequate doses of antihypertensive drugs with hypertensive drugs, as well as in elderly people. It arises with a sudden change in the position of the body( a sharp rise from the bed, chair).The reason for its occurrence is a delay in the response of the vessels of the lower limbs, they do not have time to narrow in time and as a result, there is a decrease in blood pressure, a decrease in cardiac output and, again, a lack of blood supply to the brain.
4. Atherosclerotic changes in large vessels feeding the brain, and these are carotid and vertebral arteries. Atherosclerosis is known to be cholesterol plaques densely fused with the vessel wall and narrowing its lumen.
5. Loss of consciousness is possible with the appearance of a thrombus completely covering the vessel, the risk of thrombosis exists in the postoperative period of any surgical interventions, especially when replacing the heart valves with artificial ones, after shunting the coronary arteries, in the last two cases, since in the body a foreign body,the risk of thrombus formation exists throughout life and requires the continued use of indirect anticoagulants. Violation of the rhythm of the heart by the type of constant or periodic atrial fibrillation of the heart( ciliary arrhythmia) also has a high risk of thrombosis and also requires the use of disaggregants or indirect anticoagulants.
6. With anaphylactic shock( a severe manifestation of an allergic reaction to a drug), as well as an infectious-toxic shock( in severe infectious diseases), loss of consciousness is also due to the expansion of peripheral vessels and the outflow of blood from the heart, but by exitingin the blood of the vasodilator( vasodilator) mediator inflammatory and allergic processes - histamine and other intracellular elements that appear when the cellular structures are destroyed, they not only have a vasodilatorbut also increase the permeability of small capillaries, due to which the blood rushes to the skin, the circulating volume of blood decreases, and again, the cardiac output decreases, the result is a violation of the blood supply to the brain and the syncopal condition.
Recommended examinations and analyzes to clarify the cause of syncope( short-term loss of consciousness), which may be based on insufficient blood supply to the brain.
1. Consultation of a neurologist for the exclusion of neuro-vegetative-vascular dystonia.
2. Consultation of the therapist to exclude hypotension( low blood pressure, lower than 100 \ 60 mm RT), as well as the appointment of adequate doses of antihypertensive therapy in the presence of hypertensive disease.
3. ECHO KG( heart uzi), electrocardiogram, ECG Holter( daily ECG), all this to clarify the existence of heart defects, the presence of arrhythmias in the work of the heart.
4. Doppler ultrasound examination of the vessels of the neck and brain reveals an atherosclerotic or other pathology in these vessels.
Loss of consciousness due to a lack of oxygen in the blood occurs with the following diseases and conditions:
1. Lack of oxygen in the inspired air, that is, a long stay in a stuffy room.
2. It is possible to lose consciousness in severe lung diseases, especially in case of exacerbation of bronchial asthma, the appearance of asthmatic status, at high degrees of chronic obstructive pulmonary disease( obstructive bronchitis).
When paroxysm of prolonged cough in patients with obstructive pulmonary disease, the mechanism of occurrence of a double, first directly due to a lack of oxygen in the blood and secondly increases with prolonged cough intrathoracic pressure, which prevents venous return, resulting in a decrease in cardiac output.
3. In anemia with low hemoglobin of high degree( below 70-80 g / l), fainting is possible under any conditions. With higher hemoglobin numbers, the likelihood of loss of consciousness increases when you are in a stuffy room.
4. In cases of poisoning with carbon monoxide. CO - a colorless gas without odor and taste, which increases the risk of poisoning. Poisoning often occurs in the home during furnace heating, gas columns and the absence of the required exhaust and airing of the room, when exhaust gases from the car engine enter the driver's cabin( for example, while the driver sleeps in the car with the engine running with the windows closed or in the garage).Penetrating through the lungs into the blood, carbon monoxide combines with hemoglobin to form carboxyhemoglobin, blocks the transport of oxygen by blood, there is acute oxygen starvation - hypoxia, besides binding to myoglobin( a protein contained in muscles), CO inhibits contraction of the myocardium muscle.
In order to eliminate the causes of short-term loss of consciousness due to a lack of oxygen in the blood, the following tests and tests are desirable:
1 A general blood test, which reveals the amount of hemoglobin and red blood cells, as well as the number of eosinophils, one can judge the presence of bronchial asthma.
2. Radiography of the lungs - we exclude chronic bronchitis, oncological and other lung diseases.
3. Spirography( exhale air with effort into a special device) allows you to judge the functions of external respiration.
4. If you suspect a bronchial asthma of an allergic genesis it is useful to visit an allergist and make tests for allergens.
Syncopal conditions in the violation of the metabolism( nutrition) of the brain, occur mainly with a disease such as diabetes.
1. In case of an overdose of insulin, the amount of sugar in the blood decreases-hypoglycemia, resulting in a breakdown in the supply of the brain, which leads to a disruption in the function of nerve impulse transmission.
2. Diabetic ketoacidotic coma - occurs vice versa with a lack of insulin and an increased amount of glucose in the blood( blood sugar above 17-20 mmol / l).characterized by the increased formation of ketone bodies( acetone, urea) in the liver and an increase in their content in the blood. As a result of the violation of metabolism in the cells of the f brain and as a consequence of loss of consciousness. The peculiarity of this coma is the odor of acetone from the patient.
Lactacidotic( lactic acid coma) in diabetes usually occurs against a background of renal insufficiency and hypoxia. A large amount of lactic acid is noted in the blood. In contrast to ketoacidotic coma, there is no smell of acetone.
For the diagnosis of diabetes requires repeated surrender of blood to sugar from a finger on an empty stomach. With an increase in glucose in the capillary blood of more than 6.1 to 7.0 mmol / l, suggests a decrease in glucose tolerance( that is, a decrease in the sensitivity of insulin to glucose), an increase in glucose above 7.0 mmol / l is alarming in terms of diabetes mellitus, and then it is requireddelivery of blood after a load with glucose( on a hungry stomach blood is given for sugar, then 75 grams of glucose dissolved in a glass of water is drunk and after 2 hours the level of sugar in the capillary blood is measured.) The glucose level after a load above 11.1 indicates the presence of diabetes.the glucose level in urine is important( normally should not be). The most accurate method of establishing a diagnosis of diabetes is the measurement of glycosylated hemoglobin, which is a time average of the concentration of glucose in the blood for 6-8 weeks preceding the observation.
It makes sense to produceultrasound examination of the pancreas, in order to eliminate diseases leading to diabetes mellitus. As you know, insulin is produced in the cells of the pancreas.
The impairment of impulse transmission along the axons of the brain or the occurrence of pathological discharges in the neurons of the brain arises under the following conditions:
1. First of all, the epileptic syndrome is recurrent seizures, often with loss of consciousness, resulting from hypersynchronous discharge of neurons of the brain( pathological foci of excitation in the cortexbrain).Seizures, unlike other cases of loss of consciousness, are characterized by the presence of clonic( muscle twitching) and tonic( increased tone, muscle tension) seizures.
2. For various craniocerebral injuries in which there is a concussion, bruise, compression of the brain, resulting in the displacement of the cerebral hemispheres, relatively rigidly fixed brain stem, there is a transient increase in intracranial pressure, tension and twisting of long axons( nervefibers) deep in the white matter of the hemispheres, and the brain stem. In mild cases, as a result of this process, the conductivity of axons( temporary, short-term loss of consciousness) is temporarily impaired, severe edema and rupture of axons and small vessels accompanying them( coma-prolonged loss of consciousness of varying degrees).
3. Loss of consciousness may occur if there is an ischemic or hemorrhagic stroke. The difference is that in the first case, the violation of the blood supply to the brain arises from the clogging of a vessel due to a thrombus, which can be caused by atherosclerosis or toxic effects of certain substances( from practice, I observe a large number of ischemic strokes after consuming alcohol substitutes, includingand after taking in a large number of alcohol-containing infusions sold in pharmacies.
Hemorrhagic stroke( intracerebral hemorrhage) is the rupture of the brain vessel, always hasmore serious disease and a higher percentage of deaths
One of the important factors in the development of both types of strokes is uncontrolled hypertension, for the brain is unfavorable in terms of the development of strokes, both constantly high and spasmodic( low to high blood pressure)
First aid for unconsciousness
What to do if you witness a loss of consciousness by another person.
1. If a loss of consciousness occurred in a stuffy room, when carrying out mass events. More likely to faint due to lack of oxygen or due to overexcitation of vegetative innervation of the body. The mechanism of this state is sometimes of a mixed nature.
Action in this case:
1. Expand the collar of a shirt or other clothing.
2. Open a window for oxygen access or take the victim to a well-ventilated room.
3. Bring the cotton wool with ammonia to the nasal passages up to 1 -2 minutes.
4. If after that, do not come to consciousness on the right side, place your right hand along the trunk, place the head on the back surface of your left hand. In this situation, there is less likelihood of tongue twisting, and the airways are more free. If you can then check with the index finger of your hand, having previously opened the jaw, there is no tongue lancing in the throat. If there is, then you need to release the airways by fixing the tongue to the side surface of the oral cavity( pressing the thumb of your hand).Naturally completely by blocking the airways.
5. Check for pulse and breathing( as described below).
6. If there is no pulse and breathing, if you know how to do, before the arrival of the NSR, proceed to artificial respiration and indirect heart massage( the procedure is given below).
7. Call for an ambulance, describe the symptoms as accurately as possible in case of unconsciousness.
If you find a person unconscious on the street
1. Find out from the witnesses, maybe someone knows what the patient is sick.
Sometimes in the pockets of chronic patients there are data on their disease and a record of possible care. If they are found or receive data about the patient, follow the recommendations of the note or report all the emergency data.
2. Test by feeling if there are open injuries and bleeding, if detected, try to stop it by available means before arrival of emergency medical care.
3. Check if there is a pulse, it is best to feel the pulse on the carotid artery, for this place the index and middle finger of the right hand on the thyroid cartilage of the affected person, smoothly lower the hand down the neck( when the patient is lying down) to a soft depression,feel a pulse.
4. If there is no pulse, there is no breath( there is no chest movement, there is no misting on the glass that is brought to the nose and mouth of the affected glass), and the skin is still warm, we check the pupils' reaction to light. In a living person, or in clinical death, the pupils' reaction to light persists. We check as follows:
If the patient lies with closed eyes, open the eyelids, in the presence of signs of life, we see a narrowing of the pupils to light. If the victim's eyes are open, cover them with his hand for 10 seconds, then remove the hand, must again observe the narrowing of the pupils. In the dark, any backlight( flashlight, cell phone) is used for verification. Also, to determine the signs of life, the corneal reflex is checked, for this, with a handkerchief or cotton wool, if not, then touch the eyelid with another soft textile, a blinking occurs in the living person.
In the presence of signs of life or clinical death, it is possible before the arrival of emergency medical care, start artificial respiration and indirect( this is for specialists, performed at chest dissection) cardiac massage. More often than not, the early onset of resuscitation is more beneficial than the ambulance brigade that resides after a while. The only exception for artificial respiration not by specialists is the suspicion of a fracture of the spine in the cervical section.
Methods of artificial respiration and indirect heart massage.
Patient is lying on his back, previously freeing of possible vomit masses and mucus airways. We jerk the head of the victim by lining the roller under the occipital region of the head so that the lower jaw protrudes forward. With tight compression of the jaws, you can use the compression method of the lateral surfaces of the lower jaw. Next, we perform artificial respiration by mouth-to-mouth( used most often), or "mouth to nose"( used in cases of inaccessibility of oral cavities).To do this, through the handkerchief, do 2 breaths in the patient, pre-clamped nose or mouth( depending on the type of artificial respiration), then we carry out pressing with the straightened hands, stacked one on top of the other in the lower third of the sternum in an amount of 8-10 clicks, with a reasonable applicationforces for the plying of the chest, and naturally releasing the airways for air release. When carrying out artificial respiration and indirect heart massage together, the following method is suggested: One holds mouth-to-mouth or mouth-to-nose breathing in the amount of one breath, the other makes 4-5 strokes on the chest.
Cycles of artificial respiration and indirect heart massage are repeated until the arrival of emergency medical care.