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Acute management at a lung fever

Lung fever — the acute infectious disease (option of an acute pneumonia) which is characterized by defeat of one (sometimes more) lung lobes fibrinous inflammatory process and a peculiar cyclic current. The activator — a pathogenic pneumococcus.
Symptoms In typical cases the disease begins sharply, with a fever (in 80%), than fast temperature increase to 39 — 40 With, thorax pains at breath, a headache, is more rare — vomitings. At damage of a basal pleura pain is localized in epigastric area (more rare — in ileal). A precursory symptom is cough with difficult coughed up viscous phlegm of mucopurulent character then taking a red or rusty form.
At objective research: the patient quite often holds forced position (more often on a sick side), the person is hyperemic (more considerably — on the sick party), on lips herpetic rashes are often observed mucous have a cyanochroic honey agaric, scleras are hysterical. Shallow breathing, to 30 — 40 in a minute. Pulse is speeded up to 100 — 120 in a minute, sometimes arrhythmic (ekstrasistoliya); arterial pressure is often reduced. Limits of relative cordial dullness can be expanded in the diameter, tones are muffled, on a top — often systolic noise. On an ECG — signs of an overload of the right departments of heart, shift of the ST segment, change of a tooth of; disturbances of a rhythm and conductivity meet.
Physical changes from a respiratory organs depend on localization and the volume of defeat and also on a phase of pathological process. In the first days of a disease over a zone of defeat shortening of a percussion sound decides on a tympanic shade, the breath weakened with the strengthened exhalation, crepitation on a limited site — wet small-bubbling rattles is often listened. In the next days the percussion sound becomes stupid, breath bronchial with a large number of wet rattles, the pleural rub quite often is defined, the bronchophony is strengthened. In a permission stage breath becomes rigid (and further vesicular), final crepitation the number of wet rattles appears dullness decreases becomes less intensive, the bronchophony disappears.
Atypically lung fever proceeds at old men; alcoholics (the heavy current with nonsense up to a picture of delirium tremens is observed); at patients with apical localization (a heavy current at very scanty physical data).
Diagnosis. Is established on the basis of a clinical picture. Differential diagnosis is carried out with focal (drain) pneumonia, fridlenderovsky pneumonia, exudative pleurisy, tubercular lobar pneumonia.
Complications: exudative pleurisy, abscessing, carditis (endo-, peri-, mio-), purulent meningitis, glomerulonephritis, collapse or infectious and toxic shock, sepsis, fluid lungs, acute pulmonary heart, toxic delirium.
Acute management. Anesthesia: 5 ml of analginum or Baralginum or 2 ml of a tramal (tramadol) in / century. Before transportation — 1 000 000 PIECES of penicillin, in oil at the quiet allergic anamnesis.
At emergence of an asthma oxygen — 4 — 6 p/tn. For elimination of a delirious syndrome — 10 — 20 mg of Sibazonum (diazepam) in/in slowly. Septic shock: 20 ml/kg of crystalloids in the first 5 — 20 min. (at heart, renal or respiratory failure the dose decreases twice), at inefficiency — 8 — 36 mkg/kg/min. of a dopamine, are titrated to effect, at a dose over 20 mkg/kg/min. can be replaced with noradrenaline — 05 — 30 mkg/min. The fluid lungs is stopped with a systolic pressure of SD> 160 mm rg. the Art. Pentaminum to 50 mg in/in extremely slowly or Sodium nitroprussidum — 05 — Yu mkg/kg/min. At SD> 100 mm rg. the Art. — 10 — 200 mkg/min. of nitroglycerine. Furosemide — 1 — 2 mg/kg in / century. Digoxin — to 05 mg (0,25 mg/amp.) in/in at a fluid lungs with a paroxysmal form of fibrillation and an atrial flutter, supraventricular tachycardia.
Hospitalization: on a stretcher on a sick side in pulmonary department.

 
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