According to ICD 10 fracture of the zygomatic bone. Zygomatic bone fracture

The body reacts to stress instantly, dramatically throwing a huge amount of adrenaline into the bloodstream. As a result, the blood vessels, activity is intensifying of cardio-vascular system... To ensure maximum blood flow to the brain, the digestive, genitourinary and other systems are turned off (all oxygen and glucose are transferred to the human muscle tissue), the pulse is accelerated, which leads to the expansion of the heart vessels, as well as the vessels of the brain.

It is not surprising that if, in the first three minutes after cardiac arrest, an adrenaline solution is injected directly into the heart, blood circulation, heart rate can be restored, and saved from death.

The hormone adrenaline is produced by the cells of the adrenal medulla, and it is always present in small quantities in the body. In case of danger, severe fright, physical injury or other stressful situations, its production increases sharply, as a result of which the “run or fight” reaction is activated, which makes it possible to run at an atypical speed for a person, overcome high obstacles, and in case of fatigue, improves muscle performance.

A sharp rush of adrenaline develops in a person a timely protective reaction to unexpected shock and stressful situations, making it possible to react in time and take concrete actions. The hormone increases the amount of glucose that feeds the brain, stimulating brain activity and the central nervous system, making it possible to navigate a dangerous situation and find a way out.

At the same time, adrenaline stimulates immune system and is able to suppress the development of allergic and inflammatory processes in the body.

Signs of an adrenaline rush are pale hands, face, dilated pupils, a sharp increase blood pressure. This situation lasts about five minutes, because literally in a few seconds, as adrenaline begins to be released, the systems that extinguish it are activated, as a result of which the excess of the hormone leaves the body through sweat, tears or urine.

The release of an excess amount of adrenaline is necessary, otherwise the process of oxidation and decay of protein will start, as a result of which the tone of the body will decrease, decrease muscle massthat can provoke exhaustion. Since a high amount of the hormone causes an increased blood pressure, it can lead to heart failure, cause arrhythmias, aneurysms, stroke.

If the release of adrenaline occurs in small quantities, it signals adrenal disease, severe allergies, kidney disease. It is often not enough for people who have undergone severe heart surgery, are experiencing severe depression, have lost too much blood (for example, due to an accident).

Therefore, if a person becomes too apathetic and reacts poorly to external stimuli for a long time, it is imperative to consult a doctor for diagnosis of the disease and subsequent treatment.

Application in medicine

In medicine, the use of artificial adrenaline is aimed at the implementation of anti-shock therapy, which makes it possible to launch systems important for the body and correct the physiological or emotional condition sick. Also, the drug is used:

• in case of violation of the blood supply to vital internal organs;
• to eliminate anaphylactic shock that occurs during cardiac arrest or during severe heart failure;
• with a sharp decrease in blood pressure;
• in acute allergic reactions various types (insect bites, medications, blood transfusions, food);
• with a low sugar level (hypoglycemia), which was provoked by too much insulin;
  some ENT diseases;
• with too high intraocular pressure (open-angle glaucoma), as well as during eye surgery;
• with bronchial asthma, asthma attacks;
• with ventricular fibrillation (chaotic contraction of myocardial fibers at a frequency of 250-280 per minute, which can lead to complete cardiac arrest within two minutes).

Tablets are prescribed for angina pectoris, arterial hypertension, prescribed for syndromes that accompanies too high anxiety, compression in the chest or a feeling of lying across chest crossbeams. Suppositories with adrenaline are used for hemorrhoids: thanks to the hormone, they reduce arterial inflow, quickly stop bleeding, and cause spasms of the capillaries that surround the rectum.

Characteristics of the drug

The international non-proprietary name (INN) active substance drug "Adrenaline" is epinephrine, which belongs to the clinical and pharmacological group of alpha-beta adrenergic agonist. In some preparations, the active substance was obtained from the adrenal glands of cattle, in others it is of synthetic origin. Drugs may have different shape release:

• 0.1% solution of epinephrine hydrochloride;
• 0.18% solution of epinephrine hydrotartrate;
• in tablets (release form - homeopathic granules D3);
• candles with adrenaline (for more effective treatment hemorrhoids).

Solutions for external use are produced in 10 ml vials, for subcutaneous, intravenous and intramuscular injection - in ampoules of 1 ml (the cost of five ampoules is from 65 rubles and above). Store hermetically sealed orange vials or sealed ampoules in a place protected from the sun.

The pharmacological action of the drug is such that while taking the medication, vasospasm occurs almost throughout the body, with the exception of the pulmonary, coronal and cerebral vessels. This leads to an increase in blood pressure and activation of skeletal muscles, causes contraction of the uterus, relaxes the bronchi, reduces the tone of smooth muscles in the intestinal region.

For this reason, the drug Adrenaline is often used during operations to stop severe bleeding, in case of anaphylactic shock, which was caused by drugs, animal or insect bites. The drug has a characteristic instant, but short-term effect.

Since too large doses of the drug cannot be administered in order to prolong its effect, doctors combine epinephrine with solutions of novocaine, dicaine or other anesthetic drugs. Due to this, the hormone is absorbed into the cells more slowly, which is why its effect is longer.

In addition, the drug has a stimulating effect on the human immune system, primarily by increasing the number of leukocytes that leave the spleen, bone marrow depot, and are also redistributed in case of vasospasm. This allows you to successfully use adrenaline in inflammatory, infectious processes, allergic reactions.

A beneficial effect on blood clotting is possible due to the ability of epinephrine to increase the number and activity of platelets, which occurs simultaneously with the spasm of small capillaries, due to which the blood stops.

Side effects and contraindications

Although adrenaline can save lives in a critical situation, the effect of the drug on the body is so great that it must be used with extreme caution, in no case exceeding the dose, and only as directed by a doctor. An adrenaline rush often accompanies a distorted perception of reality, dizziness.

Since the body at this moment receives an additional charge in the form of glucose, in the absence of stressful situation, energy does not find a way out, as a result of which the activity of adrenaline begins to negatively affect the heart muscle and cause heart failure. In this case, nervous breakdowns and insomnia are frequent, signaling that a person is in a state of chronic stress.

It is categorically impossible to use adrenaline simultaneously with such narcotic drugs as cyclopropane, fluorothane, chloroform: this can cause severe arrhythmia. Cannot be combined with antihistamines and oxytocin, as it can cause intoxication of the body. The instruction for the drug does not recommend the use of a synthetic hormone when:

• all forms of aneurysm;
• hypertension;
• atherosclerosis;
• diabetes mellitus;
• thyrotoxicosis ( high level hormones thyroid gland);
• glaucoma;
• during pregnancy and while breastfeeding.

Application

Since adrenaline has a different form of release, including in the form of a solution, if necessary, it can be injected not only subcutaneously or intramuscularly, but also intravenously. In addition, this form allows them to lubricate the skin, as well as stop bleeding by moistening a tampon or bandage in the medicine.

The instruction provides that the dosage of the drug per day should not exceed 5 ml, a single injection of the drug - no more than one. The agent must be injected very slowly and carefully. Only a doctor should do this, as well as prescribe the dosage. Otherwise, the consequences will be catastrophic: too much dose can lead to death.

The dose for the child is selected individually, if there is no improvement in the condition, adrenaline cannot be injected: it must be replaced with analogues. As for adrenaline tablets or hemorrhoid medicines containing adrenaline, they should also be taken only as directed by a doctor, strictly adhering to the instructions and dosage.

Epinephrine belongs to the powerful hypertensive drugs from the group of α and β adrenergic and sympathomimetics.

The active substance is epinephrine hydrochloride... 1 ml contains 1 mg of the component. It comes in 30 ml dark vials.

Mechanism of Action of Adrenaline

Epinephrine is a direct stimulant of α- and β-adrenergic receptors. Under its influence, the content of Ca in the smooth muscle elements increases and the degree of activity of the phospholipase enzyme increases. In parallel, compounds such as diacyglycerol and inositol triphosphate are formed, which promote the release of calcium from the "depot".

The stimulating effect on β-adrenergic receptors activates adenylate cyclase and increases the synthesis of cyclic adenosine monophosphate. As a consequence, an active reaction begins on the part of the target organs. The amount of intracellular Ca increases in the heart muscle.

Epinephrine hydrochloride increases and accelerates the heart rate, and also increases the volume of the heart (both shock and minute). Adrenaline improves atrioventricular conduction and increases automatism. Under the influence of this substance, the oxygen demand of the heart muscle increases. Epinephrine constricts small vessels skin, and, in part, striated muscles. Blood pressure (mainly systolic) increases, and when the patient receives high doses, the total peripheral vascular resistance increases. The pressor effect exerted by the substance is capable of provoking a short decrease in the pulse rate.

Adrenaline promotes relaxation of the smooth muscle elements of the bronchial walls, reduce the tone and weaken the tone of the digestive tract. After the introduction of epinephrine hydrochloride, mydriasis is fixed and a marked decrease in pressure in the eye cavity is noted. The active substance is capable of provoking hyperglycemia, and the increase in the content of free fatty acids in plasma increases.

Epinephrine biotransformation process takes place in the liver, kidneys and organs digestive system... This process involves enzymes such as monoamine oxidase and catechol-O-methyltransferase. The half-life does not exceed a few minutes. Metabolites are excreted in the urine. Epinephrine does not cross the blood-brain barrier

When is an Adrenaline injection needed?

The indications for the appointment are:

• start ;
• bronchospasm with general anesthesia;
• asystole against the background of III degree AV block;
• difficult hemostasis with bleeding from capillaries and arterioles;
• during the period surgical interventionsin which the infusion of adequate volumes of plasma substitutes does not help;
• with shock, extensive trauma and overdose of pharmacological drugs;
• prolongation of the effect of local anesthetics (including during dental procedures);
• hypoglycemia with accidental administration of an excessive dose of insulin;
• swelling of the conjunctiva.

Contraindications to the use of Adrenaline

Adrenaline solution is not administered if diagnosed:

• ventricular fibrillation;
• obstructive cardiomyopathy;
• intolerance of this drug to patients.

Dosing scheme

Epinephrine is usually given subcutaneously; in some cases, intramuscular or slow injections are indicated intravenous administration ... The standard dose for adult patients ranges from 200 mcg to 1 mg, and for younger patients, from 100 to 500 mcg.

If indicated, epinephrine injectable solution can be used as eye drops.

Epinephrine tampons can be used topically for hemostasis.

Side effects of Adrenaline

When providing assistance, the following side effects are not excluded:

Adrenaline during pregnancy and lactation

Adrenaline is able to pass through the blood-placental barrier. The substance penetrates into breast milk, which is important to consider for women during lactation. For pregnant and lactating women, epinephrine may only be administered at the discretion of the attending physician.

note

Children and the elderly should be administered adrenaline with extreme caution.

Additionally

Adrenaline is never given intra-arterially... A sharp narrowing of small vessels can lead to tissue necrosis.

In case of cardiac arrest, the injection is performed according to the indications intracoronary (1 ml).

If arrhythmia develops against the background of the use of epinephrine, β-blockers are shown as a kind of antidote.

It is important to observe caution when administering epinephrine in the presence of the following pathologies:

• sharp;
• oxygen starvation;
• atrial fibrillation;
• hypovolemia;
• cold injury;
• hypertrophy of the prostate;
• shock of non-allergenic origin, cerebral atherosclerosis.

It is undesirable to use adrenaline in parallel with drugs for inhalation anesthesia - chloroform, fluorothane, etc.

Interaction of Adrenaline with other pharmacological agents

Antagonism of blockers of α- and β-adrenergic receptors with adrenaline was noted.

Nonselective β-adrenergic blockers are capable of enhancing the presorny effect of drugs.

Against the background of the introduction of a solution of epinephrine, the effect of muscle relaxants, neuroleptics, opioids and hypnotics is weakened

The risk of cardiac arrhythmias increases with concurrent use with tricyclic

Epinephrine is used along with emergency medical care to treat life-threatening allergic reactions caused by insect bites, food, medications, latex, and other causes. Epinephrine is a class of drugs called alpha and beta adrenergic agonists (sympathomimetic agents). The drug works by relaxing the muscles respiratory tract and effects on blood vessels.

Adrenaline: use

Epinephrine is available in ampoules containing a solution (liquid) for injection under the skin or into the muscle on the outside of the thigh. The drug is usually administered as needed at the first sign of a serious allergic reaction. Use adrenaline exactly as directed; do not use it more often, or in higher or lower doses than prescribed by your doctor.

Signs of a serious allergic reaction include airway closure, shortness of breath, sneezing, hoarseness, hives, itching, swelling, skin redness, fast heartbeat, weak pulse, anxiety, confusion, stomach pain, dizziness, loss of consciousness. Talk to your doctor about these symptoms.

Do not use a drug that has expired or if the liquid in the ampoules is discolored or contains particles.

Epinephrine treats severe allergic reactions but cannot be used for medical treatment... Call an emergency medical assistance immediately after the injection of epinephrine.

Epinephrine should only be injected in the middle of the outer thigh, and may be injected through clothing if needed in an emergency. Do not inject adrenaline into your buttocks or any other part of your body.

Other uses of adrenaline

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Epinephrine: contraindications and interactions with other drugs

Before using epinephrine, tell your doctor and pharmacist if you are allergic to epinephrine, any other medicines, sulfites, or any of the ingredients in epinephrine. Your doctor may prescribe you to use epinephrine, even if you are allergic to it, for certain vital situations.

Tell your doctor and pharmacist what other prescription and over-the-counter medicines, vitamins, nutritional supplements and herbal products you are or plan to take. Be sure to mention any of the following medicinesCertain antidepressants such as amitriptyline, amoxapine, clomipramine (anafranil), desipramine, doxepin, imipramine (tofranil), maprotiline, mirtazapine, nortriptyline, protriptyline (vivactil), trimipramine antihistamines such as chlorpheniramine and diphenhydramine; beta blockers such as propranolol (anaprilin); digoxin; diuretics; ergot preparations such as dihydroergotamine, dihydroergotoxin mesylate, ergotamine and methysergide; levothyroxine; medications for irregular heartbeats, such as quinidine.

Also tell your doctor if you are taking monoamine oxidase inhibitors such as isocarboxazid, phenelzine (nardil), selegiline, and tranylcypromine, or have stopped taking these drugs within the past two weeks.

Tell your doctor if you have or have ever had chest pain, irregular heartbeat, high blood pressure, or other cardiovascular disease; diabetes; hyperthyroidism (hyperfunction of the thyroid gland); depression or others mental illness; Parkinson's disease .

Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. Talk to your doctor about how you should use epinephrine if you are pregnant.

Adrenaline: side effects

Epinephrine can cause side effects. Tell your doctor if you experience any of these side effects:

• labored breathing,
• fast or irregular heartbeat
• nausea,
• vomiting
• increased sweating,
• dizziness,
• general weakness

Subscribe to our Youtube channel !

• pallor of the skin
• uncontrolled shaking of body parts.

In case of an overdose of adrenaline, you may experience the following side effects:

• sudden numbness or weakness on one side of the body
• sudden difficulty speaking
• slow or fast heart rate,
• troubled breathing
• rapid breathing
• extreme tiredness or weakness
• cold, pale skin
• decreased urination.

The drug can cause other side effects. Tell your doctor if you have any unusual problems while using it. Misuse of this medication increases the risk of serious side effects. Follow the dosage instructions carefully.

What to do if you miss an adrenaline rush

If your doctor has instructed you to use this medication regularly, use the missed doses as soon as you remember. However, if it's already time for your next dose, skip any missed doses and continue on your schedule. Do not use a double dose to catch up.

Adrenaline: storage and disposal

Keep the drug in the container tightly closed, out of the reach of children. Store at room temperature, away from excess heat and moisture (not in the bathroom). Do not freeze. Throw away medications that are outdated or no longer needed. Talk to your pharmacist about proper disposal.

Adrenaline: overdose, emergencies - what to do

In case of overdose, poisoning, immediately call " Ambulance”Or consult your doctor. Overdose of some drugs can lead to health risks and death.

Note:this adrenaline review article is not a substitute full instructions manufacturer of the drug, serves solely for the purpose of brief information and cannot be a definitive guide to action. Any actions related to treatment and use medical supplies, carry out exclusively on the basis of the prescription of your doctor.

Adrenaline is a hormone secreted by the adrenal medulla. It is a hormone of fear, produced in the body in response to severe stress, life-threatening situation, and serves for the survival of the body. Its action is closely related to the sympathetic nervous system, which is responsible for the excitation of organs and systems. Adrenaline acts on α-, β-adrenergic receptors, scattered throughout all organs and tissues, this explains its complex effect on humans. Main effects:

• Constriction, up to spasm of blood vessels of the skin and some internal organs, which the body considers less priority in salvation and vice versa - vasodilation is vital important organssuch as the brain and heart;
• Increased strength and heart rate, increased cardiac conduction;
• Pupil dilation (hence the well-known expression "Fear has large eyes");
• Bronchodilation - relaxation of the smooth muscles of the bronchi and their expansion.

The hormone is actively used by doctors of various specialties. The dose of adrenaline varies and depends on the indications, it is administered intravenously, subcutaneously and intramuscularly. There are different opinions about the advisability of introducing an adrenaline solution intramuscularly in case of shock, however, this method is provided for by the standards of emergency medical care.

It is most often used in assisting with various allergic reactions of immediate type: Quincke's edema, with anaphylactic shock... It constricts blood vessels, raising blood pressure, stimulates the heart, and prevents biologically active substances, allergic (histamine, serotonin), reducing the severity of allergies.

The drug is available in 1 ml ampoules. Adrenaline in hypoglycemic shock (a sharp drop in blood glucose) is used as a means of promoting the active breakdown of glycogen and the release of sugar into the bloodstream.

Oculists use adrenaline drops for the treatment of glaucoma... When instilling a 0.5-2% solution, the outflow of intraocular fluid improves and the rate of moisture formation is significantly reduced.

It is also widely used in the form of nasal drops by otolaryngologists, especially as part of complex drops in the treatment of sinusitis... But it should be remembered that even with topical application adrenaline blood pressure rises. Therefore, drip with caution to patients with hypertension.

With cardiac arrest previously used intracardiac drug administration. Contemporary research show that a prick in the heart is not the most effective method start cardiac activity. It is much more effective to carry out cardiopulmonary resuscitation with the introduction of adrenaline intramuscularly, or into a connected catheter.

Attack bronchial asthma also does not do without the introduction of adrenaline. With a crisis, a prolonged spasm of the bronchi occurs, the patient takes a forced position, with an emphasis on his hands to facilitate inhalation. The condition is extremely serious and life threatening. Epinephrine hydrotartrate is urgently administered, which relaxes the bronchi with their subsequent expansion.

But here complications from the heart may arise, especially if there were chronic diseases cardiovascular system (tachycardia, hypertonic disease, atrioventricular block). The patient's heart rate increases, transient bradycardia may develop (a sharp decrease in heart rate), blood pressure rises.

Contraindications to the use of adrenaline:

• Closed-angle glaucoma
• Hypertonic disease
• Diabetes
• Pregnancy
• Cardiovascular pathology ( arterial embolism, atherosclerosis, arrhythmias, ventricular fibrillation)
• Cardiogenic, traumatic, hemorrhagic shock
• Thyrotoxicosis

Epinephrine

The international name recommended by the World Health Organization for adrenaline is. In pharmacy, there are several trade names hormone: adrenaline hydrochloride (0.1% solution), epinephrine hydrotartrate (0.18% solution), epinephrine hydrochloride Vial, epinephrine hydrotartrate.

All drugs have the same effect, belong to the group of hypertensive drugs (increase blood pressure). With intramuscular and subcutaneous administration, they are absorbed well and the maximum concentration in the blood is reached after 3-5 minutes. When injected intravenously, it is destroyed in a matter of seconds and therefore this route is not the most effective. It can also be inserted into the trachea (for intubation) and into the conjunctival sac (into the eyes).

Indications for use:

• Allergic reactions of immediate type (rapidly developing): anaphylactic shock, Quincke's edema)
• Bronchial asthma attack
• Open angle glaucoma
• Topically to stop bleeding
• Hypoglycemia
• Hypotension (prolonged decrease in blood pressure)

The dosage is selected strictly individually and can vary from 200 μg to 1 mg in adults and in children 100-500 μg.

Side effects: tachycardia, ventricular arrhythmia, nausea, vomiting, headaches (even when instilling adrenaline into the nose), bronchospasm, psychosis.

Contraindications for use: hypertension, heart disorders (cardiomyopathy, malformations, ventricular fibrillation), pregnancy and lactation (in an emergency situation, use is possible, but the risk to the mother should exceed the risk to the fetus).

In sports practice, adrenaline is included in the list of prohibited doping drugs. Its local use in the form of nasal drops is allowed. Sports training, stress, competition - all this causes a natural increase in adrenaline, with an increase in heart rate and resistance to heavy physical exertion.

Adrenaline is widely used in children's practice. In case of an asthmatic attack, 10 μg / kg is administered subcutaneously. The maximum single dose is 0.15 ml. It can be administered by inhalation spray or endotracheally (into the trachea). In case of allergic reactions, the administration is carried out subcutaneously with 10 μg / kg, if necessary, repeated after 15-20 minutes.

Adrenaline is a kind of lifesaver for resuscitators and correct application he works wonders. In the case of irrational use, overdose with serious consequences is possible: hypertensive crisis, muscle spasm of the eye, ventricular fibrillation, strokes, myocardial infarction. The action of adrenaline is stopped by the administration of α-, β-blockers (carvedilol, proxodolol, prazosin, tamsulosin).