RU2190990C1 - Method for exerting emergency medical care in the cases of exspiratory dyspnea or foreign body got into respiratory paths - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves creating excessive pressure in airconducting ducts and cough mechanism is modeled in dyspnea cases in patients suffering from respiratory path obstruction by applying manual therapy techniques to thoracic segment of the vertebral column. EFFECT: enhanced effectiveness in stopping or alleviating dyspnea, invoking productive cough, increasing vital capacity or removing foreign body from respiratory paths.

Description

 The invention relates to medicine and can be used in medical institutions of various profiles and in any other bridge (at home, on the street, etc.) to provide emergency assistance to patients during attacks of expiratory dyspnea with bronchitis, bronchial asthma, and also if foreign body into the airways.

 A known method of treating expiratory dyspnea by mechanical action with the hands of a doctor on segments of the patient's spinal column (patent 2086225 from 08/10/95, p. 9, example I).

 However, this method is not applicable when providing emergency care in the event of a sudden occurrence of expiratory dyspnea or if a foreign body enters the respiratory tract.

The proposed method of emergency care in case of expiratory dyspnea attacks or when a foreign body enters the respiratory tract consists in bringing the elbows forward to the patient in a sitting position on the couch or on the floor on his knees, and laying his hands with fingers closed “locked” on the neck, then, when the patient breathes through the mouth, the lower third of the patient’s shoulders is fixed with the left forearm of the doctor and, at the time of the patient’s exhalation, pressure is applied to the interspinous ligament of the vertebral segment at the point of maximum thoracic kyphosis according to agitated axis of the patient in the dorsal-ventral direction with simultaneous raising of the patient's elbows up together with the patient’s head, fixed with his elbows under the lower jaw, while traction, rotation and extension of the spinal column above the fixation point of the patient’s interspinous ligament, and subsequent expiration of the patient through the open mouth , then the elbows, head and spine of the patient are returned to their original position with simultaneous inhalation of the patient, carried out at the moment of crossing the middle segment of the arc described by the elbows and then fix the interspinous ligament of the overlying vertebral segment of the patient and repeat the entire cycle of operations, while sequentially fix the interspinous ligaments of the spine up to the first thoracic segment and back to the eighth thoracic vertebral segment, after each fixation, perform the whole cycle of these operations, while increasing arc motion elbows to 90-140 ^o from their starting position, the acceleration of movement elbows and acceleration of respiration of the patient, and the effect on thoracic vertebrate separated Single point from the maximum to the first thoracic kyphosis segment and back to the eighth thoracic segment continuously performed 5-15 times, focusing on the disappearance of wheezing, coughing or wet appearance free breathing, with subsequent normalization of the respiratory rhythm in 10-15 minutes after cessation of exposure.

 The method is as follows.

 I.P. The patient sits on a couch on horseback. The height of the couch is 40 cm, the width is 40 cm. In the absence of a couch, the patient can be seated astride a chair, facing the back of the chair. The patient can sit on the floor or on the bed, legs stretched forward, or stand on his knees. The patient's arms are bent at the elbows. The hands are laid on the neck, the fingers are closed "in the lock." The elbows are brought forward and in contact with each other. The patient breathes through an open mouth.

The doctor is standing to the left of the patient. With the left forearm, the doctor fixes the lower third of the patient’s shoulders in such a way that the doctor’s hand fixes the patient’s right elbow, and the patient’s left elbow is on the upper third of the doctor’s left forearm. The doctor’s right hand is clenched into a fist. With the middle phalanx of the index finger, the doctor presses on the interspinous ligament at the point of maximum kyphosis of the patient’s thoracic region. At the beginning of the patient's exhalation, the doctor simultaneously begins the movement of the right hand, fixing the interspinous ligament, in the direction of the patient's sagittal axis in the dorsal-ventral direction. With his left hand, the doctor raises the patient’s elbows up and, fixing the patient’s forearms with his head behind the lower jaw, at the same time throws the patient’s head up and back, thus tracing part of the spine above the level of fixation with his index finger of the right hand, rotation and extension (re-extension) of the spine around the transverse axis at the fixation level. In this case, the patient's elbows describe an arc of up to 70-80 ^o from the initial position, and the patient pronounces the sound "XA". The moment of the end of the movement of the patient's elbows coincides with the complete restriction of movement in the vertebral segment with extension. At the time of the doctor’s exposure, a forced expiration occurs and the patient’s cough mechanism is modeled. The movement is fast, but smooth. Simultaneously with the end of the impact of the doctor and the raising of the elbows, the forced exhalation of the patient pronouncing "HA" ends. Then the elbows, the patient’s head and his spine return to their original position, a passive exhalation occurs and the patient again pronounces the sound “XA”. Thus, during the period of movement of the elbows to the highest point and returning them to their original state, the patient performs two exhalations with the uttering of the sound "HA". Inhalation of the patient is carried out during the intersection of the middle segment of the arc described by the elbows as they move up and down.

The doctor rearranges the main phalanx of the index finger of the right hand one segment of the patient’s spine, again begins to move his elbows up and presses on the interspinous ligament in the dorsal-ventral direction (inhale) until the movement in the vertebral segment is completely limited - forced exhalation of the patient with the sound “XA” . Again, return to the starting position, inhale - the beginning of the movement, exhale - the end of the movement of the patient's elbows. Such permutations of the doctor’s hand and the movement of the patient’s elbows are carried out up to the 1st thoracic segment. Then, in the same way, from the first thoracic vertebral segment, the doctor gradually moves the right hand down to the 8th thoracic vertebral segment, stopping and producing the above-described effect on each vertebral segment of the patient. Correspondingly, the arc described by the elbows during overextension of the spine grows, reaching 90-40 ^o from the initial position of the elbows, depending on the mobility of the segments of the spinal column of the patient. Such a cycle of effects on the entire thoracic spine is called exercise. Exercises are repeated from 5 to 15 times according to the scheme described above. At the same time, the rotation of the elbows of the patient and, accordingly, of his spine around the transverse axis, passing through the fixation point, determined by the middle phalanx of the index finger of the doctor’s right hand, takes place. Synchronized with the movement of the elbows, the patient’s breathing rhythm becomes more frequent. The doctor, as it were, imposes an accelerated breathing rhythm on the patient.

Positive criteria for the application of the method are:
1) in some patients, shortness of breath decreases or ceases altogether, which can be determined at the time of exercise on the disappearance of wheezing on exhalation. Improves ventilation. The skin of the patient acquire a normal color.

 2) sometimes, at the end of the exercises, the number of wheezing in the lungs decreases sharply, numerous moist rales appear, and the patient has a cough with sputum. After coughing up sputum, the patient's condition improves.

 3) within 10-15 minutes after the end of the exercise, the resulting rapid breathing is normalized. The rhythm of breathing is restored. The vital capacity of the lungs increases by 12.5 ± 0.01%. The exhalation rate increases by 17.3 ± 0.03%, determined by hardware methods.

 4) the effect of the consequences was studied after 1-1.5 hours. Our studies of the external respiration function of such patients show an increase in the capacity of small bronchioles by 7.5 ± 0.01%, which also indicates their dilatation and removal of the obstructive component.

 5) when a foreign body enters the respiratory tract, a positive criterion is the release of a foreign body when exposed to a doctor and the subsequent elimination of reflex bronchospasm in a patient.

 It is known that the act of breathing is based on a change in the volume of the chest, which depends on the movement of the ribs, the mechanism of reciprocal innervation of the external and internal intercostal muscles and the diaphragm. When inhaling, the ribs rise, as a result of which the volume of the chest cavity increases. Upon exhalation, the ribs lower, the rib cage decreases in volume, the pressure in the alveoli increases and the air leaves the lungs through the airways (2, 3, 6).

 The cough mechanism consists in a sharp increase in air pressure in the airways due to spasm of the glottis and compression of the striated chest muscles. This overpressure also provides an increase in the rate of expiration of air, the evacuation of foreign bodies and mucus from the respiratory tract (2, 3, 6).

 In patients with chronic pulmonary diseases, chest muscle stiffness increases, kyphotic deformation in the thoracic region (barrel-shaped chest) increases, spinal flexibility decreases, and auxiliary muscles participate in the act of breathing (5). Incomplete participation of the middle and upper chest in the respiratory act leads to a decrease in external respiration function (5), which increases tissue hypoxemia and hypoxia in severe patients (1). Rigidity of the muscles of the chest during bronchospasm does not allow creating excessive pressure in the lungs on the exhale, coughing becomes unproductive, mucus accumulates in the bronchi, which increases their obstruction (1, 5, 6).

 Thus, if you passively simulate a change in the volume of the chest cavity, then you can change the pressure in the alveoli and simulate the mechanism of coughing.

 Periodic extension and overextension of the spine as described above leads to passive rotation of the ribs around the transverse axis in the vertebrocostal joints. There is a change in the volume of the chest cavity, passive distension of the lungs and an increase in their initial volume, as a result of which excess pressure rises in the alveoli. This excess pressure when modeling a passive exhalation (when lifting the elbows up and bending the spine and pronouncing the patient a sharp sound "XA") promotes the evacuation of mucus from the small bronchi to the larger ones and to the outside. In this way, the mechanism of coughing is modeled (2, 3, 6).

 Periodic application of the method leads to a decrease in kyphotic deformation in the thoracic region of patients, a decrease in muscle stiffness, and improved mobility of the ribs in the vertebrocostal joints. Objectively, there is an increase in excursion of the chest in patients, increased cough, sputum discharge.

 Clinical examples.

 1. Patient M., 46 years old. Diagnosis: hormone-dependent infectious-allergic bronchial asthma 2 tbsp., Severe. Sick for 18 years. She took hormones for 6 years and used the Beretok inhaler. The treatment is ineffective. Every night the patient has bouts. Doctors of the ambulance administered increased doses of hormonal drugs, having difficulty copying seizures for 2-3 hours, or hospitalized the patient in the intensive care unit. Contacted us for help in September 1991. During attacks of shortness of breath in a patient, the above method was used to stop them. Despite the severity of the attacks, they managed to be stopped in 7-10 exercises. During the application of the method, the patient exhaled relief, determined by the reduction of wheezing on exhalation. After the cessation of exercise, a small number of wheezing exhalations remained for 1-2 hours, but they did not prevent the patient from falling asleep and did not particularly bother her. For 2 weeks during the attacks, the method described above was used. Each time, the strength of the attacks and the number of exercises to stop them decreased. After 2 weeks, the attacks stopped. Discharged in satisfactory condition. A year later, a control examination was performed. Within a year, the patient independently canceled her hormones. Attacks of shortness of breath disturb once a week, are easily stopped by “Berotek”.

 This example demonstrates the effectiveness of the method for severe attacks of bronchial asthma.

 2. Boy Dima, 8 years old. Diagnosis: bronchial asthma. Atonic form, severe course. Sick for 3 years. 3-4 times a year was treated in a hospital where injectable forms of hormones were used. The treatment is ineffective, the attacks did not stop. Last year, attacks every day on a small physical load, smells, and for no particular reason. He took inhaled forms of adrenergic agonists. Hospitalized to us. During seizures in a child, the described method was used. The exercises were repeated 6-7 times, the attacks stopped. A week after the next relief of the attack, a productive cough with sputum appeared. Subsequently, the attacks proceeded easily, were stopped by oral administration of 1 tablet of aminophylline. After 2 weeks, the attacks stopped. Discharged in satisfactory condition. Observation in a year. There is no relapse of dyspnea. Adrenergic agonist does not accept. Physically strong.

 This example shows the effectiveness of the method in children.

 3. Patient G., 32 years old. Diagnosis: chronic obstructive bronchitis. Sick 5 years after suffering bronchopneumonia. Exacerbations of the disease in spring and autumn. During the exacerbation period, attacks of shortness of breath occurred, and coughing became unproductive. During an attack of expiratory dyspnea, the above method is applied. During the exercises, a productive cough with sputum appeared, breathing was significantly facilitated. After the cessation of the attack, cough with sputum lasted for 3 hours. The patient's condition improved, subsequent attacks proceeded easily with a productive cough, and were easily stopped with euphyllin.

 This example shows the effectiveness of the method for stopping shortness of breath in patients with chronic obstructive bronchitis.

 4. Affected L., 33 years old. On the beach while eating, I accidentally inhaled during a conversation and a piece of bread fell into the trachea. Choking began to develop. Attempts by chance to find a doctor nearby to help the victim by sharp pressure on the lower part of the sternum were unsuccessful. The striking of the victim’s back was also unsuccessful. The breath became noisy with a groan. Choking increased. Diffuse cyanosis began to develop. Horror froze on the patient's face, tears flowed from his eyes, and involuntary urination appeared. The inventors, who came running to the noise of others, applied the described method. In spite of her anxiety, a swab from a towel was inserted between her teeth to widen her mouth. The victim herself was kneeling on the sand. A sharp movement of the elbows up with simultaneous pressure on the interspinous ligament at the point of maximum kyphosis. At the time of the maximum lifting of the elbows of the victim, a piece of bread 0.3x0.3 cm in size flew out of her trachea. The victim was able to inhale and exhale air. But due to reflex bronchospasm, breathing was noisy, wheezing, difficult to inhale and exhale. The exercises were continued. Against the background of the exercises, breathing began to calm down, there was an annoying cough, a single vomiting. The patient was given a warm drink, Corvalol 50 drops. Gradually, the victim calmed down, she wanted to sleep, and she was taken home.

 The described case proves the effectiveness of the method when a foreign body enters the respiratory tract.

List of references
1. Kassil V.L., Leskin G.S., Vyzhigina M.A. Respiratory support. M., "Medicine", 1997, p. 144.

 2. Sanin M.R. Human anatomy. M., "Medicine", 1993, v.1, p.176-180.

 3. Sapin M.R. Human anatomy. M., "Medicine", 1993, v. 1, p. 255-260.

 4. Sinelnikov R.D. Atlas of human anatomy. M., "Medicine", 1978, v. 1, p. 196-198.

 5. Chuchalin A.G. Bronchial asthma, M., "Medicine", 1985, p. 36-56.

 6. Schmidt R., Teus G. Human physiology. M., 1996, v. 2, p. 566-625.

Claims (1)

A method of providing emergency care in cases of expiratory dyspnea or when a foreign body enters the respiratory tract, which consists in bringing the elbows forward to the patient in a sitting position or in a standing position, and laying hands with fingers closed in the lock on the neck, then, while breathing the patient through the mouth, fix the lower third of the patient’s shoulders with the left forearm of the doctor and, at the time of the beginning of the exhalation of the patient, exert pressure on the interspinous ligament of the vertebral segment at the point of maximum thoracic kyphosis along the sagittal axis dorso-ventral direction and fixation of this ligament while raising the patient's elbows up together with the head fixed with his elbows under the lower jaw, thereby traction, rotation and extension of the spinal column above the fixation point of the patient’s interspinous ligament, and subsequent expiration of the patient through the open mouth, then the elbows, head and spine of the patient are returned to their original position with simultaneous inhalation of the patient, carried out at the moment of crossing the middle segment of the arc described by the elbows, after which the interspinous ligament of the overlying vertebral segment of the patient is fixed and the entire cycle of operations is repeated, while the interspinous ligaments of the spine are sequentially fixed to the first thoracic segment and back to the eighth thoracic vertebral segment, after each fixation the whole cycle of these operations is performed, while the magnitude of the arc of movement increases elbows to 90-140 ^o from their starting position, the acceleration of movement elbows and rapid breathing of the patient, the effect on the interspinous ligament thoraco about the spine from the point of maximum kyphosis to 1 thoracic segment and back to the 8 thoracic segment is carried out continuously 5-15 times, focusing on the disappearance of wheezing, the appearance of wet cough or free breathing after removal of a foreign body, followed by normalization of breathing rhythm after 10-15 min after termination of exposure.