RU2369330C1 - Method of determining degree of patients' state gravity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to resuscitation science. In patient number of heart contractions (NHC), systolic arterial pressure (sAP), number of breathing movements (NBM) are determined, consciousness is evaluated by A.N.Konovalov -C, blood circulation system is evaluated by Algover index -A, breathing system is evaluated - B, additionally patient's age from 10 months to 15 years and patient's sex are taken into account, state gravity index (SGI) is calculated by special formula. If SGI is higher than 4.5 points patient's state is evaluated as grave, if it is 4.5-3.6 points - as middle gravity, if it is 3.5-3.0 points, as satisfactory, if it is 2.9-2.8 points - as middle gravity, less than 2.8 points - as grave.

EFFECT: method does not require availability of complicated medical equipment, can be used in "field" conditions of pre-hospital stage, allows to evaluate state of patient with any pathology quickly and objectively, contributes to more accurate interpretation of obtained results, irrespective of qualification and experience of medical worker.

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Description

The invention relates to methods for determining the severity of a patient’s condition and can be used by emergency medical specialists to quickly and objectively assess the condition of a patient with any pathology.

Determining the severity of the condition (STS) of a patient or victim in some cases is a difficult task. The approaches used in determining the STS of patients are based on a wide variety of criteria, the personal experience of the doctor and are often subjective.

Doctors of different specialties determine STS in the same patient in different ways.

Clear criteria for determining STS are used only for patients with traumatic brain injury. These criteria are quite specific and not suitable for determining the STS of patients with other pathologies.

A known method for determining the severity of the patient’s condition for ambulance teams based on the assessment of vital functions, including: assessment of consciousness according to A.N. Konovalov (C), assessment of the circulatory system function according to the Algover index (K), assessment of the respiratory system (D). (Baray A.V., Bogatov I.B. “A method for determining the severity of patients' condition for ambulance teams.” Scientific and Practical Medical Journal “Medicine in Kuzbass”, NP “Publishing House Medicine and Education”, special issue No. 8, 2006, p. 64-68).

The condition severity index (ITS) is calculated by summing up the scores evaluating C, K, D, and ITS is assessed on the following scale:

satisfactory condition - less than 3.5 points;

state of moderate severity - from 3.5-4.5 points:

serious condition - 4.5 points or more.

However, the proposed method does not take into account the physiological characteristics of women and children and it is not reliable in patients with hypertensive crises and blockades of the cardiac conduction system.

The objective of the invention is the development of a method for quick, objective and more accurate determination of the severity of the patient's condition by taking into account the physiological characteristics of children and women, as well as for patients with hypertensive crises and blockade of the conduction system of the heart

The problem is achieved by determining the number of heart contractions (heart rate), systolic blood pressure (SBP), and the number of respiratory movements (NPV) in a patient. Consciousness assessment is carried out according to A.N. Konovalov-C, the circulatory system is assessed according to the Algover index - A, the respiratory system is evaluated - D. Additionally, the patient's age from 10 months to 15 years and the patient's gender are taken into account. The condition severity index (ITS) is calculated by the formula:

ITS = A + C + D-Qu-Kp,

Where:

A - assessment of the circulatory system according to the Algover index, score;

C - assessment of consciousness according to A. N. Konovalov, with 1 point - clear consciousness, 2 points - stunning, 3 points - stupor, 4 points - coma;

D - assessment of the respiratory system, score;

Kv - coefficient taking into account the age of the patient from 10 months to 15 years, score;

Kv = 2.5 points for children from 10 months to 14 months;

SQ for children from 15 months to 2 years is found by the formula:

Where:

Vm is the age in months.

SQ for children over 2 years of age are found by the formula:

Where:

Vg - age in years;

Kp - coefficient taking into account gender, for patients older than 15 years, score; take CP in women over 15 years old equal to 0.2 points, in men over 15 years old equal to 0.

With ITS more than 4.5 points, the patient's condition is assessed as severe, with 4.5-3.6 points as moderate, with 3.5-3.0 points as satisfactory, with 2.9-2.8 points as average severity, less than 2.8 points as severe.

Novelty of invention

The claims are proposed taking into account the patient's age from 10 months to 15 years. This is due to the fact that children at different ages have different physiological standards for heart rate, CAD, and NPV, therefore, the correction coefficient Kv was introduced.

The coefficient Kp has been introduced, taking into account gender, for patients over 15 years of age in points. In connection with their physiological characteristics, women have more heart rate and NPV than men.

With ITS more than 4.5 points, the patient's condition is assessed as severe, with 4.5-3.6 points as moderate, with 3.5-3.0 points as satisfactory, with 2.9-2.8 points as average severity, less than 2.8 points as severe.

The set of essential features of the invention in the literature available to us was not found, therefore, the invention meets the criterion of "novelty."

The set of essential features of the invention allows to obtain a new technical result:

- The severity of the patient's condition is determined using a comprehensive analysis of objective data, the data obtained are evaluated using a point system, which allows you to quickly and easily, more individually evaluate the STS.

- The method eliminates the subjectivity of the assessment of different doctors in determining the patient's condition at the time of examination, has a single interpretation and the possibility of formalization.

- A complex combination of objective data, combined by mathematical dependence, allows a more accurate and differentiated assessment of the functional state of patients taking into account gender and age, as well as in patients with hypertensive crises and blockades of the cardiac conduction system. The method allows to evaluate the effectiveness of the therapy.

Criteria are proposed based on the assessment of vital functions, taking into account the minimum sufficient set of criteria that have a single interpretation, so that it can very quickly determine the STS in critical situations with a shortage of time.

The method is as follows.

In patients who have been at rest for at least 5 minutes, heart rate, CAD, and CDC are determined.

Assess consciousness according to A.N. Konovalov - C:

- clear consciousness - 1 point;

- stunning - 2 points;

- stiffness - 3 points;

- coma - 4 points.

Calculate the assessment of the respiratory system according to the formula:

,

,

Where:

D - assessment of the respiratory system, score;

NPV - the number of respiratory movements in min.

Calculate the assessment of the circulatory system according to the Algover index - A by the formula:

,

,

Where:

A - assessment of the circulatory system according to the Algover index, score;

Heart rate - the number of heart contractions in min;

CAD - systolic blood pressure, mmHg

The age of the patient is determined from his words, according to documents, according to a survey of relatives or tentatively according to external data.

Kv = 2.5 points for children from 10 months to 14 months;

SQ for children from 15 months to 2 years is found by the formula:

Where:

Vm is the age in months.

SQ for children over 2 years of age are found by the formula:

Where:

Vg - age in years.

Kp is taken in women over 15 years old equal to 0.2 points, in men over 15 years old equal to 0.

Given all the data obtained, ITS is calculated according to the proposed formula. And with ITS more than 4.5 points, the patient's condition is assessed as severe, with 4.5-3.6 points as moderate, with 3.5-3.0 points as satisfactory, with 2.9-2.8 points as moderate, less than 2.8 points as severe.

ITS indicators are selected on the basis of physiological norms and their ratios in both adults and children.

It is known that for adults it is considered normal that the heart rate is 60-90, blood pressure from 100 to 139 mmHg, respiratory rate from 14 to 20 in one minute, consciousness is clear. After calculating ITS for the minimum and maximum normal values in points of vital functions, an interval of ITS = 3.5-3.0 points was obtained, which determines the satisfactory condition of the patient.

Further, the calculation for the conditions of moderate and severe severity. The state of moderate severity is determined with a BH of 20-30 per minute, a shock index of about 1.0, depression of consciousness to stunning.

A serious condition is determined with a NPV of more than 30 per minute, a shock index of more than 1.5, depression of consciousness to stupor and coma. ITS is also calculated with a NPV less than 14 per minute, heart rate less than 60, CAD less than 100 mm Hg. etc. Given all the data obtained, ITS is calculated according to the proposed formula. And with ITS more than 4.5 points, the patient's condition is assessed as severe, with 4.5-3.6 points as moderate, with 3.5-3.0 points as satisfactory, with 2.9-2.8 points as moderate, less than 2.8 points as severe.

To take into account the physiological characteristics of women and children in the determination of ITS, correction factors Kv and Kp were introduced.

Correction factors are calculated based on physiological norms in children and women. The following values are obtained:

in children aged 10 months to 14 months, Kv = 2.5.

Then from 15 months the coefficient decreases every month by 0.1 and in 2 years is 1.5.

In patients older than 2 years, the coefficient decreases with an increase in age by 0.1 per year.

In women over 15 years of age, a Kp coefficient of 0.2 is introduced. In men over 15 years of age, Kn = 0.

The selection and justification of the given indicators and coefficients was carried out by processing the data obtained from 3,000 emergency patients.

Example 1

The boy is 11 years old. Complaints of general discomfort, malaise, feeling of lack of air. These complaints within one and a half hours after the conflict with classmates. In connection with the change of residence, he studies at this school recently.

Clear Consciousness C = 1.0 point. Skin, mucous membranes of normal color. Vesicular breathing NPV - 20 points, D = 2.0 points. Heart sounds are clear, rhythmic. Heart rate - 90 rpm, CAD - 100 mmHg, A = 90/100 = 0.9 points. The abdomen is soft, painless.

ITS = 0.9 + 1 + 2-0.6 = 3.3.

According to ITS = 3.3, the condition is satisfactory.

Diagnosis: reaction to stress.

Recommended: parents pay attention to the social adaptation of the child in a new team for him.

Example 2

Woman 40 years old. Complaints of nausea, dizziness, "sinking" of the heart.

I drank significant amounts of alcohol over the past two hours.

It is slowed down, it answers questions with a delay, in monosyllables, it is poorly oriented in place and time, i.e. stunning, C = 2.0 points. Bad breath smell of alcohol. Ataxia, dysarthria. The vesicular breathing, no wheezing, NPV = 18 per min, D = 18/10 = 1.8 points. Heart sounds are clear, rhythmic, heart rate - 80 per minute, CAD - 120 mmHg, A = 80/120 = 0.7 points. Belly without features. Kp = 0.2.

ITS = 0.7 + 2 + 1.8-0.2 = 4.3.

The state of moderate severity.

Diagnosis: moderate intoxication with alcohol.

Transported to the therapeutic department at the place of residence.

Example 3

Male 50 years old. Complaints of inspiratory dyspnea within an hour.

5 years ago suffered an acute myocardial infarction. Real complaints appeared suddenly after a short run.

Consciousness is clear, C = 1 point. The vesicular breathing, weakened on the right, NPV = 30 per minute, D = 30/10 = 3.0 points. Heart sounds are clear, rhythmic, the emphasis of the second tone on the pulmonary artery, heart rate - 105 per minute. CAD - 130 mm Hg, A = 105/130 = 0.8 points.

ITS = 1 + 0.8 + 3 = 4.8 points, which corresponds to a serious condition.

The diagnosis was made: IHD, post-infarction cardiosclerosis, cardiac asthma, circulatory failure 2b.

An ambulance team treated acute left ventricular failure at home. After treatment with CAD - 110 mm Hg, heart rate - 110 per min., NPV - 32 per min.

ITS = 1 + 1 + 3.2 = 5.2

The condition remains serious, with a clear deterioration, in terms of ITS = 4.8 to ITS = 5.2.

A repeated examination was performed, the ECG was recorded in dynamics, a new putative diagnosis was made: thromboembolism of the branches of the pulmonary artery.

Conducted thrombolysis with streptokinase according to the scheme.

An hour after treatment, NPV = 24 per min, SBP - 110 mmHg, heart rate - 90 per min.

ITS = 1 + 2.4 + 0.8 = 4.2

The state of moderate severity, a clear improvement, ITS decreased from 5.2 to 4.2 per point.

This example shows that it is possible to use ITS in numerical form to assess the effectiveness of the treatment.

The patient was transported to the intensive care unit of the cardiology department.

The simplicity of this method, the ease of determining the necessary parameters, which does not require sophisticated medical equipment, allows you to use this method in the "field" conditions of the prehospital stage. Evaluation of indicators by points contributes to a more accurate interpretation of the results, regardless of the qualifications and experience of the medical worker. The proposed parameters are quickly and easily determined, have a single interpretation.

Claims (1)

A method for determining the severity of a patient’s condition, including determining the patient’s number of heartbeats (heart rate), systolic blood pressure (SBP), number of respiratory movements (NPH), consciousness assessment by A.N. Konovalov-C, assessment of the circulatory system by Algover index - A, assessment of the respiratory system - D, characterized in that it additionally takes into account the patient’s age from 10 months to 15 years and the patient’s gender, calculate the severity index (ITS) by the formula:
ITS-A + C + D-Kv,
where A is the assessment of the circulatory system according to the Algover index, score;
C - assessment of consciousness according to A. N. Konovalov, with 1 point - clear consciousness, 2 points - stunning, 3 points - stupor, 4 points - coma;
D - assessment of the respiratory system, score;
Kv - coefficient taking into account the age of the patient from 10 months, score, while for children from 10 to 14 months Kv = 2.5 points, for children from 15 months to 2 years Kv are found by the formula:

,
where Vm is the age in months;
for children over 2 years of age, Qu is found by the formula:

,
where Vg is the age in years; for women over 15 years old
Sq = 0.2 points, for men over 15 years of age Sq = 0 points and with ITS more than 4.5 points, the patient's condition is assessed as severe, with 4.5-3.6 points - as moderate, with 3.5- 3.0 points - as satisfactory, with 2.9-2.8 points - as moderate, less than 2.8 points - as heavy.