RU2299717C2 - Medicine chest for emergency self-and mutual aid at hemorrhage from stomach, esophagus and duodenum - Google Patents

Abstract

FIELD: medicine, in particular, medicine chests for self-and mutual aid, applicable for offering of pre-medical aid at gastrointestinal hemorrhages.

SUBSTANCE: the medicine chest has a case, set of medical agents positioned in it in a definite order and an instruction on use of the medicine chest with an algorithm of medicine taking and urgent actions. The set of medical agents includes not more than two single therapeutic doses, one medical agent possessing a hemostatic effect, and at least one medical agent reducing the acidity of the gastric juice. Such a selection of doses of medical agents provides for offering of a quick and safe pre-medical aid.

EFFECT: provided an emergency self-and mutual aid at a hemorrhage from esophagus, stomach and duodenum.

7 cl, 2 dwg

Description

The invention relates to the field of medicine, namely to first-aid kits of emergency self-help and mutual assistance.

Bleeding from the esophagus, stomach and duodenum is a life-threatening complication of peptic ulcer of the stomach and duodenum, cirrhosis of the liver and portal hypertension, erosive and erosive-ulcerative gastritis and gastroduodenitis, reflux esophagitis, and gastric hernias gut and a number of other rarer diseases. In addition, bleeding from the esophagus, stomach, and duodenum is a fairly frequent complication of therapy with glucocorticoids, anticoagulants, aspirin, and other non-steroidal anti-inflammatory drugs. Regardless of the etiological cause, bleeding from the esophagus, stomach, and duodenum is manifested by severe weakness (fainting), dizziness, nausea, and vomiting with blood-red or black vomit that looks like thick coffee of insoluble black coffee remaining at the bottom of the cup, and also the appearance of a jelly-like black tar-like stool (A. Gorbashko. Acute gastrointestinal bleeding. - L .: Medicine. - 1974. - 240 p.)

All patients with bleeding from the esophagus, stomach, and duodenum need emergency medical care, as continued bleeding is the main cause of death among all acute diseases of the abdominal organs (Zairatyants O.V. Analysis of mortality, mortality, the number of autopsies and the quality of clinical diagnosis in Moscow for the last decade (1991-2000). Archive of pathology, - 2002. - Appendix - 64 p.).

Currently, there is a set of medicines approved by the Ministry of Health of the Russian Federation that includes a large number of pharmacological preparations and a universally recognized algorithm of medical and diagnostic actions by a doctor to effectively provide emergency qualified care to patients with bleeding from the esophagus, stomach and duodenum (Sumin S.A. 3rd ed., Revised and supplemented. - Moscow: Medical Information Agency LLC, 2002. - 656 p .; Recommendations for the provision of emergency medical care in the Russian Federation II. - Edited by A.G. Miroshnichenko and V.A. Mikhailovich, Approved by the Ministry of Health of the Russian Federation.St. Petersburg: Publishing House "SPbMAPO", 2001. - 187 pp .; G. Susla, G. Mazur, E. Saffredini F. et al. Pharmacotherapy of emergency conditions. Practical guidance. - Translation from English under the editorship of Professor EE Zvartau. - Moscow: Binom Publishing House, 1999. - 633 p.).

In stowages, suitcases and bags of ambulance crews, as a rule, there are all the necessary medicines.

At the same time, in no medical publication, scientific publications there are no clearly defined recommendations to the patient and his relatives how to determine and what should be done when bleeding from the esophagus, stomach and duodenum, what medicines, in what dose and in what sequence to take and how to take them.

There are also no sets of therapeutic agents or first-aid kits designed solely and specifically to provide emergency care for bleeding from the esophagus, stomach and duodenum by the patient himself or his relatives, i.e. a person without a medical education.

The need for such a first-aid kit is obvious, since the frequency of gastrointestinal bleeding (with acute and chronic ulcers, erosion, etc.) has increased over the past 5 years by more than 50%, amounting to 3.3% of all autopsies (Zairatyants O.V. Analysis of mortality, mortality, the number of autopsies and the quality of clinical diagnostics in Moscow over the last decade (1991-2000). Pathology archive. - 2002. - Appendix - 64 p.).

It is extremely difficult, and often impossible, for a patient with bleeding from the esophagus, stomach, and duodenum to choose 2-3 potent drugs, read and understand the instructions for each drug, and take them correctly. Relatives and relatives of the patient in such situations are at a loss and do not know what they need to do. This leads to the fact that 42.7% of patients with gastrointestinal bleeding enters the hospital later than 24 hours after the onset of bleeding (Statistical materials. The health of the population of Russia and the activities of healthcare institutions in 2001. - Health of the Russian Federation. - 2003. - No. 5 - S. 42-46).

Closest to the proposed invention according to the technical solution is a mini first aid kit for a heart attack (RF patent No. 21545432) containing a two-layer case with hermetically sealed cavities between its layers, in which a set of medical devices are provided, designed to provide emergency self-help and mutual assistance in case of a heart attack, as well as instructions for the use of therapeutic agents with an emergency algorithm located on the walls of the case, while the case has the form of a business card , Keychain or pendant, it is suitable for continuous wear with them and the use of mini-kits at any time of occurrence of an attack (at work, in transport, in the campaign, in the theater, cinema, etc.). However, the kit of medicines of this first-aid kit, including nitrodrug, aspirin, beta-blockers, anticoagulants and thrombolytics, cannot be used to provide emergency self-help and mutual aid in case of bleeding from the esophagus, stomach and duodenum.

Disclosure of invention

The basis of the present invention is the creation of a first-aid kit with such a set of therapeutic agents and an algorithm of actions that would provide emergency self-help and mutual assistance in case of bleeding from the esophagus, stomach and duodenum.

The problem is solved in that in a first-aid kit containing a case, a set of therapeutic agents arranged in it and instructions for using a first-aid kit with an algorithm for taking medications and emergency actions located on the walls of the case, according to the invention, the set of therapeutic agents contains no more than two single therapeutic doses, at least one drug having a hemostatic effect, and at least one drug that reduces the acidity of gastric juice, while the pharmaceutical preparations included in the kit are made in the form of oral administration, they are intended and provide emergency self-help and mutual assistance in case of bleeding from the esophagus, stomach and duodenum.

Of the large number of drugs used for gastrointestinal bleeding, it is drugs that reduce the acidity of the gastric juice and have a hemostatic effect, are absolutely necessary and minimally sufficient to help this category of patients. (A guidebook for a practitioner. 2000 diseases from A to Z / Edited by I.N. Denisov, Yu.L. Shevchenko. - 2nd ed., Abbr. - M .: GOETAR-MED, 2003. - С .527-528.)

To achieve the objective of the invention is the provision of the first emergency self-help and mutual assistance (namely, help, not treatment) for gastrointestinal bleeding, in most cases, a single therapeutic dose of the drug is sufficient, and an emergency doctor will carry out further treatment. However, in cases where the arrival of an ambulance doctor is delayed or when vomiting occurs immediately after taking the drug and the medicine does not have time to show its effect, a second dose of medicine is required. It is not advisable to have more than 2 doses in the first-aid kit of emergency self-help and mutual assistance, including the maximum therapeutic doses of the drugs, since in most cases an ambulance doctor will arrive no later than 2-4 hours later and, if necessary, will continue to use the medicine from his doctor’s box or prescribe new (other) drugs. Thus, for 2-4 hours, two doses of the drug in most cases will be enough to provide self-help and mutual assistance.

A distinctive feature - all the medicines included in the kit are made in the form of oral administration, are intended and provide emergency self-help and mutual aid for gastrointestinal bleeding - is also significant, since it determines the inclusion of only the safest drugs in the medicine cabinet (erroneous taking which will not cause serious undesirable consequences), as well as such a pharmaceutical form of the drug and the route of its introduction into the patient’s body that can be used either by the patient himself or his ayshee environment, i.e. persons without special medical education.

As a medicine with a hemostatic effect, the first-aid kit in a particular case has a tablet form of etamzilate and / or a fibrinolysis inhibitor, for example aminocaproic acid, and / or a donor of calcium ions, for example calcium lactate, or calcium chloride, or calcium gluconate, and / or a drug with local hemostatic effect, for example, a hemostatic sponge, or collagen hemostatic sponge, or gelatin sponge, or medical gelatin (Sumin S.A. Emergency conditions. 3rd ed., revised and supplemented. - Moscow: OO “Medical information agency”, 2002. - P.247-248; Recommendations for the provision of emergency medical care in the Russian Federation. - Edited by A.G. Miroshnichenko and V.A. Mikhailovich. Approved by the Ministry of Health of the Russian Federation. St. Petersburg: Publishing House "SPbMAPO ", 2001. - S. 49-51).

The first-aid kit as a medicine that reduces the acidity of gastric juice, in a particular case, has an acid neutralizing preparation, for example, diamond, or aluminum phosphate, or hydrotalcide, or calcium carbonate, or carbaldrate, or magaldrate, or magnesium hydroxide, or magnesium carbonate, or magnesium citrate, or sodium alginate, or simaldrate in the form of a single drug or a combination thereof or as part of other combined preparations, for example maalox, or neo-almagel, or gestid.

As a medicine that reduces the acidity of gastric juice, the first-aid kit in a particular case has a drug that reduces the production of acid by the stomach, for example, a proton pump inhibitor and / or H2-histamine receptor blocker. In particular, the first-aid kit has an omeprazole, or lansoprazole, or pantoprazole, or rabeprazole, or esomeprazole in the form of a single drug or a combination thereof, or as part of other combined preparations, as a proton pump inhibitor. As a blocker of H2-histamine receptors, the first-aid kit in a particular case has cimetidine or famotidine or nizatidine or ranitidine in the form of a single drug or a combination thereof or as part of other combined preparations.

Brief Description of the Drawings

In the future, the invention is illustrated by a description of specific examples of its implementation and the accompanying drawings, in which:

Figure 1 depicts a first-aid kit, front view (A), side view (B), rear view (C).

Figure 2 - options for a set of medicines first-aid kit to provide emergency self-help and mutual assistance with bleeding from the esophagus, stomach and duodenum.

The first-aid kit consists of a case 1, a set of therapeutic agents 2 arranged in it, which contains no more than two single therapeutic doses of at least one drug having a hemostatic effect, for example, aminocaproic acid 3, and at least one drug that reduces the acidity of gastric juice, for example, omeprozole 4 (Figure 1), while all drugs are made in the form of taking them by mouth, are intended and provide emergency self-help and mutual assistance for bleeding and of the esophagus, stomach and duodenum. On the walls of the case 1 (Fig.1A, 1B) is an instruction for using a first-aid kit with an emergency algorithm 5.

Options for the composition of the medicinal kit of the first-aid kit include drugs that have both general and / or local hemostatic effect (Figure 2). In particular, the first-aid kit contains the following preparations: a tablet form of etamsylate (Fig. 2A, 2B, 2G), and / or an inhibitor of fibrinolysis, for example aminocaproic acid (Fig. 1, 2A, 2B), and / or a donor of calcium ions, for example calcium lactate (Fig.2B), or calcium chloride, or calcium gluconate (Fig.2D), and / or hemostatic sponge (Fig.2G), or collagen hemostatic sponge, or medical gelatin, or gelatin sponge (Fig.2E)

Options for the composition of the kit of first-aid kit medicines include an acid neutralizing drug and / or a stomach acid-lowering drug (Figure 2). In particular, the first-aid kit contains the following preparations: diamondate (Fig. 2G), or aluminum phosphate (Fig. 2D), or hydrotalcite (Fig. 2B), or calcium carbonate (Fig. 2B), or carbaldrate (Fig. 2E), or magnaldate, or magnesium hydroxide, or magnesium carbonate, or magnesium citrate, or sodium alginate, or simaldrate in the form of a single drug or a combination thereof or as part of other combined preparations, for example maalox (Fig. 2A), or nealmagel, or gestid (Fig. 2A), and / or a proton pump inhibitor, for example omeprazole (Figure 1A), or lansoprazole (Figure 2A), or pantoprazole (Figure 2 G), or rabeprazole (Fig.2B), or esomeprazole (Fig.2D) in the form of a single drug or a combination thereof or as part of other combined preparations, and / or a blocker of H2-histamine receptors, for example cimetidine (Fig.2B), or famotidine (Fig. 2E), or nizatidine, or ranitidine in the form of a single drug or a combination thereof, or as part of other combined preparations.

First aid kit is used as follows. A patient with a high risk of bleeding from the esophagus, stomach and duodenum (determined by the doctor), or suffering from an ulcer, erosion of the stomach and duodenum, esophagitis, cirrhosis, or suffering from heartburn, abdominal pain, or taking warfarin, aspirin, analginum, and diclo other anti-inflammatory, analgesic, anticoagulant drugs, on the advice of a doctor or independently acquires one or more first-aid kits of emergency self-help and mutual assistance in case of bleeding from the esophagus, stomach and twelve the duodenum, carefully examines the detailed instructions attached to the first aid kit, and brief instructions 5 (Figv, 1A) located on the walls of the case of the first aid kit. He puts the first-aid kit in the pocket of his shirt, suit, wallet, purse, etc. to carry the first aid kit with you at all times. Instructions 5 on the use of the first-aid kit should be familiar to all persons living together with the sick owner of the first-aid kit.

If the patient has severe weakness (sometimes dizziness, “tinnitus” and fainting) and / or nausea, vomiting with blood red or black vomit, similar to the thick insoluble black coffee remaining at the bottom of the cup, and / or black, often like tar, stool, the patient or the person around him should take a first-aid kit, read instruction 5 (Fig. 1B) on its case, compare the patient’s manifestations of the disease with those described in the instructions and if at least one symptom coincides ( manifestations of the disease) immediately call an ambulance help and continue to act as indicated on the back of the first aid kit. The action algorithm (Fig. 1A) shows the patient which medicines, in what sequence should be taken and how to take them (Figs. 1, 2).

The possibility of industrial production of a first-aid kit for emergency self-help and mutual aid in case of bleeding from the esophagus, stomach and duodenum is obvious, since the production of medical products factory, similar in technical essence to mini-first aid kits for a heart attack, has already been carried out in Russia.

Thus, the proposed first-aid kit must always be carried with all patients with an increased risk of bleeding from the esophagus, stomach and duodenum, as they can develop gastrointestinal bleeding at any time and anywhere, and delayed assistance can have fatal consequences for a person. The first-aid kit combines the necessary information for the patient about the main clinical manifestations of such bleeding, the main therapeutic agents for emergency care and a clear algorithm for their use. In addition to the purely medical therapeutic function, it will also actively perform a very important sanitary-educational function, both among patients and their relatives and friends, and will also give the necessary confidence in the correctness of actions and the validity of an early ambulance call. Reluctance to bother people (especially at night), false shyness is one of the common causes of late hospitalization of patients. Such a first-aid kit will allow many people to carry with them all the necessary medical supplies to provide assistance and receive this help in a timely and correct manner, which will certainly increase the effectiveness of all subsequent treatment, prevent the development of serious complications and save thousands of lives of our fellow citizens.

Claims (7)

1. First-aid kit for emergency self-help and self-help, containing a case, an orderly set of medicines in it and instructions for using a first-aid kit with an algorithm for taking medications and emergency actions located on the walls of the case, characterized in that the set of medicines contains no more than two single therapeutic doses of at least one drug having a hemostatic effect and at least one drug that reduces the acidity of gastric juice, while se drugs included in the set are in the form of their reception in the mouth and provide the intended provision of emergency self- and mutual bleeding from the esophagus, stomach and duodenum. 2. The first-aid kit according to claim 1, characterized in that it has a tablet form of etamzilate and / or a fibrinolysis inhibitor, for example aminocaproic acid, and / or a calcium ion donor, for example calcium lactate, or calcium chloride, or calcium, as a medicine with a hemostatic effect. gluconate, and / or a preparation with a local hemostatic effect, for example, a hemostatic sponge, or a collagen hemostatic sponge, or a gelatin sponge, or medical gelatin. 3. The first-aid kit according to claim 1, characterized in that, as a medicine for reducing the acidity of the gastric juice, it has an acid neutralizing preparation and / or a drug that reduces the production of acid by the stomach. 4. The first-aid kit according to claim 3, characterized in that the preparation with an acid neutralizing effect has diamond, or aluminum phosphate, or hydrotalcite, or calcium carbonate, or carbaldrate, or magaldrate, or magnesium hydroxide, or magnesium carbonate, or magnesium citrate or sodium alginate, or simaldrate in the form of a single drug, or a combination thereof, or as part of other combined preparations, for example maalox, or neo almagel, or gestid. 5. The first-aid kit according to claim 3, characterized in that the proton pump inhibitor and / or the blocker of H2-histamine receptors is used as a preparation that reduces stomach acid production. 6. The first-aid kit according to claim 5, characterized in that it contains omeprazole, or lansoprazole, or pantoprazole, or rabeprazole, or esomeprazole, in the form of a single drug, or a combination thereof, or as part of other combined preparations as a proton pump inhibitor. 7. The first-aid kit according to claim 5, characterized in that it contains cimetidine, or famotidine, or nizatidine, or ranitidine in the form of a single drug, or a combination thereof, or as part of other combined preparations as a blocker of H2-histamine receptors.

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