Monthly Archive September 2018


The most dangerous condition that can suddenly occur with diabetes is hypoglycemia. Other types of diabetic coma progress gradually and do not have such severe consequences. Therefore, all relatives of diabetics should know its symptoms and be able to provide assistance to such patients.

Hypoglycemia can develop almost exclusively in diabetics, its main cause is an overdose of sugar – reducing drugs, especially against the background of insufficient food intake or increased emotional or physical stress. Sometimes an alcoholic intoxication can provoke a moment.

Symptoms of hypoglycemia – irritability, a strong sense of anger, trembling in the hands, profuse sweating, insuperable hunger, then loss of consciousness, cramps are possible. If there is no treatment, death may occur.

One night, my patient called me. With an alarmed voice, he told me that his 85-year-old mother suddenly lost consciousness. Do not call an ambulance – they are in a village, divorced from civilization, to the nearest village of kilometers 30 on a bad road, even cellular communications work intermittently.

With detailed questioning it turned out that she was taking all the medications prescribed to her, including for reducing blood sugar, but because of intestinal frustration she practically did not eat anything all day. During the evening she felt weak, lay in bed, sweating profusely (this attracted attention most of all – clothes and bed linen could literally be squeezed), and in the evening there were attacks of loss of consciousness. The patient “disconnected”, then briefly came to, not complaining about hunger, did not show aggression. After a short “light” gap, she finally lost consciousness.

I advised urgently to measure the blood sugar level, it was 2.3 mmol / l, which is a bit even for a healthy person, and for a diabetic patient it is catastrophically small. Fortunately, the patient did not lose the ability to swallow, and her son was able to give her a large amount of sweet tea. Consciousness quickly recovered, sweating was literally before our eyes. It is interesting that the mood of the patient was smooth and calm, unlike most people who suffer from hypoglycemia, which are usually at least irritated, and more often fall into aggression. Observing the patient for more than ten years, I repeatedly noted her extremely kind and non-conflicting character, which manifested itself at such a critical moment.

It should be added that loss of consciousness during hypoglycemia may be accompanied by symptoms very resembling a stroke, that often even confusing experienced neurologists. Patients may have asymmetry of the face, reduced tone of one of the arms or legs, turning the eyeballs aside. All this happens with strokes. The only difference is that with the timely administration of glucose to a patient with a low level of sugar, these symptoms completely and quickly pass.

Do not be afraid to increase blood sugar if you suspect hypoglycemia. Doctors often have to see diabetics who normally feel at a glucose concentration of up to 30mmol / l and even higher. In the long term, such figures, of course, will cause considerable harm to the body, but short-term hyperglycemia is much safer than hypoglycemia.

Remember: if a patient with diabetes is unconscious, he needs to measure blood sugar; if this is not possible, treat this as hypoglycemia, when there is no convincing reason to think about something else. The first help in this condition is to give a sweet tea. Before you give a drink to a sick person, make sure that he is able to swallow. To do this, let him drink a teaspoonful of water and make sure that the water is swallowed. If the patient does not swallow, the only way to help is to inject glucose intravenously, which the ambulance team can do, which must be called as soon as possible.

Can hypoglycemia occur in people who do not suffer from diabetes? Yes. True, this happens relatively rarely.

One day during the ambulance I got a call to the gym. The 34-year-old woman fell unconscious right in the gym. When I arrived at the scene of the incident (fortunately, it happened literally in 5-7 minutes from the moment of loss of consciousness – our team was passing just next to the sports complex), I saw a young, plump woman without external signs of trauma. Surrounding could not say anything about what she had been sick before, only noted that in the past 2-3 months she was actively engaged in sports and noticeably lost weight. After the administration of 60 ml of 40% glucose, the patient recovered to her senses. It turned out that after giving birth and breast-feeding, she gained weight and began to go to the gym constantly to restore her physical form. During the first month she lost 4 kg. This seemed to her little, so the patient reduced the calorie intake. On the day of the disease, she came to an empty stomach for the first time in her life.Fighting hunger, and then with “not clear” from where the feeling of indignation arose, she continued to do the exercises, but at some point she suddenly lost consciousness for herself.

Treatment of hypoglycemia in healthy people is the same as in diabetics – fast introduction of sugar or something sweet through the mouth or glucose intravenously if the patient does not swallow. The effect should occur quickly, literally within the first minute, otherwise doubtfulness will arise in the reliability of the diagnosis.Harm from glucose is not present – possible or probable advantage always above, than its erroneous reception.

Alcoholic coma

Alcoholic coma is a condition that arises from the abuse of alcohol. On different people, it acts differently, it is not uncommon for cases when the same dose of one person will cause only intoxication, and the other will enter from it into a state of coma.

One day during the ambulance, I arrived at a 21-year-old patient who had lost consciousness. The call came from her fellow classmates who told me that they went to the park during the day to ski, after which they drank a 0.5 liter bottle of vodka with a meager snack. Everyone’s mood was good until they noticed that their friend was lying on the bed in an unnatural position. She did not react to attempts to wake up, only moaned softly. There was a two-fold vomiting of unchanged gastric contents, fortunately, the patient’s head managed to turn sideways, otherwise it would choke.

On examination, there was a smell of alcohol from the mouth, a rapid pulse. Blood pressure was normal. The patient was taken to the acute poisoning treatment center, where my diagnosis was confirmed – “alcoholic coma”. Against the background of treatment there was a rapid improvement, the next day the girl was discharged home.

None of the patient’s friends looked poisoned, 100 grams of vodka for their organisms remained almost unnoticed. True, they told me that she had never used alcohol before. Perhaps she had some genetically determined defect in the splitting of alcohol, which led to such a severe reaction.

So, the symptoms of alcohol coma – loss of consciousness, rapid heartbeat, reddening of the face can be observed. There is necessarily a smell of alcohol in the exhaled air. Often in the room where the patient is, you can see empty bottles of alcoholic beverages, however, they can be hidden.Often patients have a characteristic appearance – the so-called stigma of alcoholism. These include the enlargement of the vessels of the nose and its swelling. Remember, in the tale of “Pinocchio” there was a character called Giuseppe Sisi Nos – it is likely that he liked to drink. In addition, the faces of alcoholics usually have a cyanotic-red color. Women often look masculine (remember the “Lovers of absinthe” Pablo Picasso), and men, on the contrary, effeminate, with hypertrophied mammary glands. Perhaps the emergence of the so-called contracture Dupuytren – sclerosis of the tendon of the palm, as a result of which the fingers “crook”, the tendon of the ring finger is especially affected. And, finally, in the last stages of the patients, salivary glands hypertrophy, forming enlarged cheeks, which can often be seen in people with a far-gone process of alcoholism.

Despite the apparent evidence of the diagnosis, alcoholic coma is not recognized by others. I want to bring one more case from my practice.

Once I came to a 40-year-old patient who worked as a nanny to a 2-year-old girl. Her parents went to the theater in the evening, leaving her daughter for the first time in her care. Returning home about 22 hours, they saw a crying child and a unconscious nurse. The girl, fortunately, quickly calmed down, and the nurse could not be brought to life, and therefore an ambulance was called. Arriving at the apartment, I saw a woman lying unconscious with traces of involuntary urination. Empty bottles were not in the apartment (they were not found afterwards), but the smell of alcohol was clearly present in the exhaled air. There was a certain bewilderment of such an obvious disregard for my duties – neither I, nor the parents of the child could believe that the nurse simply “touched” the alcohol. Therefore, I hospitalized the patient, putting her not only an alcoholic coma, but also in any case a traumatic brain injury as a second diagnosis, although in favor of the injury did not say anything – the skin was not damaged. All questions were resolved in the hospital after taking blood and urine tests for alcohol. The results showed that there is a conventionally lethal dose in the blood. The fact that the patient did not die (and she was discharged in a day), says that this dose was familiar to her.

When alcoholic coma, as with any loss of consciousness, we must try not to let vomiting into the respiratory tract. For this, the patient should be laid on his side, especially when vomiting begins. Calling for ambulance is mandatory – in the hospital it is possible to save virtually all patients.Hospitalization is also necessary in order to exclude other diseases, most often the alcoholic coma is combined with the craniocerebral trauma.

Overdose of drugs from the group of opiates

Until the 1990s, the drug overdose was so rare that most doctors in their practice did not face this disease. Drug addicts were a few units, and there were no overdoses for them because of the lack of sufficient quantities of narcotic substances. My older colleagues in the work at the ambulance told me that, for example, in the Moscow district of Leningrad in the 80s of the XX century only 3 people with opiate addiction were registered. Now it seems incredible, but these patients were registered not only in the narcological dispensary, but also at the City Emergency Station, and had the right to call a team … so that she could inject morphine into them. Net drugs were not on sale, and drug addicts often had to interrupt themselves with a homemade straw poppy extract.

Unfortunately, those times are left behind. An overdose of opiates is so common that at least once in the life of such a patient can see any person, not just a doctor. Symptoms can resemble a stroke, so I decided to put in this book a section dedicated to this state. The methods of helping with ” overdose ” are simple, and each of us can try to save the life of the victim … Three times unnecessary life, according to Dr. Livesey from the “Treasure Island”.

In the mid-1990s, when drug addiction in Russia was already widespread, I worked as an ambulance doctor in the Nevsky district of St. Petersburg. This area was famous for the Right Bank market, which, according to some estimates, ranked second in terms of drug trafficking in Europe (!). To see a drug addict preparing a drug at night in the entrance was an ordinary phenomenon, empty insulin syringes (which were used by drug addicts) were lying on every corner. I had to go to patients who had overdosed the drug.

I remember the incident that occurred at one of the gas stations. On the way from the call to the station, we decided to refuel the car. Near one of the columns, a cabriolet with an open top stopped. In the car sat two young guys of Caucasian appearance. The driver of the cabriolet came out to pay for gasoline, and suddenly he saw that his companion, sitting in the front seat, suddenly lost consciousness. More than twenty years have passed, but I still remember his desperate cry: ” Adgur ! Oro ! “Without waiting for him to run up to me, I jumped out of the car and asked:” Drugs? “Delaying a split second, he answered in the affirmative. “Strongly beat him on the cheeks ,” I said, “now we will help.” While I was getting out of the car a set for carrying out artificial ventilation, the help was already provided. The driver of the car, fortunately, literally took my recommendation to beat the patient on the cheeks. After several very strong blows, the addict opened his eyes and inhaled. The ventilation was not even required. He refused categorically from hospitalization, and I do not know how this story ended. Saying goodbye to them, I recommended not to let the victim fall asleep – to prevent repeated loss of consciousness, this is the most important preventive measure.

The patient, who is unconscious due to drug overdose, is usually young (drug addicts rarely live up to 40-50 years). Pupils must be narrow, “point”. If the pupils are wide or normal, the diagnosis of an opiate overdose is excluded. On the hands are usually visible “paths” – traces ofintravenous drug use. Skin can have a yellowish tinge due to chronic hepatitis, a constant companion of people who abuse drugs.

The first thing you can do for such a patient is to cause him severe pain. You can pinch the lobe of the ear, squeeze your fingernail with a fingernail or simply apply a few strokes on the cheeks with your palm.

In the famous film “Pulp Fiction” there is an episode in which the character John Travolta played tried to save the heroine, who lost consciousness after using drugs. When he stuck a syringe into her chest (this is very painful, the chest cage is equipped with sensitive nerve endings), she suddenly screamed and recovered, no other action was needed.

By the way, I repeatedly noticed that drug addicts leave the coma almost instantly. He just looked so “put in a coffin in a coffin”, then he opened his eyes and literally in a split second he was already fully conscious. Not from any other coma does the patient come out so suddenly.

If the infliction of pain did not help and signs of independent breathing are not observed, artificial respiration will have to be done according to the procedure detailed in the section on clinical death.

Any patient with an overdose of drugs should be treated as infected with hepatitis and AIDS viruses. Therefore, to protect yourself from these diseases, you must try to ensure that the patient’s blood does not get on your skin, especially if it has abrasions.

After the patient regains consciousness, he must be hospitalized, because often after the restoration of breathing comes a second wave of deterioration. The threat to life can be considered missing no earlier than two hours after the introduction of the drug.

I tried to write this article so that it was easily perceived and contained a lot of useful information. Did it work – to judge you.

In the process of work, I read not only modern literature, but also the works of outstanding doctors of the 20th century. It was impossible not to admire their thoughtful, scrupulous approach to diagnosis and treatment. They were multifaceted specialists with deep knowledge in various fields of medicine. Nevertheless, it must be admitted that their patients had much less chance of recovering or at least a slight relief of their suffering than any of the readers of this book. The fact is that over the past few decades, medicine has gone far ahead. Modern diagnostic methods – ultrasound, computer and magnetic resonance imaging – make it possible to diagnose diagnoses in a timely and correct manner in the most complicated cases. There are medicines that help many years to maintain a full life for patients who were previously considered incurable. The newest surgical methods of treatment, such as stenting of blood vessels, can help patients, whom physicians could only passively watch at the beginning of the XXI century , seeing their suffering and premature death.

In general, medicine now has opportunities that would seem fantastic in the middle of the 20th century. Of course, not all problems are solved.Outstanding hematologist IA Kassirsky has an aphorism: “Treatment has always been a lagging field of medicine.” This is true even now.Nevertheless, incurable diseases are becoming less and less.

I wrote these lines not only because I feel proud for the achievements of medicine. First of all, I want to tell my readers that a timely call to a doctor can save lives and keep health.

What is meant by timely treatment? When you have to go to the doctor or even call him at home, and in which cases can you wait? In my opinion, the cause for medical advice should be any worsening of health, especially arising for the first time, if it has no obvious reasons . Often, the pre-infarction condition is masked for a small cold, gastric bleeding – for indigestion, transient ischemic attack (precursor of a stroke) – for easy fainting. As a rule, it is not difficult for a doctor to correctly assess the degree of danger and provide assistance .