Dr. Long Chelsea98.com Huizhou Education_Millions of Dragons Health
In China, every January 20th is "120·National Emergency Day". Recently, in autumn and winter, the weather has gradually become cold, and it has reached a high incidence of coronary heart disease, angina pectoris, and myocardial infarction. The heart is a gas station for the circulation of human blood, because the heart constantly pushes the blood to flow through every cell, so that hundreds of millions of cells in the body "feed and drink"; at the same time, the heart is also the engine of life, on average every day. The engine will beat about 100,000 times. This engine is always working tirelessly, which is a sign of life. The high incidence of heart disease used to be 50-60 years old, but now it has been advanced to 35-50 years old. The number of patients with heart disease has doubled compared with 20 years ago, and the incidence is becoming younger. There are four main reasons: environmental pollution, life pressure, reduced exercise, and nutritional imbalance.
In the treatment, prevention and first aid of cardiovascular and cerebrovascular diseases, there are four most familiar drugs:Aspirin, nitroglycerin (and the other two of the same type), Suxiao Jiuxin Pills, Compound Danshen Dripping Pills. Which one should I use for first aid? Which one to use under what circumstances? In addition, if I don’t have these medicines, how to give first aid? Let's analyze one by one below.
Aspirin, penicillin and Valium are among the world's three classic drugs, and their contribution is to greatly reduce the incidence and mortality of cardiovascular and cerebrovascular diseases.
(1) What is the main purpose of aspirin
The clinical application of aspirin (also known as acetylsalicylic acid, a synthetic drug; the original body is Chinese willow bark, which is recorded in the Compendium of Materia Medica) is mainly used for prevention and treatment, that is, cardiovascular and cerebrovascular diseases have occurred and are very likely to It is most suitable for people with cardiovascular and cerebrovascular diseases.
(2) When to use: Fasting is best
Generally, the effect is best when taken at night on an empty stomach. Those with obvious gastrointestinal reactions can be taken after breakfast.
(3) Aspirin takes a few hours to work, but it doesn’t help
For acute myocardial infarction, aspirin has a slower onset, at least a few hours. If there is no other first aid medicine around, only aspirin, the dosage should be 300 mg instead of "two tablets" casually. In addition, in order to speed up the absorption effect, chewing and taking is more useful than "drinking and swallowing".
Nitroglycerin (also known as glycerol nitrate, glycerol trinitrate, glycerol trinitrate, is the trinitrate of glycerol, and also a kind of explosive with strong explosive power) is a kind of medicine often prepared by patients with coronary heart disease. It can quickly It relieves angina, can be first aid, and can save lives at critical times. It is an essential life-saving medicine for coronary heart disease!
(1) When to use: When you suddenly feel chest pain
The typical angina pectoris of coronary heart disease is paroxysmal chest tightness, suffocation, and chest pain, which appear behind the sternum and can radiate to the precordial area and left arm. The site of angina pectoris sometimes "deviations", appearing in the upper abdomen or radiating to the neck, lower jaw, left shoulder or right chest. During the attack, you may feel squeezing pain or swelling, or even suffocation accompanied by a fear of death. Nitroglycerin can be used at this time.
(2) When taking nitroglycerin, sitting effect is best
Sitting in the sitting position is better than lying or standing. Orthostatic hypotension can cause dizziness, hypotension, and even syncope due to insufficient blood supply to the brain. If you take the supine position when you take it, it may increase the heart burden due to the increase in blood return. , Thus affecting the efficacy of the drug.
(3) The three-piece service is invalid, you must call 120 or 911
If the condition cannot be relieved after 3 oral administrations, do not continue to consume nitroglycerin tablets, call 120 or 911 in time, and cannot move the patient at will.
Isosorbide dinitrate, commonly known as "Isosorbide". The name isosorbide is quite appropriate, and it is quite effective for angina pectoris. This medicine is a medium and short-acting preparation that has a quick effect after taking it, but it needs to be taken multiple times a day (isosorbide dinitrate itself is relatively short-acting, but isosorbide mononitrate produced by metabolism has a longer action time). The usual dose of isosorbide dinitrate is 10 mg, 3-4 times a day (of course, 20 mg or larger doses can also be used, or 6 times a day, but these are special cases).
The advantage of this medicine is that it can be taken orally or sublingually in an emergency. Although the effect of sublingual oral administration is not as fast as nitroglycerin, it is also faster than oral absorption. When nitroglycerin is not on hand, isosorbide dinitrate (isosorbide dinitrate) can also be used sublingually.
Furthermore, it can be taken in small doses, which is suitable for patients who are intolerant to the initial medication. Because nitrate drugs have the effect of dilating blood vessels, some people will cause more obvious headaches after taking it. At this time, you can start with a small dose of 5mg each time (usually 5mg/tablet), and then increase the dose after adapting. . Because nitrate drugs cannot be stopped suddenly, and the condition may "rebound" after stopping the drug, isosorbide dinitrate tablets (isosorbide) can also be taken as a dose reduction or withdrawal.
4, Isosorbide mononitrate
Isosorbide mononitrate (Xinkang, Xintai) is an active metabolite in the metabolism of isosorbide dinitrate (isosorbide). The action time of the drug is longer than isosorbide dinitrate (isosorbide) and shorter than the sustained-release dosage form, so it generally needs to be twice a day.
For the convenience of taking the medicine, there is a sustained-release preparation that is taken once a day-isosorbide mononitrate sustained-release tablets (capsules). The trade names are Imdor, Xinkang sustained-release tablets, isoladine, and Sonite. Nordson Esmo, etc. (manufacturer is different, product name is different). Take "Imdor" for this kind of sustained-release dosage form. 30% is an immediate release and 70% is a sustained release. After taking the drug, the immediate release part will take effect quickly, and the sustained release part will take effect slowly. In this way, the action time is long and the curative effect is stable.
If the sustained-release agent is scored, it can be broken apart by the score, but it cannot be pulverized and taken. For example, 60 mg 1 tablet of Imdol and 40 mg 1 tablet of Xinkang sustained-release tablets can be divided into 30 mg or 20 mg, but they cannot be divided (isosorbide mononitrate, diltiazem, nicorandil, What is the difference between the three anti-angina drugs).
Nitrate drugs have a characteristic, that is, they can't let the body have the effect of drugs all the time, which will produce tolerance to the drugs and become insensitive. This is different from antihypertensive drugs. This is because these drugs work in the body to consume a substance called "nitric oxide" in vascular endothelial cells. If the drug keeps working, the nitric oxide will be consumed, and the drug will not work.
5Suxiao Jiuxin Wan
Suxiao Jiuxin Pill is an emergency medicine for the treatment of coronary heart disease and angina pectoris. It has been clinically used for more than 20 years and has three functions of prevention, treatment and first aid. It is mainly used in emergencies, necessary for people at high risk of coronary heart disease. Suxiao Jiuxin Pills (prepared from chuanxiong, borneol, musk, toad venom and other precious Chinese medicines and western medicine nitroglycerin) can resist myocardial ischemia, protect the heart, reduce blood viscosity, relieve spasm and analgesia, and can also be taken under the guidance of a doctor , Used to prevent and treat cardiovascular and cerebrovascular diseases.
(1) When to use: Take it when chest tightness
When chest tightness, precordial discomfort, left shoulder soreness and other aura symptoms occur, you should quickly take Suxiao Jiuxin Pills, and you must not wait for the typical angina pectoris to take it again. Because every attack of angina pectoris will cause serious damage to the heart and brain function, taking the medicine in time when there are symptoms of aura can achieve better results. Generally, it takes a few minutes to take effect and can effectively prevent sudden death. However, Suxiao Jiuxin Pill is only an emergency medicine and cannot cure the disease fundamentally. See a doctor as soon as possible after the symptoms are relieved.
(2) Take it under the tongue for quick absorption
Suxiao Jiuxin Pills are suitable for sublingual administration. The active ingredients of the drug are absorbed through the sublingual mucosa and can quickly enter the blood circulation. In order to exert the drug effect faster, the pill can be crushed and then placed under the tongue.
(3) No effect after two consecutive administrations
If the symptoms are not relieved after two consecutive administrations, the patient should be sent to the hospital in time.
6Compound Danshen dripping pills
Compound Danshen Dripping Pills, the name of traditional Chinese medicine (composed of three Chinese medicines: Danshen, Panax notoginseng and Borneol, the effective ingredients mainly include phenolic acids, saponins and borneol. Among them, salvianolic acid U and salvianolic acid T are compound Danshen The unique active ingredient in dripping pills). Borneol is a very low-toxic drug with no obvious long-term toxicity. The safe dose of borneol is equivalent to 200 times the dose of borneol in the compound Danshen dripping pill, and it has no obvious mutagenic and reproductive toxicity. From "The Pharmacopoeia of the People's Republic of China." It has the effects of promoting blood circulation, removing blood stasis, regulating qi and relieving pain. Indications of chest pain caused by stagnation of qi and blood stasis, symptoms include chest tightness, precordial tingling; coronary heart disease angina pectoris see the above symptoms.
(1) When to use: chest tightness, precordial tingling
The symptoms of chest obstruction caused by qi stagnation and blood stasis include chest tightness and precordial tingling; coronary heart disease angina pectoris; combined medication for the prevention and treatment of vascular complications based on conventional treatment for diabetic patients; long-term combination based on standardized treatment for coronary heart pain and angina pectoris The treatment is also suitable for: intolerance of nitrate esters, taking aspirin or clopidogrel platelet hyporesponsiveness, impaired exercise tolerance, PCI perioperative period and asymptomatic myocardial ischemia, and the treatment of syndrome X. If there is heart pain, but I am not sure whether it is colic or other pain, what medicine should I take for emergency? In this case, we recommend taking Danshen dripping pills.
(2) Specific usage:
- For the treatment of coronary heart disease, the conventional recommended dose of compound Danshen dripping pills is 10 capsules/time, 3 times/d, orally or sublingually. 4 weeks is a course of treatment, according to the condition of the treatment can be extended;
- In the first aid, the recommended dose is 10 capsules/time, sublingually, if not relieved after 5 minutes, you can take another 10 capsules or switch to nitrates.
- When treating diabetic microvascular complications, it is recommended to take 10-20 capsules/time, 3 times/d, orally or sublingually. 24 weeks is a course of treatment, and the taking time can be extended according to the condition.
- If the patient has stomach discomfort after taking the medicine, it is recommended to take it under the tongue or take it 30 minutes after meals.
- The pretreatment effect of Compound Danshen Dripping Pills is that long-term use can effectively protect the vascular endothelium, stop the progression of atherosclerosis, stabilize atherosclerotic plaques, promote ischemic myocardial angiogenesis, and improve cardiac microcirculation. Prevent the occurrence of coronary heart disease.
(3) What is the difference between compound Danshen dripping pills and compound Danshen tablets?
Compound Danshen Dripping Pills and Compound Danshen Tablets are commonly used drugs for the treatment of coronary heart disease. Both have the effects of dilating coronary artery, increasing coronary blood flow, improving vascular microcirculation and protecting myocardial ischemia. However, the effective ingredients and efficacy of the two drugs are quite different and cannot be substituted for each other.
— The onset time of anti-angina pectoris is different
Compound Danshen tablets are directly compressed into tablets. Whether they are plain tablets or sugar-coated tablets, the disintegration time is more than 30 minutes, which cannot relieve acute attacks of coronary heart disease and angina.
The compound Danshen dripping pill is a dripping pill that can be taken under the tongue and absorbed quickly. It can be used for acute angina pectoris; the dripping pill dissolves within 3 minutes and relieves angina pectoris in 3-8 minutes.
— The side effects of the two drugs are different
The borneol in the compound Danshen tablets is used in a large amount, which is more irritating to the gastrointestinal tract. It is not easy for patients with gastritis, gastric ulcer and duodenal ulcer. The dosage of borneol in compound Danshen dripping pills is relatively reduced. Sublingual oral administration can be directly absorbed through the mucous membrane. Sublingual oral administration can be adopted for patients with cardiovascular and cerebrovascular diseases with gastric discomfort.
The Danshensu in Compound Danshen Dripping Pills has strong anti-platelet aggregation and promotion of fibrin degradation, leading to a greater risk of bleeding. When combined with warfarin, aspirin, clopyrrole and other drugs, pay attention to monitoring blood coagulation indicators.
(4) Use attention: avoid cold, spicy, greasy food, avoid tobacco, alcohol, and strong tea.
Summary: From the perspective of the onset of effect, the fastest is nitroglycerin (mainly used in emergency situations, and can save lives in critical situations), followed by isosorbide dinitrate tablets (isosorbide), and finally Suxiao Jiuxin Pills and Compound Danshen Dripping Pills (Necessary for people at high risk of coronary heart disease), but aspirin has a slow effect, mainly for prevention and treatment, which can greatly reduce the incidence of cardiovascular disease.
For first aid, in addition to the above drugs, there are the following suggestions:
Heart attack and severe pain, regardless of age, please remember the following first aid reminders:
- The patient has a history of angina pectoris. If the blood pressure and heart rate are normal, and there is no glaucoma and no alcohol, nitroglycerin should be taken immediately under the tongue;
- Patients who have chest pain for more than half an hour, have no relief of symptoms after taking nitroglycerin, and have no peptic ulcer and bleeding tendency in the past, can chew and take 300 mg of aspirin, and can also use compound Danshen dripping pills or Suxiao Jiuxin pills as an auxiliary;
- The patient is unconscious and should not be treated with oral medications to avoid aspiration.
In the above three situations, the patient should not be able to exercise, and should lie flat or semi-lying, head tilted to one side. It is recommended to call the emergency number immediately after finding the symptoms, wait for rescue, and have a professional doctor to deal with dangerous situations such as myocardial infarction, arterial dissection, pneumothorax, and pulmonary embolism.
Through the above introduction, everyone has a certain understanding of the correct use of first aid medicine, but some wrong methods for emergency operations such as chest pain, fainting, sudden death, cerebral hemorrhage, and dyspnea are still being spread on the Internet. We need to look and listen squarely.
Rumor 1: Plantar bleeding to aid cerebral hemorrhage
There was an article about “the life-saving trick for cerebral hemorrhage” which was widely circulated. It said that within 4 hours of the onset of cerebral hemorrhage, black blood can be pierced on the sole of the patient with a needle to minimize the sequelae of cerebral hemorrhage. This approach is wrong. of.
The most common causes of cerebral hemorrhage are hypertension and ruptured vascular aneurysms. The blood vessels have ruptured and the blood has reached the brain. It is necessary to stop the bleeding and prevent cerebral edema in time. A puncture on the soles of the feet will not have the effect of "bleeding". When encountering a patient with suspected cerebral hemorrhage, call the emergency number as soon as possible; place the patient on his side to prevent suffocation caused by vomit; do not move the patient at will.
Rumor 2: Double earlobe piercing blood to treat hemiplegia
There are so-called "three life-saving methods" on the Internet. The first one is: hemiplegia (regardless of cerebral hemorrhage or embolism), crooked mouth and eyes, immediately take a sewing needle to pierce the lowermost point of the patient's earlobes, and squeeze out a drop of blood each, the patient Healed immediately without leaving any sequelae.
Hemiplegia and crooked mouth and eyes are indeed symptoms of stroke. In daily treatment, traditional medicine does include bloodletting and acupuncture and fingertips. But sudden and daily treatment is completely different. When a stroke occurs, whether the cause is cerebral hemorrhage or cerebral infarction, the blood pressure in the brain is increased, blood and oxygen decrease, and the body's protective mechanism will automatically increase blood pressure, allowing blood to flow into the brain to save the dying Brain Cells. At this time, if the bloodletting is rushed, it may cause the blood pressure to drop sharply, but accelerate the death of brain cells. The correct approach is to dial 120 in time, and when waiting for the arrival of the ambulance staff, let the patient lie down, try not to move, and loosen his clothes to keep breathing smooth.
Rumor 3: Acupuncture toe to cure sudden heart disease death
It is also said that after the sudden death of a heart attack, the patient immediately took off his socks and pierced his 10 toes with a sewing needle. The patient immediately became awake.
Sudden cardiac death refers to the phenomenon of cardiac arrest caused by heart disease or other accidents, such as emotional excitement, environmental mutations, sudden accidents and other strong stimuli. Medically, it is believed that the rescue of sudden cardiac death requires cardiopulmonary resuscitation and defibrillation within the first 3 to 4 minutes. Therefore, it is very unreliable to rescue the sudden cardiac death by "acupuncture toe bleeding". People with no operating experience should remember the three words "stable, fast, and deep" when performing cardiopulmonary resuscitation, and keep performing heart compressions before the arrival of emergency personnel. Because once interrupted, the oxygen in the blood of the patient is difficult to transport to the brain, and cerebral hypoxia is prone to occur.
Rumor 4: Acupuncture with black blood on the tip of the nose rescues acute dyspnea
Similar to the previous three, regardless of asthma or acute laryngitis, etc., the patient was found to be unable to breathe, blushing and his neck was thick, so he quickly pierced the tip of his nose with a sewing needle and squeezed out two drops of black blood to cure.
In addition to asthma and acute laryngitis, heart failure, laryngeal edema, emphysema infection and many other diseases can cause acute breathing difficulties. In such cases, western medicine is the main treatment. Acupuncture and moxibustion can participate in the treatment under conditions. What needs to be done at this time is to keep the patient in a ventilated environment, keep his respiratory tract unobstructed, remove foreign bodies in the respiratory tract, and promptly use the emergency medicine prescribed by the doctor.
Rumor 5: Pressing the armpit when the heart is unwell
This method has been widely publicized, and the authors call it the simplest first aid method, specifically: when the heart is uncomfortable, or when someone falls on the ground, "pressing the armpit can save lives", so that the blood flow can be accelerated and accelerated Regain the effort, so as to rush open the blocked heart and blood vessels to achieve the purpose of "saving people".
Don't believe this method, and don't try it. Pressing the armpit is useless. When there is heart discomfort or sudden chest pain, remember not to exercise with force. At this time, you should stay calm and call the emergency number. Some patients are caused by emotional throbbing or labor, which can be relieved after a peaceful rest. When rescuers give a helping hand, do not move the patient at will to reduce their myocardial oxygen consumption. If the patient has difficulty breathing and cannot lie down, help the patient choose a semi-recumbent or a sitting position; if blood pressure drops or shock occurs, the patient should be placed in the supine position, keep the patient in a comfortable position, and keep warm, so as to relieve their discomfort.
Rumor 6: Treating heart disease
Heart disease is caused by stenosis or even blockage of the blood vessels that supply blood to the heart. Patting the elbow not only cannot relieve the stenosis and blockage, but the pain can also accelerate the beating of the sick heart, aggravate the condition and endanger life.
The correct response is to let the patient rest in a sitting or lying position and call an emergency number.
In case of sudden heart attack, angina pectoris, or myocardial infarction, Chinese medicine also has emergency methods. Press, knead, massage or squeeze Jiquan, Neiguan, Qiemen, and front large tendons. These acupressure techniques require learning to effectively give first aid. They are completely different from the aforementioned pressing and slapping of the armpit and elbow. During the period before the arrival of the ambulance, self-operation can be performed to relieve symptoms.
Rumor 7: Chest compressions should be done for a heart attack
Heart disease includes many types. Cardiopulmonary resuscitation is only needed when sudden cardiac death or cardiac arrest occurs, that is, when the heart cannot contract normally and the patient loses consciousness. When the patient's heart is not in a sudden stop and can still contract and eject blood normally, cardiopulmonary resuscitation will affect the normal heart contraction and ejection, which is harmful to health.
Cardiopulmonary resuscitation can be done when the patient is "unresponsive" or "not breathing". Patting the patient and calling out loudly, the patient has no pain, blinks, frowns, groans, etc. The reaction is "no response"; the chest does not fluctuate for 5-10 seconds as no breathing. When the patient has "no response" and "no breathing" at the same time, it can be judged as cardiac arrest and CPR should be started. Pressing position: at the midpoint of the connection between the two nipples (middle and lower sternum). Depth: 5-6 cm (about the width of the ID card). Frequency: 100-120 times/minute, press mouth-to-mouth blow 2 times every 30 times, and repeat until the emergency personnel arrive.
In addition, if you don’t have any of the above-mentioned drugs nearby, it may take about an hour for rescuers to arrive (the fastest ambulance in a big city also takes about half an hour), and there happens to be someone nearby.CoenzymeQ10, This time can also be used. Coenzyme Q10 was also a medical drug in the early days, and now it has become a popular nutrition product because of its safety, effectiveness and popularity. A 200mg coenzyme Q10, divided into 2-3 times to take a total of 4-6 pills, depending on the heart rate to determine the interval, equivalent to a quick-acting heart-relief pill But this method is the last resort, it must not be used indiscriminately.
Attachment: Coenzyme Q10 is a substance naturally present in the human body, with the highest content in the heart, liver, kidney and pancreas. Coenzyme Q10 content lower than 60% can cause palpitation, chest tightness, and body fatigue, lower than 40% can cause myocardial infarction, myocardial ischemia, coronary heart disease, and lower than 25%, the heart will stop beating or even sudden death. Commercial Coenzyme Q10 capsules can provide energy to myocardial cells, regulate heart function, and can be used for adjuvant treatment of heart failure. The "Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2018" and the "Consensus of Chinese Experts on the Diagnosis and Treatment of Fulminant Myocarditis in Adults" formally recommend coenzyme Q10 as an adjuvant drug treatment method, which can improve the energy metabolism of the patient's myocardium, thereby improving cardiac function.
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