What are the common side effects of epidurals during labor. How can low blood pressure impact mothers receiving an epidural. Are there risks of nerve damage associated with epidural anesthesia. Can epidurals cause headaches or itching. What long-term complications may arise from epidural use.

Understanding Epidural Anesthesia: Benefits and Potential Risks

Epidural anesthesia is a widely used pain management technique during childbirth, offering effective relief for many laboring mothers. However, like any medical procedure, it comes with potential side effects and risks that expectant parents should be aware of. This comprehensive guide examines the various effects an epidural may have on the body, from common temporary issues to rare but serious complications.

Common Side Effects of Epidural Anesthesia

While epidurals are generally considered safe, they can cause several side effects that range from mild discomfort to more significant issues:

Low Blood Pressure

One of the most common side effects of an epidural is a drop in blood pressure. This occurs because the medication affects the nerves that control blood vessel dilation. How does this impact the mother? It can lead to feelings of dizziness or nausea. Medical professionals closely monitor blood pressure and can administer fluids or medication through an IV if necessary to maintain normal levels.

Loss of Bladder Control

The epidural affects nerves in the surrounding area, which can lead to temporary loss of bladder sensation. This means a mother may not feel the urge to urinate even when her bladder is full. To address this issue, healthcare providers often insert a catheter to allow urine to drain. Rest assured, bladder control typically returns to normal once the epidural wears off.

Itchy Skin

Some women experience itching as a side effect of the pain relief medications used in the epidural. This can be uncomfortable but is generally not serious. If itching becomes bothersome, medical staff can provide anti-itch medication or adjust the epidural mixture.

Nausea

While less common than with other pain relief methods like morphine, nausea can still occur with epidurals. This may be related to the drop in blood pressure or a reaction to the medication itself. Anti-nausea medication can be administered if needed.

Potential Complications of Epidural Use

While less frequent, some more serious complications can arise from epidural anesthesia:

Inadequate Pain Relief

In some cases, the epidural may not provide complete pain relief. This could be due to improper placement of the catheter or individual variations in anatomy and response to the medication. If this occurs, healthcare providers may offer additional or alternative pain relief methods.

Post-Dural Puncture Headache

A severe headache can develop if the dura mater (the protective membrane surrounding the spinal cord) is accidentally punctured during the epidural procedure. This type of headache typically worsens when sitting or standing up. How is this treated? In some cases, a procedure called a blood patch may be necessary, where a small amount of the patient’s blood is injected to seal the puncture.

Respiratory Depression

Some medications used in epidurals can cause slowed breathing or drowsiness in rare cases. Medical staff closely monitor patients for any signs of respiratory issues and can quickly address them if they occur.

Neurological Risks Associated with Epidurals

While uncommon, epidurals can potentially impact the nervous system:

Temporary Nerve Damage

The epidural needle or catheter may occasionally cause nerve irritation or damage. This can result in numbness, tingling, or weakness in parts of the lower body. In most cases, these symptoms resolve within days or weeks, though some may take months to fully improve.

Permanent Nerve Damage

Extremely rare cases of permanent nerve damage have been reported following epidural anesthesia. This could lead to long-term loss of sensation or movement in affected areas. What causes this severe complication? Potential factors include direct damage to the spinal cord, infection, bleeding in the epidural space, or accidental injection of incorrect medication. It’s important to note that these events are exceedingly rare, and anesthesiologists undergo extensive training to minimize such risks.

Infection Risks and Epidural Use

While uncommon, infections related to epidural anesthesia can occur:

Localized Skin Infection

In some cases, an infection may develop at the site where the epidural catheter was inserted. This is typically a superficial infection that can be treated with antibiotics.

Deep Tissue or Spinal Infection

Although rare, more serious infections can occur in the epidural space or near the spinal cord. These infections may require intensive antibiotic treatment or, in severe cases, emergency surgery.

Other Rare Complications of Epidural Anesthesia

While extremely uncommon, other serious complications have been reported:

• Seizures (convulsions)
• Severe breathing difficulties
• In exceedingly rare instances, death

It’s crucial to emphasize that these severe complications are extremely rare. The benefits of epidural anesthesia for pain relief during labor often outweigh the risks for many women.

Making an Informed Decision About Epidural Use

When considering an epidural, it’s essential to have a thorough discussion with your healthcare provider. What questions should you ask? Consider the following:

• What are the specific risks based on my medical history?
• How experienced is the anesthesiologist performing the procedure?
• What alternatives are available if I choose not to have an epidural?
• How quickly can side effects or complications be addressed if they occur?

Your healthcare team can provide personalized information and address any concerns you may have about the procedure.

Monitoring and Managing Epidural Side Effects

Healthcare providers closely monitor patients receiving epidurals to quickly identify and address any side effects or complications. What measures are typically in place?

• Continuous blood pressure monitoring
• Regular assessments of pain levels and epidural effectiveness
• Monitoring of fetal heart rate and maternal vital signs
• Frequent checks of sensation and movement in the lower body

If any issues arise, medical staff can adjust the epidural medication, provide additional treatments, or discontinue the epidural if necessary.

Post-Epidural Care

After the epidural is removed, healthcare providers continue to monitor the patient for any lingering effects or complications. How long does this monitoring typically last? It can vary depending on the individual and the specifics of their labor and delivery, but generally continues for several hours post-delivery.

Alternatives to Epidural Anesthesia

For those concerned about the potential risks of epidurals or seeking alternative pain management options, several other techniques are available:

Natural Pain Management Methods

• Breathing techniques and relaxation exercises
• Hydrotherapy (laboring in water)
• Movement and position changes during labor
• Massage and counterpressure techniques

Non-Invasive Medical Pain Relief

• Nitrous oxide (laughing gas)
• TENS (Transcutaneous Electrical Nerve Stimulation) units
• Sterile water injections for back pain

Other Pain Medications

• IV pain medications (opioids)
• Local anesthetic injections

Each of these alternatives has its own set of benefits and potential drawbacks. Discussing these options with your healthcare provider can help you make the best choice for your individual circumstances.

The Future of Epidural Anesthesia: Ongoing Research and Improvements

Medical researchers continue to study ways to improve the safety and efficacy of epidural anesthesia. What advancements are on the horizon?

• Development of new medications with fewer side effects
• Improved techniques for epidural placement to reduce the risk of complications
• Enhanced monitoring technologies to quickly detect and address potential issues
• Personalized approaches to pain management based on individual patient factors

These ongoing efforts aim to make epidural anesthesia an even safer and more effective option for pain relief during labor and delivery.

In conclusion, while epidural anesthesia offers effective pain relief for many laboring mothers, it’s crucial to be aware of the potential side effects and risks associated with the procedure. By understanding these factors and discussing them with your healthcare provider, you can make an informed decision about whether an epidural is the right choice for your labor and delivery experience. Remember that every pregnancy and birth is unique, and what works best for one person may not be ideal for another. Trust in your medical team and your own instincts as you navigate this important decision in your birthing journey.

Side effects of an epidural

Epidurals are usually safe, but as with all medical treatments, side effects and complications can sometimes happen.

For more on side effects of epidurals in labour, read about pain relief in labour. 

Low blood pressure

It’s normal for your blood pressure to fall a little when you have an epidural. Sometimes this can make you feel sick.

Your blood pressure will be closely monitored. If necessary, fluids and medicine can be given through a drip to keep your blood pressure normal.

Loss of bladder control

After having an epidural, you may not be able to feel when your bladder is full because the epidural affects the surrounding nerves.

A catheter may be inserted into your bladder to allow urine to drain away. Your bladder control will return to normal when the epidural wears off.

Itchy skin

This can be a side effect of the pain relief medicines that may be used in your epidural.

Medicine can be given to help the itching, or the medicine in the epidural can be changed.

Feeling sick

Feeling sick (nausea) is less common with epidural medicines than with other pain relief medicines such as morphine and other opiates.

It can be treated with anti-sickness medicines, or by raising your blood pressure if it’s low.

Inadequate pain relief

The epidural may not block all your pain. You may be offered an extra, or alternative, pain relief method.

Headache

A severe headache can happen if the bag of fluid that surrounds your spine is accidentally punctured. You may need specific treatment for the headache.

A procedure known as a blood patch may be used to seal the puncture. It involves taking a small sample of your blood and injecting it into the puncture.

When the blood thickens (clots), the hole will be sealed and your headache will stop.

Not all headaches from an epidural require a blood patch. Your anaesthetist will discuss your options with you.

Slow breathing

Occasionally, some medicines used in an epidural can cause slow breathing or drowsiness.

You will be monitored closely to look for this, and it can be treated easily.

Temporary nerve damage

The needle or epidural tube can damage nerves, but this is uncommon. Nerve damage can cause loss of feeling or movement in parts of your lower body.

The most common symptom is a small, numb area with normal movement and strength. This usually gets better after a few days or weeks, but can sometimes take months.

Infection

An infection can sometimes happen around the skin next to the epidural tube.

It’s rare for the infection to spread. Antibiotics may be necessary or, rarely, emergency surgery.

Permanent nerve damage

In rare cases, an epidural can lead to permanent loss of feeling or movement in, for example, 1 or both legs.

The causes are:

• direct damage to the spinal cord from the epidural needle or catheter
• infection deep in the epidural area or near the spinal cord
• bleeding in the epidural area, causing pressure on the spinal cord
• accidentally injecting the wrong medicine into the epidural catheter

These are rare events, and anaesthetists have extensive training to reduce the chances of these complications.

Nerve damage can also happen for other reasons during surgery, which are unrelated to the epidural.

Other complications

Other, very rare, complications of an epidural include:

• fits (convulsions)
• severe breathing difficulties
• death

Before deciding to have an epidural, you should discuss the procedure with your anaesthetist.

They can provide further information and advice on the risks of developing complications.

Page last reviewed: 01 February 2023
Next review due: 01 February 2026

11 Risks of Epidurals During Delivery: Itching, Fever, and More

11 Risks of Epidurals During Delivery: Itching, Fever, and More

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Medically reviewed by Karen Gill, M. D. — By The Healthline Editorial Team on February 9, 2018

What is an epidural block?

The act of delivering a baby lives up to its name. Labor is hard, and painful, work. To make the experience more comfortable, women have a few options for pain relief, including epidurals and spinal blocks. Here’s how they’re different:

• Epidural block. For women in the United States, this is the most commonly used form of pain relief during labor. It combines analgesic and anesthetic pain relievers, which are delivered through a tube in your back. The medication blocks pain signals before they can get to your brain. Once you’ve had the injection, you’ll lose some feeling below the waist, but you’ll be awake and able to push when the time comes.
• Spinal block. A spinal blockalso numbs you from the waist down, but the medication is delivered via a shot into the fluid around your spinal cord. It works quickly, but the effects only last for an hour or two.
• Combined spinal-epidural block.This option offers the advantages of both types of anesthesia. It goes to work quickly. The pain relief lasts longer than a spinal block alone.

Both epidural blocks and combined spinal-epidural blocks make labor a less laborious and painful experience, but they’re not risk-free. These drugs can have side effects, such as low blood pressure, itching, and headache. Though rare, some side effects associated with epidurals can be serious.

Being aware of these side effects ahead of time can help you decide which option to choose.

What are the common side effects?

Common side effects range from itching to difficulty urinating.

Itching

Some of the medications used in an epidural — including opioids — can make your skin itch. A change in medication can relieve this symptom. Your doctor might also give you medication to relieve the itch.

Nausea and vomiting

Opioid pain relievers can sometimes make you feel sick to your stomach.

Fever

Women who get an epidural sometimes run a fever. According to PubMed Health, about 23 percent of women who get an epidural run a fever, compared to about 7 percent of women who don’t get an epidural. The exact reason for the spike in temperature is unknown.

Soreness

After your baby is born, your back might feel sore, but the feeling should only last for a few days. Back pain is also a common side effect of pregnancy, as the weight of your belly puts extra strain on your back. Sometimes it’s hard to tell whether the cause of your soreness is the epidural, or residual strain from the added weight of pregnancy.

Low blood pressure

About 14 percent of women who get an epidural block experience a drop in blood pressure, although it’s usually not harmful. An epidural block affects nerve fibers that control muscle contractions inside the blood vessels. This causes the blood vessels to relax, lowering blood pressure.

If the blood pressure drops too low, it can affect blood flow to your baby. To reduce this risk, most women get intravenous (IV) fluids before the epidural is placed. Your blood pressure will also be checked during labor. You’ll get medication to correct it, if needed.

Difficulty urinating

After an epidural, the nerves that help you know when your bladder is full will be numb. You may have a catheter inserted to empty your bladder for you. You should regain bladder control once the epidural wears off.

What are the rare side effects?

Rare side effects associated with epidurals range from breathing problems to nerve damage.

Breathing problems

In rare cases, the anesthetic can affect the muscles in your chest that control breathing. This can lead to slowed breathing or other breathing problems.

Severe headache

If the epidural needle accidentally punctures the membrane covering the spinal cord and fluid leaks out, it can cause a severe headache. This only happens in about 1 percent of deliveries with epidurals, according to the American Society of Anesthesiologists. The headache is treated with oral pain relievers, caffeine, and plenty of fluids.

If these doesn’t relieve the headache, the doctor performs a procedure called an epidural blood patch. A small sample of your blood is injected into the hole. When the blood clots, the hole closes and the headache should stop. Most new mothers get relief within one or two hours of having this procedure.

Infection

Any time you create an opening in the skin — such as with a needle — bacteria can get inside and cause an infection. It’s rare to have an infection from an epidural. This is because the needle is sterile and your skin is cleaned before it’s inserted. However, it can happen. The infection can spread to other parts of your body, too, but this is even more rare.

Seizure

In rare cases, an epidural can trigger a seizure if the pain medication gets into your vein. A seizure is shaking or convulsions due to abnormal electrical activity in your brain.

Nerve damage

The needle used to deliver the epidural can hit a nerve, leading to temporary or permanent loss of feeling in your lower body. Bleeding around the area of the spinal cord and using the wrong medication in the epidural can also cause nerve damage.

This side effect is extremely rare. It affects only 1 in 4,000 to 1 in 200,000 people who have an epidural block, according to the American Society of Regional Anesthesia and Pain Medicine.

Let your anesthesiologist know right away if you have symptoms such as numbness or tingling after the epidural is supposed to have worn off.

Epidurals and assisted births

Having an epidural can increase the amount of time you spend in the second stage of labor. This stage starts when your cervix is fully dilated and ends when your baby is born. Women who have an epidural can spend an extra hour in this stage of labor.

When your labor progresses too slowly, your doctor is more likely to recommend help getting your baby out. Past research showed that women who got epidurals were more likely to need a cesarean delivery. More recent studies find that this may not be true, but you may be more likely to need an assisted delivery with a vacuum or forceps if you have an epidural.

In one study done in Great Britain, the instrument-assisted delivery rate was 37.9 percent in women who’d had an epidural, compared to 16.4 percent in those who didn’t.

What’s the outlook?

Most risks from epidurals are either mild or rare. If a highly trained anesthesiologist performs your epidural or spinal block, your odds of having a complication decrease.

Meet with your anesthesiologist before your due date. Ask about their experience. Work together to create a pain relief plan that works for you.

Remember that you do have other choices besides an epidural for pain relief. Some techniques involve medication, while others are natural. Labor pain relief options include:

• deep breathing techniques
• acupuncture and acupressure
• relaxation exercises
• support from a doula or labor coach
• water immersion
• inhaled pain medication, such as nitrous oxide
• opioids

Talk to your doctor about the advantages and disadvantages of each technique. Medication provides the greatest pain relief, but it can cause side effects. Natural techniques will help you avoid side effects, but they may not cut through your pain. Make the decision based on your personal preferences and ability to tolerate pain.

Last medically reviewed on February 9, 2018

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How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Anaesthetic, epidural. (n.d.).
  hse.ie/eng/health/az/A/Anaesthetic,-epidural/Risks-and-side-effects-of-an-epidural.html
• Antonkou A, et al. (2016). The effect of epidural analgesia
  on the delivery outcome of induced labour: A retrospective case series. DOI:    
  10.1155/2016/5740534
• Epidural: Side effects. (2017).
  nhs.uk/conditions/epidural/side-effects/
• Jones L, et al. (2012). Pain management for women in labour:
  An overview of systematic reviews. DOI:
  10.1002/14651858.CD009234.pub2
• Mayo Clinic Staff. (2017). Labor pain: Weigh your options
  for relief.
  mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/labor-pain/art-20044845
• Mayo Clinic Staff. (2015). Spinal headaches.
  mayoclinic.org/diseases-conditions/spinal-headaches/symptoms-causes/syc-20377913
• Medications for pain relief during labor and delivery.
  (2017).
  acog.org/Patients/FAQs/Medications-for-Pain-Relief-During-Labor-and-Delivery
• Potential epidural side effects and risks. (n.d.).
  asahq.org/lifeline/what%20to%20expect/potential%20epidural%20side%20effects%20and%20risks
• Pregnancy and birth: Epidurals and painkillers for labor
  pain relief. (2012).
  ncbi.nlm.nih.gov/pubmedhealth/PMH0072751/
• Risks and benefits of regional anesthesia. (n.d.).
  asra.com/page/43/risks-and-benefits-of-regional-anesthesia
• Safe prevention of the primary cesarean delivery. (2014).
  acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

Feb 9, 2018

Written By

The Healthline Editorial Team

Edited By

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Medically Reviewed By

Karen Richardson Gill, MD

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Medically reviewed by Karen Gill, M.D. — By The Healthline Editorial Team on February 9, 2018

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All about epidural anesthesia – Private maternity hospital Ekaterininskaya Clinics

What to do if long-term epidural anesthesia (analgesia) is contraindicated for you or you for some reason do not want to do it during childbirth?

There is, in fact, only one real alternative – childbirth can be anesthetized with narcotic analgesics (usually fentanyl or promedol).

In certain situations (regular strong contractions, good dilatation of the cervix, satisfactory condition of the child according to ultrasound and CTG), it is safe and effective.

But, firstly, the duration of the effective action of narcotic analgesics in childbirth is much shorter (from 30 minutes to 1 hour) than the duration of the effect of DEA. Secondly, the possibility of prolonging such pain relief is significantly limited, since high doses of narcotic analgesics increase the risk of respiratory depression in mother and child. This method is usually used when there are contraindications to DEA.

There are no medical procedures that do not carry potential risks and have no contraindications for the patient. Long-term epidural anesthesia (DEA) is no exception, and it would be irresponsible not to talk about them.

What are the contraindications for DEA?

• Injuries of the spine and metal structures in the lumbar region, some congenital diseases of the spine and severe forms of curvature (scoliosis).
• Severe disorders of blood coagulation in the direction of reducing the density of the blood clot (hypocoagulation).
• Allergy to local anesthetic ropivacaine (very rare).
• Severe heart disease with fixed cardiac output.
• Tattoo in the lumbar region (the paint may contain salts of heavy metals, the entry of which into the epidural space is highly undesirable).
• The categorical written refusal of the patient from DEA (with justification of the reasons for the refusal).

What is the risk of complications and side effects with DEA?

• Insufficiently effective pain relief (mosaic block).
• Unintentional puncture of the dura mater with the development of post-puncture headache syndrome.
• Sudden drop in blood pressure.
• Nausea, vomiting, chills.
• Post-puncture back pain.
• Respiratory and cardiac arrest.
• Urinary retention and dysfunction of the pelvic organs.
• Development of persistent neurological complications in the form of paresis and paralysis.

A very impressive and intimidating list, especially the second half of it.

But according to world statistics for the 1990-2000s, the risk of fatal complications of regional anesthesia (DEA is a regional method) is 25-38 cases per 10 million obstetric patients, and does not differ significantly from the risk of general anesthesia.

The risk of developing any complications of EA (not only fatal, but generally all) is higher, but it is also quite low, and, according to various estimates, is 1 case per 50,000-80,000 births. This risk is about 8-10 times less than the risk of dying in an accident (driver, passenger or pedestrian).

Despite the impressive list of contraindications and risks, there are many undeniable advantages of using long-term epidural anesthesia (DEA).

There is practically no effect on the child – the area of ​​action of the anesthetic is limited to the nerve roots of the spinal cord of the woman in labor; neither the blood flow in the umbilical cord nor the fetal heart rate is affected by DEA performed in compliance with all safety rules.

If the situation in labor is such that there is an indication for an emergency caesarean section, an epidural catheter inserted in labor allows you to quickly inject a large dose of anesthetic (about 4 times more than for pain relief in labor), adequate for a caesarean section – and more one significant plus DEA. This is called “conversion of analgesia to anesthesia”.

In such a situation, drugs for general anesthesia are either not used at all, or are used in small doses (depending on the situation), which significantly reduces the burden on the body of the mother and child, and allows the patient to recover faster after the operation. DEA lowers blood pressure by 15-20 percent of baseline, and in patients with high blood pressure, it is a real lifesaver.

What can be said in conclusion of this large, complex and rather acute topic?
⠀
Absolutely safe medical manipulations with a degree of risk equal to zero do not exist in principle. But compliance with all the rules, safety precautions, indications and contraindications allows you to reduce the risk to an insignificant minimum. Epidural anesthesia, like any other medical manipulation, is performed when the potential benefit significantly (hundreds and thousands of times) exceeds the possible risks. And in the vast majority of cases, that is exactly what it is. One of the most important tasks of the anesthetist is to assess the risk-benefit ratio for each individual patient, and convey this information to the patient so that she understands it and can make the right decision.
⠀

articles of Oxford Medical Rivne Medical Center

Modern medical statistics show that about 7% of patients have a partial or complete allergy to local anesthesia (anesthetics). The rejection of the body is caused not by the injections themselves, but by the chemicals that make up this or that anesthesia.

Paradoxically, even the safest and most common lidocaine can cause a serious allergic reaction in a certain category of people, which can only be detected experimentally. We are talking about urticaria, various dermatological rashes, a critical deterioration in well-being and even the risk of anaphylactic shock.

The cause of an allergic reaction

Recognizing an allergic reaction to a harmless anesthetic that has been successfully used by thousands of doctors around the world is quite simple. However, first you need to deal with the nature of the problem itself, because in most people local anesthesia does not cause any negative consequences and rejection of the immune system.

Any anesthetic substance is, in fact, an irritant for the body. Most often, the body successfully fights the administered dosage, however, in some cases, sensitization occurs, due to which the immune system begins to perceive the anesthetic as a serious irritant. With subsequent “acquaintances” with the drug, the body rapidly produces antibodies, and signs of a formed allergy appear on various parts of the body: skin, nasopharynx, mucous membranes, on the surface of the bronchi and lungs.

Symptoms of drug allergy to anesthetics

Most often, allergy to anesthetic drugs manifests itself in the following reactions:

• dermatitis in various forms – redness, peeling, deterioration of skin tone;

• urticaria, in which the size, nature and total number of wheals may vary;

• allergic rhinoconjunctivitis with copious nasal and eye discharge;

• bronchospasm, the nature of which is similar to acute attacks of bronchial asthma;

• angioedema following urticaria;

• acute attack of anaphylactic shock.

The best (and sometimes the only) way to check the patient’s response to lidocaine and other local anesthetics is a test performed using a subcutaneous injection of a microdose of the substance (no more than 0. 1 ml).

First aid for anaphylactic shock

Anaphylactic shock is an allergic reaction of the body to the injected drug, which is characterized by a state of hypersensitivity of the body. This reaction is dangerous with the risk of death in the absence of immediate medical care: according to medical statistics, an acute attack of anaphylactic shock as one of the types of drug allergy has 5-10% of cases of sudden death of a patient.

Anaphylactic shock occurs in 0.03-0.05% of cases of anesthetic administration, but the risk is real and exists. There is a percentage of people in whom the test does not cause any reactions, or has a delayed effect. Therefore, unfortunately, not a single person is immune from anaphylaxis.

Oxford Medical Center doctors are theoretically and practically trained to provide emergency medical care for various conditions.

Our offices are equipped with modern equipment for diagnosing health conditions, as well as all the necessary medicines and means for emergency treatment and removing the patient from a state of shock.