The method of artificial respiration from the mouth mouth. Artificial respiration and heart massage - how to do it right

The event is carried out confidently, quickly and energetically. There is no need to take off clothes from the victim - it will take a lot of time (and here every second sometimes becomes precious), it is only unbuttoned or torn.

Having pulled the victim out of the water, first of all, it is necessary to free the mouth, nose, upper respiratory tract, and stomach from water, silt, sand, or even small objects. It's best to do it all at the same time.

Often the victim's jaws are tightly closed. The mouth is opened with fingers wrapped in some soft cloth (for example, a handkerchief), using hard flat objects (pen, spoon, board, etc.), also wrapped in soft tissues. To keep the mouth open in the future, a small cork, a dense cotton swab, or some object is inserted between the molars. If the jaws turn out to be reduced, the jaw muscles should be vigorously massaged.

Next, the assisting person gets on one knee, lifts the victim and lays him with his stomach on the thigh of the bent leg so that the victim's head is below the pelvis. Pressure should be avoided on the victim's liver, as it can easily be damaged. For this, the victim is placed on the thigh with the right side to the rescuer. If assistance is provided by two rescuers, one of them can hold the victim with closed hands by the lower edge of the chest. Opening the mouth and cleaning the oral cavity, then remove the water, squeezing the lower part of the chest in the rhythm of 14-18 times per minute. After removing water from the lungs, upper respiratory tract and stomach, the oral cavity is re-examined, the mucus is removed again, the mouth is freed from the objects that fixed it in the open state and artificial respiration is immediately started.

Continued 73-74

The mouth-to-mouth method. It is simple to perform, does not require fixation of the tongue and provides 1-2 liters of warm air to the lungs of the victim.

The victim is laid on his back or planted, leaning his back against the wall (for example, in a boat). They tilt their heads. To inhale, the rescuer exhales air from his lungs into the victim's mouth, while pinching his nose. Exhalation occurs most often passively, sometimes it is specially sucked out. Breathing and pauses should alternate rhythmically: 12-14 times per minute for adults and 18-20 times per minute for children.

The purpose of this method is reflex stimulation of the respiratory center. It occurs not only due to the expansion of the chest and due to the increased content of carbon dioxide in the exhaled air, which is a powerful irritant of the respiratory center.

It is necessary to carefully monitor that the exhaled air enters the lungs, and not the stomach, for this purpose the head is thrown back. Sometimes, in especially severe cases, special means are used (tubes, improvised items).

Mouth to nose method The principle of the method is similar to the previous one ("mouth to mouth").

During artificial respiration, in order to avoid cooling the victim, he is rubbed, massaged, warmed with heating pads. All this is done by one of the assistants.

Artificial respiration is done until normal breathing appears. You need to stop it only after ascertaining death by a medical worker!

When the victim comes to his senses, he should be warmly dressed and given hot tea or not very strong coffee.

In addition to restoring breathing, restoring blood circulation is often required. The simplest method of stimulating cardiac activity is an indirect (closed) heart massage.

75. Technique for performing indirect heart massage.

Indirect (closed) heart massage. The victim is placed on his back, always on a hard surface. The massage is performed as follows: the assisting person puts two hands, one on top of the other, on the victim's sternum just above the xiphoid process and periodically presses on the area of ​​\u200b\u200bthe heart, chest, with a heart rate. Compression of the chest should reach 3-7 cm. Especially careful pressure should be applied in children.

Performing a heart massage (6-8 pressures on the heart area) should be periodically alternated with performing artificial respiration (2-3 breaths).

To carry out artificial respiration, the victim should be laid on his back, unfasten clothing that restricts breathing and ensure the patency of the upper respiratory tract, which, in the supine position when unconscious, is closed by a sunken tongue. In addition, there may be foreign matter in the oral cavity (vomit, slipped prostheses, sand, silt, grass, etc.), which must be removed with the index finger. After that, the assisting person is located on the side of the victim’s head, slips one hand under his neck, and with the palm of the other hand presses on his forehead, tilting his head as much as possible. In this case, the root of the tongue rises and frees the entrance to the larynx, and the victim's mouth opens. The person assisting leans towards the victim’s face, takes a deep breath with his mouth open, then fully covers the victim’s open mouth with his lips and makes an energetic exhalation, inhaling air into his mouth with some effort; at the same time it closes the victim's nose. In this case, it is imperative to observe the chest of the victim, which should rise.

7. In what cases is it necessary to apply the method of carrying out artificial respiration "from mouth to nose"?

Artificial respiration from mouth to nose is performed if the patient's teeth are clenched or there is an injury to the lips or jaws. The rescuer, placing one hand on the forehead of the victim, and the other on his chin, presses his lower jaw to the upper. With the fingers of the hand supporting the chin, he should press the lower lip, thereby sealing the mouth of the victim. After a deep breath, the rescuer covers the victim's nose with his lips, creating the same air-tight dome above him. Then the rescuer makes a strong blowing of air through the nostrils, while watching the movement of the chest.

After the end of artificial inspiration, it is necessary to free not only the nose, but also the patient's mouth. It is necessary to keep the head thrown back while exhaling, otherwise the sunken tongue will interfere with exhalation.

8. How often should artificial respiration be carried out?

Artificial respiration should be carried out without interruption for more than 3-4 seconds, until full spontaneous breathing is restored or until a doctor appears and gives other instructions. It is necessary to continuously check the effectiveness of artificial respiration (good inflation of the patient's chest, absence of bloating, gradual pinking of the skin of the face). Constantly make sure that vomit does not appear in the mouth and nasopharynx, and if this happens, the victim’s airways should be cleared through the mouth before the next breath. As artificial respiration is carried out, the rescuer may feel dizzy due to a lack of carbon dioxide in his body. Therefore, it is better that two rescuers carry out air injection, changing after 2-3 minutes.

9. What is meant by resuscitation?

The use of a complex of various measures to restore the vital activity of the body is called resuscitation. Resuscitation measures are most effective when they are carried out in specialized departments equipped with the necessary equipment.

To perform artificial respiration, the victim should be laid on his back, unfasten clothing that restricts breathing, and ensure the patency of the upper respiratory tract. The person assisting leans towards the victim's face, exhales deeply, blowing air into the victim's mouth with some effort and at the same time covering his nose with his fingers. As soon as the chest rises, the air injection is stopped, the assisting person turns his face to the side, and the victim passively exhales.

If the victim has a well-determined pulse and only artificial respiration is needed, then the interval between artificial breaths should be 5 s (12 respiratory cycles per minute).

If the jaws of the victim are tightly clenched and it is not possible to open the mouth, artificial respiration "from mouth to nose" should be carried out.

An adult needs to take 15-18 breaths per minute.

Cease artificial respiration after the victim recovers sufficiently deep and rhythmic spontaneous breathing.

If the victim has pale or cyanotic skin, loss of consciousness, no pulse in the carotid arteries, cessation of breathing or convulsive, incorrect sighs, then it is necessary to perform an external heart massage along with artificial respiration.

In case of cardiac arrest, without wasting a second, the victim must be laid on a flat, rigid base: a bench, floor, board (no rollers under the shoulders and under the neck can not be placed).

If assistance is provided by one person, he is located on the side of the victim and, bending over, makes two quick vigorous blows (according to the mouth-to-nose method), then rises, remaining on the same side of the victim, puts the palm of one hand on the lower half of the sternum (stepping back two fingers higher from its lower edge), and lifts his fingers. He puts the palm of the second hand across or along and presses, helping by tilting his body. When pressing, the arms should be straightened at the elbow joints.

Pressing should be done with quick jerks, so as to displace the sternum by 4-5 cm, the duration of pressure should not exceed 0.5 s.

If the revival is carried out by one person, then for every two breaths he performs 15 compressions on the sternum. For 1 min. it is necessary to make at least 60 pressures and 12 blows.

If resuscitation is carried out correctly, the skin of the victim turns pink, the pupils constrict, spontaneous breathing is restored.

All stages of cardiopulmonary resuscitation:

Stage B. Artificial lung ventilation (ALV)

If immediately after the restoration of the airway patency, spontaneous breathing has not been restored or it is inadequate, then it is urgent to proceed to the 2nd stage of cardiopulmonary resuscitation - mechanical ventilation. Mechanical ventilation begins with simple and fairly effective methods - expiratory, i.e., mechanical ventilation by introducing into the lungs of the victim (through his mouth or nose) the air exhaled by the resuscitator. The use of these methods does not require any equipment, therefore it is applicable in any setting (where appropriate devices may not be available). But even in the presence of a respirator, one should not waste minutes on delivering and attaching it to the victim: it is necessary to immediately begin conducting mechanical ventilation in the expiratory way. In this case, air containing 16-18% oxygen enters the lungs of the victim.

When conducting mechanical ventilation by the expiratory method, the minimum required volume is considered to be a double "physiological norm", i.e. 500 ml X 2 \u003d 1000 ml. The introduction of such a volume of air into the lungs of the victim helps straighten the collapsed alveoli, stimulate the respiratory center, enough to saturate hemoglobin with oxygen.

Therefore, ventilation with exhaled air is effective and accessible to everyone. It must be remembered that immediately started ventilation with air after cardiac arrest brings much more benefit than using oxygen for these purposes, but after a few minutes.

There are 2 methods of expiratory ventilation - from mouth to mouth and from mouth to nose.

When performing mechanical ventilation from mouth to mouth, the resuscitator throws his head back with one hand and tightly clamps his nose with the thumb and forefinger of this hand. The other hand extends the neck, i.e., the airway is constantly maintained. Then, after a deep breath, the resuscitator, tightly clasping the lips of the victim with his lips, blows air with force into the respiratory tract of the victim. In this case, the patient's chest should rise. When taking away the mouth, a passive exhalation occurs. The patient's next breath can be taken after the chest has lowered and taken its original position.

Artificial ventilation of the lungs from mouth to mouth

In cases where the victim is unable to open his mouth or when ventilation through the mouth is impossible for some reason (resuscitation in water, lack of tightness between the mouth of the resuscitator and the victim, trauma in the mouth), the mouth-to-nose method is effective.

With this method, with one hand located on the patient's forehead, the head is thrown back, and with the other, pulling up the chin, the lower jaw is pushed forward. At the same time, the mouth is closed. Then, as in the previous method, they take a deep breath, cover the victim's nose with their lips and exhale. IVL in adults is carried out at a frequency of 12 breaths per minute, i.e., the lungs of the victim must be inflated every 5 seconds. In newborns and infants, air is blown simultaneously into the mouth and nose (for the facial skull of the child is very small) at a frequency of 20 times per minute.

Artificial ventilation of the lungs from mouth to nose

Regardless of who (adult or child) and what method is used during mechanical ventilation, the following rules should be observed:

1. It is necessary to ensure the tightness of the system "the lungs of the victim - the lungs of the resuscitator". If the mouth or nose of the victim is not tightly covered by the lips of the resuscitator, then air will come out. Such ventilation will be inefficient.

2. Constantly monitor the adequacy of ventilation: observe the rise of the chest during inhalation and lowering during exhalation, or listen to the movement of air from the lungs during exhalation.

3. Remember that ventilation is possible with the provision of airway patency.

The arsenal of aids for expiratory ventilation includes manual breathing devices, an Ambu bag, and air ducts. When using the Ambu bag, the doctor is on the side of the patient's head. With one hand, he throws back the patient's head and at the same time tightly presses the mask to his face, the nose of the mask with I finger, and the chin with II; III-V fingers pull the patient's chin up, while the mouth closes and breathing is carried out through the nose.

For more efficient ventilation, air ducts are used. The air duct pushes the root of the tongue forward, providing air access. It must be remembered that the introduction of an airway does not guarantee the patency of the respiratory tract, so tilting the head is always required. In a resuscitation set, you need to have several airways of different sizes, as a short airway can push the tongue to the entrance to the throat. The duct is inserted into the mouth with the bulge down and then rotated 180°.

When using the S-shaped Safar tube, it is necessary to squeeze the nose with one hand, and try to close the corners of the mouth with the other to ensure the tightness of the system. It should be noted that it is quite difficult to achieve complete tightness of the respiratory system using the Safar S-shaped tube. More effective ventilation with an Ambu bag.

Artificial respiration. Before starting artificial respiration, the following steps should be taken quickly:

- release the victim from clothing that restricts breathing (unbutton the collar, untie the tie, unbutton the trousers, etc.);

- lay the victim on his back on a horizontal surface (table or floor);

─ tilt the victim’s head back as much as possible, placing the palm of one hand under the back of the head, and with the other hand press on the victim’s forehead until his chin is in line with the neck .;

- examine the oral cavity with your fingers, and if foreign content (blood, mucus, etc.) is found, it must be removed by removing dentures at the same time, if any. To remove mucus and blood, it is necessary to turn the head and shoulders of the victim to the side (you can bring your knee under the shoulders of the victim), and then, using a handkerchief or the edge of a shirt wound around the index finger, clean

wash the mouth and pharynx. After that, it is necessary to give the head its original position and tilt it back as much as possible, as indicated above;

- blowing air through gauze, a scarf, a special device - "air duct".

At the end of the preparatory operations, the assisting person takes a deep breath and then exhales the air with force into the victim's mouth. At the same time, he should cover the entire mouth of the victim with his mouth, and pinch his nose with his fingers. . Then the caregiver leans back, freeing the mouth and nose of the victim, and takes a new breath. During this period, the victim's chest descends and passive exhalation occurs.

If, after blowing in air, the chest of the victim does not straighten out, this indicates an obstruction of the respiratory tract. In this case, it is necessary to push the lower jaw of the victim forward. To do this, you need to put four fingers of each hand behind the corners of the lower

her jaw and, resting her thumbs on its edge, push the lower jaw forward so that the lower teeth are in front of the upper ones. It is easier to push the lower jaw with the thumb inserted into the mouth.

When performing artificial respiration, the assisting person must ensure that air does not enter the victim's stomach. When air enters the stomach, as evidenced by bloating "under the spoon", gently press the palm of your hand on the stomach between the sternum and navel.

In one minute, 10-12 injections should be done to an adult (i.e., after 5-6 s). When the first weak breaths appear in the victim, an artificial breath should be timed to the beginning of an independent breath and carried out until deep rhythmic breathing is restored.

Heart massage. With rhythmic pressure on the chest, i.e. on the front

chest wall of the victim, the heart is compressed between the sternum and spine and pushes blood out of its cavities. When the pressure is released, the chest and heart expand and the heart fills with blood from the veins.

To perform a heart massage, you need to stand on either side of the victim in a position in which a more or less significant tilt over him is possible. Then it is necessary to determine by probing the place of pressure (it should be about two fingers above the soft end of the sternum) and put the lower part of the palm of one hand on it, and then put the second hand at a right angle over the first hand and press on the chest of the victim, slightly helping with this tilt of the entire body. The forearms and humerus bones of the assisting hands should be extended to failure. The fingers of both hands should be brought together and should not touch the victim's chest. Pressing should be done with a quick push so as to move the lower part of the sternum down by 3-4 cm, and in obese people by 5-6 cm. The pressing force should be concentrated on the lower part of the sternum, which is more mobile. Avoid pressure on the top

sternum, as well as on the ends of the lower ribs, since this can lead to their fracture. It is impossible to press below the edge of the chest (on soft tissues), since it is possible to damage the organs located here, primarily the liver.

Pressing (push) on the sternum should be repeated approximately 1 time per second. After a quick push, the arms remain in the reached position for about 0.5 s. After that, you should straighten up slightly and relax your hands without taking them away from the sternum.

To enrich the blood of the victim with oxygen, simultaneously with a heart massage, it is necessary to carry out artificial respiration according to the “mouth-to-mouth” (“mouth-to-nose”) method.

If assistance is provided by one person, these operations should be alternated in the following order: after two deep blows into the mouth or nose of the victim - 15 pressures on the chest. The effectiveness of external heart massage is manifested primarily in the fact that with each pressure on the sternum on the carotid artery, the pulse is clearly felt. To determine the pulse, the index and middle fingers are placed on the victim's Adam's apple and, moving the fingers to the side, carefully feel the surface of the neck until the carotid artery is determined.

teria. Other signs of the effectiveness of massage are the narrowing of the pupils, the appearance of independent breathing in the victim, a decrease in the cyanosis of the skin and visible mucous membranes.

The restoration of the victim's heart activity is judged by the appearance of his own, not supported by massage, regular pulse. To check the pulse every 2 minutes interrupt the massage for 2-3 seconds. The preservation of the pulse during the break indicates the restoration of independent work of the heart. If there is no pulse during the break, you must immediately resume the massage.