Teaching the precordial beat technique

When sudden death especially after defeat electric shock, the first thing to start help is to strike a blow on the victim's sternum. This rather simple manipulation can be practiced only on special robotic simulators "Gosha" or "George".

If the blow is struck within the first minute after cardiac arrest, the chance of revival is greater than 50%.
When struck in the presence of a pulse on carotid artery, there is a risk of provoking cardiac arrest. Therefore, before striking, it is imperative to make sure that there is no pulse in the carotid artery. But all the speculations that the blow is extremely life-threatening have no practical basis. If this blow posed a real threat, then boxing and all game sports, except for chess, should be urgently banned.
In addition, to kill a person who is already in a state of clinical death is more than absurd. Therefore, in extreme situation it is better to use a real chance of salvation than to complain that at the right moment there was no doctor nearby, and by this circumstance to justify their inaction in saving a person's life.

Representatives of some firms that produce simulators argue that this blow is prohibited by the Ministry of Health, or that only doctors who have joined the American Association of Cardiologists have the right to inflict it. If this is true, then why has the Ministry of Health not yet banned boxing and all game sports? We all understand perfectly well that during the Olympic Games in Athens, all boxers urgently joined the American Association of Cardiologists. Otherwise, how could they be released into the ring? They fight, and even very professionally hitting the body! Where is the logic of prohibition? The truth, as always, lies on the surface: "If our simulators fall apart after the first blow, then it must be urgently banned." How many human lives have been lost because of the criminal lies and self-interest of such scoundrels!

Rules for inflicting precordial blow

1. After you have made sure that there is no pulse in the carotid artery, you need to cover the xiphoid process with two fingers.
2. To strike with a fist on the sternum above your fingers, covering the xiphoid process.
3. After the impact, be sure to check the pulse in the carotid artery.

Displaying the correct actions on the robot:
1. There will be a pulse on the carotid artery.
2. Pupil constriction will occur.
The pulse on the carotid artery and the reaction of the pupils are maintained for 1 minute.

Displaying erroneous actions on the robot:
1. In the event of a repeated blow to the sternum in the presence of a pulse on the carotid artery, the pulse and pupil response will disappear.
2. In case of a blow to the xiphoid process, the red indicator "Xiphoid process fracture" will light up.

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Precordial beat

Precardiac beat -
quick rescue strike

It is enough to resort to the statistics of sports, or rather boxing, to strongly doubt the reality of killing with one blow of the fist. For a million battle matches on the whole planet withthere are no more than 3-5 deaths per year. If we consider that a boxer of average weight and average training level receives about 30-50 punches to the body, then the probability of killing with a fist blow is no more than 1 case in 10 million.

At the same time, if a stroke is inflicted in the first minute after cardiac arrest, then revival occurs in 7 out of 10 cases of sudden death. How can one deny the experience of domestic medicine, which has been successfully using

Why, in the opinion of some officials, only a certified doctor has the right to inflict a precordial stroke? What is more dangerous— a series of 30 pressures on the chest with a force of more than 40 kg during chest compressions or a single fist blow with a swing of 20-30 cm? But for some reason, precordial stroke should be prohibited, and every graduate is obliged to master the technique of chest compressions. high school.
This is no longer absurd, it is malicious intent and a real crime!

As it turned out, in the National Project for 2025, officials have pledged many billions of rubles to ensure the use of a defibrillator (electric shock) in every case of sudden death. It's great when rescue vehicles are within walking distance of airports and train stations, stadiums and shopping centers, at public transport stops, in every workshop and gym. The price of the device is five thousand euros. But in this case, the end justifies the means.

As a doctor, I fully support this project.If a defibrillator shock is available within 3-5 minutes, then thousands of lives are saved. However, it should be borne in mind that the effectiveness of its use is limited to 10-15 minutes of carrying out a complex of cardiopulmonary resuscitation, and today this rescue apparatus is at the scene only with the arrival of an ambulance. How many of our fellow citizens are doomed to die while a bright future comes? But, what abundant "cuts" are included in this project!

REMEMBER!
Where cash begins, not only does conscience end, but also common sense: mortal danger to the deceased.
The result of such nonsense is thousands of lives lost.

Rules for striking the sternum

IMPOSSIBLE!
Apply a precordial blow and chest compressions
a living person and, moreover, to work out the skills of their implementation
on their comrades.

First rule
Make sure there is no pulse before striking on the carotid artery. The likelihood of cardiac arrest, although negligible, is stillshould not tempt fate. Death on football and hockey fields, albeit extremely rare,but it does occur.

IT IS FORBIDDEN!
Strike when there is a pulse on the carotid artery.

Second rule
Remove clothing from the chest before striking.or at least make sure there are no buttons, medallions, orother items. Even a pectoral cross can play a fatal role in this case.

IT IS FORBIDDEN!
Strike without removing clothing from the chest

Third rule
It is necessary to cover the xiphoid process with two fingers of the left hand,to keep it from being hit. The xiphoid process breaks off easily from the sternumand injures the liver, which can be tragic.

IT IS FORBIDDEN!
To strike at the xiphoid process.

Fourth rule
The blow should be applied with an edge, a palm clenched into a fist, slightly higherthe xiphoid process, covered with two fingers of the other hand. A blow to the sternum resemblespunching an angry boss on the table. In this case, the aim of the strike is not to "break through"chest, and shake it. The elbow of the striking hand must point to the side.the victim's abdomen. Otherwise, the blow will be struck across the sternum, whichcan lead to injury in the elderly.

IT IS FORBIDDEN!
Strike across the brisketwhen the elbow of the striking hand is directed towards the rescuer.

Fifth rule
For children under 7-8 years of age, shock can be fatal.Chest at this age does not have a sufficiently reliable costal and muscular frame thatcan lead to injury to internal organs.

IT IS FORBIDDEN!

Stab children under 5-7 years of age.

Sixth rule
After hitting it is necessary check pulse in the carotid artery.If, after a blow to the sternum, there is no recovery, then it is necessary to proceed with the complexcardiopulmonary resuscitation, which consists of chest compressions and breathsartificial respiration.

Many readers have seen more than once how they do artificial respiration and chest compressions - such a tense moment could not but become one of the most highlighted in the film industry. Alas, when shooting feature films, reliability is far from always in trend, which, along with a number of philistine myths (for example, about the obligatory rib fractures at this event) sometimes creates rather strange ideas about cardiopulmonary resuscitation (CPR) among the population. In this article, we'll show you how to do CPR correctly.

Let's stipulate right away that even the most competent article on the Internet will never replace "live" learning. Therefore, if in your locality there are some courses of the first medical care- be sure to visit them in order to see the technique of performing an indirect (closed) heart massage at least once. And even better - try it yourself on a special phantom doll, which, if everything is done correctly, immediately signals this.

Why CPR is done

As practice shows, if it did not come from old age or prolonged chronic illness, which has depleted the body's reserves, is often a reversible process.

We can live for a long time without food, some without water. But without air, without fresh oxygen, which is necessary for normal life all the time, death occurs within a few minutes. If, due to some reason, the basic "workers of life" of our body, heart and lungs, refused to work, then oxygen ceases to enter the blood and is carried by it to the organs in need. The first to suffer from this deficiency is the brain, which is able to live without oxygen for an average of five minutes. Rather, the brain itself is not so much as its cortex, in which our personality is hidden somewhere. Simpler and more ancient parts of the brain can live longer, but in this case, even if it is possible to start breathing and blood circulation, the body will remain in a state of "vegetable" - it will function, but will never regain consciousness. This condition is called social death.

The main goal of CPR- to provide the brain with the necessary oxygen for its minimum support. At correct conduct resuscitation, it is possible to resume spontaneous breathing and heartbeat. But even if this does not happen - CPR should be carried out up to 30 minutes after loss of consciousness - passive breathing movements and at the very least deliver oxygen to the "addressee", which can allow the body to hold out in a living state until the arrival of an ambulance team, which always has medications and instrumentation for more effective events.

According to statistics, timely provision of correct first aid for sudden stop heart attack from myocardial infarction triples survival

Indications for CPR

• Lack of consciousness. The person does not respond to the hail and other external stimuli, including pain. Pupils don't react to light - be sure to check this reflex. To do this, you just need to open the eye, stretching the eyelids, and shine something, or turn the patient's head to an artificial or natural source Sveta. If the pupil does not decrease, it is at least a coma.
• Lack of breathing. When it is required to determine whether a person is breathing, there is no need to bring a hand, a mirror or anything else to his lips or nostrils. Just place your ear to his mouth, nose, or chest and listen. Sometimes there may be a short-term presence of the so-called. agonal breathing, when the muscles responsible for inhalation and exhalation contract at the same time. Movement chest convulsive, while inside her breathing cannot be heard.
• Lack of palpitations. There are states when the heart works, but the pulse on the hands is difficult to determine. To find out if there is blood circulation, you need to check the pulse in the carotid arteries. To do this, press your fingers between the Adam's apple and the long neck muscle, which begins at the interclavicular fossa and goes to the skull behind the ear (sternocleidomastoid muscle). Try right now to gently feel the pulse of the carotid arteries in yourself, it's easy. Just do not press your fingers too hard - dizziness or fainting is possible.

It is necessary to keep the fingers on the carotid artery for up to 5 seconds, because sometimes there is not a cardiac arrest, but a decrease in its contractions

CPR Technique: Preparation

First of all, call an ambulance and call someone for help - extra arms add efficiency.

Place the person on a hard surface. Raise his legs and, if possible, put them on something, so that their level is higher than the body. Kneel down beside the patient on the side of your chest. Unbutton his clothes.

First you have to ensure airway patency. If a person is lying on his back and there is no consciousness, then an overly relaxed tongue can sink in and block the path of air. There may also be, for example, vomit in the mouth that interferes with breathing.

If there is no injury cervical spine - throw the patient's head back, with one hand supporting the neck from below, while with the other, gently pressing on the forehead. Take the lower jaw and push it forward so that the lower teeth are in front of the upper ones or at least at the same level with them. The mouth should be open. See if there is anything inside that is obstructing breathing. If there is, remove it with your fingers wrapped in a handkerchief or napkin (if the napkin, be sure not to break).

In case of injury to the cervical spine or suspicion of it, limit yourself to extending the jaw and opening the mouth.

Place a roller under the patient's neck, to maintain a tilted head position. Pinch his nose and take two test mouth-to-mouth deep breaths, preferably through an air-permeable handkerchief for hygiene reasons. At this time, watch the victim's chest - it should rise when inhaling. If this is not the case, look for an air barrier. Availability possible foreign body v respiratory tract such as a piece of food.

To remove a foreign body, you can try with a sharp movement, as with an indirect heart massage (see below), push through upper part abdomen towards the chest.

If the chest moves during the control inhalation, proceed to the stimulation of the heart contractions.

CPR Technique: Precardiac Impact

If a person has lost consciousness in your presence or it is reliably known that less than a minute has passed since the loss of consciousness, it is advisable to start the effect on the heart with a precordial beat.

The purpose of a precordial stroke is to transfer mechanical energy from a concussion of the chest and inside its heart into electrical impulses, which will resume an independent heartbeat. Therefore, a precordial blow should not pursue the goal of causing injury - it should be massive, but not hard. Kind of like hitting the table of an angry man. should be applied over the chest completely free from clothing or jewelry such as medallions.

The xiphoid process continues the sternum downward from the point where the ribs converge. Cover it with one hand to prevent it from breaking off from the blow. With the other hand, from a height of about thirty centimeters, shock the rib of your fist on the sternum five centimeters above the xiphoid process. Check the carotid pulse after the stroke. If it fails to start the heart, after 3-5 seconds, repeat the beat and check the pulse again. If it is absent, go directly to chest compressions.

What was written above should not only be passively read, but also imagined a sequence of actions, well laid out on the shelves. Due to the fact that in such a situation every moment is precious, you must firmly understand that for everything initial activities, described above, starting from the definition of clinical death and up to precordial stroke inclusive - you should not spend more than 20-30 seconds. Your every action should be quick and confident, without unnecessary fuss and excitement.

It is strictly forbidden to train a precordial stroke on living people - it can cause cardiac arrest!

CPR technique: chest compressions and artificial respiration

so called, because the resuscitator presses on the heart not directly, as is the case with surgical operations, and through the chest wall. The goal is to restore its electrical potential and independence of work by mechanical contractions of the heart.

We repeat once again that a person should lie on a flat, hard surface.

Extend your arms completely, place your palm on your palm criss-cross or squeeze your fingers into a "lock", as in the picture. If criss-cross, the fingers should not touch the chest to prevent rib fractures. Your shoulders should be directly over the patient's chest, parallel to it. Hands - perpendicular to the sternum. The place of application of efforts is about 3-4 cm above the xiphoid process. The pressure is produced with the wrist part of the palm, which directly continues the line of the hands, perpendicular to the sternum.

We emphasize once again that the arms should be fully extended all the time. Thrusts should be made with the body - slightly, but at the same time sharply, rhythmically and energetically bending it; thus, the required force must be generated by part of your own weight. Do the first jerks to test the elasticity and resistance of the chest. Here it is important to find the moment between non-action and “overdoing”. The depth of the necessary compression (i.e., how much the chest should bend) is 5 cm. The frequency of chest contractions is one hundred per minute, i.e. about 2/3 seconds per push. This frequency is very important, and therefore cardiac resuscitation is quite exhausting for untrained people.

Movements must be precise and consistent. The patient's torso should not sway. You cannot tear your hands off the sternum or move them.

In the United States, since 2010, it has not been recommended for unprepared people to carry out both artificial respiration and chest compressions at the same time, limiting themselves to the latter. There is an explanation for this - at the time of clinical death, blood most often stores a certain amount of oxygen in itself, and even inside the lungs its supply is far from being exhausted. However, the caveat is that, alas, the ambulance usually arrives in the USA faster than ours. Therefore, one must be prepared for any scenario of the development of the situation. Let's just say - if you are sure that the ambulance will arrive in the next five minutes, then you can limit yourself to only an indirect heart massage. If you are not sure, then conduct artificial respiration in parallel.

You need to breathe mouth-to-mouth through a handkerchief or napkin. Take two breaths after 30 pushes.

Previously, the ratio of impulses to breaths was 5: 1, later 15: 2; according to recent research 30: 2 is enough - this provides a minimum sufficient amount of oxygen in the lungs, and the accumulating carbon dioxide additionally stimulates the respiratory center

In this rhythm, it is necessary to do three cycles of "massage-breathing", and then check the pulse on the carotid arteries. If it is absent, continue resuscitation, checking the pulse every three cycles. CPR should be done either before the ambulance arrives or within 30 minutes of unconsciousness.

If in the process you break the patient's ribs (a crunching sensation under the arms and a corresponding sound), slightly reduce the frequency and amplitude of the shocks, but in no case stop resuscitation.

If it appeared, the patient began to turn pink, and the pupils react to light - it means that you are doing everything right. In this case, resuscitation can be stopped by completing it with several mouth-to-mouth breaths at intervals of five seconds. But not to lose vigilance - then it will be necessary to monitor whether the patient is breathing on his own (if not, continue artificial respiration) and whether the pulse on the carotid arteries is stable (if it disappears again, continue heart massage).

When carrying out artificial respiration, make sure that air does not enter the stomach (in this case, there will be a protrusion under xiphoid process). If this happens, turn the patient's head to one side and press on the stomach with a light, sharp movement to provoke an eructation. At the same time, do not overdo it so that the person does not choke on vomit.

Common CPR Errors

To summarize, we will list the most that inexperienced resuscitators do. These are the points to pay maximum attention to when learning CPR techniques.

• inappropriate surface under the patient (soft, uneven, or tilted)
• incorrect position of the hands during compression (pressure is applied inaccurately, not stimulating the heart normally and provoking complications in the form of fractures of the ribs and sternum)
• insufficient chest compression (less than 5 cm, but here you need to understand the differences in physique different people; the figure is given for the average person - but for, for example, heavy weightlifters, it is slightly more, and for thin women - a little less)
• poor ventilation (insufficient inhalation or obstructions in the airway)
• CPR delay or a break of more than ten seconds

If all the technical points are observed correctly, you have a very high chance of snatching a person from the clutches of death. Remember this, and, in addition to the material just read, take first aid courses if possible.

Video about conducting a heart massage

Precordial beat again mentioned in the literature as a way to restore cardiac activity. It is an important interim step before more drastic action can be taken because even in intensive care units the immediate availability of a defibrillator or cardioscope cannot always be ensured.

Two sharp punches from a height of 20-30 cm, they are applied along the sternum at the border of the middle and lower third with immediate subsequent monitoring of the pulse on the carotid artery or a cardioscope. Without positive result from two strokes, you should immediately go to closed massage and artificial ventilation of the lungs according to the generally accepted method.

Mechanism of action of precordial stroke is based on an attempt to transfer the mechanical energy of a concussion into electrical impulse, which will cause depolarization of the ventricles and their contraction. It is a kind of mechanical pacemaker. If myocardial hypoxia has not gone too far (cardiac arrest no more than 30-40 seconds), this can lead to the restoration of cardiac contractions during fibrillation and high pulseless tachycardia (N. Yu. Semigolovsky, 2000). At the same time, it should be borne in mind that the complex visible on the cardioscope, as a rule, does not indicate a sufficient systole capable of providing the necessary cardiac output... The weakness of the resulting depolarization effect cannot be considered reliable. It requires further support if cardiac activity does not recover.

A number of sources indicate that the precordial blow can be delivered with ventricular fibrillation, but not with asystole, and ECG monitoring is required. It is believed that with asystole, it is not only ineffective, but also harmful. In our opinion, the method can be useful in any case, even in the absence of ECG control confirming the type of cardiac arrest. You just need to remember about the seconds, and not about the minutes of using this technique. In any case, it is hardly worse and more dangerous to resort to a precordial stroke than to immediately begin a closed heart massage.

Professor N. Yu. Semigolovsky with co-authors adheres to the same tactics (2001). In a hospital setting cardiac patients they use the UNIVERSAL scheme:
U - punch in the precordial region
H - external heart massage
AND - mechanical ventilation in the simplest ways or tracheal intubation
B - venipuncture / catheterization
E - electrocardiography / cardioscopy
R - defibrillator discharge
C - stimulation of the heart with a pacemaker (according to indications)
A - adrenaline / atropine
L - lidocaine

V last years is not as uncommon as it used to be, and has become more common even in patients young age... This condition can happen anywhere - on the street, in public transport, at sporting events, etc. In this regard, any person, and not only medical worker, should know how to correctly and timely provide emergency care to the victim. This is especially true of techniques such as precordial stroke. Of course, when carrying out such a strike, there are rules, which will be discussed below.

So, precordial stroke is a method of physical impact on the chest of the patient in whom it has occurred. Such an impact is able to translate the physical vibrations of the anterior chest wall and the walls of the heart into electrical excitation of the fibers of the heart muscle, since the heart tissue has the property of electrical excitability, as a result of which its mechanical stimulation is capable of providing an electrical impulse response. In other words, the mechanical effect on the heart area is a kind of mechanical pacemaker, thanks to which the normal cardiac cycle... However, a number of authors are inclined to believe that such an effect is not enough for the occurrence of a full-fledged electrical systole, capable of providing an adequate release of blood into the aorta, and, consequently, providing blood flow to the brain. Regarding a similar effect on the heart in medical literature there have been a lot of controversies, and yet at the present time:

A precordial stroke is considered an effective resuscitation aid, but only if the patient actually had a cardiac arrest, and the stroke was carried out in the first 30-40 seconds after that.

When should you perform a precordial beat?

The indication for carrying out this resuscitation aid in the provision of first aid is the absence of an independent heartbeat in the patient, which is caused by and / or asystole (cardiac arrest) due to other rhythm disturbances. Clinically, asystole, which caused clinical death, is accompanied by such signs as:

• Loss of consciousness
• Lack of pulse in the carotid and femoral arteries,
• Dilated pupils with no response to light
• Lack of independent breathing movements,
• The presence of a blue tint on the skin of the face, neck, hands.

If the physician has the ability to perform an ECG or cardioscopy using a monitor on a defibrillator, ventricular fibrillation, electro-mechanical dissociation of the heart and asystole can be reliably detected.

The algorithm for diagnosing cardiac arrest is as follows:

1. If a person fell and lost consciousness, you should call him, shake him by the shoulder. It is unacceptable to hit a person on the cheeks, you can spray your face with water.
2. In the absence of a reaction, feel the pulse oscillations of the carotid artery (at an angle of the lower jaw), assess the presence of independent respiratory movements - see if there is an excursion of the chest, listen to the sound of exhaled air with your ear, or feel the exhaled air with your cheek (algorithm “look, listen, feel” ).
3. In the absence of pulse and respiratory movements - immediately start performing a precordial blow with further indirect and artificial ventilation air using artificial respiration.

When shouldn't a precordial blow be delivered?

This resuscitation allowance categorically not applied if there is a pulse on the carotid artery and in the presence of independent respiratory movements. This is fraught with cardiac arrest in a person who simply fainted or is in a coma, as well as in a patient with convulsive syndrome... That is, the lack of consciousness in a patient with a normal heart rate can be mistakenly regarded as clinical death as a result, inflicting a precordial shock could cause irreparable harm to the patient.

If the victim has open chest lesions(open gaping wounds with massive bleeding, prolapse of organs into the lumen chest cavity), and you can also visually determine rib fractures (deformation of the ribs, protruding parts of the ribs), performing a precordial blow is meaningless. In this case, you should wait for the arrival of doctors or rescuers.

Thus, the only contraindication for performing a precordial blow with an integral chest frame without visible damage is the presence of a pulse on the carotid or femoral arteries, as well as the presence of an independent heart rate on the cardiogram or on the cardioscope of the defibrillator.

About patients childhood it should be noted that the conduct of a precordial stroke categorically contraindicated in children under 7 years of age due to the high probability of damage internal organs... This category of victims immediately begins to perform chest compressions.

Technique for performing precordial blow

So, correctly, the precordial beat is inflicted in a certain way. After a person has fallen and fainted, the person providing assistance (hereinafter referred to as the resuscitator) must perform a series of sequential actions within 30-60 seconds:

Figure: Performing a precordial beat

If cardiac arrest occurs in medical institution, there is no point in wasting time looking for a defibrillator, since it is necessary to immediately start inflicting a precordial blow. If the defibrillator is close at hand, such as when cardiac arrest occurs in the ward intensive care, the resuscitation physician should immediately determine the type of asystole using a cardioscope and begin using electro-pulse therapy.

Are complications possible when saving a person's life?

The only complication of precordial stroke is fracture of the ribs and sternum with possible damage to the lungs and pleura... This complication is very common, but lung damage is much less common. But in the event that, with the help of a blow and subsequent massage of the heart, it was possible to return a person to life, a fracture of the rib quite successfully lends itself conservative treatment that does not cause significant discomfort to the patient.

Video: conducting a precordial stroke