At what stage does resuscitation begin? Cardiac arrest: how to provide first aid? Medicines for the treatment of hypertension

This page will teach you the practical skills of primary cardiopulmonary resuscitation in acute heart failure with cardiac arrest. Knowing the correct algorithm of actions, you will be able to independently provide emergency medical care by giving the victim an indirect heart massage and artificial ventilation of the lungs.

It often happens that none of the people around the victim has the necessary knowledge, and upon the arrival of the ambulance team, doctors can only state the death of the patient. You, having studied the materials of this article, will be able to artificially support the life of the victim until the arrival of emergency medical assistance.

It is categorically important for absolutely all people to have the skills of the first medical care. Bookmark this page and share it with your friends.

For those who are too lazy to read - at least check out this video. It is quite detailed and even considers the main errors, however, for a full study of the issue, we still recommend that you read this entire page and the appendix to it.

Dangerous symptoms of cardiovascular disease

The following signs may be harbingers of critical, life threatening, states:

• sudden, sharp pain in an area of ​​the heart that had never been seen before.
• Severe weakness, severe shortness of breath, dizziness, loss of consciousness.
• Sudden attack of very strong or vice versa weak heartbeat.
• Blue skin, cold sweat, swelling of the jugular veins.
• Choking, rales, wheezing, cough with frothy reddish/pink sputum.
• Nausea and vomiting.

Having found such symptoms in yourself, especially for the first time, you should immediately call and find a person who would control your condition and be able to provide assistance.

What can cause a heart to stop?

• Like a complication cardiovascular disease.
• Drowning.
• Electric shock.
• Hypothermia.
• Anaphylactic and hemorrhagic shock.
• Lack of oxygen, for example, during suffocation.
• Sudden cardiac arrest of unknown cause.
• And some other reasons.

If indicated (more on that below), you can help all of these victims by performing primary cardiopulmonary resuscitation.

Indications for cardiac massage (signs of clinical death)

The following symptoms are direct indications for starting primary resuscitation (cardiopulmonary resuscitation):

• Unconscious state.
• Absence of pulse in the peripheral and carotid arteries.
• Lack of breathing or its agonal type (frequent, superficial, convulsive, hoarse).

Additional signs: significant dilation of the pupils (weak reaction to light) and blanching or blue skin.

Action plan for cardiopulmonary resuscitation

1. We pay attention to the safety of the approach to the victim.
2. We check the presence of consciousness in the victim - absent.
3. We call an ambulance.
4. We examine the oral cavity.
5. We check the presence of a heartbeat and breathing - absent.
6. We perform indirect heart massage with artificial ventilation lungs before the arrival of an ambulance or the person regains consciousness (reacts to your actions, coughing, groaning, breathing and palpitations appeared).

1. Security check

We check for threats from above, below and to the sides - heavy objects that can fall on you, wires, wild animals, slippery floors and many other factors that can not only prevent you from resuscitation, but also put your life at risk.

2. Checking consciousness

The first step is to make sure that the victim is unconscious. To do this, you do not need to hit him in the face, just grab him by the shoulders and loudly ask about something. Immediately pay attention to the people around you, ask them to assist you in saving the person.

Attention! If the victim became ill with you, then after you have made sure that he is unconscious, you should immediately check the pulse on the carotid artery (for more details, see the fifth paragraph). When absence of pulse (only in the absence of a pulse) you should apply to the victim.

3. Call an ambulance

From a landline phone number 03, from a cell phone 103 or 112. Learn more about that and talk to the dispatcher correctly.

4. Revision of the oral cavity

We examine the oral cavity for presence in it foreign objects that obstruct breathing. If there are foreign objects (including vomit, mucus, pieces of food), we clean it with gentle movements of a finger wrapped in gauze or any other cloth. Pay attention to the position of the tongue so that it does not sink into the throat, thereby blocking the path for air.

5. Check for pulse and breathing

The absence of a heartbeat indicates cardiac arrest. The pulse should be checked on large arteries - to do this, put a couple of fingers on the common carotid artery (to the left or right of the Adam's apple, two centimeters under the jaw). Practice on yourself. Note that in infants, the heartbeat should be checked by pressing the fingers against inside hands, slightly above the antecubital fossa.

Indications for resuscitation:

• Artificial ventilation of the lungs - in the absence of breathing for 5 seconds.
• Indirect heart massage - in the absence of a pulse for 10 seconds.

To check for breathing, gently tilt the victim's head back (by pressing on the forehead and lifting the chin), then bring your cheek to his nostrils to feel, hear, or surprise his breathing. Place your head on the patient so that your gaze is directed to his chest so that you can see her movement.

In addition, the presence of breathing can be checked by bringing a mirror to the patient's nostrils - if condensation does not form on it, then there is no breathing. However, this method can fail you, it is much more reliable to use your own senses - sight, hearing and touch.

Indirect cardiac massage and artificial respiration (IVL)

Heart massage can be direct and indirect. Direct is when the heart is compressed by hand, through an incision in the chest. Indirect means rhythmic pressing on the chest.

The procedure for conducting an indirect heart massage and artificial ventilation of the lungs:

1. The victim lies on his back. The surface on which it lies should be hard and even, so as not to bend under your pressure. In no case should it be a sofa or something soft.
2. Place something under the victim's shins so that his straight legs in the area of ​​\u200b\u200bthe feet are raised 20-30 centimeters above his head.
3. Free your chest from clothing.
4. Determine the point for heart massage - draw a mental line between the nipples and place your palm exactly in the middle, or attach two or three fingers of one hand to the xiphoid process, and then attach the palm of the other hand to them. This is the correct position.
5. Lock your hands together and begin rapid chest compressions (at a rate of 100-120 compressions per minute).
6. Every 30 clicks, 2 exhalations should be made into the victim's mouth, then again we proceed to heart massage.

Cardiac massage and ventilation should be started as soon as possible. Continue until the patient regains consciousness or the arrival of more qualified medical assistance.

Want to explore the issue in more detail? Read the appendix to this article - which thoroughly explains the technique of chest compressions and mechanical ventilation, as well as precordial impact (a punch to the heart in order to restore a normal heartbeat).

Do not be afraid to make the victim worse. In extreme cases, you can accidentally break the ribs, which you will know by the characteristic crunch. Even in this case, you should only once again make sure that the position of the hands on the sternum is correct and continue resuscitation.

The process of dying goes through certain stages, characterized by physiological changes and clinical signs. Scientists have identified:

• preagony;
• agony;
• clinical death.

The preagony lasts from several minutes to a day. In the body, changes occur associated with a lack of oxygen in the internal organs. Many biologically active substances are formed, waste slags are retained. Systolic (upper) blood pressure does not rise above 50 - 60 mm Hg. The pulse is weak. Pallor of the skin, cyanosis (blue tint) of the lips and extremities is increasing. Consciousness is retarded. Breathing is rare or frequent shallow.

The agony lasts up to several hours. Consciousness is absent, pressure is not determined, muffled heart sounds are heard during auscultation, the pulse on the carotid artery is of weak filling, the pupils do not react to light. Breathing is rare, convulsive or shallow. The color of the skin becomes marbled. Sometimes there are short bursts of consciousness and heart activity.

Clinical death is characterized by complete cessation of breathing and heart. Consciousness is absent, pupils are wide and do not react to light. The duration of this phase in adults is from three to five minutes, in children from five to seven minutes (with normal temperature air).

In adults, the most common cause of clinical death is acute heart failure. associated with fibrillation (frequent uncoordinated twitches of the heart muscle). V childhood Approximately 80% of deaths are due to respiratory failure. Therefore, cardiopulmonary resuscitation in children and adults is different.

Following the clinical, there comes the biological dying of the organism, in which, due to irreversible changes, it is no longer possible to restore the functioning of organs and systems.

There is a term "social or brain death". It is applicable if, due to the death of the cerebral cortex, a person cannot think and be considered a member of society.

Stages of resuscitation

All resuscitation measures are subject to one principle: it is necessary to strive to prolong life, and not delay death. The sooner first aid is started, the more chances the victim has.

Depending on the start time of the events, the stages are distinguished:

• at the scene;
• during transportation;
• in a specialized intensive care unit or intensive care unit.

Providing assistance at the scene

It is difficult for any inexperienced person to determine the severity of the condition of the patient or the victim, to diagnose the agonal state.

How to establish clinical death at the scene?

Simple signs of the deceased:

• the person is unconscious, does not respond to questions;
• if it is not possible to feel the pulse on the forearm and on the carotid artery, you should try to unfasten the clothes on the victim and put your ear to the left of the sternum to try to hear heartbeats;
• the absence of breathing is checked by a hair brought to the nose or mouth. On the move chest better not to navigate. Be aware of limited time.
• Pupils dilate after 40 seconds of cardiac arrest.

What needs to be done first?

Before the arrival of a specialized ambulance team, if you really want to help, then do not overestimate your strengths and capabilities:

• call for help;
• look at your watch and note the time.

The algorithm of subsequent actions is based on the scheme:

• cleansing respiratory tract;
• carrying out artificial respiration;
• indirect heart massage.

Full-fledged measures of cardiopulmonary resuscitation cannot be carried out by one person

Cleansing is best done with a finger wrapped in a cloth. Turn the victim's face to the side. You can turn the patient on his side and apply several blows between the shoulder blades to improve airway patency.

For artificial respiration, the lower jaw should be pushed as far forward as possible. This rule prevents the tongue from sinking. The person holding the breath should stand behind the head of the victim, slightly thrown back, with his strong thumbs protrude the jaw. Take a deep breath, and exhale the air into the patient's mouth, pressing your lips tightly. Exhaled air contains up to 18% oxygen, which is enough for the victim. It is necessary to pinch the nose of the patient with the fingers of one hand so that the air does not come out. If there is a handkerchief or a thin napkin, you can put it on the patient's mouth and breathe through the fabric. An indicator of a good breath is the expansion of the victim's chest. The respiratory rate should be 16 per minute. The restoration of respiratory movements stimulates the brain and activates other body functions.

This work requires physical strength, a replacement will be required in a few minutes

In the first twenty minutes after stopping, the heart still retains the properties of automatism. To carry out an indirect heart massage, the patient must be on a hard surface (floor, boards, road surface). The technique of the procedure consists in squeezing pushes with the palms of both hands on the lower part of the sternum. In this case, the heart is located between the sternum and the spine. The shocks should be moderate in strength. The frequency is about 60 per minute. Massage should be carried out before the arrival of specialists. It has been proven that the correct heart massage allows you to keep the general blood circulation at the level of 30% of the norm, and the brain - only 5%.

The best option when one person does artificial respiration, the other is a heart massage, while they coordinate the movements so that pressure on the sternum is not produced during air blowing. If there is no one to help and the primary activities have to be carried out by one person, then he will have to alternate: for one breath, three massage pushes.

An open heart massage is performed only when you stop during the operation. The surgeon opens the heart membranes and makes squeezing movements with his hand.

Indications for direct massage are very limited:

• multiple damage to the ribs and sternum;
• cardiac tamponade (blood fills the heart bag and does not allow contraction);
• thromboembolism of the pulmonary artery that arose during the operation;
• cardiac arrest with tension pneumothorax (air got between the pleura and causes pressure on the lung tissue).

The criteria for effective revitalizing actions are the following features:

• the appearance of a weak pulse;
• independent respiratory movements;
• constriction of the pupils and their reaction to light.

Resuscitation during transportation

This step is to continue first aid. It is carried out by trained professionals. Basic cardiopulmonary resuscitation is provided with medical instruments and equipment. The procedure for resuscitation of the victim does not change: the airways are checked and cleaned, artificial respiration and chest compressions continue. Of course, the technique of performing all the tricks is much better than that of non-professionals.

One of the tasks of the ambulance is to quickly deliver the victim to the hospital

With the help of a laryngoscope, the oral cavity and upper respiratory tract are examined and cleaned. When blocking the access of air, a tracheotomy is done (a tube is inserted through the hole between the cartilages of the larynx). A curved rubber duct is used to prevent the tongue from falling in.

For artificial respiration, a mask is used or the patient is intubated (a plastic sterile tube is inserted into the trachea and connected to the apparatus). Most often, an Ambu bag is used, followed by manual compression to allow air to enter. Modern specialized machines have more advanced techniques for artificial respiration.

Taking into account the activities already started at the previous stage, adult patients are defibrillated with a special apparatus. Intracardiac adrenaline solution may be administered with repeated defibrillation.

If a weak pulsation appears, heart sounds are heard, then through the catheter in the subclavian vein, medications and a solution that normalizes the properties of blood.

In the "Ambulance" there is an opportunity to take an electrocardiogram and confirm the effectiveness of the measures taken.

Events in a specialized department

The task of the resuscitation departments of hospitals is to ensure round-the-clock readiness for the admission of agonizing victims and the provision of the entire range of medical care. Patients come in from the street, are delivered by ambulance or are transferred on a gurney from other parts of the hospital.

The staff of the department has special training and experience of not only physical, but also psychological stress.

As a rule, the team on duty includes doctors, nurses, and a nurse.

The agonizing patient is immediately connected to a sound monitor to control cardiac activity. In the absence of own breathing, intubation and connection to the apparatus are performed. The supplied respiratory mixture must contain a sufficient concentration of oxygen to combat organ hypoxia. Solutions are injected into the vein, providing an alkalizing effect, normalizing blood counts. For increase blood pressure, stimulation contractile activity heart, protection and restoration of brain function are added immediate-acting drugs. The head is covered with ice packs.

Resuscitation of children

The basic principles are the same with adults, but children's body has its own characteristics, so the methods of revival may differ.

• The most common cause of terminal conditions in children are injuries and poisoning, and not diseases, as in adults.
• To clear the upper respiratory tract, you can put the baby on your knee with your stomach and tap on the chest.
• Heart massage is done with one hand, and the newborn with the first finger.
• When small patients are admitted to the hospital, intracalcaneal administration of solutions and drugs is more often used due to the inability to waste time searching for veins. Veins also approach the bone marrow, and they do not collapse in a serious condition.
• In resuscitation of children, defibrillation is used less often, because the main cause of death in childhood is respiratory arrest.
• All tools have a special children's size.
• The algorithm of the doctor's actions depends on spontaneous breathing, listening to heartbeats and the color of the child's skin.
• Resuscitation measures are started even in the presence of their own, but inferior breathing.

Contraindications for resuscitation

Contraindications are defined by the standards of medical care. Cardiopulmonary resuscitation is not initiated under the following conditions:

• the patient has entered the agonal period of an incurable disease;
• more than 25 minutes have passed since the cardiac arrest;
• clinical death occurred against the background of the provision of a full set of intensive medical care;
• if there is a written refusal of an adult or a documented refusal of the parents of a sick child.

Treatment of diseases should be carried out in a timely manner

There are criteria for termination of resuscitation:

• during the course it turned out that there are contraindications;
• the duration of resuscitation without effect lasts half an hour;
• repeated cardiac arrests are observed, stabilization cannot be achieved.

The given times are observed at average normal air temperature.

Every year, new research by scientists is introduced into practice, vital medicines for the treatment of serious illnesses. It's best not to bring it up. A reasonable person makes every effort for prevention, uses the advice of specialists.

Cardiopulmonary resuscitation. Guidelines N 2000/104

<*>Developed by the Research Institute of General Resuscitation of the Russian Academy of Medical Sciences.

Description of the method

Method formula. The Guidelines in the form of algorithms present the main methods of conducting cardiopulmonary resuscitation (CPR), describe the indications for its use and termination. The main drugs used in the implementation of cardiopulmonary resuscitation, their dosages and routes of administration are indicated. Action algorithms are presented in the form of diagrams (see Appendix).

Indications for cardiopulmonary resuscitation:

- lack of consciousness, breathing, pulse on the carotid arteries, dilated pupils, lack of pupillary reaction to light;

- unconscious state; rare, weak, thready pulse; shallow, rare, fading breathing.

Contraindications for cardiopulmonary resuscitation:

- terminal stages of incurable diseases;

- biological death.

Logistics

Used medicines: epinephrine (N 006848, 11/22/95), norepinephrine (N 71/380/41), lidocaine (N 01.0002, 01/16/98), atropine (N 70/151/71), procainamide (N 71/380/37) , bretidium (N 71/509/20), amiodarone (N 008025, 01/21/97), mexiletine (N 00735, 08/10/93), sodium bicarbonate (N 79/1239/6).

Defibrillators (domestic): DFR-1, state. register. N 92/135-91, DKI-N-04, state. register. No. 90/345-37.

Defibrillators (import): DKI-S-05, state. register. N 90 / 348-32, DKI-S-06, state. register. No. 92/135-90 (Ukraine); DMR-251, TEM ED (Poland), No. 96/293; M 2475 B, Hewlett-Packard (USA), N 96/438; Monitor M 1792 A, Hewlett-Packard CodeMaster XL (USA), N 97/353.

The main tasks of cardiopulmonary resuscitation are the maintenance and restoration of brain functions, the prevention of the development of terminal conditions<**>and removal of victims from them; restoration of the activity of the heart, respiration and blood circulation; prevention of possible complications.

<**>Terminal states are the extreme states of the body, transitional from life to death. All of them are reversible, revival is possible at all stages of dying.

Resuscitation should be carried out according to the accepted methodology immediately after the emergence of a threat to the development of a terminal state, in full and under any conditions.

The resuscitation complex includes: artificial lung ventilation (ALV), external heart massage, prevention of recurrence of terminal conditions, and other measures to prevent death.

There are 5 stages of resuscitation: diagnostic, preparatory, initial, removal from the terminal state (resuscitation itself), prevention of relapse of the terminal state.

Diagnostic phase of resuscitation. In all cases, before resuscitation, it is necessary to check the presence of consciousness in the victim. If the patient is unconscious, check for spontaneous breathing, determine the pulse on the carotid artery. For this:

- with closed 2, 3, 4 fingers on the front surface of the neck, find the protruding part of the trachea - Adam's apple;

- move your fingers along the edge of the Adam's apple in depth, between the cartilage and the sternocleidomastoid muscle;

- feel for the carotid artery, determine its pulsation. It is not necessary to determine the condition of the victim by the pulse on the forearm (on the radial artery) due to significantly lower reliability;

- check the condition of the pupils: put the brush on the forehead, lift the upper eyelid with one finger. Determine the width and reaction of the pupil to light: when the eye is opened, the pupil normally narrows. The reaction can be established by first closing the eyes with the affected palm - after a quick opening, the pupil narrows.

Check for fractures of the cervical vertebrae (the presence of a palpable bony protrusion on the back of the neck, sometimes an unnatural position of the head), severe injuries of the neck, the occipital part of the skull.

The total time spent on diagnostics is 10–12 s.

If there is no pulsation in the carotid arteries, the pupils are dilated, they do not react to light - immediately start resuscitation.

Preparatory stage of resuscitation:

- place the victim on a rigid base;

- free the chest and stomach from tight clothing.

The initial stage of resuscitation:

- check the patency of the upper respiratory tract;

- if necessary, open your mouth;

- restore the patency of the upper respiratory tract.

Check and, if necessary, restore airway patency. Use the method of tilting the head (if there are no contraindications).

Technics. Take a position on the side of the victim's head, on his knees (if he lies on the floor, etc.). Put your hand on your forehead so that the 1st and 2nd fingers are on both sides of the nose; bring the other hand under the neck. With a multidirectional movement (one hand backwards, the second - anteriorly) unbend (throw back) the head back; the mouth usually opens.

Very important: throwing back the head should be carried out without any violence (!), until the obstacle appears.

Make 1 - 2 test breaths to the victim. If air does not pass into the lungs, proceed to restore the patency of the upper respiratory tract.

Turn your head to one side, open your mouth, fix the jaws with the crossed 1st and 2nd fingers. Insert closed straightened 2nd and 3rd fingers of the other hand into the mouth (you can wrap your fingers with a handkerchief, bandage, piece of cloth if this does not require time). Quickly, carefully, in a circular motion, check the oral cavity, teeth. In the presence of foreign bodies, mucus, broken teeth, dentures, etc., grab them and remove them with a rowing movement of the fingers. Check the airway again.

In some cases, due to spasm of the masticatory muscles, the mouth may remain closed. In such situations, you should immediately begin to forcibly open the mouth.

Ways to open the mouth. With all options for opening the mouth, it is necessary to achieve displacement of the lower jaw anteriorly: the lower front teeth should slightly go forward relative to the upper teeth (to free the airways from the sunken tongue that closes the entrance to the trachea).

You should act in one of two existing ways.

Bilateral capture of the lower jaw. The rescuer is placed behind or somewhat to the side of the head of the victim; the second - fifth fingers are located under the lower jaw, the first fingers - in the stop position on the corresponding sides of the chin (anterior part of the lower jaw). Tilt the head back with the palms and the adjacent part of the forearm and fix it in this position. With an oppositely directed movement of the brush, with an emphasis on the first fingers, move the lower jaw downward, forward and at the same time open the mouth.

Anterior grip of the lower jaw. Put the brush on your forehead, tilt your head back. Insert the first finger of the other hand into the mouth behind the base of the front teeth. With the second - with the fifth fingers, grasp the chin, open the mouth with a downward movement and at the same time slightly pull the lower jaw anteriorly.

If it was not possible to open the mouth using these methods, start ventilation using the mouth-to-nose method.

Removal of foreign bodies from the upper respiratory tract. If the airways are blocked foreign bodies(for example, food):

- when the victim is standing - apply 3 - 5 sharp blows to the interscapular region with the base of the brush or grab the upper part of the abdomen (epigastric region) with your hands, close the brushes in the lock and make 3 - 5 sharp pushes in the direction of the inside and a little upward;

- when the victim is lying down - turn him on his side, apply 3 - 5 sharp blows to the interscapular region with the base of the brush;

- when lying on your back - place the brushes one on top of the other in upper section abdomen, produce 3 - 5 sharp shocks in the upward direction;

- in a sitting position - deflect the body of the victim anteriorly, apply 3-5 sharp blows to the interscapular region with the base of the brush.

Removal from the terminal state (actual resuscitation). The first component of resuscitation is the ventilator. The basic principle of IVL is active inhalation, passive exhalation.

IVL is carried out by expiratory methods mouth to mouth, mouth to nose (in newborns and young children - mouth to mouth and nose at the same time) and hardware methods.

The mouth-to-mouth method is carried out directly or through a mask with a valve device, a portable mouthpiece (in order to protect the rescuer from infection). The use of a handkerchief, a piece of cloth, gauze, a bandage is meaningless, because. makes it difficult to introduce the required volume of air and does not protect against infection.

To carry out mechanical ventilation by the mouth-to-mouth method, you should tilt your head back, if necessary, use one of the mouth opening methods. Pinch the nose with the first and second fingers of the hand fixing the forehead. Take a deep enough breath, press your mouth to the victim's mouth (ensure complete tightness), exhale air strongly and sharply into the victim's mouth. Control each breath by lifting the anterior chest wall. After inflating the lungs - inhaling the victim - release his mouth, monitor independent passive exhalation by lowering the front chest wall and the sound of escaping air.

Periodically carry out pauseless ventilation: without waiting for a complete passive exhalation, carry out 3-5 breaths at a fast pace.

The mouth-to-nose method is especially important because allows for mechanical ventilation in more difficult conditions - with injuries to the lips, injuries of the jaws, organs of the oral cavity, after vomiting, etc .; to a certain extent, this method protects the rescuer from infection.

To perform mechanical ventilation using the mouth-to-nose method, the victim’s head should be thrown back, fixed with a hand located on the forehead. With the palm of the other hand, grasp the chin and adjacent parts of the lower jaw from below, bring the lower jaw slightly forward, tightly close and fix the jaws, pinch the lips with the first finger. Take a deep enough breath. Grasp the victim's nose so as not to pinch the nasal openings. Press the lips firmly around the base of the nose (to ensure complete tightness). Exhale into the victim's nose. Monitor the rise of the anterior wall of the chest. Then release the nose, control the exhalation.

With proper ventilation, 1 - 1.5 liters of air should be inhaled into the lungs of the victim, i.e. to do this, the rescuer needs to take a deep enough breath. With less air desired effect will not be, with more - there will not be enough time for a heart massage.

The frequency of IVL (inflation of the lungs) should be 10-12 times per 1 min. (about 1 time in 5 s).

When inflating the lungs (artificial inhalation of the victim), it is necessary to constantly monitor the anterior chest wall: with proper ventilation, the chest wall rises during inhalation - therefore, air enters the lungs. If the air has passed, but the front wall of the chest has not risen, it means that it did not get into the lungs, but into the stomach: it is urgent to remove the air. To do this, quickly turn the victim on his side, press him on the stomach area - the air will come out. Then turn the victim on his back and continue to help him.

Errors during mechanical ventilation, which can lead to the death of the victim:

- lack of tightness at the time of air injection - as a result, the air goes out without getting into the lungs;

- the nose is badly pinched when blowing air using the mouth-to-mouth or mouth method - when blowing air using the mouth-to-nose method - as a result, the air comes out without entering the lungs;

- the head is not thrown back - the air does not go into the lungs, but into the stomach;

- control over the rise of the anterior chest wall at the time of inspiration is not provided;

- for the restoration of spontaneous breathing can be mistaken for: gag reflex, spasm of the diaphragm, etc.

If errors are excluded, non-pause ventilation should be carried out: 3-5 artificial breaths should be performed at a fast pace, without waiting for passive exhalations; following this, quickly check the pulse on the carotid artery. If a pulse appears, continue mechanical ventilation until the patient's condition improves.

If there is no pulse on the carotid artery, immediately start an external heart massage.

The second component of resuscitation is an external heart massage. Heart massage must be carried out carefully, rhythmically, continuously, in full, but sparingly, in compliance with all the requirements of the methodology - otherwise it will not be possible to revive the victim or great harm will be done - fractures of the ribs, sternum, damage to the internal organs of the chest and abdominal cavity.

Heart massage is carried out in combination with mechanical ventilation.

It is necessary that the base of the brush is 2 - 3 cm higher xiphoid process sternum, the axis of the base of the hand coincided with the axis of the sternum. The technique should be practiced so well that the determination of the position of the base of the brush is carried out automatically.

The base of the second brush should be on the first (respectively, the axis of the base of this brush) at an angle of 90°. The fingers of both hands should be straightened. Compression (compression) of the sternum should be carried out jerkily, with outstretched arms, without bending them in elbow joints; massage is carried out by the whole body.

The frequency of chest compressions currently- 100 times in 1 min. Each element should consist of 2 phases - a sharp push and immediately after it the next compression phase without pressure reduction, which is about 50% of the cycle duration (compression phase - 0.3 - 0.4 s). The force of the push should be commensurate with the elasticity of the chest.

In especially difficult situations, it is advisable to increase the frequency of shocks to 100 - 120 per 1 min.

Precordial stroke. With a sudden cessation of blood circulation - asystole, ventricular fibrillation of the heart, ventricular tachycardia in adults, as well as with a sharp increase in the pulsation of the heart muscle, a positive effect is possible after sufficiently strong precordial punches in the region of the middle third of the body of the sternum.

It is advisable to start external heart massage with 1-2 precordial strokes, while simultaneously monitoring their effectiveness by the pulse on the carotid artery.

If there is no effect from punches, external massage should be carried out in the ratio of inhalation / massage push: with one rescuer - 2:15, with two rescuers - 1:5. In both cases, it is necessary to periodically carry out bespauzny IVL.

Resuscitation scheme

Resuscitation by one person. Kneel down at the side of the victim's head. In the absence of contraindications, proceed to resuscitation.

Check and, if necessary, restore the patency of the upper respiratory tract. According to indications - open your mouth in one of the ways. Turn to the initial (middle) position, throw back the head, start mechanical ventilation by the mouth-to-mouth method, if it is impossible - by the mouth-to-nose method or one of the hardware methods. Do not forget to follow the rise of the anterior chest wall! If necessary, quickly remove air from the stomach, continue mechanical ventilation.

Hold at a fast pace 3 - 5 breaths to the victim - without pauses. Check the pulse on the carotid artery, the pupil. In the absence of a pulse, pupil reaction - apply 1 - 2 precordial beats, immediately check the pulse. In the absence of a pulse, immediately start an external heart massage according to the method described above. Push the sternum to a depth of 3-4 cm towards the spine. The pace of massage is 70 - 72 pushes per 1 min. Do not forget about fixing the sternum at the end of each push (up to 0.3 - 0.4 s). IVL ratio. heart massage - 2:15.

Control the effectiveness of resuscitation! After each series of precordial beats, while continuing to massage with one hand, check the pulse on the carotid artery. Periodically check the condition of the pupils.

Resuscitation by two rescuers. One of the caregivers provides airway patency and ventilation. The second - at the same time, conducts an external heart massage (the ratio of mechanical ventilation. external heart massage is 1: 5. Compressions are carried out in the rhythm of 70 - 72 shocks per 1 minute. The depth of deflection of the sternum is 3 - 5 cm). The control of the pulse, pupils is carried out constantly in the intervals between blowing air into the lungs of the victim.

If the carotid arteries pulsate in time with the massage shocks, the pupils constrict (anisocoria, deformity are noted at first), the skin of the nasolabial triangle turns pink, the first independent breaths appear - it is necessary to achieve a sustainable effect.

If in the next few seconds after the termination of resuscitation, the pulsation of the carotid arteries disappears, the pupils dilate again, there is no breathing - you should immediately resume resuscitation, continue it continuously under constant monitoring of the effectiveness of the measures taken.

Actions in the absence of effect. If during resuscitation already in the first 2 - 3 minutes. there are no results (the carotid arteries do not pulsate in time with the massage shocks, the pupils remain wide, do not react to light, there are no independent breaths), it follows:

- check the correctness of resuscitation, eliminate errors;

- to carry out the centralization of blood circulation - to raise the legs by 15 ° (some authors recommend raising the legs by 50 - 70 °);

- increase the strength of massage pushes and the depth of breathing, carefully observe the rhythm of the massage, especially the two-stage massage push.

Termination of resuscitation. Resuscitation measures stop if all actions to revive, carried out in a timely manner, methodically correctly, in full, do not lead to the restoration of cardiac activity for at least 30 minutes. and at the same time there are signs of the onset of biological death.

In the process of resuscitation, after the appearance of at least one pulse on the carotid artery or pupillary reaction during an external heart massage, the time (30 minutes) is counted each time anew.

Prevention of recurrence of the terminal state. The main task is to ensure a stable physiological position of the victim, which is carried out by transferring him to the position on the right side. All actions must be consistent, carried out in strict order, quickly, sparingly. Fractures are contraindications cervical spine, severe head and neck injuries.

Specialized measures to maintain and restore the vital functions of the body include: defibrillation of the heart, mechanical ventilation, chest compressions, drug therapy.

Transthoracic electrical defibrillation of the heart. One of the main causes of cardiac arrest is ventricular fibrillation, which occurs as a result of acute heart failure, massive blood loss, asphyxia, electrical injury, drowning and other causes. Electrical defibrillation is virtually the only treatment for ventricular fibrillation. Obviously, the time from the onset of fibrillation to the delivery of the first shock determines the success of this treatment. The European Resuscitation Council insists on the need for early defibrillation in the life-saving chain of action.

Technics. Defibrillation is performed under ECG control, if it is impossible to conduct ECG control - blindly, usually by two medical workers.

Responsibilities of the first medical worker: preparation of equipment, electrodes, selection of the exposure dose.

Examination:

— state of the electrodes (presence of fabric pads);

- continuity of the electrical circuit (according to a special indicator installed on the instrument panel or on one of the electrodes);

- operation of the defibrillator by pressing the buttons installed on the electrodes.

Preparation of electrodes: wetting pads with hypertonic sodium chloride solution; v extreme situations wetting with plain water is acceptable. In the presence of electrode paste - applying it in a thin layer on the metal surface of the electrodes (in this case, the discharge is performed without spacers).

The position of the victim: the victim must be in a supine position (always isolated from the ground).

Exposure doses: the first three discharges should be 200 J, 200 J, 360 J sequentially (when using imported defibrillators with a monopolar pulse).

When using domestic defibrillators DFR-1 or DKI-N-04, generating a bipolar Gurvich impulse, doses "3", "4", "5".

Responsibilities of the second health worker (usually the one who performs the heart massage):

- be on the side of the victim; place the defibrillator electrode according to the apex of the heart - on the left, place the second electrode somewhat to the right of the sternum in the first intercostal space;

- give commands: to the first medical worker “Turn off the electrocardiograph” (or recording devices, if they do not have special protection); to all those present - “Get away from the patient!”;

- firmly press the electrodes to the patient's body;

- conduct a discharge, remove the electrodes;

- give the command: "Turn on the electrocardiograph (cardioscope)".

First medical worker controls the effectiveness of defibrillation according to ECG data, in the absence of an electrocardiograph - by restoring cardiac activity, the appearance of a pulse in the carotid arteries, heart sounds (during auscultation), by constriction of the pupils.

If there is no effect, continue heart massage, mechanical ventilation. Prepare the defibrillator for the second shock.

Mistakes. Loose pressing of the electrodes - in this case, the discharge efficiency is sharply reduced.

Termination of resuscitation during the preparation of the defibrillator is unacceptable, because. this will lead to a dangerous loss of time, a rapid aggravation of the victim's condition.

Complications:

- a burn of 1 - 2nd degree, if the defibrillator electrodes are loosely pressed to the body or fabric pads are poorly moistened, which creates a high electrical resistance of the chest;

- violations of the contractile function of the heart, when defibrillation has to be carried out repeatedly (in individual cases dozens of times) with recurrences of ventricular fibrillation at short intervals.

Safety rules. Electrode handles must be well insulated. At the moment of the discharge, you can not touch the patient, the bed on which he lies. The entire procedure should, if possible, be carried out under ECG control.

If the electrocardiograph (cardioscope) is not equipped with a special safety device, then at the moment the impulse is given, the device must be disconnected from the patient for a few seconds: disconnect the cable going to the device from the electrodes.

Artificial ventilation of the lungs. For mechanical ventilation with a respirator, tracheal intubation is the optimal procedure, despite the fact that the technique requires special training. The use of a laryngeal mask may be an alternative to tracheal intubation; although this technique does not give absolute guarantees against aspiration, such cases are rare. The use of pharyngotracheal and esophagotracheal airways requires additional training.

If it is impossible to perform cardiopulmonary resuscitation by conventional methods (severe fractures of both jaws, nasal bones, burns, damage to facial tissues, fractures of the cervical vertebrae, bones of the occipital part of the skull, etc.), as well as if tracheal intubation is impossible, conicotomy is performed.

A conicotomy is an incision in the trachea between the thyroid and cricoid cartilages. A simple, affordable, quickly performed operation (performed within 1–2 minutes) is performed with any cutting tool. In acute asphyxia, it is carried out without anesthesia; in other cases (mainly in stationary conditions), anesthesia of the skin, the front surface of the neck is performed with 0.5 - 1.0% novocaine solution with 0.1% adrenaline solution (1 drop per 5 ml of novocaine).

Indirect cardiac massage. Description of indirect cardiac massage. The sequence of measures for cardiopulmonary resuscitation - see Appendix, algorithms 1, 2, 3.

General principles of drug therapy

The introduction of drugs. Venous access, especially central venous catheterization, remains the preferred method of administering drugs during cardiopulmonary resuscitation (CPR). However, the risk of central venous catheterization means that the decision to perform it must be made on an individual basis, depending on the experience of the physician and the overall situation. If such a decision is made, this procedure should not delay the necessary resuscitation. If drugs are administered to peripheral vein, then to improve their entry into the bloodstream, it is recommended to rinse the cannula and catheter with 20 ml of 0.9% NaCl solution after each injection. If it is impossible to use the venous bed, the administration of drugs can be carried out endotracheally. Only epinephrine/norepinephrine, lidocaine, and atropine are administered this way. In this case, it is recommended to increase the standard intravenous doses by 2-3 times and dilute the preparations with saline to 10 ml. After the introduction, 5 breaths are taken to increase the dispersion to the distal parts of the tracheobronchial tree.

Vasopressors. Adrenaline/epinephrine is still the best drug of all sympathomimetic amines used during cardiac arrest and CPR, due to its pronounced combined stimulating effect on alpha and beta receptors. The most important is the stimulation of alpha receptors by adrenaline, because. it causes an increase in resistance peripheral vessels without constriction of the cerebral and coronary vessels, increases systolic and diastolic pressure during massage, resulting in improved cerebral and coronary blood flow, which, in turn, facilitates the restoration of independent heart contractions. The combined alpha and beta stimulating effects increase cardiac output and blood pressure at the onset of spontaneous reperfusion, resulting in an increase in cerebral blood flow and blood flow to other vital organs.

With asystole, adrenaline helps to restore spontaneous cardiac activity, because. it increases perfusion and myocardial contractility. In the absence of a pulse and the appearance of unusual complexes on the ECG (electromechanical dissociation), adrenaline restores a spontaneous pulse. Although epinephrine can cause ventricular fibrillation, especially when an already affected heart is stopped, it also helps to restore the heart rhythm in ventricular fibrillation and ventricular tachycardia.

During CPR, adrenaline should be administered intravenously at a dose of 0.5-1.0 mg (for adults) in a solution of 1 mg / ml or 1 mg / 10 ml. The first dose is administered without waiting ECG results, re-introduce it every 3 - 5 minutes. because The action of adrenaline is short. If intravenous adrenaline cannot be administered, it should be administered endotracheally (1-2 mg in 10 ml of isotonic solution).

After restoration of spontaneous circulation to increase and maintain cardiac output and blood pressure adrenaline can be administered intravenously (1 mg in 250 ml) starting at a rate of 0.01 mcg/min. and adjusting it depending on the response. To prevent ventricular tachycardia or ventricular fibrillation during the administration of a sympathomimetic amine, it is recommended to simultaneously infuse lidocaine and bretilium.

Antiarrhythmic drugs. Lidocaine, which has an antiarrhythmic effect, is the drug of choice for the treatment of ventricular extrasystoles, ventricular tachycardia and for the prevention of ventricular fibrillation. However, when ventricular fibrillation has developed, antiarrhythmic drugs should be administered only in the case of several unsuccessful attempts at defibrillation, since these drugs, by suppressing ventricular ectopia, make it difficult to restore an independent rhythm.

The use of lidocaine alone does not stabilize the rhythm in ventricular fibrillation, but it can stop an attack of ventricular tachycardia. For persistent ventricular fibrillation, lidocaine should be used in conjunction with attempts at electrical defibrillation, and if not effective, it should be replaced with bretilium. How to use lidocaine.

Atropine is a classic parasympathomimetic that lowers the tone vagus nerve, increases atrioventricular conduction, reduces the likelihood of ventricular fibrillation. It can increase the heart rate not only with sinus bradycardia, but also with severe atrioventricular block with bradycardia, but not with complete atrioventricular block, when isadrin (isonroterenol) is indicated. Atropine is not used during cardiac arrest and CPR, except in cases of persistent asystole. With spontaneous circulation, atropine is indicated if the decrease in heart rate is below 50 in 1 min. or in bradycardia accompanied by premature ventricular contraction or hypotension.

Atropine is used at doses of 0.5 mg per 70 kg of body weight intravenously and, if necessary, repeatedly up to a total dose of 2 mg, which causes a complete blockade of the vagus nerve. With atrioventricular block III degree larger doses should be tried. Atropine is effective when administered endotracheally.

buffer preparations. The use of buffers (in particular, sodium bicarbonate) is limited to cases of severe acidosis and cardiac arrest due to hyperkalemia or an overdose of tricyclic antidepressants. Sodium bicarbonate is used at a dose of 50 mmol (100 ml of a 4% solution), which may be increased depending on clinical data and the results of an acid-base study.

Cardiopulmonary resuscitation in ventricular fibrillation

Ventricular fibrillation (VF) leads to an almost immediate cessation of effective hemodynamics. VF may occur in acute coronary insufficiency, intoxication with cardiac glycosides, develop against the background of electrolyte imbalance and acid-base balance, hypoxia, anesthesia, operations, endoscopy, etc. , ethacizin, mexiletin, etc.) can cause life-threatening arrhythmias.

The precursors of VF, which in some cases can play the role of a triggering factor, include early, paired, polytopic ventricular extrasystoles, runs of ventricular tachycardia. The special prefibrillatory forms of ventricular tachycardia include: alternating and bidirectional; polymorphic ventricular tachycardia with congenital and acquired QT interval lengthening syndrome and with normal QT interval duration.

The process of VF development is staged, and if initial stage of its development on the ECG, large-wave oscillations are recorded, then it responds well to treatment. But gradually the shape of the fibrillation curve changes: the amplitude of the oscillations decreases, their frequency also decreases. The chances of successful defibrillation are dropping by the minute.

Technics. Defibrillation is performed under ECG control, if it is impossible - blindly, usually by two health workers (see Appendix, algorithm 3).

The duration of circulatory arrest is often unknown. Resuscitation should begin with 1 - 2 precordial strokes, external heart massage in combination with artificial ventilation of the lungs. After this time, if large-wave oscillations are recorded on the ECG, transthoracic defibrillation is performed.

If sluggish, low-wave fibrillation is recorded on the ECG, one should not rush to apply a discharge; it is necessary to continue mechanical ventilation and heart massage, intravenously inject adrenaline and continue heart massage until high-amplitude oscillations appear on the ECG. During these activities, the probability positive effect increased by defibrillation.

An important point for successful defibrillation is the correct placement of the electrodes. When defibrillating to reduce electrical resistance chest, a special conductive gel or gauze moistened with a hypertonic saline solution is used. It is necessary to ensure a tight pressing of the electrodes to the surface of the chest (pressure force should be about 10 kg). Defibrillation must be carried out in the expiratory phase (in the presence of respiratory excursions of the chest), because. transthoracic resistance in these conditions is reduced by 10 - 15%. During defibrillation, none of the resuscitation participants should touch the bed and the patient.

The sequence of measures to restore cardiac activity in the presence of VF is currently quite well known. Features of diagnostic and medical measures are set out in Algorithm 3 (see Appendix).

The main criterion for potentially successful resuscitation and full recovery of patients is early defibrillation, provided that heart massage and artificial respiration are started no later than 1-4 minutes.

In patients with massive heart attack myocardial infarction complicated by cardiogenic shock or pulmonary edema, as well as in patients with severe chronic heart failure, the elimination of VF is often accompanied by its recurrence or the development of electromechanical dissociation (EMD), severe bradycardia, asystole. This is more often observed in cases of using defibrillators that generate monopolar pulses.

After the restoration of cardiac activity, monitoring is necessary for subsequent timely and adequate therapy. In some cases, so-called post-conversion rhythm and conduction disturbances can be observed (migration of the pacemaker through the atria, nodal or ventricular rhythms, dissociation with interference, incomplete and complete atrioventricular blockade, atrial, nodal and frequent ventricular extrasystoles).

Prevention of the recurrence of VF in acute diseases or lesions of the heart is one of the priorities after the restoration of cardiac activity. Preventive therapy for recurrent VF should be differentiated as far as possible. Most common causes recurrent and refractory VF are respiratory and metabolic acidosis due to inadequate CPR; respiratory alkalosis, unreasonable or excessive administration of sodium bicarbonate, excessive exoendogenous sympathetic or, conversely, parasympathetic stimulation of the heart, leading, respectively, to the development of prefibrillatory tachycardia or bradycardia; initial hypo- or hyperkalemia, hypomagnesemia; toxic effect of antiarrhythmic drugs; frequent repeated discharges of the defibrillator with a monopolar maximum energy pulse shape.

The use of antiarrhythmic drugs for the prevention and treatment of VF. When determining the tactics of preventive therapy, particular importance should be given to the effectiveness of the drug, the duration of its action and the assessment of possible complications. In cases where VF is preceded by frequent ventricular extrasystole, the choice of drug should be based on its antiarrhythmic effect.

Lidocaine. Currently, lidocaine is recommended to prescribe: with frequent early, paired and polymorphic extrasystoles, in the first 6 hours acute infarction myocardium, frequent ventricular extrasystoles leading to hemodynamic disturbances; ventricular tachycardia or their jogging (over 3 in 1 hour); refractory VF; for the prevention of recurrent VF. Scheme of administration: 50 mg for 2 minutes. then every 5 min. up to 200 mg, at the same time lidocaine is administered intravenously (2 g of lidocaine + 250 ml of 5% glucose). During refractory fibrillation, large doses are recommended: bolus up to 80-100 mg 2 times with an interval of 3-5 minutes.

Procainamide. Effective for the treatment and prevention of sustained ventricular tachycardia or VF. Saturating dose - up to 1500 mg (17 mg / kg), diluted in saline, injected intravenously at a rate of 20 - 30 mg / min. maintenance dose - 2 - 4 mg / min.

Bretidium. It is recommended to use in VF, when lidocaine and / or novocainamide are ineffective. It is administered intravenously at a dose of 5 mg/kg. If VF persists, after 5 min. enter 10 mg/kg, then in 10 — 15 min. another 10 mg/kg. The maximum total dose is 30 mg/kg.

Amiodarone (Cordarone). Serves as a backup for the treatment of severe arrhythmias refractory to standard antiarrhythmic therapy and in cases where other antiarrhythmic drugs have side effect. Assign intravenously at 150 - 300 mg for 5 - 15 minutes. and then, if necessary, up to 300-600 mg for 1 hour under the control of blood pressure; maximum dose- 2000 mg / day.

Meksiletin. Used to treat ventricular arrhythmias: intravenously 100 - 250 mg for 5 - 15 minutes. then within 3.5 hours; maximum - 500 mg (150 mg / h), maintenance dose of 30 mg / h (up to 1200 mg for 24 hours).

To the complex therapeutic measures along with antiarrhythmic drugs, it is necessary to include drugs that improve myocardial contractility, coronary blood flow and systemic hemodynamics; great importance attached medicinal substances, normalizing acid-base and electrolyte balance. Currently, in everyday practice, the use of potassium and magnesium preparations has proven itself well.

Efficiency of using the method

The problem of sudden circulatory arrest in hospital and out-of-hospital conditions due to the widespread prevalence of cardiovascular diseases, traumatic injuries, massive blood loss, asphyxia, etc. remains extremely relevant throughout the world.

Airway obstruction, hypoventilation, and cardiac arrest are major causes of death in accidents, heart attacks, and other emergencies. When blood circulation stops for more than 3 - 5 minutes. and uncorrected severe hypoxemia, irreversible brain damage develops. Immediate use of cardiopulmonary resuscitation can prevent the development of biological death of the body. These methods can be applied in any setting. Hence the need to know the main reasons that caused sudden stop cardiac activity, and, accordingly, ways to prevent them.

Training doctors of various specialties (general practitioners, dentists, ophthalmologists, etc.), who usually do not know the methods of cardiopulmonary resuscitation, will help to avoid sudden death in the context of non-specialized resuscitation care. Cardiopulmonary resuscitation techniques are constantly being improved, so physicians of all specialties should be kept up-to-date with new insights and advances in this field. Mastering the elements of emergency diagnosis of terminal conditions and resuscitation techniques is the most important task. Development Guidelines will contribute to a wider introduction of methods of cardiopulmonary resuscitation into practical medicine.

Appendix

ALGORITHM 1. MAIN LIFE SUPPORT MEASURES

(in the absence of injury). ——— Ripple on large Call for help. ¦ arteries Maintain patency ¦ ¦ upper respiratory tract. ¦ / Observe and determine often ¦ There is no independent ¦ (circulatory arrest) breathing ¦ Call for help. ¦ Lay in position for Available (breathing stops)<- реанимации. Уложить в положение для Начать сердечно-легочную реанимации. реанимацию Сделать 10 вдохов. ¦ Позвать на помощь. / Продолжать искусственное Оценить ритм сердца дыхание. Действовать в зависимости Часто определять пульсацию от выявленных нарушений на крупных артериях. Выяснять причину

Cardiopulmonary resuscitation

Fundamentals of cardiopulmonary resuscitation

The concept of cardiopulmonary and cerebral resuscitation

Cardiopulmonary resuscitation(CPR) is a set of medical measures aimed at returning a patient who is in a state of clinical death to a full life.

clinical death called a reversible state in which there are no signs of life (a person does not breathe, his heart does not beat, it is impossible to detect reflexes and other signs of brain activity (a flat line on the EEG)).

The reversibility of the state of clinical death in the absence of life-incompatible injuries caused by trauma or disease directly depends on the period of oxygen starvation of brain neurons.

Clinical evidence suggests that full recovery is possible if no more than five to six minutes have elapsed since the cessation of the heartbeat.

Obviously, if clinical death occurred against the background of oxygen starvation or severe poisoning of the central nervous system, then this period will be significantly reduced.

Oxygen consumption is highly dependent on body temperature, so with initial hypothermia (for example, drowning in ice water or falling into an avalanche), successful resuscitation is possible even twenty minutes or more after cardiac arrest. And vice versa - at elevated body temperature, this period is reduced to one or two minutes.

Thus, the cells of the cerebral cortex suffer the most during the onset of clinical death, and their recovery is of decisive importance not only for the subsequent biological life of the organism, but also for the existence of a person as a person.

Therefore, the restoration of cells of the central nervous system is a top priority. To emphasize this thesis, many medical sources use the term cardiopulmonary and cerebral resuscitation (cardiopulmonary and cerebral resuscitation, CPR).

The concepts of social death, brain death, biological death

Delayed cardiopulmonary resuscitation greatly reduces the chances of restoring the body's vital functions. So, if resuscitation was started 10 minutes after cardiac arrest, then in the vast majority of cases, a complete restoration of the functions of the central nervous system is impossible. Surviving patients will suffer from more or less pronounced neurological symptoms. associated with damage to the cerebral cortex.

If the provision of cardiopulmonary resuscitation began to be carried out 15 minutes after the onset of a state of clinical death, then most often there is a total death of the cerebral cortex, leading to the so-called social death of a person. In this case, it is possible to restore only the vegetative functions of the body (independent breathing, nutrition, etc.), and as a person, a person dies.

20 minutes after cardiac arrest, as a rule, total brain death occurs, when even vegetative functions cannot be restored. Today, the total death of the brain is legally equated with the death of a person, although the life of the organism can be maintained for some time with the help of modern medical equipment and drugs.

biological death It is a mass death of cells of vital organs, in which the restoration of the existence of the organism as an integral system is no longer possible. Clinical evidence suggests that biological death occurs 30-40 minutes after cardiac arrest, although its signs appear much later.

Tasks and importance of timely cardiopulmonary resuscitation

Carrying out cardiopulmonary resuscitation is designed not only to resume normal breathing and heartbeat, but also to lead to a complete restoration of the functions of all organs and systems.

Back in the middle of the last century, analyzing autopsy data, scientists noticed that a significant proportion of deaths are not associated with life-incompatible traumatic injuries or incurable degenerative changes caused by old age or illness.

According to modern statistics, timely cardiopulmonary resuscitation could prevent every fourth death, returning the patient to a full life.

Meanwhile, information about the effectiveness of basic cardiopulmonary resuscitation at the prehospital stage is very disappointing. For example, in the United States, about 400,000 people die from sudden cardiac arrest every year. The main reason for the death of these people is the untimeliness or poor quality of first aid.

Thus, knowledge of the basics of cardiopulmonary resuscitation is necessary not only for doctors, but also for people without medical education, if they are worried about the life and health of others.

Indications for cardiopulmonary resuscitation

The indication for cardiopulmonary resuscitation is the diagnosis of clinical death.

Signs of clinical death are divided into basic and additional.

The main signs of clinical death are: lack of consciousness, breathing, heartbeat, and persistent dilation of the pupils.

You can suspect the lack of breathing by the immobility of the chest and the anterior wall of the abdomen. To verify the reliability of the sign, you need to bend down to the face of the victim, try to feel the movement of air with your own cheek and listen to the breath sounds coming from the patient's mouth and nose.

In order to check the availability heartbeat. it is necessary to probe pulse on the carotid arteries (on the peripheral vessels, the pulse is not felt when the blood pressure drops to 60 mm Hg and below).

The pads of the index and middle fingers are placed on the region of the Adam's apple and are easily shifted to the side into the hole bounded by the muscle roller (sternocleidomastoid muscle). The absence of a pulse here indicates cardiac arrest.

To check pupil reaction. slightly open the eyelid and turn the patient's head into the light. Persistent dilation of the pupils indicates a deep hypoxia of the central nervous system.

Additional signs: a change in the color of visible skin (dead pallor, cyanosis or marbling), lack of muscle tone (a slightly raised and released limb falls limply like a whip), lack of reflexes (no response to touch, cry, pain stimuli).

Since the time interval between the onset of clinical death and the occurrence of irreversible changes in the cerebral cortex is extremely small, a quick diagnosis of clinical death determines the success of all subsequent actions.

Contraindications for cardiopulmonary resuscitation

The provision of cardiopulmonary resuscitation is aimed at returning the patient to a full life, and not delaying the process of dying. Therefore, resuscitation measures are not carried out if the state of clinical death has become the natural end of a long-term serious illness that has exhausted the body's strength and entailed gross degenerative changes in many organs and tissues. We are talking about the terminal stages of oncological pathology, the extreme stages of chronic heart disease. respiratory, renal. liver failure and the like.

A contraindication to cardiopulmonary resuscitation are also visible signs of the complete futility of any medical measures.

First of all, we are talking about visible damage that is incompatible with life.

For the same reason, resuscitation measures are not carried out in case of detection of signs of biological death.

Early signs of biological death appear 1-3 hours after cardiac arrest. This is the drying of the cornea, cooling of the body, cadaveric spots and rigor mortis.

Drying of the cornea is manifested in clouding of the pupil and a change in the color of the iris, which seems to be covered with a whitish film (this symptom is called "herring shine"). In addition, there is a symptom of a "cat's pupil" - with a slight compression of the eyeball, the pupil shrinks into a slit.

Cooling of the body at room temperature occurs at a rate of one degree per hour, but in a cool room the process is faster.

Cadaverous spots are formed due to the post-mortem redistribution of blood under the influence of gravity. The first spots can be found on the bottom of the neck (behind, if the body lies on the back, and in front, if the person died lying on his stomach).

Rigor mortis begins in the jaw muscles and subsequently spreads from top to bottom throughout the body.

Thus, the rules for conducting cardiopulmonary resuscitation prescribe the immediate start of measures immediately after the diagnosis of clinical death is established. The only exceptions are those cases where the impossibility of returning the patient to life is obvious (visible injuries incompatible with life, documented irreparable degenerative lesions caused by a severe chronic disease, or pronounced signs of biological death).

Stages and stages of cardiopulmonary resuscitation

The stages and stages of CPR were developed by the Patriarch of Resuscitation, author of the first international manual on CPR and Cerebral Resuscitation, Peter Safar, PhD, University of Pittsburgh.

Today, international standards for cardiopulmonary resuscitation provide for three stages, each of which consists of three stages.

First stage. in fact, it is primary cardiopulmonary resuscitation and includes the following steps: securing the airway, artificial respiration and closed heart massage.

The main goal of this stage is to prevent biological death by urgently combating oxygen starvation. Therefore, the first basic stage of cardiopulmonary resuscitation is called basic life support .

Second stage is carried out by a specialized team of resuscitators, and includes drug therapy, ECG control and defibrillation.

This stage is called continued life support. because doctors set themselves the task of achieving spontaneous circulation.

Third stage performed exclusively in specialized intensive care units, which is why it is called long-term maintenance of life. Its ultimate goal is to ensure the complete restoration of all bodily functions.

At this stage, a comprehensive examination of the patient is performed, while determining the cause that caused the cardiac arrest, and assessing the degree of damage caused by the state of clinical death. They carry out medical measures aimed at the rehabilitation of all organs and systems, achieve the resumption of full-fledged mental activity.

Thus, primary cardiopulmonary resuscitation does not involve determining the cause of cardiac arrest. Her technique is extremely unified, and the assimilation of methodological techniques is available to everyone, regardless of professional education.

Algorithm for conducting cardiopulmonary resuscitation

The algorithm for conducting cardiopulmonary resuscitation was proposed by the American Heart Association (ANA). It provides for the continuity of the work of resuscitators at all stages and stages of providing care to patients with cardiac arrest. For this reason, the algorithm is called chain of life .

The basic principle of cardiopulmonary resuscitation in accordance with the algorithm: early warning of a specialized team and a quick transition to the stage of further life support.

Thus, drug therapy, defibrillation and ECG control should be carried out as early as possible. Therefore, calling for specialized medical care is a top priority for basic cardiopulmonary resuscitation.

Rules for conducting cardiopulmonary resuscitation

If assistance is provided outside the walls of a medical institution, the safety of the place for the patient and the resuscitator should first be assessed. If necessary, the patient is moved.

At the slightest suspicion of the threat of clinical death (noisy, rare or abnormal breathing, confusion, pallor, etc.), you must call for help. The cardiopulmonary resuscitation protocol requires “many hands”, so the participation of several people will save time, increase the efficiency of primary care and, therefore, increase the chances of success.

Since the diagnosis of clinical death must be established as soon as possible, every movement should be saved.

First of all, you should check the presence of consciousness. If there is no response to the call and questions about well-being, the patient can be shaken slightly by the shoulders (extreme caution is necessary in case of suspected spinal injury). If the answer to the questions cannot be achieved, it is necessary to strongly squeeze the victim's nail phalanx with your fingers.

In the absence of consciousness, it is necessary to immediately call for qualified medical assistance (it is better to do this through an assistant, without interrupting the initial examination).

If the victim is unconscious and does not respond to pain irritation (groaning, grimace), then this indicates a deep coma or clinical death. In this case, it is necessary to simultaneously open the eye with one hand and evaluate the reaction of the pupils to light, and with the other check the pulse on the carotid artery.

In unconscious people, a pronounced slowing of the heartbeat is possible, so you should expect a pulse wave for at least 5 seconds. During this time, the reaction of the pupils to light is checked. To do this, slightly open the eye, assess the width of the pupil, then close and open again, observing the reaction of the pupil. If possible, then direct the light source to the pupil and evaluate the reaction.

The pupils can be persistently constricted in case of poisoning with certain substances (narcotic analgesics, opiates), so this symptom cannot be fully trusted.

Checking for the presence of a heartbeat often greatly slows down the diagnosis, so international recommendations for primary cardiopulmonary resuscitation state that if a pulse wave is not detected within five seconds, then the diagnosis of clinical death is established by the absence of consciousness and breathing.

To register the absence of breathing, they use the technique: “I see, I hear, I feel.” Visually observe the absence of movement of the chest and the anterior wall of the abdomen, then bend over to the patient's face and try to hear breath sounds and feel the movement of air with the cheek. It is unacceptable to waste time applying pieces of cotton wool, mirrors, etc. to the nose and mouth.

The cardiopulmonary resuscitation protocol states that the detection of such signs as unconsciousness, lack of breathing and pulse wave on the main vessels is quite enough to make a diagnosis of clinical death.

Pupil dilation is often observed only 30-60 seconds after cardiac arrest, and this sign reaches its maximum in the second minute of clinical death, so precious time should not be wasted in establishing it.

Thus, the rules for conducting primary cardiopulmonary resuscitation prescribe as early as possible seeking help from outsiders, calling a specialized team if a critical condition of the victim is suspected, and starting resuscitation as early as possible.

Technique for primary cardiopulmonary resuscitation

Ensuring airway patency

In an unconscious state, the tone of the muscles of the oropharynx decreases, which leads to the blocking of the entrance to the larynx by the tongue and surrounding soft tissues. In addition, in the absence of consciousness, there is a high risk of blockage of the respiratory tract with blood, vomit, fragments of teeth and prostheses.

The patient should be placed on their back on a firm, level surface. It is not recommended to put a roller from improvised materials under the shoulder blades, or to give an elevated position to the head. The standard for primary cardiopulmonary resuscitation is Safar's triple maneuver: tilting the head back, opening the mouth, and pushing the mandible forward.

To ensure tilting of the head, one hand is placed on the fronto-parietal region of the head, and the other is brought under the neck and gently lifted.

If a serious injury to the cervical spine is suspected (fall from a height, divers' injuries, car accidents), head tilting is not performed. In such cases, it is also impossible to bend the head and turn it to the sides. The head, chest and neck must be fixed in the same plane. Airway patency is achieved by slightly extending the head, opening the mouth, and protruding the mandible.

The extension of the jaw is provided with two hands. The thumbs are placed on the forehead or chin, and the rest cover the branch of the lower jaw, shifting it forward. It is necessary that the lower teeth are on the same level with the upper ones, or slightly in front of them.

The patient's mouth, as a rule, opens slightly when the jaw is advanced. Additional opening of the mouth is achieved with one hand with the help of a cross-shaped insertion of the first and second fingers. The index finger is inserted into the corner of the victim's mouth and pressed on the upper teeth, then the thumb is pressed on the lower teeth opposite. In case of tight compression of the jaws, the index finger is inserted from the corner of the mouth behind the teeth, and the patient's forehead is pressed with the other hand.

Safar's triple intake is completed with a revision of the oral cavity. With the help of the index and middle fingers wrapped in a napkin, vomit, blood clots, fragments of teeth, fragments of prostheses and other foreign objects are removed from the mouth. Tightly fitting dentures should not be removed.

Artificial lung ventilation

Sometimes spontaneous breathing is restored after the airway is secured. If this does not happen, proceed to artificial ventilation of the lungs by the mouth-to-mouth method.

The victim's mouth is covered with a handkerchief or napkin. The resuscitator is located on the side of the patient, he brings one hand under the neck and slightly raises it, puts the other on the forehead, trying to tilt the head back, pinches the victim’s nose with the fingers of the same hand, and then, taking a deep breath, exhales into the victim’s mouth. The effectiveness of the procedure is judged by chest excursion.

Primary cardiopulmonary resuscitation in infants is performed by the mouth-to-mouth and nose method. The child's head is thrown back, then the resuscitator covers the child's mouth and nose with his mouth and exhales. When performing cardiopulmonary resuscitation in newborns, it should be remembered that the tidal volume is 30 ml.

The mouth-to-nose method is used for injuries of the lips, upper and lower jaw, inability to open the mouth, and in case of resuscitation in the water. First, with one hand they press on the forehead of the victim, and with the second they put forward the lower jaw, while the mouth closes. Then exhale into the patient's nose.

Each breath should take no more than 1 s, then you should wait for the chest to lower and take another breath into the lungs of the victim. After a series of two breaths, they move on to chest compressions (closed heart massage).

The most common complications of cardiopulmonary resuscitation occur at the stage of aspiration of the respiratory tract with blood and air entering the victim's stomach.

To prevent blood from entering the patient's lungs, a permanent toilet of the oral cavity is necessary.

When air enters the stomach, a protrusion is observed in the epigastric region. In this case, turn the head and shoulders of the patient to the side, and gently press on the swelling area.

Prevention of air entry into the stomach includes adequate airway management. In addition, inhalation of air during chest compressions should be avoided.

Closed heart massage

A necessary condition for the effectiveness of closed heart massage is the location of the victim on a hard, even surface. The resuscitator can be located on either side of the patient. The palms of the hands are placed one on top of the other, and placed on the lower third of the sternum (two transverse fingers above the place of attachment of the xiphoid process).

Pressure on the sternum is produced by the proximal (carpal) part of the palm, while the fingers are raised up - this position avoids a fracture of the ribs. The rescuer's shoulders should be parallel to the victim's chest. In chest compressions, the elbows are not bent to use some of their own weight. Compression is performed with a quick vigorous movement, while the displacement of the chest should reach 5 cm. The relaxation period is approximately equal to the compression period, and the entire cycle should be a little less than a second. After 30 cycles, take 2 breaths, then start a new series of chest compression cycles. In this case, the technique of cardiopulmonary resuscitation should provide a frequency of compressions: about 80 per minute.

Cardiopulmonary resuscitation in children under 10 years of age involves a closed heart massage with a frequency of 100 compressions per minute. Compression is performed with one hand, while the optimal displacement of the chest in relation to the spine is 3-4 cm.

For infants, a closed heart massage is performed with the index and middle fingers of the right hand. Cardiopulmonary resuscitation of newborns should provide a frequency of contractions of 120 beats per minute.

The most typical complications of cardiopulmonary resuscitation at the stage of closed heart massage: rib fractures. sternum, liver rupture, heart injury, lung injury from broken ribs.

Most often, injuries occur due to incorrect positioning of the resuscitator's hands. So, if the hands are too high, a fracture of the sternum occurs, if shifted to the left, a fracture of the ribs and injury to the lungs by fragments, if shifted to the right, a liver rupture is possible.

Prevention of cardiopulmonary resuscitation complications also includes monitoring the ratio of compression force and chest elasticity so that the impact is not excessive.

Criteria for the effectiveness of cardiopulmonary resuscitation

During cardiopulmonary resuscitation, constant monitoring of the victim's condition is necessary.

The main criteria for the effectiveness of cardiopulmonary resuscitation:

• improvement of skin color and visible mucous membranes (decrease in pallor and cyanosis of the skin, the appearance of a pink color of the lips);
• constriction of the pupils;
• restoration of pupillary response to light;
• pulse wave on the main, and then on the peripheral vessels (you can feel a weak pulse wave on the radial artery on the wrist);
• blood pressure 60-80 mm Hg;
• occurrence of respiratory movements.

If a distinct pulsation appears on the arteries, then chest compression is stopped, and artificial ventilation of the lungs is continued until spontaneous breathing normalizes.

The most common reasons why CPR is not effective are:

• the patient is located on a soft surface;
• incorrect position of the hands during compression;
• insufficient chest compression (less than 5 cm);
• ineffective ventilation of the lungs (checked by chest excursions and the presence of passive exhalation);
• delayed resuscitation or a break of more than 5-10 s.

In the absence of signs of the effectiveness of cardiopulmonary resuscitation, the correctness of its implementation is checked, and rescue activities are continued. If, despite all efforts, 30 minutes after the start of resuscitation, signs of restoration of blood circulation did not appear, then rescue activities are stopped. The moment of termination of primary cardiopulmonary resuscitation is recorded as the moment of death of the patient.

Before use, you should consult with a specialist.

Information ,

Cardiac arrest is characterized by the cessation of the work of the heart muscle. It is most often the direct cause of death. This condition can occur for various reasons with any person. Those who are nearby at this moment can be given first aid in case of cardiac arrest. The first 3-4 minutes are key in resuscitation care and are called clinical death. In the absence of such assistance, the brain ceases to function due to the cessation of blood circulation, which leads to the so-called social death, when the work of the heart and lungs can be restored, but it is unlikely that a person will be brought back to consciousness.

Why can the heart stop?

The work of the heart stops if the beats of the heart muscle become too fast, chaotic, uncoordinated with no pumping of blood, or when the heart stops completely.

The main causes of cardiac arrest are:

• Heart damage:
  • heart attack,
  • ischemic heart disease,
  • Arrhythmia,
  • angina,
  • Myo- and endocarditis,
  • aortic aneurysm,
  • Damage to the heart valves.
• Lack of oxygen due to:
  • Heart failure and cardiac arrest
  • Drowning or suffocation
  • gas poisoning,
  • Electric shock or lightning strike
  • Heat stroke or severe freezing,
  • Loss of a large amount of blood
  • A blow inflicted to the region of the heart.

How to understand that there was a cessation of the work of the heart

The main symptoms of cardiac arrest are:

• Loss of consciousness - after cardiac arrest occurs after a few moments, not exceeding 5 seconds, it can be determined by the lack of a person's reaction to any stimuli.
• The absence of pulsation when probing the carotid artery - it is located in the region of 2-3 cm away from the thyroid gland.
• Cessation of breathing - determined by the absence of chest movements.
• No listening to heart sounds
• Unusual coloration of the skin - pallor or blue,
• Dilated pupils - can be seen after lifting the upper eyelid and subsequent illumination of the eye. In the event that the pupil is dilated and does not constrict with the direction of light, it is necessary to immediately begin resuscitation.
• Convulsions that occur during a period of loss of consciousness.

All of the listed symptoms indicate the need for resuscitation, except in cases where there is no point in carrying it out:

• Cardiac arrest in severe diseases (oncology with metastases),
• Obtaining serious injuries of the skull with crushing of the brain.

First aid steps for cardiac arrest

It is necessary to immediately call an ambulance, it is impossible to interrupt resuscitation measures for the provision of first aid associated with cardiac arrest.

1. Feel the pulse with three fingers - middle, index and ring fingers - preferably on the carotid artery.

2. Clarify the absence of breathing.

3. If the symptoms listed above are obvious, it is not necessary to measure the pulse and pressure of the victim, it is better, without wasting time, to proceed with resuscitation measures.

4. Someone from the environment or you yourself should call an ambulance, indicating the causes of cardiac arrest and the measures being taken at the moment.

5. Immediately begin heart massage and mouth-to-mouth breathing.

6. For this, the victim is placed with his back on a hard surface in order to open the paths for breathing. If necessary, everything that can interfere with normal breathing should be removed from the mouth - prostheses, food, mucus, foreign bodies, broken teeth.

7. Try to tilt the patient's head back so that the chin is in a vertical position. The lower jaw, at the same time, must be advanced to avoid retraction of the tongue. If this is neglected, then air can enter the stomach instead of the lungs, which will not ensure the effectiveness of emergency care.

8. Start immediate resuscitation. During artificial respiration, the nose of the victim is pinched, air is drawn into the lungs, the lips of the helper clasp the lips of the patient and 2 exhalations are made into the victim's mouth. It is necessary to completely clasp the lips to eliminate the loss of exhaled air. Its amount should not be very large, otherwise you will quickly get tired. During the mouth-to-nose breathing process, the mouth is closed with the hand, and air is blown into the nostrils.

If artificial respiration is performed correctly, the chest will rise during inhalation and fall during the period of airway clearance. If such movement is not observed, it is necessary to check how passable the airways are.

9. Along with breathing, it is necessary to do a heart massage.

In case of cardiac arrest and cessation of breathing, cardiac massage is performed only in conjunction with artificial respiration. In another case, it does not make sense, due to the fact that during artificial respiration, the blood is enriched with oxygen.

After two breaths, the helper kneels near the victim, puts the left hand on the bottom of the chest in the middle (the distance to the end of the sternum should be equal to two horizontal fingers), the right hand on top in a cross-like position, the arms should be in a straight state. The heart massage technique consists in rhythmic pressure on the chest to compress the heart muscle, which is located between the spine and the sternum. 15 pressure movements are made on the chest without taking off the hands at a speed equal to 1 pressure per second. Pressing on the chest must be done in such a way that it falls a few centimeters, usually about 5. So the heart will perform its direct functions of pumping blood. At the same time, from the left side (ventricle) of the heart, blood passes through the aorta to the brain, from the right - to the lungs, where it is saturated with oxygen. When the pressure on the sternum stops, the heart fills with blood again.

It should be noted that the massage of the heart muscle for preschool children is done with two fingers on one hand - the middle one, as well as the index one, for schoolchildren - with one palm. Special care is required when massaging older people. Excessive pressure on the chest can lead to a broken rib or damage to internal organs.

10. Then you need to repeat the breaths and continue to press on the chest.

11. After carrying out the procedure in the amount of two times, you need to stop and check your breathing and pulse. If they don't exist, continue.

12. If all actions are carried out by two people, then the role of one is only to massage the heart, the other - to inhale air. In this case, the ratio of the frequency of breaths and pressure on the sternum should be equal to 1 to 5, i.e. for every 5 compressions, there should be one breath at the time of expansion of the chest.

13. Continue all of the above measures until there is a pulse and breathing. In the event that it was possible to restore breathing, but there is no pulse, you should continue the massage without ventilation of the lungs and, conversely, if a pulse appears, but breathing is not restored, continue breathing "mouth to mouth". If these functions are fully restored, it is necessary to monitor the patient's condition and record all measurements before the doctor arrives.

The movement of a patient with symptoms of cardiac arrest is possible only in a special resuscitation ambulance or after the restoration of the heart and breathing.

How to determine how effective resuscitation was

The correctness and effectiveness of the actions performed are assessed using:

• Feeling the pulse in the region of the main arteries - carotid, femoral, radial.
• Definitions of increasing blood pressure up to 80 mm.
• Observations of constriction of the pupils and restoration of their reaction to a light stimulus.
• Determination of the presence of spontaneous breathing.
• Restoration of normal skin color instead of bluish and pale.

If cardiac activity and respiratory function do not resume after half an hour from the start of resuscitation, and the pupils are wide and do not respond to light radiation, it can be said that irreversible processes have occurred in the body of the victim with brain death and further resuscitation is inappropriate. If signs of death occur before the expiration of half an hour, resuscitation measures can be stopped earlier.

The technique of resuscitation in case of cardiac arrest allows you to save the life and health of a person. Today, there are cases when the tactics of such behavior in an emergency situation helped save a person's life and gave him the opportunity to enjoy every day.

The algorithm of actions during cardiac and respiratory arrest is described.

Cardiopulmonary resuscitation (abbreviated as CPR) is a complex of urgent measures for cardiac and respiratory arrest, with the help of which they try to artificially support the vital activity of the brain until spontaneous circulation and respiration are restored. The composition of these activities directly depends on the skills of the person providing assistance, the conditions for their implementation and the availability of certain equipment.

Ideally, resuscitation carried out by a person who does not have a medical education consists of a closed heart massage, artificial respiration, and the use of an automatic external defibrillator. In reality, such a complex is almost never performed, since people do not know how to properly conduct resuscitation, and external external defibrillators are simply not available.

Determination of vital signs

In 2012, the results of a huge Japanese study were published, in which more people were registered with cardiac arrest that occurred outside the hospital. Approximately 18% of those victims who underwent resuscitation were able to restore spontaneous circulation. But only 5% of patients remained alive after a month, and with preserved functioning of the central nervous system - about 2%.

It should be taken into account that without CPR, these 2% of patients with a good neurological prognosis would have no chance of life. 2% of those injured are lives saved. But even in countries with frequent resuscitation courses, care for cardiac arrest outside the hospital is less than half of the cases.

It is believed that resuscitation, correctly carried out by a person who is close to the victim, increases his chances of resuscitation by 2-3 times.

Resuscitation must be able to carry out physicians of any specialty, including nurses and doctors. It is desirable that people without a medical education could do it. Anesthesiologists-resuscitators are considered the greatest professionals in the restoration of spontaneous circulation.

Indications

Resuscitation should be started immediately after the discovery of the injured person, who is in a state of clinical death.

Clinical death is a period of time lasting from cardiac and respiratory arrest to the occurrence of irreversible disorders in the body. The main signs of this condition include the absence of a pulse, breathing, and consciousness.

It must be recognized that not all people without a medical education (and with it, too) can quickly and correctly determine the presence of these signs. This can lead to an unjustified delay in the start of resuscitation, which greatly worsens the prognosis. Therefore, current European and American recommendations for CPR take into account only the absence of consciousness and breathing.

Resuscitation techniques

Check the following before starting resuscitation:

• Is the environment safe for you and the victim?
• Is the victim conscious or unconscious?
• If it seems to you that the patient is unconscious, touch him and ask loudly: "Are you all right?"
• If the victim did not answer, and there is someone else besides him, one of you should call an ambulance, and the second should start resuscitation. If you are alone and have a mobile phone, call an ambulance before starting resuscitation.

To remember the order and methodology of cardiopulmonary resuscitation, you need to learn the abbreviation "CAB", in which:

1. C (compressions) - closed heart massage (ZMS).
2. A (airway) - opening of the airways (ODP).
3. B (breathing) - artificial respiration (ID).

1. Closed heart massage

Carrying out VMS allows you to ensure the blood supply to the brain and heart at a minimum - but critically important - level that maintains the vital activity of their cells until spontaneous circulation is restored. With compressions, the volume of the chest changes, due to which there is a minimum gas exchange in the lungs, even in the absence of artificial respiration.

The brain is the organ most sensitive to reduced blood supply. Irreversible damage in its tissues develop within 5 minutes after the cessation of blood flow. The second most sensitive organ is the myocardium. Therefore, successful resuscitation with a good neurological prognosis and restoration of spontaneous circulation directly depends on the quality of the VMS.

The victim with cardiac arrest should be placed in the supine position on a hard surface, the person providing assistance should be placed to the side of him.

Place the palm of your dominant hand (depending on whether you are right-handed or left-handed) in the center of your chest, between your nipples. The base of the palm should be placed exactly on the sternum, its position should correspond to the longitudinal axis of the body. This focuses the compression force on the sternum and reduces the risk of rib fractures.

Place the second palm on top of the first and interlace their fingers. Make sure that no part of the palms touches the ribs to minimize pressure on them.

For the most efficient transfer of mechanical force, keep your arms straight at the elbows. Your body position should be such that your shoulders are vertically above the victim's chest.

The blood flow created by a closed heart massage depends on the frequency of compressions and the effectiveness of each of them. Scientific evidence has demonstrated the existence of a relationship between the frequency of compressions, the duration of pauses in the performance of VMS and the restoration of spontaneous circulation. Therefore, any breaks in compressions should be minimized. It is possible to stop VMS only at the time of artificial respiration (if it is carried out), assessment of the recovery of cardiac activity and for defibrillation. The required frequency of compressions is 100-120 times per minute. To give you a rough idea of ​​the pace at which the VMS is being conducted, you can listen to the rhythm in the song "Stayin' Alive" by the British pop group the BeeGees. It is noteworthy that the very name of the song corresponds to the goal of emergency resuscitation - "Staying alive."

The depth of chest deflection during VMS should be 5–6 cm in adults. After each pressing, the chest should be allowed to fully straighten, since incomplete restoration of its shape worsens blood flow. However, you should not remove your hands from the sternum, as this can lead to a decrease in the frequency and depth of compressions.

The quality of the VMS performed decreases sharply over time, which is associated with the fatigue of the person providing assistance. If resuscitation is carried out by two people, they should change every 2 minutes. More frequent shifts can lead to unnecessary breaks in HMS.

2. Opening the airways

In a state of clinical death, all the muscles of a person are in a relaxed state, due to which, in the supine position, the victim's airways can be blocked by a tongue that has shifted to the larynx.

To open the airways:

• Place the palm of your hand on the victim's forehead.
• Tilt his head back, straightening it in the cervical spine (this technique should not be done if there is a suspicion of damage to the spine).
• Place the fingers of the other hand under the chin and push the lower jaw up.

3. CPR

Current CPR guidelines allow people who have not received special training not to perform ID, as they do not know how to do it and only waste precious time, which is better to devote entirely to chest compressions.

People who have undergone special training and are confident in their ability to perform ID with high quality are recommended to carry out resuscitation measures in the ratio of “30 compressions - 2 breaths”.

ID rules:

• Open the victim's airway.
• Pinch the patient's nostrils with the fingers of your hand on his forehead.
• Press your mouth firmly against the victim's mouth and exhale normally. Take 2 such artificial breaths, following the rise of the chest.
• After 2 breaths, start VMS immediately.
• Repeat cycles of "30 compressions - 2 breaths" until the end of resuscitation.

Algorithm for basic resuscitation in adults

Basic resuscitation (BRM) is a set of actions that can be carried out by a person providing assistance without the use of medicines and special medical equipment.

The cardiopulmonary resuscitation algorithm depends on the skills and knowledge of the person providing assistance. It consists of the following sequence of actions:

1. Make sure there is no danger at the point of care.
2. Determine if the victim is conscious. To do this, touch him and loudly ask if everything is all right with him.
3. If the patient somehow reacts to the appeal, call an ambulance.
4. If the patient is unconscious, turn him onto his back, open his airway and assess for normal breathing.
5. In the absence of normal breathing (not to be confused with infrequent agonal sighs), start VMS at a rate of 100-120 compressions per minute.
6. If you know how to do an ID, perform resuscitation with a combination of "30 compressions - 2 breaths."

Features of resuscitation in children

The sequence of this resuscitation in children has slight differences, which are explained by the peculiarities of the causes of cardiac arrest in this age group.

Unlike adults, in whom sudden cardiac arrest is most often associated with cardiac pathology, in children, respiratory problems are the most common causes of clinical death.

The main differences between pediatric resuscitation and adult:

• After identifying a child with signs of clinical death (unconscious, not breathing, no pulse on the carotid arteries), resuscitation should begin with 5 artificial breaths.
• The ratio of compressions to artificial breaths during resuscitation in children is 15 to 2.
• If assistance is provided by 1 person, an ambulance should be called after resuscitation within 1 minute.

Using an automated external defibrillator

An automated external defibrillator (AED) is a small, portable device that can deliver an electrical shock (defibrillation) to the heart through the chest.

Automated external defibrillator

This shock has the potential to restore normal cardiac activity and resume spontaneous circulation. Since not all cardiac arrests require defibrillation, the AED has the ability to evaluate the victim's heart rate and determine if a shock is needed.

Most modern devices are capable of reproducing voice commands that give instructions to people providing assistance.

AEDs are very easy to use and have been specifically designed to be used by non-medical people. In many countries, AEDs are placed in high-traffic areas such as stadiums, train stations, airports, universities, and schools.

The sequence of actions for using the AED:

• Turn on the power of the device, which then starts to give voice instructions.
• Expose your chest. If the skin on it is wet, dry the skin. The AED has sticky electrodes that must be attached to the chest as shown on the device. Attach one electrode above the nipple, to the right of the sternum, the second - below and to the left of the second nipple.
• Make sure the electrodes are firmly attached to the skin. Connect the wires from them to the device.
• Make sure no one is touching the victim and click the "Analyze" button.
• After the AED analyzes the heart rate, it will give you instructions on how to proceed. If the machine decides that defibrillation is needed, it will warn you about it. At the time of application of the discharge, no one should touch the victim. Some devices perform defibrillation on their own, some require the Shock button to be pressed.
• Resume CPR immediately after shock is applied.

Termination of resuscitation

CPR should be stopped in the following situations:

1. An ambulance arrived, and its staff continued to provide assistance.
2. The victim showed signs of the resumption of spontaneous circulation (he began to breathe, cough, move, or regained consciousness).
3. You are completely exhausted physically.

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Cardiopulmonary resuscitation

Cardiopulmonary resuscitation (CPR) is a set of medical measures aimed at returning a patient who is in a state of clinical death to a full life.

Oxygen consumption is highly dependent on body temperature, so with initial hypothermia (for example, drowning in ice water or falling into an avalanche), successful resuscitation is possible even twenty minutes or more after cardiac arrest. And vice versa - at elevated body temperature, this period is reduced to one or two minutes.

Delayed cardiopulmonary resuscitation greatly reduces the chances of restoring the body's vital functions. So, if resuscitation was started 10 minutes after cardiac arrest, then in the vast majority of cases, a complete restoration of the functions of the central nervous system is impossible. Surviving patients will suffer from more or less pronounced neurological symptoms associated with damage to the cerebral cortex.

Carrying out cardiopulmonary resuscitation is designed not only to resume normal breathing and heartbeat, but also to lead to a complete restoration of the functions of all organs and systems.

Signs of clinical death are divided into basic and additional.

The main signs of clinical death are: lack of consciousness, breathing, heartbeat, and persistent dilation of the pupils.

The pads of the index and middle fingers are placed on the region of the Adam's apple and are easily shifted to the side into the hole bounded by the muscle roller (sternocleidomastoid muscle). The absence of a pulse here indicates cardiac arrest.

First of all, we are talking about visible damage that is incompatible with life.

For the same reason, resuscitation measures are not carried out in case of detection of signs of biological death.

Drying of the cornea is manifested in clouding of the pupil and a change in the color of the iris, which seems to be covered with a whitish film (this symptom is called "herring shine"). In addition, there is a symptom of a "cat's pupil" - with a slight compression of the eyeball, the pupil shrinks into a slit.

Stages and stages of cardiopulmonary resuscitation

Today, international standards for cardiopulmonary resuscitation provide for three stages, each of which consists of three stages.

Algorithm for conducting cardiopulmonary resuscitation

If the victim is unconscious and does not respond to pain irritation (groaning, grimace), then this indicates a deep coma or clinical death. In this case, it is necessary to simultaneously open the eye with one hand and evaluate the reaction of the pupils to light, and with the other check the pulse on the carotid artery.

Technique for primary cardiopulmonary resuscitation

In an unconscious state, the tone of the muscles of the oropharynx decreases, which leads to the blocking of the entrance to the larynx by the tongue and surrounding soft tissues. In addition, in the absence of consciousness, there is a high risk of blockage of the respiratory tract with blood, vomit, fragments of teeth and prostheses.

Sometimes spontaneous breathing is restored after the airway is secured. If this does not happen, proceed to artificial ventilation of the lungs by the mouth-to-mouth method.

To prevent blood from entering the patient's lungs, a permanent toilet of the oral cavity is necessary.

A necessary condition for the effectiveness of closed heart massage is the location of the victim on a hard, even surface. The resuscitator can be located on either side of the patient. The palms of the hands are placed one on top of the other, and placed on the lower third of the sternum (two transverse fingers above the place of attachment of the xiphoid process).

For infants, a closed heart massage is performed with the index and middle fingers of the right hand. Cardiopulmonary resuscitation of newborns should provide a frequency of contractions of 120 beats per minute.

Criteria for the effectiveness of cardiopulmonary resuscitation

• improvement of skin color and visible mucous membranes (decrease in pallor and cyanosis of the skin, the appearance of a pink color of the lips);
• constriction of the pupils;
• restoration of pupillary response to light;
• pulse wave on the main, and then on the peripheral vessels (you can feel a weak pulse wave on the radial artery on the wrist);
• blood pressure.Hg;
• occurrence of respiratory movements.

If a distinct pulsation appears on the arteries, then chest compression is stopped, and artificial ventilation of the lungs is continued until spontaneous breathing normalizes.

• the patient is located on a soft surface;
• incorrect position of the hands during compression;
• insufficient chest compression (less than 5 cm);
• ineffective ventilation of the lungs (checked by chest excursions and the presence of passive exhalation);
• delayed resuscitation or a break of more than 5-10 s.

In the absence of signs of the effectiveness of cardiopulmonary resuscitation, the correctness of its implementation is checked, and rescue activities are continued. If, despite all efforts, 30 minutes after the start of resuscitation, signs of restoration of blood circulation did not appear, then rescue activities are stopped. The moment of termination of primary cardiopulmonary resuscitation is recorded as the moment of death of the patient.

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Cardiopulmonary resuscitation - algorithm and stages. How is cardiopulmonary resuscitation performed?

The cause of every fourth death is untimely or unskilled first aid. That is why it is important to be able to do artificial respiration, massage a stopped heart. Properly rendered first aid saves many lives.

Fundamentals of cardiopulmonary resuscitation

If a person’s pulse is not felt, the pupils do not constrict from light - these are symptoms of clinical death. However, in the absence of injuries or diseases that are absolutely incompatible with life, this condition is reversible. It is possible to bring a dying person back to life if 5-6 minutes have passed after the cardiac arrest. What happens to a person when medical help comes late?

The chances of a full restoration of body functions are sharply reduced:

• 10 minutes after the victim's heart stops, resuscitation can save the person, but his nervous system will be defective;
• 15 minutes later, you can resume breathing, heartbeat, but a person is threatened with social death (mentally a full-fledged person);
• 30-40 minutes after cardiac arrest, it is no longer possible to restore the body - biological death occurs.

Cardiopulmonary resuscitation (CPR for short) is a scientifically developed set of medical measures that can help with clinical death. The primary task in such a situation is the restoration of brain cells, the functions of the nervous system. Comprehension of the basics of cardiopulmonary resuscitation and mastery of practical skills give a real chance to save a human life.

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Indications for cardiopulmonary resuscitation

Sometimes disputes arise. When should cardiopulmonary resuscitation be performed? With a diagnosis of "clinical death", which is obvious if 4 vital signs are missing:

• pallor or blueness of the skin;
• muscle atony (a raised arm or leg falls lifelessly);
• lack of response to any stimuli.

Rules for conducting cardiopulmonary resuscitation

Actions should begin with clarification of the fact of loss of consciousness. How is cardiopulmonary resuscitation performed? If a person does not react in any way to loud questions, calls to respond, you can pat him on the cheeks, pinch him. The immobility of the chest indicates the absence of respiratory movements. During cardiac arrest, the pulse is not felt on the carotid artery. It is necessary to follow international recommendations: if it is not detected for 5 seconds, clinical death is declared, guided by the lack of consciousness and breathing.

Cardiopulmonary resuscitation, algorithm of actions

The continuity of the manipulations of voluntary assistants and doctors at all stages of work with people who have a cardiac arrest is its main principle. Carrying out cardiopulmonary resuscitation is figuratively called the "chain of life". CPR can be successful if the ambulance is called as early as possible and quickly implemented:

• medical treatment;
• defibrillation of the heart;
• ECG control.

Cardiopulmonary resuscitation in children

The most important CPR measures are artificial respiration and chest compressions. Babies restore interrupted breathing by taking "from the mouth - to the mouth and nose." How to do cardiopulmonary resuscitation? You need to throw back the baby's head and, covering his mouth and nose with his mouth, blow in the air. You just need to be careful, remembering that his tidal volume is only 30 ml!

How to do artificial respiration and heart massage if the child's lips or jaws are injured? The mouth-to-nose technique is used. Should:

• fix the forehead of the baby with one hand;
• push the lower jaw with the second hand;
• with the mouth closed, briefly, in 1 second, inhale air into the nose of a small patient;
• then a short pause;
• after the chest falls, take a second breath.

Following artificial ventilation of the lungs, an external massage of the heart, which has stopped due to acute insufficiency, is started. For young children, external heart massage is done with two fingers of the right hand: middle and index. Compression - elastic pressing on the region of the heart - must be done with such efforts that the chest is displaced to the spinal column by 3-4 cm.

Cardiopulmonary resuscitation according to new standards

The primary task is to eliminate oxygen starvation in order to prevent the biological death of a person. Tactics of cardiopulmonary resuscitation according to the new standards includes 3 stages:

Stage 1 - Primary CPR:

• elimination of obstructions in the airways;
• lung ventilation;
• external cardiac massage.

• determination of the consequences of clinical death;
• restoration of the functions of the whole organism;
• full resumption of mental activity.

Errors during cardiopulmonary resuscitation

The most common reasons for CPR failure are:

• untimely help;
• ineffective lung ventilation;
• weak vibrations of the chest during compression (for adults - less than 5 cm);
• too soft surface on which the victim is placed;
• incorrect setting of the hands of the resuscitator.

If 30 minutes of action does not help restore blood circulation, ascertain the death of the victim and stop CPR. Errors in cardiopulmonary resuscitation during the elimination of acute heart failure are fraught with serious complications. The consequence of incorrect setting of the hands of the resuscitator and excessive efforts are:

• rib fractures;
• lung injury by their fragments;
• liver ruptures;
• heart injury.

Contraindications for cardiopulmonary resuscitation

The purpose of CPR is to return a person to life, and not to delay death, therefore, such measures are futile in the presence of contraindications to cardiopulmonary resuscitation. This:

• clinical death due to diseases with total degenerative changes in the body (the last stage of cancer, acute respiratory, heart failure, etc.);
• the presence of severe injuries that are incompatible with life;
• signs of biological death (clouding of the pupil, cold body, the first cadaveric spots on the neck, etc.).

Cardiopulmonary resuscitation simulators

These manuals are designed to educate the general population about CPR. The simulators of cardiopulmonary resuscitation of the Maxim series of domestic production are effective. The most perfect model - "Maxim III" is a computerized mannequin with a monitor and a wall-mounted scoreboard-torso, which displays the correctness of all manipulations. The simpler models "Maxim II" and "Maxim I" also allow you to practice the necessary skills.

Video: cardiopulmonary resuscitation of the victim

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

Cardiopulmonary resuscitation: implementation algorithm, terminal states

The boundary between life and death, called the terminal state by doctors, can be within one breath, one heartbeat, one moment ... At such moments, all vital systems undergo significant changes. The most severe violations lead them to a state when the body loses the ability to recover without outside help. Cardiopulmonary resuscitation (CPR), which arrived in time and performed according to all the rules, in most cases succeeds and brings the victim back to life if his body has not stepped over the limit of its capabilities.

Unfortunately, it doesn't always work out the way you would like. This happens for a number of reasons that do not depend on the desire of the patient, his relatives or the ambulance crew, all misfortune can happen far from the city (highway, forest, reservoir). At the same time, the damage can be so serious, and the case is so urgent that the rescuers may not have time, because sometimes everything is decided by seconds, moreover, the possibilities of cardiopulmonary resuscitation are not unlimited.

"Don't think down the seconds..."

The terminal state is accompanied by deep functional disorders and requires intensive care. In the case of slow development of changes in the vital organs, first responders have time to stop the process of dying, which consists of three stages:

• Preagonal with the presence of a number of disorders: gas exchange in the lungs (appearance of hypoxia and Cheyne-Stokes respiration), blood circulation (drop in blood pressure, changes in rhythm and heart rate, lack of bcc), acid-base state (metabolic acidosis), electrolyte balance (hyperkalemia) . Cerebral disorders also start registering at this stage;
• Agonal - characterized as a residual manifestation of the functional abilities of a living organism with the aggravation of those disorders that began in the pre-agonal phase (decrease in blood pressure to critical numbers - 20 - 40 mm Hg, slowing of cardiac activity). Such a state precedes death, and if a person is not helped, then the final stage of the terminal state begins;
• Clinical death, when cardiac and respiratory activity ceases, but for another 5-6 minutes it is still possible to return the body to life with timely cardiopulmonary resuscitation, although this period is lengthened under conditions of hypothermia. A set of measures to restore life is appropriate during this period, since a longer time calls into question the effectiveness of cerebral resuscitation. The cerebral cortex, as the most sensitive organ, can be so damaged that it will never function normally again. In a word, the death of the cortex (decortication) will occur, as a result of which its connection with other brain structures will be disconnected and "a person will turn into a vegetable."

Thus, situations that require cardiopulmonary and cerebral resuscitation can be combined into a concept corresponding to the 3rd stage of thermal conditions, called clinical death. It is characterized by the cessation of cardiac and respiratory activity, and only about five minutes remain to save the brain. True, under conditions of hypothermia (body cooling), this time can really be extended up to 40 minutes or even an hour, which sometimes gives an extra chance for resuscitation.

What does the state of clinical death mean?

Various life-threatening situations can cause clinical death. Often it is a sudden cardiac arrest caused by a violation of the heart rhythm:

It should be noted that in modern concepts, the cessation of cardiac activity is understood not so much as a mechanical cardiac arrest, but as an insufficiency of the minimum blood circulation necessary for the full operation of all systems and organs. However, this condition can occur not only in people with patients who are registered with a cardiologist. More and more cases of sudden death of young men are recorded, even without an outpatient card in the clinic, that is, they consider themselves absolutely healthy. In addition, diseases that are not associated with heart pathology can stop blood circulation, so the causes of sudden death are divided into 2 groups: cardiogenic and non-cardiogenic origin:

• The first group consists of cases of weakening the contractility of the heart and impaired coronary circulation.
• Another group includes diseases caused by significant violations of the functional and compensatory abilities of other systems, and acute respiratory, neuroendocrine and heart failure are the result of these disorders.

It should not be forgotten that often a sudden death among “full health” does not even give 5 minutes for reflection. Complete cessation of blood circulation quickly leads to irreversible phenomena in the cerebral cortex. This time will be all the more reduced if the patient already had problems with the respiratory, cardiac and other systems and organs. This circumstance encourages the start of cardiopulmonary and cerebral resuscitation as early as possible in order not only to return the person to life, but also preserve his mental integrity.

The last (final) stage of the existence of a once living organism is considered to be biological death, in which irreversible changes occur and the complete cessation of all vital processes. Its signs are: the appearance of hypostatic (cadaveric) spots, a cold body, rigor mortis.

Everyone should know this!

When, where and under what circumstances death can overtake is difficult to predict. The worst thing is that a doctor who knows the procedure for conducting basic resuscitation cannot suddenly appear or be already present nearby. Even in a big city, an ambulance may not be at all fast (traffic jams, distance, station congestion, and many other reasons), so it is very important for anyone to know the rules of resuscitation and first aid, because there is very little time to return to life (about 5 minutes ).

The developed algorithm for cardiopulmonary resuscitation begins with general questions and recommendations that significantly affect the survival of the victims:

1. Early recognition of the terminal state;
2. Immediate call for an ambulance with a brief but sensible explanation of the situation to the dispatcher;
3. First aid and emergency start of primary resuscitation;
4. The fastest (as far as possible) transportation of the victim to the nearest hospital with an intensive care unit.

The cardiopulmonary resuscitation algorithm is not only artificial respiration and chest compressions, as many people think. The basics of measures to save a person consist in a strict sequence of actions, starting with an assessment of the situation and the condition of the victim, providing him with first aid, carrying out resuscitation in accordance with the rules and recommendations, specially developed and presented as an algorithm for cardiopulmonary resuscitation, which includes:

• Assessment of the situation (time, place, remoteness of medical institutions, crowding) with the elimination of a possible danger to the rescuer and the resuscitated person (busy highway);
• Determination of the patient's consciousness, for which he should be shaken slightly by the shoulder and asked as loudly as possible what is wrong with him and whether help is needed. If the victim is conscious, everything is simpler: calling an ambulance, providing first aid, monitoring the patient until the arrival of doctors;
• In cases of lack of consciousness, the presence of breathing, the pulse on the carotid artery, the reaction of the pupils to light should be immediately determined (10 seconds are allotted for everything). To hear breathing, it is necessary to tilt the head of the victim, raise the chin, try to detect exhaled air and chest excursion.

An ambulance is called in any case, the behavior of the rescuer depends on the situation. In the absence of signs of life, the rescuer immediately proceeds to cardiopulmonary resuscitation, strictly observing the stages and procedure for carrying out these activities. Of course, if he knows the basics and rules of basic resuscitation.

Stages of resuscitation

The greatest effectiveness of cardiopulmonary resuscitation can be expected in the first minutes (2-3). If a misfortune happened to a person outside a medical institution, of course, one should try to give him first aid, but for this it is necessary to master the technique and know the rules for such events. Primary preparation for resuscitation involves laying the patient in a horizontal position, freeing from tight clothing, accessories that interfere with the implementation of basic techniques for saving human life.

The basis of cardiopulmonary resuscitation is based on a set of measures, the task of which is:

1. Removal of the victim from the state of clinical death;
2. Restoration of life support processes;

Basic resuscitation is designed to solve two main tasks:

• Ensure airway patency and ventilation of the lungs;
• Maintain circulation.

The prognosis depends on time, so it is very important not to miss the moment of cardiac arrest and the start of resuscitation (hours, minutes), which is carried out in 3 stages while maintaining the sequence for pathology of any origin:

1. Emergency provision of patency of the upper respiratory tract;
2. Restoration of spontaneous cardiac activity;
3. Prevention of posthypoxic cerebral edema.

Thus, the cardiopulmonary resuscitation algorithm does not depend on the cause of clinical death. Of course, each stage includes its own methods and techniques, which will be described below.

How to make the lungs breathe?

Immediate airway management techniques work particularly well if the victim's head is tilted back at the same time as the jaw is fully extended and the mouth is opened. This technique is called the triple Safar technique. However, about the first stage in order:

• The victim must be laid on his back in a horizontal position;
• For maximum tilting of the patient's head, the rescuer needs to put one hand under his neck, and place the other on his forehead, while making a test breath "from mouth to mouth";
• If there is no effectiveness from a test breath, they try to push the victim's lower jaw forward to the maximum, then up. The objects that caused the closure of the respiratory tract (dentures, blood, mucus) are quickly removed by any means that are at hand (handkerchief, napkin, piece of cloth).

It should be remembered that it is permissible to spend the very minimum of time on these activities. And the time for reflection is not included in the emergency protocol at all.

Recommendations for urgent rescue measures are useful only to ordinary people who do not have a medical education. The ambulance team, as a rule, owns all the techniques and, in addition, in order to restore the patency of the airways, uses various types of air ducts, vacuum aspirators, and, if necessary (obturation of the lower parts of the DP), performs tracheal intubation.

Tracheostomy in cardiopulmonary resuscitation is used in very rare cases, since this is already an operative intervention that requires special skills, knowledge and a certain amount of time.. An absolute indication for it is only obstruction of the airways in the region of the vocal cords or at the entrance to the larynx. Such manipulation is more often performed in children with laryngospasm, when there is a danger of the child's death on the way to the hospital.

If the first stage of resuscitation was not successful (the patency was restored, but the respiratory movements did not resume), simple techniques are used, which we call artificial respiration, the technique of which is very important for any person to master. ALV (artificial ventilation of the lungs) without the use of a "breather" (breathing apparatus - they are equipped with all ambulances) begins with the rescuer's own exhaled air blown into the nose or mouth of the resuscitated. It is more expedient, of course, to use the “mouth-to-mouth” technique, since narrow nasal passages can be clogged with something or simply become an obstacle at the inhalation stage.

Step by step IVL will look something like this:

1. The reviver takes a deep breath and at the same time, in order to create tightness, pinches the victim’s nostrils with his fingers, exhales the air and monitors the movement of the chest: if its volume increases, then the process is going in the right direction and will be followed by a passive exhalation with a decrease in chest volume. cells;
2. The frequency of respiratory cycles is 12 movements per minute, and the pause between them is 5 seconds. The volume of inhalation created artificially should be about 1 liter;
3. The most significant measure of the positive effect of artificial respiration is the movement (expansion and collapse) of the chest. If, when performing artificial respiration techniques, the epigastric region expands, one can suspect that air does not enter the lungs, but into the stomach, which is fraught with the movement of gastric contents upward and impaired airway patency.

At first glance, it seems that such a ventilation method cannot give high efficiency, so some are skeptical about it. Meanwhile, this wonderful technique has saved and continues to save more than one life, although for the reviver it is quite tiring. In such cases, if possible, various devices and devices for ventilation help, improving the physiological basis of artificial respiration (air + oxygen) and observing hygiene rules.

Video: artificial respiration and first aid for an adult and a child

The resumption of spontaneous cardiac activity is an inspiring sign

The basics of the next stage of resuscitation (artificial circulatory support) can be represented as a two-step process:

• Techniques that make up the first urgency. This - closed heart massage;
• Primary intensive care, which involves the administration of drugs that stimulate the heart. As a rule, this is an intravenous, intratracheal, intracardiac injection of adrenaline (with atropine), which can be repeated if necessary during resuscitation (a total of 5-6 ml of the drug is acceptable).

Such resuscitation as cardiac defibrillation, is also carried out by a medical worker who arrived at the call. Indications for it are conditions caused by ventricular fibrillation (electric shock, drowning, coronary heart disease, etc.). However, ordinary people do not have access to a defibrillator, so it is not advisable to consider resuscitation from this point of view.

defibrillation of the heart

The most accessible, simple and at the same time effective method of emergency restoration of blood circulation is an indirect heart massage. According to the protocol, it should be started immediately, as soon as the fact of an acute cessation of blood circulation is recorded, regardless of the causes and mechanism of its occurrence (unless it is a polytrauma with a fracture of the ribs and a rupture of the lung, which is a contraindication). It is necessary to carry out a closed massage all the time until the heart begins to work independently in order to provide blood circulation at least in a minimal amount.

How to make the heart work?

A closed heart massage is started by a bystander who happened to be nearby. And since any of us can become this passer-by, it would be nice to get acquainted with the methodology for carrying out such an important procedure. You should never wait until the heart stops completely or hope that it will restore its activity on its own. The inefficiency of heart contractions is a direct indication for the beginning of CPR and chest compressions in particular. The effectiveness of the latter is due to strict observance of the rules for its implementation:

1. Laying the patient in a horizontal position on a hard surface (a springy, soft surface will help to shift the body under the influence of the hands of the resuscitator).
2. The location of the area of ​​application of the force of the hands of the rescuer on the sternum (lower third), in no case deviating from the midline. In this case, it does not matter which side of the victim the rescuer will stand on.
3. Hands folded crosswise are placed on the sternum (3-4 fingers below the xiphoid process) and pressure is applied with the wrists (without the participation of fingers).

Video: chest compressions

Effectiveness of revitalization measures. Criteria for evaluation

If CPR is performed by one person, then two rapid air injections into the lungs of the victim alternate with chest compressions and, thus, the ratio of artificial respiration: closed heart massage will be = 2:12. If resuscitation is carried out by two rescuers, then the ratio will be 1:5 (1 breath + 5 chest compressions).

Conducting an indirect heart massage is carried out under mandatory control over the effectiveness, the criteria for which should be considered:

• Change in the color of the skin ("face comes to life");
• The appearance of pupillary reaction to light;
• Resumption of pulsation of the carotid and femoral arteries (sometimes the radial);
• An increase in blood pressure domm. rt. Art. (when measured in the traditional way - on the shoulder);
• The patient begins breathe on your own which, unfortunately, happens infrequently.

The prevention of the development of cerebral edema should be remembered, even if the heart massage lasted only a couple of minutes, not to mention the absence of consciousness for a couple of hours. In order to preserve the personal qualities of the victim after the restoration of cardiac activity, he is prescribed hypothermia - cooling to 32-34 ° C (meaning positive temperature).

When is a person declared dead?

It often happens that all efforts to save lives are in vain. At what point do we begin to understand this? Resuscitation measures lose their meaning if:

1. All signs of life disappear, but symptoms of brain death appear;
2. Half an hour after the start of CPR, even reduced blood flow does not appear.

However, I would like to emphasize that the duration of resuscitation measures also depends on a number of factors:

• Causes that led to sudden death;
• Duration of complete cessation of breathing and circulation;
• The effectiveness of efforts to save a person.

It is believed that any terminal condition, regardless of the cause of its occurrence, serves as an indication for CPR, so it turns out that resuscitation measures, in principle, have no contraindications. In general, this is true, but there are some nuances that can be considered contraindications to some extent:

1. Polytraumas received, for example, in an accident, may be accompanied by a fracture of the ribs, sternum, rupture of the lungs. Of course, resuscitation in such cases should be carried out by a high-class specialist who can recognize serious violations at a glance, which can be attributed to contraindications;
2. Diseases when CPR is not performed due to inappropriateness. This applies to cancer patients in the terminal stage of the tumor, patients who have suffered a severe stroke (hemorrhage in the trunk, large hemispheric hematoma), with severe dysfunction of organs and systems, or patients already in a "vegetative state".

In conclusion: segregation of duties

Everyone can think to himself: “It would be nice not to face such a situation that I had to carry out resuscitation measures.” Meanwhile, this does not depend on our desire, because life, at times, presents various surprises, including unpleasant ones. Perhaps, someone's life will depend on our composure, knowledge, and skills, therefore, remembering the cardiopulmonary resuscitation algorithm, you can brilliantly cope with this task, and then be proud of yourself.

The procedure for resuscitation, in addition to ensuring the patency of the airways (IVL) and the resumption of blood flow (closed heart massage), includes other techniques used in an emergency situation, but they are already in the competence of qualified medical workers.

The beginning of intensive care is associated with the introduction of injection solutions not only intravenously, but also intratracheally and intracardiac, and for this, in addition to knowledge, skill is also needed. Conducting electrical defibrillation and tracheostomy, the use of ventilators and other devices for the implementation of cardiopulmonary and cerebral resuscitation - these are the capabilities of a well-equipped ambulance team. An ordinary citizen can only use his own hands and improvised means.

Once next to a dying person, the main thing is not to get confused: quickly call an ambulance, start resuscitation and wait for the brigade to arrive. The rest will be done by the doctors of the hospital, where the victim with a siren and "flashing lights" will be delivered.

Content

When a person's heart stops, the threat of death is the highest. There are many reasons for the “motor” to stop working: hypothermia, lack of oxygen, ischemia, hemorrhagic or anaphylactic shock. An accident, acute poisoning of the body, lightning strike, electric current, cardiovascular insufficiency, myocardial infarction, traumatic brain injury can also provoke a state of clinical death. First aid for cardiac arrest has a very small time factor (5-6 minutes). How to do everything right and do no harm?

Rules for first aid in case of cardiac arrest

The main actions aimed at providing assistance are artificial respiration and chest compressions. It should be remembered when it is impossible to start resuscitation measures:

• If the victim has lost consciousness, does not react to the environment, but the pulse and breathing are felt.
• If an extensive fracture of the chest is suspected, these measures cannot be performed!

First aid, when signs of cardiac arrest are identified, includes:

1. Immediate call to the rescue service. It is necessary to tell the doctors where you are, what symptoms the victim has.
2. Next, free him from outerwear, provide oxygen access.
3. Check the pulse, consciousness, pupillary reaction, breathing. If these signs are absent, then only then should one proceed to resuscitation techniques.

First aid algorithm:

1. Position the victim on a level surface. Check the pulse and see if the pupils react to bright light.
2. Tilt your head back at a 45 degree angle. Clear the airways of foam, vomit, blood or mucus, if any.
3. External massage should alternate with artificial respiration. If resuscitation is done by two, then the ratio of "inhalation-massage" is 1/5, if one person, then 2/15.
4. During artificial ventilation of the lungs, the victim needs to open his mouth, pinch his nose.

How to do artificial respiration

The main help in cardiac arrest, which allows you to save a life in a quick way, is artificial respiration. It is necessary to grab the victim by the chin with one hand, pinch his nose with the other, then gently inhale air into the victim's lungs. The chest will rise when you inhale, and if this action does not occur, most likely there is an obstruction in the airways.

Technique for performing chest compressions

Before you start, you need to perform an important action - a precordial beat. It is performed once, they hit the sternum (its middle part) with a fist. Chest compression is the first emergency treatment for cardiac arrest to maintain circulation. The rescuer puts his palms on the chest of the victim, rhythmically presses on the chest area. Depth of pressing 5 cm, frequency - 100/min. Alternate: 30 compressions and 2 breaths. Activities are aimed at automatically starting the work of the heart muscle.

Direct cardiac massage

This procedure can only be performed by a surgeon under conditions of absolute sterility and antisepsis. The method involves direct contact with the human heart. The doctor literally compresses the organ, focusing on the left ventricle to ensure the outflow of blood. This event is combined with artificial respiration of the lungs or a ventilator. The efficiency of work is checked on the readings of the heart rate monitor and cardiogram.

Video: what to do with sudden cardiac arrest

In the video below, the anesthesiologist of the Institute of Cardiology will show the procedure for first aid when the heart stops working: checking the victim’s pulse and cardiopulmonary resuscitation. After watching this video, you will gain valuable knowledge and learn how to provide the necessary first aid.

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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