Prevent retraction of the tongue. Treatment of acute respiratory failure. Retraction of the tongue and laryngospasm. Reasons for stopping breathing during sleep, or sleep apnea syndrome. Why it happens and how to treat

The unconscious state always contains a certain danger. A person who has lost consciousness does not feel anything, his pain threshold lowered, he does not understand what is happening to him, is not able to help himself. Therefore, the victim needs medical care.

The unconscious state is characterized by a serious threat of choking with vomit, blood, mucus and other masses that rush from digestive tract outside, blocking the airways. However, more often in practice there is another problem that is considered more dangerous than the movement of vomit, this is the displacement of the root of the tongue.

What it is?

Relaxation of the muscles of the lower jaw and root at a time when a person is unconscious will inevitably lead to the movement of the tongue from its usual position to the larynx. This phenomenon in the people and medicine was called "retraction of the tongue." It is characterized by the displacement of the muscles of the tongue to the wall of the larynx, which leads to the cessation of air flow into the lungs, resulting in suffocation, in other words, asphyxia.

The retraction of the root of the tongue is primarily dangerous because, if not needed help, a person will suffocate due to lack of air. Asphyxia, which develops as a result of the displacement of the tongue, leads to a decrease in the level of oxygen in the tissues and an increase in the level of carbon dioxide in the blood. As a result, a person dies within 10 minutes from suffocation.

Causes of tongue retraction

The main reason for the development of this pathological condition is the relaxation of the root of the tongue and the muscles of the lower jaw, which partly control the position of the tongue in the oral cavity. So, for example, if the victim has a broken lower jaw on both sides, then the probability of displacement of the root of the tongue is quite high.

However, in medical practice, such a cause of tongue displacement as a broken jaw is rare. Much more often, a similar phenomenon occurs during a long coma, in which many muscles atrophy, including the tongue. Retraction of the tongue in a patient may occur after the application of anesthesia before surgery. Also, pathology is observed in victims of accidents and other accidents that entail a strong pain shock.

Epilepsy is one of the causes

There are still many myths about swallowing the tongue during epileptic seizure. Some people who are ignorant of medicine try to open the mouth of an epileptic during an attack with a spoon, pens, or their own fingers, simultaneously fixing the unclenched jaws with a stick or other objects. It should be noted here that such activities will not only not help the patient, but can also break his teeth and damage the oral mucosa.

The only way a passer-by can help a person suffering from an epileptic seizure is to try to secure the space around him as much as possible: remove hot and sharp objects in order to prevent head injury, lay soft clothes under it. During an attack, a person can, but in no case will he swallow it, for another reason that during an epileptic seizure, all the muscles of the body are extremely tense and in hypertonicity.

However, retraction of the tongue can really happen, only not during an attack, but after it, when the muscles, on the contrary, are in a state of hypotonicity. AT this case relaxation of the root of the tongue can cause it to move from its usual position and subsequent blockage of the larynx.

Appearances of pathology

As mentioned, main symptom and at the same time, the most negative consequence of tongue displacement is suffocation. A person cannot breathe air, as the path to the lungs is blocked. Nor can he exhale the air filled with carbon dioxide, as a result of which blood circulation is disturbed in the body. This leads to a change in the complexion of the patient, it acquires a bluish tint. How longer man does not receive the necessary amount of oxygen, the further the so-called cyanosis spreads: the upper part turns blue chest.

A person who has had a retraction of the root of the tongue begins to sweat profusely, the veins in his neck swell and increase in size. He begins to make reflex arms and legs, rushing from side to side due to the inability to take a full breath. By itself, breathing is hoarse, arrhythmic (due to excessive stress intercostal muscles and neck muscles).

How to help?

First of all, a person who has had a displacement of the tongue must be placed in horizontal position. After performing this manipulation, it is necessary to throw back his head: the left hand is placed on the forehead of the victim, and the right hand at this time raises the neck, a fixative (pillow, roller) is placed under it. After tilting the head, you need to push it lower jaw. To do this, its right and left corners are taken with two hands, shifted down and then rise forward. If breathing is restored, then the person should be turned to one side to prevent re-sagging.

If these measures did not help restore airway patency when the tongue retracted, then you need to move on to a proven and guaranteed way to stop the state of suffocation by getting rid of causative factor. In this case, this is the removal of the tongue from the oral cavity and its fixation from the outside. Manipulation involves pulling the tongue out of the mouth with the help of cloth-wrapped fingers, tweezers, tongs, and, in fact, any tool capable of capturing and holding the tongue. next step is its fixation at the chin by means of an adhesive plaster or bandage.

If the displacement of the root of the tongue occurred due to a fracture of the lower jaw, then assistance should immediately begin with its removal from the mouth and subsequent fixation at the chin. Subsequent manipulations, such as matching and connecting fragments of a broken jaw, can only be performed in a specialized institution. Also, in the carriages called by the ambulance, doctors can provide professional assistance in case of retraction of the tongue, as they have devices for artificial ventilation of the lungs. A special air duct is placed between the root of the tongue and the wall of the pharynx, providing the lungs with air flow.

What Not to Do

All manipulations regarding the movement of the victim in space and changing the position of his head and neck are contraindicated if a person has a suspicion of a fracture of the cervical region. Any inaccurate movement in relation to the victim can harm him even more. In this case, it is enough to change the position of the jaw forward and down.

It is also worth noting that some citizens have a myth firmly entrenched in their heads, which says that it is necessary to take out the tongue and pin it with a pin, needle to the collar of the clothes or the cheek of the victim. To do this is absolutely contraindicated, and it is pointless. Moreover, first aid in case of tongue retraction should not be provided by such barbaric methods. To fix the tongue, a regular adhesive plaster attached to the chin is suitable. Moreover, the fixation itself is necessary in extreme cases usually enough to change the position of the head and neck.

Language Root Displacement Warning

When a person loses consciousness, the muscles of his body relax, including the tongue, which can fall against the back of the larynx, causing an attack of suffocation. This does not happen so often with ordinary fainting, but a number of measures should still be carried out, the purpose of which is to prevent the retraction of the tongue. Its main principle is to tilt the head of the victim back by raising the neck and placing a roller under it. It is also possible to attach the tongue with an adhesive bandage or bandage passing through the bottom of the lower jaw and securing around the forehead. If the jaw is broken, then you need to act differently: you need to put a person on his stomach, face down.

Conclusion

The fall of the tongue is quite dangerous phenomenon, which consists in the displacement of its root and blockage of the respiratory tract. similar condition occurs when the muscles of the body, including the tongue, relax during unconsciousness, coma and anesthesia, as well as fractures of the lower jaw.

When the tongue is displaced, a person begins to suffocate, the veins in his neck swell, his breathing becomes hoarse, his face gradually turns blue. You can help a person by throwing his head back and changing the position of the jaw. It also helps to fix the tongue outside the mouth by attaching it to the chin, but in no case with pins or needles.

Acute respiratory and circulatory disorders are the leading cause of death in accidents, heart attacks or severe injuries. More than 340 thousand people die annually on the roads of various countries alone, more than 140 thousand die on the water and die from heart attack over 1 million people.

Nature has determined a strict "time limit" for the life of a victim with severe impairment of vital functions. It is well known that circulatory arrest for more than 5 minutes per normal conditions leads to irreversible changes in the cells of the cerebral cortex and the process of revitalization becomes unpromising. This explains the need for an immediate struggle for the life of the victim.

First aid to the victim can practically be provided only by the one who happened to be nearby. The arrival of an ambulance is inevitably associated with the loss of valuable time, often exceeding the limits of a possible revival. Statistics show that in 30-50% of cases, deaths can be avoided with emergency conditions if timely and correctly provide assistance to the victims.

The most important task of practical health care is the all-round approximation of the first emergency care to the population. To a certain extent, this task will be helped by systematic training not only of medical personnel, but also of the organized part of the population by simple and available methods providing emergency care for life-threatening conditions.

EMERGENCY HELP FOR ACUTE RESPIRATORY DISORDERS

There are many reasons that can lead to life-threatening breathing disorders. They can be represented as follows.

1. Damage central mechanisms regulation of breathing: severe injuries of the head and spinal cord, electric shock or lightning strikes, cerebral hemorrhage (stroke), poisoning from sleeping pills or drugs, sharp inflammatory diseases brain and meninges.
2. Stay in the atmosphere with low content oxygen (smoky and gassed workshops, garages, silos, abandoned wells and mines, tanks), leading to oxygen starvation(hypoxia), loss of consciousness, convulsions, and subsequently cardiac arrest.
3. Full or partial obstruction respiratory tract. It is observed when the root of the tongue and lower jaw is retracted in patients who are in an unconscious state; on hit foreign bodies in the oropharynx, trachea and bronchi, compression of the larynx and trachea (edema, goiter, tumors); drowning, spasm of the glottis (laryngospasm) and bronchi ( bronchial asthma, allergy). In these cases, gas exchange is disturbed, suffocation increases, which leads a person to critical situation.
4. Injuries to the chest and lungs, noted in severe trauma with multiple fractures ribs, chest compression, electric shock, convulsive states(tetanus, epilepsy, fever), compression of the lungs due to ingestion pleural cavity(thin-walled bag around the lung) air, fluid, blood. In these cases, the normal mechanism of breathing is disturbed in patients, hypoxia increases ( oxygen deficiency), which can lead to cardiac arrest.
5. lung disease or injury; inflammation, swelling, injury lung tissue. In these conditions, respiratory disorders sometimes increase gradually, but, despite this, they sometimes pose a threat to life.
6. Respiratory disorders due to circulatory and gas exchange disorders: with myocardial infarction and heart failure, cardiac arrest, shock, severe blood loss, exhaust gas poisoning ( carbon monoxide), aniline dyes, cyanide compounds.

The respiratory disorders indicated in this group are of a secondary nature, but when providing first aid in these cases, artificial respiration methods cannot be dispensed with.

most disturbing and dangerous symptom life threatening respiratory disorders - respiratory arrest (apnea), which is determined by the absence respiratory movements chest and diaphragm, the absence of respiratory noise and air movement, increasing cyanosis of the face. In case of doubt (there is breath or not), it should be considered that there is no breath.

Signs of respiratory distress are also shortness of breath, frequent and shallow or, on the contrary, rare breathing (5-8 breaths per 1 minute), shortness of breath with a long inhalation or exhalation, a feeling of suffocation and psychomotor agitation. Important signs of respiratory distress are increasing cyanosis of the lips, face, fingertips, confusion (coma).

Emergency care for acute respiratory disorders includes two steps:

• A - the release of the respiratory tract from mucus and foreign bodies;
• B - carrying out artificial respiration.

Both techniques form the basis of the first emergency resuscitation aid and represent a kind of "alphabet" of resuscitation, in which the sequence of techniques is conditionally determined by the following order of letters: A, B, C.

If the use of the first two methods of resuscitation did not work, the victim does not breathe and he has no pulse, then the third one is added to the methods taken!

• C - cardiopulmonary bypass by external heart massage.

These revitalization techniques form the basis of medical care. They are available to every person who will learn them. They do not require any additional conditions or special equipment apart from knowledge and practical skills.

Airway clearance techniques

Most common cause the closure of the airways in patients or victims who are unconscious is the retraction of the root of the tongue and lower jaw due to the relaxation of all the muscles that support the lower jaw. The muscles hang down and the root of the tongue blocks the entrance to the larynx.

More often this occurs when the patient is lying on his back, since exhalation in these cases is free, and inhalation is impossible, despite the efforts of the muscles of the chest and abdomen. The volume of air in the lungs progressively decreases, its rarefaction in the airways increases, and the tongue "sucks", sinking even deeper into the oropharynx. If the patient is not helped, he will die.

The technique of releasing the airways consists in the maximum extension of the head. To do this, the assisting person places one hand on the back of the neck, the other in the forehead and produces a slight but vigorous extension of the head backwards. At the same time, the muscles of the floor of the oral cavity and the root of the tongue and the epiglottis associated with it are stretched, shifted upward and open the entrance to the larynx.

If the patient still has independent breathing, then after removing the obstacle in the airways, it improves significantly, its depth increases. Along with this, the patient's bluish complexion disappears, consciousness may clear up.

If there is no spontaneous breathing, it is necessary to produce artificial respiration mouth-to-mouth or mouth-to-nose. Keeping the position of the patient's head in a state of extension, after a deep breath, widely embracing the victim's mouth and pinching his nose with his fingers, make a forced exhalation into his respiratory tract.

The effectiveness of inflation can be seen by the increase in chest volume and the noise of exhaled air. If during the forced blowing of air into the respiratory tract of the victim there is any resistance, the chest does not straighten out or the air goes into the stomach and you can see how the swelling increases in epigastric region, then the airway is not cleared and the obstruction persists.

It was noted that in 20% of patients, especially in elderly and old age, reception of maximum extension of the head full disclosure does not provide airways. In such cases, it is necessary for the patient to push the lower jaw forward. To do this, with the pressure of the thumbs of both hands, it is first shifted down, and then with the help of the index fingers located at the corners of the lower jaw, it is pushed forward so that the teeth of the lower jaw are in front of the upper incisors.

Optimal conditions for the release of the airways from retraction of the tongue are achieved combined reception: maximum extension of the head, extension of the lower jaw and opening of the patient's mouth.

In this case, the oral cavity becomes available for inspection. If there is liquid content or pieces of food in the mouth, they must be quickly removed (with a finger wrapped in a napkin) and the mouth should be dried with a towel or improvised material. At the end of the toilet, the oral cavity immediately begin to carry out artificial respiration.

If an unconscious patient has spontaneous breathing, then in order to prevent re-entrapment of the root of the tongue and lower jaw, it is necessary to keep his head in a state of extension all the time. If this is not possible (if there are other victims who need help), the patient should be given a stable lateral position.

For this, the patient is turned on the right side, the right hand is brought to the body, right leg bend in knee joint, and lead to the stomach, left hand bent at the elbow joint, and her palm is placed under the right half of the patient's face. At the same time, the head is slightly thrown back. In such a stable position on the side, favorable conditions for breathing, the retraction of the tongue, the flow of mucus or blood into the respiratory tract is excluded. The patient should be monitored until the ambulance arrives.

Dangerous breathing disorders occur when foreign bodies enter the respiratory tract, for example, poorly chewed meat food. The food bolus, stuck in the oropharynx, leads to squeezing of the epiglottis and closing the entrance to the larynx. The victim stops breathing, there is no voice (explained by gestures), he cannot cough, since inhalation is impossible. Subsequently, suffocation occurs, consciousness disappears, convulsions appear, and death is possible. This person needs urgent help.

For removing food bolus from the oropharynx, the following technique is offered: the victim in a standing position, slightly inclined, is applied swipe the base of the palm in the interscapular region. In this case, a powerful artificially induced cough shock is obtained, which, after 2-3 strokes, first contributes to the displacement and then the removal of the food bolus.

If this technique turned out to be ineffective, the following can be recommended: the rescuer stands behind the victim, covers him with his right hand so that the palm, clenched into a fist, is located in the epigastric region; with his left hand he grabs his right hand and with an energetic movement squeezes the body of the victim from the bottom up. Created in this way high blood pressure in upper section abdominal cavity and airways is transmitted jerkily to the place of the obstacle in the oropharynx and contributes to the ejection of the foreign body.

If the patient is unconscious and lies on the floor, then the removal of the foreign body from the oropharynx is carried out as follows: the head is extended as much as possible, the mouth is opened, the tongue is pulled out with a napkin, and with the index and middle fingers, immersed deep in the oropharynx, they try to grab or push the food lump.

If the patient has weakened or absent spontaneous breathing, after the toilet of the oral cavity, artificial ventilation of the lungs is started - artificial respiration according to the "mouth to mouth" method.

Under the same conditions, another technique for removing a foreign body from the oropharynx can be applied. The patient is turned into a prone position. With the left hand they grab the head in the forehead and throw it back, and with the palm right hand apply 3-4 tapping blows in the middle zone of the interscapular region. Then the patient needs to be turned on his back, do digital examination half a mouth and remove the foreign body. If necessary, start artificial ventilation lungs.

If liquid enters the respiratory tract (for example, when drowning), it is necessary to give the victim a position with his head down, hanging his torso over right knee rescuer. With the left hand, the head is unbent as far back as possible, and with the palm of the right hand, 3-5 blows are applied to the back. The air push created by this, and the force of gravity contribute to the outflow of fluid from the respiratory tract.

Compression in the stomach area under the weight of the victim's body contributes to the outflow of fluid from the digestive canal, which creates more favorable conditions for subsequent revival.

If the rescuer does not have sufficient physical strength, then in such cases it is possible to turn the victim on his right side, throw his head back and apply 4-5 blows from the back in the interscapular region with the palm of his right hand. Then make a toilet of the oral cavity and proceed to artificial ventilation of the lungs.

If liquid or mucus enters the respiratory tract in young children or newborns, it is necessary to lift the child by the legs upside down with the left hand (the liquid flows out due to its gravity). Open the child's mouth with your right hand and dry his mouth with a finger wrapped in a napkin. In this case, you can apply the tapping technique on the back. Then you should switch to artificial ventilation of the lungs, if necessary.

If solid foreign bodies enter the child's respiratory tract, he should be placed face down on his left arm and left thigh, slightly bent at the knee joint, and pressing the legs with his shoulder and forearm to the body, lower him head down. With the right hand, inflict several tapping blows on the back. If the foreign body moves freely in the airways due to its gravity, it will descend to vocal cords. During inhalation or during the tapping period, a foreign body may pop out of the respiratory tract.

It should be remembered that if such emergency procedures are unsuccessful, it is necessary to call an ambulance and take the patient to the hospital, where they will use special instrumental methods removal of foreign bodies. Delay in providing medical care often leads to severe complications from the respiratory organs.

When foreign bodies (liquid or solid) enter the respiratory tract in adults, the principle of removing them under normal emergency conditions remains the same as in children: creating an inclined position and tapping on the back. An inclined position for an adult can be created using the back of a chair, through which he "outweighs" his torso, and with his arms lowered down, he holds and leans on the seat.

This position should be created as long as possible, periodically repeating tapping with the palm of the hand on the lateral surfaces of the chest. The patient should also be referred to medical institution, calling an ambulance to prevent possible further complications.

To acute disorders breathing applies to asthma attack, which is characterized by an attack of suffocation (bronchospasm), a typical posture of a patient with raised shoulders, a short breath and a long painful exhalation with the participation of all muscles. The attack is accompanied by coughing and wheezing in the lungs, severe cyanosis of the face.

First aid consists in relieving an attack of bronchospasm with special pharmacological agents about which patients are usually well aware. Aerosol inhalations are most effective in this case: salbutamol, euspiran, aetmopent, isadrin, etc. Aerosol inhalations (1-2 procedures) relieve an asthmatic attack in a few minutes.

These are the simplest methods of ensuring the patency of the airway - the first essential component"ABC" of revival.

In cases of respiratory arrest or its sharp weakening, it is necessary to proceed to next appointment(C) - artificial respiration.

Methods of artificial respiration

Until the 60s of our century, manual methods of artificial respiration by external exposure to the chest were widespread. In terms of their effectiveness, they are significantly inferior to expiratory ones, which are based not on squeezing the chest, but on blowing air into the patient's respiratory tract according to the “mouth-to-mouth” or “mouth-to-nose” method. Research has shown that artificial respiration using instillation techniques has a number of advantages and has practically “crowded out” other methods in emergency care.

• Firstly, the methods of air injection are physiologically justified for ensuring gas exchange, since the oxygen content in the exhaled air is 16-18 vol.% and it is enough to support the life of the victim for a long time.
• Secondly, with this method, a sufficiently large volume of air is blown in and the blowing efficiency is easy to control. The caregiver observes how the victim's chest rises and straightens.
• Thirdly, the method of blowing air is not tiring, and schoolchildren and adolescents can use it at any time in various situations after receiving a brief instruction.

Artificial respiration methods have a disadvantage: their use is contraindicated in the presence of a risk of infection ( infectious diseases, venereal diseases).

Mouth-to-mouth artificial respiration technique consists in the fact that the assisting person, having performed the head extension and opening of the airways, after a deep breath widely open mouth closes the mouth of the victim and produces a forced blowing of air into his lungs. At the same time, with his cheek or fingers, he must close the nasal passages of the patient to create complete tightness.

At the same time, chest excursion is monitored. The first 3-5 breaths should be done at a fast pace, and the next - at a frequency of 12-14 per minute. The inspiratory volume should be approximately 600-700 cm3 for an adult, which is less than half vital capacity lungs of a middle-aged person.

After the air is blown in, the assisting person moves his head to the side, the victim passively exhales through the open airways. With each inhalation, the chest should rise, and with exhalation, it should fall.

If during the blowing of air in the airways there is any resistance or the air goes into the stomach, it is necessary to more intensively perform the head extension technique.

It is also necessary to carefully monitor that gastric contents do not appear in the oropharynx, because with the next blowing of air, it can enter the patient's lungs and cause complications. The contents of the oral cavity should be immediately removed with a tissue, towel or other improvised material.

For hygienic purposes, the patient's mouth should be covered with a clean napkin or handkerchief, which, without interfering with the blowing of air, isolate the patient's face from direct contact.

Before carrying out artificial respiration, the victim must be laid on a hard, flat surface, the neck and chest area should be freed from clothing, and the abdomen should be exposed. These activities are necessary for simultaneous closed heart massage.

In some conditions of the victim (convulsive reduction of the jaws, trauma to the lower jaw and soft tissues), artificial respiration "from mouth to mouth" cannot be performed. In these cases, proceed to artificial respiration according to the "mouth to nose" method.

His technique is simple. With one hand, located on the scalp and forehead, throw back the head of the victim, with the other, raising his chin and lower jaw, close his mouth. The mouth can be covered additionally with a napkin and thumb. Air is blown through the nasal passages, covered with a clean napkin or handkerchief.

During the period of passive exhalation, the victim's mouth should be slightly opened. Then the blowing is repeated in the same rhythm. The effectiveness of air injections is assessed by the degree of respiratory excursions of the chest.

Artificial respiration in children is performed by blowing air into the mouth and nose at the same time. The frequency of breaths should be 18-20 breaths per minute, but the volume of breaths should be small so as not to damage the lungs by overstretching. The volume of air blown in is controlled by the amount of chest excursion and depends on the age of the child.

The release of the respiratory tract from mucus and foreign bodies, the implementation of artificial respiration with such an extremely serious complication, like cardiac arrest, does not ensure the success of resuscitation. In addition to ventilation of the lungs, it is necessary to solve another very important task: how to deliver oxygen from the lungs to vital organs and, first of all, to the brain and heart muscle.

This problem is solved by the third method of the "alphabet" of animation, marked with the letter "C". It is aimed at .

Sylvester's method: the victim is placed on his back, a roller is placed under the shoulder blades, and therefore the head is thrown back. Then, the person performing artificial respiration kneels at the head, at the expense of 1-2 raises the victim's arms up and back - inhale, at the expense of 3-4 lowers down, pressing to the chest with bent elbows - exhale.

Schaeffer's method: the victim is placed on his stomach, artificial respiration sits on top (on his knees on the buttocks of the victim), wraps his arms around side surfaces chest, compresses the chest - exhale, lets go - inhale. This method is used for fractures of the upper limbs.

The method of artificial ventilation of the lungs "mouth to mouth" or "mouth to nose".

The victim is placed as far as possible on a flat and hard surface(ground, floor) facing up, then his head is thrown back as much as possible, for which it is best to put a roller (from clothes, etc.) under his back in the area of ​​​​the shoulder blades.

Before starting artificial ventilation of the lungs, it is necessary to make sure that the upper respiratory tract is patent. Usually, when the head is tilted back, the mouth opens voluntarily. If the patient's jaws are tightly compressed, then they should be moved apart with some flat object (the handle of a spoon, etc.) and a roller of bandage or cotton wool or any other non-traumatic tissue should be placed between the teeth in the form of a spacer. After that, with a finger wrapped in a handkerchief, gauze or other thin cloth, the oral cavity is quickly examined, which should be freed from vomit, mucus, blood, sand, and removable earth dentures.

It is necessary to unbutton the patient's clothes, which impede breathing and blood circulation. All these preparatory measures must be carried out as quickly as possible, but very carefully and carefully, because. gross manipulations can worsen the already critical condition of the patient or victim.

The caregiver kneels on the right hand of the victim. If there is an air duct, then it should be inserted into the oropharynx to prevent retraction of the tongue and lower jaw. If there is no air duct, the lower jaw (by the chin) should be held with the right hand, moving it forward and slightly opening the mouth. With the left hand (thumb and forefinger) pinch the nose. A gauze is preliminarily applied to the mouth.

After a deep breath, the caregiver leans over the victim, covers his mouth with his lips and evenly blows air into the victim's mouth. If the inflation is performed correctly, the victim's chest will expand.

Inhalation is performed passively due to the elastic contraction of the lung tissue and the collapse of the chest. Adults blow air 10-12 times per minute, then more often.

Artificial respiration using the "mouth-to-nose" method is performed in a similar way, with the difference that the victim's mouth is tightly covered, and the inhalation of the inhaled air is carried out through the nose.

Combating cardiac arrest, non-direct cardiac massage technique.

The main symptoms of cardiac arrest: loss of consciousness, lack of pulse, heart sounds, respiratory arrest, pallor and cyanosis of the skin, dilated pupils, convulsions.

Heart massage should be carried out in parallel with artificial respiration.

Indirect cardiac massage produce a trace. manner. The victim is placed on his back on a hard surface (floor, table, couch). The caregiver stands on the left side of the victim. The palm (base of the palm) of one hand (right) is placed on the lower third of the sternum, the other (left) - on the rear of the right. The arms should be deployed at the elbow joints. Vigorous jerky movements are made 50-70 times per minute. When pressing on the sternum, it shifts 4-5 cm towards the spine, compresses the heart, blood is pumped from the left ventricle into the aorta and enters the periphery and the brain, from the right ventricle into the lungs, where it is saturated with oxygen.

In this case, not only the strength of the hands is used, but also they are pressed with the whole body. In children, heart massage should be performed with less force, pressing on the chest with only the fingertips, and in very young children, with only one finger at a frequency of 100-120 pressures per minute.

If resuscitation is carried out by 2 people, one inflation of the lungs should be performed for 4-5 compressions of the sternum. In the absence of a peripheral pulse and respiration for 2-3 minutes, they switch to an open heart massage.

Measures for the prevention of falling tongue.

Retraction of the tongue occurs in coma, traumatic brain injury and leads to asphyxia. To prevent retraction of the tongue, it is necessary to: push the lower jaw anteriorly (behind the corner of the lower jaw with both hands), fix the tongue with blowers, turn the head on its side, hold the tongue with the help of a tongue holder or pressing it along the midline with fixation (pin) to clothes, skin .

Rescue measures in areas of catastrophic flooding (ZKZ).

When eliminating the consequences of catastrophic floods, the main tasks are:

provision of first medical aid, pre-medical and first medical aid to all flood victims,

evacuation of the injured as soon as possible to medical institutions and their timely treatment until the final outcome outside the ZKZ (Zone of Catastrophic Flooding).

First medical and first aid for drowning.

When providing first aid at the scene of an accident, one should proceed from the presence or absence of consciousness, the appearance of the victim, the nature and severity of respiratory and hemodynamic disorders, as well as associated injuries.

If the victim is rescued in the initial period with preserved consciousness, measures should be taken to eliminate emotional stress, take off wet clothes, wipe his body dry, wrap the body, give a hot drink (tea, coffee).

Airway obstruction by a foreign body

New Description

Airway obstruction by a foreign body causes asphyxia and is a life-threatening condition, occurs very quickly, the patient very often cannot explain what happened to him. In case of severe obstruction, it can lead to rapid loss consciousness and death, if you do not quickly and successfully help the victim. Immediate recognition of airway obstruction by a foreign body and treatment are of paramount importance.

Because recognition plays a key role in successful care, it is important to ask the victim, "Are you choking?" This gives him the opportunity to answer at least with a nod if he cannot speak.

Choking should be suspected, especially if:

• the episode occurred while eating, and its onset is very unexpected;
• an adult victim may grab his neck, point to his throat.4
• in children, the clue to recognition may be, for example, eating or playing with small objects before the onset of symptoms.

Severity score

Not severe choking:

• the victim can breathe and speak, his cough is effective;
• the child is conscious, cries or verbally answers questions, coughs loudly, can take a breath before coughing.

Severe suffocation:

• the victim cannot speak or make sounds;
• wheezing;
• silent or silent cough;
• cyanosis and gradual deterioration of consciousness (especially in children) to its complete loss.

Urgent care

In adults:

For mild obstruction, encourage the victim to continue coughing. There is no need to take any action other than monitoring the patient's condition.

For severe airway obstruction in a conscious victim:

• stand to the side of and slightly behind the patient, support the chest with one hand and tilt it forward (so that the foreign body enters the mouth, and does not fall down the airways);
• make 5 sharp blows to the back between the shoulder blades with the other hand (check after each blow if the obstruction has been released);
• if unsuccessful, perform 5 abdominal thrusts (Heimlich maneuver). Stand behind the victim, lean forward, place both hands clasped together around the upper abdomen and pull sharply inward and upward;

• continue alternating between 5 blows to the back and 5 abdominal thrusts until they succeed or until the victim loses consciousness.

If the victim is unconscious:

• put it on the floor, on your back;
• call immediately ambulance;
• initiate CPR (even if a pulse is present in a choking patient who is unconscious).

Algorithm for emergency care for obstruction by a foreign body in adults

In children:

1. If the obstruction is not severe, encourage the child to cough and watch him
2. In an conscious child with severe airway obstruction by a foreign body:

• Give 5 hits to the child's back
• If blows to the back do not clear the airway, give 5 chest thrusts for children under 1 year of age or 5 abdominal thrusts for children over 1 year of age. This technique creates an artificial cough, which increases the pressure in chest cavity and may dislodge the foreign body.

• position the child lying, face down, on your lap;
• support the baby's head by placing thumb hands on the corner of the lower jaw, and one or two other fingers of the same hand on its opposite side;
• do not compress soft tissues under the child's mandible, as this can increase airway obstruction;
• make 5 sharp blows on the back of the child between the shoulder blades;
• the goal is to clear the airway with any of these punches, not to do all 5.

Back blows in children older than 1 year:

• are more effective if the child is positioned head down;
• a small child can be positioned on the rescuer's lap, like an infant;
• if this is not possible, lean the child forward while supporting him and hit the back between the shoulder blades from behind.

If blows to the back have not dislodged the foreign body and the child is still conscious, use chest thrusts in infants or abdominal thrusts in children over 1 year of age. Do not use abdominal thrusts on infants.

• turn the child into a supine position, head down. This is safely achieved by placing the free hand along the back of the baby and clasping the back of his head with a brush;
• support the baby with the hand that is placed on your hip;
• determine the location of chest compressions (in the lower half of the sternum, about one finger width above the xiphoid process);
• perform 5 chest thrusts; they are similar to chest compressions, but sharper and less frequent.

Abdominal tremors in children older than 1 year:

• place yourself behind the child, place your hands around his body, connect them together on the stomach between the navel and the xiphoid process;
• sharply pull your hands in and up;
• repeat up to 5 times;
• make sure you don't push xiphoid process or ribs - this can cause injury to the abdominal organs.

After chest thrusts or the Heimlich maneuver, the child should be reassessed. If the foreign body has not been removed and the child is still conscious, alternate back blows and chest thrusts or Heimlich maneuvers.

1. An unconscious child with severe airway obstruction by a foreign body:
2. Airway patency. Open the child's mouth and look for a visible foreign body. If found - try to remove it with one finger. Do not blindly try and try again - this can push the foreign body deeper.
3. Artificial breaths. Open the airway with head extension and mandibular thrust, then deliver 5 rescue breaths. Monitor the effectiveness of each breath in lifting the chest.
4. Chest compressions and CPR:

• after 5 artificial breaths (if there is no reaction - movements, coughing, spontaneous breathing), proceed to chest compressions without assessing signs of circulation;
• if you are alone, perform CPR as recommended on children for 1 minute, and then call an ambulance (unless someone else has done this);
• when the airways are open for artificial respiration - check the oral cavity for the presence of a foreign body;
• if it is visualized, try to remove it with one finger;
• if the foreign body is removed, open and check the airway; administer artificial respiration if the child is not breathing;
• if the child has regained consciousness and began to spontaneously breathe effectively - put him in a stable position on his side and control his breathing and level of consciousness until the ambulance arrives.

old description

On the Internet in search query epilepsy tongue - is not a rare event. At the appointment of an epileptologist such a question about language during an epileptic seizure asked infrequently, but there were cases.

What happens during an epileptic seizure with the tongue

During large generalized convulsive attack Grand mal there is a fall, snoring breathing, salivation, sometimes crying, generalized tonic-clonic convulsions.

Language in such cases of epilepsy can be pulled out tongue prolapse).

During epileptic tongue can be clamped between the teeth and bitten when clenching the jaws during convulsions of the masticatory muscles. In such cases, there may be bites and inner wall cheeks. When biting the tongue during an epileptic seizure, foam from the patient's mouth may be slightly stained with blood (the foam has pink color). After the attack, traces of the past epileptic seizure remain in the form tongue bite and cheeks. Considering that patients do not remember their Grand mal attack, and there may not be witnesses to the attack, then tongue bite and the bruising of the whole body may be the only facts confirming what happened.

Is it necessary to pull out the tongue during an epileptic seizure?

No, you do not need to pull out the tongue during an epileptic attack!

It is impossible to swallow the tongue during an attack , it is well attached.

Block the airways with the tongue - this is not so important, since during a large convulsive attack, breathing is disturbed for a short time.

Hold the victim's tongue with your fingers – ineffective action, and even the threat of biting the fingers of an assistant.

Well, the most common thing is damage to teeth and tongue victim during such "help" during an epileptic attack. If you want to help the patient during an epileptic seizure, they put spoons, sticks, hard objects that have turned up in the mouth in order to unclench your teeth and stick out your tongue . Such actions lead to damage to the teeth and damage to the soft tissues of the oral cavity (tongue, lips, cheeks) . Result pulling out the tongue during an epileptic seizure - Broken teeth, tongue bite.

Do not put anything in your mouth or hold your tongue with your fingers during an epileptic attack. .

What to do if the patient swallowed the tongue?

Or rather: what to do if it seems to you that the patient swallowed tongue ?

I looked at what a search on the Internet gives for a request Language epilepsy. Here are common misconceptions in Yandex on the topic epilepsy tongue

1. Epilepsy is a chronic disease … bruises, cuts, missing teeth, cicatricial changes from multiple bites language and so on…

But cicatricial changes from multiple tongue bite in patients with different forms Epilepsy at the daily appointment of an epileptologist is not observed. Although each patient at the reception examining the tongue, during neurological examination and assessment of cranial nerve function. Yes, and broken teeth are rare in patients with epilepsy.

2. The patient may die if he swallows his tongue, he will suffocate. It is necessary, first of all, to plant or lay him down so that he does not fall, take a hard object, preferably a spoon, open his mouth, pressing his tongue with a spoon and keep his mouth open.

I explain. These actions will definitely lead to trauma to the teeth and tongue, if you have the strength to do it. Do not open your teeth with hard objects or fingers. Yes, and seating an adult patient during a major convulsive attack is physically difficult and not wise. The patient should be placed on the floor or bed and kept in the lateral position to avoid injury. And the patient will not be able to swallow the tongue, it is physically impossible, it is well attached.

3. I know that the main thing is not to let the person swallow the tongue. To do this, the jaw is fixed with a stick.

I explain. It is generally difficult to imagine how exactly to fix the jaw with a stick? In addition to injury, nothing can be achieved by such fixation of the jaw with a stick. These actions are dangerous.

Internet search results:

What offers in Yandex search on request epilepsy tongue - this is not funny, this is sad, this is not true, these myths are common, these actions are not rational and dangerous.

So we have established that with epilepsy, the tongue should not stick out during an attack. During an attack epilepsy, it is not necessary to open the jaw with hard objects so as not to break your teeth. Language at epileptic seizures rarely bite off, not infrequently bite the tongue. But damage to the tongue after a bite during an epileptic attack heals quickly, and there is no scarring. And swallowing the tongue during an epileptic attack is physically impossible.