Artificial respiration and chest compressions. How to properly perform artificial respiration and external heart massage Artificial respiration quantity

Resuscitation methods should be used in case of clinical death in the victim. In this state, the victim has no breathing, blood circulation. The cause of clinical death can be any injury in an accident: exposure to electric current, drowning, poisoning, etc.

The following symptoms indicate circulatory arrest, which are considered early due to their manifestation in the first 10 to 15 seconds:

absence of a pulse in the carotid artery;
the disappearance of consciousness;
the appearance of seizures.

There are also late signs of circulatory arrest. They appear in the first 20 - 60 seconds:

convulsive breathing, its absence;
dilated pupils, lack of any reaction to light;
skin color becomes earthy gray.

If no irreversible changes have occurred in the brain cells, the state of clinical death is reversible. After the onset of clinical death, the viability of the organism continues for another 4-6 minutes. Artificial respiration and chest compressions should be performed until the heartbeat and breathing are restored. For the effectiveness of resuscitation, the rules for resuscitation should be followed. We will briefly introduce you to these rules.

Restoration of blood circulation

Before proceeding with chest compressions, the caregiver must perform a precordial strike, the purpose of which is a strong shaking of the chest pile, to activate the start of the heart.

The precordial blow must be applied with the edge of the fist. The impact point is located in the region of the lower third of the sternum, or rather 2-3 cm above the xiphoid process. The blow is performed with a sharp movement, the elbow of the hand should be directed along the body of the victim.

If the precordial strike is applied correctly, the victim will return to life in a few seconds, his heartbeat will be restored, consciousness will return. If the work of the heart is not activated after such a blow, resuscitation should be started (indirect heart massage, artificial ventilation of the lungs). These measures should be continued for so long until the victim has a pulsation, the upper lip becomes pink, the pupils do not narrow.

Effective only with the right technique. Cardiac resuscitation should be done in the following sequence:

Lay the victim on a hard, level floor to avoid damage to the liver during the massage. Legs should be raised about 0.5 meters above chest level.
The caregiver should position himself on the side of the victim. The arms should be kept straight at the elbows, compression is due to the movements of the body, not the arms. The rescuer places one hand palm down on the victim's chest, and the other on top to increase compression. The fingers of the hands should not touch the chest of the victim, the hands are located perpendicular to the surface of the chest.
When performing an external heart massage, the rescuer takes a stable position; when pressing on the chest, he leans slightly forward. In this way, the weight is transferred from the body to the arms and the sternum is pushed through by 4–5 cm. Compression should be done with an average pressing force of 50 kg.
After the pressure has been performed, it is necessary to release the chest so that it completely straightens out and returns to its original position. When relaxing the sternum, it is forbidden to touch it with your hands.
The pace of compressions depends on the age of the victim. If an external heart massage should be done by an adult, then the number of pressures is 60 - 70 per minute. Massage the child should be done with two fingers (index, middle), and the number of pressures is 100 - 120 per minute.
The ratio of mechanical ventilation and heart massage in adults is 2:30. After two breaths, 30 chest compressions should be done.
Maintaining life in a person who is in a state of clinical death is possible for half an hour with proper resuscitation.

IVL

It is the second of the resuscitation methods used together.

Before doing artificial respiration of the lungs, the victim should restore the airway. For this action, the victim is placed on his back, the head is tilted back as much as possible, and the lower jaw is pushed forward. The lower jaws, after protrusion, should be at the level or in front of the upper ones.

Then check the oral cavity for the presence of foreign bodies (blood, fragments of teeth, vomit). For the purpose of personal safety, cleansing of the oral cavity should be done with the index finger, on which a sterile napkin or handkerchief is wound. If the patient has a spasm of the masticatory muscles, the mouth should be opened with a flat blunt object.

Then proceed to the artificial ventilation of the lungs. There are various ways to resuscitate breathing.

Ventilation methods

In emergency situations, rescuers resort to various methods of artificial ventilation. It is done in the following ways:

Click on the picture to enlarge

from mouth to mouth;
from mouth to nose;
from mouth to nose and mouth;
use of a mask, s-shaped air duct;
use of a mask, bag;
the use of devices.

mouth to mouth

The most common method of artificial lung ventilation is mouth-to-mouth. It is used in most cases. To perform this method of lung ventilation, the following rules should be followed:

Lay the victim on their back on a flat, hard surface.
Ensuring airway patency.
Close the victim's nose.
cover your mouth with a sterile napkin, gauze.
Exhale into the victim's mouth, which must first be tightly grasped.
After lifting the patient's chest, it is necessary to allow him to make a passive exhalation on his own.
The volume of air that the rescuer inhales into the lungs of the victim should be maximum. With large volumes of air blown, it is enough to do 12 blows per minute.

If the victim's airways are clogged by means of the tongue, foreign masses (vomiting, bone fragments), air can enter the stomach. This is dangerous because a distended stomach prevents the lungs from expanding normally.

Care should be taken to ensure that air does not enter the stomach. If air does get in, it should be removed from the organ. To do this, you need to gently press the palm of your hand on the stomach area during exhalation.

Breathing mouth to nose

The mouth-to-nose method is used when the victim has an injury to the jaw, mouth, or the jaw of the victim is very tightly compressed. To effectively perform this type of artificial respiration, the nasal passages must be free of mucus and blood.

The algorithm of actions looks like this:

Tilt the head of the victim with the hand located on the forehead, with the second hand you need to press the chin, raise the lower jaw up, closing the mouth.
Cover your nose with gauze, a sterile napkin.
Cover the victim's nose with your mouth, blow air into it.
It is necessary to follow the excursions of the chest.

Mouth to nose and mouth

This method is used for resuscitation of newborns and infants. The person providing assistance should cover the mouth and nose of the victim with his mouth and take a breath.

Mouth in s-shaped duct

A special rubber s-shaped air duct should be inserted into the victim's mouth, air is blown through it. Also, the air duct can be connected to the artificial ventilation apparatus. A special mask is applied to the face of the victim, then air is blown in, tightly pressing the mask to the face.

Using the bag and mask

For this method of ventilation, a mask should be applied to the face of the victim, bending his head back. For inhalation, the bag is squeezed, and for passive exhalation, it is released. This method is performed with special skills.

Use of devices

Devices are used only for long-term ventilation of the lungs. It is also used to treat intubated, tracheostomy victims.

In the life of each person, a situation may occur when you have to provide first aid to the victim or even carry out artificial respiration. Of course, in such a situation, getting your bearings and doing everything right is not only very important, but also very difficult. Despite the fact that everyone is taught the basics of first aid at school, not every person will be able to even roughly remember what and how to do a few years after graduation.

Most of us, by the phrase "artificial respiration" mean such resuscitation measures as mouth-to-mouth breathing and chest compressions or cardiopulmonary resuscitation, so let's dwell on them. Sometimes these simple actions help save a person's life, so you need to know how and what to do.

In what situations is it necessary to perform an indirect heart massage?

An indirect heart massage is performed to restore its work and normalize blood circulation. Therefore, the indication for its implementation is cardiac arrest. If we see the victim, then the first thing to do is to make sure of our own safety., because the injured person may be under the influence of poisonous gas, which will also threaten the rescuer. After that, it is necessary to check the work of the heart of the victim. If the heart has stopped, then you need to try to resume its work with the help of mechanical action.

How can you tell if the heart has stopped? There are several signs that can tell us about this:

cessation of breathing
pallor of the skin,
lack of pulse
lack of heartbeat
lack of blood pressure.

These are direct indications for cardiopulmonary resuscitation. If no more than 5-6 minutes have passed since the cessation of cardiac activity, then properly performed resuscitation can lead to the restoration of the functions of the human body. If you start resuscitation after 10 minutes, then it may be impossible to completely restore the functioning of the cerebral cortex. After a 15-minute cardiac arrest, it is sometimes possible to resume the activity of the body, but not thinking, since the cerebral cortex suffers too much. And after 20 minutes without a heartbeat, it is usually not possible to resume even vegetative functions.

But these figures are highly dependent on the temperature around the body of the victim. In the cold, the viability of the brain lasts longer. In the heat, sometimes a person cannot be saved even after 1-2 minutes.

How to perform cardiopulmonary resuscitation

As we have already said, any resuscitation must begin with ensuring one's own safety and checking for consciousness and a heartbeat in the victim. Checking for breathing is very simple, for this you need to put your palm on the victim’s forehead, and with two fingers of the other hand, lift his chin and push the lower jaw forward and up. After this, it is necessary to lean towards the victim and try to hear breathing or feel the movement of air with the skin. At the same time, it is advisable to call an ambulance or ask someone about it.

After that, we check the pulse. On the hand, as we are checked in the clinic, we most likely will not hear anything, so we immediately proceed to check on the carotid artery. To do this, we apply the pads of 4 fingers of the hand on the surface of the neck to the side of the Adam's apple. Here you can usually feel the beating of the pulse, if it is not there, we proceed to an indirect heart massage.

To implement an indirect heart massage, we put the base of the palm in the middle of the person’s chest and take the brushes in the lock, while holding the elbows straight. Then we carry out 30 clicks and two breaths "mouth to mouth". In this case, the victim should lie on a flat hard surface, and the frequency of pressing should be approximately 100 times per minute. The depth of pressing is usually 5-6 cm. Such pressing allows you to compress the chambers of the heart and push blood through the vessels.

After performing compression, it is necessary to check the airways and inhale air into the victim's mouth, while covering the nostrils.

How to perform artificial respiration?

Direct artificial respiration is the exhalation of air from your lungs with the lungs of another person. Usually it is done simultaneously with chest compressions and is called cardiopulmonary resuscitation. It is very important to carry out artificial respiration correctly so that air enters the respiratory tract of the injured person, otherwise all efforts may be in vain.

To take breaths, you need to put one of the palms on the victim’s forehead, and with the other hand you need to lift his chin, push the jaw forward and up and check the patency of the victim’s airways. To do this, pinch the nose of the victim and inhale air into the mouth for a second. If everything is normal, then his chest will rise, as if inhaling. After that, you need to let the air out and take a breath again.

If you are in a car, then it most likely has a special device for the implementation of artificial respiration in a car first-aid kit. It will greatly facilitate the resuscitation, but still, this is a difficult matter. To maintain strength during chest compressions, you should try to keep them straight and not bend at the elbows.

If you see that during resuscitation, arterial bleeding opens in the victim, then be sure to try to stop it. It is advisable to call someone for help, since doing everything yourself is quite difficult.

How long does resuscitation take? (Video)

If everything is more or less clear with how to carry out resuscitation, then not everyone knows the answer to the question of how long it should take. If resuscitation doesn't seem to be working, when can it be stopped? The correct answer is never. It is necessary to carry out resuscitation measures until the ambulance arrives or the moment the doctors say that they take responsibility, or, at best, until the victim shows signs of life. Signs of life include spontaneous breathing, coughing, pulse, or movement.

If you notice breathing, but the person has not yet regained consciousness, you can stop resuscitation and give the victim a stable position on his side. This will help to avoid the tongue falling, as well as the penetration of vomit into the respiratory tract. Now you can safely examine the victim for the presence and wait for the doctors, observing the condition of the victim.

You can stop resuscitation if the person doing it is too tired and cannot continue work. It is possible to refuse to carry out resuscitation measures if the victim is clearly not viable. If the victim has severe injuries that are incompatible with life or noticeable cadaveric spots, resuscitation does not make sense. In addition, you should not perform resuscitation if the absence of a heartbeat is associated with an incurable disease, such as cancer.

Good day, dear readers!

Nowadays, looking at media reports, one can see one feature - natural disasters, more and more car accidents, poisonings and other unpleasant situations occur in the world more and more often. It is these situations, emergency situations, that call for every person who finds himself in a place where someone needs help to know what to do in order to save the life of the victim. One such resuscitation measure is artificial respiration, or as it is also called artificial lung ventilation (ALV).

In this article, we will consider with you artificial respiration in combination with an indirect heart massage, since, during cardiac arrest, it is these 2 components that can return a person to consciousness, and possibly even save a life.

The essence of artificial respiration

Doctors found that after cardiac arrest, as well as breathing, a person loses consciousness and clinical death occurs. The duration of clinical death can last about 3-7 minutes. The amount of time allotted for rendering resuscitation to the victim, after which, in case of failure, the person dies, is about 30 minutes. Of course, there are exceptions, not without God's providence, when a person was brought back to life after 40 minutes of resuscitation, however, we will still focus on a short period of time. But this does not mean that if a person does not wake up after 6 minutes, you can already leave him - if your faith allows, try to the last, and God help you!

When the heart stops, it should be noted that the movement of blood stops, and with it the blood supply to all organs. Blood carries oxygen, nutrients, and when the supply of organs stops, literally after a short period of time, the organs begin to die, carbon dioxide stops leaving the body, and self-poisoning begins.

Artificial respiration and heart massage replace the natural work of the heart and the supply of oxygen to the body.

How it works? When pressing on the chest, in the region of the heart, this organ begins to artificially compress and decompress, thereby pumping blood. Remember, the heart works like a pump.

Artificial respiration in these actions is necessary to supply oxygen to the lungs, since the movement of blood without oxygen does not allow all organs and systems to receive the necessary substances for their normal operation.

Thus, artificial respiration and heart massage cannot exist without each other, except in the form of exceptions, which we wrote about a little higher.

This combination of actions is also called cardiopulmonary resuscitation.

Before considering the rules for conducting resuscitation, let's find out the main causes of cardiac arrest and how to learn about cardiac arrest.

The main causes of cardiac arrest are:

Fibrillation of the ventricles of the myocardium;
asystole;
Electric shock;
Overlapping breathing with third-party objects (lack of air) - water, vomit, food;
suffocation;
Strong, at which the temperature inside the body drops to 28 ° C and below;
Severe allergic reaction - hemorrhagic shock;
Taking certain substances and drugs - Dimedrol, Isoptin, Obzidan, barium salts or, fluorine, quinine, antagonists, cardiac glycosides, antidepressants, hypnotics, adrenoblockers, organophosphorus compounds and others;
Poisoning with substances such as drugs, gas (nitrogen, helium, carbon monoxide), alcohol, benzene, ethylene glycol, strychnine, hydrogen sulfide, potassium cyanide, hydrocyanic acid, nitrites, various insect poisons.

Cardiac arrest - how to check if it works?

To check if the heart is working, you must:

Check for a pulse - put two fingers on the neck under the cheekbones;
Check for breathing - put your hand on the chest and see if it raises, or put your ear to the heart area and listen for beats from his work;
Attach a mirror to the mouth or nose - if it is foggy, then the person is breathing;
Lift the patient's eyelids and shine a flashlight on the pupil - if the pupils are dilated and do not respond to light, the heart has stopped.

If the person is not breathing, begin artificial respiration and chest compressions.

Call an ambulance immediately before starting resuscitation. If there are other people around, start ventilating your lungs and have another person call an ambulance.

Also, it will be great if there is someone else next to you with whom you can share the care - one does a heart massage, the other artificial respiration.

Artificial respiration (AI) is an immediate emergency measure in the event that a person’s own breathing is absent or impaired to such an extent that it is a threat to life. The need for artificial respiration may arise when assisting those who have received sunstroke, drowned, electric shock, as well as poisoning with certain substances.

The purpose of the procedure is to ensure the process of gas exchange in the human body, in other words, to ensure sufficient saturation of the victim's blood with oxygen and the removal of carbon dioxide from it. In addition, artificial ventilation of the lungs has a reflex effect on the respiratory center located in the brain, as a result of which spontaneous breathing is restored.

Mechanism and methods of artificial respiration

Only due to the process of respiration, human blood is saturated with oxygen and carbon dioxide is removed from it. After air enters the lungs, it fills the air sacs called alveoli. The alveoli are permeated by an incredible number of small blood vessels. It is in the pulmonary vesicles that gas exchange takes place - oxygen from the air enters the blood, and carbon dioxide is removed from the blood.

In the event that the supply of oxygen to the body is interrupted, vital activity is threatened, since oxygen plays the “first violin” in all oxidative processes that occur in the body. That is why when breathing stops, artificial ventilation of the lungs should begin immediately.

The air entering the human body during artificial respiration fills the lungs and irritates the nerve endings in them. As a result, nerve impulses enter the respiratory center of the brain, which are a stimulus for the production of response electrical impulses. The latter stimulate the contraction and relaxation of the muscles of the diaphragm, resulting in stimulation of the respiratory process.

Artificial provision of the human body with oxygen in many cases allows you to completely restore an independent respiratory process. In the event that, in the absence of breathing, cardiac arrest is also observed, it is necessary to carry out its closed massage.

Please note that the absence of breathing triggers irreversible processes in the body after only five to six minutes. Therefore, timely artificial ventilation of the lungs can save a person's life.

All methods of performing ID are divided into expiratory (mouth-to-mouth and mouth-to-nose), manual and hardware. Manual and expiratory methods compared to hardware are considered more labor-intensive and less effective. However, they have one very significant advantage. You can perform them without delay, almost anyone can cope with this task, and most importantly, there is no need for any additional devices and devices that are far from always at hand.

Indications and contraindications

Indications for the use of ID are all cases when the volume of spontaneous ventilation of the lungs is too low to ensure normal gas exchange. This can happen in many both urgent and planned situations:

With disorders of the central regulation of respiration caused by a violation of cerebral circulation, tumor processes in the brain or its injury.
With medication and other types of intoxication.
In case of damage to the nerve pathways and neuromuscular synapse, which can be provoked by trauma to the cervical spine, viral infections, the toxic effect of certain drugs, poisoning.
With diseases and injuries of the respiratory muscles and chest wall.
In cases of lung lesions, both obstructive and restrictive.

The need to use artificial respiration is judged based on a combination of clinical symptoms and external data. Changes in the size of the pupils, hypoventilation, tachy- and bradysystole are conditions in which artificial ventilation of the lungs is necessary. In addition, artificial respiration is required in cases where spontaneous ventilation of the lungs is "turned off" with the help of muscle relaxants introduced for medical purposes (for example, during anesthesia during surgery or during intensive care for a convulsive syndrome).

As for cases when ID is not recommended, there are no absolute contraindications. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. So, for example, if the venous return of blood is difficult, artificial respiration regimes are contraindicated, which provoke an even greater violation of it. In case of lung injury, lung ventilation methods based on high-pressure air injection, etc. are prohibited.

Preparation for artificial respiration

Before performing expiratory artificial respiration, the patient should be examined. Such resuscitation measures are contraindicated for facial injuries, tuberculosis, poliomyelitis, and trichlorethylene poisoning. In the first case, the cause is obvious, and in the last three, performing expiratory ventilation endangers the resuscitator.

Before proceeding with the implementation of expiratory artificial respiration, the victim is quickly released from clothes that are squeezing the throat and chest. The collar is unbuttoned, the tie is untied, you can unfasten the trouser belt. The victim is placed supine on his back on a horizontal surface. The head is thrown back as much as possible, the palm of one hand is placed under the back of the head, and the forehead is pressed with the second palm until the chin is in line with the neck. This condition is necessary for successful resuscitation, since with this position of the head, the mouth opens, and the tongue moves away from the entrance to the larynx, as a result of which air begins to flow freely into the lungs. In order for the head to remain in this position, a roll of folded clothes is placed under the shoulder blades.

After that, it is necessary to examine the victim's oral cavity with your fingers, remove blood, mucus, dirt and any foreign objects.

It is the hygienic aspect of performing expiratory artificial respiration that is the most delicate, since the rescuer will have to touch the victim's skin with his lips. You can use the following technique: make a small hole in the middle of a handkerchief or gauze. Its diameter should be two to three centimeters. The tissue is applied with a hole to the mouth or nose of the victim, depending on which method of artificial respiration will be used. Thus, air will be blown through the hole in the fabric.

For mouth-to-mouth artificial respiration, the one who will provide assistance should be on the side of the victim's head (preferably on the left side). In a situation where the patient is lying on the floor, the rescuer kneels down. In the event that the jaws of the victim are clenched, they are forcefully pushed apart.

After that, one hand is placed on the forehead of the victim, and the other is placed under the back of the head, tilting the patient's head back as much as possible. Having taken a deep breath, the rescuer holds the exhalation and, bending over the victim, covers the area of his mouth with his lips, creating a kind of "dome" over the patient's mouth opening. At the same time, the victim's nostrils are clamped with the thumb and forefinger of the hand located on his forehead. Ensuring tightness is one of the prerequisites for artificial respiration, since air leakage through the victim’s nose or mouth can nullify all efforts.

After sealing, the rescuer exhales rapidly, forcefully, blowing air into the airways and lungs. The duration of the exhalation should be about a second, and its volume should be at least a liter in order for effective stimulation of the respiratory center to occur. At the same time, the chest of the one who is being helped should rise. In the event that the amplitude of its rise is small, this is evidence that the volume of air supplied is insufficient.

After exhaling, the rescuer unbends, freeing the victim's mouth, but at the same time keeping his head tilted back. The exhalation of the patient should last about two seconds. During this time, before taking the next breath, the rescuer must take at least one normal breath “for himself”.

Please note that if a large amount of air does not enter the lungs, but into the patient's stomach, this will make it much more difficult to save him. Therefore, periodically you should press on the epigastric (epigastric) region to free the stomach from air.

Artificial respiration from mouth to nose

With this method, artificial ventilation of the lungs is carried out if it is not possible to properly open the patient's jaws or if there is an injury to the lips or mouth area.

The rescuer puts one hand on the victim's forehead, and the other on his chin. At the same time, he simultaneously throws back his head and presses his upper jaw to the lower one. With the fingers of the hand that supports the chin, the rescuer must press the lower lip so that the victim's mouth is completely closed. After taking a deep breath, the rescuer covers the victim's nose with his lips and blows air through the nostrils with force, while watching the movement of the chest.

After artificial inspiration is completed, the patient's nose and mouth must be released. In some cases, the soft palate can prevent air from escaping through the nostrils, so when the mouth is closed, there may be no exhalation at all. When exhaling, the head must be kept tilted back. The duration of artificial expiration is about two seconds. During this time, the rescuer himself must make several exhalations-breaths "for himself."

How long is artificial respiration

To the question of how long it is necessary to carry out ID, there is only one answer. Ventilate the lungs in a similar mode, taking breaks for a maximum of three to four seconds, should be until the full spontaneous breathing is restored, or until the doctor who appears gives other instructions.

In this case, you should constantly monitor that the procedure is effective. The chest of the patient should swell well, the skin of the face should gradually turn pink. It is also necessary to ensure that there are no foreign objects or vomit in the victim's airways.

Please note that due to the ID, the rescuer himself may become weak and dizzy due to a lack of carbon dioxide in the body. Therefore, ideally, two people should perform the blowing of air, which can alternate every two to three minutes. In the event that this is not possible, the number of breaths should be reduced every three minutes so that the level of carbon dioxide in the body normalizes in the one who performs resuscitation.

During artificial respiration, you should check every minute if the victim's heart has stopped. To do this, feel the pulse on the neck in the triangle between the windpipe and the sternocleidomastoid muscle with two fingers. Two fingers are placed on the lateral surface of the laryngeal cartilage, after which they are allowed to "slide" into the hollow between the sternocleidomastoid muscle and the cartilage. It is here that the pulsation of the carotid artery should be felt.

In the event that there is no pulsation on the carotid artery, chest compressions should be started immediately in combination with ID. Doctors warn that if you miss the moment of cardiac arrest and continue to do artificial ventilation of the lungs, you will not be able to save the victim.

Features of the procedure in children

When carrying out artificial ventilation, babies under one year old use the mouth-to-mouth and nose technique. If the child is over a year old, the mouth-to-mouth method is used.

Small patients are also placed on their backs. For babies up to a year old, they put a folded blanket under their backs or slightly raise their upper body by placing a hand under their backs. The head is thrown back.

The person providing assistance takes a shallow breath, hermetically covers the mouth and nose of the child (if the baby is under one year old) or only the mouth with his lips, after which he blows air into the respiratory tract. The volume of air blown should be the smaller, the younger the young patient. So, in the case of resuscitation of a newborn, it is only 30-40 ml.

If sufficient air enters the respiratory tract, chest movements appear. It is necessary to make sure after inhalation that the chest is lowered. If too much air is blown into the lungs of the baby, this can cause the alveoli of the lung tissue to rupture, as a result of which air will escape into the pleural cavity.

The frequency of breaths should correspond to the respiratory rate, which tends to decrease with age. So, in newborns and children up to four months, the frequency of inhalations-exhalations is forty per minute. From four months to six months, this figure is 40-35. In the period from seven months to two years - 35-30. From two to four years, it is reduced to twenty-five, in the period from six to twelve years - to twenty. Finally, in a teenager aged 12 to 15 years, the respiratory rate is 20-18 breaths per minute.

Manual methods of artificial respiration

There are also so-called manual methods of artificial respiration. They are based on a change in the volume of the chest due to the application of an external force. Let's consider the main ones.

Sylvester's way

This method is the most widely used. The victim is placed on his back. A cushion should be placed under the lower part of the chest so that the shoulder blades and the back of the head are lower than the costal arches. In the event that two people perform artificial respiration using this technique, they kneel on either side of the victim so as to be at the level of his chest. Each of them holds the victim's hand in the middle of the shoulder with one hand, and a little above the level of the hand with the other. Then they begin to rhythmically raise the victim's arms, stretching them behind his head. As a result, the chest expands, which corresponds to inhalation. After two or three seconds, the victim's hands are pressed to the chest, while squeezing it. This performs the function of exhalation.

In this case, the main thing is that the movements of the hands should be as rhythmic as possible. Experts recommend that those who perform artificial respiration use their own rhythm of inhalations and exhalations as a "metronome". In total, about sixteen movements per minute should be done.

ID by the Sylvester method can be produced by one person. He needs to kneel behind the head of the victim, intercept his hands above the hands and perform the movements described above.

With fractures of the arms and ribs, this method is contraindicated.

Schaeffer's method

In the event that the victim's hands are injured, the Schaeffer method can be used to perform artificial respiration. Also, this technique is often used to rehabilitate people injured while on the water. The victim is placed prone, the head is turned to the side. The one who does artificial respiration kneels, and the body of the victim should be located between his legs. Hands should be placed on the lower part of the chest so that the thumbs lie along the spine, and the rest lie on the ribs. When exhaling, you should lean forward, thus compressing the chest, and while inhaling, straighten up, stopping the pressure. The arms do not bend at the elbows.

Please note that with a fracture of the ribs, this method is contraindicated.

Laborde method

The Laborde method is complementary to the methods of Sylvester and Schaeffer. The victim's tongue is grasped and rhythmic stretching is performed, simulating respiratory movements. As a rule, this method is used when breathing has just stopped. The appeared resistance of the tongue is proof that the person's breathing is being restored.

Kallistov's method

This simple and effective method provides excellent lung ventilation. The victim is placed prone, face down. A towel is placed on the back in the area of the shoulder blades, and its ends are carried forward, passing under the armpits. The one who provides assistance should take the towel by the ends and raise the body of the victim seven to ten centimeters from the ground. As a result, the chest expands and the ribs rise. This corresponds to the breath. When the torso is lowered, it simulates exhalation. Instead of a towel, you can use any belt, scarf, etc.

Howard's way

The victim is positioned supine. A cushion is placed under his back. Hands are taken behind the head and pulled out. The head itself is turned to the side, the tongue is extended and fixed. The one who performs artificial respiration sits astride the victim's femoral area and places his palms on the lower part of the chest. Spread fingers should capture as many ribs as possible. When the chest is compressed, it corresponds to inhalation; when the pressure is stopped, it simulates exhalation. Twelve to sixteen movements should be done per minute.

Frank Yves method

This method requires a stretcher. They are installed in the middle on a transverse stand, the height of which should be half the length of the stretcher. The victim is laid prone on the stretcher, the face is turned to the side, the arms are placed along the body. A person is tied to a stretcher at the level of the buttocks or thighs. When lowering the head end of the stretcher, inhale is carried out, when it goes up - exhale. The maximum breathing volume is achieved when the victim's body is tilted at an angle of 50 degrees.

Nielsen method

The victim is placed face down. His arms are bent at the elbows and crossed, after which they are placed palms down under the forehead. The rescuer kneels at the head of the victim. He puts his hands on the shoulder blades of the victim and, without bending them at the elbows, presses with his palms. This is how exhalation happens. To inhale, the rescuer takes the shoulders of the victim at the elbows and straightens up, lifting and pulling the victim towards himself.

Hardware methods of artificial respiration

For the first time, hardware methods of artificial respiration began to be used in the eighteenth century. Even then, the first air ducts and masks appeared. In particular, doctors suggested using bellows for blowing air into the lungs, as well as devices created in their likeness.

The first automatic devices for ID appeared at the end of the nineteenth century. At the beginning of the twentieth, several varieties of respirators appeared at once, which created an intermittent vacuum and positive pressure either around the entire body, or only around the chest and abdomen of the patient. Gradually, respirators of this type were replaced by air blowing respirators, which differed in less solid dimensions and at the same time did not impede access to the patient's body, allowing medical manipulations to be carried out.

All currently existing ID devices are divided into external and internal. External devices create negative pressure either around the entire body of the patient or around his chest, which causes inspiration. Exhalation in this case is passive - the chest simply subsides due to its elasticity. It can also be active if the apparatus creates a positive pressure zone.

With the internal method of artificial ventilation, the device is connected through a mask or intubator to the respiratory tract, and inhalation is carried out due to the creation of positive pressure in the device. Devices of this type are divided into portable, designed to work in the "field" conditions, and stationary, the purpose of which is prolonged artificial respiration. The former are usually manual, while the latter operate automatically, driven by a motor.

Complications of artificial respiration

Complications due to artificial respiration occur relatively rarely even if the patient is on mechanical ventilation for a long time. Most often, undesirable effects relate to the respiratory system. So, due to an incorrectly chosen regimen, respiratory acidosis and alkalosis can develop. In addition, prolonged artificial respiration can cause the development of atelectasis, since the drainage function of the respiratory tract is impaired. Microatelectasis, in turn, can become a prerequisite for the development of pneumonia. Preventive measures that will help avoid the occurrence of such complications are meticulous respiratory hygiene.

If the patient breathes pure oxygen for a long time, this can cause pneumonitis. The oxygen concentration therefore should not exceed 40-50%.

In patients who have been diagnosed with abscessing pneumonia, ruptures of the alveoli may occur during artificial respiration.

There are several methods of artificial respiration, each of which has its own advantages and disadvantages. They are used (for diseases and accidents associated with the cessation of natural respiration. Artificial respiration can be performed manually and mechanically (with the use of artificial respiration apparatus) . The most effective and affordable way to restore blood circulation and cardiac activity is the "mouth-to-mouth" or "mouth-to-nose" method using heart massage, since exhaled (my air contains a significant percentage of oxygen)

15:

yes, allowing the use of artificial respiration, and carbon dioxide (ly gas, necessary for a person.

The mouth-to-mouth method (Fig. 9.2) is as follows. After the water has been removed and the mouth of the victim has been cleaned, he is laid on the ground or a hard surface.

Rice. 9.2. Method of artificial respiration "from mouth to mouth":

a - through the gasket; b - using an air duct

If help is provided by one person, then he kneels down at the head of the side, puts one hand under the neck of the victim (th, the other on the forehead and throws his head back as much as possible (backward, and clamps his nostrils with thumb and forefinger and, making a deep inhale and clasp his mouth with his lips (it is possible through a placard or gauze), blows air into his lungs. reached the goal, at the moment of maximum expansion of the chest, the rescuer takes his mouth away from the mouth of the victim (go. If the goal is not achieved, and the tongue sunk back, tightly closing the entrance to the larynx, then air cannot pass into the lungs.

With the maximum extension of the sixth section of the spine, the root of the tongue moves up, opening access to the respiratory tract (ti. A roller should be placed under the shoulders of the victim. The frequency of air blowing for an adult is 12 ... 14, for children 16 ... 18 times per minute. passive will occur (but due to the increased pressure created in the lungs, their elasticity and chest pressure.

Since the mouth and nose of children are close to each other (ha), they can be tightly wrapped around their lips at the same time and inhaled air through them into the lungs.

When air is blown "from mouth to nose" by one person, the victim is also thrown back and held as in the "mouth-to-mouth" method. Having taken a deep breath, the rescue raft (but wraps his lips around the nose of the victim and blows air into it.

The rescuer assisting the victim must be replaced after 2-3 minutes to avoid increased hyperventilation, dizziness, and even a short-term loss of consciousness.

Spravochnik_Spas_8.qxp 08/16/2006 15:2 0Page 112

Good results are obtained by mouth-to-mouth and mouth-to-nose artificial respiration in combination with chest compressions. By pressing on the sternum, the heart can be displaced towards the spine by 3 ... and filled with blood.

With the help of an indirect heart massage, it is possible to carry out an artificial movement of blood through the vessels and maintain vital functions in the body for a long time. Rhythmic compression of the heart between the sternum and the spine, in addition, stimulates the activity of the heart muscle, contributes to its blood circulation and self-contraction.

The victim is placed on a hard surface (ground, floor, plank, table), otherwise the massage does not reach its goal. sternum and spine.

Having felt the lower end of the victim's sternum, about two fingers above this place of the sternum, put the palm of one hand, place the other hand on top at a right angle, bring the fingers of both hands together, lift them should not touch (the chest of the victim (Fig. 9.3).

Rice. 9.3. Indirect cardiac massage

The rescuer can be to the right or left of the victim (go, if necessary, he can kneel. The rescuer's pushes, sharp rhythmic pressure with both straight hands on the lower part of the sternum should not be too strong so as not to damage the sternum, ribs and internal organs. Hands during the push should not be bent at the elbow joints.

To increase the pressure on the sternum during the push, you can use the weight of the upper body. Immediately after the push, you need to relax your hands without taking them away from the sternum, then the victim’s chest will straighten out and blood will flow to the heart.

An indirect heart massage for an adult is done in a strict rhythm of 2 or 3 blows into the mouth or nose, alternating with fifteen pushes on the sternum (about 60 pushes per minute).

For children aged 10 to 12 years, indirect heart massage should be carried out with one hand (60 ... 80 shocks per minute).

Spravochnik_Spas_8.qxp 08/16/2006 15:2 0Page 113

During inhalation, shocks to the victim's sternum should be stopped (otherwise, air will not enter the respiratory tract and lungs.

When assisting the victim by two rescuers, one of them makes one blow into the lungs of the victim "from mouth to mouth" or "from mouth to nose", and the second at this time determines the pulse on the carotid arteries. If there is no heartbeat, he begins chest compressions.

Artificial respiration "from mouth to mouth" can be done using an air duct (a tube with a diameter of 0.7 cm with a curved end, Fig. 9.2b). One end of the tube is inserted into the victim's airways, the other is taken into the mouth and periodic blowing (as described above. The shield in the upper part of the air duct is pressed against the victim’s lips, thus eliminating air leakage during blowing. The air duct is inserted between the teeth with the convex side, then at the root of the tongue it is turned with the convex side up, pressing the tongue against the bottom of the mouth so that it does not sink and does not cover the larynx.

After the appearance of spontaneous breathing in the victim, it is necessary to transfer him to breathing with pure oxygen as soon as possible.

Rice. 9.4. Artificial respiration according to the Sylvester method

Sylvester's method (Fig. 9.4) consists in laying a post (raiding on his back, after pouring out water from the respiratory tract and clearing his mouth of sand and silt. Under the shoulder blades they put a wa (face 15 ... 20 cm from linen, clothes or special wood The head is turned on its side, the tongue is pulled out of the mouth and fixed with a tongue holder. The person assisting kneels at the head of the victim, grabs his hands just above the hands and bends them at the elbow joints, pressing the forearms to the sides of the chest, which is compressed , - there is an exit. Then, according to the count of "times", the victim's hands are thrown back with a sharp movement (they are thrown back behind the head in an extended state, the chest expands, a pause is maintained, at the expense of "two", "three" a breath occurs. According to the count "four", the victim's hands again pressed against the chest, the compression of which continues in the count of "five", "six" - exhalation occurs. Such movements are repeated 14 ... 16 times per minute with this and other methods.

Spravochnik_Spas_8.qxp 08/16/2006 15:2 0Page 114

This method is the most popular, quite effective for ventilating the lungs, improving blood flow through the vessels and increasing the reflexivity of the heart, but it is very tiring. It is better to use it in combination with the Howard method, providing air supply up to 300 ml.

With the Sylvester (Bosch) method, performed together, one takes the victim by one hand, the other by the other, and both do artificial respiration, as described above. This method cannot be used for fractures of the upper limbs and ribs.

Schaefer's method is different in that the victim is laid on the stomach (the head is turned to the side so that the mouth and nose are free, the arms are pulled forward or one arm can be bent (bend at the elbow and put the victim's head on it. The tongue does not sink in this position and it may not be fixed.

The caregiver kneels over the victim (Fig. 9.5) or one knee between his legs, puts his hands on the lower chest so that the thumbs are parallel to the spine, and the rest cover the lower ribs.

On the count of "one, two, three", the assisting person compresses the chest (the chest, transferring the weight of his body to the palms of his hands without bending (bearing them at the elbows, exhalation takes place. On the count of "four, five, six", the assisting person leans back ( Fig. 9.5) pressure (pressure on the chest stops, while air enters the lungs - inhalation occurs.

Rice. 9.5. Artificial respiration according to the Schaefer method

The positive thing about this method is that the helper gets tired less, the victim’s tongue does not sink, mucus and vomit do not get into the larynx and respiratory tract. This method is used for fractures of the bones of the shoulder and forearm, but it ventilates the lungs a little, the chest, when positioned face down, compresses the heart area, which affects blood circulation, it cannot be used for fractures of the ribs.

With the Howard method, the victim is laid on his back, a roller is placed under the shoulder blades, the head is turned to one side, the tongue is pulled out and fixed with a tongue holder, the arms are thrown back (they are behind the head. The assisting person kneels on

Spravochnik_Spas_8.qxp 08/16/2006 15:2 0Page 115

the level of the hips of the victim and palms rests on the lower part of the chest, covering the chest, and the thumbs are located on the xiphoid process of the chest. Leaning forward (leaning forward, assisting with the body and body with force compresses the chest of the victim - an exhalation occurs. According to the count of "one, two", the assisting leaning back stops (squeezing the chest, it straightens out, air enters (dit into the lungs, occurs breath in. On the count of "three, four" again squeeze (part of the chest, etc.

Nilson's method (Fig. 9.6.) differs in that the victim (he is laid on his stomach face down, his arms go around him at the elbows so that the hands are located under the chin. The person assisting becomes one foot on the knee at the head, and the other on the foot at head of the victim.According to the "times" count, the person who provides help lowers the chest and shoulders of the victim to the ground (lyu, according to the "two" count, puts his palms on his back, according to the "three, four" count, he presses on the chest, providing an active exhalation.

Rice. 9.6. Artificial respiration according to the Nilsson method

According to the count "five", he takes the victim by the shoulders, lifts him onto himself, while the shoulder blades are somewhat closer, and the pull of the muscles and ligamentous apparatus of the shoulder girdle causes the chest to rise and, thus, expand - an inhalation occurs.

According to the Kallistov method (Fig. 9.7), more air enters the lungs at the entrance than according to the Schaffer method, and the person providing help does not get tired so quickly. The victim is laid face down, his head is turned to the side, his arms are stretched forward or bent at the elbows and placed under the head. The assisting person kneels at the head of the victim, puts (puts a strap and passes on the area of the victim’s shoulder blades (puts it under the armpits. lift the victim's chest. With this rise, the chest expands and inhalation occurs. Then, assisting, bending down, loosens the strap, the chest (the victim's chest falls, exhalation occurs.

Spravochnik_Spas_8.qxp 08/16/2006 15:2 0Page 116

This method is recommended to be combined with the simultaneous exhalation of oxygen using an oxygen inhaler. Kallistov's method slightly injures the lungs of the victim, therefore, it can be used for barotrauma of the lungs, when a rupture of the lung tissue is observed and the victim has no natural breathing.

Rice. 9.7. Artificial respiration according to the Kalistov method

Labarde's method is based on reflex excitation of the respiratory center, caused by rhythmic energetic sipping (by tongue every 3 ... 4 seconds, while stretching not only the front of the tongue, but also its root, irritating the in the mucous membrane of the oral cavity. Irritation is transmitted to the medulla oblongata, causing excitation of respiration.

A sign of the approaching recovery of independent breathing is the resistance that appears when pulling (tongue.

With this method, it is necessary that the sipping of the tongue coincides with the movement that provides inspiration to the victim, who (can lie both on the stomach and on the back. Tongue holder (lem or fingers wrapped in gauze, capture the tongue of the post (and at the expense "one" pull it out, at the expense of "two, three" - pause. At the expense of "four" the tongue is placed in the oral cavity, but do not let it go; at the expense of "five" - pause. This method is sometimes sufficient to restore normal breathing It is used in the presence of trauma and wounds on a large area of the body and hands, as well as in combination with another method. When spontaneous breathing occurs, artificial respiration should be continued for some time and stopped only when spontaneous breathing is fully restored in the victim.

The Kohlrausch method (Fig. 9.8.) is different in that when it is performed, a heart massage is performed simultaneously with artificial respiration. back of the victim (go, takes his left hand with his hand, bends it at the elbow and presses it with his left hand against the lateral surface of the chest, pressing (

Spravochnik_Spas_8.qxp 08/16/2006 15:2 0Page 117

pouring on the region of the heart - there is an exhalation and at the same time a massage of the heart. Then the assisting person takes it up and puts it on his head, the victim’s chest expands (Xia, air rushes into the lungs - an inhalation takes place.

Rice. 9.8. Artificial respiration according to the Kohlrausch method

With the method of grasping the chest, the assisting person sits the victim between his legs, clasps his chest with his hands, presses it strongly, thus causing exhalation. Then the rescuer relaxes his hands, i.e. lowers the victim’s compressed chest, spreads the victim’s arms (to the sides, - a breath occurs. This method can be used in cramped conditions (on boats, boats, etc.).

Lung ventilation (in l / min) at 12 breaths - exhalations for various (personal methods of artificial respiration is as follows: Schaefer's method - 9.6, Howard's - 12, Sylvester - 18, Nile and Kalis (tova - 21.6, Kalistova (Schafer - 24.

The method of artificial respiration is chosen by rescuers or a doctor, depending on the specific conditions and condition of the victim (if necessary, endotracheal intubation of the victim is performed, manual ventilators and oxygen inhalers are connected. Measures are taken to warm the victim (warm heating pads, wrapping). If there are no signs of restoration of blood circulation (from (a distinct push during the massage on the carotid or femoral artery, blood pressure below 60 (70 mm Hg. Art.), as well as constriction of the pupils and pinking of the skin of the nasolabial triangle in the first 1 ... 2 minutes after the start of the indirect heart massage and artificial lung ventilation), then the lower extremities are additionally raised 50...75 cm above the level of the heart, drug myocardial stimulation by intracardiac injection of 0.5... ml of 10% calcium chloride solution. (lung ventilation and heart massage, but not more than 10 s. In addition, in the presence of weak signs of cardiac activity, it is necessary to administer camphor and caffeine in the usual dosages.

Spravochnik_Spas_8.qxp 08/16/2006 15:2 0Page 118

Artificial ventilation of the lungs should continue until natural breathing is fully restored.

To prevent possible pulmonary edema, a 10% alcohol solution of antifolesilan is used, which can be supplied with a breathing apparatus along with oxygen, an intravenous infusion of a 5% bicarbonate solution, the introduction of 40-60 ml of 4% solution of glucose with 0.5-1.0 ml of corglycon solution or strophanthin.In order to prevent inflammatory changes in the lungs, broad-spectrum antibiotics are prescribed, and with the first suspicion of BTL, oxygen barotherapy is performed.