What is resuscitation definition. Fundamentals of resuscitation. What is clinical and biological death

Resuscitation (revitalization of the body) (from lat. re - a prefix expressing: renewal, repetition + lat. animator - giving life, the term was introduced by V.A. Negovsky), a set of measures to revive a person who is in a state of clinical death, the restoration of severely impaired or lost vital body functions

Indications for resuscitation: Indications for resuscitation are all cases of sudden death, regardless of the causes that caused it. At the same time, many emphasize if clinical death is found in an unknown person. Why exactly in the unknown, it becomes clear when discussing contraindications to resuscitation

Contraindications for resuscitation: Contraindications to resuscitation, according to currently generally recognized rules, are all cases where it is known in advance that resuscitation in a given person is absolutely useless and unpromising. Such cases include:

1. The onset of death due to a long-term debilitating disease, when the patient has already used all modern methods of treatment. For example, with sepsis, cirrhosis of the liver and some infectious diseases. or even hours) of restoration of cardiac activity, but this will no longer be an extension of life, but an extension of the process of dying, or, as many now say, an extension of death

2. When death occurs in patients with currently incurable diseases and conditions - advanced forms of malignant neoplasms, injuries and malformations that are incompatible with life, terminal stages of cerebrovascular accidents (strokes) from resuscitation was recorded in advance in the medical history in the form of a decision of a council of doctors

3. Primary CPR should not be performed and it will be absolutely useless if it is known for sure that more than 15-20 minutes have passed since death (under normal temperature conditions), if the victim has signs of rigor mortis or even decomposition

Resuscitation measures, according to the laws of the Russian Federation, can be provided by any person. But first, a diagnosis must be made - cardiac arrest.

This requires checking for ALL of the following symptoms.

1. The color of the skin is pale. How to check: The easiest way to check this is on the back of your eyelids. In the normal state, it is pink, in cardiac arrest it is white.

2. Lack of reaction in the pupils to light (they stop contracting). How to check: we close the person’s eyes, cover their eyes with our palms, after which we sharply open our eyes. When the heart is working, the pupils will contract at least a little, but.

3. The pupils are dilated.

4. No pulse on the carotid artery

clinical death- a reversible stage of dying, a transitional period between life and biological death.

Signs of clinical death

Signs of clinical death include: coma, apnea, asystole. This triad concerns the early period of clinical death (when several minutes have passed since asystole), and does not apply to cases where there are already clear signs of biological death. The shorter the period between the statement of clinical death and the start of resuscitation, the greater the chances of life for the patient, so diagnosis and treatment are carried out in parallel.

Coma diagnosed on the basis of lack of consciousness and dilated pupils that do not respond to light.

Apnea is recorded visually, by the absence of respiratory movements of the chest.

Asystole registered by the absence of a pulse in two carotid arteries. Before determining the pulse, it is recommended that the victim be artificially ventilated.

All currently known methods and schemes of revitalization necessarily include knowledge of three techniques (ABC rule):

I. Air way open - restore airway patency;

II. Breathe for victim - start ventilation; (artificial lung ventilation, IVL)

III. Circulation his blood - start heart massage.

Stages and stages of cardiopulmonary resuscitation were developed by the patriarch of resuscitation, the author of the first international manual on cardiopulmonary and cerebral resuscitation, Peter Safar, doctor of the University of Pittsburgh

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

The first stage, in fact, is primary cardiopulmonary resuscitation and includes the following steps: securing the airway, artificial respiration and closed heart massage. The main goal of this stage is to prevent biological death by urgently combating oxygen starvation. Therefore, the first basic stage of cardiopulmonary resuscitation is called elementary life support.

The second stage is carried out by a specialized team of resuscitators, and includes drug therapy, ECG monitoring and defibrillation. This stage is called further life support, as doctors set themselves the task of achieving spontaneous circulation.

The third stage is carried out exclusively in specialized intensive care units, so it is called long-term life support. Its ultimate goal is to ensure the complete restoration of all bodily functions. At this stage, a comprehensive examination of the patient is performed, while determining the cause that caused the cardiac arrest, and assessing the degree of damage caused by the state of clinical death. They carry out medical measures aimed at the rehabilitation of all organs and systems, achieve the resumption of full-fledged mental activity. Thus, primary cardiopulmonary resuscitation does not involve determining the cause of cardiac arrest. Her technique is extremely unified, and the assimilation of methodological techniques is available to everyone, regardless of professional education.

There are two main ways to carry out IVL: external method and method by blowing air into the lungs of the victim through the upper respiratory tract.

The external method consists in rhythmic compression of the chest, which leads to its passive filling with air. Currently, the external method of mechanical ventilation is not carried out, since adequate oxygen saturation of the blood, which is necessary to relieve signs of acute respiratory failure, does not occur when using it.

Air is blown into the lungs by the mouth-to-mouth or mouth-to-nose method. The caregiver blows air into the victim's lungs through his mouth or nose. The amount of oxygen in the blown air is about 16%, which is quite enough to keep the victim alive.

The most effective method is mouth-to-mouth, but this method is associated with a high risk of infection.

To avoid this, air should be blown through a special S-shaped air duct, if one is at hand. In case of its absence, you can use a piece of gauze folded in 2 layers, but no more. Gauze can be replaced with another more or less clean material, such as a handkerchief.

After the entire procedure, the person who performed the ventilator should cough well and rinse his mouth with any kind of antiseptic or at least with water.

Rules for conducting an indirect heart massage.

Rule One

If the victim is lying on the ground, be sure to kneel in front of him. It doesn't matter which side you approach it from. However, for right-handers, it will be more convenient to deliver a precordial blow if the victim is on the side of their right hand.

Rule Two

For indirect heart massage to be effective, it must be performed on a flat, hard surface.

Rule Three

Place the base of the right palm above the xiphoid process so that the thumb is directed to the chin or abdomen of the victim. Place the left hand on the palm of the right hand.

Rule Four

Move the center of gravity to the sternum of the victim and conduct an indirect heart massage with straight arms. This will allow you to save strength for the longest possible time. Bending your arms at the elbows during an indirect heart massage is tantamount to performing a physical exercise “push-ups from the floor”. Considering that with a rhythm of 60–100 pressures per minute, it is required to carry out resuscitation for at least 30 minutes even if it is ineffective (it is after this time that signs of biological death will clearly appear), then even an Olympic champion in gymnastics.

Remember! For children, indirect heart massage can be performed with one hand, and for a newborn - with two fingers.

Rule Five

Push the chest at least 3-5 cm at a frequency of 60-100 times per minute, depending on the elasticity of the chest.

Remember! Your palm should not part with the victim's sternum.

Rule six

You can start another pressure on the chest only after it has completely returned to its original position. If you do not wait until the sternum returns to its original position, and tear your hands away from it, then the next push will turn into a monstrous blow.

Remember! In cases of rib fracture, in no case should chest compressions be stopped. It is only necessary to reduce the frequency of pressing to allow the chest to return to its original position, but be sure to maintain the same depth of pressing.

Rule Seven

The optimal ratio of chest compressions to mechanical ventilation breaths is 30:2, regardless of the number of participants. With each pressure on the chest, an active exhalation occurs, and when it returns to its original position, a passive breath occurs. Thus, new portions of air enter the lungs, sufficient to saturate the blood with oxygen.

Remember! During resuscitation, priority should be given to chest compressions, and not to ventilator breaths.

Unacceptable!

Stop chest compressions, even if there are no signs of its effectiveness, until signs of biological death appear.

Human resuscitation - restoration of vital body functions, such as heartbeat (blood circulation) and breathing. In the mythology of many peoples of the world, living water is mentioned, capable of bringing people back to life and which can be obtained "for distant lands", having won many trials. In our time of unprecedented discoveries, it is no longer in a fairy tale, but in real life, what was previously considered incredible is becoming familiar, and this especially applies to the return of a person to life.

The famous Soviet scientist V. A. Negovsky, who made a significant contribution to the development of domestic and world resuscitation, wrote that just as now space flights have become commonplace, in the future the resuscitation of people who accidentally died will be a happy everyday life.

How long does it take to resuscitate a person?
The term "resuscitation" comes from the Latin words "re" - again and "animation" - "revival". Probably, in no other branch of medicine does time play such a role as in resuscitation. After all, nature has so far managed to win a few minutes to save lives.

After a person's heart stops, there comes a period called clinical death : the functions of various organs and systems of the body gradually fade away. But these processes can still be slowed down or suspended. But if a person is not resuscitated as soon as possible, then after 4-6 minutes (in exceptional cases, somehow, say, when freezing - after 8-10 minutes), biological death occurs - that is, such changes (primarily in cells brain), which cannot yet be reversed.

The beginning of clinical death is conditionally considered the last breath or the last contraction of the heart. The person lies unconscious, there is no muscle tone, the pupils do not react to light.

Resuscitate a person under such circumstances should be quickly and clearly, because you have at your disposal exactly those 4-6 minutes for which you can still save the victim.

How to define clinical death?
First you need to find out whether it was really a clinical death, or is it possibly a faint. Within 20-30 seconds (but not longer!) Determine whether a person is breathing and whether his heart is beating (to do this, control the pulse or put the ear to the chest). But it is most effective in this case to check the reaction of the pupils: if you raise your eyelids, then when you faint, the pupils narrow, that is, they react to light, and when they are clinically dead, they are sharply expanded and immobile.

The process of preparing for resuscitation. First aid.
A few more seconds (up to 20) of resuscitation are allotted to ensure that the victim is properly laid down. It is best to put it on your back on a wooden board or floor. If the accident happened on the street, then be sure to take the victim to the side of the road. Then unbutton your chest. Raise your chin as high as possible, tilting your head back and, if necessary, clean your mouth and nose.

After making sure that the person's condition is clinical death, start giving him a heart massage, accompanied by artificial respiration (best of all "mouth to mouth").

It is very good when first aid (resuscitation) is provided not by one, but by two people, coordinating their actions. However, you can do it yourself as well. Be sure to record the time when resuscitation began. This will help doctors in the future.

If resuscitation is carried out by two, then one of them stands near the head and makes artificial respiration, for example, "mouth to mouth" or "mouth to nose", and the second one performs an indirect heart massage.

Artificial respiration. First aid or resuscitation of the lungs.

First of all, for resuscitation, the victim should tilt his head back as much as possible and put a folded scarf or other clothing under his neck. Then you need to take a full chest of air, and, firmly pressing your lips to the victim, forcefully blow it into your mouth through gauze or a handkerchief. At the same time, the nose of the victim is clamped.

With this resuscitation, the chest will begin to expand and rise. After each new blowing of air into the lungs, the victim needs to break away from the handkerchief for a moment, thus creating conditions for passive exhalation. Repeat blowing air to the victim should be at least 16-18 times / min.

Artificial respiration to the victim can be done not only "mouth to mouth", but also by blowing air into his nose. When doing this, be sure to cover the victim's mouth.

CPR or resuscitation should not be stopped until the person is fully able to breathe on their own.

Indirect cardiac massage. First aid or cardiac resuscitation.

To start resuscitation of the heart, stand at the victim on the left side. Then the open palm of one hand must be placed on the border of the middle and lower parts of the chest, and the second hand on the surface of the first (on the back).

Resuscitation of the heart is carried out with energetic shocks, rhythmically pressing on the sternum from front to back. At the same time, it should slightly bend, shifting 3-5 cm in the direction of the spine. Massage is carried out only with those parts of the palm that are closer to the wrist. The frequency during resuscitation of the heart is 50-60 strokes per minute.

When the chest moves after being pressed, it causes the heart to compress and push blood out of it into the blood vessels. Then, after removing the hands from the chest, the heart fills with blood again.

Conducting resuscitation alone.
If one person is engaged in resuscitation, then he must do an indirect heart massage, be sure to alternate it with artificial respiration. To do this, after each blowing into the lungs of the victim, it is necessary to do 4-5 pressures on the sternum.

The frequency of air inhalations and passive exhalations can be slightly reduced if a significant volume of air is blown into the victim each time, but pressure on the chest should not be done less than 50-60 times / min.

I want to emphasize once again that resuscitation pressing should be done precisely at the border of the middle and lower thirds of the chest, and not the ribs. If there is not enough strength in the hands, then you can help with the weight of your own body, but do not press excessively. Since chest compressions require a lot of effort, the people who provide assistance should switch roles after a while.

If resuscitation heart massage is done correctly, then at the moment you press the chest on the victim’s arm, a pulse will be felt. After a while, lips and cheeks will turn pink, independent breaths will appear, and dilated pupils will narrow.

Resuscitation should not be stopped before the arrival of doctors. To fight for a person's life, it would seem, even in hopeless situations, is the duty of everyone.

Fainting. First aid or resuscitation of fainting.

How to help a person who has fainted?
Fainting is a short-term loss of consciousness caused by an insufficient supply of blood to the brain. It can be caused by overwork, exhaustion by disease, lack of sleep, severe nervous shock, significant blood loss, heat or sunstroke, severe pain, prolonged exposure to an unventilated and stuffy room, as well as fright.

A person who has lost consciousness is pale, a cold sweat appears on his forehead, breathing slows down and becomes shallow, the pulse weakens and quickens, hands and feet become cold. When fainting, the eyes close and open, the pupils constrict, but react to light. In mild cases of fainting, consciousness is lost for 1-2 minutes, and in severe cases, for a longer time.

When fainting, first aid (resuscitation) is to make an increased blood flow to the brain. For this unconscious person should be placed so that his head was as low as possible. Then open the collar and loosen any parts of the clothing that interfere with breathing. Open a vent or window. In warm weather, it is better to take the person outside to fresh air. A towel soaked in cold water is applied to the forehead and chest. Then the unconscious person must be given a sniff of cotton wool moistened with ammonia, if it is not available, then use vinegar or cologne. The same cotton can be rubbed with whiskey. Also, you need to put a heating pad on your feet or rub them with a hard cloth. If after such resuscitation measures the consciousness does not return to the person, then you should immediately call an ambulance.

From this article you will learn: when it is necessary to carry out cardiopulmonary resuscitation, what activities include helping a person who is in a state of clinical death. The algorithm of actions during cardiac and respiratory arrest is described.

Article publication date: 07/01/2017

Article last updated: 06/02/2019

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

Ideally, resuscitation carried out by a person who does not have a medical education consists of a closed heart massage, artificial respiration, and the use of an automatic external defibrillator. In reality, such a complex is almost never performed, since people do not know how to properly carry out resuscitation, and there are simply no external external defibrillators.

Determination of vital signs

In 2012, the results of a huge Japanese study were published that included more than 400,000 people with cardiac arrest that occurred outside of a hospital setting. Approximately 18% of those victims who underwent resuscitation were able to restore spontaneous circulation. But only 5% of patients remained alive after a month, and with preserved functioning of the central nervous system - about 2%.

It should be taken into account that without CPR, these 2% of patients with a good neurological prognosis would have no chance of life. 2% of 400,000 victims is 8,000 lives saved. But even in countries with frequent resuscitation courses, care for cardiac arrest outside the hospital is less than half of the cases.

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

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

Indications

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

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

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

Resuscitation techniques

Check the following before starting resuscitation:

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

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

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

1. Closed heart massage

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

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

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

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

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

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

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

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

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

2. Opening the airways

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

To open the airways:

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

3. CPR

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

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

ID rules:

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

Algorithm for basic resuscitation in adults

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

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

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

Features of resuscitation in children

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

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

The main differences between pediatric resuscitation and adult:

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

Using an automated external defibrillator

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

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

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

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

The sequence of actions for using the AED:

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

Termination of resuscitation

CPR should be stopped in the following situations:

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

A person must be able to carry out resuscitation, since medical assistance may not always have time to arrive before the occurrence of biological death in the victim. The process of dying does not occur in one stage. At first, a person is in a state of agony. This period is characterized by a sharp decrease in blood pressure, darkening of consciousness, disruption of the heart, lack of a pulse, and shallow breathing. The skin in this condition immediately turns pale and acquires a bluish tint. Then the body goes into a state of clinical death. Completely stop respiratory and cardiac activity. During this period, you can still return to life. After 3 - 5 minutes, the biological occurs, when it is almost impossible to bring a person back to life. Even if there is a restoration of the heartbeat and breathing, the person becomes inferior, the brain dies, and doctors can only keep alive.

In the event that a person is injured due to an electric shock, a precordial blow should first be made. Lay the person on their back on a hard surface. Find the xiphoid, place your middle and index fingers on it. Place the fist of the other hand over the fingers, pointing the elbow along the body. Hit the area hard with your fist. After that, the heart may begin to beat. If this does not happen, then proceed to the next step, which is suitable for any case of respiratory and palpitations.

Throw the head of the victim back, push the lower jaw forward, opening his mouth. Wrap your finger with a bandage or any rag. Clean the human oral cavity of any foreign inclusions, free the tongue, as in such cases it often sinks and blocks breathing. Start mouth-to-nose or mouth-to-mouth artificial respiration. If you are doing mouth-to-nose breathing, then your air exits through the open mouth of the victim, so you need to completely close it. The same thing when breathing "mouth to mouth", pinch the nose of the resuscitated.

Supplement artificial respiration with chest compressions. Place your palm in the lower third of the victim's sternum, pointing your finger down or towards the face. Place the other hand on top of the cross on the cross. Raise your fingers slightly above the surface so as not to break the victim's ribs. Massage occurs by pressing with all your weight on the designated area so that the person’s chest goes inward by 3-5 cm. The interval between pressures is 1 second.

Combine artificial respiration and chest compressions in a ratio of 1:5. Give the victim 1 breath through the respiratory tract, then carry out 5 pressures on the sternum. Well, if 2-3 people will reanimate. It is necessary to make the process harmonious: it is impossible to inhale air into the lungs and press on the chest at the same time, since the integrity of the lungs can be violated. Continue to perform these manipulations for at least 5 minutes. By this time the ambulance should have arrived. Without special equipment, a longer resuscitation is already becoming useless.

Resuscitation is a set of activities that can be carried out by both medical professionals and ordinary people, aimed at reviving a person who is in a state of clinical death. Its main signs are the absence of consciousness, spontaneous breathing, pulse and pupillary response to light. Also called intensive care unit, which treats the most severe patients on the verge between life and death and specialized emergency teams that treat such patients. Pediatric resuscitation is a very complex and responsible branch in medicine, which helps to save the smallest patients from death.

Resuscitation in adults

The algorithm for cardiopulmonary resuscitation in men and women is not fundamentally different. The main task is to achieve the restoration of airway patency, spontaneous breathing and maximum chest excursion (the amplitude of the movement of the ribs during the procedure). However, the anatomical features of obese people of both sexes make it somewhat difficult to carry out resuscitation measures (especially if the resuscitator does not have a large physique and sufficient muscle strength). For both sexes, the ratio of respiratory movements to chest compressions should be 2:30, the frequency of chest compressions should be about 80 per minute (as happens with independent contraction of the heart).

Pediatric resuscitation is a separate science, and it is most competently carried out by doctors with a specialization in pediatrics or neonatology. Children are not small adults, their body is arranged in a special way, therefore, in order to provide emergency care for clinical death in babies, you need to know certain rules. After all, sometimes out of ignorance, the wrong technique of resuscitation of children leads to death in cases where this could have been avoided.

Children's resuscitation

Very often, the cause of respiratory and cardiac arrest in children is the aspiration of foreign bodies, vomit or food. Therefore, before starting them, it is necessary to check for foreign objects in the mouth, for this you need to slightly open it and examine the visible part of the pharynx. If you have them, try to remove them yourself by placing the baby on his stomach with his head down.

The lung capacity of children is smaller than that of adults, so when performing artificial respiration, it is better to resort to the mouth-to-nose method and inhale a small amount of air.

The heart rate in children is more frequent than in adults, so resuscitation of children should be accompanied by more frequent pressure on the sternum during chest compressions. For children under 10 years old - 100 per minute, by pressure with one hand with an amplitude of chest fluctuations of no more than 3-4 cm.

Children's resuscitation is an extremely responsible event, however, while waiting for an ambulance, you should at least try to help your baby, because it can cost him his life.

Newborn resuscitation

Resuscitation of newborns is not a rare procedure that doctors perform in the delivery room immediately after the birth of the baby. Unfortunately, the birth does not always go smoothly, sometimes severe injuries, prematurity, medical manipulations, intrauterine infections and the use of general anesthesia for caesarean section lead to the fact that the child is born in a state of clinical death. The lack of certain manipulations in the framework of resuscitation of newborns leads to the fact that he may die.

Fortunately, neonatologists and pediatric nurses practice all actions to automaticity, and in the vast majority of cases they manage to restore blood circulation in a child, although sometimes he spends some time on a ventilator. Considering the fact that newborn children have a great ability to recover, most of them do not have health problems in the future, caused by a not very successful start to their life.

The word "resuscitation" in translation from Latin literally means "re-giving life." Thus, resuscitation of a person is a set of certain actions that are carried out by medical workers or ordinary people who are nearby, under favorable circumstances, allowing a person to be brought out of a state of clinical death. After that, in the hospital, if there are indications, a number of therapeutic measures are carried out aimed at restoring the vital functions of the body (the work of the heart and blood vessels, the respiratory and nervous systems), which are also part of the resuscitation. This is the only correct definition of the word, however, it is used in a broader sense with other meanings.

Very often, this term is used to refer to the department, which has the official name "reanimation and intensive care unit". However, it is long and not only ordinary people, but medical professionals themselves reduce it to one word. Another resuscitation is often called a specialized emergency medical team, which leaves for calls to people who are in extremely serious condition (sometimes clinically dead). They are equipped with everything necessary for carrying out various activities that may be needed in the process of resuscitation of a victim in severe traffic, industrial or criminal accidents, or those who suddenly have a sharp deterioration in health, which has led to a threat to life (various shocks, asphyxia, cardiac diseases, etc.).

Specialty "Anesthesiology and resuscitation"

The work of any doctor is hard work, as doctors have to take great responsibility for the life and health of their patients. However, the specialty "anesthesiology and resuscitation" stands out among all other medical professions: these doctors have a very big load, since their work is related to helping patients who are on the verge of life and death. Every day they face the most severe patients, and they are required to make immediate decisions that directly affect their lives. Resuscitation patients require attention, constant monitoring and thoughtful attitude, because any mistake can lead to their death. A particularly heavy burden falls on doctors who are engaged in anesthesiology and resuscitation of the smallest patients.

What should an anesthesiologist resuscitator be able to do

A doctor specializing in anesthesiology and resuscitation has two main and main tasks: the treatment of seriously ill patients in the intensive care unit and the assistance during surgical interventions associated with the choice and implementation of anesthesia (anesthesiology). The work of this specialist is prescribed in the job descriptions, so the doctor must carry out his activities in accordance with the main points of this document. Here is some of them:

• Evaluates the patient's condition before surgery and prescribes additional diagnostic measures in cases where there are doubts about the possibility of surgical treatment under anesthesia.
• Organizes the workplace in the operating room, monitors the serviceability of all devices, in particular the ventilator, monitors for monitoring heart rate, pressure and other indicators. Prepares all necessary tools and materials.
• Directly carries out all activities within the framework of a pre-selected type of anesthesia (general, intravenous, inhalation, epidural, regional, etc.).
• Monitors the patient's condition during the operation, if it deteriorates sharply, informs the surgeons who directly perform it, and takes all necessary measures to correct this condition.
• After the end of the operation, the patient is taken out of the state or another type of anesthesia.
• In the postoperative period, he monitors the patient's condition, in case of unforeseen situations, takes all the necessary measures for its correction.
• In the resuscitation and intensive care unit, he treats seriously ill patients using all the necessary techniques, manipulations and pharmacotherapy.
• A doctor specializing in anesthesiology and resuscitation should be proficient in various types of vascular catheterization, the technique of tracheal intubation and artificial lung ventilation, and perform various types of anesthesia.
• In addition, he must be fluent in such an important skill as cerebral and cardiopulmonary resuscitation, know how to treat all major urgent life-threatening conditions, such as various types of shocks, burn disease, polytrauma, various types of poisoning, heart rhythm and conduction disorders, tactics for especially dangerous infections, etc.

The list of what an anesthesiologist resuscitator should know is endless, because there are a great many serious conditions that he may encounter on his shift, and in any situation he must act quickly, confidently and for sure.

In addition to the knowledge and skills that relate to his professional activities, a doctor of this specialty must improve his qualifications every 5 years, attend conferences, and improve his skills.

In general, any doctor studies throughout his life, because this is the only way he will be able to provide quality care at any time according to all modern standards. In order to get a job as a doctor in the intensive care unit, a person must study for 6 years in the specialty "General Medicine" or "Paediatrics", and then complete a 1-year internship, 2-year residency or professional retraining courses (4 months ) with a degree in anesthesiology and resuscitation. Residency is the most preferable, since such a complex profession cannot be mastered qualitatively in a shorter period of time.

Further, a doctor of this specialty can begin independent work, however, in order to feel more or less calm in this role, he needs another 3-5 years. Every 5 years, a doctor must take 2-month advanced training courses at one of the departments at the institute, where he learns about all the innovations, medicinal innovations and modern methods of diagnosis and treatment.

Cardiopulmonary resuscitation: basic concepts

Despite the achievements of modern medical science, cardiopulmonary resuscitation is still the only way to bring a person out of clinical death. If no action is taken, then it will inevitably be replaced by true death, that is, biological, when a person can no longer be helped.

In general, everyone should know the basics of cardiopulmonary resuscitation, because anyone has a chance to be next to such a person, and his life will depend on his determination. Therefore, before the arrival of the ambulance, you need to try to help the person, since in this state every minute is precious, and the car will not be able to arrive instantly.

What is clinical and biological death

Before touching on the main aspects of such an important procedure as cardiopulmonary resuscitation, it is worth mentioning the two main stages of the process of attenuation of life: clinical and biological (true) death.

In general, clinical death is a reversible condition, although it lacks the most obvious signs of life (pulse, spontaneous breathing, constriction of the pupils under the influence of a light stimulus, basic reflexes and consciousness), but the cells of the central nervous system have not yet died. It usually lasts no more than 5-6 minutes, after which the neurons, which are extremely vulnerable to oxygen starvation, begin to die and true biological death occurs. However, you need to know the fact that this time interval is very dependent on the ambient temperature: at low temperatures (for example, after removing the patient from under the snow blockage) it can be 10-20 minutes, while in the heat the period when human resuscitation can be successful, reduced to 2-3 minutes.

Carrying out resuscitation during this period of time gives a chance to restore the work of the heart and the breathing process, and prevent the complete death of nerve cells. However, it is far from always successful, because the result depends on the experience and correctness of this difficult procedure. Doctors who, by the nature of their work, often encounter situations requiring intensive resuscitation, are fluent in it. However, clinical death often occurs in places remote from the hospital and the entire responsibility for its implementation lies with ordinary people.

If resuscitation was started 10 minutes after the onset of clinical death, even if the work of the heart and breathing was restored, irreparable death of some neurons had already occurred in the brain, and such a person, most likely, would not be able to return to a full life. After 15-20 minutes from the onset of clinical death, resuscitation of a person does not make sense, since all neurons have died, and, nevertheless, when the work of the heart is restored, the life of such a person can be continued by special devices (the patient himself will be in the so-called "vegetative state" ).

Biological death is recorded 40 minutes after the establishment of clinical death and / or at least half an hour of unsuccessful resuscitation. However, its true signs appear much later - 2-3 hours after the cessation of blood circulation through the vessels and spontaneous breathing.

The only indication for cardiopulmonary resuscitation is clinical death. Not making sure that the person is not in it, you should not torment him with your attempts to resuscitate. However, true clinical death - a condition in which resuscitation is the only treatment - no drugs can artificially resume the work of the heart and the breathing process. It has absolute and relative signs that allow you to suspect it quickly enough, even without a special medical education.

Absolute signs of a condition requiring resuscitation include:

• Lack of consciousness.

The patient does not show signs of life, does not answer questions.

• Lack of cardiac activity.

In order to determine whether the heart is working or not, it is not enough to attach the ear to the cardiac region: in very obese people or at low pressure, it can simply not be heard, mistaking this condition for clinical death. Pulsation on the radial artery is also sometimes very weak, moreover, its presence depends on the anatomical location of this vessel. The most effective method for determining the presence of a pulse is to check it on the carotid artery on the side of the neck for at least 15 seconds.

• Absence of breath.

Whether or not a patient is breathing in a critical condition is also sometimes difficult to determine (with shallow breathing, chest fluctuations are practically invisible to the naked eye). To find out exactly whether a person is breathing or not and start intensive resuscitation, you need to attach a sheet of thin paper, cloth or a blade of grass to your nose. The air exhaled by the patient will cause these objects to vibrate. Sometimes it is enough just to put your ear to the nose of a sick person.

• Pupillary response to light stimulus.

This symptom is quite simple to check: you need to open your eyelid and shine a flashlight, lamp or mobile phone on it. The absence of reflex pupillary constriction, together with the first two symptoms, is an indication that intensive resuscitation should be started as soon as possible.

Relative signs of clinical death:

• Pale or dead skin color
• Lack of muscle tone (raised arm limply falls to the ground or bed),
• Lack of reflexes (an attempt to prick the patient with a sharp object does not lead to reflex contraction of the limb).

They are not in themselves an indication for resuscitation, however, in combination with absolute signs, they are symptoms of clinical death.

Contraindications for intensive resuscitation

Unfortunately, sometimes a person suffers from such serious illnesses and is in a critical condition, in which resuscitation does not make sense. Of course, doctors are trying to save anyone's life, but if the patient suffers from an end-stage cancer, a systemic or cardiovascular disease that has led to decompensation of all organs and systems, then an attempt to restore his life will only prolong his suffering. Such conditions are a contraindication for intensive resuscitation.

In addition, cardiopulmonary resuscitation is not performed in the presence of signs of biological death. These include:

• The presence of cadaveric spots.
• Clouding of the cornea, a change in the color of the iris and a symptom of a cat's eye (when the eyeball is compressed from the sides, the pupil acquires a characteristic shape).
• Presence of rigor mortis.

A severe injury incompatible with life (for example, a detachment of the head or a large part of the body with massive bleeding) is a situation in which intensive resuscitation is not carried out due to its futility.

Everyone should know the basics of this urgent event, but medical workers, especially emergency services, are fluent in it. Cardiopulmonary resuscitation, the algorithm of which is very clear and specific, can be carried out by anyone, since this does not require special equipment and devices. Ignorance or incorrect implementation of elementary rules leads to the fact that when the emergency team arrives at the victim, he no longer needs resuscitation, since there are initial signs of biological death and time has already been lost.

The main principles by which cardiopulmonary resuscitation is carried out, the algorithm of actions for a person who accidentally happened to be near the patient:

Move the person to a place convenient for resuscitation (if there are no visual signs of a fracture or massive bleeding).

Assess the presence of consciousness (responds or not to questions) and reaction to stimuli (press the phalanx of the patient's finger with a fingernail or a sharp object and see if there is a reflex contraction of the hand).

Check for breathing. First, assess if there is movement of the chest or abdominal wall, then lift the patient and again monitor if there is breathing. Bring an ear to his nose for auscultation of respiratory noise or a thin cloth, thread or leaf.

Assess the reaction of pupils to light by pointing a burning flashlight, lamp or mobile phone at them. In case of poisoning with narcotic substances, the pupils may be narrowed, and this symptom is not informative.

Check for a heartbeat. Pulse control for at least 15 seconds on the carotid artery.

If all 4 signs are positive (there is no consciousness, pulse, breathing and pupillary reaction to light), then clinical death can be stated, which is a condition requiring resuscitation. It is necessary to remember the exact time when it came, if this is of course possible.

If you find out that the patient is clinically dead, you need to call for help everyone who happened to be close to you - the more people help you, the more chances to save the person.

One of the people helping you should immediately call for emergency assistance, be sure to give all the details of the incident and listen carefully to all instructions from the service dispatcher.

While one calls an ambulance, the other should immediately begin to conduct cardiopulmonary resuscitation. The algorithm of this procedure involves a number of manipulations and certain techniques.

First, it is necessary to clean the contents of the oral cavity from vomit, mucus, sand or foreign bodies. This should be done by giving the patient a position on his side, with his hand wrapped in a thin cloth.

After that, in order to avoid overlapping the respiratory tract with the tongue, it is necessary to put the patient on his back, open his mouth slightly and push the jaw forward. In this case, you need to put one hand under the patient’s neck, throw back his head, and manipulate with the other. A sign of the correct position of the jaw is a parted mouth and the position of the lower teeth directly on the same level with the upper ones. Sometimes spontaneous breathing is fully restored after this procedure. If this does not happen, then the following steps must be followed.

Next, you need to start artificial ventilation of the lungs. Its essence is as follows: a man or woman who resuscitates a person is located on the side of him, put one hand under his neck, put the other on his forehead and pinch his nose. Then they take a deep breath and exhale tightly into the mouth of a clinically dead person. After that, an excursion (movement of the chest) should be visible. If, instead, a protrusion of the epigastric region is visible, it means that air has entered the stomach, the reason for this is most likely related to the obstruction of the airways, which must be tried to be eliminated.

The third point of the cardiopulmonary resuscitation algorithm is a closed heart massage. To do this, the caregiver must position himself on either side of the patient, put his hands one on one on the lower part of the sternum (they should not be bent with the elbow joint), after which he needs to make intense pressure on the corresponding area of ​​\u200b\u200bthe chest. The depth of these pressings should ensure the movement of the ribs to a depth of at least 5 cm, lasting about 1 second. Such movements need to be done 30, and then repeat two breaths. The number of pressings during artificial indirect heart massage should coincide with its physiological contraction - that is, it should be carried out at a frequency of about 80 per minute for an adult.

Carrying out cardiopulmonary resuscitation is hard physical work, because pressing must be carried out with sufficient force and continuously until the moment when the emergency team arrives and continues all these activities. Therefore, it is optimal that several people take turns conducting it, because at the same time they have the opportunity to relax. If there are two people next to the patient, one can perform one cycle of pressing, the other - artificial ventilation of the lungs, and then change places.

The provision of emergency care in cases of clinical death in young patients has its own characteristics, so resuscitation of children or newborns differs from that in adults. First, it must be taken into account that they have a much smaller lung capacity, so trying to breathe too much into them can lead to injury or rupture of the airways. Their heart rate is much higher than in adults, therefore, resuscitation of children under the age of 10 years involves at least 100 chest compressions and an excursion of no more than 3-4 cm. Resuscitation of newborns should be even more accurate and gentle: artificial ventilation of the lungs is carried out not in the mouth, but in the nose, and the volume of air blown in should be very small (about 30 ml), but the number of clicks is at least 120 per minute, and they are carried out not with the palm, but simultaneously with the index and middle fingers.

Cycles of mechanical ventilation and closed heart massage (2:30) should replace each other before the arrival of emergency doctors. If you stop carrying out these manipulations, then a state of clinical death may again occur.

Criteria for the effectiveness of resuscitation

Resuscitation of the victim, and indeed of any person who was in clinical death, should be accompanied by constant monitoring of his condition. The success of cardiopulmonary resuscitation, its effectiveness can be assessed by the following parameters:

• Improvement of skin color (more pink), reduction or complete disappearance of cyanosis of the lips, nasolabial triangle, nails.
• Constriction of the pupils and restoration of their reaction to light.
• The appearance of respiratory movements.
• The appearance of the pulse first on the carotid artery, and then on the radial one, the heartbeat can be heard through the chest.

The patient may be unconscious, the main thing is the restoration of the heart and free breathing. If a pulsation appears, but breathing does not, then it is worth continuing only artificial ventilation of the lungs until the emergency team arrives.

Unfortunately, not always the resuscitation of the victim leads to a successful result. The main mistakes during its implementation:

• The patient is on a soft surface, the force applied by the resuscitator when pressing on the chest is extinguished due to body vibrations.
• Insufficient pressure intensity that results in chest excursion of less than 5 cm in adults.
• The cause of the airway obstruction has not been eliminated.
• Incorrect position of the hands during ventilation and heart massage.
• Delayed start of cardiopulmonary resuscitation.
• Pediatric resuscitation may not be successful due to the insufficient frequency of chest compressions, which should be much more frequent than in adults.

During resuscitation, injuries such as a fracture of the sternum or ribs may develop. However, in themselves, these conditions are not as dangerous as clinical death, so the main task of the caregiver is to return the patient to life at any cost. If successful, the treatment of these fractures is not difficult.

Resuscitation and intensive care is a department that should be present in any hospital, as the most severe patients are treated here, requiring round-the-clock close monitoring by medical workers.

Who is an intensive care patient

Resuscitation patients are the following categories of people:

• patients who are admitted to the hospital in an extremely serious condition, on the verge between life and death (coma of varying degrees, severe poisoning, of various origins, massive bleeding and trauma, after myocardial infarction and stroke, etc.).
• patients who have undergone clinical death at the prehospital stage,
• patients who were previously in the specialized department, but their condition deteriorated sharply,
• patients on the first day or several days after surgery.

Resuscitation patients are usually transferred to specialized departments (therapy, neurology, surgery or gynecology) after stabilization of their condition: restoration of spontaneous breathing and the ability to eat, recovery from a coma, maintaining normal pulse and pressure values.

Equipment in the intensive care unit

The intensive care unit is the most technically equipped, because the condition of such seriously ill patients is completely controlled by various monitors, a number of them are artificially ventilated, drugs are constantly administered through various infusomats (devices that allow you to inject substances at a certain speed and maintain their concentration in the blood at the same level) .

There are several zones in the intensive care unit:

• The treatment area, where the wards are located (in each of them there are 1-6 patients),
• Doctors' (staff's), nurses' (nursing), head of department and senior nurse's offices.
• Auxiliary zone, where everything necessary to control the cleanliness in the department is stored, junior medical personnel often rest there.
• Some intensive care units are equipped with their own laboratory, where emergency tests are carried out, there is a doctor or laboratory assistant.

Near each bed there is its own monitor, on which you can track the main parameters of the patient's condition: pulse, pressure, oxygen saturation, etc. Nearby there are artificial lung ventilation devices, an oxygen therapy device, a pacemaker, various infusion pumps, drip stands. Depending on the indications, other special equipment may be delivered to the patient. The intensive care unit can perform an emergency hemodialysis procedure. In each ward there is a table where the resuscitator works with papers or the nurse draws up an observation card.

Beds for intensive care patients differ from those in conventional departments: there is an opportunity for giving the patient an advantageous position (with a raised head end or legs), fixing the limbs if necessary.

• The staff of the intensive care unit

A large number of medical personnel work in the intensive care unit, which ensures the smooth and continuous work of the entire department:

• head of the resuscitation and intensive care unit, senior nurse, housewife,
• anesthesiologists-resuscitators,
• nurses,
• junior medical staff,
• resuscitation laboratory staff (if any),
• support services (which monitor the health of all devices).

City resuscitation - these are all intensive care units of the city, which are ready at any moment to accept severe patients brought to them by ambulance teams. Usually, in each major city, there is one leading clinic that specializes in emergency care and is on duty all the time. This is what can be called urban resuscitation. And, nevertheless, if a seriously ill patient was brought to the emergency department of any clinic, even one that does not provide assistance on that day, he will certainly be accepted and receive all the necessary assistance.

The city intensive care unit accepts not only those who are delivered by emergency teams, but also those who are brought by relatives or acquaintances on their own transport. However, in this case, time will be lost, because the treatment process continues already at the pre-hospital stage, so it is better to trust the specialists.

Regional resuscitation

The regional intensive care unit is the intensive care and intensive care unit at the largest regional hospital. Unlike the city intensive care unit, the most severe patients from all over the region are brought here. Some regions of our country have very large territories, and the delivery of patients by car or ambulance is not possible. Therefore, sometimes patients are delivered to the regional intensive care unit by air ambulances (helicopters specially equipped for emergency care), which, at the time of their landing at the airport, are waiting for a specialized car.

Regional resuscitation is engaged in the treatment of patients who unsuccessfully tried to remove their serious condition in city hospitals and interregional centers. It employs many highly specialized doctors involved in a specific profile (hemostasiologist, combustiologist, toxicologist, etc.). However, the regional intensive care unit, like any other hospital, accepts patients who are delivered by a regular ambulance.

How is the resuscitation of the victim

First aid to the victim, who is in a state of clinical death, should be provided by those who are nearby. The technique is described in section 5.4-5.5. At the same time, it is necessary to call emergency care and carry out cardiopulmonary resuscitation either until spontaneous breathing and heartbeat are restored, or until she arrives. After that, the patient is transferred to specialists, and then they continue to work on resuscitation.

Upon arrival, doctors assess the condition of the victim, whether or not there was an effect from the cardiopulmonary resuscitation performed at the pre-medical stage. They must definitely clarify the exact beginning of the onset of clinical death, because after 30 minutes it is already considered ineffective.

Artificial ventilation of the lungs by doctors is carried out with a breathing bag (Ambu), since prolonged breathing "mouth to mouth" or "mouth to nose" reliably leads to infectious complications. In addition, it is not so hard physically and allows you to transport the victim to the hospital without stopping this procedure. There is no artificial replacement for indirect heart massage, so the doctor conducts it according to general canons.

In case of a successful result, when the patient's pulse resumes, they catheterize and inject substances that stimulate the work of the heart (adrenaline, prednisone), control the work of the heart by monitoring the electrocardiogram. When spontaneous breathing is restored, an oxygen mask is used. In this condition, the patient after resuscitation is taken to the nearest hospital.

How the ambulance works

If a call arrives at the ambulance dispatcher, which reports that the patient has signs of clinical death, then a specialized team is immediately sent to him. However, not every ambulance is equipped with everything necessary for emergencies, but only an ambulance. This is a modern car, specially equipped for cardiopulmonary resuscitation, equipped with a defibrillator, monitors, infusion pumps. It is convenient and comfortable for the doctor to provide all types of emergency care. The shape of this car makes it easier to maneuver in the traffic of others, sometimes it has a bright yellow color, which allows other drivers to quickly notice it and let it pass ahead.

An ambulance with the words "newborn resuscitation" is also usually painted yellow and equipped with everything necessary for emergency care of the smallest patients who are in trouble.

A person who has experienced clinical death divides his life into “before” and “after”. However, the consequences of this condition can be quite different. For some, this is just an unpleasant memory and nothing more. And others after resuscitation cannot fully recover. It all depends on the speed of the start of revitalization activities, their quality, effectiveness, and how quickly specialized medical assistance arrived.

Features of patients who have undergone clinical death

If resuscitation measures were started in a timely manner (within the first 5-6 minutes from the onset of clinical death) and quickly led to a result, then the brain cells did not have time to die. Such a patient can return to a full life, but certain problems with memory, the level of intelligence, and the ability to exact sciences are not ruled out. If breathing and heartbeat against the background of all activities did not recover within 10 minutes, then, most likely, such a patient after resuscitation, even according to the most optimistic forecasts, will suffer from serious disturbances in the functioning of the central nervous system, in some cases, various skills and abilities are irreversibly lost, memory, sometimes the possibility of independent movement.

If more than 15 minutes have passed since the onset of clinical death, through active cardiopulmonary resuscitation, the work of breathing and the heart can be supported artificially by various devices. But the patient's brain cells have already died, and then he will be in the so-called "vegetative state", that is, there are no prospects to return his life without life support devices.

The main directions of rehabilitation after resuscitation

The volume of activities within the framework of after resuscitation directly depends on how long the person was previously in a state of clinical death. The extent to which the nerve cells of the brain have been damaged can be assessed by a neurologist, who will also prescribe all the necessary treatment as part of the recovery. It may include various physiotherapy, physical therapy and gymnastics, taking nootropic, vascular drugs, B vitamins. However, with timely resuscitation measures, clinical death may not affect the fate of the person who suffered it.