The sequence of resuscitation measures and contraindications to them. Resuscitation measures and their sequence Assistance in cardiac arrest resuscitation

An unexpected death is the most terrible and terrible thing that can happen, especially if the trouble happens to a close relative or loved one. Often, it is the correct first aid provided in case of cardiac arrest that is the only chance to save a life: before the arrival of emergency medical assistance, one must do the maximum possible to maintain blood circulation and preserve the viability of the brain. The main conditions for effectiveness are emergency care for respiratory failure and must begin immediately, and the implementation of primary resuscitation measures must be correct. It is important not to make typical mistakes that can harm a person who is in a state of clinical death.

The main indications for resuscitation

Primary emergency care for sudden cardiac arrest should be started after assessing the following signs:

• loss of consciousness;
• lack of pulse movements in the area of ​​the carotid artery;
• impaired or absent breathing.

You can’t panic, do meaningless actions and try to revive a person with blows to the chest: the first medical aid for cardiac arrest consists in carrying out primary measures to restore breathing and blood circulation in a person who is in a state of clinical death. It is necessary to assess the situation and make a decision on rendering assistance within 10-15 seconds. In parallel, it is necessary to call the resuscitation team, whose specialists will be able to take all possible measures to revive the person.

Primary activities

Cardiac arrest resuscitation by a bystander or relative consists of 3 stages.

1. Airway preparation

A person without signs of life should be laid on his back, on a hard, flat surface. Release the upper part of the chest from clothing. It is mandatory to examine the respiratory tract - if foreign bodies, dentures, blood clots are found in the mouth, obstacles must be quickly removed. To ensure optimal artificial ventilation of the lungs in a lying person, 3 steps must be performed:

• throw back your head;
• protrude the lower jaw as much as possible;
• open your mouth.

Having taken a test breath in the mouth-to-mouth method and evaluating the result of chest expansion, it is necessary to start first aid in case of sudden cardiac arrest.

1. Artificial ventilation into the lungs

To provide air to the lungs of a person who is unable to breathe on his own, it is necessary to perform the following cyclic measures:

• inhale deeply;
• clamp the nasal passages of a person lying with his head thrown back;
• exhale into an open mouth;
• evaluate the size of the breast expansion;
• release the person's mouth for passive exhalation.

The duration of each cycle is about 5 seconds. Be sure to monitor the expansion and contraction of the chest in each cycle. More important is not the quantity, but the quality: 12 full-fledged injections per minute will ensure that life-giving oxygen, which is necessary for all tissues and organs, enters the human blood.

1. Compression compression of the chest

Maintaining circulation is the most important step in providing first aid for sudden cardiac arrest. Closed chest massage mimics heart activity, helping to send oxygenated blood to vital organs. The basic rules of cardiac resuscitation are:

The optimal pace (80-100 massage movements per minute) allows you to fully simulate a normal heart rhythm. In case of cardiac arrest, resuscitation should be carried out continuously, combining external massage with artificial air injection. It is good if 2 people provide emergency assistance: in this case, you can do one air injection for 5 massage movements. If emergency care against the background of asystole is performed by one person, then the ratio should be 15 to 2 - after a cycle of 15 massage compressions, 2 blows should be performed.

Common Mistakes

An untrained and far from medicine person is far from always able to do everything right. Common and common mistakes in primary resuscitation include:

• carrying out all activities on a soft or springy surface;
• performing breaths with the head lying flat and the nostrils of the dying person not pinched;
• wrong choice of point for external massage;
• non-rhythmic chaotic pressure on the chest with insufficient or excessive force;
• conducting a closed massage without performing injections;
• non-compliance with the ratio of breaths and pressures;
• unreasonable interruption in the provision of medical care for more than 10 seconds;
• lack of control over the effectiveness of massage and artificial respiration.

After 30 minutes of resuscitation, in the absence of a heartbeat and breathing, an irreversible state sets in, when nothing can be changed, even if the resuscitation team arrived with a defibrillator. If you don’t try to do anything at all, but only call for emergency help, then biological death will occur in 7 minutes.

With the help of primary resuscitation measures, it is possible to start the heart, but only in cases where there is no serious pathology of the cardiovascular system or reflex cardiac arrest has occurred. The main task of first aid is to maintain blood circulation and respiration until the arrival of specialists with experience in resuscitation and special equipment.

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

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

It is categorically important for all people to have first aid skills. Bookmark this page and share it with your friends.

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

Dangerous symptoms of cardiovascular disease

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

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

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

What can cause a heart to stop?

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

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

Indications for cardiac massage (signs of clinical death)

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

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

Additional signs: a significant expansion of the pupils (weak reaction to light) and blanching or blueness of the skin.

Action plan for cardiopulmonary resuscitation

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

1. Security check

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

2. Checking consciousness

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

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

3. Call an ambulance

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

4. Revision of the oral cavity

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

5. Check for pulse and breathing

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

Indications for resuscitation:

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

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

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

Indirect cardiac massage and artificial respiration (IVL)

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

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

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

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

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

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

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

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

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

Determination of vital signs

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

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

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

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

Indications

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

Clinical death is a period of time lasting from cardiac 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 you think 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 give you a rough idea of ​​the pace at which the VMS is being conducted, you can listen to the rhythm in the song "Stayin' Alive" by the British pop group the BeeGees. It is noteworthy that the very name of the song corresponds to the goal of emergency resuscitation - "Staying alive."

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

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

2. Opening the airways

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

To open the airways:

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

3. CPR

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

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

ID rules:

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

Algorithm for basic resuscitation in adults

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

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

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

Features of resuscitation in children

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

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

The main differences between pediatric resuscitation and adult:

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

Using an automated external defibrillator

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

Automated external defibrillator

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

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

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

The sequence of actions for using the AED:

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

Termination of resuscitation

CPR should be stopped in the following situations:

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

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Attack of cardiac arrest

Tachycardia will go away by itself if you drink a glass of hot at night.

Sudden cardiac death, or cardiac arrest, is a serious, emergency condition that can occur even in seemingly healthy young people. Up to 90% of cases of cardiac arrest lead to cessation of breathing and death despite resuscitation, which is often too late. Only early diagnosis and treatment of heart problems, which in one way or another affect many people, will help prevent the consequences of cardiac arrest and prevent a recurrence of the situation in the future.

Causes of cardiac arrest

The heart is the real pump in our body. It "pumps" the blood, directing it through the arteries, arterioles, capillaries, and then through the veins and venules raises the blood up. The heart is located at the level of 4-8 vertebrae to the left of the chest, on top it is “dressed” in a bag - the pericardium, which protects the organ from damage. The walls of the heart are represented by the epicardium (outer shell), myocardium (muscle layer), endocardium (inner layer of the epithelium). The cavities of the heart are two atria and two ventricles, separated by septa and valves. The work of the heart can be disrupted for various reasons and with the participation of different mechanisms, and the most severe violation is a sudden cardiac arrest.

Under the syndrome of cardiac arrest is understood the cessation of work (bioelectric activity) of the body, due to many factors and leading to clinical death (potentially reversible condition), and then to the biological death of a person. The result is the end of blood circulation throughout the body, hypoxia of brain tissues, and acute heart failure. To restore the activity of the heart, relatives of the patient and doctors have only 7 minutes or less, since in a later period a person develops irreversible disorders throughout the body.

There are the following types of conditions during which the heart stops, and they all have the same clinical signs and differ only according to the ECG:

1. Asystole, or the end of the electrical activity of the body. Up to 90% of cases of cardiac arrest due to asystole occur during diastole - a period of relaxation. Primary asystole can be reflex when the vagus is irritated, when potassium metabolism is disturbed, etc. Secondary asystole develops with some types of arrhythmias, with severe heart disease left untreated.
2. Ventricular fibrillation. This condition is an uncoordinated, multidirectional contraction of the bundles of fibers of the heart muscle. Fibrillation leads to a violation of the pumping function of the organ and can be large-wave, small-wave. The causes of the pathology lie in taking a large number of dangerous pills (for example, with an overdose of cardiac glycosides), may be associated with electrical injury, drowning. In these cases, we are talking about primary fibrillation. Secondary fibrillation occurs against the background of an already existing acute heart disease - myocardial infarction, conduction disorders, etc.
3. Electromechanical dissociation, or the absence of mechanical work of the heart while maintaining eclectic activity. Other names for pathology are inefficient heart, idioventricular rhythm, cardiovascular collapse. In this case, temporary or final circulatory arrest is associated with the cessation of heart movements.

The vast majority of cases of cardiac arrest are associated with serious heart disease. Sudden cardiac death can happen for the following reasons (all of the following conditions can go into one of the types of cardiac arrest, more often - into ventricular fibrillation):

• fast (frequent) ventricular extrasystole;
• paroxysmal ventricular tachycardia;
• myocardial infarction;
• cardiogenic shock;
• arrhythmogenic shock;
• cardiac ischemia;
• complete heart block;
• Brugada syndrome;
• TELA;
• acute heart failure;
• ruptured aortic aneurysm;
• cardiac tamponade;
• myocarditis and endocarditis;
• cardiomyopathy.

Extracardiac or extracardiac conditions can also cause complete cardiac arrest or a short-term failure in its activity. These include:

• advanced oncological process;
• severe diseases of the lungs and respiratory tract, including pneumothorax;
• old age;
• asphyxia when a foreign body enters the respiratory system;
• all types of shock conditions (pain, anaphylactic, toxic shock);
• burn disease;
• overdose of the drug, alcohol, drugs (among the most dangerous drugs are beta-blockers, cardiac glycosides,
• phenothiazine derivatives, barbiturates, drugs for anesthesia);
• drowning, trauma, electric shock, severe hypothermia, violent causes of death;
• metabolic failures;
• hypovolemia;
• acute hypercalcemia;
• hypoxia;
• hypothermia.

Researchers name several risk factors that may increase the likelihood of cardiac arrest. Among them, especially noted are old age, alcoholism and smoking, obesity, intensive sports (cardiac arrest sometimes occurs in professional athletes), stress and overwork, arterial hypertension. Diabetes mellitus, high blood cholesterol, and left ventricular hypertrophy can also cause serious heart disease, which can then provoke cardiac arrest.

Separately, it should be noted SIDS, or sudden infant death syndrome, which affects children under one year old and, for the most part, occurs at the age of a child of 2-4 months. This syndrome is associated with nocturnal cardiac and respiratory arrest without serious health problems. Risk factors for cardiac arrest in an infant are:

• sleep on the stomach;
• being in a too hot room;
• sleep on soft, fluffy linen;
• tobacco smoke in the room;
• multiple pregnancy, premature birth;
• fetal growth retardation, hypoxia during gestation;
• family history - when the child's brothers or sisters died at the same age;
• infectious diseases that were transferred in the first 2 months after birth.

Symptoms and Diagnosis

If a person in cardiac arrest is at home, at work, or in other conditions, but not in a medical facility, it is difficult to assume a diagnosis and start resuscitation, but this should be done as early as possible, ideally within the first minute. Especially great difficulties arise if the symptoms of pathology occur in a dream, because then the chances of saving the patient are minimal. The cardiac arrest clinic includes several symptoms. The main symptom is the absence of breathing and pulse. A person's chest does not rise or fall, and on the mirror, which is brought to the nose, there are no foggy marks.

Also, one of the signs of cardiac arrest is the cessation of pulsation of large arteries. To determine, you should put your middle and index fingers on the area of ​​​​the carotid artery for a few seconds: if there is no pulsation, you should urgently provide emergency assistance to the person and call an ambulance. Suspicion of cardiac arrest should also arise with the following symptoms:

• pupil dilation, cessation of their response to light;
• dullness, blue face, which occurs due to the end of blood circulation;
• loss of consciousness, short (seconds), which is due to ventricular fibrillation or asystole, or prolonged, which, as a rule, means clinical death;
• a dull sound of slowing and cessation of the heartbeat, which can be noted when listening to heart sounds with the ear;
• muscle cramps are also possible;
• there is no reaction to screaming, slaps, tweaks and other external stimuli.

Diagnosis should be carried out on the spot by a person who is able to assess the basic parameters of the patient's life. Conventional methods of diagnosing cardiac arrest are not suitable, as the time costs are too high. Measurement of pressure, a cardiogram is not performed even when a person is in a medical facility: it is enough just to detect the absence of a pulsation of the common carotid artery, which is easy to find between the cervical muscles and the larynx, or in the area of ​​the femoral artery.

The duration of listening to the pulse is no more than 5 seconds, about the same time is needed to pat the patient on the cheeks and for other attempts to bring him to his senses (this will distinguish ordinary fainting from cardiac arrest). In parallel, you should ask for help from people around you or call an ambulance for the patient yourself. The assessment of the state of the pupils is also performed after the start of emergency care to analyze the dynamics. Pressure begins to be measured after the restoration of cardiac activity begins in the course of medical care for a person.

First aid

To start resuscitation, the patient should be urgently placed on a hard surface, after which the full range of measures to help a person is applied. The ABC emergency care algorithm includes the following actions:

1. A - restoration of normal patency of the respiratory system. The assisting person wraps his finger with a cloth, pushes the patient's lower jaw forward, throws his head back, and then removes all foreign bodies from the mouth (if any). You should also bring out the sunken tongue.
2. B - implementation of artificial respiration measures. Use the mouth-to-mouth technique. The nose is pinched with two fingers, air is blown into the mouth, while the results from the PMP (first aid) are controlled by the movement of the chest - the rise of the ribs and passive exhalation. In order not to come into contact with the patient's biological fluids, you need to cover the victim's mouth with a handkerchief, gauze, etc.
3. C - indirect heart massage. This type of first aid or activities carried out by ambulance doctors is the most important in cardiac arrest. Before the start of the massage, a precordial blow is made (more often such a blow is performed by doctors with ventricular fibrillation) with a fist to the sternum, and the fist is retracted to a distance cm. Since the blow is effective for only half a minute from the moment the cardiac activity ceases and threatens with bone fractures, it should not be carried out by a non-specialist.

This is the heart massage technique. You should visually find the lower third of the sternum, measure the distance about two fingers above the lower edge. The fingers for medical assistance are brought into the lock, hands are placed on a specific place on the sternum and vigorous compressions are made at a frequency of about 100 per minute. If possible, the second person should blow air into the lungs in parallel. You need to act carefully so as not to break the ribs of a person, which can seriously disrupt intrathoracic pressure. Resuscitation is continued until a pulse and breathing appear, either within 30 minutes, or until the arrival of the ambulance team.

Doctors use other measures to restore the heartbeat. These include the introduction of drugs - Adrenaline, Atropine, Norepinephrine, Epinephrine, Sodium bicarbonate, which are often administered intracardiac. Calcium preparations, magnesium sulfate, Lidocaine and many others can also be used. To restore breathing, mask ventilation or tracheal intubation is used. To start the heart in the absence of the effect of the above measures, it is necessary to undertake defibrillation. For this purpose, they use a device that starts the heart - a defibrillator, which is always in the ambulance. With the help of an electric discharge, there is a great chance to restore cardiac activity while the patient is being taken to the hospital.

Further treatment

If a person was saved after a cardiac arrest, then further treatment is carried out only in intensive care. When first aid or resuscitation in the ambulance was successful and restored the heartbeat in 5-6 minutes (sometimes more), then the person can return to a full life. In the future, it is necessary to carefully monitor the patient's condition, because cardiac arrest may recur.

A thorough examination is also mandatory - ECG, chest x-ray, ultrasound, Holter monitoring, blood tests, etc. Diagnostic methods will help to identify the causes of cardiac arrest and prevent the progression of the underlying disease and further episodes of clinical death. At the same time, the complications that have arisen are being corrected, in particular brain hypoxia, for which nootropic drugs, vitamins, and antioxidants are recommended. Many patients will require surgery to install a pacemaker if serious abnormalities in the pacemaker were found during the examination. Upon returning home, you need to urgently give up bad habits, avoid stress, eat right, and exercise only according to the doctor's prescriptions.

Possible Complications

The vast majority of people die after cardiac arrest. But of the survivors, who are so few (no more than 25%), only 10% can return to life as it was before the terrible disease. The reasons for the development of complications lie in the untimely provision of medical care, because not every family member or work colleague is able to do a heart massage or other activities. The main cause of pathology complications is ischemia of body tissues, especially the brain. The most common problems are with memory, behavior, paralysis and paresis, damage to the kidneys and liver, which greatly shorten later life.

Neurological symptoms are more severe the later the heart was started: after 6-7 minutes of being without a pulse and breathing, a person can develop severe brain damage. Post-resuscitation disease of varying severity occurs in almost 80% of cases of successful resuscitation. Some patients fall into a coma and then go into a vegetative state.

Preventive measures

The prognosis for cardiac arrest is poor. In this regard, the prevention of pathology, as well as the diseases that cause it, is extremely important. Prevention measures are:

• early initiation of therapy for heart and vascular diseases;
• quitting smoking, avoiding large amounts of alcohol;
• maintaining physical activity into old age;
• blood pressure control;
• proper, healthy nutrition;
• weight loss, cholesterol levels;
• prevention of injuries, drowning, hypothermia, exposure to current;
• prevention of drug overdose.

To prevent sudden death of an infant, he should be put to sleep only in a ventilated room, on a hard mattress, without thick blankets and toys. It is impossible to swaddle a child tightly at night, as well as lay him on his stomach for a night's sleep. It is strictly forbidden to smoke in the apartment so that the smoke does not penetrate the child's body, which causes irreparable damage to him.

Are you one of the millions with heart disease?

Have all your attempts to cure hypertension failed?

And have you already thought about drastic measures? It is understandable, because a strong heart is an indicator of health and a reason for pride. In addition, this is at least the longevity of a person. And the fact that a person who is protected from cardiovascular diseases looks younger is an axiom that does not require proof.

The presented materials are general information and cannot replace the advice of a doctor.

Cardiopulmonary resuscitation: implementation algorithm, terminal states

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

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

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

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

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

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

What does the state of clinical death mean?

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

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

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

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

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

Everyone should know this!

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

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

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

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

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

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

Stages of resuscitation

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

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

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

Basic resuscitation is designed to solve two main tasks:

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

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

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

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

How to make the lungs breathe?

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

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

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

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

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

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

Step by step IVL will look something like this:

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

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

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

The resumption of spontaneous cardiac activity is an inspiring sign

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

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

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

defibrillation of the heart

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

How to make the heart work?

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

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

Video: chest compressions

Effectiveness of revitalization measures. Criteria for evaluation

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

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

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

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

When is a person declared dead?

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

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

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

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

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

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

In conclusion: segregation of duties

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

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

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

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

Medical intervention can save a person who has fallen into a state of clinical (reversible) death. The patient will have only a few minutes before death, so nearby people are obliged to provide him with emergency first aid. Cardiopulmonary resuscitation (CPR) is ideal in this situation. It is a set of measures to restore the respiratory function and the circulatory system. Not only rescuers can help, but also ordinary people who are nearby. The manifestations characteristic of clinical death become the reason for resuscitation.

Cardiopulmonary resuscitation is a set of primary methods of saving the patient. Its founder is the famous doctor Peter Safar. He was the first to create the correct algorithm of emergency care for the victim, which is used by most modern resuscitators.

The implementation of the basic complex to save a person is necessary when identifying a clinical picture characteristic of reversible death. Its symptoms are primary and secondary. The first group refers to the main criteria. It:

• the disappearance of the pulse in large vessels (asystole);
• loss of consciousness (coma);
• complete absence of breathing (apnea);
• dilated pupils (mydriasis).

Sounded indicators can be identified by examining the patient:

Secondary signs are of varying severity. They help to make sure that cardiopulmonary resuscitation is needed. You can get acquainted with additional symptoms of clinical death below:

• skin blanching;
• loss of muscle tone;
• lack of reflexes.

Contraindications

Cardiopulmonary resuscitation of the basic form is performed by nearby people in order to save the life of the patient. An extended version of assistance is provided by resuscitators. If the victim has fallen into a state of reversible death due to a long course of pathologies that have depleted the body and cannot be treated, then the effectiveness and expediency of rescue methods will be in question. This usually leads to the terminal stage of the development of oncological diseases, severe insufficiency of internal organs and other ailments.

It makes no sense to resuscitate a person if damage is noticeable that is incomparable with life against the background of a clinical picture of a characteristic biological death. You can check out its features below:

• post-mortem cooling of the body;
• the appearance of spots on the skin;
• clouding and drying of the cornea;
• the occurrence of the phenomenon of "cat's eye";
• hardening of muscle tissue.

Drying out and a noticeable clouding of the cornea after death is called a symptom of "floating ice" because of the appearance. This sign is clearly visible. The phenomenon of "cat's eye" is determined by light pressure on the lateral parts of the eyeball. The pupil shrinks sharply and takes the form of a slit.

The rate of body cooling depends on the ambient temperature. Indoors, the decrease proceeds slowly (no more than 1 ° per hour), and in a cool environment, everything happens much faster.

Cadaverous spots are the result of redistribution of blood after biological death. Initially, they appear on the neck from the side on which the deceased was lying (front on the stomach, back on the back).

Rigor mortis is the hardening of muscles after death. The process begins with the jaw and gradually covers the entire body.

Thus, cardiopulmonary resuscitation makes sense only in the case of clinical death, which was not provoked by serious degenerative changes. Its biological form is irreversible and has characteristic symptoms, so it will be enough for nearby people to call an ambulance so that the brigade picks up the body.

The correct order of conduct

The American Heart Association regularly provides advice on how to better care for sick people. Cardiopulmonary resuscitation according to the new standards consists of the following stages:

• identifying symptoms and calling an ambulance;
• implementation of CPR according to generally accepted standards with an emphasis on indirect massage of the heart muscle;
• timely defibrillation;
• use of intensive care methods;
• complex treatment of asystole.

The procedure for conducting cardiopulmonary resuscitation is drawn up according to the recommendations of the American Heart Association. For convenience, it was divided into certain phases, titled in English letters "ABCDE". You can see them in the table below:

The voiced stages of cardiopulmonary resuscitation are compiled for doctors. It is enough for ordinary people who are close to the patient to carry out the first three procedures while waiting for an ambulance. You can find the correct execution technique in this article. Additionally, pictures and videos found on the Internet or consultations with doctors will help.

For the safety of the victim and the resuscitator, experts have compiled a list of rules and advice regarding the duration of resuscitation, their location and other nuances. You can check them out below:

Decision time is limited. Brain cells are rapidly dying, so cardiopulmonary resuscitation should be carried out immediately. There is only no more than 1 minute to make a diagnosis of "clinical death". Next, you need to start the standard sequence of actions.

Resuscitation procedures

For a simple person without medical education, only 3 receptions are available to save the life of a patient. It:

• precordial beat;
• indirect form of massage of the heart muscle;
• artificial lung ventilation.

Specialists will have access to defibrillation and direct cardiac massage. The first remedy can be used by the arriving team of doctors with the appropriate equipment, and the second only by doctors in the intensive care unit. The voiced methods are combined with the introduction of medicines.

A precordial shock is used as a substitute for a defibrillator. Usually it is used if the incident happened literally before our eyes and more than 20-30 seconds have not passed. The algorithm of actions for this method is as follows:

• If possible, pull the patient to a stable and durable surface and check for the presence of a pulse wave. In its absence, you must immediately proceed to the procedure.
• Put two fingers in the center of the chest in the region of the xiphoid process. The blow must be delivered slightly above their location with the edge of the other hand, gathered into a fist.

If the pulse cannot be felt, then it is necessary to proceed to the massage of the heart muscle. The method is contraindicated for children whose age does not exceed 8 years, since the child may suffer even more from such a radical method.

Indirect cardiac massage

An indirect form of cardiac muscle massage is a compression (squeezing) of the chest. You can carry it out, focusing on the following algorithm of actions:

• Lay the patient on a hard surface so that the body does not move during the massage.
• The side where the person performing resuscitation will stand is not important. Pay attention to the position of the hands. They should be in the middle of the chest in its lower third.
• Hands should be placed one on top of the other, 3-4 cm above the xiphoid process. Pressing is performed only with the palm of your hand (the fingers do not touch the chest).
• Compression is carried out mainly due to the body weight of the rescuer. It is different for each person, so it is necessary to make sure that the chest does not bend deeper than 5 cm. Otherwise, fractures are possible.

• duration of pressing 0.5 seconds;
• the interval between pressing does not exceed 1 second;
• the number of movements per minute is about 60.

When performing heart massage in children, it is necessary to take into account the following nuances:

• in newborns, compression is performed with 1 finger;
• in infants with 2 fingers;
• in older children with 1 palm.

If the procedure is effective, then the patient will have a pulse, the skin will turn pink and the pupillary effect will return. It must be turned on its side to prevent the tongue from sinking or suffocation with vomit.

Before carrying out the main part of the procedure, it is necessary to try the Safar method. It is performed as follows:

• First you need to lay the victim on his back. Then tilt back his head. You can achieve the maximum result by placing one hand under the victim's neck, and the other on the forehead.
• Next, open the patient's mouth and take a test breath of air. In the absence of effect, push forward and down his lower jaw. If there are objects in the oral cavity that have caused blockage of the respiratory tract, then they should be removed with improvised means (handkerchief, napkin).

In the absence of a result, it is necessary to immediately proceed to artificial ventilation of the lungs. Without the use of special devices, it is performed according to the instructions below:

In order to avoid infection of the rescuer or the patient, it is advisable to carry out the procedure through a mask or using special devices. You can increase its effectiveness by combining it with an indirect heart massage:

• When performing resuscitation alone, 15 pressures on the sternum should be done, and then 2 breaths of air for the patient.
• If two people are involved in the process, then 1 time in 5 clicks air is blown.

Direct cardiac massage

Massage the heart muscle directly only in a hospital setting. Often resort to this method with a sudden cardiac arrest during surgery. The technique for performing the procedure is given below:

• The doctor opens the chest in the region of the heart and starts rhythmically squeezing it.
• Blood will begin to flow into the vessels, due to which the work of the organ can be restored.

The essence of defibrillation is the use of a special apparatus (defibrillator), with which doctors act on the heart muscle with current. This radical method is shown in severe forms of arrhythmia (supreventricular and ventricular tachycardia, ventricular fibrillation). They provoke life-threatening disruptions in hemodynamics, which often lead to death. In cardiac arrest, the use of a defibrillator will not bring any result. In this case, other resuscitation methods are used.

Medical therapy

The introduction of special drugs is performed by doctors intravenously or directly into the trachea. Intramuscular injections are ineffective, therefore they are not carried out. Most of the following medicines are used:

• "Adrenaline" is the main drug for asystole. It helps to start the heart by stimulating the myocardium.
• "Atropine" is a group of blockers of M-cholinergic receptors. The drug helps to release catecholamines from the adrenal glands, which is especially useful in cardiac arrest and severe bradysystole.
• "Sodium bicarbonate" is used if asystole is the result of hyperkalemia (high potassium levels) and metabolic acidosis (acid-base imbalance). Especially with a prolonged resuscitation process (over 15 minutes).

Other medications, including antiarrhythmics, are used as appropriate. After the patient's condition improves, they will be kept under observation in the intensive care unit for a certain time.

Therefore, cardiopulmonary resuscitation is a set of measures to exit the state of clinical death. Among the main methods of providing assistance, artificial respiration and chest compressions stand out. They can be performed by anyone with minimal training.

There are many situations that we call force majeure or out of order. These are circumstances when you need to be able to act quickly and competently, saving the life of another person. One such situation is a cardiac arrest in a person who is nearby. So, about the symptoms of stopping and the correct actions to resuscitate the victim.

Symptoms of cardiac arrest

There are several main signs by which cardiac arrest is ascertained. Here they are:

1. Absence of pulse in large arteries. To determine the pulse, attach two fingers to the carotid artery. If it is not palpable, then it is necessary to begin to act.
2. Lack of breath. Its presence is determined by applying a mirror to the nose of the victim. This is done if the movements of the human chest are not visually determined.
3. Dilated pupils do not respond to light. It should be in the eyes, lifting the eyelids of a person, shine a flashlight. If the pupils do not constrict, then there is no reaction, and this is evidence of the cessation of the functioning of the myocardium.


4. Blueness of the face or its gray, earthy color. A change in the natural color of a person's skin is an important sign indicating a violation of blood circulation.
5. loss of human consciousness. It is associated with ventricular fibrillation or asystole. Loss of consciousness is determined by patting the victim on the face or by sound effects. It can be screaming, clapping.

The causes of cardiac arrest can be hypothermia and electrical injury, drowning or suffocation, coronary heart disease and arterial hypertension, anaphylactic shock and smoking.

How to save a person in cardiac arrest?

If the above symptoms are present in a person, then the people who are nearby have only seven minutes to resuscitate the victim, that is, save his life. Delayed assistance can lead to a person's disability.

The main tasks that need to be performed when providing assistance are restoring the victim’s breathing, heart rate, and starting the circulatory system.

Providing first aid after calling an ambulance and while waiting for it includes several sequential actions:

1. Laying a person on a hard surface.
2. Tilt his head back.
3. The release of the oral cavity from mucus and other contents.


4. Resuscitation of the victim's breathing by artificial lung ventilation. In this case, the resuscitator needs to draw air into the lungs (take a deep breath) and let it into the open mouth of the victim, pinching his nose.
5. External heart massage to the victim. It is done by sharp pressing on the heart area with the hands of the resuscitator. They must be folded perpendicularly on the heart palm to palm. After one inhalation, 4-5 clicks are made on the heart, and such actions are repeated until the restoration of independent cardiac activity (appearance of a pulse) and the appearance of breathing. Sometimes it is recommended to perform a precordial beat to enhance the action before a heart massage. It means a punch to the middle zone of the sternum. It is necessary to ensure that such a blow does not fall directly on the heart, because this will only aggravate the situation of the victim. A precordial stroke sometimes helps to instantly resuscitate a person or increase the effectiveness of a heart massage.
6. If a person has a pulse, then resuscitation should be continued until the person begins to breathe on his own.
7. Heart massage is done until the skin begins to acquire a natural shade.
8. The above activities are the initial stage of resuscitation of the victim before the arrival of the ambulance.
9. Doctors upon arrival (if the resuscitator failed to start the heart) use a defibrillator. This medical device acts on the heart muscle with an electric current.

The consequences of cardiac arrest depend on the promptness of resuscitation measures: the later a person is brought back to life, the greater the risk of complications.

Heart failure

At a stop or a very sharp weakening of cardiac activity, blood flow through the vessels stops. The main signs of cardiac arrest:

- loss of consciousness

- lack of pulse, dilated pupils

- respiratory arrest, convulsions

- paleness or bluishness of the skin and mucous membranes

Cardiac massage should be performed simultaneously with lung ventilation. When you press the heart, the blood is squeezed out and flows from the left ventricle to the aorta and further through the carotid arteries to the brain, and from the right ventricle to the lungs, where an important mechanism for revitalizing the body takes place - oxygen saturation of the blood. After the pressure on the chest stops, the cavities of the heart fill up with blood again.

The person is laid with his back on a solid base. The assisting person stands on the side of the victim and with the surfaces of the palms that overlap each other, presses on the lower third of the chest. Heart massage is carried out in jerks, pressing on the hand with the whole body up to 50 times per minute. The amplitude of oscillations in an adult should be about 4-5 cm. Every 15 clicks on the sternum with an interval of 1 second, stop the massage, hold 2 strong artificial breaths using the mouth-to-mouth or mouth-to-nose method. With the participation of 2 revitalizing, it is necessary to inhale after every five clicks. The resuscitator performing the compressions should count "1,2,3,4,5" aloud, and the resuscitator performing the ventilation should count the number of completed cycles. Early initiation of primary care improves outcome, especially if skilled care is delayed.

Artificial respiration

"mouth to mouth"- the rescuer pinches the victim's nose, takes a deep breath, presses tightly against the victim's mouth and exhales vigorously. Follows the victim's chest, which should rise. Then he raises his head and follows the passive exhalation. If the victim's pulse is well defined, then the interval between breaths should be 5 seconds, i.e. 12 times per minute. Care should be taken to ensure that the inhaled air enters the lungs and not the stomach. If air has entered the stomach, it is necessary to turn the victim on his side and gently press on the stomach between the sternum and the navel.

"mouth to nose" the rescuer with one hand fixes the head of the victim, the other grabs his chin, pushes the lower jaw slightly forward and closes tightly with the upper one. Lips pinched with thumb. Then he takes in air and tightly wraps his lips around the base of the nose, so as not to pinch the nasal openings and vigorously blow in air. Having freed the nose, follow the passive exhalation.

If an hour after the start of massage and ventilation of the lungs, cardiac activity does not resume and the pupils remain wide, the revival can be stopped.

Why can cardiac arrest occur?

First aid will be the same regardless of the reasons why such a condition has come. And yet, what must happen to stop the effective activity of the heart? Everyone should know about this. The main reason is ventricular fibrillation. This is a condition in which there is a chaotic contraction of muscle fibers in the walls of the ventricles, which leads to interruptions in the supply of blood to tissues and organs. Another reason is ventricular asystole - in this case, the electrical activity of the myocardium completely stops.

Ischemic heart disease, left ventricular hypertrophy, arterial hypertension, atherosclerosis are also risk factors that can contribute to the termination of the effective activity of the main human organ. Also, cardiac arrest can occur due to ventricular paroxysmal tachycardia, when there is no pulse on large vessels, or due to electromechanical dissociation, when there is no corresponding contraction of the ventricles in the presence of electrical activity of the heart (that is, there is no mechanical activity). There is also such a pathology as Romano-Ward syndrome, which is associated with hereditary ventricular fibrillation - it can also be the reason why sudden cardiac arrest occurs.

In some cases, first aid is also required for those people who have not previously had health problems.

External influence

The heart may stop due to:

How to determine the cessation of the heart

When the heart muscle stops functioning, the following symptoms are found:

• Loss of consciousness - it occurs almost immediately after cardiac arrest, no later than five seconds. If a person does not respond to any stimuli, then he is unconscious.
• Cessation of breathing - in this case, there are no movements of the chest.
• There is no pulsation at the site of the carotid artery - it is palpable in the zone of the thyroid gland, two to three centimeters away from it.
• Heart sounds are not audible.
• The skin becomes bluish or pale.
• Pupil dilation - this can be detected by lifting the victim's upper eyelid and illuminating the eye. If the pupil does not constrict when the light is directed, then it can be suspected that a sudden cardiac arrest has occurred. Emergency care in this case can save a person's life.
• Convulsions - may occur at the time of loss of consciousness.

All of these symptoms indicate the need for urgent resuscitation.

You can't delay!

If you find yourself near a person whose heart has stopped, the main thing that is required of you is to act quickly. There are only a few minutes to save the victim. If assistance with cardiac arrest is belated, then the patient will either die or remain incapacitated for life. Your main task is to restore breathing and heart rate, as well as start the circulatory system, because without this the vital organs (especially the brain) cannot function.

Emergency care for cardiac arrest is needed if the person is unconscious. First, slow him down, try to call out loudly. If there is no reaction, proceed to resuscitation. They include several stages.

First aid for cardiac arrest. Artificial respiration

Important! Don't forget to call an ambulance immediately. This must be done before the start of resuscitation, because then you will no longer have the opportunity to interrupt.

To open the airway, lay the victim on a hard surface with their back. Everything that can interfere with a person’s normal breathing (food, prostheses, any foreign bodies) should be removed from the mouth. tilt the patient's head back so that the chin is in a vertical position. In this case, the lower jaw must be pushed forward so that the tongue does not fall - in this case, air can enter the stomach instead of the lungs, and then first aid in case of cardiac arrest will be ineffective.

After that, directly begin to produce mouth-to-mouth breathing. Pinch the person's nose, draw air into the lungs, wrap your lips around the victim's lips and take two sharp exhalations. Note that the lips of the patient must be completely and very tightly wrapped around, otherwise exhaled air may be lost. Do not exhale too deeply, otherwise you will quickly get tired. If mouth-to-mouth artificial respiration is not possible for some reason, use the mouth-to-nose method. In this case, you should close the mouth of the victim with your hand, and blow air into his nostrils.

If medical assistance in case of cardiac arrest in the form of artificial respiration is correct, then during inhalation the patient's chest will rise, and at the moment of exhalation it will fall. If no such movements are observed, check the airway.

Heart massage

Simultaneously with artificial respiration, chest compressions (chest compressions) should also be performed. One manipulation without the other will not make sense. So, after you have taken two breaths into the victim's mouth, place the left hand on the lower part of the sternum in the middle, and place the right hand on top of the left in a cruciform position. In this case, the arms should be straight, not bent. Next, begin to rhythmically press on the chest - this will entail compression of the heart muscle. Fifteen pressing movements should be made without taking off the hands at a speed of one pressing per second. With the right manipulations, the chest should drop by about five centimeters - in this case, we can say that the heart pumps blood, that is, from the left ventricle, blood flows through the aorta to the brain, and from the right to the lungs, where it is saturated oxygen. At that moment, when the pressure on the sternum stops, the heart fills with blood again.

If the massage is done to a preschool child, then pressing movements on the chest area should be done with the middle and index fingers of one hand, and if a schoolboy - with one palm. With special care, first aid should be provided for cardiac arrest in the elderly. If you press hard on the sternum, damage to the internal organs or fracture of the hip may occur.

Continuation of resuscitation

Repeat inhalations of air and pressure on the chest should be until the victim has a breath and a pulse begins to be felt. If first aid in case of cardiac arrest is provided by two people at once, then the roles should be distributed as follows: one person takes one breath of air into the patient's mouth or nose, after which the second makes five pressures on the sternum. Then the actions are repeated.

If, thanks to resuscitation, breathing is restored, but the pulse is still not palpable, you should continue to massage the heart, but without ventilation. If a pulse appears, but the person is not breathing, it is necessary to stop the massage and continue to do only artificial respiration. In the event that the victim began to breathe and he had a pulse, resuscitation should be stopped and the patient's condition should be carefully monitored until the doctor arrives. Never attempt to move a person who has symptoms of cardiac arrest. This can be done only after the restoration of the work of the body and in a special resuscitation machine.

The effectiveness of resuscitation

To assess how correctly the first medical aid was provided to cardiac arrest, you can do the following:

When to stop resuscitation

If, after half an hour of manipulation, the respiratory function and cardiac activity of the victim did not resume, and the pupils are still dilated and do not respond to light, we can say that first aid for cardiac arrest did not lead to proper results and the person is already in the human brain irreversible processes have already taken place. In this case, further resuscitation measures are useless. If signs of death appear before the thirty-minute time has elapsed, resuscitation can be stopped earlier.

Consequences of cardiac arrest

According to statistics, of all people who had a cessation of cardiac activity, only 30 percent survived. And even fewer victims returned to normal life. Irreparable harm to health was mainly caused due to the fact that the first medical aid was not provided in time. In cardiac arrest, immediate resuscitation is very important. The life of the patient depends on how quickly they began to be produced. The later cardiac activity is resumed, the greater the likelihood of serious complications. If oxygen is not supplied to vital organs for a long time, then ischemia, or oxygen starvation, occurs. As a result, the kidneys, brain, liver are damaged, which subsequently adversely affects a person's life. If you do massage to compress the chest very vigorously, you can break the patient's ribs or provoke pneumothorax.