Artificial respiration and heart massage - rules and techniques. Non-apparatus methods of performing artificial respiration Correct technique for performing artificial respiration

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rice. 9.3. Indirect cardiac massage

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

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

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

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

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

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

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

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

Rice. 9.4. Artificial respiration according to the Sylvester method

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

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

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

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

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

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

Rice. 9.5. Artificial respiration according to the Schaefer method

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

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

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

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

Rice. 9.6. Artificial respiration according to the Nilsson method

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

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

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This method is recommended to be combined with the simultaneous exhalation of oxygen using an oxygen inhaler. Kallistov's method does not injure the lungs of the victim a little, so it can be used for barotrauma of the lungs, when a rupture of the lung tissue is observed and the victim has no natural breathing.

Rice. 9.7. Artificial respiration according to the Kalistov method

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

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

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

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

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

Rice. 9.8. Artificial respiration according to the Kohlrausch method

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

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

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

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

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

I remember studying at the institute and working on a model of a person. We then learned to do artificial respiration, and I must say, it turned out for everyone. This means that anyone who knows when and how to give artificial respiration can help the victim survive.

Let's leave aside the technique of artificial respiration, there will be another article on this site about this. First you need to understand when and why artificial respiration is done, and even why it is called that.

Why is artificial respiration so called?

The fact is that artificial respiration is performed if the victim does not have his own breath. But to live, he needs oxygen, he needs to breathe. Another person does this for him, and the victim breathes, but artificially. By the way, another name for artificial respiration is the kiss of life, which also reflects the meaning of the action.

Why do artificial respiration?

In order for the blood to continue to be saturated with oxygen, oxygen is artificially inhaled into the victim's mouth. That, getting into the lungs, enriches the blood, and the victim lives. Because without access to a fresh portion of oxygen in the human brain, irreversible consequences occur within 5 minutes. IRREVERSIBLE! Those. even if help arrives on time and the victim can be saved, such a person may remain disabled for the rest of his life due to the loss of his brain functions.

What is done with artificial respiration?

With artificial respiration, 2 actions are performed: inhalation of fresh air into the mouth so that it enters the lungs (be sure to make sure that there are no foreign objects in the victim's mouth), and an indirect (closed) heart massage.

These actions can be performed by one person, it can be done by two people - one takes a mouth-to-mouth breath, the other does a heart massage.

Why is chest compressions necessary?

An indirect heart massage is needed in order for the heart muscle to contract and push a new portion of oxygen-enriched blood to the head region, to the brain. Because the injured person is in a state of clinical death, then he does not have his own breathing or heartbeat. With the help of external forces (providing first aid people), such a victim is artificially maintained in a state of life support.

When should artificial respiration be given?

Immediately after the victim's heartbeat and breathing have stopped. If there is no pulse, no heartbeat is heard, the person is not breathing, urgently call an ambulance, supporting the victim with artificial respiration.

How long should (can) do artificial respiration?

You need to do it until medical help arrives. Not for a moment stopping resuscitation. Remember that just 5 minutes without oxygen can permanently deprive the brain of the possibility of normal functioning.

Artificial respiration can be done as long as there is hope!!!

Poisoning by certain substances can cause respiratory arrest and heartbeat. In such a situation, the victim needs help immediately. But there may not be doctors nearby, and an ambulance will not arrive in 5 minutes. Each person should know and be able to put into practice at least basic resuscitation measures. These include artificial respiration and external cardiac massage. Most people probably know what it is, but they do not always know how to correctly perform these actions in practice.

Let's find out in this article what kind of poisoning can lead to clinical death, what kind of human resuscitation techniques exist, and how to do artificial respiration and chest compressions correctly.

What kind of poisoning can stop breathing and heartbeat

Death as a result of acute poisoning can happen from anything. The main causes of death in case of poisoning are the cessation of breathing and heartbeat.

Arrhythmias, atrial and ventricular fibrillation, and cardiac arrest can be caused by:

When is artificial respiration necessary? Respiratory arrest occurs due to poisoning:

In the absence of breathing or heartbeat, clinical death occurs. It can last from 3 to 6 minutes, during which there is a chance to save a person if you start doing artificial respiration and chest compressions. After 6 minutes, it is still possible to bring a person back to life, but as a result of severe hypoxia, the brain undergoes irreversible organic changes.

When to start resuscitation

What to do if a person falls unconscious? First you need to determine the signs of life. The heartbeat can be heard by putting your ear to the victim's chest or by feeling the pulse on the carotid arteries. Breathing can be detected by the movement of the chest, bending over to the face and listening for the presence of inhalation and exhalation, bringing the mirror to the nose or mouth of the victim (it will fog up when breathing).

If no breathing or heartbeat is detected, resuscitation should be started immediately.

How to do artificial respiration and chest compressions? What methods exist? The most common, accessible to everyone and effective:

external heart massage;
breathing "from mouth to mouth";
breathing from mouth to nose.

It is advisable to conduct receptions for two people. Heart massage is always performed together with artificial ventilation.

What to do if there are no signs of life

Free the respiratory organs (oral, nasal cavity, pharynx) from possible foreign bodies.
If there is a heartbeat, but the person is not breathing, only artificial respiration is done.
If there is no heartbeat, artificial respiration and chest compressions are performed.

How to do chest compressions

The technique of performing an indirect heart massage is simple, but requires the right actions.

Why is an indirect heart massage impossible if the victim lies on a soft one? In this case, the pressure will not be refused on the heart, but on a pliable surface.

Very often, with an indirect heart massage, ribs are broken. There is no need to be afraid of this, the main thing is to revive a person, and the ribs will grow together. But keep in mind that broken edges are most likely the result of improper execution and the pressing force should be moderated.

Age of the victim	How to press	pressure point	Pressing depth	Click frequency	Inhale/press ratio
Age up to 1 year	2 fingers	1 finger below the nipple line	1.5–2 cm	120 and more	2/15
Age 1-8		2 fingers from the sternum		100–120
Adult	2 hands	2 fingers from the sternum	5-6 cm	60–100	2/30

Artificial respiration from mouth to mouth

If in the mouth of a poisoned person there are secretions dangerous for the resuscitator, such as poison, poisonous gas from the lungs, an infection, then artificial respiration is not necessary! In this case, you need to limit yourself to an indirect heart massage, during which, due to pressure on the sternum, about 500 ml of air is ejected and again sucked in.

How to do mouth-to-mouth artificial respiration?

For your own safety, it is recommended that artificial respiration be best done through a napkin, while controlling the pressing density and preventing air from “leaking”. Exhalation should not be sharp. Only a strong, but smooth (within 1-1.5 seconds) exhalation will ensure the correct movement of the diaphragm and the filling of the lungs with air.

Artificial respiration from mouth to nose

Mouth-to-nose artificial respiration is performed if the patient cannot open his mouth (for example, due to spasm).

Having laid the victim on a straight surface, tilt his head back (if there are no contraindications for this).
Check the patency of the nasal passages.
If possible, the jaw should be extended.
After a maximum breath, you need to blow air into the nose of the injured person, tightly closing his mouth with one hand.
After one breath, count to 4 and take the next.

Features of resuscitation in children

In children, the resuscitation technique is different from that in adults. The chest of babies up to a year old is very delicate and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect heart massage is performed not with palms, but with two fingers. The movement of the chest should be no more than 1.5-2 cm. The frequency of pressing is at least 100 per minute. At the age of 1 to 8 years, massage is done with one palm. The chest should move 2.5–3.5 cm. Massage should be performed at a frequency of about 100 pressures per minute. The ratio of inhalation to chest compressions in children under 8 years old should be 2/15, in children over 8 years old - 1/15.

How to do artificial respiration for a child? For children, artificial respiration can be performed using the mouth-to-mouth technique. Since babies have a small face, an adult can carry out artificial respiration covering both the mouth and nose of the child at once. Then the method is called "from mouth to mouth and nose." Artificial respiration for children is done at a frequency of 18-24 per minute.

How to determine if resuscitation is performed correctly

Signs of effectiveness, subject to the rules for performing artificial respiration, are as follows.

The effectiveness of heart massage should also be checked every minute.

If, when performing an indirect heart massage, a push appears on the carotid artery, similar to a pulse, then the pressing force is sufficient so that blood can flow to the brain.
With the correct implementation of resuscitation measures, the victim will soon have heart contractions, pressure will rise, spontaneous breathing will appear, the skin will become less pale, the pupils will narrow.

You need to complete all the steps for at least 10 minutes, and preferably before the ambulance arrives. With a persistent heartbeat, artificial respiration should be performed for a long time, up to 1.5 hours.

If resuscitation measures are ineffective within 25 minutes, the victim has cadaveric spots, a symptom of a "cat's" pupil (when pressing on the eyeball, the pupil becomes vertical, like a cat's) or the first signs of rigor mortis - all actions can be stopped, since biological death has occurred.

The sooner resuscitation is started, the greater the likelihood of a person returning to life. Their correct implementation will help not only bring back to life, but also provide oxygen to vital organs, prevent their death and disability of the victim.

Methods for artificial respiration and external heart massage

Artificial respiration. It is carried out in cases where the victim does not breathe or breathes very badly (rarely, convulsively, as if with a sob), and also if his breathing constantly worsens, regardless of what caused it: electric shock, poisoning, drowning, etc. d.

The most effective method of artificial respiration is the "mouth-to-mouth" or "mouth-to-nose" method, since this ensures that a sufficient volume of air enters the victim's lungs. The "mouth-to-mouth" or "mouth-to-nose" method is based on the use of air exhaled by the caregiver, which is forced into the victim's airways and is physiologically suitable for the victim to breathe. Air can be blown through gauze, a handkerchief, etc. This method of artificial respiration makes it easy to control the flow of air into the lungs of the victim by expanding the chest after blowing and then subsiding as a result of passive exhalation.

To carry out artificial respiration, the victim should be laid on his back, unfasten clothing that restricts breathing and ensure the patency of the upper respiratory tract, which, in the supine position when unconscious, is closed by a sunken tongue. In addition, there may be foreign contents in the oral cavity (vomit, slipped dentures, sand, silt, grass, if a person was drowning, etc.), which must be removed with the index finger wrapped in a scarf (cloth) or bandage, turning the head the victim on one side (Fig. 19).

Rice. 19. Cleansing the mouth and throat

After that, the assisting person is located on the side of the victim’s head, slips one hand under his neck, and with the palm of the other hand presses on his forehead, throwing his head back as much as possible (Fig. 20).

Rice. 20. The position of the head of the victim during artificial respiration

In this case, the root of the tongue rises and frees the entrance to the larynx, and the victim's mouth opens. The person providing assistance leans towards the victim’s face, takes a deep breath with his mouth open, then fully covers the victim’s open mouth with his lips and exhales vigorously, blowing air into his mouth with some effort; at the same time, he covers the nose of the victim with his cheek or fingers of the hand located on the forehead (Fig. 21). In this case, it is imperative to observe the chest of the victim, which should rise. As soon as the chest has risen, the air injection is stopped, the assisting person raises his head, and the victim passively exhales. In order for the exhalation to be deeper, you can gently press the hand on the chest to help the air out of the lungs of the victim.

If the victim has a well-determined pulse and only artificial respiration is necessary, then the interval between artificial breaths should be 5 s, which corresponds to a respiratory rate of 12 times per minute.

Rice. 21. Carrying out artificial respiration according to the "mouth to mouth" method

Rice. 22. Carrying out artificial respiration according to the "mouth to nose" method

In addition to the expansion of the chest, a good indicator of the effectiveness of artificial respiration can be the pinking of the skin and mucous membranes, as well as the exit of the victim from an unconscious state and the appearance of independent breathing.

When performing artificial respiration, the assisting person must ensure that the blown air enters the lungs, and not into the victim's stomach. When air enters the stomach, as evidenced by bloating "under the spoon", gently press the palm of your hand on the stomach between the sternum and navel. This may cause vomiting, so it is necessary to turn the head and shoulders of the victim to the side (preferably to the left) to clear his mouth and throat.

If the chest does not rise after blowing in air, it is necessary to push the victim's lower jaw forward (see Fig. 18).

If the victim's jaws are tightly clenched and it is not possible to open his mouth, artificial respiration should be performed according to the mouth-to-nose method (Fig. 22).

In the absence of spontaneous breathing and the presence of a pulse, artificial respiration can also be carried out in a sitting or vertical position if the accident occurred in the basket of the tower, on a support or on a mast (Fig. 23 and 24). At the same time, the head of the victim is thrown back as much as possible or the lower jaw is pushed forward. The rest of the tricks are the same. Small children are blown into the mouth and nose at the same time, covering the child's nose with their mouth (Fig. 25). The smaller the child, the less air he needs to inhale and the more often it should be blown in comparison with an adult (up to 15-18 times per minute).

Rice. 23. Carrying out artificial respiration at the workplace in the position of the victim sitting

Rice. 24. Carrying out artificial respiration at the workplace in the vertical position of the victim

Rice. 25. Carrying out artificial respiration to a child

The volume of air in the mouth of an adult is enough for a newborn. Therefore, the inflation should be incomplete and less abrupt, so as not to damage the child's airways.

When the first weak breaths appear in the victim, an artificial breath should be timed to the moment he begins to breathe independently.

Cease artificial respiration after the victim recovers sufficiently deep and rhythmic spontaneous breathing.

External cardiac massage. If not only breathing is absent, but also the pulse on the carotid artery, artificial respiration alone is not enough when providing assistance, since oxygen from the lungs cannot be carried by blood to other organs and tissues. In this case, it is necessary to resume blood circulation artificially, for which external heart massage should be performed.

The human heart is located in the chest between the sternum and the spine. The sternum is a movable flat bone. In the position of a person on his back (on a hard surface), the spine is a rigid fixed base. If you press on the sternum, the heart will be compressed between the sternum and the spine and the blood from its cavities will be squeezed into the vessels. If you press on the sternum with jerky movements, then the blood will be pushed out of the cavities of the heart in much the same way as it happens during its natural contraction. This is called an external (indirect, closed) heart massage, in which blood circulation is artificially restored. Thus, when artificial respiration is combined with external heart massage, the functions of respiration and blood circulation are imitated.

An indication for resuscitation is cardiac arrest, which is characterized by a combination of the following symptoms: pallor or cyanosis of the skin, loss of consciousness, absence of a pulse in the carotid arteries, cessation of breathing or convulsive, incorrect breaths. In case of cardiac arrest, without wasting a second, the victim must be laid on a flat, rigid base: a bench, a floor, in extreme cases, put a board under his back.

If assistance is provided by one person, he is located on the side of the victim and, bending over, makes two quick energetic blows (according to the “mouth-to-mouth” or “mouth-to-nose” method), then unbends, remaining on the same side of the victim, palm puts one hand on the lower half of the sternum, retreating two fingers higher from its lower edge (Fig. 26 and 27), and raises the fingers (see Fig. 17). He puts the palm of the second hand on top of the first across or along and presses, helping by tilting his body. When pressing, the arms should be straightened at the elbow joints.

It should be pressed in quick crowds so as to displace the sternum by 4-5 cm, the duration of pressure is not more than 0.5 s, the interval between individual pressures is not more than 0.5 s.

Rice. 26. The location of the hands during external heart massage

Rice. 27. The position of the person providing assistance during external heart massage

During pauses, the hands are not removed from the sternum (if two people provide assistance), the fingers remain raised, the arms are fully extended at the elbow joints.

If the revival is carried out by one person (Fig. 28), then for every two deep blows, he makes 15 pressures on the sternum, then again makes two blows and again repeats 15 pressures, etc. At least 60 pressures and 12 blows must be done per minute , i.e., perform 72 manipulations, so the pace of resuscitation should be high. Experience shows that most of the time is spent on artificial respiration. It is impossible to delay the blowing, as soon as the chest of the victim has expanded, it must be stopped.

Rice. 28. Carrying out artificial respiration and external heart massage by one person

Rice. 29. Carrying out artificial respiration and external heart massage together

With the participation of two people in resuscitation (Fig. 29), the ratio of breathing - massage is 1: 5, i.e. after one deep blowing, five pressures on the chest are performed. During artificial inhalation to the victim, the one who massages the heart does not perform pressure, since the forces developed during pressure are much greater than during inhalation (pressure during inhalation leads to ineffective artificial respiration, and consequently, resuscitation measures). When resuscitation is carried out together, it is advisable for two assisting people to change places after 5-10 minutes.

With the correct performance of external heart massage, each pressure on the sternum causes a pulse to appear in the arteries.

The caregivers should periodically monitor the correctness and effectiveness of external cardiac massage by the appearance of a pulse on the carotid or femoral arteries. When carrying out resuscitation by one person, he should interrupt the heart massage for 2-3 seconds every 2 minutes to determine the pulse on the carotid artery (see Fig. 17). If two people are involved in resuscitation, then the pulse on the carotid artery is controlled by the one who conducts artificial respiration. The appearance of a pulse during a massage break indicates the restoration of the activity of the heart (the presence of blood circulation). At the same time, heart massage should be immediately stopped, but artificial respiration should be continued until stable independent breathing appears. In the absence of a pulse, it is necessary to continue to massage the heart.

Artificial respiration and external cardiac massage should be carried out until the patient is restored to stable spontaneous breathing and heart activity or until he is transferred to medical personnel.

If resuscitation is effective (the pulse is determined on large arteries during pressure on the sternum, pupils narrow, the cyanosis of the skin and mucous membranes decreases), cardiac activity and independent breathing in the victim are restored.

A prolonged absence of a pulse with the appearance of other signs of revival of the body (spontaneous breathing, constriction of the pupils, attempts by the victim to move his arms and legs, etc.) is a sign of cardiac fibrillation. In these cases, it is necessary to continue to give artificial respiration and heart massage to the victim before transferring him to medical personnel.

Resuscitation measures in children under 12 years of age have their own peculiarities. For children from one to 12 years old, heart massage is performed with one hand (Fig. 30) and from 70 to 100 pressures are made per minute, depending on age, for children under one year old - from 100 to 120 pressures per minute with two fingers (index and middle) in the middle sternum (Fig. 31) or with the thumbs of both hands, clasping the child's torso with the rest of the fingers.

Fig.30. External cardiac massage for children under 12 years old

Rice. 31. Carrying out external heart massage for newborns and children under the age of one year

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Artificial respiration, like normal natural respiration, aims to ensure gas exchange in the body, i.e. saturate the victim's blood with oxygen and remove carbon dioxide from the blood. In addition, artificial respiration, acting reflexively on the respiratory center of the brain, thereby contributes to the restoration of independent breathing of the victim. Blood saturated with oxygen is sent by the heart to all organs, tissues and cells, in which, due to this, normal oxidative processes continue. Among the large number of existing manual (without the use of special devices) methods of performing artificial respiration, the most effective is the method "Mouth to mouth" ("mouth to mouth") or "Mouth to nose" ("mouth to nose") (Fig. 3 ).

It consists in the fact that the caregiver blows air from his lungs into the lungs of the victim through his mouth or nose.

Before starting artificial respiration, you must quickly perform the following operations:

Release the victim from clothing restricting breathing;

Lay the victim on his back on a horizontal surface;

Tilt the victim’s head back as much as possible, placing the palm of one hand under the back of the head, and with the other hand press on the victim’s forehead (Fig. 3a) until his chin is in line with the neck (Fig. 36). With this position of the head, the tongue moves away from the entrance to the larynx, thereby providing a free passage for air into the lungs. However, with this position of the head, the mouth usually opens. To maintain the achieved position of the head, a roll of folded clothes should be placed under the shoulder blades;

Examine the oral cavity and, if foreign contents are found in it, remove it by removing dentures at the same time, if any.

To remove mucus and blood, the head and shoulders of the victim are turned to the side (you can bring your knee under the shoulders of the victim), and then with the help of a handkerchief or the edge of a shirt wound around the index finger, they clean the mouth and pharynx. After that, the head is given the initial position and thrown back as much as possible, as shown in Fig. 3b.

At the end of the preparatory operations, the assisting person takes a deep breath and then exhales the air with force into the victim's mouth.

At the same time, he should cover the entire mouth of the victim with his mouth, and pinch his nose with his cheek or fingers (Fig. 4a).

Then the caregiver leans back, freeing the mouth and nose of the victim, and takes a new breath. During this period, the chest of the victim descends and passive exhalation occurs (Fig. 46). For young children, air can be blown into the mouth and nose at the same time, while the assisting person covers the mouth and nose of the victim with his mouth.

Control over the flow of air into the lungs of the victim is carried out by eye on the expansion of the chest with each blow. If the chest of the victim does not expand when air is blown in, this indicates an obstruction of the airways.

Fig.5. Mandibular thrust with two hands

In this case, it is necessary to push the lower jaw of the victim forward. To do this, the assisting person (Fig. 5) places four fingers of each hand behind the corners of the lower jaw and, resting his thumbs on its edge, pushes the upper jaw forward so that the lower teeth are in front of the upper ones.