Indirect cardiac massage: the correct technique and the moment when you need to call an ambulance. Complications and mistakes during massage. Features of cardiopulmonary resuscitation in children

Article publication date: 02/08/2017

Article last updated: 12/18/2018

In this article, you will learn what is indirect massage hearts, for what, to whom and who can do it. Is it possible to harm a person by performing this procedure, and how to make it really help.

An indirect heart massage is called a resuscitation event. emergency care aimed at replacing and restoring stopped cardiac activity.

This procedure is the most important for saving the life of a person who has a cardiac arrest and is in a state of clinical death. Therefore, each person must be able to do cardiac massage. Even if you are not a specialist, but at least approximately know how this procedure should go, do not be afraid to do it.

You will not harm the patient if you do something not quite right, and if you do nothing, it will lead to his death. The main thing is to make sure that there are really no heartbeats. Otherwise, even a perfectly executed massage will hurt.

The essence and meaning of cardiac massage

The purpose of heart massage is to artificially recreate, replace cardiac activity in case of its stop. This can be achieved by squeezing the cavities of the heart from the outside, which imitates the first phase of cardiac activity - contraction (systole) with a further weakening of pressure on the myocardium, which imitates the second phase - relaxation (diastole).

This massage can be done in two ways: direct and indirect. The first is only possible with surgical intervention when there is direct access to the heart. The surgeon takes it in his hand and performs a rhythmic alternation of compression with relaxation.

An indirect heart massage is called indirect because there is no direct contact with the organ. Compression is carried out through the wall chest because the heart is located between the spine and the sternum. Effective pressure on this area is capable of ejecting about 60% of the blood volume into the vessels compared to the self-contracting myocardium. Thus, the blood will be able to circulate through the largest arteries and vital organs (brain, heart, lungs).

Indications: who really needs this procedure

The most important thing in cardiac massage is to determine whether a person needs it or not. There is only one indication - complete. This means that even if an unconscious patient has pronounced violations rhythm, but at least some cardiac activity is preserved, it is better to refrain from the procedure. Squeezing the beating heart can cause it to stop.

The exception is cases of severe ventricular fibrillation, in which they seem to tremble (about 200 times per minute), but do not perform a single full-fledged contraction, as well as weakness sinus node and, in which the heartbeat is less than 25 beats per minute. If such patients are not helped, the condition will inevitably worsen, and cardiac arrest will occur. Therefore, they can also be given indirect massage if there is no other way to help.

The justification for the expediency of this procedure is described in the table:

Clinical death is the stage of dying after the cessation of cardiac activity lasting 3-4 minutes. After this time, irreversible processes occur in the organs (primarily in the brain) - biological death. Therefore, the only time when you need to do cardiac massage is the period of clinical death. Even if you do not know when the cardiac arrest occurred and are not sure if there is a heartbeat, look for other signs of this condition.

The sequence of actions that make up the indirect heart massage technique includes:

1. Determine if the patient has a pulse and heartbeat:

• Feel with your fingers the anterolateral surfaces of the neck in the projection of the location of the carotid arteries. The absence of a pulsation indicates cardiac arrest.
• Listen with your ear or phonendoscope to the left half of the chest.

2. If you doubt the absence of heartbeats, before doing chest compressions, determine other signs of clinical death:

3. If these signs occur, feel free to proceed with an indirect heart massage, observing the technique of execution:

• Lay the patient on his back, but only on a hard surface.
• Open the patient's mouth, if there is mucus, vomit, blood or any foreign bodies in it, clean oral cavity fingers.
• Tilt the victim's head back well. This will prevent the tongue from slipping. It is advisable to fix it in this position by placing any roller under the neck.
• Stand to the right of the patient at chest level.
• Place the hands of both hands on the sternum at a point that is located two fingers above the lower end of the sternum (the border between the middle and lower thirds).
• Hands should lie in this way: the fulcrum of one hand is the soft part of the palm in the area of ​​elevation thumb and the little finger just below the wrist. Place the second brush on the one located on the chest and interlace their fingers into the castle. Fingers should not lie on the ribs, as they can cause fractures during the massage.
• Lean over the victim in such a way that, with correctly located brushes, you seem to rest against the sternum. The arms should be straight (unbent at the elbows).

The technique for performing pressure on the chest should be as follows:

1. At least 100 times per minute.
2. So that it is pressed 3-5 cm.
3. Apply compression not by flexing and extending your arms at the elbows, but by pressing your whole body. Your hands should be a kind of transmission lever. So you will not get tired and will be able to massage as much as you need. This procedure requires a lot of effort and energy.

An indirect heart massage can last about 20 minutes. Check every minute to see if there is a pulse. carotid arteries. If, after this time, the heartbeats have recovered, further massage is not advisable.

Do artificial respiration simultaneously with cardiac massage is not necessary, but it is possible. The correct execution technique in this case: after 30 pressures, take 2 breaths.

Forecast

The effectiveness of indirect heart massage is unpredictable - from 5 to 65% ends with the restoration of cardiac activity and saving a person's life. The prognosis is better when performed in young people without concomitant diseases and damage. But cardiac arrest without indirect massage in 100% ends in death.

1. 
   the appearance of a distinct pulse wave on the carotid arteries after each contraction.
2. 
   constriction of the pupils.
3. 
   reduction in cyanosis.
4. 
   emergence of spontaneous respiratory movements.

Cardiac massage should be combined with artificial lung ventilation. Effective artificial respiration, carried out in combination with chest compressions, requires a rhythmic repetition of vigorous breaths at a frequency of 12-15 per minute, i.e. one "breath" for 5 chest compressions. In this case, these manipulations should be alternated in such a way that the blowing does not coincide with the moment of chest compression during heart massage.

If resuscitation is carried out by one person, then after every 15 chest compressions, he should make 2 vigorous slow breaths of air into the lungs with a duration of at least 1-2 s. Control the position of the head so that air does not enter the esophagus.

In two-person resuscitation, one breath is taken after 5 chest compressions. The resuscitator, performing mechanical ventilation, controls the effectiveness of heart massage upon the appearance of pulse waves on the carotid arteries. Constantly monitor the possibility of the patient's independent cardiac activity (at the beginning after 20-30 seconds, then every 2-3 minutes).

If after 30-40 minutes from the start of resuscitation, cardiac activity has not recovered, resuscitation should be considered unsuccessful and terminated.

When performing an external heart massage, it should be borne in mind that in the elderly, the elasticity of the chest is reduced due to age-related ossification of the costal cartilages, therefore, with vigorous massage and too much compression of the sternum, a fracture of the ribs can occur. This complication is not a contraindication to continuing cardiac massage, especially if there are signs of its effectiveness.

When massaging, one should not place the hand over the xiphoid process of the sternum, since by sharply pressing on it, one can injure left lobe liver and other organs located in upper section abdominal cavity. This is serious complication resuscitation.

After clinical death, irreversible changes occur in the tissues (primarily in the cells of the cerebral cortex), already determining the state of biological death, in which full recovery the functions of various organs cannot be achieved. The onset of biological death is established both by the cessation of breathing and cardiac activity, and on the basis of the appearance of so-called reliable signs biological death: a decrease in body temperature below 20 ° C 9 or to a temperature environment), the formation of cadaveric spots 2-4 hours after cardiac arrest (occur due to the accumulation of blood in the lower parts of the body), the development of rigor mortis (solidification of muscle tissue).

Signs of biological death.

1. 
   lack of heartbeat, pulse, respiration, pupillary response to light.
2. 
   clouding and drying of the cornea
3. 
   softening eyeball, when the eye is squeezed, the pupil is deformed and resembles a constricted cat eye(symptom "cat's eye")
4. 
   decrease in body temperature to ambient temperature
5. 
   the appearance of cadaveric spots of blue-purple color on the underlying parts of the body
6. 
   rigor mortis, this indisputable sign of death occurs 2-4 hours after death. Later rigor mortis passes.

The doctor ascertains the fact of death, writes down in the history of the disease - the day, hour and minutes. The deceased is undressed, laid on his back with straightened limbs without a pillow. Values ​​​​from the deceased are removed in the department in the presence of the attending or on-call doctor and transferred to storage. If the valuables cannot be removed, then this is recorded in the medical history and the corpse is sent to the morgue with valuables. tie up lower jaw, lower the eyelids, cover with a sheet and leave in bed for 2 hours (taken out of the ward). The nurse writes in ink on the thigh of the deceased his last name, first name and patronymic, department number, date of death, and a direction is attached to the leg, where the full name, medical history number, time of death are indicated, clinical diagnosis. Tells relatives.

1) 16-20 per minute

2) 40-70 per minute

3) 60-80 per minute

4) 70-90 per minute

2. Characteristics of the pulse of a healthy person

1) small, filiform, rhythmic

2) moderate filling, tension, rhythmic

3) good filling, tense, rhythmic

4) weak content, tense, arrhythmic

3. Normal performance BP in a healthy adult

1) 80/60 mmHg

2) 100/60 mmHg

3) 120/60 mm Hg

4) 160/100 mmHg

4. Heart rate per 1 degree rise in temperature

1) does not change

2) increases by 10 heart beats

3) increases by 20 heart beats

4) decreases by 10 heart beats

5. The level of blood pressure is characterized by the property of the pulse

3) filling

4) frequency

6. Pulse pressure reflects

1) difference between systolic and diastolic pressure

2) pulse voltage level

3) filling level of the pulse

4) pulse rate

7. When counting the pulse, the artery is pressed against the radius

1) with one finger

2) two fingers

3) three fingers

4) with all fingers of the brush

1) 12-14 per minute

2) 16-18 per minute

3) 22-24 per minute

4) 26-28 per minute

5) 30-32 per minute

9. Accelerated shallow breathing called

1. 
   orthopnea
2. 
   bradypnea
3. 
   tachypnea
4. 
   bradycardia
5. 
   tachycardia

1. 
   in a horizontal position on the back on a rigid stretcher
2. 
   in a horizontal position on the back on a soft stretcher
3. 
   in the frog position
4. 
   in Trendelenburg position

1) blockage respiratory tract foreign body

2) drug poisoning

3) pulmonary embolism

4) drowning

5) acute tracheitis

12. Inspiratory dyspnea is characterized by difficulty

1) inhale

3) inhalation and exit

13. For expiratory dyspnea characteristic difficulty

3) inhalation and exit

1. 
   hemothorax
2. 
   pneumothorax
3. 
   pyothorax
4. 
   hydrothorax

1. In admission department hospital delivered injured in a road accident with total loss consciousness. actions of the nurse.

1. 
   Homehertaskse: 4 min (4%)

Cardiac massage is a mechanical effect on the heart after it has stopped in order to restore its activity and maintain continuous blood flow until the heart resumes its work.

Signs of sudden cardiac arrest are as follows:

sharp pallor,

Loss of consciousness,

The disappearance of the pulse on the carotid arteries, the cessation of breathing or the appearance of rare convulsive breaths (agonal breathing),

Pupil dilation.

The heart is located between the posterior surface of the sternum and the anterior surface of the spine, i.e. between two hard surfaces. By reducing the space between them, you can compress the region of the heart and cause artificial systole. In this case, blood from the heart is ejected into the large arteries of the large and small circles of blood circulation. If the pressure is stopped, then the contraction of the heart stops and the blood is sucked into it. This is artificial diastole. The rhythmic alternation of chest compressions and the cessation of pressure replaces cardiac activity, providing the necessary blood circulation in the body. This is the so-called indirect heart massage - the most common method of revitalization, carried out simultaneously with mechanical ventilation.

Indications for cardiac massage are all cases of cardiac arrest.

ACTION ALGORITHM:

1. Lay the victim on their back on a hard base.

2. Stand to the left of the victim and place your palms on the lower third of the sternum 2 transverse fingers above the xiphoid process.

Place the palm of one hand perpendicular to the axis of the sternum, the palm of the other hand - on the back surface perpendicular to the first.

3. Bring both hands to the position of maximum extension, fingers should not touch the chest. hand fingers,

located below, should be directed upwards (towards the head).

4. With the effort of the whole body with the help of the hands (the hands should remain straight during the massage), jerkily, rhythmically press on

breastbone so that it bends 4-5 cm. In the position of maximum deflection, it must be held for a little less than 1 second. Then

stop pressing, but do not take your palms off the sternum.

REMEMBER! The number of chest compressions should average 70 per minute.

Criteria for the effectiveness of chest compressions

1.Color change skin(they become less pale, grey, cyanotic)

2. Constriction of the pupils with the appearance of a reaction to light

3. The appearance of a pulse on large arteries(sleepy, femoral)

4. The appearance of blood pressure at the level of 60-8 mm Hg.

5. Subsequent restoration of spontaneous breathing.

Complications of chest compressions

Fracture of the ribs and sternum with injury to the heart, lung and pleura, development of pneumo- and hemothorax.

REMEMBER! CPR must be started immediately in any setting where respiratory and cardiac arrest occurs. The main condition for successful revival is the correct combination of free airway patency, mechanical ventilation and heart massage. Only joint application 3 stages ensures sufficient oxygen supply to the blood and its delivery to the organs, primarily to the brain.

The cessation of the activity of the heart can occur under the influence of the most various reasons(drowning, suffocation, gas poisoning, electric shock and lightning, cerebral hemorrhage, myocardial infarction and other heart diseases, heat stroke, blood loss, a strong direct blow to the heart, burns, freezing, etc.) and in any environment - in hospital, dental office, home, outdoor, industrial. In any of these cases, the resuscitator has only 3-4 minutes at his disposal to make a diagnosis and restore the blood supply to the brain.

There are two types of cardiac arrest- asystole (complete cessation activity of the heart) and fibrillation ventricles, when certain fibers of the heart muscle contract chaotically, uncoordinated. Both in the first and in the second case, the heart stops “pumping” blood and the blood flow through the vessels stops.

The main symptoms of cardiac arrest that allow for a quick diagnosis are:

• loss of consciousness;
• lack of pulse, including on the carotid and femoral arteries;
• absence of heart sounds;
• stop breathing;
• pallor or cyanosis of the skin and mucous membranes;
• pupil dilation;
• convulsions that may appear at the time of loss of consciousness and be the first noticeable symptom of cardiac arrest.

These symptoms are so convincing evidence of circulatory arrest and that there is not a second to lose on additional examination(measuring blood pressure, determining the pulse rate) or looking for a doctor, but you must immediately begin resuscitation - heart massage and artificial respiration. It should be remembered that cardiac massage should always be carried out simultaneously with artificial respiration, as a result of which the circulating blood is supplied with oxygen. Otherwise, resuscitation is meaningless.

Currently, two types of heart massage are used - open, or direct, which is used only during operations on the organs. chest cavity, and closed, external, carried out through the unopened chest.

Technique of external heart massage.

The meaning of external massage is the rhythmic squeezing of the heart between the sternum and spine. In this case, blood is expelled from the left ventricle into the aorta and enters, in particular, into the brain, and from the right ventricle into the lungs, where it is saturated with oxygen. After the pressure on the sternum stops, the chambers of the heart are filled with blood again. When conducting an external massage of the heart, the patient is placed on his back on a solid foundation (floor, earth). Do not massage on a mattress or soft surface. The resuscitator stands on the side of the patient and with the palmar surfaces of the hands laid one on top of the other, presses on the sternum with such force as to bend it towards the spine by 4-5 cm. The frequency of compressions is 50-70 per minute. Hands should lie on the lower third of the sternum, i.e. 2 fingers above the xiphoid process.

In children, heart massage should be performed with only one hand, and in children infancy- with the tips of two fingers with a frequency of 100-120 pressures per minute. The point of application of the fingers in children under 1 year old is at the lower end of the sternum. When conducting a massage, adults need to apply not only the strength of the hands, it is necessary to press with the whole body. Such a massage requires considerable physical tension and very tiring. If resuscitation is performed by one person, then every 15 compressions of the sternum with an interval of 1 s, he must, having stopped the massage, perform 2 strong breaths mouth-to-mouth, mouth-to-nose, or a special manual respirator. If two people are involved in resuscitation, one lung inflation should be performed after every 5 compressions of the sternum.

The effectiveness of heart massage is evaluated according to the following criteria:

• the appearance of a pulse on the carotid, femoral and radial arteries;
• increase in blood pressure up to 60-80 mm Hg. Art.;
• constriction of the pupils and the appearance of their reaction to light;
• the disappearance of the cyanotic color and "dead" pallor;
• subsequent restoration of spontaneous breathing.

It should be remembered that a rough external heart massage can lead to serious complications - a fracture of the ribs with damage to the lungs and heart. At strong pressure on the xiphoid process sternum can rupture the stomach and liver. Particular care should be taken when massaging children and the elderly.

If after 30-40 minutes from the start of a heart massage, artificial respiration and drug therapy cardiac activity is not restored, the pupils remain wide, without reaction to light, it can be considered that irreversible changes and brain death have occurred in the body, and it is advisable to stop resuscitation. When obvious signs death, resuscitation may be terminated earlier.

For some serious illnesses and traumatic injuries malignant tumors with metastases, severe trauma to the skull with crush of the brain) resuscitation will not make sense and should not be started. In other cases sudden death there is always hope for the revival of the patient, and for this all possible measures must be taken.

Transportation of a patient with respiratory and cardiac arrest can be made only after the restoration of cardiac activity and respiration or in a special ambulance in which resuscitation can be continued.

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), 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 stepped over 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, reservoir). 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.

Video: cardiopulmonary resuscitation (film of the Russian National Council for Resuscitation)

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

The terminal state is accompanied by deep functional disorders and requires intensive care. In case of slow development of changes from the vital important organs The first responders have time to stop the dying process, 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 (fall 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 residual manifestation functional abilities of a living organism with the aggravation of those disorders that began in the preagonal 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 life is expedient precisely during this period, since more long time calls into question the effectiveness of cerebral resuscitation. The cerebral cortex, as the most sensitive organ, can 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 others brain structures disunite and "man 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 this is sudden stop heart caused by a heart rhythm disorder:

1. ventricular fibrillation;
2. Atrioventricular blockade (with Adams-Stokes-Morgagni syndrome);
3. Paroxysmal ventricular tachycardia.

It should be noted that in contemporary ideas the cessation of cardiac activity is understood not so much as mechanical cardiac arrest, but as the 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 contractility heart and coronary artery disease.
• Another group includes diseases caused by significant violations of 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 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 beginning of cardiopulmonary and cerebral resuscitation as early as possible in order not only to bring the person back to life, but also to preserve his mental usefulness.

The last (final) stage of the existence of a once living organism is biological death, at which irreversible changes occur and the complete cessation of all life 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 fast at all (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 issues 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 that begin with an assessment of the situation and the condition of the victim, first aid, resuscitation in accordance with the rules and recommendations, specially developed and presented as an algorithm for cardiopulmonary resuscitation, which includes:

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 trouble happened to a person outside medical institution Of course, you should try to give him first aid, but for this you need to know the technique and know the rules for such events. Initial preparation for resuscitation involves laying the patient in horizontal position, exemption from tight clothing, accessories that interfere with the implementation of the basic methods of 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 action salvation are useful only to ordinary people who do not have 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 different kinds air ducts, vacuum aspirators, and if necessary (obturation lower divisions DP) - performs tracheal intubation.

Tracheostomy in cardiopulmonary resuscitation is used in very rare cases because it's already surgical intervention requiring special skills, knowledge and a certain amount of time. Absolute reading to it is only the obturation of the airways in the area 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 (patency restored, but respiratory movements have not resumed), they use simple techniques that 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:

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 for the reviver it is quite tiring. In such cases, if there is such an opportunity, various devices and ventilators help, which improve physiological basis 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 - indoor massage hearts;
• Primary intensive care, involving the introduction medicines 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 a resuscitation technique as cardiac defibrillation is also carried out medical worker who arrived on a call. Indications for it are conditions caused by ventricular fibrillation (electric shock, drowning, ischemic disease hearts, etc.). However ordinary people they do not have access to a defibrillator, so it is not advisable to consider resuscitation from this point of view.

The most affordable, simple and at the same time effective technique emergency restoration of blood circulation is considered 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 on its own, so that at least in minimum volume provide blood circulation.

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 strict observance rules for it:

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 10-12 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 up to 60-70 mm. rt. Art. (when measuring traditional way- on the shoulder);
• The patient begins to breathe independently, 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. So that after the restoration of cardiac activity, preserved personal qualities the victim, he is assigned to conduct 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 considered that indications for CPR are any terminal state regardless of the cause of its occurrence, therefore, 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 at a glance serious violations, which can be attributed to contraindications;
2. Diseases when CPR is not performed due to inappropriateness. This applies to cancer patients terminal stage tumors, patients who have had a severe stroke (bleeding into the trunk, large hemispheric hematoma), having severe violations functions 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 extreme situation However, they are already within the competence of qualified medical professionals.

The start of intensive care is associated with the introduction 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 the implementation of 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.