How to do artificial respiration and chest compressions. How to do it right: indirect heart massage and ventilation

The indirect method of cardiac massage is one of the methods of resuscitation carried out by pressing on the chest. This event must be performed as a result of stopping the heartbeat to restore blood circulation.

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The concept of indirect massage

Getting injuries associated with blood loss entails shutting down the functioning of the heart muscle. To prevent cell death, resuscitation of the victim must be applied.

In terms of time it takes no more than 0.5 hour, but if this period has expired, then clinical death occurs.

In total, there are two ways to provide first aid to the victim - indirect and direct massage heart muscle. When blood circulation ceases to circulate, the exchange of gases in the tissues at the intercellular level in the body stops.

Cells begin to die, and the internal organs are poisoned by decay products. Cell death depends on the speed of synthesis of useful components. This especially affects the brain, it gradually dies after 4 minutes after cessation of access to the brain blood.

Circumstances of resuscitation

External cardiac massage should be performed if the injured person has the following:

• lack of consciousness;
• pupils during forced opening do not react to light;
• no signs of a heartbeat;
• breath is not felt.

Chest compression is the most acceptable way to show signs of life, especially if drugs are not used for this.

An indirect heart massage, including the technique for performing it, involves squeezing the bones between the chest and spine. In the victim during this period, the ribs become the most pliable.

If a person is in a state of clinical death, it is easy to move the chest, during the event, the pressure in the heart muscle simultaneously increases and its volume decreases.

When performing movements in a given rhythm, the blood pressure in the cavities of the heart and in the vessels becomes unequal. From the left ventricle, blood enters the aorta of the brain, and from the right ventricle - to the lungs, where the cells of the organs are saturated with oxygen.

Important! When the pressure on the chest stops, the muscle expands and fills with blood, and when pressed, it is pushed out again. Thus, the heartbeat created artificially is maintained.

How to restore blood circulation

External cardiac massage is performed rib compression method. The following happens in the body:

• passing from the atrial region through the cavities of the valves, the blood fluid enters the region of the ventricles, and then spreads through the vessels;
• since the pressure is applied periodically, the circulation of the blood is not inhibited, and the blood continues to spread.

How to do a heart massage

This technique is necessary to create an electrical impulse of the heart muscle, which ensures the restoration of the functioning of the organ. If this process is not stopped, then within 0.5 hours you can regain consciousness, but you should know how to do chest compressions and have basic skills.

Advice! Be sure to perform these steps when performing artificial inhalations and exhalations. The force of pressure on the chest should not exceed 3 to 5 cm, which ensures the release of air masses in an amount of approximately 500 ml with each press. In this case, IVL is carried out.

What actions are performed with an indirect heart massage?

Performing indirect massage

Every person should know the rules for conducting an indirect heart massage for an adult.

chest compressions training

Execution technique contains the following information:

1. The injured person lies on a solid foundation or on the ground. If the first aid provider is right-handed, then it will be preferable for him to kneel on the right to perform the precordial strike with his right hand. If, on the contrary, you are left-handed, then the location on the left will be most convenient.
2. The maximum result from a closed massage will be provided if the victim is found on a flat and firm surface.
3. To apply pressure, the palm of the right hand must be placed about 4 cm above the xiphoid process, but the location of the thumb must be oriented to the stomach or chin of the victim. The other palm should be placed on the first at a right angle.
4. When directly performing the event, you do not need to bend your elbows, and the center of gravity should be kept relative to the chest. Restoring the work of the heart is a rather difficult task, as it would seem, and therefore one must be able to maintain the strength to conduct, and when bending the elbows, one can quickly become exhausted. To make sure that brings results, you should periodically check the presence of a pulse in an injured person. The number of clicks in one minute 60 - 100 times is the optimal pace of chest compressions.
5. The pressure between the ribs should not exceed 3 to 5 cm. This depends on how elastic the bones are. Do not take your hands off the body of an injured person. The chest should return to its previous position, but if you remove your palms and put them back, then such an action is equivalent to a powerful blow. So can injure the victim even more.
6. For 30 pressures, 2 breaths should be taken. As a result, inhalation and passive exit occur, which contributes to the saturation of the lungs with oxygen.

As mentioned earlier, after 0.5 hours, signs of life should appear, but if this does not happen, then death comes.

heartbeat

To know how to do chest compressions correctly, must be remembered following:

1. If the ribs are broken, you should not stop working, you can only reduce the number of clicks, but the depth of pressure should be left the same.
2. When performing resuscitation, it is worth paying more attention to pressing, and not to artificial inhalation of air.
3. Before performing resuscitation directly, make a precardinal punch from a height of about 0.3 m and only after that carry out the prescribed measures.

Resuscitation of children

What sequence of actions should be followed when providing first aid to children under the age of one year and older?

Helping kids is different than helping adults. The difference is in the depth of pressure and the area of ​​impact on the body area. Actions should be performed with one palm. For newborn babies, perform compression using two fingers.

Where to learn to do chest compressions

Indirect cardiac massage in children produced in this way:

1. Place your fingers below the level of the nipples and start pressing, with a frequency of more than 120 times per minute, the depth of pushing from 1.5 to 2 cm, while air inlets should be performed at least one in 5 presses.
2. If the baby is one year old and not more than 7 years old, then the optimal pace of indirect heart massage is from 100 to 200 pressures with a depth of 3 to 4 cm. The number of breaths is 1 with 5 pressures. Before holding, 2 fingers are placed higher from the xiphoid process.
3. If the child is over 7 years old, then the location of the fingers is the same as in the previous version, the depth of pressing is from 4 to 5 cm with a frequency of 80 to 100 times. Air is blown in at the rate of 2 times for 15 pressures.

Important nuances

When indirect massage should not be used hearts? It depends on a number of circumstances. The technique of resuscitation is associated with the cardiovascular system, so there are a number of contraindications:

1. Fractured ribs and other chest injuries.

2. If the heart muscle does not work for half an hour.

3. In the presence of a heartbeat, even if it is weak.

4. With an increased degree of risk to one's own life.

5. With open wounds and bleeding you have to make your own decision for such first aid.

Advice! It is necessary to massage the heart muscle according to the technology. In the regulatory framework, there is an article on the right of everyone to provide first aid, but only in relation to an adult. If you resuscitate the baby, then it should be consent from parents. The effectiveness of the event depends on the readiness for action and skills.

Video: Performing chest compressions

In the event of an accident or finding a person in an unconscious state, this area of ​​\u200b\u200bthe area must not be left until the ambulance arrives. Properly performed closed heart massage, and timely assistance to the victim contribute to the preservation of life.

• The main signs of cardiac arrest
• How NMS is carried out
• Mandatory steps in the process of heart massage
• Recommendations for effective massage
• Closed heart massage for a child 10-12 years old
• Technique and rules for NMS and artificial respiration for infants

The first and main method of rescuing a person who has stopped breathing is chest compressions, or NMS. It can be carried out in order to restore the work of the heart muscle simultaneously with blood circulation, since it requires mechanical action. Only after this is the restoration of the vital activity of the body and the continuous blood flow normalizes.

If a cardiac arrest occurs, then in almost any case it is necessary to do artificial respiration. The patient will need first aid to keep his body alive until an ambulance arrives. To carry out all the activities associated with NMS, significant efforts are required, which involve artificial respiration.

The main signs of cardiac arrest

Cardiac arrest is considered a sudden and complete cessation of cardiac activity, which in certain cases can occur simultaneously with the bioelectrical activity of the myocardium. The main reasons for stopping are:

1. Asystole of the ventricles.
2. Paroxysmal tachycardia.
3. and etc.

Predisposing factors include:

1. Smoking.
2. Age.
3. Alcohol abuse.
4. Genetic.
5. Excessive stress on the heart muscle (for example, playing sports).

Sudden sometimes occurs due to injury or drowning, possibly due to blocked airways as a result of electric shock.

In the latter case, clinical death inevitably occurs. It should be remembered that the following signs can signal a sudden cardiac arrest:

1. Consciousness is lost.
2. Rare convulsive sighs appear.
3. There is a sharp pallor on the face.
4. In the region of the carotid arteries, the pulse disappears.
5. Breathing stops.
6. Pupils dilate.

An indirect heart massage is performed until the restoration of independent cardiac activity occurs, among the signs of which the following can be distinguished:

1. The person comes to consciousness.
2. A pulse appears.
3. Decreases pallor and blueness.
4. Breathing resumes.
5. Pupils constrict.

Thus, in order to save the life of the victim, it is necessary to carry out resuscitation, taking into account all the circumstances, and at the same time call an ambulance.

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How NMS is carried out

Carrying out NMS, or external heart massage, is performed with artificial ventilation of the lungs.

This is done by alternating between ventilation and massage, regardless of the reasons why the heart stopped. The main thing is to remember the timeliness and correctness of the actions performed related to cardiac resuscitation of a patient whose body has lost its vital functions. This leads to the death of the victim before the arrival of the ambulance.

The body of the victim has signs of cardiac arrest, so he needs an ambulance. It can only be provided by those people who at that moment were near him. First, they kneel near the patient's chest, determine the area on the palm, which should be pressed. The base of the palm can easily be bent with sufficient pressure.

It is necessary to follow the massage technique correctly, rhythmically squeezing the chest and pressing on it with both hands, which causes blood to be squeezed out of the heart muscle, which begins to spread through the vessels. There is a pressing of the heart to the spine. The process of blood circulation in the body of the victim is resumed if about 60-70 pressings with both hands are performed per minute. If there is no cardiac activity, then these manipulations will be enough.

If clinical death occurs, then muscle tone is significantly reduced, so the mobility of the chest increases, which makes it easier to perform actions related to simulating the work of the heart muscle. Whether there is blood circulation is established simultaneously with the observation of the pulse. It is measured at the wrist, neck, or femoral artery.

If the condition is terminal, then the pulse should be felt where the area of ​​the carotid artery is located, since it is not possible to determine it at the level of the wrist. For this purpose, fingers are placed on the larynx, on top of the so-called Adam's apple, after which they are moved along the neck.

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Mandatory steps in the process of heart massage

According to the methodology, the NMS rescuer begins to conduct, standing on the right side of the patient. To detect the xiphoid process, first run a finger along the ribs of a person. With the help of the index and middle fingers, a small tubercle is found on the sternum, which should be lower than the level of the nipples, or on it. Then it is necessary, having measured two fingers above the xiphoid process, to place the left hand with the palm down in this place.

The palm of the base is placed on the found place. Next, with the palm on top of the left hand, place the right hand on its back side so that the fingers are pointing up. This position of the hands will allow you to block the hands due to the fingers fastened with a lock. It is important to ensure that the shoulders of the rescuer are located directly above the chest of the patient, placing his palms on his sternum and straightening his elbows.

At the next stage, they already begin to massage, pressing with both hands on the chest. The chest is pressed through no less than 3-5 cm. The rescuer must squeeze the sternum in jerks so that it can be displaced exactly 3-5 cm in the direction of the spine, holding for about half a second (if the victim is an adult). After that, the rescuer should relax his hands, but do not tear them off his chest. We should not forget about artificial respiration, which is done to the patient.

With NMS, it is required to compress the heart, that is, its muscles, where the sternum and spine are located, which is associated with squeezing blood into the arteries. When the pressure stops, the heart fills with blood through the veins. Be sure to remember that with proper NMS, only 20-40% of the blood circulation rate of a healthy person is provided, which is sufficient to maintain the body's vital functions for an hour before the ambulance arrives. In this regard, you cannot stop actions, but you can interrupt for seconds by continuing actions.

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Particular attention should be paid to the location of the rescuer, who needs to be much higher than the patient's body. He can sit on a chair or kneel near the victim if he is lying on the floor. It is necessary to ensure that the arms are straight during the massage, so you need to press when the strength of the hands is used simultaneously with the severity of the victim's torso. This allows for efficiency to conserve energy, so that NMS can be carried out for a long time.

The fingers should not lie on the chest, as an effective massage is necessary. All forces must be directed to the lower third of the sternum, and not to the chest wall area itself, which will reduce the risk associated with fracture of the ribs.

If the patient is in a horizontal position on a hard, level surface, then it is easier for the rescuer to apply pressure on the sternum so that the heart muscle can contract. The HMS scheme assumes not only the correct location, but also the right way to press.

Quickly starting to implement the NMS, forcefully press on the sternum area. It can go to a depth equal to half the height of the entire chest. After pressing, relaxation immediately follows.

It is important to monitor the coincidence of moments associated with pressure and relaxation. It is necessary to squeeze the patient's sternum with such force that it is pressed against the spine by 5-6 cm, at a pace close to normal heart rhythms.

Cardiac massage should be performed for at least 30 minutes. Performing an external heart massage should remember that you can not stop the massage process until 30 clicks have been made. If you often rest, then this will only harm the victim, since resuscitation carried out in these rhythms causes the cessation of the blood circulation process completely.

Having made 30 clicks on the chest area, about two breaths are taken into the patient's mouth, which can be done after 150 times. It is necessary to observe the pressure rate of about 100 times per minute, which is suitable for any patient, with the exception of a newborn.

You should wait for an ambulance or take the necessary actions until the pulse in the carotid artery resumes. If there is no pulse, then the massage should be continued until signs of biological death begin to appear, developing after clinical death has occurred within an hour.

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Resuscitation actions are carried out when a person has a lack of pulse and breathing. Resuscitation measures include indirect heart massage and artificial ventilation of the lungs (artificial respiration). Each person should be trained in these skills in order to provide timely assistance to the victim and save his life.

Resuscitation measures must be carried out correctly, in accordance with medical standards and algorithms. Only with proper cardiopulmonary resuscitation is it possible to restore vital functions.

Technique of indirect heart massage and artificial lung ventilation

External (indirect) heart massage is a compression that leads to compression of the heart muscle and pumping blood around the body. The indication for closed heart massage is the absence of a pulse. Moreover, the pulse must be determined only on large arteries (femoral, carotid).

Rules and procedure for conducting indirect (external) heart massage:

• A second hand is superimposed on top of the working one;
• It is necessary to make compressions only with arms straightened at the elbows. In this case, you need to press with your whole body, and not just with your hands. Only in this case will there be sufficient force to compress the heart;
• Only the sternum is pressed through by 3 - 5 centimeters, you can not touch the ribs;
• Compressions should be rhythmic and equal in strength. The frequency of compressions is from 100 to 120 per minute.

CPR can be performed in several ways: mouth to mouth, the most commonly used method, mouth to nose, mouth to mouth and nose, used in young children and with an Ambu bag.

Algorithm for performing artificial respiration:

• Lay the person on a flat surface, put a small roller under the neck. Open your mouth and check for foreign bodies in it;
• Place a handkerchief or gauze over the victim's mouth or nose. This will protect the rescuer from contact with the secretions of the victim and possible infection;
• Pinch the nose of the patient;
• Inhale, put your lips around the open mouth of the patient and press them tightly so that the air does not escape. And exhale in the usual volume;

• Control the correctness of artificial respiration. While inhaling air, pay attention to the person's chest. She must rise;
• Inhale and exhale again into the victim's mouth. It should be noted that the rescuer should not breathe often and deeply. Otherwise, he will feel dizzy and may lose consciousness.

First perform artificial respiration. It is necessary to take 2 breaths in a row, the elapsed time is 10 seconds, and then proceed to indirect massage.

The ratio of artificial respiration (IVL) to chest compressions is 2:15.

Resuscitation of one person

Resuscitation is a labor-intensive and energy-consuming process. Therefore, it is recommended that 2 rescuers carry them out. But this condition is not always feasible. Therefore, in some situations, it is necessary for 1 person to perform rescue procedures. How to act in such conditions?

Technique for performing indirect heart massage and ventilation by one person:

• Lay the victim on his back on a flat surface, put a roller under the neck;
• First, ventilation is performed by mouth-to-mouth or mouth-in. If injections are made through the nose, then you should close your mouth and fix it by the chin. If artificial respiration is carried out through the mouth, then pinch the nose;
• 2 breaths are carried out;
• Then the rescuer immediately proceeds to perform an indirect massage. He must perform all manipulations clearly, quickly and correctly;
• 15 compressions (pressures) are performed on the chest. Then again artificial respiration.

It is difficult for one person to perform cardiopulmonary resuscitation, therefore, in this case, the number of compressions should not be less than 80 - 100 per minute.

The rescuer performs resuscitation until: the appearance of a pulse and breathing, the arrival of the Ambulance, the expiration of 30 minutes.

Carrying out cardiopulmonary resuscitation by two rescuers

If there are two rescuers, then resuscitation is much easier to perform. One person does artificial respiration, and the second indirect massage.

Algorithm for performing indirect (external) heart massage 2rescuers:

• The victim is correctly laid down (on a hard and even surface);
• 1 rescuer is located at the head, and the second puts his hands on the sternum;
• First, you need to make 1 injection and check the correctness of its implementation;
• Then 5 compressions, after which the events are repeated;
• Compressions are counted by ear so that the second person can prepare in time for mechanical ventilation. Resuscitation in this case is carried out continuously.

The speed of compressions in the provision of cardiopulmonary resuscitation by 2 people is 90 - 120 per minute. Rescuers must change so that the effectiveness of resuscitation does not decrease over time. If the rescuer who performs the massage wants to change, then he must warn the second rescuer in advance (for example, during the count: "changed", 2, 3, 4.5).

Features of external heart massage and mechanical ventilation in children

The technique of performing resuscitation for children directly depends on their age.

Signs of the effectiveness of cardiopulmonary resuscitation

It should be remembered that only effective and correct resuscitation can save a person's life. How to determine the effectiveness of rescue procedures? There are several signs that will help assess the correctness of the performance of cardiopulmonary resuscitation.

Signs of the effectiveness of chest compressions include:

• The appearance of a pulse wave on large arteries (carotid femoral) at the time of compression. It can track 2 rescuers;
• The dilated pupil begins to narrow, a reaction to light appears;
• The skin changes color. Cyanosis and pallor are replaced by a pinkish tint;
• Gradual increase in blood pressure;
• There is an independent respiratory activity. If there is no pulse at the same time, then it is necessary to continue to perform only actions without mechanical ventilation.

The main mistakes during resuscitation

For cardiopulmonary resuscitation to be effective, it is necessary to eliminate all errors that can lead to death or serious consequences.

The main mistakes in the implementation of rescue activities include:

• Delay in providing assistance. When a patient has no signs of vital activity, namely pulse and breathing, a few minutes can decide his fate. Therefore, resuscitation should begin immediately;
• Insufficient strength when performing compressions. In this case, a person presses only with his hands, and not with his body. The heart does not contract enough and therefore the blood is not pumped;

• Too much pressure. Especially in small children. This can lead to damage to internal organs and separation of the sternum from the costal arches and its fracture;
• Incorrect hand placement and pressure with the whole hand leads to fracture of the ribs and damage to the lungs;
• Long break between compressions. It should not be longer than 10 seconds.

Further rehabilitation of a person

A person who has stopped breathing and cardiac activity even for a short time must be hospitalized. In the hospital, the doctor will determine the severity of the patient's condition, and prescribe the appropriate treatment.

In the hospital, it is mandatory to carry out:

• Laboratory and instrumental examination;
• If necessary, life support in the intensive care unit. If the patient does not breathe on his own, then connect the ventilator;
• Infusion therapy and parenteral nutrition if necessary;
• Symptomatic therapy (maintaining the work of the cardiac, respiratory, cerebral, urinary systems).

The duration of rehabilitation depends on many factors.:

• Cause of cardiac and respiratory arrest. The more serious the pathology, the longer the recovery takes;
• Duration of clinical death;
• Patient's age;
• The general condition of his body before the development of a pathological condition (the presence of chronic, congenital diseases).

When should chest compressions be used?

An indirect heart massage is performed when the patient has no pulse, that is, clinical death. This is the only and absolute indication. There are many reasons for cardiac arrest (acute coronary insufficiency, anaphylactic, pain, hemorrhagic shock, exposure to low temperatures, and so on).

It should be noted that it is important to provide resuscitation assistance only in the absence of a pulse. If the heart rate is weak and rare, then chest compressions should not be done. Since in this case, this manipulation will only lead to cardiac arrest.

If a person is found on the street, then you need to approach and ask if he needs help. If the person does not respond, then call an ambulance and determine the presence of breathing and pulse. If they are not available, proceed with CPR immediately.

External signs that indicate cardiac arrest:

• Loss of consciousness;
• Paleness and cyanosis of the skin and mucous membranes;
• Dilated pupils do not react to light;
• Swelling of the neck veins.

Indirect massage of such a vital organ as the heart is carried out in cases of its stop in a person due to biological malfunctions in the body or in case of injury due to accidents. It is possible to bring a person back to life after the heart stops functioning in a maximum of 6 minutes, which is why it will not be superfluous to know how to properly and under what circumstances it is necessary to independently perform emergency resuscitation to the victim.

The essence of self-guided cardiopulmonary resuscitation

In case of cardiac arrest and complete cessation of breathing, it is necessary to establish the biological process of blood circulation and air exchange in the body. Located between the movable sternum and the fixed spine, the heart periodically contracts, receiving blood flows and pushing them into the vessels. It is these contractions that are responsible for in the body. The need for artificial filling of the lungs with air by an outsider simultaneously with an indirect heart massage is due to the need to receive air flows by the lungs and heart.

Thus, an indirect heart massage (external) has as its goal an artificial imitation of the function of blood circulation and respiration.

Compulsory chest compressions

An indirect heart massage is mandatory for the following signs of a lack of active work of the heart and lungs:

• lack of breath
• the absence of the slightest manifestations of the work of the pulses
• Lack of pupillary response to harsh bright light
• cyanosis of the skin
• pallor of the face

Cardiac resuscitation is carried out exclusively in combination with artificial respiration, otherwise the attempts made to bring the person back to life will be unsuccessful. An indirect heart massage is performed in the presence of at least one cardiac arrest.

Consistency and complexity of chest compressions

A set of measures to normalize blood circulation in order to restore heartbeat and breathing consists of two main parts:

1. preparatory
2. direct massage

The preparatory part implies a competent position of the victim and the person who will perform indirect massage. First of all, the victim should be laid on a hard surface: for this, he must be dragged onto asphalt or another hard surface. If this is not possible, you can put a board directly under the chest to strengthen the area of ​​​​contact of the chest with the support.

The head of the resuscitated person should be laid back; to fix this position, a special roller or similar device should be placed under the neck.

This is necessary for carrying out artificial respiration in between massage sessions, so that the blown air penetrates as deep as possible into the chest. Before starting resuscitation, it is necessary to make sure that there are no foreign objects in the oral cavity.

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The person performing chest compressions should be kneeling at the side of the victim. The body of the body should be slightly directed forward so that when pressing with the palms on the chest area, the force comes from the weight of the whole body, and not just from the hands.

Directly indirect heart massage begins with tilting the head of the victim slightly back, then, with the nasal passage clamped, inhalations are made into the oral cavity 4-5 times. Only after this should immediately be carried out 1 cycle of chest compressions in the amount of 30 times with a frequency of 100 times per minute. Next, repeat the artificial respiration procedure. These two main actions alternate continuously for 6-7 minutes or until the ambulance arrives.

The force of pressing the chest should be equated to a depth of pressing up to 5 cm, even if one or more ribs are presumably broken during resuscitation of the victim - the procedure must not be interrupted.

It is important to choose the right area of ​​the chest for indirect massage, namely to press the base of the palms. To do this, it is necessary from the place where the ribs converge to rise higher to the throat by 2-3 fingers. You can calculate this point in another way:

the distance from the junction of the clavicle in front to the junction of the ribs is conditionally divided into three parts, the massage is performed on the border of the middle lower third. In men, this border corresponds to the middle nipple line, in contrast to women.

The outcome of the whole process depends on a well-conducted technical rehabilitation - the heart will work again or the increase in blood flow and blood circulation will not be able to affect the normalization of the functioning of the vital organs of the body.

Features and differences of cardiopulmonary resuscitation in children, contraindications

The technique of this procedure is significantly different in (up to a year) and in preschool children. The difference is directly in the specifics of pressing on the chest.

In infants, indirect heart massage is carried out with only two fingers: the middle and ring fingers. The frequency of massage pressure in infants should be increased to 120 per minute. The causes of cardiac and respiratory arrest can be not only injuries or an accident. An infant's heart may stop due to congenital diseases or sudden death syndrome. In preschool children, the base of only one palm is involved in the process of cardiac resuscitation.

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There are contraindications for indirect heart massage:

• penetrating wound to the heart
• penetrating lung injury
• closed or open traumatic brain injury
• absolute absence of hard surface
• other visible wounds incompatible with emergency resuscitation

Without knowing the rules for resuscitation of the heart and lungs, as well as the existing contraindications, you can aggravate the situation even more, leaving the victim no chance of salvation.

The effectiveness of indirect massage

The effectiveness of cardiopulmonary resuscitation can be judged by the signs of life that have appeared in the victim. This is the resumption of the pulse, the appearance of weak breathing or a sharp deep breath, the reaction of the pupils to a sharp and bright light also appears, namely their narrowing, further normalization and restoration of breathing, increased pressure, disappearance of pallor and cyanosis on the arms and neck.

You can finish indirect heart massage, if necessary, after probing the pulse of the carotid artery, however, to stabilize the condition, it can be carried out for a longer time.

Specialists and doctors recommend not to stop resuscitation of the victim until the ambulance arrives, even if he has no signs of life and improvement in his condition. Official permission to stop chest compressions can only be given by a qualified doctor.

What is unacceptable with external heart massage

To achieve exceptional results of indirect heart massage, namely, the resumption of normal blood circulation and the process of air exchange, and bringing a person to life by tactile acupressure on the heart through the chest, you must follow some simple recommendations:

1. Act confidently and calmly, do not fuss.
2. In view of self-doubt, do not leave the victim in danger, namely, it is imperative to carry out resuscitation measures.
3. Quickly and carefully carry out preparatory procedures, in particular, freeing the oral cavity from foreign objects, tilting the head back to the position necessary for artificial respiration, freeing the chest from clothing, and a preliminary examination for the detection of penetrating wounds.
4. Do not tilt the victim's head back excessively, as this can lead to obstruction of the free flow of air into the lungs.
5. Continue resuscitation of the victim's heart and lungs until the arrival of doctors or rescuers.

In emergency situations, when you can save a person's life, you just need to know the basics of first aid. One of these fundamental skills is the technique of which is described in this publication. Having studied some methods of its application, you can save a human life.

Performing chest compressions

First of all, they determine the sudden absence of breathing, consciousness, and then proceed to resuscitation, in parallel calling an ambulance. First, place the patient on a hard surface.
Resuscitation should be carried out immediately at the place where the victim was found, if this is not dangerous for the resuscitator.

If assistance is provided by a non-professional resuscitator, then only pressure on the sternum is allowed. An indirect heart massage, the technique of which is described below, includes the following points.

Sequencing

• To begin with, the place of compression in the lower third of the sternum is determined.
• They have one hand with a protrusion of the palmar surface (“fifth hand”) almost on the lowest part of the sternum. The other hand is placed on top of it in the same way. It is possible to place the palms according to the principle of the castle.
• Squeezing movements are performed with arms straightened at the elbows, while transferring the weight of your body when pressed. When performing compression, the hands are not torn off the chest.
• The frequency of pressure on the sternum should be no less than 100 times per minute or approximately 2 compressions per second. The displacement of the chest in depth is at least five centimeters.
• If performed, then for 30 compressions there should be two respiratory movements.

It is highly desirable that the periods of pressure on the sternum and the absence of compression are the same in time.

Nuances

An indirect heart massage, the technique of which is familiar to every doctor, requires, if tracheal intubation is performed, that movements be performed at a frequency of up to 100 times per minute without a break for respiratory resuscitation. It is carried out in parallel, while 8-10 breaths per minute are performed.

Compression of the sternum in children under ten to twelve years of age is performed with one hand, and the ratio of the number of compressions should be 15:2.

Since rescuer fatigue can lead to reduced compression quality and patient death, if there are two or more caregivers, it is advisable to change the chest pressurer every two minutes to prevent degradation of chest compressions. Resuscitator replacement should last no longer than five seconds.

It must be remembered that the rules for conducting an indirect heart massage require to ensure the patency of the respiratory system.

In individuals with a lack of consciousness, muscular atony and obstruction of the airways by the epiglottis and the root of the tongue develop. Obturation occurs in any position of the patient, even lying on his stomach. And if the head is tilted with the chin to the chest, then this condition occurs in 100% of cases.

The following initial actions are preceded by an indirect heart massage:

"Triple take" and tracheal intubation are the gold standard in the course of respiratory recovery.

"Triple Take"

Safar has developed three sequential actions that improve the effectiveness of resuscitation:

1. Tilt your head back.
2. Open the patient's mouth.
3. Push the patient's lower jaw forward.

When such a heart massage and artificial respiration are performed, the anterior muscles of the neck are stretched, after which the trachea opens.

Caution

We must be careful and careful, because it is possible to damage the spine in the neck when performing actions on the airways.

Spinal injuries are most likely to occur in two groups of patients:

• victims of road accidents;
• in the event of a fall from a height.

Such patients can not bend the neck, turn the head to the side. You need to moderately pull your head towards you, and then keep your head, neck, torso in the same plane with a minimum tilting of the head back, as indicated in the Safar technique. An indirect heart massage, the technique of which in such cases requires special care, is performed only if these recommendations are observed.

Opening the oral cavity, its revision

The patency of the airways after tilting the head is not always fully restored, because in some unconscious patients with atony of the muscles, the nasal passages are closed by the soft palate during breathing.

It may also be necessary to remove foreign objects from the oral cavity (blood clot, fragments of teeth, vomit, dentures)
Therefore, at first, in such patients, the oral cavity is examined and freed from foreign objects.

To open the mouth, use the "reception of crossed fingers." The doctor stands near the patient's head, opens and examines the oral cavity. If there are foreign objects, they must be removed. With the right index finger, the corner of the mouth is taken down from the right, this helps to free the oral cavity from liquid contents on its own. Fingers wrapped in a napkin, clean the mouth and pharynx.

An attempt is made with air ducts (no more than 30 seconds). If the goal is not achieved, stop trying and continue to carry out mechanical ventilation with a face mask or The mouth-to-mouth, mouth-to-nose techniques are also used. Heart massage and artificial respiration in such cases are carried out depending on the result.

After 2 minutes of resuscitation, it is necessary to repeat the attempt of tracheal intubation.

When an indirect heart massage is performed, the technique of which is described here, then when breathing "mouth to mouth" the duration of each breath should be 1 second. This method is considered effective if there are movements of the victim's chest during artificial respiration. It is important to avoid excessive ventilation of the lungs (no more than 500 milliliters), since it can cause complications in the form of reflux from the stomach and ingestion or entry into the lungs of its contents. In addition, excessive ventilation increases pressure in the chest cavity, which in turn reduces venous return to the heart and survival from sudden cardiac arrest.