Indirect body massage. Technique for performing indirect heart massage. What does chest compressions do?

If the victim has no pulse, the following violations heart activity:

• A sharp weakening or even complete cessation contractions of the heart, which is the result of a long stay of the victim under the influence of current, as well as the absence timely assistance in case of primary respiratory failure;
• Education under action electric current disparate and multi-temporal (fibrillar) contractions individual groups fibers of the heart muscle, which cannot ensure the work of the heart as a pump that pumps blood into the vessels, which occurs under the action of alternating current great strength even if the victim is under voltage for a short time; in this case, breathing for some time after the release of the victim from the action of the current may still continue, but the work of the heart is not effective and is not able to support life.

Therefore, in the absence of a pulse in the victim, to maintain the vital activity of the body (to restore blood circulation), it is necessary, regardless of the reason that caused the cessation of the heart, simultaneously with artificial respiration(by blowing air) carry out outdoor massage hearts. It should be borne in mind that without proper and timely preliminary assistance to the victim before the arrival of a doctor medical assistance may be late and ineffective.

External (indirect) massage is performed by rhythmic contractions of the heart through the anterior wall chest when pressing on a relatively mobile lower part the sternum behind which the heart is located. In this case, the heart is pressed against the spine and blood is squeezed out of its cavities into blood vessels. By repeating pressure at a frequency of 66 - 70 times per minute, you can ensure sufficient blood circulation in the body in the absence of heart work.

The possibility of such an imitation of the work of the heart arises as a result of a deep loss muscle tone(tension) in a dying person, as a result of which his chest becomes more mobile and supple than in a healthy person.

To conduct an external heart massage, the victim should be laid with his back on a hard surface (low table, bench or on the floor), expose his chest, remove the belt, suspenders and other items of clothing that restrict breathing. The person providing assistance should stand on the right or left side of the victim and take a position in which a more or less significant inclination over the victim is possible. If the casualty is laid on a table, the caregiver should stand on a low chair, and if the casualty is on the floor, the caregiver should kneel next to the casualty.

Having determined the position of the lower third of the sternum (Figure 6, a), the assisting person must put on it upper edge palms of the arm extended to failure, and then put the other hand on top of the arm (Figure 6, b) and press on the chest of the victim, slightly helping with the tilt of your body. Pressing should be done with a quick push so as to move the lower part of the sternum down towards the spine by 3-4 cm, and in fat people- by 5 - 6 cm. The pressing force should be concentrated on the lower part of the sternum, which, due to its attachment to the cartilaginous ends of the lower ribs, is mobile. Top part the sternum is fixed to bony ribs and when pressed on it can break. Pressure on the end of the lower ribs should also be avoided, as this can lead to their fracture. In no case should you press below the edge of the chest (on soft tissues), since it is possible to damage the organs located here, primarily the liver.

Pressing on the sternum should be repeated approximately once per second.

After a quick push, the hands remain in the reached position for about one third of a second. After that, the hands should be removed, freeing the chest from pressure in order to allow it to straighten out. This favors the suction of blood from the large veins into the heart and its filling with blood.

If there is an assistant, one of the caregivers, less experienced in this matter, should carry out artificial respiration by blowing air as a less complicated procedure, and the second, more experienced, should perform chest compressions. To provide the body enough oxygen in the absence of the work of the heart, artificial respiration should be carried out simultaneously with a heart massage by blowing air into the lungs of the victim.

Since pressure on the chest makes it difficult to expand during inhalation, blowing should be done in the intervals between pressures or during a special pause provided every 4 to 6 pressures on the chest.

If the assisting person does not have an assistant and is forced to perform artificial respiration and external heart massage alone, these operations should be alternated in the following order: after 2–3 deep blows into the mouth or nose of the victim, he makes 15–20 pressures on the chest, then again produces 2 - 3 deep breaths and again makes 15 - 20 pressures for the purpose of heart massage, etc. In this case, air blowing should be timed to coincide with the time of cessation of pressure on the chest or interrupting the heart massage for the time of blowing (about 1 second).

With equal qualifications of persons providing assistance, it is advisable for each of them to carry out artificial respiration and external heart massage, alternately replacing each other every 5-10 minutes. Such an alternation will be less tiring than the continuous performance of the same procedure, especially heart massage.

The effectiveness of external heart massage is manifested primarily in the fact that each pressure on the sternum leads to the appearance of a pulsating oscillation of the walls of the arteries in the victim (checked by another person).

At proper conduct artificial respiration and heart massage, the following signs of recovery appear in the victim:

1. Improvement in the complexion, acquiring a pinkish tint instead of a gray-earthy color with a bluish tinge, which the victim had before treatment;
2. The emergence of independent respiratory movements, which become more even as relief (revitalization) activities continue;
3. Pupil constriction.

The degree of pupillary constriction can serve as the most accurate indicator of the effectiveness of the assistance provided. Narrow pupils in the revived person indicate a sufficient supply of oxygen to the brain, and vice versa, the beginning expansion of the pupils indicates a deterioration in the supply of blood to the brain and the need to take more effective measures to revive the victim. This can be helped by raising the victim's legs about 0.5 m from the floor and leaving them in an elevated position during the entire time of external cardiac massage. This position of the victim's legs contributes to a better blood flow to the heart from the veins of the lower body. To keep the legs in a raised position, something should be placed under them.

Artificial respiration and external cardiac massage should be carried out until spontaneous breathing and heart work appear, however, the appearance of weak breaths (in the presence of a pulse) does not give grounds for stopping artificial respiration.

In this case, as already mentioned above, the blowing of air should be timed to coincide with the start of the victim's own inhalation. The recovery of heart activity in the victim is judged by the appearance of his own regular pulse, not supported by massage. To check the pulse, the massage is interrupted for 2 to 3 seconds, and if the pulse persists, this indicates independent work hearts. If there is no pulse during the break, you must immediately resume the massage.

Prolonged absence of pulse and heart rhythm with spontaneous breathing and narrow pupils indicates cardiac fibrillation. In these cases, it is necessary to continue measures to revive the victim until the arrival of a doctor or until the victim is taken to hospital. medical institution with the continuous continuation of measures to revitalize the car.

It should be remembered that even a short-term cessation of revitalizing activities (1 minute or less) can lead to irreparable consequences.

After the appearance of the first signs of revival, external heart massage and artificial respiration should be continued for 5-10 minutes, timing the blowing to the moment of one's own inspiration.

In life, there are situations that cannot be predicted in advance. For example, you need to help a person whose heart has stopped. This condition is called clinical death.

The blood supply may stop different reasons. The process is reversible if carried out in a timely manner indoor massage hearts. This is a methodology for human resuscitation, which is chest decompression.

It is very important to conduct an external massage strictly on the heart. Unfortunately, the time for resuscitation is limited to half an hour.

After 30 minutes, it is virtually impossible to bring a person back to life.

You need to know the features of the procedure, which manipulation technique is most effective, and how to bring the patient to his senses with the help of CPR (cardiopulmonary resuscitation). Only by observing the procedure for performing an indirect heart massage with your hands, you can restore the organ's performance.

What is NMS

There are several methods of human resuscitation and chest compressions are one of them.

Manipulation implies the restoration of blood circulation, as a result of the onset clinical death. The victim needs to squeeze the chest so as to start blood circulation, which in turn will lead to the resumption of an independent heartbeat. Compression should be uniform and sustained.

The method involves the restoration of the health of the body in the patient, without special devices.

It is important to remember that the resuscitation procedure helps the victim only the first half hour after clinical death. Therefore, it should be carried out immediately after the pulse stops. If you follow established order actions and correctly calculate the forces, the victim will quickly have to recover.

An important criterion is the calculation of the power of pressure on the chest. If you press too hard on the chest, you can damage the respiratory tract, which will adversely affect critical condition person.

An indirect heart massage should be combined with mechanical ventilation - artificial ventilation of the lungs. Thus, independent respiratory activity is restored, and some processes responsible for blood circulation are normalized.

Rules for resuscitation

Heart massage is performed strictly according to the established instructions. If all the manipulations are carried out correctly, a pulse will begin to appear within 10 minutes.

The technique for performing an indirect heart massage is as follows:

1. It is necessary to put the victim on a flat surface, stand on the right hand of the person. Thus, the procedure will be as efficient as possible. NMS needs to be done quickly, but carefully;
2. lay the foundation right palm on the xiphoid process. Thumb should point to the stomach of the victim;
3. The next stage is resuscitation. When performing an indirect heart massage, you need to control it so that the execution technique is not violated. All manipulations are performed only with straight hands. The palms should be straight, fingers should not be bent. This position of the hands allows resuscitation in the specified period of time, namely 30 minutes, without loss of strength for the person providing assistance. With the appearance of the first pulse, manipulation cannot be stopped. The heartbeat should be fully restored. The abundant flow of blood that rushed after the stop of the muscular organ can lead to rupture of the blood channel, which is fraught with lethal outcome. How to make sure that there is no damage to the organ? The rules of conduct indicate that when a heartbeat appears, it is necessary to reduce the frequency of pressure, but not stop the procedure;
4. The technique of chest compressions depends on age category victim. If clinical death has occurred in a child who is 7 years old or more, the manipulation is performed with one hand. For infants under 1 year old, the procedure is carried out only with a finger;
5. Chest compression should be performed to a depth of at least five centimeters. An important factor the elasticity of the chest appears. During a closed massage, one hand should not leave the chest space. Otherwise, the procedure will not bring results;
6. Press on the chest should be at intervals of 1-3 seconds. Especially if the victim has a disease of cardio-vascular system. The depth of compression is no more than three centimeters. The frequency of pressure should not be violated;
7. If the victim's ribs are broken, the sternum is broken, or there are chips on the costal bones, a heart massage is not performed. Without calculating the force of pressure, you can break the ribs, and, in the worst case, part of the bone will damage the lungs;
8. Artificial respiration is performed after 30 clicks. More or less often it is not recommended, since oversaturation with oxygen will not have a favorable effect on the condition of the victim. When conducting an indirect heart massage, it is necessary to provide the patient with the proper amount of oxygen until the first heartbeat appears;
9. If the algorithm of the procedure is followed, a pulse will appear within 5 minutes after the cardiac arrest;

The resuscitation session must not be interrupted. Everything is done quickly, without panic. It is important to record the moment of clinical death. By the end of the allotted time, you can speed up the performance of an indirect heart massage, but leave the pressure on the chest the same.

After that, within 30 minutes, you need to complete resuscitation, since biological death irreversible. Artificial start of the heartbeat is possible provided that the patient's brain remains intact. In case of trauma to the head organ, it is not possible to carry out the procedure.

The essence and algorithm of the massage

If the victim does not show signs of life, the pupils do not react to light or other factors, there is no respiratory and cardiac activity, an indirect heart massage is performed in conjunction with artificial respiration.

Resuscitation can be medical institution, with the help of a defibrillator and an injection of adrenaline, but in some situations, the victim may not live to see the intensive care unit.

As noted earlier, only hard surface. A bed or a soft sofa is not a good place for resuscitation. After the patient is placed in the desired position, a light precordial punch should be applied.

In 30% of cases, after such a start of the heart, the restoration of the work of the organ will follow.

Particular attention should be paid to the resuscitation of newborns and children aged 6 months to 1 year. The rib skeleton of an infant is very weak and may not withstand a strong load. The resuscitation time is reduced to 10-15 minutes, then - biological death.

What actions are performed with an indirect heart massage to a newborn?

All manipulations are carried out with two fingers - index and middle. The depth of compression is one and a half centimeters. During a closed heart massage to a newborn, it is necessary to alternate pressing and ventilation in the sequence of 20:2.

If within 10 minutes there were no signs of a pulse, you need to increase the frequency of pressing. After 15 min. - fatal outcome.

It's important to know: The resuscitation procedure has only two contraindications. The first is the presence of acute heart disease in the period of relapse or remission. The second is the onset of biological death.

For similar situations there is no technique to restore the heartbeat. In other cases, the resuscitation procedure can be performed by any person, regardless of age and gender.

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Resuscitation actions are carried out when a person has a lack of pulse and breathing. AT resuscitation 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 when correct execution Cardiopulmonary resuscitation has the ability 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, sleepy).

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 if foreign bodies in him;
• 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 in order to be effective resuscitation did not decline 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 tinge;
• 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

To cardiopulmonary resuscitation was 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 may damage 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 even a short time respiratory and cardiac arrest was noted, it is necessary to hospitalize. In the hospital, the doctor will determine the severity of the patient's condition, and prescribe the appropriate treatment.

In the hospital at without fail carry out:

• Laboratory and instrumental examination;
• If necessary, life support 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. How more serious pathology the longer the recovery takes;
• Duration of clinical death;
• Patient's age;
• The general condition of his body before development pathological condition(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 reading. There are many reasons for cardiac arrest (acute coronary insufficiency, anaphylactic, pain, hemorrhagic shock, impact on the body 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 a heartbeat weak and rare, then an indirect heart massage cannot 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 ambulance and check for breathing and pulse. If they are not available, proceed with CPR immediately.

External signs that indicate cardiac arrest:

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

When conducting an indirect heart massage, it is necessary to release the chest of the victim from clothes, put him on his back on a hard surface (floor, table, etc.), and raise his legs for better blood flow to the heart from the veins of the lower body by about 0.5 m. Then the assisting person puts his palm right hand on the lower half of the sternum (two fingers above its lower edge), while slightly raising the fingers. The rescuer puts the palm of the left hand on top of the right hand across and presses, helping with his own body. Pressing should be done in quick jerks with a frequency of 60 ... 80 times per minute. When pressing on the chest, the heart is compressed between the sternum and the spine and the blood from the cavities of this organ is pushed into the vessels. When the hands are released from the chest, due to the elasticity of the muscles, the heart

returns to its original volume and blood from large veins is sucked into the cavity of the heart.

Heart massage is considered effective when a pulse appears on the carotid, femoral and radial arteries, when the pupils constrict and their reaction to light appears, when the pale earthy (bluish) color of the skin disappears, and subsequently when breathing and blood circulation are restored. If breathing is not restored and the pupils are dilated, artificial respiration and chest compressions should not be interrupted even for a short time until the ambulance arrives.

3. Equipment.

"Maxim III - 01". The simulator of cardiopulmonary and cerebral resuscitation is spring-mechanical with an indication of the correctness of the actions and test modes (dummy). The simulator is equipped with an electronic control panel, which determines the correct position of the head, the state of the waist belt, the adequacy of the blown air, the compression force, the correct position of the hands during chest compressions, the correctness of resuscitation by one or two rescuers, the state of the pupils of the victim, the appearance of a pulse. The simulator can be used in three modes:

1-training-used to work out individual elements of resuscitation;

2-test - resuscitation mode by one rescuer;

3-test - resuscitation mode by two rescuers.

After a correctly performed resuscitation complex, the simulator automatically "comes to life": a pulse appears on the carotid artery, sound signals, the pupils of the victim narrow.

The wall panel is an image of a person's torso with a light signaling of actions to resuscitate the victim. The scoreboard is connected to the electronic control panel using connectors located on the rear panel of the control panel and allows you to visually demonstrate the resuscitation process. The simulator is powered from the mains 220 V 50 Hz through a network adapter or from an independent source of direct current 12-14 V through the connector on the remote control and the cable attached to the simulator. The simulator has overall dimensions: (1600±10)х(650±10)х(350±10) mm; weight: no more than 10 kg

4. Order of performance of work.

4.1. Prepare the simulator for practical training.

To conduct practical exercises, you should lay the simulator horizontally, connect the adapter to a 220V or 50Hz network or a special cable to a 12-14V DC source. Turn on the power supply toggle switch located on the rear panel of the electronic control panel. At the same time, the green signal “on” will turn on on the remote control. network", as well as red ones, signaling that the victim's belt is not unfastened, but

the head is not thrown back (similar signals on the wall board). The simulator "Maxim Sh-01" is used in three modes, the description of which is given below.

It often happens that a person abruptly, without visible prerequisites, loses consciousness, stops normal functioning respiratory system stops blood circulation. There can be many reasons for this condition, but the main thing is not to get confused and provide the victim with emergency assistance.

The resuscitation complex of procedures, along with artificial respiration, also includes cardiac massage. It must be done immediately, because after the blood supply stops, the cells of the body die from accumulated toxins and lack of oxygen. Irreversible processes in the brain occur already starting from 3-4 minutes oxygen starvation. Timely assistance will help prevent the death of the victim before the arrival of the ambulance team.

Classic heart massage is a special procedure that allows you to restore blood circulation in the human body. It is used for sudden, sudden cardiac arrest.

First task cardiac massage is the resumption of myocardial activity, the start of blood circulation by artificial, mechanical means. To do this, first, the cardiac cavities are compressed from the outside, simulating the phase of contraction of the heart muscle, and then the pressure is weakened and the myocardium relaxes.

Depending on the method of conducting, such a massage is divided into external (indirect) and internal (direct). Each of them has both its indications and the specifics of implementation.

Main indications

External heart massage is performed immediately upon cessation of blood supply and does not require any mechanisms, devices and devices. You can understand that the procedure is needed with the naked eye:

1. If a person loses consciousness, his pupils dilate and do not react to light.
2. The pulse is not heard (the arteries located on the neck, which are responsible for cerebral circulation, are especially important).
3. The skin takes on a bluish-pale color.

But it is worth noting that in the event that the patient has lost consciousness, but signs of cardiac activity are noticeable, it is better to refrain from massage, since squeezing the heart muscle, if it still contracts, can cause it to stop.

Direct massage should be used in the following situations:

• if conventional cardiopulmonary resuscitation fails;
• during cardiac arrest during surgical operation in the chest area abdominal cavity or in the very heart;
• if the heart stopped due to injury.

Sometimes indications are significant air embolism, wrong anatomical structure chest, clinical death due to hypothermia. This type massage is carried out exclusively by qualified medical professionals.

Kinds

What is the difference between these two types of cardiac massage that can help resuscitate a patient with cardiac arrest?

Indirect massage can be performed by anyone with a minimum of knowledge in order to save the victim and carry out emergency assistance, waiting medical workers. It is called so because there is no direct contact with the heart, it is influenced from the outside through the chest.

An effective procedure helps the myocardium to eject into the blood vessels about 60% of the blood ejected by itself, which makes it possible to fill the vessels with blood fluid and bring it to the vital important tissues and organs, such as the brain or lungs. NMS helps to restore cardiac activity.

Direct massage is performed only by a doctor on open heart patient. During the procedure, the heart is gently squeezed by hand through an incision in the chest or abdomen. ICP is not a simple intervention to provide emergency care and it requires certain skills and qualifications of a physician.

Algorithm for conducting indirect heart massage and artificial respiration

Indirect massage, or closed, is characterized by decompression (squeezing) of the chest with a certain rhythm and in designated place. If a main body the cardiovascular system refuses to work, it gets turned on in the following way. When pressing on the chest, the heart muscle contracts and mechanically squeezes blood out of itself into the vessels. If the sternum straightens, the heart relaxes, and then venous blood flows into it.

During such a massage, artificial respiration is necessarily carried out in order to enrich the body with oxygen.

In order to properly conduct a closed massage, you need to know how many clicks and breaths you need to do and in what sequence.

According to the rules of first aid, two breaths should be taken through the mouth or nose after every fifteen compressions on the chest. In this case, about four such circles per minute come out, while 60 clicks should be done. In addition, the pressure of the palms should not move the sternum more than 4-6 cm towards the spine.

With the correct execution technique, the hands are located one on top of the other in the lower third of the sternum (region of the ventricles of the heart). Press with a quick push with the part of the palm that is closer to the wrist. Having finished pressing, the hands are removed, allowing you to gain venous blood into the heart chambers.

Combination of NMS and artificial respiration

An important factor is the position of the victim on his back on a flat and hard surface, and the rescuer, accordingly, must be much higher in order to easily rest against the body with straight arms. This position will allow you not to get tired when pressing, using not just your hands, but the weight of your entire body.

The patient's head should be tilted back to avoid falling of the tongue, if possible, immobilize it altogether, for example, by placing something twisted into a roller under the neck. If there is vomit in the mouth, any foreign objects, blood, etc. – you need to carefully clean it with your fingers.

Cardiac massage in children occurs according to certain rules, which differ from the rules for adults:

Sometimes such actions do not give a result, then it is recommended to resort to the help of tourniquets, applying them to the limbs for a short time (up to 2 minutes). Thus, the blood will drain to the heart, helping it to start working.

An injection of adrenaline (up to 2 ml) may also help. In any case, it is advisable to spend NMS for about twenty minutes. If at the end of this time there is no positive result, the heartbeat will not be restored.

Carrying out PMS

The implementation of massage directly became possible from the middle of the twentieth century, when they began to do surgical interventions in the region of the heart (thoracic surgery). It also has certain requirements and techniques, the essence of which can be summarized.

Conditions for fulfillment

First, PMS requires open access to the heart. If the organ is open during surgery, this speeds up the start of the procedure, the outcome of which often depends on a few moments. If there are no such conditions, and massage is necessary, the doctor makes an incision in the chest wall along the fifth intercostal space. The massager's hand should have room for a normal girth of the organ.

Technique

The execution technique itself is as follows:

There is a second option for performing a direct massage, during which the heart is pressed against the sternum. In this case, with one hand, the organ is captured from behind and pressed against the sternum, while the second is located from the outside. Spend 60-70 squeezes per minute, giving a break to relax. This method is used less often, since the heart cavity does not get rid of blood enough and the effect of the procedure is much lower.

In both the first and second cases, PMS is carried out and stopped under the same conditions as conventional cardiopulmonary resuscitation.

Efficiency and prognosis

Forecasts mainly depend on how timely the NPS was started. So, when implementing this method in the first minute after cardiac arrest, a positive result is achieved in 60% of cases. Although the NPS given time carried out infrequently, the results of its use for the resumption of blood circulation are quite high.

Saving lives and restoring the activity of the heart muscle ends from 5 to 65% of cases of organ massage. Here, an important role is also played by the time of the beginning of the rescue operation, as well as the age of the victim. The younger he is and the less burdened with severe injuries or comorbidities, the higher will be the result of the NMS.

The following signs in a patient indicate a positive effect:

• restoration of breathing;
• constriction of the pupils;
• resumption of pulse (primarily carotid arteries pulsate in time with pressing);
• skin and mucous membranes become healthier.

Everyone can have a situation when you need to help the victim with clinical death, regardless of its causes. After stopping the heart has to start by artificial means. This is done through massage.

Most often, in the conditions of the operating room, the method of direct massage is used, in normal conditions- indirect together with artificial respiration. Simple, but well-coordinated movements can activate electrical activity organism, which means saving human life.