Rules for artificial respiration and indirect heart massage. Indirect cardiac massage: technique. Cardiac massage and artificial respiration

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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 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

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.

The uninterrupted work of the heart is a prerequisite for the continuation of life. 5 minutes after it stops, the cerebral cortex begins to die, so it is extremely important to start performing artificial or indirect heart massage (CHM) as early as possible, even if you are not completely sure of the correctness of your actions.

The main task of cardiac massage is the artificial replacement of myocardial contraction in cases where they were stopped.

This can be achieved in two ways:

• performance of indirect heart massage by non-specialists, rescuers or medical staff of the ambulance team;
• by a cardiac surgeon performing manual manipulation directly on the heart during the operation.

Massage manipulations are aimed at maintaining blood circulation through the large vessels of the brain, lungs and myocardium. The correct frequency and depth of indirect action on the heart through the chest wall can provide a 60% release of blood volume compared to the blood flow that occurs with a self-contracting myocardium.

Pressing imitates the contraction of the heart muscle (systole), about its termination, during the complete weakening of the chest, - relaxation (diastole).

The basic complex of resuscitation measures also includes ensuring the patency of the respiratory tract and performing artificial lung ventilation (ALV). Their main goal is to maintain gas exchange by forced air renewal.

On a note. It has been established that the main factor in the success of resuscitation is adequate actions during chest compressions. If you are afraid or reluctant to perform artificial respiration, then be sure to give the victim chest compressions, according to the rules described below.

Conditions in which you can do an external heart massage

Indications for indirect heart massage is the cessation of its beating - the onset of clinical death, recognized by the following signs:

• permanent loss of consciousness;
• lack of pulse;
• stop breathing;
• large pupils that do not react to light.

With pain in the heart and / or other symptoms observed in cardiovascular diseases, for example, slowing down inhalations and exhalations, indirect massage and mechanical ventilation are prohibited.

Attention. Artificial massage for the heart "for the future" can end either by stopping its work, or by a significant deterioration in the condition of a sick person.

How to start the procedure of indirect myocardial massaging

Before talking directly about the heart massage technique itself, we will pay attention to the preparatory actions that will simultaneously serve as permission to perform it:

• Quickly inspect the scene so that you yourself do not get into a similar situation, for example, do not receive an electric shock from a bare wire.
• Check if the victim is conscious. It is forbidden to shake it strongly, beat it on the cheeks, douse it with water, let it smell ammonia or ammonia, waste time looking for and applying a mirror to the lips. Firmly squeeze the person, who you think is lifeless, by the arm or leg, gently shake and call out loudly.
• If there is no reaction, make sure the casualty is lying on a firm and level surface and turn them on their back. If there is no need, then once again do not move and do not transfer a person who is in trouble anywhere.
• Open the victim's mouth slightly and tilt your ear to him so that you can see his chest from the side-top, if you can, then try to feel the pulse at this time where you can and know how. For 10 seconds, explore the breath using the “SOS - listen, feel, look” method (see photo above). Here's what it is:
  1. C - listen with your ear to see if there are sounds of inhalations and exhalations;
  2. O - try to feel the presence of exhalation with your cheek;
  3. C - look at the chest, whether it moves or not.

Why is the need for cardiac massage primarily determined by the absence of respiratory cycles, and not by cardiac arrest?

• Firstly, it is difficult for ordinary people to quickly find a “healthy” pulse on the wrist even in a normal situation, to say nothing of extreme conditions in which, in addition to weakness of the beat and / or too rare beats, it is recommended to palpate the heart rate on the carotid artery.
• Secondly, a frightened person may be afraid to open the victim's eyes to determine the size of the pupils, moisture and transparency of the cornea, or be unable to correctly assess these characteristics.
• Thirdly, because the loss of breath rather quickly ends with cardiac arrest and loss of consciousness. If there is no breathing, the main thing is to provide blood access to the brain, and not allow its cortex to die.

Method of indirect heart massage

Currently, not for doctors or rescuers, but for ordinary people who, due to the prevailing circumstances, are forced to provide assistance in starting the work of the heart and restoring respiratory cycles, the following procedure is recommended:

• C (circulacion) - performing a cycle of external heart massage;
• A (airway) - control and ensuring the free entry of air into the lungs;
• In (breathe) - artificial ventilation of the lungs.

How to do an indirect cardiac massage

1. The location of the hands of the person providing assistance should be perpendicular to the chest of the victim, and he himself should be on the side of it.
2. The palms should be folded one on top of the other, and the fingers should be raised, or the fingers should be joined in the lock.
3. In order not to injure the lower extremity of the sternum - the xiphoid process, the base of the "lower" palm should be rested in its middle.
4. The frequency of compressions with chest compressions is the optimal pace for an adult from 100 to 120 compressions per second.
5. While pressing, do not bend your elbows! The pressure is due to the gravity of the body during its tilt.
6. The number of massage pressures in one continuous cycle is 30 times.
7. The pressing force should be such that the palms “sink down” by 5-6 cm.

On a note. Be sure to ensure that the ratio of the time of pressing and the time of returning the hands to the starting position is the same. This is essential for filling the heart chambers with a sufficient volume of blood.

Ensuring access of air to the lungs and artificial ventilation of the lungs

Since cardiac massage provides only blood movement and cannot prevent hypoxia of the tissues of the cerebral cortex, massaging should be combined with mechanical ventilation to ensure gas exchange.

Before starting artificial respiration, it is necessary to facilitate free access of air to the lungs.

First, lay the head of the victim in a position that prevents the tongue from falling back (see figure above):

• tilt your head back - at the same time press on your forehead with one hand, and lift your neck with the other (1);
• push the lower jaw forward - pick up the lower jaw with your fingers and match the lower and upper teeth in one plane (2);
• open your mouth, pulling your chin down a little (3);
• check the position of the tongue, and if it is sunk, pull it out with two fingers.

Then check the position of the tongue and the presence of mucus. If necessary, the tongue is pulled out with 2 fingers, like tongs, and the mucus is collected with the index finger, acting like a spatula.

Important. If a neck fracture is suspected, the head is not thrown back, and when performing an artificial breath, in order not to move the vertebrae further, they try not to exert strong pressure on the mouth.

Technique and rules of ventilation

If, after the first 30 rhythmic pressures on the middle of the sternum and the restoration of airway patency, cardiac activity has not resumed, the alternation of mechanical ventilation with the “mouth-to-mouth” technique and IMS begins:

1. Take a deep breath yourself, pinching the victim's nose with two fingers.
2. Within the 1st second, exhale your air completely into his mouth. At this time, squint your eyes and look at the chest, whether it has expanded or not.
3. Pause for 2-4 seconds. It will simulate a passive exhalation.
4. Repeat a second exhalation into the mouth, controlling the movements of the chest.
5. Straighten up and start doing 30 presses on the middle of the chest.

Number of rescue breaths

It is not necessary to do more than 2 exhalations into the victim's mouth. Their excess increases the tidal volume, which leads to a decrease in cardiac output and blood circulation.

Artificial respiration techniques

The mouth-to-mouth method is replaced with a mouth-to-nose method if a person has a mouth injury or is unable to open it. At the same time, it is necessary to monitor the tightness of the ventilator, just in case, supporting the chin with your fingers.

Causes of IVL inefficiency

If during the first artificial breaths the chest does not swell, then this may be the result of:

• insufficient sealing of the airways - the nose (or mouth) is not tightly clamped;
• weak expiratory strength of the caregiver;
• the presence in the oral cavity of the affected mucus or foreign objects.

What to do in the first two cases is clear, and when trying to remove a foreign object with your thumb and forefinger, be extremely careful not to push it even deeper.

Features of cardiopulmonary resuscitation in children

To help children, remember a few simple and easy-to-remember rules:

1. The algorithm for performing cardiopulmonary resuscitation, the pace and frequency of pressing during indirect heart massage for all age categories, starting from birth, is the same, as well as its ratio with mechanical ventilation - 30 to 2.
2. In an infant, tilting the head back should be easy. A strong deflection of the neck in infants leads to impaired airway patency!
3. For a child aged 1 to 10 years, pressing on the middle of the sternum is carried out with only one hand. In newborns and infants, indirect heart massage is done with bundles of 2 (middle and ring) or 3 (+ index) fingers.
4. The infant is blown into the mouth and nose at the same time. This technique is also recommended for older children, as long as the size of the facial skull allows such a girth to be made without violating its tightness.
5. Be careful! The strength, depth and volume of air during passive inspiration should not be large, especially if mechanical ventilation is performed on the baby. Conventionally, the volume should be equal to the amount of air that fits “between your cheeks”, taken without a deep breath, and the exhalation should be like a breath.

On a note. The recommended force (depth) of pressing in children and newborns is approximately 1/3 of the diameter of the chest. Don't be afraid to break bones. At this age, they are still malleable and not completely ossified.

When you can and should call for help

It is absolutely impossible to delay the start of an external heart massage, but when can you be distracted by calls for help and a call to an ambulance?

Presence of people and age of the unconscious person	Procedure
	Call out loud and short to those you see. Do this without stopping pressing on the sternum. After they arrive, quickly ask to call the ambulance, continuing resuscitation. After the call, they can help, for example, you continue to do mechanical ventilation, and they, alternating with each other, IMS.
	After performing "SOS", first call an ambulance. Otherwise, all your efforts to maintain blood flow in the cerebral cortex may be meaningless if professional medical care is not provided in time.
	No calls! First of all, do 4-5 cycles of IMS + IVL. And only after that interrupt the call to the ambulance.

The duration of the IC and the actions performed after it

It is necessary to continue resuscitation until you are replaced by a doctor or a rescuer who has arrived on call.

If your actions were successful - there were signs of life, then you need to follow the protocol "Actions after resuscitation":

• Lay the person down as shown in the picture above. While in it, he will not be able to accidentally tip over on his back. This will save him from choking on vomit, which quite often begins to be thrown out after the IMS. For insurance, you can put a pillow, a twisted blanket or any other, even a hard object, under your back, and cover it with a blanket on top. Note:
  1. the left palm is placed under the cheek, but it is better that the left forearm serves as a neck roll;
  2. the left leg is bent and rests on the floor with the knee;
  3. the whole torso is not clearly located on its side, but the stomach is slightly turned to the floor.
• The baby should be held in your arms, in a position on its side so that you can see his face and chest all the time.
• In no case should you give medicine, drink, eat or give injections.
• Do not leave a person unattended, controlling the continuity of his breathing.

And in conclusion of this article, in order to convince you that doing cardiac massage and artificial respiration is not very difficult, watch a short video with the correct technique for performing these resuscitation manipulations. The price of your composure, overcoming insecurities and fears is the saved human life.

resuscitation is a set of measures aimed at revitalizing the body. The task of the resuscitator is to restore and maintain cardiac activity, respiration and metabolism of the patient. Resuscitation is most effective in cases of sudden cardiac arrest with preserved compensatory capabilities of the body. If the cardiac arrest occurred against the background of a severe, incurable disease, when the compensatory capabilities of the body are completely exhausted, resuscitation is ineffective.

There are three types of terminal states: preagonal state, agony, clinical death.

Predagonal state. The patient is lethargic, there is marked shortness of breath, the skin is pale, cyanotic, blood pressure is low (60-70 mm Hg) or not detected at all, weak frequent pulse.

Agony. The deep stage of the dying process, which is characterized by the absence of consciousness (the pulse is thready or disappears altogether, blood pressure is not detected). Breathing is shallow, quickened, convulsive or significantly reduced.

clinical death. It occurs immediately after the cessation of breathing and blood circulation. This is a kind of transitional state from life to death, lasting 3-5 minutes. The main metabolic processes are sharply reduced and, in the absence of oxygen, are carried out due to anaerobic glycolysis. After 3-5 minutes, irreversible phenomena occur, primarily in the central nervous system, and true, or biological, death occurs.

Cardiac arrest can be sudden or gradual on the background of a long-term chronic disease. In the latter case, cardiac arrest is preceded by preagony and agony. The causes of sudden cardiac arrest are: myocardial infarction, blockage (obstruction) of the upper respiratory tract by foreign bodies, reflex cardiac arrest, heart injury, anaphylactic shock, electrical injury, drowning, severe metabolic disorders (hyperkalemia, metabolic acidosis).

Signs of cardiac arrest, i.e. the onset of clinical death, are: 1) the absence of a pulse in the carotid artery; 2) dilation of the pupil with the absence of its reaction to light; 3) respiratory arrest; 4) lack of consciousness; 5) pallor, rarely cyanosis of the skin; 6) lack of pulse in the peripheral arteries; 7) lack of blood pressure; 8) absence of heart sounds. The time to establish a diagnosis of clinical death should be as short as possible. The absolute signs are the absence of a pulse on the carotid artery and the expansion of the pupil with the absence of its reaction to light. If these signs are present, resuscitation should be started immediately. Cardiopulmonary resuscitation consists of four stages: I - restoration of airway patency; II - artificial ventilation of the lungs; III - artificial circulation; IV - differential diagnosis, drug therapy, cardiac defibrillation.

The first three stages can be carried out in an out-of-hospital setting and by non-medical personnel with appropriate resuscitation skills. Stage IV is carried out by doctors of emergency medical care and resuscitation departments.

I stage- restoration of airway patency. Mucus, sputum, vomit, blood, foreign bodies can be the cause of impaired airway patency. In addition, the state of clinical death is accompanied by muscle relaxation: as a result of relaxation of the muscles of the lower jaw, the latter sinks, pulls the root of the tongue, which closes the entrance to the trachea.

The victim or patient must be laid on his back on a hard surface, turn his head to one side, open his mouth with crossed fingers I and II of the right hand and clean the oral cavity with a handkerchief or napkin wound around II or III fingers of the left hand (Fig. 3). Then turn your head straight and tilt back as much as possible. In this case, one hand is placed under the neck, the other is located on the forehead and fixes the head in an upturned form. When the head is tilted back, the lower jaw is pushed up along with the root of the tongue, which restores airway patency.

II stage- artificial lung ventilation. At the first stages of cardiopulmonary resuscitation, it is carried out by mouth-to-mouth, mouth-to-nose and mouth-to-mouth-to-nose methods.

Artificial resuscitation from mouth to mouth through a tube

To perform artificial respiration using the “mouth-to-mouth” method, the assisting person stands on the side of the victim, and if the victim lies on the ground, he kneels down, puts one hand under his neck, puts the other on his forehead and throws his head back as much as possible, I and II with fingers clamps the wings of the nose, presses his mouth tightly to the mouth of the victim, exhales sharply. Then it is removed for the patient to passively exhale. The volume of the blown in air - from 500 to 700 ml. Respiration rate - 12 times per 1 min. To control the correctness of artificial respiration is the excursion of the chest - inflation during inhalation and collapse during exhalation.

In case of traumatic injuries of the lower jaw or in cases where the jaws are tightly clenched, it is recommended to perform mechanical ventilation using the “mouth-to-nose” method. To do this, putting their hand on their forehead, they throw their head back, grab the lower jaw with the other hand and press it tightly against the upper jaw, closing the mouth. Lips grab the victim's nose and exhale. In newborns, IVL is carried out by the mouth-to-mouth and nose method. The child's head is tilted back. With his mouth, the resuscitator covers the mouth and nose of the child and inhales. The respiratory volume of the newborn is 30 ml, the respiratory rate is 25-30 per minute.

In the described cases, ventilation must be carried out through gauze or a handkerchief to prevent infection of the respiratory tract of the person conducting resuscitation. For the same purpose, mechanical ventilation can be carried out using a 5-shaped tube, which is used only by medical personnel (see Fig. 5, d). The tube is bent, keeps the root of the tongue from retracting and thereby prevents airway obstruction. The 8-shaped tube is inserted into the oral cavity with the curved end up, sliding along the lower edge of the upper jaw. At the level of the root of the tongue, it is rotated by 180°. The cuff of the tube tightly closes the victim's mouth, and his nose is pinched with his fingers. Breathing is carried out through the free lumen of the tube.

Cardiopulmonary resuscitation performed by one (a) and two persons (b).

IVL can also be carried out with a face mask with an Ambu bag. The mask is applied to the face of the victim, covering the mouth and nose. The narrow nose of the mask is fixed with the thumb, the lower jaw is lifted up with three fingers (III, IV, V), the second finger fixes the lower part of the mask. At the same time, the head is fixed in a tilted position. Rhythmic compression of the bag with the free hand inhales, passive exhalation is carried out through a special valve into the atmosphere. The bag can be supplied with oxygen.

Stage III-artificial circulation - carried out with the help of heart massage. Compressing the heart allows you to artificially create cardiac output and maintain blood circulation in the body. At the same time, the blood circulation of vital organs is restored: the brain, heart, lungs, liver, kidneys. There are closed (indirect) and open (direct) heart massage.

Indirect cardiac massage

At the pre-hospital stage, as a rule, a closed massage is performed, in which the heart is compressed between the sternum and spine. Manipulation must be carried out by laying the patient on a hard surface or by placing a shield under his chest. The palms are placed one on top of the other at a right angle, placing them on the lower third of the sternum and stepping back from the place of attachment of the xiphoid process to the sternum by 2 cm (Fig. 6). By pressing on the sternum with a force of 8-9 kg, it is displaced to the spine by 4-5 cm. Heart massage is carried out by continuously rhythmic pressure on the sternum with straight arms at a frequency of 60 pressures per minute.

In children under 10 years of age, heart massage is performed with one hand at a frequency of 80 pressures per minute. In newborns, external heart massage is performed with two (II and III) fingers, they are placed parallel to the sagittal plane of the sternum. The frequency of pressure is 120 per minute.

Open (direct) heart massage is used for operations on the chest, its injuries, significant chest rigidity and ineffective external massage. To perform an open heart massage, the chest is opened in the fourth intercostal space on the left. The hand is inserted into the chest cavity, four fingers are brought under the lower surface of the heart, the thumb is placed on its front surface. Massage is carried out by rhythmic contraction of the heart. During operations when the chest is wide open, open heart massage can be performed by squeezing the heart with both hands. In case of cardiac tamponade, the pericardium must be opened.

Resuscitation measures can be carried out by one or two persons (Fig. b). When carrying out resuscitation measures, one person providing assistance stands on the side of the victim. After the diagnosis of cardiac arrest is made, the oral cavity is cleaned, 4 blows into the lungs are performed using the mouth-to-mouth or mouth-to-nose methods. Then sequentially alternate 15 pressures on the sternum with 2 blows into the lungs. When carrying out resuscitation measures, two persons providing assistance stand on one side of the victim. One performs a heart massage, the other - a ventilator. The ratio between mechanical ventilation and closed massage is 1:5, i.e. one blowing into the lungs is carried out every 5 pressures on the sternum. The conductive ventilator controls the correctness of the closed heart massage by the presence of a pulsation on the carotid artery, and also monitors the state of the pupil. The two people conducting resuscitation change periodically. Resuscitation measures in newborns are carried out by one person who performs 3 consecutive blows into the lungs, and then 15 pressures on the sternum.

The effectiveness of resuscitation is judged by the narrowing of the pupil, the appearance of its reaction to light and the presence of a corneal reflex. Therefore, the resuscitator should periodically monitor the state of the pupil. Every 2-3 minutes it is necessary to stop the heart massage in order to determine the "appearance of independent contractions of the heart by the pulse on the carotid artery. When they appear, it is necessary to stop the heart massage and continue mechanical ventilation.

The first two stages of cardiopulmonary resuscitation (restoration of airway patency, artificial lung ventilation) are taught to a wide mass of the population - schoolchildren, students, workers in production. The third stage - closed heart massage - is trained by employees of special services (police, traffic police, fire protection, water rescue services), paramedical personnel.

IV stage- differential diagnosis, medical therapy, cardiac defibrillation - is carried out only by specialist doctors in the intensive care unit or in an intensive care unit. At this stage, such complex manipulations as electrocardiographic examination, intracardiac administration of drugs, defibrillation of the heart are carried out.

Attachment 1.

Indent from edge to text 2cm

Commander of SOOPr "Camelot"

Elistratov P.A.

soldier SOOPr "Camelot"

Ivanova I.I.

Being at the post (where, what date, what time) I noticed (a) a drunken citizen.

I asked (a) to leave the premises, in response I heard (a) scolding. With the help of an operational duty officer, he called a police squad, to whom he handed over the detainee. The violator turned out to be (full name) student (course, group, faculty, educational institution).

Chief of staff (full name)

Date and signature

Indent from edge to text 3cm Indent from edge to text 1.5cm

Indent from edge to text 2cm

Everyone can find themselves in a situation where a person walking nearby loses consciousness. We immediately have a panic that needs to be put aside, because that person needs help.

Every person is obliged to know and apply at least basic resuscitation actions. These include chest compressions and artificial respiration. Most people undoubtedly know what it is, but not everyone will be able to properly help.

In the absence of a pulse and breathing, it is necessary to take immediate action, provide air access and rest of the patient, and also call an ambulance team. We will tell you how and when to perform chest compressions and artificial respiration.

The human heart has four chambers: 2 atria and 2 ventricles. The atria provide blood flow from the vessels to the ventricles. The latter, in turn, carry out the release of blood into the small (from the right ventricle into the vessels of the lungs) and large (from the left - into the aorta and further, to other organs and tissues) circulation circles.

In the pulmonary circulation, gases are exchanged: carbon dioxide leaves the blood into the lungs, and oxygen into it. More precisely, it binds to the hemoglobin of red blood cells.

In the systemic circulation, the reverse process occurs. But, besides it, nutrients come from the blood into the tissues. And the tissues “give away” the products of their metabolism, which are excreted by the kidneys, skin and lungs.

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. ventricular fibrillation, 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 cardiac arrest 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.

In case of circulatory arrest, tissue metabolism and gas exchange stops. In the cells there is an accumulation of metabolic products, and in the blood - carbon dioxide. This leads to a stoppage of metabolism and cell death as a result of "poisoning" by metabolic products and lack of oxygen.

Moreover, the higher the initial metabolism in the cell, the less time is needed for its death due to circulatory arrest. For example, for brain cells, this is 3-4 minutes. Cases of revival after 15 minutes refer to situations when, before cardiac arrest, the person was in a state of cooling.

An indirect heart massage involves squeezing the chest, which must be done to compress the chambers of the heart. At this time, blood through the valves enters the ventricles from the atria, then it is sent to the vessels. Due to rhythmic pressure on the chest, the movement of blood through the vessels does not stop.

This method of resuscitation must be done to activate the heart's own electrical activity, and this helps to restore the independent work of the organ. First aid can bring results in the first 30 minutes after the onset of clinical death. The main thing is to correctly follow the algorithm of actions, follow the approved first aid technique.

Massage in the heart area must be combined with mechanical ventilation. Each punching of the chest of the victim, which must be done by 3-5 cm, provokes the release of about 300-500 ml of air. After the compression stops, the same portion of air is sucked into the lungs. By squeezing / releasing the chest, an active inhalation is performed, then a passive exhalation.

What is direct and indirect heart massage

Cardiac massage is indicated for flutter and cardiac arrest. It can be done:

• open (direct).
• closed (indirect) method.

Direct heart massage is carried out during surgery with an open chest or abdominal cavity, and the chest is also specially opened, often even without anesthesia and observing the rules of asepsis. After the heart is exposed, it is carefully and gently squeezed by the hands in a rhythm of 60-70 times per minute. Direct cardiac massage is performed only in the operating room.

Indirect cardiac massage is much easier and more affordable in any conditions. It is done without opening the chest simultaneously with artificial respiration. By pressing on the sternum, you can move it 3-6 cm towards the spine, squeeze the heart and force the blood out of its cavities into the vessels.

When the pressure on the sternum ceases, the cavities of the heart expand, and blood is sucked into them from the veins. By indirect heart massage, it is possible to maintain pressure in the systemic circulation at the level of 60-80 mm Hg. Art.

The method of indirect heart massage is as follows: the assisting person puts the palm of one hand on the lower third of the sternum, and the other on the back surface of the previously applied hand to increase pressure. On the sternum produce 50-60 pressures per minute in the form of quick shocks.

After each pressure, the hands are quickly taken away from the chest. The period of pressure should be shorter than the period of expansion of the chest. For children, massage is carried out with one hand, and for newborns and children under one year old - with the tips of 1 - 2 fingers.

The effectiveness of heart massage is assessed by the appearance of pulsations in the carotid, femoral and radial arteries, an increase in blood pressure to 60-80 mm Hg. Art., constriction of the pupils, the appearance of their reaction to light, the restoration of breathing.

When and why is heart massage done?

An indirect heart massage is necessary in cases where the heart has stopped. In order for a person not to die, he needs outside help, that is, you need to try to “start” the heart again.

Situations where cardiac arrest is possible:

• Drowning,
• traffic accident,
• electric shock,
• fire damage,
• The result of various diseases,
• Finally, no one is immune from cardiac arrest for unknown reasons.

Cardiac arrest symptoms:

• Loss of consciousness.
• Absence of a pulse (usually it can be felt on the radial or carotid artery, that is, at the wrist and on the neck).
• Absence of breath. The most reliable way to determine this is to hold a mirror up to the victim's nose. If it does not fog up, then there is no breathing.
• Dilated pupils that do not respond to light. If you open your eyes a little and shine a flashlight, it will immediately be clear whether they react to light or not. If a person's heart is working, then the pupils will immediately narrow.
• Gray or blue complexion.

Chest compression (CCM) is a resuscitation procedure that saves many lives every day around the world. The sooner you start doing NMS to the victim, the more chances he has to survive.

NMS includes two methods:

1. mouth-to-mouth artificial respiration, restoring breathing in the victim;
2. compression of the chest, which, together with artificial respiration, forces the blood to move until the victim's heart can again pump it throughout the body.

If a person has a pulse but is not breathing, they need artificial respiration but not chest compressions (a pulse means the heart is beating). If there is no pulse or breathing, both artificial respiration and chest compressions are needed to force air into the lungs and maintain circulation.

Closed heart massage must be performed when the victim has no pupillary reaction to light, breathing, cardiac activity, consciousness. External heart massage is considered to be the simplest method used to restore cardiac activity. It does not require any medical devices to perform.

External cardiac massage is represented by rhythmic squeezing of the heart through compressions performed between the sternum and spine. It is not difficult for victims who are in a state of clinical death to perform chest compressions. This is due to the fact that in this state, muscle tone is lost, and the chest becomes more pliable.

When the victim is in a state of clinical death, the caregiver, following the technique, easily displaces the victim's chest by 3-5 cm. Each contraction of the heart provokes a decrease in its volume, an increase in intracardiac pressure.

Due to the implementation of rhythmic pressures on the chest area, a difference in pressure arises inside the heart cavities that extend from the heart muscle of the blood vessels. Blood from the left ventricle travels down the aorta to the brain, while blood from the right ventricle travels to the lungs, where it is oxygenated.

After the cessation of pressure on the chest, the heart muscle expands, intracardiac pressure decreases, and the heart chambers fill with blood. External heart massage helps to recreate artificial circulation.

Closed heart massage is performed only on a hard surface, soft beds are not suitable. When performing resuscitation, it is necessary to follow this algorithm of actions. After placing the victim on the floor, a precordial punch should be performed.

The blow should be directed to the middle third of the chest, the required height for the blow is 30 cm. To perform a closed heart massage, the paramedic first puts the palm of one hand on the other hand. After that, the specialist begins to perform uniform shocks until signs of restoration of blood circulation appear.

In order for the ongoing resuscitation to bring the desired effect, you need to know, follow the basic rules, which are the following algorithm of actions:

1. The caregiver must determine the location of the xiphoid process.
2. Determination of the compression point, which is located in the center of the axis, of the finger 2 above the xiphoid process.
3. Place the base of the palm on the calculated compression point.
4. Perform compression along the vertical axis, without sudden movements. Compression of the chest should be performed to a depth of 3 - 4 cm, the number of compressions per chest area - 100 / minute.
5. For children under one year old, resuscitation is performed with two fingers (second, third).
6. When performing resuscitation to young children under one year old, the frequency of pressing on the sternum should be 80 - 100 per minute
7. Adolescent children are helped with the palm of one hand.
8. Adults are resuscitated in such a way that the fingers are raised and do not touch the chest area.
9. It is necessary to perform an alternation of two breaths of mechanical ventilation and 15 compressions on the chest area.
10. During resuscitation, it is necessary to monitor the pulse on the carotid artery.

Signs of the effectiveness of resuscitation are the reaction of the pupils, the appearance of a pulse in the carotid artery. The method of conducting an indirect heart massage:

• put the victim on a hard surface, the resuscitator is on the side of the victim;
• rest the palms (not fingers) of one or both straight arms on the lower third of the sternum;
• press the palms rhythmically, in jerks, using the weight of one's own body and the efforts of both hands;
• if during an indirect heart massage a fracture of the ribs occurs, it is necessary to continue the massage by placing the base of the palms on the sternum;
• the pace of massage is 50-60 strokes per minute; in an adult, the amplitude of chest oscillations should be 4-5 cm.

Simultaneously with a heart massage (1 push per second), artificial respiration is performed. For 3-4 pressures on the chest, there is 1 deep exhalation into the mouth or nose of the victim, if there are 2 resuscitators. If there is only one resuscitator, then every 15 pressures on the sternum with an interval of 1 second, 2 artificial breaths are required. The frequency of inspiration is 12-16 times per minute.

For children, massage is performed carefully, with the brush of one hand, and for newborns - only with the fingertips. The frequency of chest compressions in newborns is 100-120 per minute, and the point of application is the lower end of the sternum.

It is also necessary to carefully perform an indirect heart massage for the elderly, since with rough actions, fractures in the chest area are possible.

How to do heart massage in an adult

Stages of implementation:

1. Get ready. Gently shake the casualty by the shoulders and ask, "Is everything all right?" This way you make sure that you are not going to do NMS to a person who is conscious.
2. Quickly check if he has any serious injuries. Focus on the head and neck as you will be manipulating them.
3. Call an ambulance if possible.
4. Lay the victim on their back on a hard, flat surface. But if you suspect a head or neck injury, do not move it. This can increase the risk of paralysis.
5. Provide air access. Kneel near the casualty's shoulder for easy access to the head and chest. Perhaps the muscles that control the tongue relaxed, and he blocked the airways. To restore breathing, you need to release them.
6. If there is no neck injury. Open the victim's airway.

Place the fingers of one hand on his forehead, and the other on the lower jaw near the chin. Gently push your forehead back and pull your jaw up. Keep your mouth open so your teeth are almost touching. Do not place your fingers on the soft tissues under the chin - you may inadvertently block the airway you are trying to clear.

If there is a neck injury. In this case, neck movement can cause paralysis or death. Therefore, you will have to clear the airways in a different way. Kneel behind the victim's head, resting your elbows on the ground.

Curl your index fingers over your jaw near your ears. With a strong movement, lift the jaw up and out. This will open the airway without neck movement.

7. Keep the victim's airway open.

Bend over to his mouth and nose, looking towards his legs. Listen to see if there is a sound from the movement of air, or try to catch it with your cheek, see if the chest is moving.

8. Begin artificial respiration.

If no breath is caught after opening the airway, use the mouth-to-mouth method. Pinch your nostrils with the index finger and thumb of the hand that is on the victim's forehead. Take a deep breath and close your mouth tightly with your lips.

Take two full breaths. After each exhalation, inhale deeply as the victim's chest collapses. It will also prevent swelling of the abdomen. Each breath should last one and a half to two seconds.

9. Check the victim's reaction.

To make sure there is a result, see if the victim's chest rises. If not, move his head and try again. If after that the chest is still motionless, it is possible that a foreign body (for example, dentures) is blocking the airway.

To release them, you need to make pushes in the stomach. Place one hand with the base of the palm on the middle of the abdomen, between the navel and chest. Place your other hand on top and interlace your fingers. Lean forward and make a short sharp push up. Repeat up to five times.

Check your breath. If he is still not breathing, repeat pushing until the foreign body is pushed out of the airway or help arrives. If the foreign body has come out of the mouth but the person is not breathing, their head and neck may be in the wrong position, causing the tongue to block the airway.

In this case, move the victim's head by placing your hand on the forehead and tilting it back. When pregnant and overweight, use chest thrusts instead of abdominal thrusts.

10. Restore circulation.

Keep one hand on the victim's forehead to keep the airway open. With the other hand, check the pulse in the neck by feeling for the carotid artery. To do this, put your index and middle fingers in the hole between the larynx and the muscle following it. Wait 5-10 seconds to feel the pulse.

If there is a pulse, do not squeeze your chest. Continue artificial respiration at a rate of 10-12 breaths per minute (one every 5 seconds). Check your pulse every 2-3 minutes.

11. If there is no pulse, and help has not yet arrived, proceed to squeezing the chest.

Spread your knees for a safe time. Then with the hand that is closer to the victim's legs, feel for the lower edge of the ribs. Move your fingers along the edge to feel where the ribs meet the sternum. Put your middle finger in this place, next to it forefinger.

It should be above the lowest point of the sternum. Place the base of your other hand on your sternum next to your index finger. Remove your fingers and place this hand on top of the other. Fingers should not rest on the chest. If the hands lie correctly, all the effort should be concentrated on the sternum.

This reduces the risk of rib fracture, lung puncture, liver rupture. Elbows tense, arms straight, shoulders directly over the arms - you are ready. Using body weight, press the victim's sternum 4-5 centimeters. You need to press with the bases of the palms.

After each press, release the pressure so that the chest returns to its normal position. This gives the heart a chance to fill with blood. To avoid injury, do not change the position of the hands when pressing. Do 15 clicks at the rate of 80-100 clicks per minute. Count "one-two-three ..." to 15. Click on the count, release for a break.

Alternate compression and artificial respiration. Now take two breaths. Then again find the correct position for the hands and do another 15 clicks. After four complete cycles of 15 compressions and two breaths, check the carotid pulse again. If it's still not there, continue with NMS cycles of 15 compressions and two breaths, starting with a breath.

Watch for reactions. Check your pulse and breathing every 5 minutes. If a pulse is felt but no breathing is heard, take 10-12 breaths per minute and check the pulse again. If there is both a pulse and breathing, check them more closely. Continue NMS until the following happens:

• the victim's pulse and breathing will be restored;
• doctors will arrive;
• You will get tired.

Features of resuscitation in children

In children, the resuscitation technique is different from that in adults. The chest of babies up to a year old is very delicate and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect heart massage is performed not with palms, but with two fingers.

The movement of the chest should be no more than 1.5-2 cm. The frequency of pressing is at least 100 per minute. At the age of 1 to 8 years, massage is done with one palm. The chest should move 2.5–3.5 cm. Massage should be performed at a frequency of about 100 pressures per minute.

The ratio of inhalation to chest compressions in children under 8 years old should be 2/15, in children over 8 years old - 1/15. How to do artificial respiration for a child? For children, artificial respiration can be performed using the mouth-to-mouth technique. Since babies have a small face, an adult can carry out artificial respiration covering both the mouth and nose of the child at once. Then the method is called "from mouth to mouth and nose."

Artificial respiration for children is done at a frequency of 18-24 per minute. 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.

There are contraindications for indirect heart massage:

• penetrating wound to the heart;
• penetrating injury to the lung;
• closed or open traumatic brain injury;
• the absolute absence of a solid 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.

External baby massage

Conducting indirect massage for babies is as follows:

1. Gently shake the baby and say something out loud.

His reaction will allow you to make sure that you are not going to do NMS on a conscious baby. Quickly check for injuries. Focus on the head and neck as you will be manipulating these parts of the body. Call an ambulance.

If possible, ask someone to do this. If you are alone, do NMS for one minute, and only then call the professionals.

2. Clear your airways. If the baby is choking or something is stuck in the airway, then perform 5 chest thrusts.

To do this, place two fingers between his nipples and push quickly, in an upward direction. If you are concerned about a head or neck injury, move your baby as little as possible to reduce the risk of paralysis.

3. Try to get your breath back.

If the infant is unconscious, open his airway by placing one hand on his forehead and gently lift his chin with the other to allow air to enter. Do not apply pressure to the soft tissues under the chin as this may block the airway.

The mouth must be open. Take two mouth-to-mouth breaths. To do this, inhale, tightly close your mouth and nose of the baby with your mouth. Gently exhale some air (the lungs of an infant are smaller than those of an adult). If the chest rises and falls, then the amount of air seems to be appropriate.

If the baby has not started breathing, move his head slightly and try again. If nothing has changed, repeat the airway opening procedure. After removing objects blocking the airways, check breathing and pulse.

Continue with NMS if necessary. Continue artificial respiration with one breath every 3 seconds (20 per minute) if the infant has a pulse.

4. Restore circulation.

Check the pulse on the brachial artery. To find it, feel the inside of the upper arm, above the elbow. If there is a pulse, continue artificial respiration, but do not squeeze the chest.

If the pulse is not felt, begin to squeeze the chest. To determine the position of the baby's heart, draw an imaginary horizontal line between the nipples.

Place three fingers below and perpendicular to this line. Raise your index finger so that two fingers are one finger below the imaginary line. Press them on the sternum so that it drops 1-2.5 cm.

5. Alternate pressing and artificial respiration. After five presses, take one breath. Thus, you can do about 100 clicks and 20 breathing movements. Do not stop NMS until the following happens:
   • the baby will begin to breathe on its own;
   • he will have a pulse;
   • doctors will arrive;
   • You will get tired.

Having laid the patient on his back and throwing his head as far as possible, you should twist the roller and place it under the shoulders. This is necessary in order to fix the position of the body. The roller can be made independently from clothes or towels.

You can do artificial respiration:

• from mouth to mouth;
• from mouth to nose.

The second option is used only if it is impossible to open the jaw due to a spasmodic attack. In this case, you need to press the lower and upper jaws so that the air does not escape through the mouth. You also need to tightly grab your nose and blow in air not abruptly, but vigorously.

When performing the mouth-to-mouth method, one hand should cover the nose, and the other should fix the lower jaw. The mouth should fit snugly against the victim's mouth so that there is no leakage of oxygen.

It is recommended to exhale air through a handkerchief, gauze or a napkin with a hole in the middle of 2-3 cm. And this means that air will enter the stomach.

The person conducting resuscitation of the lungs and heart should take a deep long breath, hold the exhalation and bend over to the victim. Place your mouth tightly against the patient's mouth and exhale. If the mouth is loosely pressed or the nose is not closed, then these actions will not have any effect.

The supply of air through the rescuer's exhalation should last about 1 second, the approximate volume of oxygen is from 1 to 1.5 liters. Only with this volume, lung function can resume.

After that, you need to free the mouth of the victim. In order for a full exhalation to take place, you need to turn his head to the side and slightly raise the shoulder of the opposite side. This takes about 2 seconds.

If pulmonary measures are carried out effectively, then the victim's chest will rise when inhaling. You should also pay attention to the stomach, it should not swell. When air enters the stomach, it is necessary to press under the spoon so that it comes out, as this makes the whole process of revitalization difficult.

Pericardial beat

If clinical death has occurred, a pericardial blow can be applied. It is such a blow that can start the heart, as there will be a sharp and strong effect on the sternum.

To do this, you need to clench your hand into a fist and strike with the edge of your hand in the region of the heart. You can focus on the xiphoid cartilage, the blow should fall 2-3 cm above it. The elbow of the arm that will strike should be directed along the body.

Often this blow brings the victims back to life, provided that it is applied correctly and in a timely manner. The heartbeat and consciousness can instantly be restored. But if this method did not restore function, artificial lung ventilation and chest compressions should be applied immediately.

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

1. When artificial respiration is performed correctly, you can notice the movement of the chest up and down during passive inspiration.
2. If the movement of the chest is weak or delayed, you need to understand the reasons. Probably a loose fit of the mouth to the mouth or to the nose, a shallow breath, a foreign body that prevents air from reaching the lungs.
3. If, when inhaling air, it is not the chest that rises, but the stomach, then this means that the air did not go through the airways, but through the esophagus. In this case, you need to put pressure on the stomach and turn the patient's head to one side, as vomiting is possible.

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

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

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

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

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

How to do a massage correctly To achieve the exceptional effectiveness of an 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 addition to the rules for conducting an indirect heart massage and the specifics of behavior in an emergency, do not forget about personal hygiene measures: you should use disposable napkins or gauze during artificial respiration (if any).

The phrase “saving lives is in our hands” in cases of need to immediately perform an indirect heart massage on an injured person who is on the verge of life and death takes on a direct meaning.

When carrying out this procedure, everything is important: the position of the victim and, in particular, his individual parts of the body, the position of the person performing indirect heart massage, clarity, regularity, the timeliness of his actions and absolute confidence in a positive outcome.

When to stop CPR?

It should be noted that cardiopulmonary resuscitation should be continued until the arrival of the medical team. But if the heartbeat and lung function have not recovered within 15 minutes of resuscitation, then they can be stopped. Namely:

• when there is no pulse in the carotid artery in the neck;
• breathing is not performed;
• pupil dilation;
• skin is pale or bluish.

And of course, cardiopulmonary resuscitation is not performed if a person has an incurable disease, for example, oncology.

Rules for conducting artificial respiration.

If the victim does not breathe at all or, being in an unconscious state, breathes rarely and convulsively, with a sob, but his pulse is felt, you should immediately send for a doctor, and before he arrives, do artificial respiration.

Before this, it is necessary to quickly unbutton the victim’s clothing that restricts breathing (tie, belt), but you should not undress him, as this is useless and time-consuming, and the probability of success is the less, the later artificial respiration is started (if it is started 5 minutes after once the victim has stopped breathing, there is little hope of recovery). It is necessary to open the victim's mouth and remove everything that may interfere with breathing (for example, displaced dentures), i.e. ensure the patency of the upper respiratory tract.

The most effective method of artificial respiration is the method " mouth to mouth" or " mouth to nose"- this is the blowing of air from the mouth of the rescuer into the mouth or nose of the victim.

This method of artificial respiration makes it easy to control the flow of air into the lungs of the victim by expanding the chest after inhalation and its subsequent subsidence as a result of passive exhalation.

To carry out artificial respiration, the victim should be laid on his back, unfasten clothing that restricts breathing, put something soft under the shoulder blades, and lightly press on the head so that it leans back as much as possible (Fig. 5.3).

Rice. 5.3. The position of the head of the victim during artificial respiration

In this case, the root of the tongue rises and frees the entrance to the larynx, and the victim's mouth opens. In this case, the tongue does not block the passage of air into the throat. Next, pinch the nose of the victim, and taking a deep breath, sharply exhale the air into the mouth of the victim (Fig. 5.4).

Rice. 5.4. Performing artificial respiration

Air blowing can be done through a dry handkerchief, gauze, a special device - "air duct". If the victim has a well-determined pulse and only artificial respiration is needed, then the interval between artificial breaths should be 5 s (12 respiratory cycles per minute). During these 5 seconds, the victim exhales; the air comes out by itself. You can facilitate the exit by lightly pressing on the chest.

For children, air is blown less sharply than for adults, in a smaller volume and more often up to 15-18 times per minute.

Artificial respiration is stopped after the victim recovers rhythmic independent breathing.

Rules for conducting an indirect heart massage.

If the victim’s pulse is not felt even on the neck, then a heart massage is performed, pressing on the lower third of the victim’s chest (but not “under the spoon”) with quick sharp jerks of the rescuer’s palms laid one on top of the other (Fig. 5.5).

Rice. 5.5. The position of the person assisting during external heart massage

Pressing should be done in quick bursts, so as to displace the sternum by 4-5 cm, the duration of pressure is not more than 0.5 s, the interval between individual pressures is 0.5 s. Each pressure compresses the heart and drives blood through the circulatory system. For 1 minute it is necessary to make at least 60 pressures.

For children under 12 years of age, pressure is done with one hand and more often 70 ... 100 per minute, depending on age. Children up to a year - with two fingers 100 ... 120 times per minute. Every 2 minutes, it is recommended to check for 2-3 seconds to see if a pulse has appeared.

6. Fire safety

Fire resistance of building structures

In terms of flammability, building structures are divided into fireproof, flame retardant and combustible.

Fireproof are building structures made of non-combustible materials.

flame retardant constructions made of slow-burning materials or combustible materials protected from fire and high temperatures by fireproof materials are considered (for example, a fire door made of wood and covered with asbestos sheet and roofing steel).

Under fire resistance building structures, it is customary to imply their ability to perform operational functions for a certain period of time, while maintaining a given load-bearing capacity (no collapse) and the ability to protect from combustion products and flames under fire conditions.

The fire resistance of a building structure is assessed fire resistance limit, representing the time in hours from the start of testing the structure according to the standard temperature-time regime until one of the following signs appears:

- the formation of through cracks or holes in the design sample through which combustion products or flames penetrate;

- an increase in the average temperature at the measurement points on the unheated surface of the structure by more than 160 °C, or at any point on this surface by more than 190 °C compared to the temperature of the structure before the test, or by 220 °C, regardless of the initial surface temperature; deformation and collapse of the structure, loss of bearing capacity.