Artificial respiration and chest compressions. Artificial respiration methods: sequence of actions

Artificial respiration is performed when

The victim is not breathing;

The victim breathes very badly (rarely, convulsively, with a sob):

The victim's breathing keeps getting worse.

The most effective method of artificial respiration is the "mouth-to-mouth" or "mouth-to-nose" method, since this ensures that a sufficient volume of air enters the victim's lungs.

Air is blown through gauze, a clean handkerchief, etc. or "air duct".

To perform artificial respiration:

1) Lay the victim on his back, unfasten clothing that restricts breathing.

2) Ensure the patency of the upper respiratory tract (clean the mouth, pull out the tongue, which may be sunken).

3) The person assisting is located on the side of the victim's head.

4) Put one hand under the neck of the victim, and with the palm of the other hand press on his forehead, tilting his head as far as possible (the root of the tongue rises, it is released into the larynx, the mouth opens).

5) Bend over to the face of the victim, take a deep breath with an open mouth.

6) Fully tightly cover the open mouth of the victim with your lips and exhale vigorously, blowing air into the victim’s mouth (at the same time close his nose with his cheek or fingers of the hand located on the forehead),

7) Observe the chest of the victim:

As soon as she has risen, stop blowing air, turn her face towards the person providing assistance; there is a passive expiration of the victim;

When air enters the stomach, bloating occurs “under the spoon”, you must carefully press the palm of your hand on the stomach between the sternum and navel (if vomiting occurs, turn the head and shoulders of the victim to one side and clear the mouth);

If, after blowing in air, the chest does not straighten out, it is necessary to push the victim's lower jaw forward so that the lower teeth stand in front of the upper ones.

8) Observe the interval between artificial breaths, which should be 5 seconds (12 respiratory cycles per minute).

Artificial respiration is stopped after the victim recovers deep and rhythmic spontaneous breathing.

At the workplace, artificial respiration can be carried out in the victim's sitting position (for example, in a cradle) or in an upright position (fastened when descending from a height, etc.).

Resuscitation measures - the combination of artificial respiration with indirect heart massage allows you to simulate the functions of respiration and blood circulation.

If the revival is carried out by one person, then 2 breaths of artificial respiration are done after 15 pressures on the sternum. The rate of resuscitation must be high. For 1 minute, you need to do 60 pressures and 12 blows.

If the revival is carried out by two people, then 2 breaths of artificial respiration are done after 5 pressures on the sternum.

During artificial inhalation of the victim, the one who massages the heart does not apply pressure, because the forces developed with pressure are much greater than with inhalation, which leads to the ineffectiveness of artificial respiration, and, consequently, to resuscitation measures.

TICKET #5

Safety briefing, types of briefing.

According to the nature and timing of the briefings are divided into:

Introductory- conducted with all newly hired, regardless of their education and length of service. It is carried out by a labor protection engineer or a person who is assigned these duties by order. An entry is made in the registration log about the briefing with the obligatory signature of the instructed and the instructing person;

Initial on-the-job training- carried out before the start of production activities with each employee individually with a practical demonstration of safe working methods and methods. Possible with a group of people serving the same type of equipment, and within a common workplace. Conducted by the master or immediate supervisor. An entry is made in the registration log about the briefing with the obligatory signature of the instructed and the instructing person;

Re-briefing- all workers pass, regardless of qualifications, education, length of service, at least once every six months. An entry is made in the registration log about the briefing with the obligatory signature of the instructed and the instructing person;

unscheduled- carried out individually or with a group of workers of the same profession:

With the introduction of new standards, rules, instructions, new or revised labor protection. ;

When changing the technological process, replacing equipment. Raw materials, materials, and other factors affecting labor safety;

In case of violation by employees of labor safety requirements, which can lead or have led to injury, accident or fire;

At the request of the supervisory authorities;

For breaks in work - 60 days, and for special work (increased labor safety requirements) - more than 30 days.

An entry is made in the registration log about the briefing with the obligatory signature of the instructed and the instructing person.

Target- carry out:

When performing one-time work that is not related to direct duties in the specialty (cleaning the territory, loading, etc.);

When eliminating the consequences of accidents, natural disasters;

In the performance of work for which a work permit, permit and other documents are issued.

An entry is made in the registration log about the briefing with the obligatory signature of the instructed and instructing

Primary briefing at the workplace, repeated, unscheduled and targeted is carried out by the immediate supervisor of the work.

The previously used artificial respiration (artificial ventilation of the lungs) by means of bending the arms and legs of the victim is no longer used. There is a more effective method of restoring breathing - "mouth to mouth" and "mouth to nose".

Before starting artificial respiration, it is necessary to make sure that the upper respiratory tract of the victim is patent. To do this, the head of the victim is thrown back, since in this position the airways are better opened. To avoid retraction of the tongue, the lower jaw of the victim is pushed forward.

If the jaws are tightly compressed, then they must be carefully pushed apart with some flat (not sharp!) Object and a roller made of any clean cloth should be placed between the teeth, and preferably a bandage (if any). After that, with a finger wrapped in a bandage, gauze, a clean handkerchief or a clean cloth, quickly examine the oral cavity and free it from vomit, mucus, blood, sand, algae, etc.

If the victim has removable dentures, they must be removed. After that, unfasten, which can impede breathing and blood circulation. The entire preparatory part must be done very quickly, but carefully and carefully, since the severe, sometimes critical condition of the victim can be worsened even more. After the upper respiratory tract is cleared, the victim should be quickly and carefully laid with his back on a flat, flat surface, and arms stretched along the body. Then the head of the victim is thrown back. With one hand, pull the lower jaw forward and down, and pinch the nose with the fingers of the other hand.

It is necessary to ensure that the tongue of the victim does not sink and does not block the airways. In case of tongue sticking, it is necessary to stretch it out and hold it with your fingers or pin (you can even sew) the tip of the tongue to the clothes. The one who provides assistance stands on either side of the victim. Then he takes a maximum breath and, leaning towards the victim, tightly presses his lips to his open mouth, making maximum exhalation at this moment, making sure that when air enters the respiratory tract and lungs, the victim's chest expands as much as possible.

After straightening the chest, it is necessary to take the mouth away from the lips and stop squeezing the nose of the victim. At this point, the air itself should come out of his lungs, simulating exhalation. Such breaths should be taken every 3-4 seconds. The intervals between breaths and the depth of each breath should be the same.

In case of trauma to the tongue, jaw or lips, another method is used - “mouth to nose”. The technique for carrying out this method is the same as in the first case, only the mouth of the victim must be tightly closed. Air is blown from the mouth of the resuscitator into both nostrils of the victim.

If you start to do artificial respiration as soon as possible after stopping breathing, then it often leads to success. The first independent breath is not always expressed quite clearly and can be seen only by a weak rhythmic contraction of the neck muscles, resembling a swallowing movement. After that, the respiratory movements become more pronounced, increase, but can occur at large intervals and be convulsive in nature.

Closed heart massage.

Heart massage is an artificial compression of its cavities, which helps push blood into the bloodstream and irritates the nervous apparatus of the heart muscle. As a rule, it is carried out with a sudden cardiac arrest (with shock, lightning, falling into an avalanche, etc.). When the victim is in a state of death, his chest becomes more mobile as a result of a decrease in muscle tone.

And since the heart is located between the sternum and the spine, when you press the chest, it can be compressed so much that the blood from its cavities is squeezed into the vessels, and when the compression stops, the heart straightens again, and a new portion of blood from the veins enters it. By repeating sharp and strong pressure on the front of the chest, you can artificially maintain blood circulation in the vessels.

The first signs of cardiac arrest.

- Severe bluishness or pallor.
- The pulse on the radial and carotid arteries is not felt.
- When listening with the ear, the work of the heart is not audible.

The technique for conducting a closed heart massage is as follows. The victim is laid on his back on a hard flat surface. The one who will provide assistance stands on the left and puts the palm of one hand on the lower chest of the victim, and puts the palm of the second hand on it. Then, with energetic jerky movements of the arms extended at the elbow joints, the resuscitator presses on the sternum. After each pressure, the hands must be raised from the chest, giving it the opportunity to straighten out so that the cavities of the heart are filled with blood. About 60 pressures should be performed per minute.

Signs of cardiac recovery.

- The appearance of an independent pulse on the carotid or radial arteries.
- Reducing the pallor or cyanosis of the skin.

Resuscitation and timing of its implementation in emergency situations.

The success of resuscitation depends on the time of its start after the accident, the correctness and quality of artificial respiration and closed heart massage, or a combination of both. But the combination of these two techniques when returning the victim to life is possible only if at least two people provide assistance. Alone, although it is possible, it is very difficult and ineffective.

When assisting together, one of them does a heart massage, and the other at the same time - artificial respiration. In this case, blowing into the mouth or nose of the victim should be done every four pushes on his sternum. If assistance is provided by one person, then the sequence of resuscitation techniques and their mode change - every two fast air injections into the lungs, 10-12 chest compressions are performed with an interval of 1 second.

As soon as cardiac activity becomes stable (a pulse begins to be felt and a heartbeat is heard), artificial respiration is continued until it is completely independent. In the absence of heart contractions, artificial respiration and heart massage are carried out for 60 to 90 minutes, but if neither one nor the other appears during this period, then resuscitation can be stopped.

Obvious signs of biological death.

- Clouding of the cornea and its drying.
- When squeezing the eye with fingers from the sides, the pupil narrows and resembles a cat's eye.

Based on the book "Encyclopedia of Survival".
Chernysh I.V.

There are so many situations in life that a person can influence and change the outcome for the better. But sometimes people simply do not have enough basic skills to help the victims. Therefore, it never hurts to learn how to act when a bystander or family member has stopped breathing. Any person can provide first aid to a patient, observing elementary rules and following clear instructions. Violation of the respiratory process can be caused by a foreign body entering the mouth or trachea or by the tongue falling into the mouth.

When is ventilation done?

The procedure for saving a person should begin with determining the source of the problem. Ventilation of the lungs should be done in the following cases:

If there is a cardiac arrest. To restore breathing, it is necessary to perform an indirect heart massage.
There was a retraction of the tongue (a person is without creation). While lying down, the muscles of the tongue and pharynx relax, because of this, the root of the tongue can move and close the entrance to the trachea. At the same time, respiratory movements are present, but the noise cannot be heard. In this case, it would be appropriate to tilt the head back, which will allow the entrance to be released and air to enter the trachea. In order for the mouth to open, the hand of the person providing assistance should be under the neck of the person and pressure is applied to the forehead with the other hand.
If a foreign body has got into the organs that provide the passage of air (it can be a particle of water, food, dirt, as well as blood and other objects). Symptoms of this problem are weak breathing movements, cyanotic knees and lips, frequent pulse (110 or more beats per minute), noisy convulsive inhalation, exhalation with the sound of hoarseness.

Having determined the reason for stopping (difficulty) breathing, first aid is required for the victim. But for this you need to create comfortable conditions for the victim.

Methods of lung ventilation

The breathing recovery procedure should be carried out until a positive result occurs. First you need to remove clothes from the victim, which can squeeze the chest area, then you should provide an open mouth and unclench your clenched teeth.

There are three ways to perform ventilation:

To apply this method, the victim must lie with his back up, one arm is under his head, the second is extended along the body, his face is turned to the side. The performer of artificial respiration should position himself so that the patient's thighs are between his knees. At the same time, the palms are on the back of the victim, and the fingers wrap around him from the sides. Leaning forward, the person leans on outstretched arms and leans back, exhaling-inhaling.
To apply the second method, the victim is placed with his back to the surface and in the area of the shoulder blades he places a bundle with clothes, this allows the patient's head to be thrown back. The mouth should be cleaned and the tongue extended. During the procedure, the tongue is slightly pulled down to the chin. To exhale, you need to take the hands of the victim at the elbows and press them to the side of the chest. To inhale, raise your arms and throw them behind your head.
The mouth-to-mouth method is the most common and effective way to restore the victim's breathing. Before starting the procedure, the person should be on his back with his head thrown back (the chin and neck should be on the same line). The victim's mouth must be cleared of mucus. Air enters through the mouth of the person providing assistance, while the victim's nose must be pinched. It is necessary to make 10-12 injections per minute.

Before giving first aid to the victim, you need to call an ambulance. By the time she arrives, you can save someone's life.

Each of us is not immune from the situation when a loved one or just a passerby receives an electric shock, heat stroke, which leads to respiratory arrest, and often to the cessation of the heart. In such a situation, a person's life will depend only on the instant reaction and assistance provided. Schoolchildren should already know what artificial heart massage is and with which you can bring the victim back to life. Let's figure out what these tricks are and how to properly apply them.

Reasons for stopping breathing

Before dealing with first aid, it is necessary to find out in what situations breathing can stop. The main reasons for this condition include:

suffocation, which is the result of inhaling carbon monoxide or attempting suicide by hanging;
drowning;
electric shock;
severe cases of poisoning.

These reasons are the most common in medical practice. But you can name others - in life, what just does not happen!

Why is it necessary

Of all the organs in the human body, the brain needs oxygen the most. Without it, after about 5-6 minutes, cell death begins, which will lead to irreversible consequences.

If first aid, artificial respiration and heart massage are not provided in a timely manner, then a person who has returned to life can no longer be called a full-fledged person. The death of brain cells will subsequently lead to the fact that this organ will no longer be able to work as before. A person can turn into a completely helpless creature that will require constant care. It is for this reason that the quick reaction of others who are ready to provide first aid to the victim is very important.

Features of adult resuscitation

How to do artificial respiration and heart massage is taught at a secondary school in biology lessons. Only most people are sure that they will never get into such a situation, so they don’t really delve into the intricacies of such manipulations.

Finding themselves in such a situation, many are lost, unable to orient themselves, and precious time is running out. Resuscitation of adults and children has its own differences. And they are worth knowing. Here are some features of resuscitation in adults:

When all these factors are taken into account, you can proceed to resuscitation, if necessary.

Actions before artificial respiration

Quite often, a person loses consciousness, but breathing is preserved. In such a situation, it must be taken into account that in an unconscious state, all the muscles of the body relax. This also applies to the tongue, which, under the influence of gravity, slides down and can close the larynx, which will lead to suffocation.

The first step when you find an unconscious person is to take steps to ensure the free flow of air through the larynx. You can put a person on his side or throw his head back and open his mouth by pressing on the lower jaw. In this position, there will be no danger that the tongue will completely clog the larynx.

After that, it is necessary to check whether spontaneous breathing has resumed. Almost all of the films or biology lessons know that for this it is enough to bring a mirror to your mouth or nose - if it is fogged up, then the person is breathing. In the absence of a mirror, you can use the phone screen.

It is important to remember that while all these checks are being made, the lower jaw must be supported.

If the victim is not breathing due to drowning, suffocation with a rope or a foreign body, an urgent need to remove a foreign object and clean the oral cavity if necessary.

If all the procedures are carried out, and breathing has not recovered, it is necessary to immediately perform artificial respiration, heart massage, if it has stopped working.

Rules for performing artificial respiration

If all the causes that caused the respiratory arrest are eliminated, but it has not recovered, then it is urgently necessary to start resuscitation. Artificial respiration can be carried out by different methods:

inhalation of air into the mouth of the victim;
blowing into the nose.

The first method is most often used. Unfortunately, not everyone knows how to do artificial respiration and heart massage. The rules are quite simple, you just need to follow them exactly:

If the victim, after all the efforts, does not come to his senses and does not begin to breathe on his own, then you will have to urgently do a closed heart massage and artificial respiration at the same time.

Artificial respiration technique " mouth in nose»

This method of resuscitation is considered the most effective, as it reduces the risk of air entering the stomach. The procedure for this is as follows:

Most often, if all manipulations are performed correctly and in a timely manner, it is possible to bring the victim back to life.

The effect of heart muscle massage

Most often, artificial heart massage and artificial respiration are combined in first aid. Almost everyone imagines how such manipulations are carried out, but not everyone knows what their meaning is.

The heart in the human body is a pump that vigorously and constantly pumps blood, while supplying oxygen and nutrients to cells and tissues. When performing an indirect massage, pressure is applied to the chest, and the heart begins to contract and push blood into the vessels. When the pressure stops, the myocardial chambers expand and venous blood enters the atria.

Thus, blood flows through the body, which carries everything the brain needs.

Algorithm for conducting cardiac resuscitation

In order for cardiac resuscitation to be more effective, it is necessary to lay the victim on a hard surface. In addition, you will have to unbutton your shirt and other clothes. The belt on trousers for men must also be removed.

the point is located at the intersection of the inter-nipple line and the middle of the sternum;
it is necessary to retreat from the chest by the thickness of two fingers to the head - this will be the desired point.

After determining the desired pressure point, you can proceed to resuscitation.

Technique of heart massage and artificial respiration

The sequence of actions during resuscitation manipulations should be as follows:

It must be taken into account that artificial respiration and chest compressions require considerable effort, so it is advisable that there is someone else nearby who can take over and provide assistance.

Features of helping children

Resuscitation measures in young children have their own differences. The sequence of artificial respiration and heart massage in babies is the same, but there are some nuances:

Signs of Effective Help

When performing, you need to know the signs by which you can judge its success. If artificial respiration and external heart massage are performed correctly, then most likely, after a while, the following signs can be observed:

there is a pupillary reaction to light;
the skin becomes pinkish;
a pulse is felt on the peripheral arteries;
the victim begins to breathe on his own and regains consciousness.

If artificial heart massage and artificial respiration do not give a result within half an hour, then resuscitation is ineffective and must be stopped. It should be noted that the earlier cardiopulmonary resuscitation is started, the more effective it will be in the absence of contraindications.

Contraindications for resuscitation

Artificial heart massage and artificial respiration aim to return a person to a full life, and not just delay the time of death. Therefore, there are situations when such resuscitation is pointless:

The rules of artificial respiration and suggest that resuscitation is started immediately after the detection of cardiac arrest. Only in this case, if there are no contraindications, we can hope that the person will return to a full life.

We figured out how to do artificial respiration and heart massage. The rules are quite simple and clear. Don't be afraid that you won't succeed. Here are some tips to help save a life:

If something does not work out with artificial respiration, then you can and should continue to do heart massage.
In most adults, breathing stops due to the cessation of the myocardium, so massage is more important than artificial respiration.
Do not be afraid that as a result of excessive pressure, you will break the victim's ribs. Such an injury is not fatal, but a person's life will be saved.

Each of us may need such skills at the most unexpected moment, and it is very important in such a situation not to get confused and do everything possible, because life often depends on the correctness and timeliness of actions.

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.

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:

Asystole of the ventricles.
Paroxysmal tachycardia.
ventricular fibrillation, etc.

Predisposing factors include:

Smoking.
Age.
Alcohol abuse.
Genetic.
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 from electric shock.

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

Consciousness is lost.
Rare convulsive sighs appear.
There is a sharp pallor on the face.
In the region of the carotid arteries, the pulse disappears.
Breathing stops.
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:

The person comes to consciousness.
A pulse appears.
Decreases pallor and blueness.
Breathing resumes.
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 cardiac 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 technique 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:

mouth-to-mouth artificial respiration, restoring breathing in the victim;
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 equipment 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 person assisting, 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 places 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:

The caregiver must determine the location of the xiphoid process.
Determination of the compression point, which is located in the center of the axis, of the finger 2 above the xiphoid process.
Place the base of the palm on the calculated compression point.
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.
For children under one year old, resuscitation is performed with two fingers (second, third).
When performing resuscitation to young children under one year old, the frequency of pressing on the sternum should be 80 - 100 per minute
Adolescent children are helped with the palm of one hand.
Adults are resuscitated in such a way that the fingers are raised and do not touch the chest area.
It is necessary to perform an alternation of two breaths of mechanical ventilation and 15 compressions on the chest area.
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:

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.
Quickly check if he has any serious injuries. Focus on the head and neck as you will be manipulating them.
Call an ambulance if possible.
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.
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.
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.

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.

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.

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.

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 compress 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.

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 under one 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 done 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:

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.

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.

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.

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.

Alternate pressing and artificial respiration. After five clicks, take one breath. Thus, you can do about 100 clicks and 20 breathing movements. Do not stop NMS until the following occurs:
- 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 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:

When artificial respiration is performed correctly, you can notice the movement of the chest up and down during passive inspiration.
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.
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:

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

You need to perform 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:

Act confidently and calmly, do not fuss.
In view of self-doubt, do not leave the victim in danger, namely, it is imperative to carry out resuscitation measures.
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.
Do not tilt the victim's head back excessively, as this can lead to obstruction of the free flow of air into the lungs.
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 wipes 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.