Rules for external (indirect) cardiac massage. What indicates the effectiveness of chest compressions?
Heart massage – mechanical impact on the heart after it has stopped in order to restore its activity, as well as to maintain continuous blood flow until the heart resumes functioning.
Indications for cardiac massage are all cases of cardiac arrest. The heart may stop beating various reasons: spasm coronary vessels, acute heart failure, myocardial infarction, severe trauma, lightning or electric shock etc.
Signs of cardiac arrest:
1. No pulse on carotid arteries.
2. The pupils are dilated and do not react to light.
3. There is no breathing or the appearance of rare, convulsive breaths.
4. There is no consciousness.
5. The skin is pale.
6. Blood pressure is not determined.
7. Heart sounds cannot be heard.
If these signs are present, resuscitation should begin immediately.
There are two main types of heart massage: indirect, or external (closed), and direct, or internal (open).
Indirect cardiac massage is based on the fact that when pressing on the chest from front to back, the heart, located between the sternum and the spine, is compressed so much that blood from its cavities enters the vessels. After the pressure stops, the heart straightens and venous blood enters its cavity.
In case of cardiac arrest, chest compressions should be started as soon as possible. The most effective cardiac massage is started immediately (no more than 1 minute) after cardiac arrest.
First, the victim is given a short blow with the edge of the palm (clenched into a fist) from a distance of 20-30 cm on the sternum (the bone located in the middle of the chest in front). If after 5 seconds the pulse does not recover, you should begin chest compressions.
Efficiency indirect massage heart is provided the right choice the place of application of force to the victim’s chest (the lower half of the sternum immediately above the xiphoid process).
The massager’s hands must be correctly positioned: the proximal part of the palm of one hand is placed on the lower half of the sternum, strictly on its midline and 2 fingers above the xiphoid process, and the palm of the other is placed on the back of the first, perpendicular to its axis; the fingers of the first hand should be slightly raised and not put pressure on chest the victim. The arms should be straight at the elbow joints.
The person performing the massage should stand quite high (sometimes on a chair, stool, stand, if the patient is lying on a high bed or on operating table), as if hanging with your body over the victim and putting pressure on the sternum not only with the force of your hands, but also with the weight of your body.
The pressing force should be sufficient to move the sternum towards the spine by 4-6 cm.
The pace of the massage should be such as to provide at least 60 heart compressions per minute (80 compressions per minute are recommended).
Performing CPR
When conducting two-person resuscitation the massager compresses the chest 5 times with a frequency of approximately 1 time per 1 second, after which the second person providing assistance makes one energetic and quick exhalation from the mouth to the victim’s mouth or nose. 12 such cycles are carried out in 1 minute.
If one person performs resuscitation, then he is forced to perform chest compressions at a more frequent rhythm - approximately 15 heart compressions in 12 seconds, then 2 vigorous blows of air into the lungs in 3 seconds. 4 such cycles are performed in 1 minute, resulting in 60 heart compressions and 8 breaths.
When hit large quantity air not into the lungs, but into the stomach, the swelling of the latter will make it difficult to save the patient. Therefore, it is advisable to periodically empty his stomach of air by pressing on the epigastric (epigastric) region (Fig. 3.10).
It should be remembered that rough external cardiac massage can lead to severe complications– rib fractures with damage to the lungs and heart. At strong pressure rupture of the stomach and liver may occur on the xiphoid process of the sternum. Particular care should be taken when performing massage on children and the elderly.
Efficiency resuscitation measures determined by five criteria:
1. The appearance of pulsation in the carotid, femoral and radial arteries in time with the massage.
2. Promotion blood pressure up to 60-80 mm Hg. Art.
3. Constriction of the pupils and the appearance of their reaction to light.
4. Disappearance of bluish coloration and “deadly” pallor
5. The appearance of independent breaths.
If after 30-40 minutes from the start of cardiac massage, artificial respiration and drug therapy cardiac activity is not restored, the pupils remain wide, there is no reaction to light, we can assume that the body has developed irreversible changes It is advisable to stop both brain death and resuscitation. When obvious signs death, resuscitation may be stopped earlier.
For some serious illnesses And traumatic injuries (malignant tumors with metastases, severe skull injury with crushing of the brain) resuscitation will not make sense and should not be started. In other cases sudden death There is always hope for the patient to be revived, and for this purpose all possible measures must be taken.
Transportation of a patient with respiratory and cardiac arrest can be carried out only after restoration of cardiac activity and breathing or in a specialized ambulance, in which resuscitation measures can be continued.
It should be remembered that resuscitation must be carried out immediately after the cessation of breathing and cardiac activity. Resuscitation in more late dates(later than 5 minutes) breathing and cardiac activity can be restored, but normal brain activity will not resume.
conclusions
1. When a person enters a state clinical death to revive it, a complex is being carried out medical events aimed at restoring lost or fading vital important functions body, called resuscitation. Within the framework of PMP, cardiopulmonary resuscitation is carried out - restoration of breathing and cardiac activity. The sequence of cardiopulmonary resuscitation follows the “ABC rule”: A – restore airway patency; B – start ventilation of the lungs; C – start cardiac massage.
2. To ensure the effectiveness of cardiopulmonary resuscitation, its activities must be carried out on the basis of compliance with certain rules. When resuscitation is carried out by two persons, one compresses the chest 5 times with a frequency of approximately 1 time per 1 second, after which the second person providing assistance blows air into the victim’s lungs once. 12 such cycles are carried out in 1 minute. If one person performs resuscitation, then first he performs approximately 15 heart compressions in 12 seconds, then in 3 seconds he performs 2 air injections into the victim’s lungs. 4 such cycles are performed in 1 minute.
3. It is necessary to constantly monitor the effectiveness of resuscitation measures. Resuscitation is effective if the patient’s skin and mucous membranes turn pink, the pupils constrict and a reaction to light appears, spontaneous breathing resumes or improves, and a pulse appears in the carotid artery.
Control questions.
1. What is resuscitation? What are its components? Where are resuscitation activities carried out?
4. Describe general order performing artificial pulmonary ventilation.
5. What is the frequency respiratory cycles when performing artificial ventilation of the lungs in the presence of the victim’s own heartbeat?
6. How long is it carried out? artificial ventilation lungs? What are the main signs of cardiac arrest?
7. List possible reasons cardiac arrest. What is cardiac massage?
8. Why does indirect cardiac massage cause blood circulation in the vessels?
9. What is appropriate and time limit starting artificial heart massage after stopping it?
10. Describe the position of the hands of the person performing artificial cardiac massage.
11. By what indicator is the required force of pressure on the ore cell of the person being reanimated determined?
12. What is the frequency of compressions (minimum, recommended) on the chest of the person being resuscitated when performing chest compressions and the victim is breathing on their own?
13. With what frequency and in what sequence are indirect cardiac massage and artificial ventilation performed during resuscitation by two rescuers? one rescuer?
14. By what signs is the effectiveness of resuscitation measures determined? Under what conditions should resuscitation measures carried out as part of first aid be considered ineffective and discontinued?
15. Name possible cases in which resuscitation measures should be considered meaningless.
Cardiac massage is a mechanical effect on the heart after it has stopped in order to restore its activity and maintain continuous blood flow until the heart resumes functioning.
Signs of sudden cardiac arrest are:
Sharp pallor
Loss of consciousness,
Disappearance of the pulse in the carotid arteries, cessation of breathing or the appearance of rare convulsive breaths (agonal breathing),
Pupil dilation.
The heart is located between the posterior surface of the sternum and the anterior surface of the spine, i.e. between two hard surfaces. By reducing the space between them, you can compress the heart area and cause artificial systole. In this case, blood from the heart is ejected into the large arteries of the systemic and pulmonary circulation. If the pressure is stopped, the compression of the heart stops and blood is sucked into it. This is artificial diastole. The rhythmic alternation of chest compressions and cessation of pressure replaces cardiac activity, which ensures the necessary blood circulation in the body. This is the so-called indirect cardiac massage - the most common method of resuscitation, carried out simultaneously with mechanical ventilation.
Indications for cardiac massage are all cases of cardiac arrest.
ACTION ALGORITHM:
1. Lay the victim on his back on a hard base.
2. Stand to the left of the victim and place your palms on the lower third of the sternum, 2 transverse fingers above the xiphoid process.
Place the palm of one hand perpendicular to the axis of the sternum, the palm of the other hand on the back surface perpendicular to the first.
3. Bring both hands to the position of maximum extension; fingers should not touch the chest. fingers,
located below should be directed upward (towards the head).
4. Using the whole body with the help of your hands (your hands should remain straight during the massage), push and rhythmically press on the
the sternum so that it bends by 4-5 cm. In the position of maximum deflection, it must be held for a little less than 1 second. Then
Stop pressing, but do not lift your palms from the sternum.
REMEMBER! The number of compressions on the sternum should be an average of 70 per minute.
Criterion for the effectiveness of indirect cardiac massage
1.Color change skin(they become less pale, gray, cyanotic)
2. Constriction of the pupils with the appearance of a reaction to light
3. Appearance of pulse in large arteries (carotid, femoral)
4. Appearance of blood pressure at the level of 60-8 mm Hg.
5. Subsequent restoration of spontaneous breathing.
Complications of chest compressions
Fracture of the ribs and sternum with injury to the heart, lung and pleura, development of pneumo- and hemothorax.
REMEMBER! CPR must be started immediately in any setting where respiratory and cardiac arrest occurs. The main condition for successful revival is the correct combination of free airway, mechanical ventilation and cardiac massage. Only joint use 3 stages ensures sufficient oxygen supply to the blood and its delivery to organs, primarily to the brain.
INTRODUCTION
Indirect cardiac massage modern ideas plays a primary role in resuscitation, so cardiopulmonary resuscitation in adults begins with chest compressions, and not with artificial respiration, as was previously the case.
Legal regulation of the relationship between man and society at all times could not bypass the sphere of protecting the health of citizens and medical activities. However, the right to health protection and accessible medical care has only relatively recently begun to be provided for in the legislation of various countries.
In 1948, this right was declared internationally in the Universal Declaration of Human Rights.
Despite the obvious importance in life modern society legal regulation protecting the health of citizens, in Russian Federation Legislative support for human rights to health before 1990 was very limited and was limited to the “Fundamentals of Legislation of the USSR and Union Republics on Health Care” (1961) and the RSFSR Law “On Health Care” (1971), adopted in accordance with the above principles.
TECHNIQUE OF INDIRECT HEART MASSAGE AND ARTIFICIAL VENTILATION. SIGNS OF EFFECTIVENESS OF RESUSCITATION MEASURES. LEGAL ASPECTS OF CERTIFICATION OF DEATH
To perform chest compressions, the patient must lie on a flat, hard surface. Hands should be placed in the center of the chest between the nipples. The applied arm should be elastically extended in wrist joint, and the fingers should not touch the underlying hand and chest. Your elbows should be fully straight and your shoulders should be directly above your palms.
Rice. 1
When performing indirect cardiac massage, strong and fast rhythmic pushes should be performed with a depth of pressure of 4-5 cm and a frequency of compressions on the chest of 100 per minute. In this case, it is necessary to ensure that the chest is straightened after each compression to fill the heart with blood, making sure that the duration of compression and decompression of the chest is approximately the same.
It is extremely important to interrupt chest compressions as little as possible (pauses to inflate or check the pulse should not exceed 10 seconds). Every time chest compressions stop, blood circulation also stops. The more often chest compressions are interrupted, the worse the prognosis for survival. Indirect cardiac massage with the above requirements is a difficult physical labor, fast fatigue-inducing, which leads to a decrease in the quality of chest compressions. Given the importance of chest compressions, it should be performed alternately (if resuscitation is provided by 2 or more medical workers).
When carrying out artificial ventilation of the lungs, it is necessary to perform 2 air injections using the mouth-to-mouth method (the mouth-to-nose method is not used in adults) after 30 compressions on the chest. The airways are “opened” again. Index and thumb They pinch the patient’s nose with one hand, support his chin with the fingers of the other hand, take a normal (shallow) breath, seal the patient’s mouth with their lips (“kiss of life”) and exhale. Maintaining a tilted head and protruded jaw, they retract their lips so that air can passively exit the patient's airway. Perform a second exhalation and return to chest compressions.
Insufflation of air should last 1 second and be accompanied by visible excursion of the chest. The exhalation should not be too large or sharp. The volume of blown air should be 500-600 ml. Avoid excessive frequency, force, or volume of breaths, but strive to perform mechanical ventilation as quickly as possible (eg, 2 breaths in less than 10 seconds) to minimize pauses in chest compressions. As soon as this becomes possible, additional oxygen must be connected.
Rice. 2 - Methods of artificial respiration: a) mouth to mouth; b) from mouth to nose
Ventilation using a self-inflating breathing bag in an emergency situation is more effective than the exhalation of a rescuer. The breathing bag ventilates the patient's lungs using atmospheric air, which contains up to 21% oxygen, while the air exhaled by the rescuer contains only 16% oxygen. You should know the volume of the bag and remember that the volume of air blown in should be 500-600 ml (that is, a one-liter bag should be emptied approximately halfway). Although the breathing bag is a very simple device, it is difficult for one person to use. It is often difficult for a solo responder to achieve a seal while holding the face mask on the patient with one hand and squeezing the bag with the other. It is preferable that with breathing bag 2 people worked: one presses the face mask and holds the patient’s airways open (throwing back the head, extending the jaw), the other compresses the bag, ventilating the patient’s lungs. This way, a better seal is achieved.
Chest compressions and mechanical ventilation in a ratio of 30:2 continue until the emergency team arrives with a defibrillator or the patient begins to show signs of life.
The effectiveness of resuscitation measures is assessed according to the following criteria:
1. The appearance of the pupils' reaction to light. Constriction of the pupils indicates the flow of oxygen-enriched blood into the patient’s brain. If the pupils remain wide and do not react to light, one can think of brain death.
2. During closed cardiac massage, its effectiveness is controlled by placing two fingers on the area of projection of the carotid arteries; in this case, at the moment of compression of the heart, the pulsation of the carotid artery should be felt. The appearance of pulsation in the carotid arteries after a short-term (no more than 3-5 seconds) cessation of massage indicates the restoration of independent cardiac activity. If resuscitation is carried out by two people, then the pulse in the carotid arteries and the condition of the pupils is monitored by the resuscitator performing mechanical ventilation.
3. Restoration of spontaneous breathing. If spontaneous breathing is restored during CPR, becomes stable and sufficient in volume, the goals of primary CPR can be considered achieved. However, we should not forget about CPR, and in this case the patient (or victim) should not fall out of sight of the resuscitators for even a minute.
According to the method of establishment and legal confirmation, death is an objective state. She in mandatory registered with the civil registry office.
As a statement of legal death, the following are distinguished:
1) offensive biological death certified by a medical professional;
2) entry into force of a court decision made in accordance with Part 2 of Art. 269 of the Code of Civil Procedure of the Republic of Tajikistan on establishing the fact of death in certain time and in certain circumstances in the event of a refusal by the civil registry to register a death;
3) entry into legal force of a court decision declaring a citizen dead when the court establishes the fact of the person’s absence and any information about him at his place of residence for three years;
4) entry into legal force of a court decision to declare a citizen dead when the court establishes the fact that the person went missing under circumstances threatening death or giving reason to assume his death from a certain accident, and the absence of the person himself for 6 months;
5) entry into legal force of a court decision declaring a citizen dead when the court establishes the fact that the person disappeared in connection with hostilities, and the absence of the person himself for one year from the date of the end of hostilities.
Indicators of the effectiveness of cardiac massage:
the appearance of a distinct pulse wave in the carotid arteries after each compression.
constriction of the pupils.
reduction of cyanosis.
emergence of independent breathing movements.
Cardiac massage should be combined with artificial ventilation. Effective artificial respiration, carried out in combination with indirect cardiac massage, requires rhythmic repetition of vigorous insufflations at a frequency of 12-15 per minute, i.e. one “inhalation” for 5 chest compressions. In this case, these manipulations should be alternated in such a way that the inflation does not coincide with the moment of compression of the chest during cardiac massage.
If resuscitation is carried out by one person, then after every 15 chest compressions he should make 2 vigorous, slow blows of air into the lungs for at least 1-2 seconds. Control the position of your head so that air does not enter the esophagus.
When performing resuscitation by two people, one breath is taken after 5 chest compressions. The resuscitator performing mechanical ventilation monitors the effectiveness of cardiac massage by the appearance of pulse waves in the carotid arteries. Constantly monitor the possibility of spontaneous cardiac activity in the patient (initially after 20-30 seconds, then every 2-3 minutes).
If, after 30 - 40 minutes from the start of resuscitation, cardiac activity has not recovered, resuscitation should be considered unsuccessful and discontinued.
When performing external cardiac massage, it should be taken into account that in elderly people the elasticity of the chest is reduced due to age-related ossification of the costal cartilages, therefore, with vigorous massage and too much compression of the sternum, rib fractures can occur. This complication is not a contraindication for continuing cardiac massage, especially if there are signs of its effectiveness.
When performing a massage, you should not place your hand over the xiphoid process of the sternum, since sharply pressing on it can injure you. left lobe liver and other organs located in upper section abdominal cavity. This is serious complication resuscitation measures.
After clinical death, irreversible changes occur in tissues (primarily in the cells of the cerebral cortex), already determining the state of biological death, in which complete restoration of functions various organs fails to achieve. The onset of biological death is established both by the cessation of breathing and cardiac activity, and on the basis of the appearance of so-called reliable signs of biological death: a decrease in body temperature below 20 °C 9 or to fever environment), formation 2-4 hours after cardiac arrest cadaveric spots(occur due to the accumulation of blood in the lower parts of the body), the development of rigor mortis (thickening of muscle tissue).
Signs of biological death.
absence of heartbeat, pulse, breathing, pupil reaction to light.
clouding and drying of the cornea of the eye
softening eyeball, when the eye is compressed, the pupil is deformed and resembles a narrowed one cat eye(cat's eye symptom)
decrease in body temperature to ambient temperature
the appearance of cadaveric spots of blue-purple color on the underlying parts of the body
rigor mortis, this indisputable sign of death occurs 2-4 hours after death. Rigor mortis later goes away.
The doctor ascertains the fact of death and records the day, hour and minutes in the medical history. The deceased is undressed and placed on his back with straightened limbs without a pillow. Valuables are removed from the deceased in the department in the presence of the attending or duty doctor and transferred for storage. If the valuables cannot be removed, then this is recorded in the medical history and the corpse is sent to the morgue with the valuables. tied up lower jaw, lower the eyelids, cover with a sheet and leave in bed for 2 hours (take out of the room). The nurse writes in ink on the thigh of the deceased his last name, first name and patronymic, department number, date of death, and a direction is attached to the leg, indicating his full name, medical history number, time of death, clinical diagnosis. Informs relatives.
1) 16-20 per minute
2) 40-70 per minute
3) 60-80 per minute
4) 70-90 per minute
2. Characteristics of the pulse of a healthy person
1) small, thread-like, rhythmic
2) moderate filling, tension, rhythmic
3) good filling, tense, rhythmic
4) weak filling, tense, arrhythmic
3. Normal indicators Blood pressure in a healthy adult
1) 80/60 mmHg.
2) 100/60 mmHg.
3) 120/60 mmHg.
4)160/100 mmHg.
4. Heart rate per temperature increase of 1 degree
1) does not change
2) increases by 10 heart beats
3) increases by 20 heart beats
4) decreases by 10 heart beats
5. The level of blood pressure is characterized by the property of the pulse
3) filling
4) frequency
6. Pulse pressure reflects
1) the difference between systolic and diastolic pressure
2) pulse voltage level
3) pulse filling level
4) heart rate
7. When counting the pulse, the artery is pressed against the radius
1) one finger
2) two fingers
3) three fingers
4) all fingers of the hand
1) 12-14 per minute
2) 16-18 per minute
3) 22-24 per minute
4) 26-28 per minute
5) 30-32 per minute
9. Rapid shallow breathing called
orthopnea
bradypnea
tachypnea
bradycardia
tachycardia
in a horizontal position on your back on a rigid stretcher
V horizontal position on your back on a soft stretcher
in the frog position
in Trendelenburg position
1) blockage of the respiratory tract by a foreign body
2) drug poisoning
3) pulmonary embolism
4) drowning
5) acute tracheitis
12. Inspiratory dyspnea is characterized by difficulty
1) inhalation
2) exhalation
3) inhalation and exit
13. Expiratory dyspnea is characterized by difficulty
3) inhalation and exit
hemothorax
pneumothorax
pyothorax
hydrothorax
1. A victim of a car accident with complete loss of consciousness was brought to the hospital emergency department. Nurse's actions.
Homeherassignmentse: 4 min (4%)
Heart massage: types, indications, closed (indirect) with mechanical ventilation, rules
It often happens that a random passerby on the street may need help on which his life depends. In this regard, any person, even if he does not have medical education, must know and be able to correctly and competently, and most importantly, immediately, provide assistance to any victim.
That is why training in the methods of such activities as indirect cardiac massage and artificial respiration begins at school during life safety lessons.
Cardiac massage is a mechanical effect on the heart muscle in order to maintain blood flow through large vessels the body at the moment the heartbeat stops caused by one or another disease.
Heart massage can be direct or indirect:
- Direct massage carried out only in the operating room, during open heart surgery chest cavity, and is carried out through squeezing movements of the surgeon’s hand.
- Execution technique indirect (closed, external) heart massage anyone can master it, and it is carried out in combination with artificial respiration. (T.n.z.).
However, according to the current legislation of the Russian Federation, a person providing emergency care (hereinafter referred to as a resuscitator) has the right not to perform artificial respiration using the “mouth to mouth” or “mouth to nose” method in cases where there is direct or hidden threat for his health. So, for example, in the case when the victim has blood on his face and lips, the resuscitator may not touch him with his lips, since the patient may be infected with HIV or viral hepatitis. An antisocial patient, for example, may turn out to be a patient with tuberculosis. Due to the fact that predicting the presence dangerous infections it is impossible for a specific patient to be unconscious until the ambulance arrives medical care artificial respiration may not be performed, and assistance to a patient with cardiac arrest is provided through chest compressions. Sometimes they teach in specialized courses - if the resuscitator has plastic bag or a napkin, you can use them. But in practice, we can say that neither a bag (with a hole for the victim’s mouth), nor a napkin, nor a medical disposable mask purchased at a pharmacy protect against a real threat of transmission of infection, since contact of mucous membranes through the bag or wet (from breathing) resuscitator) the mask still happens. Contact of mucous membranes is a direct route of transmission of the virus. Therefore, no matter how much the resuscitator wants to save the life of another person, one should not forget about one’s own safety at this moment.
After doctors arrive at the scene, artificial pulmonary ventilation (ALV) begins, but with the help of an endotracheal tube and an Ambu bag.
Algorithm for external cardiac massage
So, what to do before the ambulance arrives if you see an unconscious person?
Firstly, do not panic and try to correctly assess the situation. If a person has just fallen in front of you, or has been injured, or has been pulled out of the water, etc., the need for intervention should be assessed, since indirect cardiac massage is effective in the first 3-10 minutes from the onset of cardiac arrest and breathing. If a person has not been breathing for a long time (more than 10-15 minutes) according to the people nearby, resuscitation can be performed, but most likely it will be ineffective. In addition, it is necessary to assess the presence of a threatening situation for you personally. For example, you cannot provide assistance on a busy highway, under falling beams, near an open flame during a fire, etc. Here you need to either transfer the patient to a more safe place, or call an ambulance and wait. Of course, the first option is preferable, since minutes count for someone else’s life. The exception is for victims who are suspected of having a spinal injury (diver injury, car accident, fall from a height), it is strictly forbidden to carry them without a special stretcher, however, when saving lives is at stake, this rule can be neglected. It is impossible to describe all situations, so in practice you have to act differently each time.
After you see a person unconscious, you should shout out to him loudly, lightly hit him on the cheek, in general, attract his attention. If there is no reaction, we place the patient on his back on a flat, hard surface (on the ground, floor, in the hospital we lower the recumbent gurney to the floor or transfer the patient to the floor).
NB! Artificial respiration and cardiac massage are never performed on a bed; its effectiveness will obviously be close to zero.
Next, we check the presence of breathing in a patient lying on his back, focusing on the rule of three “Ps” - “look-listen-feel.” To do this, you should press on the patient’s forehead with one hand, “lift” the lower jaw upward with the fingers of the other hand and bring the ear closer to the patient’s mouth. We look at the chest, listen to breathing and feel the exhaled air with our skin. If this is not the case, let's start.
Once you have made the decision to conduct cardiopulmonary resuscitation, you need to call one or two people from the environment to you. Under no circumstances do we call ambulance ourselves - we don’t waste precious seconds. We give the command to one of the people to call the doctors.
After visually (or by touching with your fingers) an approximate division of the sternum into three thirds, we find the border between the middle and lower. According to the recommendations for complex cardiopulmonary resuscitation, this area should be struck with a fist with a swing (precordial blow). This is exactly the technique that is practiced at the first stage. medical workers. Nevertheless, a common person who has not made such a blow before can harm the patient. Then, in the event of subsequent proceedings regarding broken ribs, the actions of NOT the doctor may be regarded as an abuse of authority. But in the case of successful resuscitation and broken ribs, or when the resuscitator does not exceed his authority, the outcome of the court case (if one is initiated) will always be in his favor.
start of cardiac massage
Then, to begin a closed cardiac massage, the resuscitator, with clasped hands, begins to perform rocking, pressing movements (compressions) on the lower third sternum with a frequency of 2 clicks per second (this is a fairly fast pace).
We fold our hands into a lock, while the leading hand (right for right-handers, left for left-handers) wraps its fingers around the other hand. Previously, resuscitation was carried out simply by putting hands on top of each other, without grip. The effectiveness of such resuscitation is much lower; now this technique is not used. Only hands interlocked.
hand position during cardiac massage
After 30 compressions, the resuscitator (or a second person) exhales two times into the victim’s mouth, while closing his nostrils with his fingers. At the moment of inhalation, the resuscitator should straighten up to inhale completely, and at the moment of exhalation, bend over the victim again. Resuscitation is carried out in a kneeling position next to the victim. It is necessary to perform indirect cardiac massage and artificial respiration until cardiac activity and breathing resume, or in the absence of such, until rescuers arrive who can provide more effective mechanical ventilation, or within 30-40 minutes. After this time, there is no hope for restoration of the cerebral cortex, since biological death usually occurs.
The real effectiveness of chest compressions consists of the following facts:
According to statistics, the success of resuscitation and full recovery vital functions in 95% of victims it is observed if the heart was able to “start” in the first three to four minutes. If a person was without breathing and heartbeat for about 10 minutes, but resuscitation was still successful, and the person began to breathe on his own, he will subsequently survive resuscitation disease, and, most likely, will remain deeply disabled with an almost completely paralyzed body and a violation of the higher nervous activity. Of course, the effectiveness of resuscitation depends not only on the speed of performing the described manipulations, but also on the type of injury or disease that led to it. However, if chest compressions are necessary, first aid should be started as soon as possible.
Video: performing chest compressions and mechanical ventilation
Once again about the correct algorithm
Unconscious person → “Are you feeling bad? Can you hear me? Do you need help? → No response → Turn over onto your back, lay on the floor → Pull out the lower jaw, look, listen, feel → No breathing → Note the time, start resuscitation, instruct a second person to call an ambulance → Precordial blow → 30 compressions on the lower third of the sternum/2 exhale into the victim’s mouth → After two to three minutes, assess the presence of respiratory movements → No breathing → Continue resuscitation until doctors arrive or within thirty minutes.
What can and cannot be done if resuscitation is necessary?
According to legal aspects first aid you have every right provide assistance to an unconscious person, since he cannot give his consent or refuse. Regarding children, it is a little more complicated - if the child is alone, without adults or without official representatives(guardians, parents), then you are obliged to start resuscitation. If the child is with parents who actively protest and do not allow touching the unconscious child, all that remains is to call an ambulance and wait for the rescuers to arrive on the sidelines.It is strictly not recommended to provide assistance to a person if there is a threat to own life, including if the patient has open, bloody wounds and you do not have gloves. In such cases, everyone decides for themselves what is more important to them - to protect themselves or to try to save the life of another.
Do not leave the scene if you see a person unconscious or in in serious condition – this will be qualified as leaving in danger. Therefore, if you are afraid to touch a person who may be dangerous to you, you must at least call him an ambulance.
Video: presentation on cardiac massage and mechanical ventilation by the Ministry of Health of the Russian Federation
