How long to do artificial respiration. Rules for conducting artificial respiration

Often the life and health of an injured person depends on how correctly first aid is provided to him.

According to statistics, in case of cardiac arrest and respiratory functions, it is first aid that increases the chance of survival by 10 times. After all, oxygen starvation of the brain for 5-6 minutes. leads to irreversible death of brain cells.

Not everyone knows how resuscitation is carried out if the heart stops and there is no breathing. And in life, this knowledge can save a person's life.

The reasons that led to cardiac arrest and breathing can be:

poisoning with toxic substances;
electric shock;
suffocation;
drowning;
trauma;
severe illness;
natural causes.

Before starting resuscitation measures, it is necessary to assess the risks for the victim and voluntary helpers - is there a threat of collapse of the building, explosion, fire, electric shock, gas contamination of the room. If there is no threat, then you can save the victim.

First of all, it is necessary to assess the patient's condition:

whether he is in a conscious or unconscious state - whether he is able to answer questions;
whether the pupils react to light - if the pupil does not narrow with increasing light intensity, then this indicates cardiac arrest;
determination of the pulse in the area of the carotid artery;
check of respiratory function;
study of the color and temperature of the skin and mucous membranes;
assessment of the posture of the victim - natural or not;
examination for the presence of injuries, burns, wounds and other external injuries, assessing their severity.

The person should be hailed, asked questions. If he is conscious, then it is worth asking about his condition, well-being. In a situation where the victim is unconscious, fainting, it is necessary to conduct an external examination and assess his condition.

The main sign of the absence of a heartbeat is the absence of pupillary reaction to light rays. In the normal state, the pupil constricts under the influence of light and expands when the light intensity decreases. Extended indicates dysfunction of the nervous system and myocardium. However, the violation of the reactions of the pupil occurs gradually. The complete absence of the reflex occurs 30-60 seconds after a complete cardiac arrest. Some medications, narcotic substances, and toxins can also affect the latitude of the pupils.

The work of the heart can be checked by the presence of tremors of blood in large arteries. It is not always possible to feel the pulse of the victim. The easiest way to do this is on the carotid artery, located on the side of the neck.

The presence of breathing is judged by the noise coming out of the lungs. If breathing is weak or absent, then characteristic sounds may not be heard. It is not always at hand to have a fogging mirror, through which it is determined whether there is breathing. Chest movement may also be imperceptible. Leaning towards the mouth of the victim, note the change in sensations on the skin.

A change in the shade of the skin and mucous membrane from natural pink to gray or bluish indicates circulatory disorders. However, in case of poisoning with certain toxic substances, the pink color of the skin is preserved.

The appearance of cadaveric spots, waxy pallor indicates the inappropriateness of resuscitation. This is also evidenced by injuries and injuries incompatible with life. It is impossible to carry out resuscitation measures with a penetrating wound of the chest or broken ribs, so as not to pierce the lungs or heart with bone fragments.

After the condition of the victim has been assessed, resuscitation should immediately begin, since after the cessation of breathing and heartbeat, only 4-5 minutes are allotted for the restoration of vital functions. If it is possible to revive after 7-10 minutes, then the death of part of the brain cells leads to mental and neurological disorders.

Insufficiently prompt assistance can lead to permanent disability or death of the victim.

Resuscitation algorithm

Before starting resuscitation pre-medical measures, it is recommended to call an ambulance team.

If the patient has a pulse, but he is in a deep fainting state, he will need to be laid on a flat, hard surface, the collar and belt should be relaxed, turning his head to one side to exclude aspiration in case of vomiting, if necessary, clear the airways and oral cavity from accumulated mucus, and vomiting.

It should be noted that after cardiac arrest, breathing can continue for another 5-10 minutes. This is the so-called "agonal" breathing, which is characterized by visible movements of the neck and chest, but low productivity. Agony is reversible, and with properly performed resuscitation, the patient can be brought back to life.

If the victim does not show any signs of life, then the rescuing person must perform a series of the following steps in stages:

put the victim on any flat, free, while removing the restrictive elements of clothing from him;
throw back your head, put under your neck, for example, a jacket or sweater rolled up with a roller;
pull down and push slightly forward the lower jaw of the victim;
check if the airways are free, if not, then release them;
try to restore respiratory function using the mouth-to-mouth or mouth-to-nose method;
massage the heart indirectly. Before starting resuscitation of the heart, it is worthwhile to perform a "pericardial blow" in order to "start" the heart or increase the effectiveness of heart massage. A punch is applied to the middle part of the sternum. It is important to try not to hit the lower part of the xiphoid process - a direct blow can worsen the situation.

Resuscitating the patient, periodically check the patient's condition - the appearance and frequency of the pulse, the light response of the pupil, breathing. If the pulse is palpable, but there is no spontaneous breathing, the procedure must be continued.

Only when breathing appears can resuscitation be stopped. In the absence of a change in state, resuscitation is continued until the arrival of the ambulance. Only a doctor can give permission to end the resuscitation.

The technique of carrying out respiratory resuscitation

Restoration of respiratory function is carried out by two methods:

mouth to mouth;
mouth to nose.

Both methods do not differ in technique. Before starting resuscitation, the patient's airway is restored. For this purpose, the mouth and nasal cavity are cleaned of foreign objects, mucus, and vomit.

If there are dentures, they are removed. The tongue is pulled out and held to avoid blocking the airways. Then proceed to the actual resuscitation.

The mouth-to-mouth method

The victim is held by the head, placing 1 hand on the forehead of the patient, the other - pressing the chin.

The patient's nose is squeezed with fingers, the resuscitator takes the deepest possible breath, presses his mouth tightly against the patient's mouth and exhales air into his lungs. If the manipulation is carried out correctly, then the chest rise will be noticeable.

If the movement is noted only in the abdomen, then the air has entered the wrong way - into the trachea, but into the esophagus. In this situation, it is important to ensure that air enters the lungs. 1 artificial breath is performed for 1 s, exhaling air strongly and evenly into the respiratory tract of the victim with a frequency of 10 “breaths” per 1 minute.

Mouth to nose technique

The mouth-to-nose resuscitation technique completely coincides with the previous method, except that the resuscitator exhales into the patient's nose, tightly clamping the victim's mouth.

After artificial inhalation, air should be allowed to exit the patient's lungs.

Respiratory resuscitation is carried out using a special mask from the first aid kit or by covering the mouth or nose with a piece of gauze or cloth, a handkerchief, but if they are not there, then there is no need to waste time looking for these items - rescue measures should be carried out immediately.

Method of cardiac resuscitation

To begin with, it is recommended to free the chest area from clothing. The caregiver is located to the left of the resuscitated. Perform mechanical defibrillation or pericardial shock. Sometimes this measure triggers a stopped heart.

If there is no reaction, then an indirect heart massage is performed. To do this, you need to find the place where the costal arch ends and place the lower part of the palm of the left hand on the lower third of the sternum, and put the right one on top, straightening the fingers and lifting them up (the “butterfly” position). The push is carried out with arms straightened in the elbow joint, pressing with all the weight of the body.

The sternum is pressed to a depth of at least 3-4 cm. Sharp pushes are made with a frequency of 60-70 pressures per 1 minute. - 1 press on the sternum in 2 sec. Movements are performed rhythmically, alternating push and pause. Their duration is the same.

After 3 min. the effectiveness of the activity should be checked. The fact that cardiac activity has recovered is evidenced by probing the pulse in the carotid or femoral artery, as well as a change in complexion.

Carrying out simultaneous cardiac and respiratory resuscitation requires a clear alternation - 2 breaths per 15 pressures on the heart area. It is better if two people provide assistance, but if necessary, the procedure can be performed by one person.

Features of resuscitation in children and the elderly

In children and older patients, the bones are more fragile than in young people, so the force of pressing on the chest should be commensurate with these features. The depth of chest compression in elderly patients should not exceed 3 cm.

In children, depending on the age and size of the chest, massage is carried out:

in newborns - with one finger;
in infants - two;
after 9 years - with both hands.

Newborns and infants are placed on the forearm, placing the palm under the back of the child and holding the head above the chest, slightly thrown back. The fingers are placed on the lower third of the sternum.

Also, in infants, you can use another method - the chest is covered with palms, and the thumb is placed in the lower third of the xiphoid process. The frequency of shocks varies in children of different ages:

Age (months/years)	The number of pressures in 1 min.	Depth of deflection (cm)
≤ 5	140	˂ 1.5
6-11	130-135	2-2,5
12/1	120-125	3-4
24/2	110-115	3-4
36/3	100-110	3-4
48/4	100-105	3-4
60/5	100	3-4
72/6	90-95	3-4
84/7	85-90	3-4

When performing resuscitation of breathing in children, it is done with a frequency of 18-24 "breaths" in 1 min. The ratio of resuscitation movements of the heart beat and "inspiration" in children is 30:2, and in newborns - 3:1.

The life and health of the victim depends on the speed of the start of resuscitation measures and the correctness of their implementation.

It is not worth it to stop the return of the victim to life on your own, since even medical workers cannot always determine the moment of death of the patient visually.

Artificial respiration (AI) is an immediate emergency measure in the event that a person’s own breathing is absent or impaired to such an extent that it is a threat to life. The need for artificial respiration may arise when assisting those who have received sunstroke, drowned, electric shock, as well as poisoning with certain substances.

The purpose of the procedure is to ensure the process of gas exchange in the human body, in other words, to ensure sufficient saturation of the victim's blood with oxygen and the removal of carbon dioxide from it. In addition, artificial ventilation of the lungs has a reflex effect on the respiratory center located in the brain, as a result of which spontaneous breathing is restored.

Mechanism and methods of artificial respiration

Only due to the process of respiration, human blood is saturated with oxygen and carbon dioxide is removed from it. After air enters the lungs, it fills the air sacs called alveoli. The alveoli are permeated by an incredible number of small blood vessels. It is in the pulmonary vesicles that gas exchange takes place - oxygen from the air enters the blood, and carbon dioxide is removed from the blood.

In the event that the supply of oxygen to the body is interrupted, vital activity is threatened, since oxygen plays the “first violin” in all oxidative processes that occur in the body. That is why when breathing stops, artificial ventilation of the lungs should begin immediately.

The air entering the human body during artificial respiration fills the lungs and irritates the nerve endings in them. As a result, nerve impulses enter the respiratory center of the brain, which are a stimulus for the production of response electrical impulses. The latter stimulate the contraction and relaxation of the muscles of the diaphragm, resulting in stimulation of the respiratory process.

Artificial provision of the human body with oxygen in many cases allows you to completely restore an independent respiratory process. In the event that, in the absence of breathing, cardiac arrest is also observed, it is necessary to carry out its closed massage.

Please note that the absence of breathing triggers irreversible processes in the body after only five to six minutes. Therefore, timely artificial ventilation of the lungs can save a person's life.

All methods of performing ID are divided into expiratory (mouth-to-mouth and mouth-to-nose), manual and hardware. Manual and expiratory methods compared to hardware are considered more labor-intensive and less effective. However, they have one very significant advantage. You can perform them without delay, almost anyone can cope with this task, and most importantly, there is no need for any additional devices and devices that are far from always at hand.

Indications and contraindications

Indications for the use of ID are all cases when the volume of spontaneous ventilation of the lungs is too low to ensure normal gas exchange. This can happen in many both urgent and planned situations:

With disorders of the central regulation of respiration caused by a violation of cerebral circulation, tumor processes in the brain or its injury.
With medication and other types of intoxication.
In case of damage to the nerve pathways and neuromuscular synapse, which can be provoked by trauma to the cervical spine, viral infections, the toxic effect of certain drugs, poisoning.
With diseases and injuries of the respiratory muscles and chest wall.
In cases of lung lesions, both obstructive and restrictive.

The need to use artificial respiration is judged based on a combination of clinical symptoms and external data. Changes in the size of the pupils, hypoventilation, tachy- and bradysystole are conditions in which artificial ventilation of the lungs is necessary. In addition, artificial respiration is required in cases where spontaneous ventilation of the lungs is "turned off" with the help of muscle relaxants introduced for medical purposes (for example, during anesthesia during surgery or during intensive care for a convulsive syndrome).

As for cases when ID is not recommended, there are no absolute contraindications. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. So, for example, if the venous return of blood is difficult, artificial respiration regimes are contraindicated, which provoke an even greater violation of it. In case of lung injury, lung ventilation methods based on high-pressure air injection, etc. are prohibited.

Preparation for artificial respiration

Before performing expiratory artificial respiration, the patient should be examined. Such resuscitation measures are contraindicated for facial injuries, tuberculosis, poliomyelitis, and trichlorethylene poisoning. In the first case, the cause is obvious, and in the last three, performing expiratory ventilation endangers the resuscitator.

Before proceeding with the implementation of expiratory artificial respiration, the victim is quickly released from clothes that are squeezing the throat and chest. The collar is unbuttoned, the tie is untied, you can unfasten the trouser belt. The victim is placed supine on his back on a horizontal surface. The head is thrown back as much as possible, the palm of one hand is placed under the back of the head, and the forehead is pressed with the second palm until the chin is in line with the neck. This condition is necessary for successful resuscitation, since with this position of the head, the mouth opens, and the tongue moves away from the entrance to the larynx, as a result of which air begins to flow freely into the lungs. In order for the head to remain in this position, a roll of folded clothes is placed under the shoulder blades.

After that, it is necessary to examine the victim's oral cavity with your fingers, remove blood, mucus, dirt and any foreign objects.

It is the hygienic aspect of performing expiratory artificial respiration that is the most delicate, since the rescuer will have to touch the victim's skin with his lips. You can use the following technique: make a small hole in the middle of a handkerchief or gauze. Its diameter should be two to three centimeters. The tissue is applied with a hole to the mouth or nose of the victim, depending on which method of artificial respiration will be used. Thus, air will be blown through the hole in the fabric.

For mouth-to-mouth artificial respiration, the one who will provide assistance should be on the side of the victim's head (preferably on the left side). In a situation where the patient is lying on the floor, the rescuer kneels down. In the event that the jaws of the victim are clenched, they are forcefully pushed apart.

After that, one hand is placed on the forehead of the victim, and the other is placed under the back of the head, tilting the patient's head back as much as possible. Having taken a deep breath, the rescuer holds the exhalation and, bending over the victim, covers the area of his mouth with his lips, creating a kind of "dome" over the patient's mouth opening. At the same time, the victim's nostrils are clamped with the thumb and forefinger of the hand located on his forehead. Ensuring tightness is one of the prerequisites for artificial respiration, since air leakage through the victim’s nose or mouth can nullify all efforts.

After sealing, the rescuer exhales rapidly, forcefully, blowing air into the airways and lungs. The duration of the exhalation should be about a second, and its volume should be at least a liter in order for effective stimulation of the respiratory center to occur. At the same time, the chest of the one who is being helped should rise. In the event that the amplitude of its rise is small, this is evidence that the volume of air supplied is insufficient.

After exhaling, the rescuer unbends, freeing the victim's mouth, but at the same time keeping his head tilted back. The exhalation of the patient should last about two seconds. During this time, before taking the next breath, the rescuer must take at least one normal breath “for himself”.

Please note that if a large amount of air does not enter the lungs, but into the patient's stomach, this will make it much more difficult to save him. Therefore, periodically you should press on the epigastric (epigastric) region to free the stomach from air.

Artificial respiration from mouth to nose

With this method, artificial ventilation of the lungs is carried out if it is not possible to properly unclench the patient's jaws or if there is an injury to the lips or mouth area.

The rescuer puts one hand on the victim's forehead, and the other on his chin. At the same time, he simultaneously throws back his head and presses his upper jaw to the lower one. With the fingers of the hand that supports the chin, the rescuer must press the lower lip so that the victim's mouth is completely closed. After taking a deep breath, the rescuer covers the victim's nose with his lips and blows air through the nostrils with force, while watching the movement of the chest.

After artificial inspiration is completed, the patient's nose and mouth must be released. In some cases, the soft palate can prevent air from escaping through the nostrils, so when the mouth is closed, there may be no exhalation at all. When exhaling, the head must be kept tilted back. The duration of artificial expiration is about two seconds. During this time, the rescuer himself must make several exhalations-breaths "for himself."

How long is artificial respiration

To the question of how long it is necessary to carry out ID, there is only one answer. Ventilate the lungs in a similar mode, taking breaks for a maximum of three to four seconds, should be until the full spontaneous breathing is restored, or until the doctor who appears gives other instructions.

In this case, you should constantly monitor that the procedure is effective. The chest of the patient should swell well, the skin of the face should gradually turn pink. It is also necessary to ensure that there are no foreign objects or vomit in the victim's airways.

Please note that due to the ID, the rescuer himself may become weak and dizzy due to a lack of carbon dioxide in the body. Therefore, ideally, two people should perform the blowing of air, which can alternate every two to three minutes. In the event that this is not possible, the number of breaths should be reduced every three minutes so that the level of carbon dioxide in the body normalizes in the one who performs resuscitation.

During artificial respiration, you should check every minute if the victim's heart has stopped. To do this, feel the pulse on the neck in the triangle between the windpipe and the sternocleidomastoid muscle with two fingers. Two fingers are placed on the lateral surface of the laryngeal cartilage, after which they are allowed to "slide" into the hollow between the sternocleidomastoid muscle and the cartilage. It is here that the pulsation of the carotid artery should be felt.

In the event that there is no pulsation on the carotid artery, chest compressions should be started immediately in combination with ID. Doctors warn that if you miss the moment of cardiac arrest and continue to do artificial ventilation of the lungs, you will not be able to save the victim.

Features of the procedure in children

When carrying out artificial ventilation, babies under one year old use the mouth-to-mouth and nose technique. If the child is over a year old, the mouth-to-mouth method is used.

Small patients are also placed on their backs. For babies up to a year old, they put a folded blanket under their backs or slightly raise their upper body by placing a hand under their backs. The head is thrown back.

The person providing assistance takes a shallow breath, hermetically covers the mouth and nose of the child (if the baby is under one year old) or only the mouth with his lips, after which he blows air into the respiratory tract. The volume of air blown should be the smaller, the younger the young patient. So, in the case of resuscitation of a newborn, it is only 30-40 ml.

If sufficient air enters the respiratory tract, chest movements appear. It is necessary to make sure after inhalation that the chest is lowered. If too much air is blown into the baby's lungs, this can cause the alveoli of the lung tissue to rupture, as a result of which air will escape into the pleural cavity.

The frequency of breaths should correspond to the respiratory rate, which tends to decrease with age. So, in newborns and children up to four months, the frequency of inhalations-exhalations is forty per minute. From four months to six months, this figure is 40-35. In the period from seven months to two years - 35-30. From two to four years, it is reduced to twenty-five, in the period from six to twelve years - to twenty. Finally, in a teenager aged 12 to 15 years, the respiratory rate is 20-18 breaths per minute.

Manual methods of artificial respiration

There are also so-called manual methods of artificial respiration. They are based on a change in the volume of the chest due to the application of an external force. Let's consider the main ones.

Sylvester's way

This method is the most widely used. The victim is placed on his back. A cushion should be placed under the lower part of the chest so that the shoulder blades and the back of the head are lower than the costal arches. In the event that two people perform artificial respiration using this technique, they kneel on either side of the victim so as to be at the level of his chest. Each of them holds the victim's hand in the middle of the shoulder with one hand, and a little above the level of the hand with the other. Then they begin to rhythmically raise the victim's arms, stretching them behind his head. As a result, the chest expands, which corresponds to inhalation. After two or three seconds, the victim's hands are pressed to the chest, while squeezing it. This performs the function of exhalation.

In this case, the main thing is that the movements of the hands should be as rhythmic as possible. Experts recommend that those who perform artificial respiration use their own rhythm of inhalations and exhalations as a "metronome". In total, about sixteen movements per minute should be done.

ID by the Sylvester method can be produced by one person. He needs to kneel behind the head of the victim, intercept his hands above the hands and perform the movements described above.

With fractures of the arms and ribs, this method is contraindicated.

Schaeffer's method

In the event that the victim's hands are injured, the Schaeffer method can be used to perform artificial respiration. Also, this technique is often used to rehabilitate people injured while on the water. The victim is placed prone, the head is turned to the side. The one who does artificial respiration kneels, and the body of the victim should be located between his legs. Hands should be placed on the lower part of the chest so that the thumbs lie along the spine, and the rest lie on the ribs. When exhaling, you should lean forward, thus compressing the chest, and while inhaling, straighten up, stopping the pressure. The arms do not bend at the elbows.

Please note that with a fracture of the ribs, this method is contraindicated.

Laborde method

The Laborde method is complementary to the methods of Sylvester and Schaeffer. The victim's tongue is grasped and rhythmic stretching is performed, simulating respiratory movements. As a rule, this method is used when breathing has just stopped. The appeared resistance of the tongue is proof that the person's breathing is being restored.

Kallistov's method

This simple and effective method provides excellent lung ventilation. The victim is placed prone, face down. A towel is placed on the back in the area of the shoulder blades, and its ends are carried forward, passing under the armpits. The one who provides assistance should take the towel by the ends and raise the body of the victim seven to ten centimeters from the ground. As a result, the chest expands and the ribs rise. This corresponds to the breath. When the torso is lowered, it simulates exhalation. Instead of a towel, you can use any belt, scarf, etc.

Howard's way

The victim is positioned supine. A cushion is placed under his back. Hands are taken behind the head and pulled out. The head itself is turned to the side, the tongue is extended and fixed. The one who performs artificial respiration sits astride the victim's femoral area and places his palms on the lower part of the chest. Spread fingers should capture as many ribs as possible. When the chest is compressed, it corresponds to inhalation; when the pressure is stopped, it simulates exhalation. Twelve to sixteen movements should be done per minute.

Frank Yves method

This method requires a stretcher. They are installed in the middle on a transverse stand, the height of which should be half the length of the stretcher. The victim is laid prone on the stretcher, the face is turned to the side, the arms are placed along the body. A person is tied to a stretcher at the level of the buttocks or thighs. When lowering the head end of the stretcher, inhale is carried out, when it goes up - exhale. The maximum breathing volume is achieved when the victim's body is tilted at an angle of 50 degrees.

Nielsen method

The victim is placed face down. His arms are bent at the elbows and crossed, after which they are placed palms down under the forehead. The rescuer kneels at the head of the victim. He puts his hands on the shoulder blades of the victim and, without bending them at the elbows, presses with his palms. This is how exhalation happens. To inhale, the rescuer takes the shoulders of the victim at the elbows and straightens up, lifting and pulling the victim towards himself.

Hardware methods of artificial respiration

For the first time, hardware methods of artificial respiration began to be used in the eighteenth century. Even then, the first air ducts and masks appeared. In particular, doctors suggested using bellows for blowing air into the lungs, as well as devices created in their likeness.

The first automatic devices for ID appeared at the end of the nineteenth century. At the beginning of the twentieth, several varieties of respirators appeared at once, which created intermittent vacuum and positive pressure either around the entire body, or only around the chest and abdomen of the patient. Gradually, respirators of this type were replaced by air blowing respirators, which differed in less solid dimensions and at the same time did not impede access to the patient's body, allowing medical manipulations to be carried out.

All currently existing ID devices are divided into external and internal. External devices create negative pressure either around the entire body of the patient or around his chest, which causes inspiration. Exhalation in this case is passive - the chest simply subsides due to its elasticity. It can also be active if the apparatus creates a positive pressure zone.

With the internal method of artificial ventilation, the device is connected through a mask or intubator to the respiratory tract, and inhalation is carried out due to the creation of positive pressure in the device. Devices of this type are divided into portable, designed to work in the "field" conditions, and stationary, the purpose of which is prolonged artificial respiration. The former are usually manual, while the latter operate automatically, driven by a motor.

Complications of artificial respiration

Complications due to artificial respiration occur relatively rarely even if the patient is on mechanical ventilation for a long time. Most often, undesirable effects relate to the respiratory system. So, due to an incorrectly chosen regimen, respiratory acidosis and alkalosis can develop. In addition, prolonged artificial respiration can cause the development of atelectasis, since the drainage function of the respiratory tract is impaired. Microatelectasis, in turn, can become a prerequisite for the development of pneumonia. Preventive measures that will help avoid the occurrence of such complications are meticulous respiratory hygiene.

If the patient breathes pure oxygen for a long time, this can cause pneumonitis. The oxygen concentration therefore should not exceed 40-50%.

In patients who have been diagnosed with abscessing pneumonia, ruptures of the alveoli may occur during artificial respiration.

Artificial respiration is artificial ventilation of the lungs, replacing the patient's own breathing. Artificial respiration is used when breathing stops or is depressed due to accidents (during, drug poisoning, etc.), when, as well as when foreign bodies enter the respiratory tract. Artificial respiration is widely used in anesthesiology and resuscitation, when the patient's skeletal and respiratory muscles are deliberately turned off. Artificial respiration for days, months and even years is used for lesions of the spinal cord and its roots (, amyotrophic lateral sclerosis, myelitis).

Rice. 1. Artificial respiration from mouth to

When breathing stops at home, on the street, on the beach, etc., the most effective way is from mouth to mouth (Fig. 1) or from mouth to. Taking the patient's lower jaw with the left hand, the parietal region with the right hand or holding the nose with it, the patient's head is thrown back as much as possible. This is the best position for freeing the airways from a stuck tongue. Then they deeply inhale the air into their lungs and blow it into the mouth or nose of the patient, again draw air into the lungs for the next blow, etc.

In the first minute, the rescuer should breathe deeper and faster.

Control over the correctness of ventilation: during inhalation, the patient rises and quickly falls during exhalation. If there is no cardiac arrest, then after 4-6 injections, an increasing pinking of the patient's face is noted. The force of blowing air into the lungs is small - no more than when inflating a volleyball rubber bladder. The main thing in the method is to keep the head in the correct position and create tightness during inhalation. In order not to touch the lips of the mouth and nose of the patient, you should put a gauze or handkerchief on them. It is more convenient if you insert a nasopharyngeal cannula (or rubber tube) through the patient's nostril to a depth of 6-8 cm and blow air through it, holding the patient's mouth and other nostril closed.

It is also possible to blow air through the mask of the anesthesia machine, since the latter is very tightly applied to the face. By attaching a hose to it, you can perform artificial respiration without leaning towards the patient. You can enter the victim with a conventional oropharyngeal or S-shaped cannula, which very well prevents the retraction of the tongue, but in essence there is only one method - blowing air into the lungs of the victim. Intensive ventilation of the lungs is continued until the patient's own breathing disappears and appears. If there is also a cardiac arrest, then artificial respiration is interspersed with an external heart massage (see). If, at the first attempt to blow air into the lungs of the victim, an obstacle is felt, then the mouth is quickly opened and the oral cavity and pharynx are inspected with a finger and removed (see). In emergency situations, mouth-to-mouth or mouth-to-nose artificial respiration is indispensable.

Artificial respiration methods based on squeezing or stretching the victim's chest with the hands create an insufficient tidal volume, do not free the airways from a sinking tongue, and require great physical effort; their efficiency in comparison with the method described above is much less.

Rice. 2. Methods of manual artificial respiration: 1 - according to Sylvester (on the left - inhale, on the right - exhale); 2 - according to Nielsen (left - exhale, right - inhale).

Artificial respiration according to the Sylvester method(Fig. 2, 1): the patient, lying on his back, sharply raise his outstretched arms above his head, which causes stretching of the chest - inhale, then sharply put the folded hands on the chest and squeeze it - exhale.

Artificial respiration according to the Sylvester method - Brochu: a pillow is placed under the shoulders, which causes the head to tilt back and frees the airways, otherwise the method is similar to the first.

Artificial respiration according to the Nielsen method(Fig. 2.2): the victim lies on his stomach (face down). Inhalation is produced by a sharp lifting of the torso by the shoulders in their lower third. Quickly lower the victim and increase the depth of exhalation with pressure on the chest. Of the large number of manual methods, these are considered the best, but even they are at least 2 times less effective than mouth-to-mouth artificial respiration.

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Classmates

The need for artificial respiration arises in cases where breathing is absent or disturbed to such an extent that it threatens the life of the patient. lawsuit natural respiration - an urgent first aid measure for drowned people, in case of suffocation, electric shock, heat and sunstroke, with some poisoning.

Before starting artificial respiration, it is necessary to make sure that the victim's upper respiratory tract is patent. Usually when the head is thrown back, the airways open better. If the patient's jaws are tightly compressed, they should be carefully pushed apart with some flat object (spoon handle, etc.), put a bandage or fabric roller between the teeth. After that, quickly examine the oral cavity with a finger wrapped in a scarf or gauze and free it from vomit, mucus, blood, sand (removable dentures must be removed). Then unbutton the victim's clothes that impede breathing and blood circulation.

All these preparatory manipulations must be carried out very quickly, but carefully and carefully, as it is possible to worsen the already critical situation of the victim.

Signs of respiratory recovery. CPR started immediately is often successful. The first independent breath is not always sufficiently clearly expressed and is often recorded only by a weak rhythmic contraction of the neck muscles, resembling a swallowing movement. Then the respiratory movements increase, but can take place at large intervals and be convulsive in nature.

Artificial respiration method "mouth to mouth"

Quickly and carefully lay the victim on his back with arms extended along the body on a flat hard surface. Release the chest from belts, harnesses, clothing. Throw the head of the victim up, with one hand pull his lower jaw anteriorly and downwards, and pinch his nose with the fingers of the other. Make sure that the victim's tongue does not sink and does not close the airways. In case of retraction, pull out the tongue and hold it with your fingers or pin (sew) the tip of the tongue to the clothes.

Performing artificial respiration, take a maximum breath, bend over to the victim, press your lips tightly against his open mouth and exhale as much as possible. At this point, make sure that as air enters the respiratory tract and lungs of the victim, his chest expands as much as possible.

After straightening the chest, take the mouth away from the lips of the victim and stop squeezing the nose. At this point, the air will begin to leave the victim's lungs on their own.

Breaths should be taken every 3-4 seconds. The intervals between breaths and the depth of each breath should be the same.

Mouth-to-nose artificial respiration technique

This method is used for trauma to the tongue, jaw, lips. The position of the victim, the frequency and depth of breaths, additional therapeutic measures are the same as with artificial respiration by the mouth-to-mouth method. The victim's mouth must be tightly closed. Blowing is performed in both nostrils of the victim.

Features of artificial respiration in children

To restore breathing in children under 1 year of age, artificial ventilation of the lungs is carried out according to the method from mouth to mouth and nose, in children older than 1 year - according to the method from mouth to mouth. Both methods are carried out in the position of the child on the back, for children under 1 year old, a low roller (folded blanket) is placed under the back or the upper part of the body is slightly raised with the hand brought under the back, the child's head is thrown back.The caregiver takes a breath (shallow!), hermetically covers the mouth and nose of the child or (in children over 1 year old) only the mouth, and blows air into the child’s respiratory tract, the volume of which should be the smaller, the younger the child (for example, in a newborn it is equal to 30-40 ml). With a sufficient volume of air blown in and air entering the lungs (and not the stomach), chest movements appear. After completing the blow, you need to make sure that the chest is lowering. Blowing an excessively large volume of air for a child can lead to serious consequences - rupture of the alveoli of the lung tissue and air escaping into the pleural cavity. The frequency of inspirations should correspond to the age-related frequency of respiratory movements, which decreases with age. On average, the respiratory rate in 1 minute is in newborns and children up to 4 months. life - 40, at 4-6 months. - 40-35, at 7 months. - 2 years old - 35-30, at 2-4 years old - 30-25, at 4-6 years old - about 25, at 6-12 years old - 22-20, at 12-15 years old - 20-18.

If two people provide assistance, then one of them does a heart massage, and the other - artificial respiration. In this case, blowing into the mouth or nose of the victim is done every four pushes on his chest.

In cases where assistance is provided by one person, which is extremely difficult, then the sequence of manipulations and the mode change - every two quick injections of air into the lungs of the victim, 10-12 chest compressions are performed with an interval of 1 second.

With preserved cardiac activity (a pulse is felt, a heartbeat is heard), artificial respiration is carried out until spontaneous breathing is restored. In the absence of heart contractions, artificial respiration and heart massage are carried out for 60-90 minutes. If during this period spontaneous breathing does not appear and cardiac activity does not resume, resuscitation is stopped.

Artificial respiration, like normal natural respiration, aims to ensure gas exchange in the body, i.e. saturate the victim's blood with oxygen and remove carbon dioxide from the blood. In addition, artificial respiration, acting reflexively on the respiratory center of the brain, thereby contributes to the restoration of independent breathing of the victim. Blood saturated with oxygen is sent by the heart to all organs, tissues and cells, in which, due to this, normal oxidative processes continue. Among the large number of existing manual (without the use of special devices) methods for performing artificial respiration, the most effective is the “Mouth to mouth” (“mouth to mouth”) or “Mouth to nose” (“mouth to nose”) method (Fig. 3 ).

It consists in the fact that the caregiver blows air from his lungs into the lungs of the victim through his mouth or nose.

Before starting artificial respiration, you must quickly perform the following operations:

Release the victim from clothing restricting breathing;

Lay the victim on his back on a horizontal surface;

Tilt the victim’s head back as much as possible, placing the palm of one hand under the back of the head, and with the other hand press on the victim’s forehead (Fig. 3a) until his chin is in line with the neck (Fig. 36). With this position of the head, the tongue moves away from the entrance to the larynx, thereby providing a free passage for air into the lungs. However, with this position of the head, the mouth usually opens. To maintain the achieved position of the head, a roll of folded clothes should be placed under the shoulder blades;

Examine the oral cavity and, if foreign contents are found in it, remove it by removing dentures at the same time, if any.

To remove mucus and blood, the head and shoulders of the victim are turned to the side (you can bring your knee under the shoulders of the victim), and then with the help of a handkerchief or the edge of a shirt wound around the index finger, they clean the mouth and throat. After that, the head is given the initial position and thrown back as much as possible, as shown in Fig. 3b.

At the end of the preparatory operations, the assisting person takes a deep breath and then exhales the air with force into the victim's mouth.

At the same time, he should cover the entire mouth of the victim with his mouth, and pinch his nose with his cheek or fingers (Fig. 4a).

Then the caregiver leans back, freeing the mouth and nose of the victim, and takes a new breath. During this period, the chest of the victim descends and passive exhalation occurs (Fig. 46). For young children, air can be blown into the mouth and nose at the same time, while the assisting person covers the mouth and nose of the victim with his mouth.

Control over the flow of air into the lungs of the victim is carried out by eye on the expansion of the chest with each blow. If the chest of the victim does not expand when air is blown in, this indicates an obstruction of the airways.

Fig.5. Mandibular thrust with two hands

In this case, it is necessary to push the lower jaw of the victim forward. To do this, the assisting person (Fig. 5) places four fingers of each hand behind the corners of the lower jaw and, resting his thumbs on its edge, pushes the upper jaw forward so that the lower teeth are in front of the upper ones.