Restoration of airway patency. Methods for restoring airway patency
Restoration of airway patency is essential for successful resuscitation. Violation of the airway can be associated with relaxation of the muscles and retraction of the tongue, ingestion of vomit, water, excessive mucus formation, and foreign bodies.
If the victim is in a supine position and unconscious, then the root of the tongue is likely to sink. In this case, artificial respiration will be ineffective. To restore airway patency, you need to put one hand on the head of the victim in the area of \u200b\u200bthe hairline, and with the other hand, grab his chin. Then, pressing on the head, throw it back with the first hand and bring the chin forward with the second hand.
The mouth of the victim will then open slightly. Then the index and middle fingers of the left hand are inserted into the mouth and the oral cavity is examined. If necessary, remove foreign bodies. You can wrap your fingers to remove mucus, blood, and more. To remove fluid (water, stomach contents, blood) from the respiratory tract, a drainage position is used.
It is necessary to turn the victim on his side, while maintaining the existing position of his head and torso relative to each other. This position promotes the outflow of fluid through the nose and mouth. Then its remnants can be removed with suction, a rubber can, wiped in the mouth with a napkin. Change the position of the victim should not be in case of spinal injury in the cervical region.
If foreign bodies get stuck in the throat, they are removed with the index finger. It is deeply advanced in the oral cavity of the victim along the tongue. Then, bending the finger, pry off the foreign object and push it out. This technique should be performed carefully so as not to advance the foreign object even deeper.
If large foreign bodies are stuck in the larynx or trachea, a tracheostomy is performed. A tracheal incision is made through the front surface of the neck and a hollow tube is inserted through it into the trachea. Such manipulation is usually performed in a hospital setting. After restoration of airway patency, it is possible to start artificial respiration and chest compressions.
Artificial respiration is performed when stopping, severe oxygen deficiency, which often happens with head and neck injuries, acute poisoning, etc. When breathing stops, a person loses consciousness, his face turns blue. Respiratory arrest is determined by the absence of movements of the victim's chest by placing a palm on it. When listening to the lungs with a phonendoscope, breath sounds are also not detected.
To perform artificial respiration, it is necessary to lay the victim on his back, tilt his head back as much as possible to prevent tongue retraction. There are two methods of artificial respiration: mouth-to-mouth and mouth-to-nose. If for some reason it is impossible to exhale into the patient's mouth, for example, his teeth are tightly clenched or there is an injury to the lips or bones of the facial part, then they clamp his mouth and exhale into his nose.
Before carrying out artificial respiration, you need to take a handkerchief or any other piece of loose tissue, preferably gauze, as a pad during artificial respiration. The caregiver stands to the right of the victim. If a person is lying on the floor, you need to kneel next to him. Clean the oral cavity from mucus, blood and other foreign contents, then cover the mouth with a prepared clean handkerchief or gauze.
With the left hand, it is necessary to bring the lower jaw of the victim forward around the corners so that the lower teeth are in front of the upper ones, and with the right hand, pinch his nose. Having taken a deep breath, the person assisting, clasping the lips of the victim with his mouth, through a napkin makes the maximum energetic exhalation into his mouth. And it is very important to create close contact with the lips of the victim. If this is not done, then the air inhaled into it will leave through the corners of the mouth, and if you do not pinch the nose, then through it. Then all efforts will be in vain.
Artificial respiration can be carried out using an air duct (S-shaped tube). It is inserted into the victim's mouth and held with one hand along with the chin, with the other hand they pinch the nose. Passive breath of the victim should last approximately 1 second. After that, the assisting person releases the patient's mouth and unbends. Passive exhalation of the victim should be 2 times longer than inhalation, about 2 seconds. At this time, the caregiver takes 1-2 small ordinary breaths of exhalation for himself.
During resuscitation, 10–15 blows of air into the mouth or nose of the victim are performed per minute. If artificial respiration is performed correctly and air enters his lungs, there will be noticeable movement of his chest. If her movements are insufficient, then this indicates that either the patient's tongue sinks, or the volume of inhaled air is too small.
Simultaneously with the start of artificial respiration, the presence of contractions is checked. If they are absent, an indirect heart massage is performed simultaneously with artificial respiration.
Indications for an indirect heart massage are its stop, life-threatening cardiac arrhythmias (fibrillation). The victim is laid on his back on a hard surface (floor, asphalt, long table, hard stretcher), his head is thrown back. Determine the presence or absence of breathing, heartbeat. The caregiver then stands to the left of the victim or kneels if the victim is on the ground.
He places the palm of his left hand on the lower third of his sternum, and on top of it - the palm of his right hand. The left hand is located along the sternum, the right - across. Presses on the sternum strongly enough - so that it bends by 5-6 cm, lingers in this position for a moment, after which it quickly releases its hands. The frequency of pressure should be 50-60 in 1 minute. Every 15 pressures, 2 frequent breaths are taken by the victim using the mouth-to-mouth or mouth-to-nose method.
Signs of the effectiveness of indirect heart massage are the narrowing of previously dilated pupils, the appearance of a heartbeat, spontaneous breathing. Massage is carried out until the restoration of cardiac activity, the appearance of a distinct on the arteries of the limbs.
If this was not achieved within 20 minutes, then resuscitation should be stopped and the death of the victim should be certified. If the first aid provider has a friend, then it would be optimal to simultaneously conduct an indirect heart massage and artificial respiration in a ratio of 3: 1 - 5: 1, that is, for 3-5 massage movements in the sternum - 1 breath.
Based on the book "Quick help in emergency situations."
Kashin S.P.
54. Ensuring the patency of the upper respiratory tract in children
Ensuring the patency of the upper respiratory tract in children. In an unconscious patient, obstruction of the upper respiratory tract is primarily due to retraction of the tongue. In addition, in the supine position, the protruding occiput can contribute to neck flexion, and the entrance to the airways will be closed. Therefore, ensuring an unobstructed airway is the main task of the prehospital physician.
Mechanism of airway obstruction in the supine position
To restore airway patency, it is necessary to perform the "triple reception" of Safar, which includes three stages:
1) throw back (unbend) the head;
2) open the patient's mouth;
3) push the lower jaw and remove all visible foreign bodies (fragments of teeth, mucus, vomit, etc.).
Airway management can also be accomplished by using a head extension maneuver with chin thrust.
Extension of the head at the atlanto-occipital joint with chin thrust.
1. Place one hand on the child's forehead, and gently bend the head back, moving it to a neutral position. The neck will be slightly extended.
2. Excessive hyperextension is undesirable, as the cervical spine arches and shifts the larynx anteriorly.
3. Simultaneously with the extension of the head, place the fingers of the other hand over the bony part of the lower jaw, near the chin point. Move the lower jaw up and towards you to open the airway. Be careful not to close your lips and mouth or move the soft tissue under your chin, because doing so can close rather than open your airway.
4. If there is hypersalivation, vomiting or a foreign body, remove them.
Mandible and tongue retraction maneuver.
To extend the lower jaw, it is necessary to grab the II - V or II - IV fingers of both hands on both sides of the corners of the victim's lower jaw and pull it forward and up with force. With the thumbs, which remain free with this technique, you can pull back the upper lip.
If it is necessary to remove a foreign body in an unconscious patient, the lower jaw should be brought forward along with the tongue.
To perform this maneuver, you must:
- make sure the child is unconscious;
- insert the thumb into the patient's mouth and place two or three fingers on the outside of the jaw;
- squeeze the tongue and lower jaw between the thumb and other fingers and bring it forward and up;
- quickly inspect the mouth;
- in case of vomiting, hypersecretion, the presence of blood, fragments of teeth or a foreign body, remove them.
With the correct position of the child, ensuring the patency of the respiratory tract, the external auditory meatus and the shoulder are located at the same level.
Restoration and maintenance of airway patency in case of suspected head and neck injury.
If the patient has a head and neck injury, it is very important to immobilize the cervical spine and adequately open the airway with a jaw thrust maneuver. Head extension with chin protrusion to secure airway patency is not recommended in this case, as movement of the neck may exacerbate the injury.
If damage to the cervical spine is suspected, the lower jaw should be advanced without tilting the head. In this case, this is the safest method that allows you to secure the airway with a motionless neck.
Assessing the effectiveness of breathing after restoration of airway patency.
After the airway is cleared, it is necessary to make sure that the child has adequate breathing. For this purpose, within no more than 10 seconds, it is necessary to evaluate the excursions of the chest and abdomen, feel the movement of air at the mouth and nose of the child, hear the exhaled flow of air from the mouth. You can listen to breath sounds over the airways, which will allow you to determine the degree of respiratory failure in the child.
If the child is breathing adequately, does not show any signs of injury, and does not require artificial respiration or other CPR, then it is necessary to turn him on his side in the so-called recovery position.
Recovery position to maintain airway patency
This position allows the airway to be kept open.
To move the child into a recovery position. it is necessary to simultaneously turn the head, shoulders and body of the patient to the side. The child's leg, which will be on top, must be bent and the knee pushed forward, which will make the position stable.
This position helps keep the airway open, stabilizes the cervical spine, minimizes the risk of aspiration, limits pressure on bony prominences and peripheral nerves, allows observation of the child's breathing and appearance (including the color of the mucous membranes of the lips), and provides access to the patient for medical interventions.
In case of inadequate spontaneous breathing, artificial respiration is necessary.
Restoration of airway patency is an important stage, without which it is unthinkable to carry out effective cardiopulmonary resuscitation.
The causes of airway obstruction are as follows: tongue retraction, the presence of mucus, sputum, vomit, blood, foreign bodies.
The choice of airway repair method depends on the level of obstruction and the circumstances in which the obstruction occurs.
ACTION ALGORITHM:
1. Lay the patient on a rigid base, unbuttoning tight clothes.
2. Turn the patient's head to the side.
3. With a finger wrapped in a handkerchief or gauze, clean the oral cavity from mucus, vomit, blood, sputum.
4. For this purpose, you can use an ordinary rubber bulb, after cutting off its thin end, or an electric suction.
5. If available, remove removable dentures from the patient.
6. If there are foreign bodies with 2 - 3 fingers, like tweezers, try to grab and remove the foreign body / if possible /.
7. Bring the right hand under the neck, and put the left hand on the forehead, and tilt the patient's head / bend back /.
8. Place a roller under the shoulder blades. In this position, the tongue rises up and moves away from the back of the pharynx. Thus, the obstruction to the path of air is eliminated and the lumen of the airways is small.
These measures are necessary because in the supine position and relaxed muscles, the airway lumen decreases, and the root of the tongue closes the entrance to the trachea.
ARTIFICIAL LUNG VENTILATION / IVL /.
IVL is carried out by the method of active blowing of air into the lungs of the victim.
The task of mechanical ventilation is to replace the lost or weakened volume of ventilation of the pulmonary alveoli.
IVL can be carried out in several ways. The simplest of them is artificial ventilation of the lungs according to the “mouth-to-mouth” or “mouth-to-nose” method.
ACTION ALGORITHM:
1. Maintain a clear airway.
2. With the thumb and forefinger of the hand located on the patient's forehead, pinch the nose and perform ventilation in the mouth-to-mouth manner.
3. Take a deep breath.
4. Pressing your mouth tightly against the patient's mouth, isolated with a gauze (or handkerchief), make a deep energetic exhalation into his airways. Try to blow in a large volume (about 1 liter) of air so that the chest expands well.
5. Then step back, keeping the patient's head tilted back, and allow passive exhalation to occur.
6. As soon as the chest drops and takes its original position, repeat the cycle.
Remember! The duration of the inhalation should be 2 times shorter than the exhalation. The frequency of injections on average should be equal to 15 - 20 per minute.
When carrying out mechanical ventilation by the mouth-to-nose method, the position of the patient is the same, but the patient's mouth is closed and at the same time the lower jaw is shifted forward to prevent the tongue from sinking. Blowing is done through the patient's nose.
IVL EFFICIENCY CRITERION.
1. Simultaneous expansion of the chest with inflation.
2. Listening and feeling the movement of the blown jet during inspiration.
COMPLICATIONS IVL.
Air enters the stomach, resulting in swelling of the epigastric region. This can lead to regurgitation of gastric contents, i.e. passive leakage of stomach contents into the respiratory tract.
INDIRECT / CLOSED / HEART MASSAGE.
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, it is possible to compress the region of the heart and artificially induce systole. In this case, blood from the heart is ejected into the large arteries of the large and small circles of blood circulation. If the pressure is stopped, then the contraction of the heart will stop and blood is sucked into it. This is artificial diastole.
The rhythmic alternation of chest contraction and the cessation of pressure replaces cardiac activity, providing the necessary pressure, replaces cardiac activity, providing the necessary blood circulation in the body. This is the so-called indirect heart massage - the most common method of revitalization, carried out simultaneously with mechanical ventilation.
ACTION ALGORITHM:
1. Place the patient on a solid base / floor, ground, operating table, gurney, bed with a hard base, etc. /
2. Stand on the side of the patient and place your palms on the lower third of the sternum 2 transverse fingers / 1.5 - 2.5 cm / above the xiphoid process. Place the palm of the right hand perpendicular to the axis of the sternum, the palm of the left hand - on the back surface at an angle of 90 degrees to the base of the right hand. Both hands are brought to the position of maximum extension, fingers should not touch the chest.
3. With the effort of the whole body with the help of the hands / during the massage, the hands should remain straight / jerk and rhythmically press on the sternum so that it bends 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 take your palms off the sternum. The number of compressions on the sternum should be on average 60 - 70 per minute.
EFFICIENCY CRITERION OF CLOSED HEART MASSAGE.
1. Change in the color of the skin / they become less pale, gray, cyanotic
2. Constriction of the pupils with the appearance of a reaction to light.
3. The appearance of a pulse on the large arteries / carotid, femoral, radial /.
4. The appearance of blood pressure at the level of 60 - 80 mm Hg.
5. Subsequent restoration of spontaneous breathing.
COMPLICATION OF CLOSED HEART MASSAGE
Fracture of the ribs and sternum with injury to the heart, lung and pleura and the development of pneumo- and hemothorax.
NOTE:
WHEN REVIVED BY ONE PERSON:
Having ensured the patency of the airways, 2 blows into the lungs and then 15 pressures on the sternum / ratio 2: 15/.
WHEN REVIVED BY TWO PEOPLE,
One assisting person performs mechanical ventilation, the other - heart massage in the ratio of 1 breath - 5 pressures on the sternum / 1: 5 /.
A prerequisite for effectiveness is the cessation of injections at the time of pressure on the sternum and, conversely, it is not necessary to massage when the injection is performed.
To restore airway patency, open your mouth the victim and clean the oropharynx To do this, in the victim, who is in the supine position, the lower jaw is displaced downwards, pressing the chin with the thumbs, and then with the help of three fingers placed at the corners of the jaw, push it forward (triple reception). The floor of the oral cavity, the root of the tongue and the epiglottis are mixed anteriorly, opening the entrance to the larynx. Overextension of the head back increases the effectiveness of this technique. It is very important to keep your head in this position.
To prevent the victim from closing his mouth, you need to place a spacer between his jaws (rolled handkerchief, cork, etc.). The mouth dilator is used only for severe lockjaw and in cases where it is impossible to open the mouth using these techniques. The use of a tongue holder is justified only in some cases, for example, with fractures of the cervical spine, when it is impossible to tilt the head back or give the victim a safe position.
If there are no devices for cleaning the oropharynx, sputum removal and foreign content (vomit, mud, sand, etc.) is produced with a finger wrapped in cloth. Sputum, which usually accumulates in the retropharyngeal space, is easily removed by suction, especially if the procedure is carried out under direct laryngoscopy
In the absence of any devices restore airway patency in case of tongue attack it is possible with the help of a special technique (see Fig. 32.2), which also facilitates the evacuation of the contents from the oral cavity. To prevent retraction of the tongue of the victim, lay on his side or stomach.
If it is necessary to transport the victim in the supine position, you should put a roller under his shoulders or hold the extended lower jaw with your hands. You can grab the tongue with your fingers (through gauze). If everything is done correctly, then spontaneous breathing is restored. To prevent the retraction of the tongue, the use of air ducts is most effective (Fig. 35.1). Most often, rubber or plastic air ducts are used, the shape of which corresponds to the curvature of the surface of the tongue. The air duct must be sufficiently long and wide. One end should be in the laryngeal part of the pharynx between the root of the tongue and the back surface of the oropharynx, and the other, having a shield, is placed between the teeth and fixed with a thread. The internal diameter of the airway must be sufficient to allow normal spontaneous breathing and the insertion of a suction catheter. Do not use a short or insufficiently wide air duct. If there are difficulties with the introduction of the air duct, it should be turned with a bend upwards and, passing between the teeth, rotate in the mouth to the correct position. If necessary, mechanical ventilation is better to use an S-shaped air duct, which has a non-fixed rubber shield, which allows you to adjust the depth of the air duct insertion into the oropharynx (Fig. 35.2).
Rice. 35.1. Types of air ducts.
a - Gvsdslla; b - S-shaped; in - Mayo; g - nasal.
Rice. 35.2. The use of air ducts.
a - determination of the length of the duct; b - position of the air duct: 1 - oral, 2 - nasal, 3 - incorrect.
Removal of foreign bodies from the respiratory tract. If solid foreign bodies enter the respiratory tract, 4 blows should be made in the interscapular region, 4 strong shocks in the epigastric region (reception is contraindicated in pregnancy), auxiliary manual breathing by squeezing the chest. First aid is completed by picking up a foreign body at the entrance to the larynx with a finger and removing it.
Postural drainage and accessory cough. If the patient is unconscious and aspiration of water, blood, or other fluids has occurred, positional drainage should be applied using gravity to facilitate the evacuation of fluid from the bronchi into the trachea and then into the larynx. In the most severe and acute cases, effective drainage of the respiratory tract is provided in the position of the patient with the head lowered and the foot end raised, as well as when turning it from side to side. The effectiveness of drainage by position increases with the use of percussion and auxiliary cough. Of course, a victim with multiple severe injuries, especially with fractures of the spine and skull, cannot be turned.
In the event of a drowning, the first step in helping ashore is to raise the pelvis to free the stomach and respiratory tract from water. When transporting such a victim, you can put it on its side with a raised pelvis, lowering its head.
If, with respiratory failure caused by emphysema, bronchitis and asthma, spontaneous breathing is preserved and bronchial obstruction progresses, it is recommended to induce an auxiliary cough by sharply squeezing the lower half of the chest during exhalation synchronously with coughing movements. Both postural drainage and assisted coughing are performed with spontaneous breathing prior to the start of mechanical ventilation. Auxiliary cough is contraindicated in traumatic brain injury due to increased intracranial pressure, with trauma to the cervical and thoracic spine, as paralysis is possible. With a spinal injury, only longitudinal traction is necessary. Turning the patient without proper immobilization can cause displacement of the vertebrae and compression of the spinal cord. If the patient cannot cough up on his own or cough tension is dangerous for him, it is necessary to intubate the trachea, followed by suction of the contents from the trachea and bronchi.
There are certain rules suction content from the respiratory tract which must be observed even in an emergency. It is important that the catheter is sterile, so it is better to use disposable catheters. First, check the tightness and correctness of the connections of the entire suction system. It is necessary to completely evacuate sputum from the upper respiratory tract. In a victim lying on his back, sputum usually accumulates in the retropharyngeal space. The best suction method is with a laryngoscope and visual control. When sucking through the nose, the catheter is inserted through the lower nasal passage to the back of the pharynx with a quick movement with the suction turned off. Then the suction is turned on and the catheter is removed by rotating it, as well as moving it slightly back and forth. The same procedure is performed through the mouth. By the sound that arises from the movement of the secret through the suction tube, determine the effectiveness of aspiration. If the catheter is transparent, then it is easy to establish the nature of sputum (mucus, pus, blood, etc.). At the end of the procedure, the catheter should be washed with a solution of furacilin. When sucking from the oral cavity, you can use a transparent curved mouthpiece attached to the suction tube. After emergency tracheal intubation, sputum should be carefully aspirated from the trachea and bronchi.
Tracheal intubation is the final method of emergency care for acute respiratory disorders. This is the most important and most effective technique, restoring the patency of both the upper and lower respiratory tract. In cases where the methods described above have proved ineffective, tracheal intubation should be resorted to as soon as possible. It is also indicated in all cases of severe hypoventilation and apnea, after severe poisoning with toxic gases, after cardiac arrest, etc. Only tracheal intubation allows you to quickly and effectively suck out the tracheobronchial secret. The inflatable cuff prevents aspiration of gastric contents, blood, and other fluids. Through an endotracheal tube, it is easy to carry out mechanical ventilation in the simplest ways, for example, “mouth-to-tube”, using an Ambu bag or a manual breathing apparatus.
Rice. 35.3. A set of instruments for tracheal intubation.
a - laryngoscope with a set of blades; b - endotracheal tubes (No. 1-10); in - mandrsn; g - suction tip; e - Meigill forceps.
For tracheal intubation, you need: a complete set of endotracheal tubes (sizes 0 to 10), a laryngoscope with a set of blades, mandrin, Meigill's forceps and other devices (Fig. 35.3).
The endotracheal tube is inserted through the mouth or through the nose using a laryngoscope or blindly. When providing emergency care, orotracheal intubation is usually indicated, which takes less time than nasotracheal intubation, and is the method of choice in the unconscious state of the patient and severe asphyxia. The position of the head during intubation is classic or improved (Fig. 35.4; 35.5).
Rice. 35.4. Stages of orotracheal intubation. The position of the head during tracheal intubation is classic (A), improved (B).
a - direct laryngoscopy; b - entrance to the larynx; 1 - epiglottis; 2 - vocal cord; 3 - glottis; 4 - chsrpalovidny cartilage; 5 - entrance to the esophagus; c - tracheal intubation; g - inflation of the cuff; e - fixation of the endotracheal tube.
Nasotracheal intubation in an emergency situation can be performed if it is impossible to perform orotracheal intubation, fracture of the cervical spine and occipital bone. The direction of insertion of the tube must strictly correspond to the location of the lower nasal passage, the largest and widest. The patency of the nasal passages may be different in the right or left side of the nose. If there is an obstacle to the movement of the tube, change sides. For nasotracheal intubation, a long endotracheal tube is used, approximately one number shorter than the tube used for orotracheal intubation. The endotracheal tube must pass the suction catheter freely.
Rice. 35.5. Nasotracheal intubation.
a-using Msigilla spikes; b - blindly.
Causes of difficulty in intubation may include obstruction of the nasal passages, enlarged tonsils, epiglottids, croup, laryngeal edema, mandibular fractures, and a short ("bull") neck. Tracheal intubation can be extremely difficult if the patient's head and neck are not properly aligned with the midline of the anatomical structures, and if the airway is blocked by blood, vomit, or other obstructions. Due to the mobility of the trachea, finger pressure may facilitate intubation.
After a thorough toilet of the trachea and bronchi, the victim is transported to a medical facility. If mechanical ventilation is necessary, it is carried out at this stage of medical care.
Cricothyroidotomy (conicotomy) carried out at the level of the glottis and above it if it is impossible to intubate the trachea in case of threatening asphyxia due to partial or complete airway obstruction. It quickly restores airway patency. For its implementation, only a scalpel and minimal preparation are needed.
Anatomical landmarks are the thyroid and cricoid cartilages of the larynx. The upper edge of the thyroid cartilage, protruding on the anterior surface of the neck in the form of an angle and well palpable through the skin, is called the laryngeal protrusion. The cricoid cartilage is located below the thyroid and is well defined by palpation. Both cartilages are connected in front by a cone-shaped membrane, which is the main reference point for cricothyroidotomy and puncture. The membrane is located close under the skin, is easily palpated, and is less vascularized compared to the trachea. Its average size is 0.9 x 3 cm. With a correctly performed cricothyroidotomy, damage to the thyroid gland and neck vessels is excluded (Fig. 35.6; 35.7).
Rice. 35.6. Anatomical landmarks in cricothyroidotomy.
1 - thyroid cartilage; 2 - cricoid cartilage; 3 - cricoid membrane. The site of dissection or puncture of the cricoid membrane is indicated by a circle.
Rice. 35.7. Cricothyroidotomy.
a - dissection of the cricothyroid membrane in the transverse direction; b - percutaneous cricothyroidotomy: 1 - puncture site, 2 - insertion of a curved cricothyroidotomy cannula with a trocar, 3 - removal of the trocar, 4 - fixation of the cannula and preparation for mechanical ventilation.
A transverse incision of the skin about 1.5 cm long is made strictly above the membrane, the fatty tissue is exfoliated, the membrane is cut in the transverse direction and a tube with an inner diameter of at least 4-5 mm is inserted into the hole. This diameter is sufficient for spontaneous breathing. You can use special conicotomes and needles with a plastic catheter attached. Puncture of the cricothyroid membrane with a smaller diameter needle does not restore adequate spontaneous respiration, but allows for translaryngeal HF IVL and save the life of the patient for the time required to complete tracheal intubation. Cricothyroidotomy is not recommended for young children.
Tracheostomy is not the main method of emergency care at the prehospital stage, since its implementation requires a certain skill, appropriate tools, etc. When performing a tracheostomy, one should be aware of the likelihood of damage to the jugular veins and even air embolism of the pulmonary artery, bleeding from the surrounding veins and arteries that is difficult to stop. In most cases, tracheal intubation is preferable, except in situations where it is not possible (crushing of the maxillofacial region, larynx, fatal obstruction of the upper respiratory tract).
Rear extension of the head. Execution Method:
Option number 1 . During mouth-to-nose ventilation. One hand of the resuscitator is superimposed on the forehead of the victim, the thumb of the other hand is placed in the gap between the lower lip and the chin of the victim, the remaining four fingers of the same hand press the lower jaw to the upper. It is necessary to ensure that the victim's lips are tightly compressed (so that there is no air release during ventilation).
Option number 2. During mouth-to-mouth ventilation. One hand of the resuscitator is superimposed on the forehead of the victim, the nose is closed with the thumb and forefinger; the other is placed under the neck. The head is recurved backwards. The victim's mouth is open by approximately one transverse finger. Contraindications for the use of hyperextension of the head: suspected trauma to the head and cervical spine.
Removal of the lower jaw anteriorly. The thumbs of both hands of the resuscitator are superimposed between the lower lip and chin. The remaining fingers are superimposed on the corners of the lower jaw. Pressure is applied to the corners of the lower jaw in the “forward and upward” direction, with the thumbs the chin is retracted downwards. The mouth is half open. Contraindications: suspected mandibular fracture (mobility of the mandibular bone, crepitus on palpation, deformity or hematoma in the mandible, etc.).
Language fixation. A dry triangular piece of cloth is wrapped around the tongue of the victim and pulled out of the mouth. During artificial ventilation, it is fixed outside the oral cavity. Contraindications: bleeding from the oral cavity, trauma to the lower jaw with damage (chipped) of the lower incisors (risk of bleeding from the vessels of the tongue).
Invasive methods should only be carried out when none of the above methods is possible.
Language fixation. A safety pin is pierced through the muscle of the tongue perpendicular to the muscle fibers. For the ends of the pin, the tongue is removed from the oral cavity. Another option: after piercing the tongue with a pin, fix it to the victim's cheek.
Conicotomy. It is carried out when it is impossible to carry out the above measures, or tracheal intubation, or if emergency mechanical ventilation of the lungs is necessary if tracheal intubation is impossible. We present a simplified version that does not require a cutting tool and opening the trachea.
Necessary equipment: disposable syringe; a needle for intravenous injection, preferably with a diameter of 1 mm or more, in the absence of a wide needle - a needle of any diameter; syringe 2 ml, cut across approximately in the middle; Ambu bag or ventilator. It is desirable to have: needle catheter (at least 1 mm in diameter) or a central vein catheter.
With the thumb and forefinger of one hand, the skin on the neck is stretched around the trachea, the trachea is fixed from the sides. A syringe with a needle put on it punctures the trachea along the midline in the gap between the thyroid and cricoid cartilages. Puncture direction: at an angle of 45° to the length of the trachea and towards the diaphragm. After a feeling of failure, the syringe plunger is pulled towards itself, air should freely pass into the syringe.
A cut-off syringe is connected to the needle, an Ambu bag or a ventilator is attached to it, and artificial ventilation of the lungs is carried out.
If there is a catheter on the needle after tracheal puncture, the needle is removed and ventilation is carried out through the catheter.
In the presence of a catheter for catheterization of the central vein, a conductor is passed through the needle into the trachea, then a catheter is passed through the conductor, and after that ventilation of the lungs is carried out through the catheter. Manipulation should not be performed in the absence of the necessary experience and equipment.
Tracheal intubation. It is carried out in the presence of appropriate instruments (endotracheal tubes, blades) and sufficient skill, by an experienced specialist.
After the restoration of airway patency, no later than 60 seconds after the start of resuscitation, the resuscitator should start artificial ventilation of the lungs.
At the initial stage of ventilation, the resuscitator makes two slow, shallow exhalations. After each exhalation, the resuscitator turns his head so that the chest excursion of the victim is visible, the resuscitator's ear and cheek opposite the victim's nose and mouth at a distance of about 30-40 cm, the resuscitator listens and feels the air exhaled by the victim.
In the absence of chest excursion, in the absence of spontaneous exhalation of the victim, the resuscitator again checks the airway patency and again conducts the initial stage of ventilation. In the absence of effect, these measures are carried out three times, after which a tracheotomy or conicotomy is necessary. The duration of this stage should not exceed 10-15 seconds.
After the initial stage of ventilation, the resuscitator begins to carry out artificial ventilation of the lungs using the “mouth to mouth”, “mouth to nose” or “mouth to mouth and nose” method of the victim (see Table 13).
Tab. 13 .Methods of artificial ventilation of the lungs
| IVL method | Execution Method | Features of the |
| IVL method "mouth to nose" | The resuscitator is on his knees on the side of the victim, performs rearward extension of the head according to option No. 1, opens his mouth wide with his lips, wraps tightly (important!) around the victim’s nose so that there is no air leakage around the resuscitator’s lips. A normal breath is taken. | Make sure that the victim's mouth is tightly closed. Ensure that there is no venting of air around the lips of the resuscitator. Exhalation should not be forced or very deep. After expiration, the resuscitator evaluates the patient's spontaneous exhalation and the effectiveness of the chest excursion. Contraindications: m acute epistaxis, obstruction of the nasal passages, fracture of the bones of the nose |
| IVL method “mouth to mouth” | The resuscitator on his knees on the side of the victim, performs rear extension of the head according to option No. 2, or the lower jaw retraction technique; opens his mouth wide, tightly wraps his lips (IMPORTANT!) around the mouth of the victim so that there is no air leakage around the lips of the resuscitator. A normal breath is taken. | Make sure the victim's nose is closed. Ensure that there is no venting of air around the lips of the resuscitator. Make sure that air does not enter the stomach of the victim (clinically manifested by the absence of chest excursion and the appearance of epigastric swelling). Exhalation should not be forced or very deep. After his exhalation, the resuscitator evaluates the spontaneous exhalation of the patient and the effectiveness of the excursion of his chest. Contraindications: trauma to the face with a defect in the bones of the lower jaw, the impossibility of tightly wrapping the lips around the mouth of the victim, massive bleeding from the oral cavity |
| IVL “mouth to mouth and nose” | The resuscitator on his knees on the side of the victim, performs rear extension of the head according to option No. 2, or the lower jaw retraction technique; opens his mouth wide, tightly wraps his lips (IMPORTANT!) around the mouth and nose of the victim so that there is no air leakage around the lips of the resuscitator. A normal breath is taken. | It is carried out in children under 1 year old. Features of the conduct and contraindications - see above. |
Note: Respiratory rate should be age-appropriate.
Complications of IVL: a) Entry of air into the stomach of the victim. Clinic: lack of spontaneous exhalation, lack of chest excursion of the victim and swelling of the epigastrium. Treatment: the head of the victim turns to the side, with one hand the resuscitator opens the victim's mouth, the other presses on the epigastric region, squeezing air out of the stomach. The second option is the setting of a gastric tube (the use is possible only in case of tracheal intubation or tracheotomy). b) Rupture of lung tissue with the development of pneumothorax (an extremely rare complication at the prehospital stage without the use of ventilators). Clinic: lack of chest excursion, bulging of the intercostal spaces on the side of the lesion, total cyanosis. Treatment: puncture of the pleural cavity. c) Inadequate volume of ventilation of the lungs of the victim. Clinic: small excursion of the chest, persistent cyanosis on the background of mechanical ventilation. Treatment: Increase the rescuer's expiratory volume. d) Hyperoxygenation of the resuscitator (with excessively forced breathing). Clinic: dizziness, drop in blood pressure, impaired consciousness up to loss. Treatment: Reduce the rate or depth of the rescuer's breathing.
After the start of mechanical ventilation, the resuscitator proceeds to conduct an indirect heart massage, with a frequency corresponding to age norms, acting in the following sequence:
1. Perform a pericardial stroke (an attempt to restore the electrical activity of the heart mechanically).
2. Takes the correct position of the body: see above.
3. With the little finger, finds the costal angle of the chest and sets the fingers squeezed together, except for the thumb, on the sternum. At the point of touching the sternum with the index finger (or slightly higher), a palm is applied to conduct an indirect heart massage.
4. When laying the palm on the sternum, the fingers are bent without separation from the sternum, the thenar area of the palm is superimposed in the area of the terminal phalanx of the index finger, or slightly higher. After that, the fingers unbend and do not touch the sternum. The second hand is superimposed on top of the rear of the palm (during resuscitation in an adult).
5. Make sure that the arms are extended at the elbows and that the fingers of the underlying hand do not touch the chest.
6. In a vertical direction, presses on the chest so that it contracts approximately 4-5 cm in an adult and 1-3 cm in a child, depending on age.
In a child under 8 years of age, indirect massage is performed with one hand.
In a newborn, heart massage is performed with two fingers:
1 option: the child is on his back on a hard surface, after mechanical ventilation with the index and middle fingers superimposed on the sternum 1 transverse finger below the internipple line, compression is performed in the vertical direction in the transverse direction of the chest by 1-1.5 cm.
Option 2: with the thumbs of both hands, the sternum is compressed in the transverse direction. The fingers are superimposed on one transverse finger below the internipple line. The remaining four fingers of both hands tightly cover the child's chest from the sides and back. The method is more convenient for tracheal intubation.
The ratio of mechanical ventilation and chest compressions. When resuscitation is carried out by one resuscitator: for 2 breaths 10-15 chest compressions in an adult and a child over 8 years old, in a child under 8 years old - for 1 breath 5 chest compressions.
When carrying out resuscitation by two resuscitators: 5 chest compressions for 1 breath, regardless of the age of the child.
Every 5-7 cycles of resuscitation (IVL + indirect massage), the presence of a pulse on the carotid artery is checked.
Complications.Ineffective heart massage(with insufficient pressure on the chest). Clinic: lack of pulsation on the carotid artery when pressing on the chest (checked by an assistant), persistent pallor of the skin.
Fractures of the ribs, sternum and xiphoid process with excessive load or improper laying of hands on the sternum. Clinic: lack of expansion of the chest after pressing on it, a characteristic crunch when pressing on the chest.
Damage to lung tissue fragments of ribs with the development of pneumothorax (see above).
Damage to large vessels with the development of internal bleeding. Clinic characteristic of hemorrhagic shock. Treatment: providing venous access and initiation of infusion.
The effectiveness of resuscitation will be evidenced by the restoration of the heart rhythm, pink skin, an increase in systolic blood pressure to 60-80 mm Hg. Art., the appearance of spontaneous breathing and the reaction of the pupil to light.
If possible, the resuscitator begins to additionally administer medications to increase the effectiveness of resuscitation. The introduction of drugs is recommended only after the start of mechanical ventilation and chest compressions. . It is necessary to provide access to the venous bed as soon as possible. Remember that the use of medications does not replace resuscitation!
Tab. fourteen. Medications during resuscitation
| A drug | Route of administration | Dosage | Multiplicity of introduction |
| Adrenaline 0.1% solution | In/in In/cardio To the floor of the mouth Endotracheal | After 1-1.5 minutes of ineffective resuscitation, the initial dose is administered. Repeated doses are administered three times every 3-5 minutes of ineffective resuscitation | |
| Atropine 0.1% solution | 0.1 ml/year 0.1 ml/year 0.2-0.3 ml/year 0.2-0.3 ml/year + 3-10 ml saline depending on age | After 1-1.5 minutes of ineffective resuscitation, the initial dose is administered. Repeated doses are administered three times every 3-5 minutes of ineffective resuscitation | |
| Prednisolone (optional drug) | In / in In / cardio To the floor of the mouth Endotracheal | Dose not less than 1 mg/kg | Single doses are repeatedly administered up to 5 times during resuscitation. |
| Lidocaine 2% solution (optional drug, used for ventricular fibrillation tachyarrhythmias, etc.) | In / in In / cardio | Bolus administration at the rate of 2-5 mg/kg diluted with saline solution (5-10 ml), then continuous infusion at the rate of 0.5-2 mg/kg per day. | |
| Sodium bicarbonate 4% solution (optional) | I/V | 2 ml/kg | The indicated dose can be administered rapidly drip or bolus every 15 minutes of ineffective resuscitation. |
After resuscitation, access to the venous bed, administration of medications, and if the measures taken are ineffective, as well as in the case of resuscitation of a patient who is being treated in a hospital, electrical defibrillation should be performed.
During defibrillation, the electrodes must be lubricated or moistened with a conductive substance; except for the person conducting the defibrillation, no one should touch the patient at the time of the discharge, for which the resuscitator warns the assistants before defibrillation; the electrodes should tightly touch the skin of the victim at the time of the discharge in order to avoid burns. The initial discharge dose is 2 J/kg (1 J = 1 W.s). If the first shock is ineffective, the next dose is 4 J/kg. The total number of discharges performed can be up to 7.
Stop resuscitation in the absence of effect after 25-30 minutes, except for the situation when the victim is in a state of severe hypothermia (body temperature below 34 ° C): drowning in cold water, freezing, falling asleep with snow, etc. In this case, the resuscitation time countdown begins only after an increase in body temperature to 35.5-36 ° C.
Resuscitation measures are not carried out: 1) patients with signs of biological death; 2) patients with incurable chronic diseases or multiple malformations incompatible with life; 3) with an injury incompatible with life.
Acute respiratory failure (ARF)
ARF is a pathological condition characterized by the inability of the lungs to provide sufficient oxygenation of the body, despite the maximum tension of all compensatory mechanisms.
ODN - characterized by rapid development and represents the greatest danger. Assessment of the adequacy of breathing should be a priority when a child is admitted to a hospital in a serious condition, since it is respiratory disorders that can lead to death in the shortest possible time.
The signs of the possible presence of decompensated respiratory failure include: a) total cyanosis, or acrocyanosis; b) tachypnea, exceeding age norms by more than 15-20%; c) bradypnea, or pathological respiratory rhythms; d) tachycardia exceeding age norms by more than 15-20%; e) bradycardia, f) participation in breathing of the auxiliary muscles of the abdominal press, intercostal muscles, retraction of compliant places of the chest, violation of the mechanics of breathing; g) dysfunction of the central nervous system (hyperexcitability, inappropriate behavior, convulsions, or lethargy, up to coma).
In the presence of at least one of these signs, the issue of hospitalization in the intensive care unit and the immediate start of intensive care should be decided.
In the absence of these signs, the child can be hospitalized in the somatic department, where it is necessary to establish the cause of ARF (Tables 15, 16).
Tab. fifteen.The most common causes leading to tachypnea, depending on the type of shortness of breath
| The nature of shortness of breath | ||
| inspiratory(predominantly difficulty in breathing, retraction of the jugular fossa on inspiration, noisy “stenotic” breathing, intercostal muscles are involved in breathing) | expiratory(predominantly difficult exhalation, exhalation: inhalation = 3:1 or more, chest is often swollen, abdominal muscles are involved in breathing) | mixed(difficulty inhaling and exhaling approximately equally) |
| 1. False croup: - viral - bacterial 2. True croup (diphtheria) 3. Stridor 4. Epiglottitis 5. Foreign body of the upper respiratory tract | 1. Bronchiolitis 2. Obstructive bronchitis 3. Bronchial asthma attack 4. Expiratory stridor | 1. Pneumonia 2. Acute heart failure 3. Decompensated acidosis 4. CNS lesions 5. Salicylates poisoning |
Tab. 16.Differential diagnosis of diseases leading to shortness of breath
| Disease | The most characteristic signs |
| Inspiratory dyspnea | |
| False croup (viral) | Onset against the background of SARS, acute, disease duration from several hours to 1 day, barking cough, hoarseness, noisy breathing. |
| False croup (bacterial) | Sick for 2-3 days on the background of SARS, signs of toxicosis, exsicosis, fever, rough cough, auscultatory signs of bronchitis or pneumonia, noisy breathing. |
| True croup (diphtheria) | Severe intoxication, aphonia, swelling of the mucous membranes, raids in the oral cavity and on the tonsils, no history of preventive vaccinations |
| Stridor | The condition and well-being are not disturbed, ill from birth, snoring breathing, the nature of breathing changes with a change in body position, there are no other signs of DN |
| Epiglottitis | The onset is sudden, with progression of DN, intoxication is strongly pronounced, temperature up to 39-40 ° C, severe sore throat, hypersalivation, dysphagia |
| foreign body | The onset is sudden, against the background of full health, a painful cough is characteristic, a connection with playing with small objects or food, sometimes a foreign body balls in the trachea during breathing. Note: if a foreign body of the upper respiratory tract is suspected, the patient should be transported to the hospital ONLY in a sitting position, accompanied by a doctor. Summons a bronchoscopist for the removal of a foreign body. If this is not possible, transport the patient while sitting, accompanied by a resuscitator, having equipment for intubation or conicotomy at the ready. |
| expiratory dyspnea | |
| bronchiolitis | Age up to 1 year, the condition is extremely serious, usually severe DN, cyanosis, the effect of antispasmodics is insignificant, the abundance of small bubbling rales |
| Obstructive bronchitis | Age up to 3 years, most often sick for the first time, signs of acute respiratory viral infections, wheezing breathing, difficulty exhaling, auscultatory abundance of dry and wet rales in the lungs, the picture is the same on both sides |
| Asthma attack | Age over 3 years, most often the disease is repeated, there are no signs of acute respiratory viral infections, the attack is associated with contact with the allergen, wheezing, breathing is difficult, auscultatory abundance of dry rales in the lungs, the picture is the same on both sides |
| expiratory stridor | The state and well-being are not disturbed, he has been ill since birth, his breathing is snoring, the nature of breathing changes with a change in body position, there are no other signs of DN. |
| Mixed dyspnea | |
| Pneumonia | Any age, there are signs of an infectious disease, local auscultatory and percussion changes |
| Decompensated acidosis | Association with an infectious disease, “machine” breathing, pale skin with a gray tint, often microcirculation disorders |
| heart failure | History of cardiac pathology, tachycardia and muffled heart tones, signs of decompensated heart failure: liver enlargement, moist rales on auscultation |
| Salicylate poisoning | Reception of salicylates on the background of SARS in a dose exceeding the age. Breathing is deep, frequent, with pauses. Sopor or coma, profuse sweating, skin hyperemia. Often signs of a clotting disorder (bleeding, vomiting coffee grounds) |
After establishing the cause and starting therapy for the underlying disease that led to ARF, it is necessary to treat the syndrome of acute respiratory failure and related complications according to general principles. These include:
1. Restoration of airway patency. This is of particular importance when providing assistance at the prehospital stage, or in the presence of decompensated ARF. The methods of restoring airway patency include at the prehospital stage: head overextension in the cervical region, removal of the lower jaw, introduction of air ducts, mechanical ventilation by mouth-to-mouth, mouth-to-mouth and nose, mouth-to-nose ; in an ambulance: IVL with a tight mask using an AMBU bag; in the first-aid post: intubation (or tracheostomy) followed by mechanical ventilation in a hospital in a specialized department.
2. Carrying out oxygen therapy. The technique for carrying out at various degrees of ARF is presented in the table, systems for conducting oxygen therapy (except for ventilators) - in table 17. It should be remembered about the toxic effect of oxygen, therefore, all patients receiving oxygen at a concentration of more than 50% must be additionally prescribed vitamins E for antioxidant purposes and C in age dosages.
3. Improving the rheological properties of sputum and facilitating its discharge from the respiratory tract. The main thing in this direction is the appointment of adequate infusion therapy, periodic changes in body position, percussion or vibration massage, the appointment of inhalation therapy, as well as bronchodilators and mucolytics.
4. Since respiratory failure, especially in severe cases, is accompanied by metabolic disorders (acidosis), their correction is necessary.
Tab. 17. Methods for supplying oxygen
Tab. eighteen.Diagnosis and oxygen therapy of respiratory failure depending on the severity
| Degree | Clinic | Treatment |
| 0 (initial prizes) | Shortness of breath is not expressed or + 5% of the norm, there is no cyanosis, only the main respiratory muscles are involved in breathing. There is no tachycardia, the central nervous system is without features. Changes are determined only in the gas composition of the blood | Oxygen therapy is not indicated. Therapy of the underlying disease |
| 1 (compensated) | Shortness of breath + 10% of the norm without the participation of auxiliary muscles, tachycardia + 10% of the norm, blood pressure is normal or elevated. Cyanosis of the nasolabial triangle, passing by inhalation of 45% oxygen. CNS without features. In the gas composition of the blood, respiratory alkalosis, hypoxemia are determined, signs of metabolic acidosis are possible | Oxygen Therapy: Intermittent delivery (10-20 minutes every hour) of 30-45% warm humidified oxygen through nasal catheters, either through nasal cannulas or in an oxygen tent at a rate of 2-8 liters per minute is possible. In the absence of effect, a constant supply of oxygen in the same ways. The appointment of sedatives is not indicated |
| Signs of transition to the 2nd degree | Shortness of breath + 15% of the norm, auxiliary muscles are involved in breathing. Cyanosis of the nasolabial triangle disappears only when 60-100% oxygen is inhaled. Cardiovascular and nervous system - as in stage 1 | Oxygen therapy: continuous supply of warm humidified 60-100% oxygen through nasal cannulas or nasal catheter or oxygen tent at a rate of 8-10 liters per minute |
| 2 (subcomp-nsiro-bathroom) | Shortness of breath + 20% of the norm, pronounced participation in breathing of the auxiliary muscles, breathing is frequent and superficial. Tachycardia +15% of the norm, blood pressure increased. The skin is pale, sometimes acrocyanosis, which disappears when 100% oxygen is inhaled. Signs of hypoxic damage to the central nervous system: motor and speech anxiety. In the gas composition of the blood, hypercapnia, pronounced metabolic acidosis, a decrease in the partial oxygen content of the blood are noted. | Oxygen therapy: a constant supply of humidified warm 60-100% oxygen to the oxygen tent at a rate of up to 8-10 liters per minute. With severe anxiety, the appointment of sedatives (GHB 50 mg / kg). If there is no effect within 1.5-2 hours or upon transition to stage 3 - tracheal intubation and transfer of the child to breathing with PEEP (Gregory, Martin-Buer, CPAP systems) |
| Signs of transition to stage 3 | Precoma, coma, seizures | Intubation and transfer of the child to mechanical ventilation (parameters see below) |
| 3 (decompensated) | Bradypnea, pathological rhythms of breathing, signs of the collapse of the respiratory center (breathing of the diaphragm and chest in opposite phases), nodding movements of the head, swallowing air, a sharp retraction of the sternum on inspiration, a pronounced participation of auxiliary muscles in breathing. Bradycardia, blood pressure decreased. Cyanosis or a sharp pallor of the skin, decreasing only with hyperventilation. Coma, convulsions, or complete muscle atony | Tracheal intubation and transfer of the child to mechanical ventilation. The initial parameters of mechanical ventilation before determining (if possible) the gas composition or saturation of hemoglobin O 2 (SaO 2) of the blood. When using devices that work by volume: DO=10-15 ml/kg, NPV +10-15% of the norm, inspiratory pressure (Pvd)=10-40 cm of water. Art. depending on age, expiratory pressure (Pvy) = 1-2 cm of water. Art.; the percentage of oxygen in the inhaled mixture (FiO 2) = 60-70%. When using devices operating on pressure: NPV + 10-15% of the norm, FiO 2 60-70%. Inspiratory time (Tvd): premature 0.45; newborns 0.50-0.55; 1-3 months 0.60-0.65; 3-6 months 0.65-0.70; 1-3 years 0.75-0.85; 3-6 years 0.85-0.90; 6-9 years old 0.95-1.05; 14 years and adults 1.55-2.55. Inhale: exhale - premature 1:1.4; newborns 1:1.5; 1-3 months 1:1.6-1:1.7; 6 months 1:1.8; 1 year 1:1.9; older than a year 1:2. Rvd: premature 10 cm of water. Art.; newborns 15-17 cm of water. Art.; 3 months -1 year 20-22 cm of water. Art.; 3-6 years 25-28 cm of water Art.; 9-10 years 30-35 cm H 2 O; 12-14 years 35-40 cm of water Art. Rvyd: in preterm infants with SDR 4-6 cm of water. Art.; in all other cases 1-2 cm H 2 O |
| Respiratory and cardiac arrest, deep coma | Resuscitation and ventilation (see above) |
Assessment of the condition of a patient with respiratory failure should be carried out frequently, if the therapy is ineffective within 1-1.5 hours, or when signs of life-threatening conditions appear, the intensity of therapy increases and a resuscitator is called for a consultation. Table 19 presents laboratory and clinical signs, the definition of which indicates the effectiveness of the measures taken.
Tab. 19.Criteria for the effectiveness of the treatment of ARF
| signs | Efficiency of ongoing activities | Inefficiency of ongoing activities |
| Clinical signs | ||
| Cyanosis | Decrease or absence | Does not change or increases |
| Dyspnea | Disappears or decreases | Does not change, or increases, or decrease in breathing, accompanied by a violation of the central nervous system |
| Tahikar-diya | Decreases or disappears | Increases, or there is a tendency to bradycardia in conjunction with CNS damage |
| CNS state | Anxiety decreases or disappears or, on the contrary, disturbed consciousness is restored | No dynamics, or increasing restlessness or lethargy |
| Condition of the skin | Reduction or disappearance of signs of a pronounced microcirculation disorder (rough marbling, positive s-m "white spot", cold extremities) | Lack of positive dynamics or the appearance of severe microcirculation disorders |
| Laboratory data | ||
| Blood gas indicators | pO 2 > 80 mm Hg. Art. pCO 2< 50 мм рт. ст. НСО 3 < 30мэкв/л, рН около 7,3 | RO 2< 60 мм рт. ст., рСО 2 >60 mmHg Art. 19 meq/l< НСО 3 >40 meq/l, pH< 7 |
| SaO 2 | About 89-90% | Below 89% |
In conclusion, it should be emphasized once again that the assessment of the patient's condition should be carried out in a complex, and the above data can only serve as approximate guidelines in this.
