Connection to a ventilator - indications and implementation. How to perform artificial respiration Providing artificial respiration

Artificial respiration (AR) is an emergency measure emergency assistance in the event that a person’s own breathing is absent or impaired to such an extent that it poses a threat to life. The need for artificial respiration may arise when providing assistance to those who have received sunstroke, drowning, 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 removal of carbon dioxide. In addition, artificial ventilation has a reflex effect on the respiratory center located in the brain, as a result of which independent breathing is restored.

Mechanism and methods of artificial respiration

Only through the process of breathing does a person’s blood become saturated with oxygen and carbon dioxide is removed from it. After air enters the lungs, it fills the lung sacs called alveoli. The alveoli are penetrated 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.

If the body's supply of oxygen is interrupted, vital activity is at risk, since oxygen plays the “first fiddle” in all oxidative processes that occur in the body. That is why, when breathing stops, artificially ventilating the lungs should be started 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 are sent to the respiratory center of the brain, which are a stimulus for the production of response electrical impulses. The latter stimulate contraction and relaxation of the diaphragm muscles, resulting in stimulation of the respiratory process.

Artificially providing the human body with oxygen in many cases makes it possible to completely restore independent respiratory process. In the event that cardiac arrest is also observed in the absence of breathing, it is necessary to perform a closed cardiac massage.

Please note that the absence of breathing triggers irreversible processes in the body within five to six minutes. Therefore, timely artificial ventilation 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 are considered more labor-intensive and less effective compared to hardware methods. However, they have one very significant advantage. They can be performed without delay, almost anyone can cope with this task, and most importantly, there is no need for any additional devices and instruments, which are not always at hand.

Indications and contraindications

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

1. For disorders of the central regulation of breathing caused by a violation cerebral circulation, tumor processes of the brain or brain injury.
2. For medicinal and other types of intoxication.
3. In case of defeat nerve pathways and neuromuscular junction, which can be triggered by injury cervical spine spine, viral infections, toxic effect of some medicines, poisoning.
4. For diseases and injuries respiratory muscles and chest wall.
5. In cases of lung lesions of both obstructive and restrictive nature.

The need to use artificial respiration is judged based on the combination clinical symptoms and external data. Changes in pupil size, hypoventilation, tachy- and bradysystole are conditions that require artificial ventilation. In addition, artificial respiration is required in cases where spontaneous ventilation of the lungs is “turned off” using injections. medical purpose muscle relaxants (for example, during anesthesia for surgical intervention or during intensive care convulsive syndrome).

As for cases when ID is not recommended, then absolute contraindications does not exist. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. So, for example, if venous return of blood is difficult, artificial respiration modes are contraindicated, which provoke even greater disruption. In case of lung injury, ventilation methods based on the injection of air from high pressure etc.

Preparing for artificial respiration

Before performing expiratory artificial respiration, the patient should be examined. Such resuscitation measures are contraindicated for facial injuries, tuberculosis, poliomelitis and trichlorethylene poisoning. In the first case, the reason is obvious, and in the last three, performing expiratory artificial respiration puts the person performing resuscitation at risk.

Before starting expiratory artificial respiration, the victim is quickly freed from clothing squeezing the throat and chest. The collar is unbuttoned, the tie is undone, and the trouser belt can be unfastened. The victim is placed supine on his back on a horizontal surface. The head is tilted back as much as possible, the palm of one hand is placed under the back of the head, and the other palm is pressed on the forehead 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 cushion of folded clothing is placed under the shoulder blades.

After this, 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. Can be used next appointment: Make a small hole in the middle of a handkerchief or gauze. Its diameter should be two to three centimeters. The fabric is placed with a hole on the victim’s mouth or nose, depending on which method of artificial respiration will be used. Thus, air will be blown through the hole in the fabric.

To carry out artificial respiration using the mouth-to-mouth method, the person who will provide assistance must 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. If the victim's jaws are clenched, they are forced apart.

After this, one hand is placed on the victim’s forehead, 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. At the same time, the victim’s nostrils are pinched with the thumb and index finger 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 quickly, forcefully exhales, blowing air into the airways and lungs. The duration of exhalation should be about a second, and its volume should be at least a liter for effective stimulation of the respiratory center to occur. At the same time, the chest of the person receiving assistance should rise. If the amplitude of its rise is small, this is evidence that the volume of air supplied is insufficient.

Exhaling, the rescuer unbends, freeing the victim's mouth, but at the same time keeping his head thrown back. The patient should exhale for 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 number of air does not enter the lungs, but into the patient’s stomach, this will significantly complicate his rescue. Therefore, you should periodically press on the epigastric region to empty the stomach of air.

Artificial respiration from mouth to nose

This method of artificial ventilation is carried out if it is not possible to properly unclench the patient’s jaws or there is an injury to the lips or oral area.

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

After artificial inspiration is completed, you need to free the patient's nose and mouth. In some cases, the soft palate may prevent air from escaping through the nostrils, so when the mouth is closed, there may be no exhalation at all. When exhaling, head in mandatory kept tilted back. The duration of artificial exhalation is about two seconds. During this time, the rescuer himself must take several exhalations and inhalations “for himself.”

How long does artificial respiration last?

There is only one answer to the question of how long ID should be carried out. You should ventilate your lungs in this mode, taking breaks for a maximum of three to four seconds, until full spontaneous breathing is restored, or until the doctor appears and gives other instructions.

At the same time, you should constantly ensure that the procedure is effective. The patient's chest should swell well, and the facial skin should gradually turn pink. It is also necessary to ensure that there is no foreign objects or vomit.

Please note that due to the ID, the rescuer himself may experience weakness and dizziness due to a lack of carbon dioxide in the body. Therefore, ideally, air blowing should be done by two people, who can alternate every two to three minutes. If this is not possible, the number of breaths should be reduced every three minutes so that the person performing resuscitation normalizes the level of carbon dioxide in the body.

During artificial respiration, you should check every minute to see if the victim’s heart has stopped. To do this, use two fingers to feel the pulse in the neck in a triangle between windpipe and the sternocleidomastoid muscle. Two fingers are placed on lateral surface laryngeal cartilage, after which they are allowed to “slide” into the hollow between the sternocleidomastoid muscle and the cartilage. This is where the pulsation of the carotid artery should be felt.

If there is no pulsation in the carotid artery, chest compressions in combination with ID should be started immediately. Doctors warn that if you miss the moment of cardiac arrest and continue to perform artificial ventilation, it will not be possible to save the victim.

Features of the procedure in children

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

Small patients are also placed on their back. For babies up to one year old, place a folded blanket under their back or slightly raise it top part torso, placing your hand under your back. The head is thrown back.

The person providing assistance takes a shallow breath, seals her lips around the child’s mouth and nose (if the baby is under one year old) or just the mouth, and then blows air into the respiratory tract. The volume of air blown in should be less, the younger the patient. So, in the case of resuscitation of a newborn, it is only 30-40 ml.

If a sufficient volume of air enters the respiratory tract, chest movement occurs. After inhaling, you need to make sure that the chest drops. Blowing too much air into your baby's lungs can cause the alveoli to rupture. lung tissue, as a result of which air will escape into the pleural cavity.

The frequency of insufflations should correspond to the breathing frequency, which tends to decrease with age. Thus, in newborns and children up to four months, the frequency of inhalations and 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 changing the volume of the chest due to the application of external force. Let's look at the main ones.

Sylvester's method

This method is 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 artificial respiration is performed using this method by two people, they kneel on either side of the victim so as to be positioned at the level of his chest. Each of them holds the victim’s hand in the middle of the shoulder with one hand, and with the other just above the level of the hand. Next, 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 functions of exhalation.

In this case, the main thing is that the movements of the hands are as rhythmic as possible. Experts recommend that those performing artificial respiration use their own rhythm of inhalation and exhalation as a “metronome”. In total, you should do about sixteen movements per minute.

ID using the Sylvester method can be performed by one person. He needs to kneel behind the victim’s head, grab his arms above the hands and perform the movements described above.

For broken arms and ribs, this method is contraindicated.

Schaeffer method

If the victim's arms are injured, the Schaeffer method can be used to perform artificial respiration. This technique is also often used for the rehabilitation of people injured while on the water. The victim is placed prone, with his head turned to the side. The one who performs artificial respiration kneels, and the victim’s body should be located between his legs. Hands should be placed on the lower chest to thumbs lay along the spine, and the rest lay on the ribs. When exhaling, you should lean forward, thus compressing the chest, and while inhaling, straighten, stopping the pressure. The elbows are not bent.

Please note that this method is contraindicated for fractured ribs.

Laborde method

The Laborde method is complementary to the Sylvester and Schaeffer methods. The victim's tongue is grabbed and rhythmically pulled, simulating breathing movements. As a rule, this method is used when breathing has just stopped. The resistance of the tongue that appears is evidence that the person’s breathing is being restored.

Kallistov method

This one is simple and effective method Provides excellent 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 passed forward, threaded under the armpits. The person providing assistance should take the towel by the ends and lift the victim’s torso seven to ten centimeters from the ground. As a result, the chest expands and the ribs rise. This corresponds to inhalation. When the torso is lowered, it simulates exhalation. Instead of a towel, you can use any belt, scarf, etc.

Howard's method

The victim is positioned supine. A cushion is placed under his back. Hands are moved behind the head and extended. The head itself is turned to the side, the tongue is extended and secured. The one who performs artificial respiration sits astride the victim’s thigh area and places his palms on the lower part of the chest. With your fingers spread, you should grab as many ribs as possible. When the chest is compressed, it simulates inhalation; when the pressure is released, it simulates exhalation. You should do twelve to sixteen movements per minute.

Frank Eve's 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 placed prone on the stretcher, the face is turned to the side, and the arms are placed along the body. The person is tied to the stretcher at the level of the buttocks or thighs. When lowering the head end of the stretcher, inhale; when it goes up, exhale. 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 victim’s head. He places his hands on the victim’s shoulder blades and, without bending them at the elbows, presses with his palms. This is how exhalation occurs. To inhale, the rescuer takes the victim’s shoulders at the elbows and straightens, lifting and pulling the victim towards himself.

Hardware artificial respiration methods

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

The first automatic ID machines appeared at the end of the nineteenth century. At the beginning of the twenties, several types of respirators appeared at once, which created intermittent vacuum and positive pressure either around the entire body, or only around the patient’s chest and abdomen. Gradually, respirators of this type were replaced by air-injection respirators, which had less solid dimensions and did not impede access to the patient’s body, allowing medical procedures to be performed.

All ID devices existing today are divided into external and internal. External devices create negative pressure either around the patient's entire body or around his chest, thereby inhaling. Exhalation in this case is passive - the chest simply collapses due to its elasticity. It can also be active if the device creates a positive pressure zone.

At internal way In artificial ventilation, the device is connected through a mask or intubator to the respiratory tract, and inhalation is carried out by creating positive pressure in the device. Devices of this type are divided into portable, intended for work in “field” conditions, and stationary, the purpose of which is long-term 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 and even if the patient is on artificial ventilation for a long time. More often undesirable consequences concern respiratory system. Thus, 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, which will help avoid the occurrence of such complications is careful hygiene of the respiratory tract.

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

In patients who have been diagnosed with abscess pneumonia, alveolar ruptures may occur during artificial respiration.

From this article you will learn: in what situations it is necessary to perform artificial respiration and chest compressions, the rules for performing cardiopulmonary resuscitation, the sequence of actions in case of a victim. Common execution errors closed massage heart and artificial respiration, ways to eliminate them.

Article publication date: 07.17.2017

Article updated date: 06/02/2019

Indirect cardiac massage (abbreviated CCM) and artificial respiration (abbreviated ID) are the main components of cardiopulmonary resuscitation (CPR), which is performed on people who have stopped breathing and circulation. These activities help maintain supply to the brain and heart muscle. minimum quantity blood and oxygen, which are necessary to maintain the vital activity of their cells.

However, even in countries with frequent courses in artificial respiration and chest compressions, resuscitation measures are carried out only in half of cases of cardiac arrest outside medical institution. According to a large Japanese study published in 2012, approximately 18% of people in cardiac arrest who received CPR were able to restore spontaneous circulation. After a month, only 5% of the victims remained alive, and neurological disorders were absent in only 2%. Despite these not very optimistic figures, performing resuscitation measures is the only chance of life for a person with cardiac and respiratory arrest.

Modern recommendations for CPR follow the path of maximizing simplification of resuscitation actions. One of the goals of such a strategy is to maximize the involvement of people close to the victim in providing assistance. Clinical death is a situation where it is better to do something wrong than to do nothing at all.

It is precisely because of this principle of maximum simplification of resuscitation measures that the recommendations include the possibility of performing only NMS, without ID.

Indications for CPR and diagnosis of clinical death

Almost the only indication for performing ID and NMS is the state of clinical death, which lasts from the moment of circulatory arrest until the onset of irreversible disorders in the body’s cells.

Before you start performing artificial respiration and chest compressions, you need to determine whether the victim is in a state of clinical death. Already at this very first stage, an unprepared person may have difficulties. The fact is that determining the presence of a pulse is not as easy as it seems at first glance. Ideally, the person providing assistance should feel the pulse in the carotid artery. In reality, he quite often does this incorrectly, moreover, he mistakes the pulsation of his blood vessels in his fingers for the pulse of the victim. It is because of such errors that the clause on checking the pulse in the carotid arteries when diagnosing clinical death was removed from modern recommendations, if assistance is provided by people without medical education.

Currently, the following steps must be taken before starting NMS and ID:

1. After locating a victim who you believe may be clinically dead, check for hazardous conditions around the victim.
2. Then walk up to him, shake his shoulder and ask if he's okay.
3. If he answered you or somehow reacted to your request, this means that he is not in cardiac arrest. In this case, call ambulance.
4. If the victim does not respond to your call, turn him on his back and open his airways. To do this, carefully straighten your head at the neck and move your upper jaw up.
5. Once the airway is open, assess for normal breathing. Do not confuse agonal sighs, which may still be observed after cardiac arrest, with normal breathing. Agonal sighs are superficial and very rare, they are non-rhythmic.
6. If the victim is breathing normally, turn him on his side and call an ambulance.
7. If the person is not breathing normally, call others for help, call an ambulance (or have someone else do it), and begin CPR immediately.

That is, for the onset of NMS and ID, the absence of consciousness and normal breathing is sufficient.

Indirect cardiac massage

NMS is the basis of resuscitation measures. It is its implementation that ensures the minimum necessary blood supply to the brain and heart, so it is very important to know what actions are performed during indirect cardiac massage.

Carrying out NMS should begin immediately after identifying the victim as lacking consciousness and normal breathing. For this:

• The heel of your palm right hand(for left-handers – left) place it on the center of the victim’s chest. It should lie exactly on the sternum, slightly below its middle.
• Place your second palm on top of the first, then interlace their fingers. No part of your hand should touch the victim's ribs, as this increases the risk of fracture when performing NMS. The base of the lower palm should lie strictly on the sternum.
• Position your torso so that your arms rise above the victim’s chest perpendicularly and are extended at the elbow joints.
• Using your body weight (not arm strength), bend the victim's chest to a depth of 5-6 cm, then allow it to restore its original shape, that is, fully straighten, without removing your palm from the sternum.
• The frequency of such compressions is 100–120 per minute.

Performing NMS is difficult physical labor. It has been proven that after about 2–3 minutes, the quality of its performance by one person decreases significantly. It is therefore recommended that, if possible, people providing assistance change each other every 2 minutes.

Errors when performing NMS

• Delay in the start of the event. For a person in a state of clinical death, every second of delay in starting CPR can result in a lower chance of resumption of spontaneous circulation and a worsening neurological prognosis.
• Long breaks during NMS. It is allowed to interrupt compression for no longer than 10 seconds. This is done for ID, changing caregivers, or when using a defibrillator.
• Insufficient or too great compression depth. In the first case, the maximum possible blood flow will not be achieved, and in the second, the risk increases traumatic injuries chest.

Artificial respiration

Artificial respiration is the second element of CPR. It is designed to ensure the supply of oxygen to the blood, and subsequently (subject to NMS) to the brain, heart and other organs. It is precisely the reluctance to perform ID using the “mouth-to-mouth” method that in most cases explains the failure to provide assistance to victims by people who are close to them.

ID execution rules:

1. ID for adult victims is performed after 30 chest compressions.
2. If there is a handkerchief, gauze or some other material that allows air to pass through, cover the victim's mouth with it.
3. Open his airway.
4. Pinch the victim's nostrils with your fingers.
5. Keeping the airway open, press your lips tightly against his mouth and, trying to maintain a tight seal, exhale as usual. At this moment, look at the victim's chest, observing whether it rises as you exhale.
6. Make 2 such artificial breaths, spending no more than 10 seconds on them, then immediately proceed to NMS.
7. The ratio of compressions to artificial breaths is 30 to 2.

Errors when executing ID:

• Attempting to carry out without properly opening the airway. In such cases, the blown air ends up either outside (which is better) or into the stomach (which is worse). The danger of blown air entering the stomach is to increase the risk of regurgitation.
• Not pressing your mouth tightly enough to the victim’s mouth or not closing your nose. This results in a lack of airtightness, which reduces the amount of air that enters the lungs.
• The pause in the NMS is too long, which should not exceed 10 seconds.
• Carrying out ID without stopping NMS. In such cases, the blown air will most likely not enter the lungs.

It is precisely because of the technical complexity of performing ID and the possibility of unwanted contact with the victim’s saliva that it is allowed (moreover, it is strongly recommended) for people who have not completed special courses in CPR, in the case of assisting adult victims with cardiac arrest, to do only NMS with a frequency of 100–120 compressions in a minute. More than proven high efficiency resuscitation measures carried out in out-of-hospital conditions by people without medical training, which consist only of chest compressions, compared to traditional CPR, which includes a combination of NMS and ID in a ratio of 30 to 2.

However, it should be remembered that CPR consisting of chest compressions only can only be performed by adults. For children, the following sequence of resuscitation actions is recommended:

• Identification of signs of clinical death.
• Opening of the airway and 5 artificial breaths.
• 15 chest compressions.
• 2 artificial breaths, after which again 15 compressions.

Stopping CPR

Resuscitation measures can be stopped after:

1. The appearance of signs of resumption of spontaneous circulation (the victim began to breathe normally, move or react in some way).
2. An ambulance arrived and continued CPR.
3. Complete physical exhaustion.

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

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

Not everyone knows how resuscitation measures are carried out if the heart has stopped and there is no breathing. And in life, this knowledge can save a person’s life.

Causes and signs of cardiac and respiratory arrest

The reasons that led to cardiac and respiratory arrest may be:

Before starting resuscitation measures, you should assess the risks for the victim and volunteer helpers - is there a threat of building collapse, 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:

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

The main sign of absence of heartbeat is the absence of pupil reaction to light rays. IN in good condition The pupil contracts when exposed to light and dilates when the light intensity decreases. Advanced indicates dysfunction nervous system and myocardium. However, disruption of pupil reactions occurs gradually. Complete absence reflex occurs 30-60 s after complete cardiac arrest. Some medications can also affect the width of the pupils, narcotic substances, toxins.

The functioning of the heart can be checked by the presence of blood impulses in the large arteries. It is not always possible to find the victim’s pulse. 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 of air escaping from the lungs. If breathing is weak or absent, then characteristic sounds may not be heard. It is not always possible to have a fogging mirror at hand, which can be used to determine whether there is breathing. Movement of the chest may also not be noticeable. Leaning towards the victim’s mouth, 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 problems. However, when poisoned by some toxic substances pink color of the skin is preserved.

The appearance of cadaveric spots and waxy pallor indicates the inappropriateness of resuscitation efforts. This is also evidenced by injuries and damage incompatible with life. Resuscitation measures should not be carried out in case of a penetrating wound to the chest or broken ribs, so as not to pierce the lungs or heart with bone fragments.

After the victim’s condition has been assessed, resuscitation should be started immediately, since after breathing and heartbeat stop, only 4-5 minutes are allotted to restore vital functions. If it is possible to revive after 7-10 minutes, then the death of some brain cells leads to mental and neurological disorders.

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

Algorithm for resuscitation

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

If the patient has a pulse, but it is in the deep fainting, you will need to lay him down on a flat, hard surface, loosen the collar and belt, turning his head to the side to prevent aspiration in case of vomiting, if necessary, clear the airways and oral cavity from accumulated mucus and vomiting.

It is worth noting 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. The agony is reversible, and with properly performed resuscitation measures the patient can be brought back to life.

If the victim does not show any signs of life, then the rescuer must perform the following steps step by step:

When resuscitating the patient, the patient’s condition is periodically checked - 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. If there is no change in condition, resuscitation continues until the ambulance arrives. Only a doctor can give permission to complete the revival.

Method of performing respiratory resuscitation

Restoration of respiratory function is carried out using two methods:

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

If dentures are present, they are removed. The tongue is pulled out and held to prevent blockage of the airway. Then they begin the actual resuscitation.

Mouth-to-mouth method

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

They squeeze the patient’s nose with their 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, the chest will rise noticeably.

If movement is observed only in the abdominal area, then the air has entered the wrong direction - into the trachea, but into the esophagus. In this situation, it is important to ensure that air gets into the lungs. 1 artificial breath is performed within 1 s, strongly and evenly exhaling air into the victim’s respiratory tract with a frequency of 10 “breaths” per 1 min.

Mouth-to-nose technique

The mouth-to-nose resuscitation technique is completely identical to the previous method, except that the person performing the resuscitation exhales into the patient’s nose, tightly closing the victim’s mouth.

After artificial inhalation, the air should be allowed to leave 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, or a handkerchief, but if they are not there, then there is no need to waste time looking for these items - it is worth carrying out rescue measures immediately.

Cardiac resuscitation technique

To begin with, it is recommended to release chest area from clothes. The person providing assistance is located to the left of the person being resuscitated. Perform mechanical defibrillation or pericardial shock. Sometimes this measure restarts a stopped heart.

If there is no reaction, then perform an indirect cardiac massage. To do this, you need to find the end of the costal arch and place the lower part of the palm of your left hand on the lower third of the sternum, and place your right hand on top, straightening your fingers and raising them up (butterfly position). The push is carried out straightened in elbow joint hands, pressing with all body weight.

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

After 3 min. The effectiveness of the activity should be checked. The fact that cardiac activity has been restored is indicated by palpation of the pulse in the area of ​​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 performed:

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

You can also use another method for infants - cover the chest with your palms, and thumb located in the lower third of the xiphoid process. The frequency of kicks varies among children of different ages:

When performing respiratory resuscitation in children, it is done with a frequency of 18-24 “breaths” per 1 minute. The ratio of resuscitation movements of the cardiac impulse and “inhalation” in children is 30:2, and in newborns – 3:1.

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

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

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What kind of poisoning can cause breathing and heartbeat to stop?

Death as a result acute poisoning can happen from anything. The main causes of death in case of poisoning are cessation of breathing and heartbeat.

Arrhythmia, atrial and ventricular fibrillation and cardiac arrest can be caused by:

In what cases is artificial respiration necessary? Respiratory arrest occurs due to poisoning:

If there is no breathing or heartbeat, clinical death. It can last from 3 to 6 minutes, during which there is a chance of saving the person if you start artificial respiration and chest compressions. After 6 minutes, it is still possible to bring a person back to life, but as a result of severe hypoxia, the brain undergoes irreversible organic changes.

When to start resuscitation measures

What to do if a person falls unconscious? First you need to identify signs of life. The heartbeat can be heard by placing your ear to the victim's chest or by feeling the pulse in the carotid arteries. Breathing can be detected by the movement of the chest, leaning towards the face and listening for inhalation and exhalation by holding a mirror to the victim’s nose or mouth (it will fog up when breathing).

If no breathing or heartbeat is detected, resuscitation should begin immediately.

How to do artificial respiration and chest compressions? What methods exist? The most common, accessible to everyone and effective:

• external cardiac massage;
• mouth-to-mouth breathing;
• breathing "from mouth to nose".

It is advisable to conduct receptions for two people. Cardiac massage is always carried out together with artificial ventilation.

Procedure in the absence of signs of life

1. Free the respiratory organs (oral, nasal cavity, pharynx) from possible foreign bodies.
2. If there is a heartbeat, but the person is not breathing, only artificial respiration is performed.
3. If there is no heartbeat, artificial respiration and chest compressions are performed.

How to do indirect cardiac massage

The technique of performing indirect cardiac massage is simple, but requires the right actions.

Why is indirect cardiac massage impossible if the victim is lying on something soft? In this case, the pressure will be released not on the heart, but on the pliable surface.

Very often, ribs are broken during chest compressions. There is no need to be afraid of this, the main thing is to revive the person, and the ribs will grow together. But you need to take into account that broken ribs are most likely the result of incorrect execution and you should moderate the pressing force.

Artificial respiration from mouth to mouth

If a poisoned person has secretions in the mouth that are dangerous for the resuscitator, such as poison, poisonous gas from the lungs, or an infection, then artificial respiration is not necessary! In this case, you need to limit yourself to performing an indirect cardiac massage, during which, due to pressure on the sternum, about 500 ml of air is expelled and again absorbed.

How to do mouth-to-mouth artificial respiration?

For your own safety, it is recommended that artificial respiration is best done through a napkin, while controlling the tightness of the pressure and preventing air “leakage”. Exhalation should not be sharp. Only strong but smooth (for 1–1.5 seconds) exhalation will ensure proper movement of the diaphragm and filling of the lungs with air.

Artificial respiration from mouth to nose

Artificial respiration “mouth to nose” is performed if the patient is unable to open his mouth (for example, due to a spasm).

1. Having laid the victim on a straight surface, tilt his head back (if there are no contraindications for this).
2. Check the patency of the nasal passages.
3. If possible, the jaw should be extended.
4. After a maximum inhalation, you need to blow air into the injured person’s nose, tightly covering his mouth with one hand.
5. After one breath, count to 4 and take the next one.

Features of resuscitation in children

In children, resuscitation techniques differ from those in adults. The chest of babies under one year old is very tender and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect cardiac massage is performed not with the palms, but with two fingers. The movement of the chest should be no more than 1.5–2 cm. The frequency of compressions is at least 100 per minute. From 1 to 8 years of age, massage is done with one palm. The chest should move 2.5–3.5 cm. Massage should be performed at a frequency of about 100 pressures per minute. The ratio of inhalation to compression on the chest in children under 8 years old should be 2/15, in children over 8 years old - 1/15.

How to perform artificial respiration for a child? For children, artificial respiration can be performed using the mouth-to-mouth technique. Since kids small face, an adult can perform artificial respiration by immediately covering both the mouth and nose of the child. The method is then called “mouth to mouth and nose.” Artificial respiration is given to children at a frequency of 18–24 per minute.

How to determine if resuscitation is being performed correctly

Signs of effectiveness when following the rules for performing artificial respiration are as follows.

When artificial respiration is performed correctly, you may notice the chest moving up and down during passive inspiration.

1. If the movement of the chest is weak or delayed, you need to understand the reasons. Probably a loose fit of the mouth to the mouth or nose, a shallow breath, a foreign body preventing the air from reaching the lungs.
2. If, when you inhale air, it is not the chest that rises, but the stomach, then this means that the air did not go through the airways, but through the esophagus. In this case, you need to press on the stomach and turn the patient's head to the side, as vomiting is possible.

The effectiveness of cardiac massage also needs to be checked every minute.

1. If, when performing an indirect cardiac massage, a push appears on the carotid artery, similar to a pulse, then the pressing force is sufficient for blood to flow to the brain.
2. If resuscitation measures are performed correctly, the victim will soon experience heart contractions, blood pressure will rise, spontaneous breathing will appear, the skin will become less pale, and the pupils will narrow.

All actions must be completed for at least 10 minutes, or better yet, before the ambulance arrives. If the heartbeat persists, artificial respiration must be performed for a long time, up to 1.5 hours.

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

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

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Artificial respiration (Artificial ventilation)

If there is a pulse but no breathing: carry out artificial ventilation.

Artificial ventilation. Step one

Provide restoration of airway patency. To do this, the victim is placed on his back, his head is thrown back as much as possible and, grabbing the corners of the lower jaw with his fingers, he pushes it forward so that the teeth of the lower jaw are located in front of the upper ones. Check and clean the oral cavity of foreign bodies. To comply with safety measures, you can use a bandage, napkin, or handkerchief wrapped around your index finger. To keep the victim's mouth open, you can insert a rolled up bandage between the jaws.

Artificial ventilation. Step two

To carry out artificial ventilation of the lungs using the mouth-to-mouth method, it is necessary, while holding the victim’s head back, take a deep breath, pinch the victim’s nose with your fingers, press your lips tightly to his mouth and exhale.

When performing artificial lung ventilation using the mouth-to-nose method, air is blown into the victim’s nose while covering his mouth with his hand.

Artificial ventilation. Step three

After inhaling air, it is necessary to move away from the victim; his exhalation occurs passively.
To comply with safety and hygiene measures, insufflation should be done through a moistened napkin or a piece of bandage.

The frequency of injections should be 12-18 times per minute, that is, you need to spend 4-5 seconds on each cycle. The effectiveness of the process can be assessed by the rise of the victim’s chest when his lungs are filled with inhaled air.

Indirect cardiac massage

If there is no pulse or breathing: time for indirect cardiac massage!

The sequence is as follows: first, indirect cardiac massage, and only then inhalation of artificial respiration. But! If discharge from the mouth of a dying person poses a threat (infection or poisoning by poisonous gases), only chest compressions should be performed (this is called non-ventilation resuscitation).

With each compression of the chest by 3-5 cm during chest compressions, up to 300-500 ml of air is expelled from the lungs. After the compression stops, the chest returns to its original position and the same volume of air is sucked into the lungs. Active exhalation and passive inhalation occur.
With indirect cardiac massage, the rescuer’s hands are not only the heart, but also the lungs of the victim.

You must act in the following order:

Indirect cardiac massage. Step one

If the victim is lying on the ground, be sure to kneel in front of him. At the same time, it does not matter from which side you approach it.

Indirect cardiac massage. Step two

For indirect cardiac massage to be effective, it must be performed on a flat, hard surface.

Indirect cardiac massage. Step three

Position the base right palm above the xiphoid process so that the thumb is directed towards the chin or abdomen of the victim. Left palm place on top of the palm of your right hand.

Indirect cardiac massage. Step four

Move your center of gravity to the victim's sternum, keeping your arms straight at the elbows. This will allow you to maintain maximum strength long time. Bend your elbows when performing chest compressions - the same as doing push-ups from the floor (example: resuscitate the victim with pressure at a rate of 60-100 times per minute, at least 30 minutes, even if resuscitation is ineffective. Because only after this time signs are clearly visible biological death. Total: 60 x 30 = 1800 push-ups).

For adults, indirect cardiac massage is performed with two hands, for children - with one hand, for newborns - with two fingers.

Indirect cardiac massage. Step five

Push the chest at least 3-5 cm with a frequency of 60-100 times per minute, depending on the elasticity of the chest. In this case, the palms should not come off the victim’s sternum.

Indirect cardiac massage. Step six

You can begin applying pressure on the chest only after it has completely returned to its original position. If you don't wait for the sternum to return to its original position and press, the next push will turn into a monstrous blow. Performing chest compressions can result in fracture of the victim's ribs. In this case, the indirect cardiac massage is not stopped, but the frequency of compressions is reduced to allow the chest to return to its original position. At the same time, be sure to maintain the same depth of pressing.

Indirect cardiac massage. Step seven

The optimal ratio of chest compressions and mechanical ventilation breaths is 30/2 or 15/2, regardless of the number of participants. With each pressure on the chest, an active exhalation occurs, and when it returns to its original position, a passive inhalation occurs. Thus, new portions of air enter the lungs, sufficient to saturate the blood with oxygen.