Cardiopulmonary resuscitation. Resuscitation measures and their sequence Resuscitation definition

A person must be able to perform resuscitation, since medical assistance cannot always arrive before biological death occurs in the victim. The dying process does not occur in one stage. At first the person is in a state of agony. This period is characterized by a sharp decrease in blood pressure, blackouts, disturbances in heart function, absence of pulse, and shallow breathing. The skin in this state immediately turns pale and acquires a bluish tint. Then the body goes into a state of clinical death. Respiratory and cardiac activity stop completely. During this period it is still possible to return to life. After 3–5 minutes, biological pain sets in, when it is almost impossible to bring a person back to life. Even if the heartbeat and breathing are restored, the person becomes disabled, the brain dies, and doctors can only support vital functions.

If a person is injured due to an electric shock, a precordial shock should be performed first. Place the person's back on a hard surface. Find the xiphoid, place your middle and index fingers on it. Place the fist of your other hand above your fingers, pointing your elbow along your body. Hit this area sharply with your fist. After this, the heart may begin to beat. If this does not happen, then proceed to the next stage, which is suitable for any case of breathing and heartbeat disturbances.

Throw the victim's head back, push the lower jaw forward, opening his mouth. Wrap your finger in a bandage or any rag. Clean the person’s mouth from any foreign matter, free the tongue, as in such cases it often sinks and blocks breathing. Start mouth-to-nose or mouth-to-mouth artificial respiration. If you do mouth-to-nose breathing, your air comes out through the victim's open mouth, so you need to close it completely. The same thing when breathing “mouth to mouth”, pinch the nose of the person being resuscitated.

Supplement artificial respiration with indirect cardiac massage. Place your palm in the lower third of the victim's sternum, pointing your finger down or towards the face. Place your other palm on top of the cross. Raise your fingers slightly above the surface so as not to break the victim’s ribs. The massage occurs by pressing with all your weight on the designated area so that the person’s chest goes inward by 3 - 5 cm. The interval between pressures is 1 second.

Combine artificial respiration and chest compressions in a ratio of 1:5. Give the victim 1 breath through the airway, then apply 5 compressions to the sternum. It’s good if 2–3 people will resuscitate. It is necessary to make the process harmonious: you cannot simultaneously inhale air into the lungs and press on the chest, as this can damage the integrity of the lungs. Continue performing these manipulations for at least 5 minutes. An ambulance should arrive by this time. Without special equipment, longer resuscitation becomes useless.

In the life of every person, a situation may arise when it is necessary to provide first aid to the victim or even perform artificial respiration. Of course, in such a situation, navigating and doing everything right is not only very important, but also very difficult. Despite the fact that everyone is taught the basics of first aid at school, not every person will be able to even approximately remember what and how to do a few years after leaving school.

Most of us by the phrase “artificial respiration” mean resuscitation measures such as mouth-to-mouth breathing and chest compressions or cardiopulmonary resuscitation, so let’s look at them. Sometimes these simple actions help save a person’s life, so you need to know how and what to do.

In what situations is it necessary to perform indirect cardiac massage?

Indirect heart massage is performed to restore its function and normalize blood circulation. Therefore, the indication for its implementation is cardiac arrest. If we see a victim, the first thing we need to do is make sure of our own safety., because the injured person may be under the influence of poisonous gas, which will also threaten the rescuer. After this, it is necessary to check the victim’s heart function. If the heart has stopped, then you need to try to resume its work using mechanical action.

How can you determine whether the heart has stopped? There are several signs that can tell us about this:

• cessation of breathing
• pale skin,
• lack of pulse,
• absence of heartbeat,
• no blood pressure.

These are direct indications for cardiopulmonary resuscitation. If no more than 5-6 minutes have passed since the cessation of cardiac activity, then properly performed resuscitation can lead to the restoration of the functions of the human body. If you start resuscitation after 10 minutes, it may be impossible to completely restore the functioning of the cerebral cortex. After a 15-minute cardiac arrest, it is sometimes possible to resume the body’s activity, but not thinking, since the cerebral cortex suffers too much. And after 20 minutes without a heartbeat, it is usually not possible to resume even autonomic functions.

But these numbers greatly depend on the temperature around the victim’s body. In the cold, brain vitality lasts longer. In the heat, sometimes a person cannot be saved even after 1-2 minutes.

How to Perform Cardiopulmonary Resuscitation

As we have already said, any resuscitation measures must begin with ensuring your own safety and checking the presence of consciousness and heartbeat in the victim. It is very simple to check for breathing; to do this, you need to place your palm on the victim’s forehead, and with two fingers of the other hand, lift his chin and push the lower jaw forward and up. After this, you need to lean towards the victim and try to hear breathing or feel the movement of air on your skin. At the same time, it is advisable to call an ambulance or ask someone about it.

After this, we check the pulse. On the arm, the way they test it in the clinic, we most likely won’t hear anything, so we immediately proceed to check on the carotid artery. To do this, place the pads of 4 fingers on the surface of the neck on the side of the Adam's apple. Here you can usually feel the pulse beating; if there is none, we proceed to chest compressions.

To implement indirect cardiac massage, we place the base of the palm in the middle of the person’s chest and take the hands into the lock, while keeping the elbows straight. Then we perform 30 presses and two mouth-to-mouth breaths. In this case, the victim should lie on a flat, hard surface, and the frequency of pressing should be approximately 100 times per minute. The depth of pressure is usually 5-6 cm. Such pressure allows you to compress the chambers of the heart and push blood through the vessels.

After performing compression, it is necessary to check the airway and breathe air into the victim’s mouth, while closing the nostrils.

How to properly perform artificial respiration?

Direct artificial respiration is exhaling air from your lungs into the lungs of another person. Usually it is done simultaneously with chest compressions and this is called cardiopulmonary resuscitation. It is very important to carry out artificial respiration correctly so that air enters the respiratory tract of the injured person, otherwise all efforts may be in vain.

To inhale, you need to place one of your palms on the victim’s forehead, and with the other hand you need to lift his chin, move his jaw forward and up and check the patency of the victim’s airway. To do this, you need to pinch the victim's nose and breathe air into the mouth for a second. If everything is normal, then his chest will rise, as if inhaling. After this, you need to let the air come out and inhale again.

If you are driving a car, then it most likely has a special device for artificial respiration in the car first aid kit. It will greatly facilitate resuscitation, but still, it is a difficult matter. To maintain strength during chest compressions, you must try to keep them straight and not bend your elbows.

If you see that during resuscitation the victim is experiencing arterial bleeding, be sure to try to stop it. It is advisable to call someone for help, since doing everything on your own is quite difficult.

How long is it necessary to carry out resuscitation measures (Video)

While everything is more or less clear about how to carry out resuscitation, not everyone knows the answer to the question of how long it should take. If resuscitation does not seem to be successful, when can it be stopped? The correct answer is never. It is necessary to carry out resuscitation measures until the ambulance arrives or until the doctors say that they are taking responsibility or, in the best case, until the victim shows signs of life. Signs of life include spontaneous breathing, coughing, pulse or movement.

If you notice breathing, but the person has not yet regained consciousness, you can stop resuscitation and place the victim in a stable position on his side. This will help prevent the tongue from sticking, as well as the penetration of vomit into the respiratory tract. Now you can calmly examine the victim for presence and wait for the doctors, observing the condition of the victim.

CPR can be stopped if the person doing it is too tired to continue. It is possible to refuse resuscitation measures if the victim is clearly not viable. If the victim has severe injuries that are incompatible with life or noticeable cadaveric spots, resuscitation does not make sense. In addition, resuscitation should not be performed if the absence of a heartbeat is due to an incurable disease, such as cancer.

Nowadays, you can often hear from the media that people die “out of the blue,” the so-called sudden death. In fact, anyone can face sudden death at any time and anywhere. And in order to be able to save a dying person, you need to master some basic skills, which include CPR.

Cardiopulmonary resuscitation (CPR)- this is a set of emergency measures that are carried out to bring a person out of clinical death (to revive a person).

Clinical death- This is a reversible condition in which breathing and blood circulation completely stop. The reversibility of this condition ranges from 3 to 7 minutes (this is how long our brain can live without oxygen). It all depends on the ambient temperature (survival increases in the cold) and the initial condition of the patient.

It is important that resuscitation measures are started immediately after clinical death is diagnosed. Otherwise, the cerebral cortex will die and then, even if it is possible to resume cardiac activity, we will lose the person as an individual. A person will turn into a vegetable who will no longer be able to regulate any vital processes. Only his body will exist, which will be able to breathe only with the help of an apparatus, and feed exclusively through special systems.

Signs of clinical death

Any capable person facing clinical death can become a resuscitator. Signs of clinical death include:

Stages of CPR

If you see these signs, you should immediately begin resuscitation.

It is necessary to lay the victim on a flat horizontal surface;

If possible, you need to elevate the dying person's legs (put them on a chair or other accessible object);

Activities that improve blood supply to the brain

Free the chest from clothing, unfasten the belt and other elements of clothing that tighten the chest and abdominal region;

It is necessary to determine the area where indirect cardiac massage will be performed.
Location of the xiphoid process Press on the chest 3-5 cm above the xiphoid process and strictly along the midline (i.e., on the sternum). In men, this area can be identified by drawing a line along the nipples. Where this line crosses the sternum is the desired point. Placement of the palm during CPR The palm of one hand must be placed on the back of the other hand (to create a lock) and the arms straightened at the elbows;



Direct cardiac massage. Without bending your elbows, press on the sternum in the designated place with such force that it bends 5-6 cm (this is felt quite well), after which the sternum is allowed to fully straighten (i.e., return to its original position). We press not with our hands, but with our whole body.
Straight arms when pressing on the sternum. The thrusts should be rhythmic and quite sharp. Moreover, for an effective massage, the frequency of compressions on the chest should be at least 100 per minute (you should aim for 120). Those. per second you should make 1.5-2 clicks.
There should be 30 such clicks at once.

After 30 presses, you need to switch to artificial ventilation (blowing air from your mouth into the victim’s mouth or nose). To do this you need:

Then you need to move on to direct air injection. To protect yourself, blow air through a cloth (handkerchief or napkin). To ensure that all your air gets into the victim's airway, you must press your lips tightly to his mouth (open your mouth wide, cover his lips so that his mouth is in yours) and pinch his nose.

Before doing this, breathe air into your lungs, but not very deeply. The exhalation should be sharp. Don't exhale all of your air from your lungs (exhalation should include about 80% of your air in your lungs). You need to make two such exhalations. Then start cardiac massage again.

1. Thus, you perform CPR cycles consisting of 30 chest compressions and 2 mouth-to-mouth breaths. (30:2). After 3-5 such cycles, it is necessary to re-evaluate the victim’s pulse and breathing. If you feel the beating of the carotid artery and see the person taking spontaneous breaths, of course, resuscitation should be stopped. If cardiac activity does not resume, continue CPR until help arrives.

Addition

If no one is near you, try to call for help as you prepare for CPR. If no one responds, start resuscitating the patient and call an ambulance during the break between cycles (i.e. after 3-5 cycles).

P.S. If you doubt the correctness of your actions, immediately dial the ambulance number and turn on speakerphone. This way, you can be given the instructions you need and your hands will be free to follow those instructions.

If no one can help you and you are unable to call an ambulance, continue CPR as long as you can. But when you feel completely exhausted, your head is spinning, your eyes are darkening, immediately stop all your actions. Otherwise, you risk lying next to a dying person, and then they will find not one corpse, but two.

If there are people near you, then try to organize them to save the person. It is necessary to quickly distribute roles: one calls an ambulance, another holds the victim’s legs up (preferably, but if this is not possible, then do not touch the legs), the third does a cardiac massage, the fourth performs artificial ventilation.

In the case when there are two resuscitators, one immediately performs 30 compressions on the chest, after which it stops and the second resuscitator blows air into the victim, then the first begins cardiac massage again. After several cycles, resuscitators should switch places so as not to quickly become exhausted.

If you suspect or know that the victim has a disease transmitted by airborne droplets or nutrition (for example, tuberculosis in the active phase) or if he is clearly an antisocial person, you can limit yourself to a cardiac massage without blowing air.

The more people who have basic knowledge of how to revive the human body, the more victims can be saved.

Introduction

Resuscitation is a set of measures aimed at restoring fading or recently extinguished vital functions of the body by temporarily replacing them (prosthetics) in combination with intensive therapy.

Resuscitation includes not only measures aimed at restoring cardiac activity and breathing in patients and victims who are in a state of clinical death, but also measures aimed at preventing clinical death, as well as artificial control, sometimes very long, of respiratory functions, heart function, and activity. brain, metabolic processes, etc. There are cardiac, respiratory, cardiopulmonary, cerebral resuscitation. Resuscitation may include measures carried out even before cardiac arrest, for example, restoration of patency of the upper respiratory tract in case of sudden asphyxia.

Resuscitation includes artificial ventilation, restoration of blood supply to the brain and other organs through direct or indirect cardiac massage, electrical defibrillation, and drug therapy.

Resuscitation can be limited to any one measure, for example, immediate restoration of the patency of the upper respiratory tract in case of acute asphyxia, when the activity of the respiratory center has not yet stopped and adequate breathing is restored spontaneously immediately after elimination of obstruction of the upper respiratory tract, or electrical defibrillation of the heart in acute the occurrence of ventricular fibrillation in a patient undergoing monitoring. An electric current pulse passed through the heart in the first 10-20 s after circulatory arrest can stop fibrillation, and the rhythmic activity of the heart and breathing are subsequently restored spontaneously. With the development of complete transverse heart block and a very slow rhythm of contraction of its ventricles, which does not provide the tissue with the necessary amount of oxygenated blood, cardiac pacing is a resuscitation measure, because It is with its help that blood circulation is restored, ensuring the vital functions of the body.

Types of resuscitation

There are cardiopulmonary and cerebral resuscitation.

Cardiopulmonary resuscitation (CPR) is a set of medical measures aimed at returning a patient in a state of clinical death to a full life.

Clinical death is a reversible condition in which there are no signs of life (a person is not breathing, his heart is not beating, it is impossible to detect reflexes and other signs of brain activity (a flat line on the EEG)). The reversibility of the state of clinical death in the absence of damage incompatible with life caused by injury or disease directly depends on the period of oxygen starvation of brain neurons. Clinical data indicate that full recovery is possible if no more than five to six minutes have passed since the heartbeat stopped. Obviously, if clinical death occurs due to oxygen starvation or severe poisoning of the central nervous system, then this period will be significantly reduced. Oxygen consumption is highly dependent on body temperature, so with initial hypothermia (for example, drowning in icy water or being caught in an avalanche), successful resuscitation is possible even twenty minutes or more after cardiac arrest. And, conversely, at elevated body temperature, this period is reduced to one or two minutes. Thus, the cells of the cerebral cortex suffer the most when clinical death occurs, and their restoration is of decisive importance not only for the subsequent biological activity of the body, but also for the existence of a person as an individual. Therefore, restoration of cells of the central nervous system is a top priority. To emphasize this point, many medical sources use the term cardiopulmonary and cerebral resuscitation (CPC).

Concepts of social death, brain death, biological death Delayed cardiopulmonary resuscitation greatly reduces the chances of restoring the body’s vital functions. Thus, if resuscitation measures were started 10 minutes after cardiac arrest, then in the vast majority of cases, complete restoration of the functions of the central nervous system is impossible. Surviving patients will suffer from more or less severe neurological symptoms associated with damage to the cerebral cortex. If cardiopulmonary resuscitation began 15 minutes after the onset of clinical death, then most often there is a total death of the cerebral cortex, leading to the so-called social death of a person. In this case, it is possible to restore only the vegetative functions of the body (independent breathing, nutrition, etc.), and the person dies as an individual. 20 minutes after cardiac arrest, as a rule, total brain death occurs, when even autonomic functions cannot be restored.

Today, total brain death is legally equivalent to the death of a person, although the life of the body can still be maintained for some time with the help of modern medical equipment and medications.

Biological death is the mass death of cells of vital organs, in which restoration of the existence of the organism as an integral system is no longer possible. Clinical data indicate that biological death occurs 30-40 minutes after cardiac arrest, although its signs appear much later. The tasks and importance of timely cardiopulmonary resuscitation Carrying out cardiopulmonary resuscitation is intended not only to resume normal breathing and heartbeat, but also to lead to the complete restoration of the functions of all organs and systems. Back in the middle of the last century, analyzing autopsy data, scientists noticed that a significant portion of deaths were not associated with traumatic injuries incompatible with life or incurable degenerative changes caused by old age or illness.

According to modern statistics, timely cardiopulmonary resuscitation could prevent every fourth death, returning the patient to a full life. Meanwhile, information about the effectiveness of basic cardiopulmonary resuscitation in the prehospital stage is very disappointing. For example, in the United States, about 400,000 people die every year from sudden cardiac arrest. The main reason for the death of these people is the untimeliness or poor quality of first aid. Thus, knowledge of the basics of cardiopulmonary resuscitation is necessary not only for doctors, but also for people without medical education if they are concerned about the life and health of others.

The term “resuscitation” refers to a set of measures taken to restore vital functions in a person who has been clinically dead. They are carried out when the pulse and breathing stop, and the pupils do not react to light. In addition, in medical parlance, intensive care is the name given to a specialized ambulance team and intensive care unit designed to treat seriously ill patients who are on the verge of life and death.

General information

It has long been proven that after the heart stops and the breathing process stops, the human body lives for several more minutes, despite the fact that oxygen does not enter it. The cerebral cortex is the first to suffer from hypoxia. From the moment of her death, the biological death of a person occurs. This occurs approximately 4 minutes after the cessation of vital processes. Thus, there is a short period of time in which it is possible to restore a person’s blood circulation and breathing. It is important to know that resuscitation is an event that everyone must know how to carry out in order to provide timely assistance to the patient before the doctors arrive. The sooner they are carried out, the higher the likelihood of a favorable outcome.

The period of revival of the patient is divided into 2 stages:

1. Cardiopulmonary resuscitation.
2. Intensive therapy.

In the first case, emergency assistance is provided, in the second, the consequences of clinical death (cardiac and respiratory arrest) are eliminated and the pathological condition that led to it is treated. During the period of life support, the patient is constantly in the intensive care unit.

Causes of clinical death

Typically, cardiac arrest occurs due to:

• Anaphylactic shock. This condition is usually a consequence of allergies.
• Heart diseases, the course of which negatively affects the functioning of the organ.
• Constantly being in a state of stress, as well as high intensity physical activity. A natural consequence is a significant deterioration in the blood supply to the organ.
• Blockage of blood vessels with blood clots.
• Large blood loss resulting from injury or injury, including a violent one.
• Ingestion or administration of unsafe medications and dietary supplements. For example, after inappropriate injections of Synthol, any bodybuilder can end up in intensive care.
• Toxic shock resulting from the action of harmful chemical compounds.
• Asphyxia.
• Serious diseases of the respiratory system.

Every person should understand that resuscitation is a set of measures, the correctness of which not only medical workers, but also ordinary people should be aware of.

Symptoms of clinical death

This condition requires emergency care, so it is necessary to be able to recognize it in a timely manner.

1. Unconscious state. It occurs a few seconds after blood circulation stops.
2. No pulse. This is the first sign that oxygen has stopped flowing to the brain. The slightest delay can cost a person his life.
3. Lack of breathing. How can I check this? You need to pay attention to whether the person’s chest makes characteristic movements, then bend over to his face with your left ear and try to catch any sounds. After this, you can try to feel his breathing on the skin by raising your hand to the patient’s mouth. In medical language, this method is called “see, hear, feel.”
4. Dilated pupils, no reaction to light.

If symptoms of clinical death are detected in a person, assistance should be provided immediately.

Cardiopulmonary resuscitation

Its task is to resume the processes of breathing and blood circulation. Liquid connective tissue must be forcibly enriched with oxygen and deliver it to the brain.

The algorithm for performing pulmonary-cardiac resuscitation is as follows:

1. Preparing the patient. The person must be laid with his back on a hard surface (floor, asphalt, etc.). The victim needs to expose his chest, as there may be various jewelry under his clothes, which can lead to additional injuries during resuscitation.
2. Restoration of airway patency. To do this, you need to wrap the cloth around your index finger and free the victim’s mouth from mucus, foreign objects or vomit. Next, you need to tilt the person’s head back to get rid of the tongue sinking. To do this, you need to place a roll of clothing under his neck or shoulder blade area (not under the back of his head). Hard objects are not suitable for these purposes, since with further chest compressions there is an extremely high probability of breaking the victim’s spine.
3. Delivery of a precordial blow. At the bottom of the sternum is the xiphoid process. If you place your fingers on this zone, then a little higher (2-3 cm) will be the point of impact. To carry it out, you need to take a position so that the elbow is above the victim’s stomach, and the edge of the palm clenched into a fist is above the sternum. Next, you need to apply just one sharp blow to the point above the xiphoid process. The goal is to shake the chest and get the heart pumping again. After the blow is made, you need to check your pulse. If it is detected, the victim must be laid on his side; if he is not present, follow the next step.
4. Indirect cardiac massage. The technique is as follows: take a position to the right of the person, place the left palm about 10 cm above the xiphoid process. It is important that the fingers do not touch the chest. Place the right brush on top. Both arms should not bend at the elbow joints. Next, you need to rhythmically press on the sternum (palms should be on it all the time) approximately 60-70 times per minute (in adults). When making pushes, it is important that they move towards the spine by 3-5 cm. Massage can be alternated with artificial respiration. To do this, you need to pinch the patient’s nose with the fingers of your left hand, then press your mouth tightly against the person’s mouth through a napkin and forcefully exhale the air.

It is important to know that resuscitation is a set of measures that can be carried out simultaneously with the presence of several assistants. For example, one person performs artificial respiration on the victim, and the second performs chest compressions. Doctors perform revival measures according to the same scheme; in addition, medications and a defibrillator can be used. Contrary to popular belief, epinephrine injections into the heart are not given during resuscitation and have not been found to be effective.

How is it done in children?

If there is a sudden stop in blood circulation, you need to assess the child’s condition within 5-10 seconds.

Signs of clinical death in children are:

• unconscious state;
• pulse cannot be felt;
• dilated pupils;
• lack of reflex reactions.

Before the ambulance arrives, the algorithm for resuscitation of children is as follows:

1. Ensure airway patency (methods are similar to those used in adult victims).
2. Artificial ventilation. You need to take 5 mouth-to-mouth breaths and check for a pulse. In its absence, it is necessary to begin alternating chest compressions and mouth-to-mouth breathing. In this case, 2 breaths should be taken for 15 beats. The frequency of chest compressions is 100-120 per minute.

Activities should be carried out until the arrival of doctors.

Features of neonatal resuscitation

The algorithm for its implementation is similar to that applicable to older children. If the victim is a child under 1 year old, the difference lies in the method of performing chest compressions. It is carried out as follows: you need to place your index and middle fingers on the lower part of the sternum (just below the level of the nipples) and make quick, sharp pressures with them (about 120 per minute).

Intensive therapy

Its task is to maintain the vital functions of the patient’s body throughout the entire time he is in critical condition.

In medical institutions, the main structural unit is the intensive care unit. Seriously ill patients are constantly cared for, and doctors monitor the dynamics of changes in their health indicators. Transfer to a regular ward is issued when conditions incompatible with life are eliminated.

Termination of resuscitation measures

All attempts to restore vital human processes are completed in the following cases:

• Resuscitation for 30 minutes did not produce results (10 minutes in the case of newborns).
• Biological death was recorded.

In addition, you need to know that resuscitation is a measure that is not carried out if clinical death is a consequence of the progression of incurable pathologies or the consequences of injuries that are incompatible with life.

Finally

Bringing a person back to life can be carried out both by doctors in a medical institution and by ordinary people anywhere where the victim is. To do this, you need to know the main stages and methods of resuscitation measures.