Cardiopulmonary resuscitation techniques. artificial ventilation of the lungs and indirect heart massage. Rules and technique for artificial respiration and chest compressions

The need to do artificial respiration and indirect heart massage occurs in cases where the injured person cannot breathe on his own and the lack of oxygen threatens his life. Therefore, everyone should know the technique and rules for artificial respiration in order to provide timely assistance.

Methods of artificial respiration:

1. From mouth to mouth. The most efficient method.
2. From mouth to nose. It is used in cases where it is impossible to unclench the victim's jaws.

Artificial respiration mouth to mouth

The essence of the method is that the person providing assistance blows air from his lungs into the lungs of the victim through his mouth. This method is safe and very effective as a first aid.

Carrying out artificial respiration begins with the preparation:

1. Loosen or remove tight clothing.
2. Lay the injured person on a horizontal surface.
3. Place the palm of one hand under the back of the person’s head, and tilt his head back with the other so that the chin is in line with the neck.
4. Place a roller under the victim's shoulder blades.
5. Wrap your fingers with a clean cloth or handkerchief, examine the human oral cavity with them.
6. Remove, if necessary, blood and mucus from the mouth, remove dentures.

How to do mouth-to-mouth artificial respiration:

• prepare a clean gauze or handkerchief, put it on the victim's mouth;
• pinch his nose with your fingers;
• take a deep breath and forcefully exhale the maximum amount of air into the victim's mouth;
• release the nose and mouth of a person so that a passive exhalation of air occurs, and take a new breath;
• repeat the procedure every 5-6 seconds.

If artificial respiration is given to a child, the air should be blown in less abruptly and take a less deep breath, since the volume of the lungs in children is much smaller. In this case, you need to repeat the procedure every 3-4 seconds.

At the same time, it is necessary to monitor the flow of air into the lungs of a person - the chest should rise. If the expansion of the chest does not occur, then there is an obstruction of the airways. To correct the situation, you need to push the jaw of the victim forward.

As soon as independent breaths of a person are noticed, artificial respiration should not be stopped. It is necessary to blow in air simultaneously with the inhalation of the victim. You can finish the procedure in case of restoration of deep spontaneous breathing.

Artificial respiration mouth to nose

This method is used when the jaws of the victim are strongly compressed, and the previous method cannot be carried out. The technique of the procedure is the same as when blowing air into the mouth, only in this case it is necessary to exhale into the nose, holding the mouth of the injured person with the palm of your hand.

How to perform artificial respiration with closed heart massage?

Preparation for indirect massage coincides with the rules for preparing for artificial respiration. External heart massage artificially supports blood circulation in the body and restores heart contractions. It is most effective to carry it out simultaneously with artificial respiration in order to enrich the blood with oxygen.

Technique:

Article publication date: 02/08/2017

Article last updated: 12/18/2018

From this article you will learn: what is an indirect heart massage, for what, to whom and who can do it. Is it possible to harm a person by performing this procedure, and how to make it really help.

An indirect heart massage is a resuscitation emergency aimed at replacing and restoring stopped cardiac activity.

This procedure is the most important for saving the life of a person whose heart has stopped and who is in a state of clinical death. Therefore, each person must be able to do cardiac massage. Even if you are not a specialist, but at least approximately know how this procedure should go, do not be afraid to do it.

You will not harm the patient if you do something not quite right, and if you do nothing, it will lead to his death. The main thing is to make sure that there are really no heartbeats. Otherwise, even a perfectly executed massage will hurt.

The essence and meaning of cardiac massage

The purpose of heart massage is to artificially recreate, replace cardiac activity in case of its stop. This can be achieved by squeezing the cavities of the heart from the outside, which imitates the first phase of cardiac activity - contraction (systole) with a further weakening of pressure on the myocardium, which imitates the second phase - relaxation (diastole).

This massage can be done in two ways: direct and indirect. The first is possible only with surgical intervention, when there is direct access to the heart. The surgeon takes it in his hand and performs a rhythmic alternation of compression with relaxation.

An indirect heart massage is called indirect because there is no direct contact with the organ. Compression is applied through the chest wall, as the heart is located between the spine and the sternum. Effective pressure on this area is capable of ejecting about 60% of the blood volume into the vessels compared to the self-contracting myocardium. Thus, the blood will be able to circulate through the largest arteries and vital organs (brain, heart, lungs).

Indications: who really needs this procedure

The most important thing in cardiac massage is to determine whether a person needs it or not. There is only one indication - complete. This means that even if an unconscious patient has severe rhythm disturbances, but at least some cardiac activity is preserved, it is better to refrain from the procedure. Squeezing the beating heart can cause it to stop.

The exceptions are cases of severe ventricular fibrillation, in which they seem to tremble (about 200 times per minute), but do not perform a single full-fledged contraction, as well as weakness of the sinus node and in which the heartbeat is less than 25 beats per minute. If such patients are not helped, the condition will inevitably worsen, and cardiac arrest will occur. Therefore, they can also be given indirect massage if there is no other way to help.

The justification for the expediency of this procedure is described in the table:

Clinical death is the stage of dying after the cessation of cardiac activity lasting 3-4 minutes. After this time, irreversible processes occur in the organs (primarily in the brain) - biological death occurs. Therefore, the only time when you need to do cardiac massage is the period of clinical death. Even if you do not know when the cardiac arrest occurred and are not sure if there is a heartbeat, look for other signs of this condition.

The sequence of actions that make up the indirect heart massage technique includes:

1. Determine if the patient has a pulse and heartbeat:

• Feel with your fingers the anterolateral surfaces of the neck in the projection of the location of the carotid arteries. The absence of a pulsation indicates cardiac arrest.
• Listen with your ear or phonendoscope to the left half of the chest.

2. If you doubt the absence of heartbeats, before doing chest compressions, determine other signs of clinical death:

3. If these signs occur, feel free to proceed with an indirect heart massage, observing the technique of execution:

• Lay the patient on his back, but only on a hard surface.
• Open the patient's mouth, if there is mucus, vomit, blood or any foreign bodies in it, clean the oral cavity with your fingers.
• Tilt the victim's head back well. This will prevent the tongue from slipping. It is advisable to fix it in this position by placing any roller under the neck.
• Stand to the right of the patient at chest level.
• Place the hands of both hands on the sternum at a point that is located two fingers above the lower end of the sternum (the border between the middle and lower thirds).
• The hands should lie in this way: the fulcrum of one hand is the soft part of the palm in the area of ​​\u200b\u200bthe elevation of the thumb and little finger immediately below the wrist. Place the second brush on the one located on the chest and interlace their fingers into the castle. Fingers should not lie on the ribs, as they can cause fractures during the massage.
• Lean over the victim in such a way that, with correctly located brushes, you seem to rest against the sternum. The arms should be straight (unbent at the elbows).

The technique for performing pressure on the chest should be as follows:

1. At least 100 times per minute.
2. So that it is pressed 3-5 cm.
3. Apply compression not by flexing and extending your arms at the elbows, but by pressing your whole body. Your hands should be a kind of transmission lever. So you will not get tired and will be able to massage as much as you need. This procedure requires a lot of effort and energy.

An indirect heart massage can last about 20 minutes. Check every minute for a pulse in the carotid arteries. If after this time the heartbeats have recovered, further massage is not advisable.

It is not necessary to do artificial respiration at the same time as cardiac massage, but it is possible. The correct execution technique in this case: after 30 pressures, take 2 breaths.

Forecast

The effectiveness of indirect heart massage is unpredictable - from 5 to 65% ends with the restoration of cardiac activity and saving a person's life. The prognosis is better when performed in young people without comorbidities and injuries. But cardiac arrest without indirect massage in 100% ends in death.

Poisoning by certain substances can cause respiratory arrest and heartbeat. In such a situation, the victim needs help immediately. But there may not be doctors nearby, and an ambulance will not arrive in 5 minutes. Each person should know and be able to put into practice at least basic resuscitation measures. These include artificial respiration and external cardiac massage. Most people probably know what it is, but they do not always know how to correctly perform these actions in practice.

Let's find out in this article what kind of poisoning can cause clinical death, what kind of resuscitation techniques exist for a person, and how to do artificial respiration and chest compressions correctly.

What kind of poisoning can stop breathing and heartbeat

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

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

When is artificial respiration necessary? Respiratory arrest occurs due to poisoning:

In the absence of breathing or heartbeat, clinical death occurs. It can last from 3 to 6 minutes, during which there is a chance to save a person if you start doing 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

What to do if a person falls unconscious? First you need to determine the signs of life. The heartbeat can be heard by putting your ear to the victim's chest or by feeling the pulse on the carotid arteries. Breathing can be detected by the movement of the chest, bending over to the face and listening for the presence of inhalation and exhalation, bringing the mirror to the nose or mouth of the victim (it will fog up when breathing).

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

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

• external heart massage;
• breathing "from mouth to mouth";
• breathing from mouth to nose.

It is advisable to conduct receptions for two people. Heart massage is always performed together with artificial ventilation.

What to do if there are no 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 done.
3. If there is no heartbeat, artificial respiration and chest compressions are performed.

How to do chest compressions

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

Why is an indirect heart massage impossible if the victim lies on a soft one? In this case, the pressure will not be refused on the heart, but on a pliable surface.

Very often, with an indirect heart massage, ribs are broken. There is no need to be afraid of this, the main thing is to revive a person, and the ribs will grow together. But keep in mind that broken edges are most likely the result of improper execution and the pressing force should be moderated.

Artificial respiration from mouth to mouth

If in the mouth of a poisoned person there are secretions dangerous for the resuscitator, such as poison, poisonous gas from the lungs, an infection, then artificial respiration is not necessary! In this case, it is necessary to confine ourselves to conducting an indirect heart massage, during which, due to pressure on the sternum, about 500 ml of air is ejected and again sucked in.

How to do mouth-to-mouth artificial respiration?

For your own safety, it is recommended that artificial respiration be best done through a napkin, while controlling the pressing density and preventing air from “leaking”. Exhalation should not be sharp. Only a strong, but smooth (within 1-1.5 seconds) exhalation will ensure the correct movement of the diaphragm and the filling of the lungs with air.

Artificial respiration from mouth to nose

Mouth-to-nose artificial respiration is performed if the patient cannot open his mouth (for example, due to 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 breath, you need to blow air into the nose of the injured person, tightly closing his mouth with one hand.
5. After one breath, count to 4 and take the next.

Features of resuscitation in children

In children, the resuscitation technique is different from that in adults. The chest of babies under one year old is very delicate and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect heart massage is performed not with palms, but with two fingers. The movement of the chest should be no more than 1.5-2 cm. The frequency of pressing is at least 100 per minute. At the age of 1 to 8 years, 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 chest compressions in children under 8 years old should be 2/15, in children over 8 years old - 1/15.

How to do artificial respiration for a child? For children, artificial respiration can be performed using the mouth-to-mouth technique. Since babies have a small face, an adult can carry out artificial respiration covering both the mouth and nose of the child at once. Then the method is called "from mouth to mouth and nose." Artificial respiration for children is done at a frequency of 18-24 per minute.

How to determine if resuscitation is performed correctly

Signs of effectiveness, subject to the rules for performing artificial respiration, are as follows.

The effectiveness of heart massage should also be checked every minute.

1. If, when performing an indirect heart massage, a push appears on the carotid artery, similar to a pulse, then the pressing force is sufficient so that blood can flow to the brain.
2. With the correct implementation of resuscitation measures, the victim will soon have heart contractions, pressure will rise, spontaneous breathing will appear, the skin will become less pale, the pupils will narrow.

You need to complete all the steps for at least 10 minutes, and preferably before the ambulance arrives. With a persistent heartbeat, artificial respiration should be performed for a long time, up to 1.5 hours.

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

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

Artificial respiration. Before starting artificial respiration, the following steps should be taken quickly:

- release the victim from clothing that restricts breathing (unbutton the collar, untie the tie, unbutton the trousers, etc.);

- lay the victim on his back on a horizontal surface (table or floor);

─ tilt the victim’s head back as much as possible, placing the palm of one hand under the back of the head, and with the other hand press on the victim’s forehead until his chin is in line with the neck .;

- examine the oral cavity with your fingers, and if foreign content (blood, mucus, etc.) is found, it must be removed by removing dentures at the same time, if any. To remove mucus and blood, it is necessary to turn the victim’s head and shoulders to the side (you can bring your knee under the victim’s shoulders), and then, using a handkerchief or the edge of a shirt wound around the index finger, clean

wash the mouth and pharynx. After that, it is necessary to give the head its original position and tilt it back as much as possible, as indicated above;

- blowing air through gauze, a scarf, a special device - "air duct".

At the end of the preparatory operations, the assisting person takes a deep breath and then exhales the air with force into the victim's mouth. At the same time, he should cover the entire mouth of the victim with his mouth, and pinch his nose with his fingers. . Then the caregiver leans back, freeing the mouth and nose of the victim, and takes a new breath. During this period, the victim's chest descends and passive exhalation occurs.

If, after blowing in air, the chest of the victim does not straighten out, this indicates an obstruction of the respiratory tract. In this case, it is necessary to push the lower jaw of the victim forward. To do this, you need to put four fingers of each hand behind the corners of the lower

her jaw and, resting her thumbs on its edge, push the lower jaw forward so that the lower teeth are in front of the upper ones. It is easier to push the lower jaw with the thumb inserted into the mouth.

When performing artificial respiration, the assisting person must ensure that air does not enter the victim's stomach. When air enters the stomach, as evidenced by bloating "under the spoon", gently press the palm of your hand on the stomach between the sternum and navel.

In one minute, 10-12 injections should be done to an adult (i.e., after 5-6 s). When the first weak breaths appear in the victim, an artificial breath should be timed to the beginning of an independent breath and carried out until deep rhythmic breathing is restored.

Heart massage. With rhythmic pressure on the chest, i.e. on the front

chest wall of the victim, the heart is compressed between the sternum and spine and pushes blood out of its cavities. When the pressure is released, the chest and heart expand and the heart fills with blood from the veins.

To perform a heart massage, you need to stand on either side of the victim in a position in which a more or less significant tilt over him is possible. Then it is necessary to determine by probing the place of pressure (it should be about two fingers above the soft end of the sternum) and put the lower part of the palm of one hand on it, and then put the second hand at a right angle over the first hand and press on the chest of the victim, slightly helping with this tilt of the entire body. The forearms and humerus bones of the assisting hands should be extended to failure. The fingers of both hands should be brought together and should not touch the victim's chest. Pressing should be done with a quick push so as to move the lower part of the sternum down by 3-4 cm, and in overweight people by 5-6 cm. The pressure should be concentrated on the lower part of the sternum, which is more mobile. Avoid pressure on the top

sternum, as well as on the ends of the lower ribs, since this can lead to their fracture. It is impossible to press below the edge of the chest (on soft tissues), since it is possible to damage the organs located here, primarily the liver.

Pressing (push) on the sternum should be repeated approximately 1 time per second. After a quick push, the arms remain in the reached position for about 0.5 s. After that, you should straighten up slightly and relax your hands without taking them away from the sternum.

To enrich the blood of the victim with oxygen, simultaneously with a heart massage, it is necessary to carry out artificial respiration according to the “mouth-to-mouth” (“mouth-to-nose”) method.

If assistance is provided by one person, these operations should be alternated in the following order: after two deep blows into the mouth or nose of the victim - 15 pressures on the chest. The effectiveness of external heart massage is manifested primarily in the fact that with each pressure on the sternum on the carotid artery, the pulse is clearly felt. To determine the pulse, the index and middle fingers are placed on the victim's Adam's apple and, moving the fingers to the side, carefully feel the surface of the neck until the carotid artery is determined.

teria. Other signs of the effectiveness of massage are the narrowing of the pupils, the appearance of independent breathing in the victim, a decrease in the cyanosis of the skin and visible mucous membranes.

The restoration of the victim's heart activity is judged by the appearance of his own, not supported by massage, regular pulse. To check the pulse every 2 minutes interrupt the massage for 2-3 seconds. The preservation of the pulse during the break indicates the restoration of independent work of the heart. If there is no pulse during the break, you must immediately resume the massage.

Rules for conducting artificial respiration.

If the victim does not breathe at all or, being in an unconscious state, breathes rarely and convulsively, with a sob, but his pulse is felt, you should immediately send for a doctor, and before he arrives, do artificial respiration.

Before this, it is necessary to quickly unbutton the victim’s clothing that restricts breathing (tie, belt), but you should not undress him, as this is useless and time-consuming, and the probability of success is the less, the later artificial respiration is started (if it is started 5 minutes after once the victim has stopped breathing, there is little hope of recovery). It is necessary to open the victim's mouth and remove everything that may interfere with breathing (for example, displaced dentures), i.e. ensure the patency of the upper respiratory tract.

The most effective method of artificial respiration is the method " mouth to mouth" or " mouth to nose"- this is the blowing of air from the mouth of the rescuer into the mouth or nose of the victim.

This method of artificial respiration makes it easy to control the flow of air into the lungs of the victim by expanding the chest after inhalation and its subsequent subsidence as a result of passive exhalation.

To carry out artificial respiration, the victim should be laid on his back, unfasten clothing that restricts breathing, put something soft under the shoulder blades, and lightly press on the head so that it leans back as much as possible (Fig. 5.3).

Rice. 5.3. The position of the head of the victim during artificial respiration

In this case, the root of the tongue rises and frees the entrance to the larynx, and the victim's mouth opens. In this case, the tongue does not block the passage of air into the throat. Next, pinch the nose of the victim, and taking a deep breath, sharply exhale the air into the mouth of the victim (Fig. 5.4).

Rice. 5.4. Performing artificial respiration

Air blowing can be done through a dry handkerchief, gauze, a special device - "air duct". If the victim has a well-determined pulse and only artificial respiration is needed, then the interval between artificial breaths should be 5 s (12 respiratory cycles per minute). During these 5 seconds, the victim exhales; the air comes out by itself. You can facilitate the exit by lightly pressing on the chest.

For children, air is blown less sharply than for adults, in a smaller volume and more often up to 15-18 times per minute.

Artificial respiration is stopped after the victim recovers rhythmic independent breathing.

Rules for conducting an indirect heart massage.

If the victim’s pulse is not felt even on the neck, then a heart massage is performed, pressing on the lower third of the victim’s chest (but not “under the spoon”) with quick sharp jerks of the rescuer’s palms laid one on top of the other (Fig. 5.5).

Rice. 5.5. The position of the person assisting during external heart massage

Pressing should be done in quick bursts, so as to displace the sternum by 4-5 cm, the duration of pressure is not more than 0.5 s, the interval between individual pressures is 0.5 s. Each pressure compresses the heart and drives blood through the circulatory system. For 1 minute it is necessary to make at least 60 pressures.

For children under 12 years of age, pressure is done with one hand and more often 70 ... 100 per minute, depending on age. Children up to a year - with two fingers 100 ... 120 times per minute. Every 2 minutes, it is recommended to check for 2-3 seconds to see if a pulse has appeared.

6. Fire safety

Fire resistance of building structures

In terms of flammability, building structures are divided into fireproof, flame retardant and combustible.

Fireproof are building structures made of non-combustible materials.

flame retardant constructions made of slow-burning materials or combustible materials protected from fire and high temperatures by fireproof materials are considered (for example, a fire door made of wood and covered with asbestos sheet and roofing steel).

Under fire resistance building structures, it is customary to imply their ability to perform operational functions for a certain period of time, while maintaining a given load-bearing capacity (no collapse) and the ability to protect from combustion products and flames under fire conditions.

The fire resistance of a building structure is assessed fire resistance limit, representing the time in hours from the start of testing the structure according to the standard temperature-time regime until one of the following signs appears:

- the formation of through cracks or holes in the design sample through which combustion products or flames penetrate;

- an increase in the average temperature at the measurement points on the unheated surface of the structure by more than 160 °C, or at any point on this surface by more than 190 °C compared to the temperature of the structure before the test, or by 220 °C, regardless of the initial surface temperature; deformation and collapse of the structure, loss of bearing capacity.