Method of performing indirect cardiac massage. Cardiac massage: types, indications, closed (indirect) with mechanical ventilation, rules. Rules for resuscitation of children

Injuries, wounds, poisoning can cause the main “motor” of the body to stop - human heart. Stopping blood circulation entails the cessation of tissue metabolism and gas exchange. Without blood circulation, metabolic products accumulate inside the cells, and in the blood they accumulate carbon dioxide. Metabolism stops, cells begin to die due to lack of oxygen and intoxication with metabolic products.

In this case, it is very important to at least try to carry out resuscitation measures- heart massage. There is a limited time allotted for this procedure - only thirty minutes. After this period, clinical death becomes irreversible.

Symptoms of cardiac arrest

Signs indicating cardiac arrest are: stopping the pulse (inability to feel the pulse in the carotid artery); respiratory arrest (the patient’s chest is motionless, a mirror brought to the mouth and nose does not fog); dilated pupils that do not respond to light; loss of consciousness, and the person does not come to his senses when hearing loud sounds or patting on the face; bluish-gray skin tone.

Types of heart massage

Today, there are two methods of cardiac massage: direct (open) and indirect (closed).

Direct massage is carried out exclusively by qualified medical workers and only under certain conditions: in particular, during surgical intervention on the chest organs or abdominal cavity. The essence of this procedure is to directly compress the heart muscle with your hands through an incision in the chest or abdomen (in this case, massage is carried out through the diaphragm). Due to the complexity of performing direct massage of the heart muscle, it is not a resuscitation measure that can be carried out by people who do not have the appropriate medical education and preparation.

At the same time, indirect (closed) massage of the heart muscle can be carried out in “field” conditions. This is the simplest way to help restore cardiac activity. No medical devices are required to perform it.

Indirect cardiac massage provides that during pressure on chest The chambers of the heart will also be compressed. As a result, blood will enter the ventricles from the atria through the valves, and then go into the vessels. Thanks to rhythmic pressure on the chest, the movement of blood through the vessels will not stop. As a result, its own electrical activity is activated and independent work organ.

Of course, a cardiac massage can only be successful if the algorithm of action is carefully followed and the rescuer follows the approved technique for carrying out resuscitation measures. Massage in mandatory combined with artificial ventilation. Each pressure on the victim’s chest provokes the release of about five hundred milliliters of air. When the compression stops, the same portion of air is sucked into the lungs. As a result, passive inhalation and exhalation occur.

The essence and algorithm of massage

External cardiac massage is a rhythmic compression of the heart through compressions that are performed between the sternum and the spine. Experts note that the chest of a person with cardiac arrest becomes more pliable due to loss of muscle tone, making it easy to perform compressions. The person providing assistance, if the NMS technique is followed, can easily displace the chest by three to five centimeters. Compression of the heart leads to a decrease in its volume and an increase in intracardiac pressure.

Rhythmic pressure on the chest area leads to a difference in pressure inside the heart cavities, blood vessels, which extend from the heart muscle. Blood from the left ventricle travels through the aorta to the brain, while from the right ventricle it flows to the lungs, where it is oxygenated.

After the pressure on the chest stops, the heart muscle straightens, intracardiac pressure decreases, and the chambers fill with blood. As a result, artificial circulation is recreated.

You can perform a closed massage of the heart muscle only on a hard surface. No soft sofas will do; the person must be placed on the floor. After this, it is necessary to perform the so-called precordial punch. It should be directed to the middle third of the chest. The impact height should be thirty centimeters. In order to conduct a closed cardiac massage, the person providing assistance places the palm of one hand on the other, after which he begins to perform uniform pushes according to the established technique.

Rules for performing massage

To ensure that the measures taken emergency assistance were effective, it is extremely important to follow the cardiac massage technique. Only in this case, the efforts made to restore the victim’s cardiac activity can be justified.

When performing cardiac massage, the following rules should be observed:

1. The rescuer kneels in front of the victim lying on the ground or floor. It doesn't matter which side he is on. However, if the rescuer is right-handed, it will be more convenient for him to perform a precordial blow if he is positioned right hand to the victim.
2. Base right palm position it a little higher xiphoid process. The thumb should be directed either towards the chin or towards the victim’s abdomen.
3. Hands of a man performing indirect massage hearts must be completely straightened. When the chest is displaced, the center of gravity must be moved to the chest of the person being assisted. As a result, the rescuer will be able to preserve his strength. If you bend your arms in elbow joints, then they will get tired quickly.
4. For resuscitation to be successful, first aid must arrive within half an hour. The frequency of pressure on the victim’s chest is sixty times per minute.
5. The depth to which chest compressions must be performed is three to five centimeters. In this case, the person providing assistance should not take their palms off the victim’s chest.
6. The next pressure on the chest should be done only after it returns to its original position.
7. During NMS, rib fractures are possible. This is not a reason to stop resuscitation measures. The only clarification is that pressure should be performed a little less often, but their depth should remain the same.
8. Simultaneously with the NMS, it is also carried out artificial respiration. The ratio of chest compressions to ventilation should be 30:2. Compression on the victim's chest provokes exhalation, and the return of the chest to its original position is a passive inhalation. As a result, the lungs are saturated with oxygen.
9. During resuscitation measures, more attention should be paid to closed cardiac massage rather than artificial respiration.

Algorithm for performing indirect cardiac massage

Closed cardiac massage will be effective only if it is performed in accordance with the algorithm. You must proceed as follows:

1. First of all, determine the place where the compression will be carried out. There is a common belief that a person's heart is on the left. This is not entirely true. In fact, you shouldn't put pressure on left side, and to the center of the chest. This is extremely important, because when performing compression on wrong place, you can not only fail to achieve the desired effect, but also cause harm. The point that we need is located in the center of the chest, at a distance of two fingers from the center of the sternum (where the ribs touch).
2. Place the heel of your palm on this point to thumb hands “looked” either at the stomach or at the chin of the victim, depending on which side of him you are on. Place your second palm crosswise on top of the first. Please note that only the base of the palm should be in contact with the body of the person you are helping. Fingers should remain hanging.
3. Don't bend your elbows. It is necessary to apply pressure using your own weight, and not the strength of your arm muscles, since in otherwise you will get tired quickly, and the force of pressure at each point will be different.
4. With each pressure, the victim's chest should drop to a depth of five centimeters. In other words, the compression must be strong, because this is the only way you will be able to properly disperse the blood throughout the body so that it delivers oxygen to the brain.
5. Artificial ventilation is performed between compressions. Its cyclicity is two breaths for every fifteen shocks.

Signs that resuscitation was successful are the appearance of a pulse in the area of ​​the carotid artery, as well as the reaction of the person’s pupils to light.

Conducting a closed heart massage for a child

Unfortunately, sometimes there are situations when, for one reason or another, a child’s heart stops. In this case, the reaction of people nearby should be immediate - the baby must immediately begin closed heart massage, since every second of lost time brings a tragic outcome closer.

In infants, clinical death can be caused not only by the syndrome sudden death, but also neurological diseases, sepsis, drowning, obstruction respiratory tract, acute bronchospasm, pneumonia, severe injuries or serious burns and other diseases.

There are no indications for direct massage heart problems for infants and older children are: sudden deterioration in the child’s condition, fainting, absence of heartbeat when palpating the carotid artery, cessation of respiratory activity, lack of pupillary response to light.

Features of the procedure for children

Carrying out resuscitation of children has a number of features.

First of all, chest compressions should begin in babies immediately after signs of clinical death have been detected. At the same time, artificial respiration is carried out, before starting which it is necessary to ensure the free passage of air through the respiratory tract.

Indirect cardiac massage in newborns is performed with little effort. Infants are placed on their backs, with their shoulders facing them. The thumbs should touch the front of the chest, and their base will be on the lower third of the chest.

In addition, a closed massage of the heart muscle of a newborn can be performed by placing it on your forearm, and holding its head slightly tilted back in the palm of your hand.

When performing NMS, children under one year of age should use only two fingers for pressure - the second and third. The frequency of compressions should be from eighty to one hundred per minute.

Heart massage for children aged one to seven is done while standing to the side of them, using the heel of the palm.

When resuscitating children over eight years old, massage is done with both hands. The main thing when performing NMS for a child is to carefully calculate the strength. Excessively strong pressure can lead to damage to the chest, which, in turn, can lead to injury. internal organs and the development of hemo- and pneumothorax.

Technique for performing NMS for children

When resuscitating a child, a strict sequence of actions must be carefully followed.

The child should be placed on any hard surface; infants can be placed on their own forearm. Hands are placed 1.5-2.5 cm above the xiphoid process. Pressures are performed rhythmically; the time of maximum deflection of the chest should not exceed one second. The amplitude of pressure and their frequency varies depending on the age of the child. Babies up to five months of age should be given up to one hundred and forty pressures per minute, the sternum should bend to a depth of one and a half centimeters. Children aged six months to one year should do 130-135 compressions, and the sternum should bend two to two and a half centimeters. Frequency of clicks from one to two - 120-125, from two to three - 110-115, from three to four - 100-105, from four to six - 90-100, from six to eight - 85-90, from eight to ten - 80-85, from ten to twelve - about 80, from twelve to fifteen - 75.

Resuscitation can be considered successful if the baby’s condition improves: his pupils constrict in response to light, eyelid tone appears, reflex movements of the larynx are recorded, a pulse can be detected in the carotid and femoral arteries, the color of the skin and mucous membranes improves.

Indirect (closed) cardiac massage begins after 2-3 intense breaths, if there are symptoms of cardiac asystole. The absence of cardiac activity is a signal for immediate closed cardiac massage.

ATTENTION! Before starting a closed cardiac massage, it is necessary to strike the area of ​​​​the projection of the heart with a fist from a distance of 30-40 cm. In some cases, this is enough to resume cardiac activity.

The essence of the closed heart massage method is that, as a result of mechanical action on the victim’s chest, deformation of the heart muscle is caused, which imitates heart contractions.

The human heart is located between the chest and spine, which reliably protect it from external influences. If you press intensely on the sternum area so that it deforms by 4-5 cm, which corresponds to the height internal cavity left ventricle at the time of systole, then blood will be expelled from the ventricles of the heart - blood from the left ventricle will enter the systemic circulation, and from the right - into the pulmonary circulation.

After the mechanical effect on the chest is stopped, it will return to its original position, negative pressure will arise in it and blood from the left atrium will flow into the left ventricle, and deoxygenated blood from great circle blood circulation will enter the right atrium.

In this way, it is possible to mobilize up to 40% of the minute volume of blood circulation, which is often sufficient for successful interventions.

Indirect cardiac massage without parallel conduction artificial ventilation lungs does not make sense, since in this case the blood passing through the lungs, in the absence respiratory function, is not enriched with oxygen.

Technique for closed cardiac massage

• Place the victim's back on a hard surface.
• The resuscitator is located on any convenient side of the victim.
• The resuscitator's hands are placed 2 fingers above the xiphoid process, with one hand placed on top of the other.
• Rhythmic pressure is applied to the victim's chest so that the depth of the deflection does not exceed 4-5 cm, and the frequency of pressure is 60-70 compressions per minute.
• The resuscitator makes the first press smoothly to determine the degree of elasticity of the victim’s chest.
• The movements of the resuscitator’s hands should not be jerky, since in this case there is a high probability of breaking the victim’s chest.
• You should work with straight arms, without bending them at the elbows, thus using not the strength of the arms, but the body weight of the resuscitator.
• During a closed massage, you should not take your palms off the victim’s chest.
• At correct actions resuscitator, the victim should receive a synchronous impulse on the carotid and femoral arteries in time with pressing on the chest.
• The optimal ratio of closed cardiac massage and mechanical ventilation is 1:5 - one artificial breath is given for five chest compressions.
• In the case of resuscitation performed by two people - one does mechanical ventilation, the other does closed cardiac massage. The main condition is to act alternately; you cannot do both at the same time.
• When a distinct independent pulsation of the victim’s arteries appears, constriction of his pupils, changes in color skin, the appearance of eyelid tone, closed cardiac massage is stopped, and mechanical ventilation is carried out until spontaneous breathing appears.
• For newborns, closed heart massage is performed using the nail phalanges of the first fingers, covering the back with the palms of both hands. For small children - one or two fingers. For teenagers - with one hand. The frequency of chest compressions should be within physiological norm heart rate for a specific age group.

Errors when performing closed cardiac massage

• Insufficient intensity of compression of the victim’s chest, which can be caused by insufficient pressing force or the soft surface on which the person being resuscitated lies. An objective indicator of this error is the absence of synchronous pulsation on large arteries the victim.
• Breaks during closed cardiac massage for more than 10 seconds, which is extremely undesirable (this also applies to mechanical ventilation).
• The most common complication during closed cardiac massage is a fracture of the ribs of the chest, which can cause various mechanical damage lungs, but this happens quite rarely.

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Lay the patient on a hard, flat surface, unfasten or remove any clothing, belt, or belt that is constricting the body. Determine the place of compression - the middle of the distance between the lower and upper ends of the sternum determined by palpation (with both hands).

While on the patient's side, place the proximal part of the palm of one hand on the pressure point. Place the proximal part of the palm of the other hand on top of the first. The arms are straight and positioned vertically.

Push the sternum down towards the spine by about 4-5 cm (for adults). Help the massage with your body weight.

Fix the sternum in this position for half a cycle to push blood out of the heart (artificial systole). Then quickly release it and wait half the cycle to allow the heart to fill with blood (artificial diastole).

Repeat pressures at a frequency of 80-100 per minute (slightly slower than 2 per 1 second).

One resuscitator alternates 2 inflations with 15 chest compressions. If there are two resuscitators, the ratio of the frequency of compressions to the rate of artificial ventilation is 4:1.

17.Methodology of artificial ventilation of the lungs

Restore airway patency (put the patient on his back, tilt his head back, put one hand under the neck, the other on the forehead - in this position the root of the tongue moves away from back wall pharynx and provides free access of air to the larynx and trachea).

Use protective devices that reduce the risk of disease transmission during mouth-to-mouth artificial ventilation (mask, protective film for the face), Ambu bag.

Pinch the patient's nose with your fingers and deep breath and, tightly covering the patient’s mouth with your lips, blow air into it for 1.5 - 2 seconds. Exhalation occurs passively. The frequency of injections depends on the rate of passive exhalation - for an adult, 10-12 per minute (one injection every 5 seconds). The volume of blown air is 0.5-1.0 liter.

The person performing artificial ventilation checks for pulsation of the carotid artery and monitors the patency of the airways. If you cannot inflate the lungs, you need to check whether the head is tilted back correctly, pull the patient's chin towards you and try to inflate the lungs again.

Artificial ventilation of the lungs can be carried out using a manual portable device such as RPA, artificial lung ventilation devices for the ambulance service, and artificial lung ventilation devices in intensive care units.

18. Emergency care for acute gastrointestinal bleeding

Causes of acute gastrointestinal bleeding: gastric and duodenal ulcers, tumors of the gastrointestinal tract, gastric erosions, varicose veins of the esophagus, ulcerative colitis, hemorrhoids, hemorrhagic diathesis.

Clinical symptoms of bleeding include general symptoms acute anemia and signs of gastrointestinal bleeding.

General signs of blood loss depend on its volume and can be minimal (with bleeding up to 400-500 ml) or correspond to hemorrhagic shock (with bleeding more than 700 ml). The approximate amount of blood loss is determined by the Algover “shock” index: the quotient of dividing the pulse rate by the systolic value blood pressure. With a loss of 20-30% of circulating blood volume (CBV), the Algover index corresponds to 1.0; with a loss of 30 - 50% - 1.5; with a loss of more than 50% - 2.0.

Signs of acute posthemorrhagic anemia: thirst, dizziness, tinnitus, weakness, yawning, chills. Objectively, pallor of the mucous membranes and skin, tachycardia, a transient decrease in blood pressure, preservation of the loudness of heart sounds, and functional systolic murmur at the apex are detected. IN general analysis blood hemoglobin was reduced to 100 g/l, hematocrit to 0.35.

Hemorrhagic shock:

Mental status disorders from agitation to coma,

Tachycardia from 90 or more,

Drop in blood pressure

Oliguria,

Pale mucous membranes and skin, there may be cyanosis,

Pulse of weak filling and tension to threadlike,

Deafness of heart sounds.

In a general blood test, a decrease in hemoglobin is below 100 g/l, hematocrit is below 0.35.

Signs of gastrointestinal bleeding:

Bloody vomiting (hematemesis) of unchanged blood or “coffee grounds” when bleeding from the upper sections,

Black, tarry stools (melena) with blood in the blood for a long time upper sections intestines,

Dark cherry coloring of the stool with rapid passage through the intestines or bleeding from its lower parts,

Unchanged scarlet blood in the stool (hematochezia) from the distal intestine,

Fecal masses of the “raspberry jelly” type in nonspecific ulcerative colitis.

Treatment:

1) Strict bed (stretcher) rest. Transportation in the Trendelenburg position to the surgical hospital.

2) Ice pack on the epigastric region.

4) Plasma-substituting solutions: dextran/sodium chloride, 10% hydrosethyl starch solution, 7.5% sodium chloride solution 5-7 ml per 1 kg of body weight - first intravenously, then (at blood pressure more than 80 mm Hg) - drip. The volume of infusion should exceed the volume of blood loss by 3-4 times.

5) Mezaton (phenylephrine) 1% -1 ml in 800 ml of 5% glucose solution (with blood pressure less than 80 - 90 mm Hg).

6) Dicynone (sodium etamsylate) 2-4 ml of 12.5% ​​solution intravenously every 6 hours.

7) If the effect is insufficient infusion therapy(blood pressure below 80 - 90 mmHg) norepinephrine 1-2 ml of 0.2% solution or dopamine 5 ml of 0.5% solution per 400 ml of plasma replacement solution intravenously drip, prednisolone up to 30 mg/kg intravenously slowly.

8) Oxygen therapy - inhalation of humidified oxygen through a mask or nasal catheters.

9) Blackmore probe for bleeding from the esophagus.

The patient should be on a solid base to prevent the possibility of his body shifting under the efforts of the massager’s hands (the floor or a low couch); if possible, the patient’s legs should be raised by 25 - 40 degrees.

The area where the force of the hands of the resuscitator is applied is located on the lower third of the sternum, strictly along midline, the resuscitator can be on either side of the patient.

To carry out the massage, place one palm on top of the other and apply pressure to the sternum in an area located 7 - 10 cm above the place of attachment of the xiphoid process to the sternum (Fig. 4); the hands of the massager, straightened at the elbow joints, are positioned so that only the wrist produces pressure.

Rice. 4. Closed heart massage: A– hand application point, b– massage technique.

Compression of the chest is performed due to the weight of the doctor’s body; the displacement of the sternum towards the spine (the depth of the chest deflection) should be 4 - 6 cm.

The frequency of chest compressions is 80-100 per minute, the duration of compression should be half the duration of the massage cycle.

Insufflation of air into the lungs should be carried out simultaneously with compression of the chest, frequency 10 - 12 per minute. There should be no breaks in insufflation every 5 massage cycles.

This mode is possible when resuscitation measures are carried out by two persons. If assistance is provided by one person, then the previous rule is forced to remain: after two rapid injections of air into the patient’s lungs, 10 to 12 chest compressions are performed. Chest massage can be performed from the back - in the case when cardiac arrest occurred in the prone position, and turning the patient for some reason is impossible. The massage technique does not undergo any changes, however, artificial ventilation becomes more difficult.

A prerequisite for cardiac massage is constant monitoring of its effectiveness. The criteria for the effectiveness of massage should be considered:

change in skin color - it becomes less pale, gray, cyanotic;

constriction of the pupils, if they were dilated, with the appearance of their reaction to light;

the appearance of a pulse impulse on the carotid and femoral arteries, and sometimes on the radial artery;

determination of blood pressure at the level of 60 - 70 mm Hg. Art. when measured on the shoulder,

sometimes - the appearance of independent respiratory movements.

If there are signs of restoration of blood circulation, but in the absence of a tendency to maintain independent cardiac activity, cardiac massage is carried out either until the desired effect is achieved (restoration of effective blood flow), or until signs of life permanently disappear with the development of symptoms of brain death.

If there are no signs of restoration of blood flow, despite performing a cardiac massage for 25 - 30 minutes, the patient should be considered dead and resuscitation measures can be stopped.

The timing of cessation of resuscitation measures depends on the cause of sudden death, the duration of complete cessation of blood circulation and breathing, as well as the effectiveness of resuscitation aids. A favorable outcome of revival, disappearance of skin pallor and subsequent resumption of cardiac activity portend a rapid restoration of reflex activity. With the appearance of a distinct pulsation in the arteries, cardiac massage is stopped, and only mechanical ventilation is continued until spontaneous adequate breathing is restored.

The ineffectiveness of closed massage may be due to a number of errors:

performing a massage on a patient who is lying on a soft springy surface,

incorrect position of the hands of the resuscitator, which leads to fractured ribs and ineffective massage,

too little or excessive pressure on the sternum, in the first case the massage will be ineffective, in the second - possible injury to the chest (fracture of the sternum and ribs) and its organs,

long, more than 5 - 10 s, break in massage for additional diagnostic or therapeutic measures, which contributes to a gradual increase in hypoxia of the brain and myocardium and reduces the possibility of achieving final success in resuscitation.

performing a massage without simultaneous mechanical ventilation, in this case the massage is useless, since the blood in the lungs is not oxygenated.

Medicines used in resuscitation must reach the coronary vessels, so they must be injected into the vascular bed. The most common route of administration is intravenous. It is preferable to use central veins. When administered intravenously, after the drug, it is necessary to introduce 20 - 30 ml of any solution (0.85% sodium chloride solution, 5% glucose solution, etc.) in order to push it as close to the heart as possible.

Drugs such as adrenaline, lidocaine, atropine can be injected into the trachea: either through a thin catheter and endotracheal tube, or by puncture of the cricoid membrane. When administered intratracheally, the dose of the drug increases 2 - 3 times, and it itself is diluted in 10 - 20 ml of any (see above) solution to facilitate absorption into the vessels of the small circle.

ABOUT
You should especially focus on the intracardiac route of administration, which has been used for many years. Currently, most experts do not recommend resorting to it due to the likelihood of developing severe complications. When another (intravenous or intratracheal) route is possible, intracardiac injections should not be resorted to. If it is impossible to use these routes, one should remember about intracardiac administration. Such an injection is fraught with the development of complications, but, firstly, their occurrence can be prevented, and secondly, if intracardiac injections are not used, then, of course, there will be no complications, but there will be no hope of restoring the vital functions of such a patient. And one more argument in favor of intracardiac administration: drugs enter the left ventricle, from where the path to the coronary vessels is the shortest. A syringe connected to a long (10 - 12 cm) needle is injected into the fifth intercostal space, 2 cm to the left of the left edge of the sternum and advanced deep into the tissue while constantly pulling the syringe piston toward itself (Fig. 5). When blood appears in the syringe, the medicine is quickly administered, the needle is removed and CPR is continued, with a break in

Rice. 5. Cardiac puncture for insertion permissible only for the duration of the puncture.

research of medicinal substances.

Possible complications and ways to prevent them:

1. Injury of lung tissue with a needle followed by the development of tension pneumothorax. This complication can be prevented by stopping the blowing of air into the lungs at the time of puncture. In this case, the lung collapses, and the likelihood of damage is reduced to zero.

2. Possible injury coronary vessel with subsequent development of infarction in the area of ​​its vascularization. With correct puncture - the fifth intercostal space - the occurrence of this complication is unlikely, since there are practically no large coronary vessels in this area.

3. We cannot exclude the possibility of developing cardiac tamponade due to blood entering the pericardial cavity through the puncture hole. Again, if the puncture is performed in the fifth intercostal space, then the powerful muscle of the left ventricle covers this opening during systole, and then it quickly becomes obliterated.

It should be remembered that the intracardiac route of administration is a last resort, which can be resorted to only in the absence of other options.

The first drug used in the resuscitation process is adrenalin. Firstly, it causes an increase in peripheral resistance (alpha-adrenomimetic effect), and this, in turn, leads to an increase in pressure in the aorta and an improvement in coronary and cerebral circulation. Secondly, adrenaline improves the conduction of excitation through the heart, metabolic processes it dilates the coronary vessels (beta-adrenomimetic effect), which helps restore independent cardiac activity.

An adult is administered 1 mg of adrenaline every 3 to 5 minutes throughout the entire period of resuscitation.

During the dying process, the tone of the parasympathetic nervous system increases significantly. To reduce reactions and protect cholinoreactive receptors, M-anticholinergics are used, primarily atropine. At the same time, the effect of sympathomimetics and endogenous catecholamines is enhanced. Atropine is administered intravenously in a 0.1% solution of 1 ml (1 mg) and again in the same dose every 3 to 5 minutes until the total dose does not exceed 3 mg. Atropine may have an effect in asystole and bradycardia.

Regarding application sodium bicarbonate, then its administration is indicated only if cardiac activity is not restored within 15 - 20 minutes of effective cardiopulmonary resuscitation.

With increased permeability of tissue barriers calcium may cause damage to the heart muscle and contribute to the progression of neurological disorders. Currently, calcium administration (3 - 5 ml of 10% calcium chloride solution intravenously) is indicated only in cases of hyperkalemia, hypocalcemia, or an overdose of calcium antagonists.

During resuscitation, they also use glucocorticoid hormones, which, by increasing the sensitivity of beta-adrenoreactive myocardial structures to catecholamines and normalizing the permeability of cell membranes, contribute to the restoration of cardiac activity. Prednisolone is used in a dose of 60 - 90 mg intravenously and other drugs in similar doses. If necessary, the drug is reused.

Cardiac glycosides in case of acute circulatory arrest, they are useless, and centrally acting analeptics (cordiamin, corazol) are harmful, since they sharply increase the need for oxygen in the brain and myocardium and do not have a cardiotonic effect.

For fibrillation (and severe ventricular tachycardia), an indispensable remedy is lidocaine.

When the heart stops beating, a well-executed procedure can save a life. external massage hearts. This involves rhythmic pressure on bottom part sternum for artificial pumping of blood. Such actions help restore your own electrical activity myocardium and prevent the death of brain cells.

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When is artificial massage needed?

The main indication for performing indirect cardiac massage is to stop its work. This may happen when:

• drowning,
• electric shock,
• rhythm disturbances (ventricular fibrillation, sinus node weakness),
• stroke and
• pulmonary embolism,
• hypothermia (excessive hypothermia),
• shock due to blood loss, anaphylaxis,
• poisoning carbon monoxide, alcohol, medications.

In order to be sure of cardiac arrest, you need to identify the following signs:

• no pulsation carotid arteries(check with second and third fingers);
• there is no breathing (the chest is motionless, there is no fogging on the glass or mirror when approaching the face);
• the pupils are dilated, if you shine a flashlight on them, there is no constriction;
• loss of consciousness is indicated by a tap on the face or loud sounds, if the patient does not respond to them, then this is a sign of unconsciousness;
• the skin of the face and body is pale with a grayish-bluish tint.

If the person performing resuscitation does not know how to correctly determine the pulse, then it is considered absent. To start a closed massage, the absence of consciousness and breathing is enough.

The most important factor determining later life patient with clinical death, are the first 7 minutes after cardiac arrest. Brain cells begin to die after 3-5 minutes of stopping the flow of blood into them. After 30 minutes, any resuscitation measures will be useless.

Correct sequence of actions

The complete complex for preventing death consists of the following stages:

1. Recognize cardiac arrest.
2. Call an ambulance.
3. Start external massage and ventilation (massage is a priority).
4. Intensive drug therapy.

First aid to the victim is often provided by a person who does not have special knowledge and experience, therefore, according to the latest recommendations of resuscitation specialists, until the arrival of a special team, one can only limit closed massage hearts.

A break in chest compressions severely disrupts the blood supply to the brain, so a break for ventilation should not be taken longer than 10 seconds after every 30 compressions.

Position of the patient before the procedure

In order to compress the chest, the victim's back must be on a hard surface. Therefore, it is laid on the floor or ground. A bed or sofa is not suitable for this purpose. The chest is freed from clothing, the belt is unfastened.

The airways should be cleared of contents whenever possible. To do this, use a spoon or similar object to clean oral cavity. If the mouth is closed, then lower jaw required to move forward: throw back your head, place index fingers behind the ears and with a strong movement pull the jaw up and forward.

Execution technique

When providing first aid use closed technology massage and artificial ventilation. Direct impact on the heart can only be carried out during cardiac surgery.

Indirect external (closed)

Before starting, a precordial blow is applied to the heart area. It is sometimes enough to trigger independent contractions. For this clenched fist you need to sharply hit the sternum 2 - 3 cm above the xiphoid process. A blow to the heart is more effective if no more than 20 seconds have passed since the stop. Contraindicated for children weighing up to 15 kg.

For effective resuscitation, indirect massage is much more important than all other measures, so it must be carried out as early as possible and for as long as possible before the arrival of the medical team or the appearance of signs of biological death.

Rules for closed cardiac massage:

• Kneel near your chest.
• Place straightened arms on the lower third of the sternum 2 cm above the costal angle, the shoulders of the person providing assistance are above the patient’s chest.
• Pressing is done with the lower zone of the palm with both hands (one on top of the other, fingers crossed).
• The pressure on the chest should not be due to the muscles of the arms, but the weight of the torso, the direction is strictly perpendicular.
• The deflection depth is 5 cm, the rhythm is 100 compressions per minute.

Intense pressure can cause rib fractures. This is more common in older people, but is not a reason to stop resuscitation.

Watch the video about the technique of performing indirect cardiac massage:

With ventilation

When inhaling air into the patient’s mouth, you need to check the patency of the respiratory tract, empty the mouth and nasal passages, and tilt the head back so that the chin is directed upward. Principles of artificial ventilation:

• take a deep breath,
• pinch the patient's nose and exhale into the mouth,
• after 4 seconds repeat,
• continue external cardiac massage.

To protect the resuscitator and the victim, barriers are used - a handkerchief or special masks available in the first aid kit. Effectiveness is assessed by raising the chest.

The main differences between direct and indirect

To perform direct cardiac massage, the surgeon must compress the ventricles in a rhythm of up to 60 contractions with one or both hands, forcing blood to move through the arteries. This method is used if, during an operation, a straight line is recorded on the patient’s ECG. It is justified only in cardiac arrest with an open chest or if there is surgical access near the diaphragm. Most often, such actions are carried out with.

Indirect massage requires the integrity of the chest, since it is performed by compressing it. Both types of massage lose their significance if they are started late, when the body has already experienced metabolic disorders or has arrived terminal stage serious illness internal organs.

How to massage children

Basic Rules cardiopulmonary resuscitation after 1 year they do not differ. For newborns, the chest is covered with the palms, while the chest is placed on the lower third of the sternum. thumbs, and the rest are placed under the back (the resuscitator is located on the side of the head). Pressures are applied with one finger, their depth is about 1.5 - 2 cm, and the frequency is 130 - 140 per minute.

Older children receive assistance just like adults, but up to 2 years old it is enough to use 2-3 fingers, and after that the strength of one palm is enough. Teenagers can squeeze the chest with both hands, but the pressure should be less intense than with adults.

Cardiac defibrillation is performed for indications such as heart rhythm disturbances. The method of electrical defibrillation is quite simple; it is performed by trainers, hotel staff, and flight attendants.