How to do indirect heart massage: technique. When Should Chest Compression Be Used: Technique How to Use Chest Compression

The patient should be on a solid basis to prevent the possibility of displacement of his body under the efforts of the massaging hands (floor or low couch), if possible, the patient's legs should be raised by 25 - 40 degrees.

The zone of application of the strength of the hands of the resuscitator is located on the lower third of the sternum, strictly along the midline, the resuscitator can be located on either side of the patient.

For massage, one palm is placed on top of the other and pressure is applied to the sternum in the area located 7-10 cm above the place of attachment to the sternum of the xiphoid process (Fig. 4).

Rice. four. Closed heart massage: a- point of application of hands, b- massage technique.

Chest compression is performed due to the gravity of the doctor's body, the displacement of the sternum towards the spine (depth of chest deflection) should be 4-6 cm.

The frequency of chest compression is 80-100 per 1 min, 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, the frequency is 10-12 per 1 min. Breaks in blowing every 5 cycles of massage should not be done.

This mode is possible when carrying out resuscitation by two persons. If assistance is provided by one person, then the old rule is forced to remain: after two quick injections of air into the lungs of the patient, 10-12 chest compressions are performed. Chest massage can be performed from the back - in the case when the cardiac arrest occurred in the prone position, and the patient's rotation is impossible for some reason. At the same time, the massage technique does not undergo changes, however, it becomes more difficult to carry out artificial ventilation of the lungs.

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;

definition 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 preserve independent cardiac activity, heart massage is performed either until the desired effect is achieved (restoration of effective blood flow), or until the signs of life disappear permanently with the development of symptoms of brain death.

In the absence of signs of restoration of blood flow, despite the cardiac massage for 25-30 minutes, the patient should be considered dead and resuscitation can be stopped.

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

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

carrying out massage to the patient, who lies on a soft springy surface,

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

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

a 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 the final success of resuscitation.

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

Drugs used in resuscitation must enter 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 the central veins. When administered intravenously after the drug, it is necessary to inject 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-thyroid membrane. With intratracheal administration, the dose of the drug is increased by 2-3 times, and he himself is diluted in 10-20 ml of any (see above) solution to facilitate absorption into the vessels of the small circle.

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Special mention should be made of the intracardiac route of administration, which has been used for many years. Currently, most experts do not recommend resorting to it because of the likelihood of severe complications. When another (intravenous and intratracheal) route is possible, intracardiac injections should not be resorted to. If it is impossible to use these ways, one should remember about intracardiac administration. Such an introduction is fraught with the development of complications, but, firstly, their appearance 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 life 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 tissues while constantly pulling the syringe plunger towards itself (Fig. 5). When blood appears in the syringe, the drug is quickly injected, the needle is removed and CPR is continued, a break in which

Rice. 5. Puncture of the heart for the introduction allowable only at the time of puncture.

niya medicinal substances.

Possible complications and ways to prevent them:

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

2. Possible injury coronary vessel with the subsequent development of a heart attack in the area of ​​its vascularization. With the 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. It is impossible to exclude the possibility of developing cardiac tamponade due to blood entering the pericardial cavity through the puncture hole. Again, if the puncture is carried out in the fifth intercostal space, then the powerful muscle of the left ventricle covers this hole during systole, and then it is quickly obliterated.

It should be remembered that the intracardiac route of administration is an extreme measure that can only be resorted to in the absence of other options.

The first of the drugs in the process of resuscitation is used 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 in it and expands the coronary vessels (beta-adrenomimetic effect), which contributes to the restoration of independent cardiac activity.

An adult is injected with 1 mg of adrenaline every 3-5 minutes throughout the entire period of resuscitation.

In the process of dying, the tone of the parasympathetic nervous system increases significantly. To reduce reactions and protect cholinergic receptors, M-anticholinergics are used, primarily atropine. Simultaneously, there is an increase in the effect of sympathomimetics and endogenous catecholamines. Atropine is administered intravenously in a 0.1% solution of 1 ml (1 mg) and repeated at the same dose every 3 to 5 minutes until a total dose not exceeding 3 mg. Atropine may have an effect in asystole and bradycardia.

As regards the application sodium bicarbonate, then its introduction is indicated only in the case when cardiac activity is not restored within 15-20 minutes of effective cardiopulmonary resuscitation.

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

During resuscitation, glucocorticoid hormones which, by increasing the sensitivity of beta-adrenergic structures of the myocardium to catecholamines and normalizing the permeability of cell membranes, contribute to the restoration of cardiac activity. Use prednisolone at a dose of 60 - 90 mg intravenously and other drugs at similar doses. If necessary, the drug is used repeatedly.

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

With fibrillation (and severe ventricular tachycardia), an indispensable tool is lidocaine.

Resuscitation measures are a set of actions aimed at restoring and maintaining effective blood circulation and respiratory function to save a person's life. Cardiac arrest requires immediate response and taking steps to recover. Such a procedure is considered an indirect heart massage - artificial stimulation of cardiac movements with a closed chest by decompression, that is, compression. This movement imitates systole - contraction of the heart, and relaxation - the second phase, or diastole. When an indirect heart massage should be used, read later in the article.

When should chest compressions be used?

Cardiac arrest is a situation in which gas exchange and nutrition of all tissues and organs cease. Necrosis occurs - cell death associated with the accumulation of metabolic products and the lack of oxygen supply. It is believed that the higher the metabolic rate in an organ, the less time is needed for its death due to the stoppage of effective blood circulation. For example, for brain cells, this period is only 5-7 minutes.

Providing first aid is an action that can save a person. However, you need to know when to use your cardiopulmonary resuscitation (CPR) skills, and when it is, unfortunately, pointless.

The main indication in this case is clinical death- a transitional period between life and biological death, a reversible stage of dying. At the same time, vital signs completely disappear, which is important to check when evaluating the need for an external heart massage.

Characteristic features of such a state, which must be recorded at the scene:

• No pulse on radial and carotid arteries. It is more important to detect the second option without feeling on the victim's neck characteristics pulse wave.
• Respiratory movements do not occur at all or are similar to agonal movements - sharp and strong inhalations and exhalations, or short and frequent. To check a sign, you do not need to bring a mirror or a pen to a person's mouth - their search will take precious time. Experts recommend simply looking at the movements of the chest, and this can be done while trying to find a pulse.
• The pupils are maximally dilated, there is no reaction to light - reflex constriction of the pupil.

If this description fits, then you should immediately try to restore hemodynamics - the effective movement of blood by conducting indirect massage hearts.

However, it may happen that the victim has:

• Signs of biological death. This indicates that too much time has passed since the moment of circulatory arrest. Cooling of the skin with the appearance of characteristic purple-blue cadaveric spots, stiffness of the limbs, the pupil in the form of a "cat's eye" - a thin slit.
• Severe polytrauma, when there are multiple fractures of the ribs or separation of the limbs.
• The presence of a pulse indicates that the heart is still working, even if the person is unconscious.

These conditions are contraindications for CPR.

Technique for performing chest compressions

It is not by chance that massage is called external - there is no direct contact with the structures of the heart, the action takes place with the chest closed.

The first step is to assess the condition and the presence of indications for resuscitation, after that it is important not to forget to make a call to ambulance. It is better if someone who is nearby calls.

Before doing an indirect heart massage, it is important to ensure the right conditions:

• The victim should lie on a horizontal hard surface. A universal place can be considered a hard floor or the ground if the incident occurred outdoors.
• The mouth must be cleaned. The head is turned to the side to allow vomit, blood, or foreign bodies to pass out.
• Next, it is important to throw your head back - this will protect the tongue from sinking and free Airways. It is ideal to put an impromptu roller under the neck.

The preparatory phase should last a few seconds, since each of them counts.

The technique itself consists of the following actions:

1. The position of the resuscitator is on the side of the victim at chest level.
2. The location of the hands with an indirect heart massage is on the border between the lower and middle thirds of the sternum. Approximately this point is two fingers above the lower edge of the sternum, but it is better to conditionally divide the bone into three parts and find the necessary border.
3. Hands should be connected one on top of the other, the point of application of forces is the inner part of the elevation between the thumb and little finger. It is better not to unbend the fingers of the other hand - with the “lock”, the force of impact increases.
4. Movements should be rhythmic, at least 100 per minute. The degree of pressure is 3-5 cm deep, for this it is necessary to apply a sufficiently tangible force.
5. After every 30 pressures, you need to take 2 breaths. In this case, the tidal volume should be more than usual - you should first take a deep breath.
6. The pulse on the carotid arteries is monitored every minute.

Important! The main rule is not to bend your elbows! Movements must be made with the body, not with the hands, otherwise the depth of compression will be insufficient. Hands should be a kind of transmission lever.

One person's actions

If the resuscitator is alone, then he has to cope with everything alone. Ratio recommendations vary: previously it was believed that one rescuer could take two breaths every 15 chest compressions, now this figure still does not change, it remains in the form of a 30:2 rule.

It is very difficult to perform an indirect heart massage alone, but the reason for stopping resuscitation is considered to be the exhaustion of the rescuer's strength.

Actions of two people

The help of a second witness to the tragedy is needed in order to call an ambulance and provide the most effective CPR.

If we talk about the recommendations of the European Association of Resuscitators, the ratio of 30:2 does not change regardless of the number of participants. However, the "old school" says something else - together you can take a pace of 5: 1, and then one rescuer is engaged in pressing on the chest, and the second - artificial respiration.

Another option is to carry out the entire algorithm alone, and change after a while, this saves a lot of effort and increases the chances of waiting for specialists.

Rules for resuscitation of children

The child's body is different from the adult, therefore, it requires special actions when conducting an indirect heart massage:

• Hands are located at the lower edge of the sternum.
• Pressing is carried out not with two hands, but with one or even two fingers - depending on the age of the child.
• The tidal volume should not be very large. It will be enough for babies to inhale the air that is contained in oral cavity.
• The ratio in children is allowed 5:1, while the depth of pressure is about 1.5-2 cm, but the pace remains at 100 per minute.

Forecast

According to various sources, it is worth conducting a closed heart massage until:

• pulse recovery;
• arrival of specialized assistance;
• depletion of the forces of resuscitators.

The average duration of rhythmic pressures on the sternum is about 30 minutes, after which we can reliably speak of the death of brain structures.

The prognosis depends on the time of the start of CPR, the quality of its implementation and the characteristics of the patient's body. Statistics say too contradictory figures - from 5 to 65% of cases end in the restoration of vital activity. However, the inverse relationship is obvious - without appropriate procedures, cardiac arrest leads to death in 100%. Therefore, it is the duty of every person to make every effort to save the life of the victim.

Lay the patient on a hard, flat surface, unfasten or remove clothing, belt, belt that constrains 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).

Being on the side of the patient, place the proximal part of the palm of one hand on the place of pressure. Place the proximal part of the palm of the other hand over the first. Arms are straight and vertical.

Push down the sternum to the spine by about 4-5 cm (in adults). Help massaging your body.

Hold 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 a cycle to allow the heart to fill with blood (artificial diastole).

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

One rescuer alternates 2 breaths with 15 chest compressions. If there are two rescuers, the ratio of pressure to ventilator rate is 4:1.

17.Method of artificial lung ventilation

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 the back of the 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, take a deep breath and, hermetically covering the patient's mouth with your lips, blow air into it for 1.5 - 2 seconds. Exhalation is passive. The frequency of breaths depends on the rate of passive expiration - in an adult, 10-12 breaths per minute (one breath every 5 seconds). The volume of blown air is 0.5-1.0 liters.

Performing artificial ventilation of the lungs checks for the presence of a pulsation of the carotid artery, monitors the patency of the airways. If it is not possible to inflate the lungs, it is necessary to check whether the head is thrown back correctly, pull the patient's chin towards you and again try to inflate the lungs.

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

18. Emergency care for acute gastrointestinal bleeding

Causes of acute gastrointestinal bleeding: gastric and duodenal ulcer, tumor of the gastrointestinal tract, erosion of the stomach, varicose veins of the esophagus, ulcerative colitis, hemorrhoids, hemorrhagic diathesis.

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

General signs of blood loss depend on its volume, may 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 “shock” Algover index: the quotient of dividing the pulse rate by the value of systolic blood pressure. With a loss of 20-30% of the volume of circulating blood (BCC), 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 mucous membranes and skin, tachycardia, a transient decrease in blood pressure, preservation of the volume of heart sounds, functional systolic murmur at the apex are detected. AT general analysis blood reduced hemoglobin to 100 g/l, hematocrit to 0.35.

Hemorrhagic shock:

Mental status disorders from agitation to coma,

Tachycardia of 90 or more,

drop in blood pressure,

oliguria,

Paleness of mucous membranes and skin, there may be cyanosis,

Pulse of weak filling and tension to filiform,

Deafness of heart sounds.

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

Signs of gastrointestinal bleeding:

Vomiting blood (hematemesis) with unaltered blood or "coffee grounds" when bleeding from the upper sections,

Black tarry stools (melena) with prolonged stay of blood in the upper intestines,

Dark cherry color of the stool with a rapid passage through the intestines or bleeding from its lower sections,

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

Raspberry jelly stools in nonspecific ulcerative colitis.

Treatment:

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

2) Ice pack on the epigastric region.

4) Plasma-substituting solutions: dextran / sodium chloride, 10% hydrosiethyl starch solution, 7.5% sodium chloride solution 5-7 ml per 1 kg of body weight - first intravenously by stream, then (with blood pressure over 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 (at arterial pressure less than 80 - 90 mm Hg).

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

7) In case of insufficient effect of infusion therapy (blood pressure below 80 - 90 mm Hg) norepinephrine 1-2 ml of 0.2% solution or dopamine 5 ml of 0.5% solution per 400 ml of plasma-substituting 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.

Everyone can find themselves in a situation where a person walking nearby loses consciousness. We immediately have a panic that needs to be put aside, because that person needs help.

Every person is obliged to know and apply at least basic resuscitation actions. These include chest compressions and artificial respiration. Most people undoubtedly know what it is, but not everyone will be able to properly help.

In the absence of a pulse and breathing, it is necessary to take immediate action, provide air access and rest of the patient, and also call an ambulance team. We will tell you how and when to perform chest compressions and artificial respiration.

The human heart has four chambers: 2 atria and 2 ventricles. The atria provide blood flow from the vessels to the ventricles. The latter, in turn, carry out the release of blood into the small (from the right ventricle into the vessels of the lungs) and large (from the left - into the aorta and further, to other organs and tissues) circulation circles.

In the pulmonary circulation, gases are exchanged: carbon dioxide leaves the blood into the lungs, and oxygen into it. More precisely, it binds to the hemoglobin of red blood cells.

AT big circle circulation is reversed. But, besides it, nutrients come from the blood into the tissues. And the tissues “give away” the products of their metabolism, which are excreted by the kidneys, skin and lungs.

Cardiac arrest is considered a sudden and complete cessation of cardiac activity, which in certain cases can occur simultaneously with the bioelectrical activity of the myocardium. The main reasons for stopping are:

1. Asystole of the ventricles.
2. Paroxysmal tachycardia.
3. ventricular fibrillation, etc.

Predisposing factors include:

1. Smoking.
2. Age.
3. Alcohol abuse.
4. Genetic.
5. Excessive stress on the heart muscle (for example, playing sports).

Sudden cardiac arrest sometimes occurs due to injury or drowning, possibly due to blocked airways as a result of electric shock.

In the latter case, clinical death inevitably occurs. It should be remembered that the following signs can signal a sudden cardiac arrest:

1. Consciousness is lost.
2. Rare convulsive sighs appear.
3. There is a sharp pallor on the face.
4. In the region of the carotid arteries, the pulse disappears.
5. Breathing stops.
6. Pupils dilate.

An indirect heart massage is performed until the restoration of independent cardiac activity occurs, among the signs of which the following can be distinguished:

1. The person comes to consciousness.
2. A pulse appears.
3. Decreases pallor and blueness.
4. Breathing resumes.
5. Pupils constrict.

Thus, in order to save the life of the victim, it is necessary to carry out resuscitation, taking into account all the circumstances, and at the same time call an ambulance.

In case of circulatory arrest, tissue metabolism and gas exchange stops. In the cells there is an accumulation of metabolic products, and in the blood - carbon dioxide. This leads to a stoppage of metabolism and cell death as a result of "poisoning" by metabolic products and lack of oxygen.

Moreover, the higher the initial metabolism in the cell, the less time is needed for its death due to circulatory arrest. For example, for brain cells, this is 3-4 minutes. Cases of revival after 15 minutes refer to situations when, before cardiac arrest, the person was in a state of cooling.

An indirect heart massage involves squeezing the chest, which must be done to compress the chambers of the heart. At this time, blood through the valves enters the ventricles from the atria, then it is sent to the vessels. Due to rhythmic pressure on the chest, the movement of blood through the vessels does not stop.

This method of resuscitation must be done to activate the heart's own electrical activity, and this helps to restore the independent work of the organ. First aid can bring results in the first 30 minutes after the onset of clinical death. The main thing is to correctly follow the algorithm of actions, follow the approved first aid technique.

Massage in the heart area must be combined with mechanical ventilation. Each punching of the chest of the victim, which must be done by 3-5 cm, provokes the release of about 300-500 ml of air. After the compression stops, the same portion of air is sucked into the lungs. By squeezing / releasing the chest, an active inhalation is performed, then a passive exhalation.

What is direct and indirect heart massage

Cardiac massage is indicated for flutter and cardiac arrest. It can be done:

• open (direct).
• closed (indirect) method.

Direct cardiac massage is performed during surgery with an open chest or abdominal cavity, and also specially open the chest, often even without anesthesia and observing the rules of asepsis. After the heart is exposed, it is carefully and gently squeezed by the hands in a rhythm of 60-70 times per minute. Direct cardiac massage is performed only in the operating room.

Indirect cardiac massage is much easier and more affordable in any conditions. It is done without opening the chest simultaneously with artificial respiration. By pressing on the sternum, you can move it 3-6 cm towards the spine, squeeze the heart and force the blood out of its cavities into the vessels.

When the pressure on the sternum ceases, the cavities of the heart expand, and blood is sucked into them from the veins. By indirect heart massage, it is possible to maintain pressure in the systemic circulation at the level of 60-80 mm Hg. Art.

The method of indirect heart massage is as follows: the assisting person puts the palm of one hand on lower third sternum, and the other - on the back surface of the previously imposed hand to increase pressure. On the sternum produce 50-60 pressures per minute in the form of quick shocks.

After each pressure, the hands are quickly taken away from the chest. The period of pressure should be shorter than the period of expansion of the chest. For children, massage is carried out with one hand, and for newborns and children under one year old - with the tips of 1 - 2 fingers.

The effectiveness of heart massage is assessed by the appearance of pulsations in the carotid, femoral and radial arteries, an increase in blood pressure to 60-80 mm Hg. Art., constriction of the pupils, the appearance of their reaction to light, the restoration of breathing.

When and why is heart massage done?

An indirect heart massage is necessary in cases where the heart has stopped. In order for a person not to die, he needs outside help, that is, you need to try to “start” the heart again.

Situations where cardiac arrest is possible:

• Drowning,
• traffic accident,
• electric shock,
• fire damage,
• The result of various diseases,
• Finally, no one is immune from cardiac arrest for unknown reasons.

Cardiac arrest symptoms:

• Loss of consciousness.
• Absence of a pulse (usually it can be felt on the radial or carotid artery, that is, at the wrist and on the neck).
• Absence of breath. The most reliable way to determine this is to hold a mirror up to the victim's nose. If it does not fog up, then there is no breathing.
• Dilated pupils that do not respond to light. If you open your eyes a little and shine a flashlight, it will immediately be clear whether they react to light or not. If a person's heart is working, then the pupils will immediately narrow.
• Gray or blue complexion.

Chest compression (CCM) is a resuscitation procedure that saves many lives every day around the world. The sooner you start doing NMS to the victim, the more chances he has to survive.

NMS includes two methods:

1. mouth-to-mouth artificial respiration, restoring breathing in the victim;
2. compression of the chest, which, together with artificial respiration, forces the blood to move until the victim's heart can again pump it throughout the body.

If a person has a pulse but is not breathing, they need artificial respiration but not chest compressions (a pulse means the heart is beating). If there is no pulse or breathing, both artificial respiration and chest compressions are needed to force air into the lungs and maintain circulation.

Closed heart massage must be performed when the victim has no pupillary reaction to light, breathing, cardiac activity, consciousness. External heart massage is considered to be the simplest method used to restore cardiac activity. It does not require any medical equipment to perform.

External cardiac massage is represented by rhythmic squeezing of the heart through compressions performed between the sternum and spine. It is not difficult for victims who are in a state of clinical death to perform chest compressions. This is due to the fact that in this state the muscle tone, a rib cage becomes more pliable.

When the victim is in a state of clinical death, the person assisting, following the technique, easily displaces the victim's chest by 3-5 cm. Each contraction of the heart provokes a decrease in its volume, an increase in intracardiac pressure.

Due to the implementation of rhythmic pressures on the chest area, a difference in pressure arises inside the heart cavities that extend from the heart muscle of the blood vessels. Blood from the left ventricle travels down the aorta to the brain, while blood from the right ventricle travels to the lungs, where it is oxygenated.

After the cessation of pressure on the chest, the heart muscle expands, intracardiac pressure decreases, and the heart chambers fill with blood. External heart massage helps to recreate artificial circulation.

Closed heart massage is performed only on a hard surface, soft beds are not suitable. When performing resuscitation, it is necessary to follow this algorithm of actions. After placing the victim on the floor, a precordial punch should be performed.

The blow should be directed to the middle third of the chest, the required height for the blow is 30 cm. To perform a closed heart massage, the paramedic first places the palm of one hand on the other hand. After that, the specialist begins to perform uniform shocks until signs of restoration of blood circulation appear.

In order for the ongoing resuscitation to bring the desired effect, you need to know, follow the basic rules, which are the following algorithm of actions:

1. The caregiver must determine the location of the xiphoid process.
2. Determination of the compression point, which is located in the center of the axis, of the finger 2 above the xiphoid process.
3. Place the base of the palm on the calculated compression point.
4. Perform compression along the vertical axis, without sudden movements. Compression of the chest should be performed to a depth of 3 - 4 cm, the number of compressions per chest area - 100 / minute.
5. For children under one year old, resuscitation is performed with two fingers (second, third).
6. When performing resuscitation to young children under one year old, the frequency of pressing on the sternum should be 80 - 100 per minute
7. children adolescence help is provided with the palm of one hand.
8. Adults are resuscitated in such a way that the fingers are raised and do not touch the chest area.
9. It is necessary to perform an alternation of two breaths of mechanical ventilation and 15 compressions on the chest area.
10. During resuscitation, it is necessary to monitor the pulse on the carotid artery.

Signs of the effectiveness of resuscitation are the reaction of the pupils, the appearance of a pulse in the carotid artery. The method of conducting an indirect heart massage:

• put the victim on a hard surface, the resuscitator is on the side of the victim;
• rest the palms (not fingers) of one or both straight arms on the lower third of the sternum;
• press the palms rhythmically, in jerks, using the weight of one's own body and the efforts of both hands;
• if during an indirect heart massage a fracture of the ribs occurs, it is necessary to continue the massage by placing the base of the palms on the sternum;
• the pace of massage is 50-60 strokes per minute; in an adult, the amplitude of chest oscillations should be 4-5 cm.

Simultaneously with a heart massage (1 push per second), artificial respiration is performed. For 3-4 pressures on the chest, there is 1 deep exhalation into the mouth or nose of the victim, if there are 2 resuscitators. If there is only one resuscitator, then every 15 pressures on the sternum with an interval of 1 second, 2 artificial breaths are required. The frequency of inspiration is 12-16 times per minute.

For children, massage is performed carefully, with the brush of one hand, and for newborns - only with the fingertips. The frequency of chest compressions in newborns is 100-120 per minute, and the point of application is the lower end of the sternum.

It is also necessary to carefully perform an indirect heart massage for the elderly, since with rough actions, fractures in the chest area are possible.

How to do heart massage in an adult

Stages of implementation:

1. Get ready. Gently shake the casualty by the shoulders and ask, "Is everything all right?" This way you make sure that you are not going to do NMS to a person who is conscious.
2. Quickly check if he has any serious injuries. Focus on the head and neck as you will be manipulating them.
3. Call an ambulance if possible.
4. Lay the victim on their back on a hard, flat surface. But if you suspect a head or neck injury, do not move it. This can increase the risk of paralysis.
5. Provide air access. Kneel near the casualty's shoulder for easy access to the head and chest. Perhaps the muscles that control the tongue relaxed, and he blocked the airways. To restore breathing, you need to release them.
6. If there is no neck injury. Open the victim's airway.

Place the fingers of one hand on his forehead and the other on lower jaw around the chin. Gently push your forehead back and pull your jaw up. Keep your mouth open so your teeth are almost touching. Don't put your fingers on soft tissues under the chin - you can inadvertently block the airways that you are trying to free.

If there is a neck injury. In this case, neck movement can cause paralysis or death. Therefore, you will have to clear the airways in a different way. Kneel behind the victim's head, resting your elbows on the ground.

Curl your index fingers over your jaw near your ears. With a strong movement, lift the jaw up and out. This will open the airway without neck movement.

7. Keep the victim's airway open.

Bend over to his mouth and nose, looking towards his legs. Listen to see if there is a sound from the movement of air, or try to catch it with your cheek, see if the chest is moving.

8. Begin artificial respiration.

If no breath is caught after opening the airway, use the mouth-to-mouth method. Pinch your nostrils with the index finger and thumb of the hand that is on the victim's forehead. Take a deep breath and close your mouth tightly with your lips.

Take two full breaths. After each exhalation, inhale deeply as the victim's chest collapses. It will also prevent swelling of the abdomen. Each breath should last one and a half to two seconds.

9. Check the victim's reaction.

To make sure there is a result, see if the victim's chest rises. If not, move his head and try again. If after that the chest is still motionless, it is possible that foreign body(e.g. dentures) obstruct the airways.

To release them, you need to make pushes in the stomach. Place one hand with the base of the palm on the middle of the abdomen, between the navel and chest. Place your other hand on top and interlace your fingers. Lean forward and make a short sharp push up. Repeat up to five times.

Check your breath. If he is still not breathing, repeat pushing until the foreign body is pushed out of the airway or help arrives. If the foreign body has come out of the mouth but the person is not breathing, their head and neck may be in the wrong position, causing the tongue to block the airway.

In this case, move the victim's head by placing your hand on the forehead and tilting it back. When pregnant and overweight, use chest thrusts instead of abdominal thrusts.

10. Restore circulation.

Keep one hand on the victim's forehead to keep the airway open. With the other hand, check the pulse in the neck by feeling for the carotid artery. To do this, put your index and middle fingers in the hole between the larynx and the muscle following it. Wait 5-10 seconds to feel the pulse.

If there is a pulse, do not compress your chest. Continue artificial respiration at a rate of 10-12 breaths per minute (one every 5 seconds). Check your pulse every 2-3 minutes.

11. If there is no pulse, and help has not yet arrived, proceed to squeezing the chest.

Spread your knees for a safe time. Then with the hand that is closer to the victim's legs, feel for the lower edge of the ribs. Move your fingers along the edge to feel where the ribs meet the sternum. Put on this place middle finger, next to it index.

It should be above the lowest point of the sternum. Place the base of your other hand on your sternum next to your index finger. Remove your fingers and place this hand on top of the other. Fingers should not rest on the chest. If the hands lie correctly, all the effort should be concentrated on the sternum.

This reduces the risk of rib fracture, lung puncture, liver rupture. Elbows tense, arms straight, shoulders directly over the arms - you are ready. Using body weight, press the victim's sternum 4-5 centimeters. You need to press with the bases of the palms.

After each press, release the pressure so that the chest returns to its normal position. This gives the heart a chance to fill with blood. To avoid injury, do not change the position of the hands when pressing. Do 15 clicks at the rate of 80-100 clicks per minute. Count "one-two-three ..." to 15. Click on the count, release for a break.

Alternate compression and artificial respiration. Now take two breaths. Then again find the correct position for the hands and do another 15 clicks. After four complete cycles of 15 compressions and two breaths, check the carotid pulse again. If it's still not there, continue with NMS cycles of 15 compressions and two breaths, starting with a breath.

Follow the reaction. Check your pulse and breathing every 5 minutes. If a pulse is felt but no breathing is heard, take 10-12 breaths per minute and check the pulse again. If there is both a pulse and breathing, check them more closely. Continue NMS until the following happens:

• the victim's pulse and breathing will be restored;
• doctors will arrive;
• You will get tired.

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 the 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. In infants, indirect heart massage is carried out with only two fingers: the middle and ring fingers. The frequency of massage pressure in infants should be increased to 120 per minute.

The causes of cardiac and respiratory arrest can be not only injuries or an accident. A baby's heart may stop for a reason. congenital diseases or due to sudden death syndrome. In preschool children, the base of only one palm is involved in the process of cardiac resuscitation.

There are contraindications for indirect heart massage:

• penetrating wound to the heart;
• penetrating injury to the lung;
• closed or open traumatic brain injury;
• the absolute absence of a solid surface;
• other visible wounds incompatible with emergency resuscitation.

Without knowing the rules for resuscitation of the heart and lungs, as well as the existing contraindications, you can aggravate the situation even more, leaving the victim no chance of salvation.

External baby massage

Conducting indirect massage for babies is as follows:

1. Gently shake the baby and say something out loud.

His reaction will allow you to make sure that you are not going to do NMS on a conscious baby. Quickly check for injuries. Focus on the head and neck as you will be manipulating these parts of the body. Call an ambulance.

If possible, ask someone to do it. If you are alone, do NMS for one minute, and only then call the professionals.

2. Clear your airways. If the baby is choking or something is stuck in the airway, then perform 5 chest thrusts.

To do this, place two fingers between his nipples and push quickly, in an upward direction. If you are concerned about a head or neck injury, move your baby as little as possible to reduce the risk of paralysis.

3. Try to get your breath back.

If the infant is unconscious, open his airway by placing one hand on his forehead and gently lift his chin with the other to allow air to enter. Do not apply pressure to the soft tissues under the chin as this may block the airway.

The mouth must be open. Take two mouth-to-mouth breaths. To do this, inhale, tightly close your mouth and nose of the baby with your mouth. Gently exhale some air (the lungs of an infant are smaller than those of an adult). If the chest rises and falls, then the amount of air seems to be appropriate.

If the baby has not started breathing, move his head slightly and try again. If nothing has changed, repeat the airway opening procedure. After removing objects blocking the airways, check breathing and pulse.

Continue with NMS if necessary. Continue artificial respiration with one breath every 3 seconds (20 per minute) if the infant has a pulse.

4. Restore circulation.

Check the pulse on the brachial artery. To find it, feel inside upper arm, above the elbow. If there is a pulse, continue artificial respiration, but do not squeeze the chest.

If the pulse is not felt, begin to squeeze the chest. To determine the position of the baby's heart, draw an imaginary horizontal line between the nipples.

Place three fingers below and perpendicular to this line. Raise your index finger so that two fingers are one finger below the imaginary line. Press them on the sternum so that it drops 1-2.5 cm.

5. Alternate pressing and artificial respiration. After five clicks, take one breath. Thus, you can do about 100 clicks and 20 breathing movements. Do not stop NMS until the following occurs:
   • the baby will begin to breathe on its own;
   • he will have a pulse;
   • doctors will arrive;
   • You will get tired.

Having laid the patient on his back and throwing his head as far as possible, you should twist the roller and place it under the shoulders. This is necessary in order to fix the position of the body. The roller can be made independently from clothes or towels.

You can do artificial respiration:

• from mouth to mouth;
• from mouth to nose.

The second option is used only if it is impossible to open the jaw due to a spasmodic attack. In this case, you need to press the lower and upper jaws so that the air does not escape through the mouth. You also need to tightly grab your nose and blow in air not abruptly, but vigorously.

When performing the mouth-to-mouth method, one hand should cover the nose, and the other should fix the lower jaw. The mouth should fit snugly against the victim's mouth so that there is no leakage of oxygen.

It is recommended to exhale air through a handkerchief, gauze or napkin with a hole in the middle of 2-3 cm. And this means that air will enter the stomach.

The person conducting resuscitation of the lungs and heart should take a deep long breath, hold the exhalation and bend over to the victim. Place your mouth tightly against the patient's mouth and exhale. If the mouth is loosely pressed or the nose is not closed, then these actions will not have any effect.

The supply of air through the rescuer's exhalation should last about 1 second, the approximate volume of oxygen is from 1 to 1.5 liters. Only with this volume, lung function can resume.

After that, you need to free the mouth of the victim. In order for a full exhalation to take place, you need to turn his head to the side and slightly raise the shoulder of the opposite side. This takes about 2 seconds.

If pulmonary measures are carried out effectively, then the victim's chest will rise when inhaling. You should also pay attention to the stomach, it should not swell. When air enters the stomach, it is necessary to press under the spoon so that it comes out, as this makes the whole process of revitalization difficult.

Pericardial beat

If clinical death has occurred, a pericardial blow can be applied. It is such a blow that can start the heart, as there will be a sharp and strong effect on the sternum.

To do this, you need to clench your hand into a fist and strike with the edge of your hand in the region of the heart. You can focus on the xiphoid cartilage, the blow should fall 2-3 cm above it. The elbow of the arm that will strike should be directed along the body.

Often this blow brings the victims back to life, provided that it is applied correctly and in a timely manner. The heartbeat and consciousness can instantly be restored. But if this method did not restore function, artificial lung ventilation and chest compressions should be applied immediately.

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

1. At correct execution artificial respiration, you can notice the movement of the chest up and down during passive inspiration.
2. If the movement of the chest is weak or delayed, you need to understand the reasons. Probably a loose fit of the mouth to the mouth or to the nose, a shallow breath, a foreign body that prevents air from reaching the lungs.
3. If, when inhaling air, it is not the chest that rises, but the stomach, then this means that the air did not go through the airways, but through the esophagus. In this case, you need to put pressure on the stomach and turn the patient's head to one side, as vomiting is possible.

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 perform 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's" pupil (when pressing on eyeball the pupil becomes vertical, like a cat) or the first signs of stiffness - 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.

How to do a massage correctly To achieve the exceptional effectiveness of an indirect heart massage, namely the resumption of normal blood circulation and the process of air exchange, and bringing a person to life by tactile acupressure on the heart through the chest, you must follow some simple recommendations:

1. Act confidently and calmly, do not fuss.
2. In view of self-doubt, do not leave the victim in danger, namely, it is imperative to carry out resuscitation measures.
3. Quickly and carefully carry out preparatory procedures, in particular, freeing the oral cavity from foreign objects, tilting the head back to the position necessary for artificial respiration, freeing the chest from clothing, and a preliminary examination for the detection of penetrating wounds.
4. Do not tilt the victim's head back excessively, as this can lead to obstruction of the free flow of air into the lungs.
5. Continue resuscitation of the victim's heart and lungs until the arrival of doctors or rescuers.

In addition to the rules for conducting an indirect heart massage and the specifics of behavior in an emergency, do not forget about personal hygiene measures: you should use disposable wipes or gauze during artificial respiration (if any).

The phrase “saving lives is in our hands” in cases of need to immediately perform an indirect heart massage on an injured person who is on the verge of life and death takes on a direct meaning.

When carrying out this procedure, everything is important: the position of the victim and, in particular, his individual parts of the body, the position of the person performing indirect heart massage, clarity, regularity, the timeliness of his actions and absolute confidence in a positive outcome.

When to stop CPR?

It should be noted that cardiopulmonary resuscitation should be continued until the arrival of the medical team. But if the heartbeat and lung function have not recovered within 15 minutes of resuscitation, then they can be stopped. Namely:

• when there is no pulse in the carotid artery in the neck;
• breathing is not performed;
• pupil dilation;
• skin is pale or bluish.

And of course, cardiopulmonary resuscitation is not performed if a person has an incurable disease, for example, oncology.

Method of external heart massage It consists in the rhythmic compression of the heart between the anterior wall of the chest and the spine by pressing on the sternum. When the heart is compressed between the sternum and the spine, blood is squeezed out of the left and right ventricles of the heart. Blood from the left ventricle through the arterial vessels enters the organs (brain, liver, kidneys), and from the right ventricle through the pulmonary vessels to the lungs. In the lungs, blood is saturated with oxygen. Therefore, external heart massage can be effective only when artificial respiration is performed. With the cessation of pressure on the sternum, the chest expands and the cavities of the heart fill with blood. By squeezing the heart between the sternum and the spine, artificial circulation is created. The blood flow at this time is 20-40% of the norm, which allows you to maintain life.

The technique of external heart massage. To conduct an external heart massage, it is necessary to lay the victim or patient on his back on a hard surface. This is an indispensable condition for the effectiveness of massage. If the patient is lying on a table or other hard high object, the massage is done while standing, if on the ground, then the massage is done kneeling down. The first aid provider is located to the right or left of the victim, quickly gropes for the lower end of the sternum (xiphoid process) and places the hand of one hand 2 fingers above it perpendicular to the sternum. The brush of the second hand sets from above parallel to the sternum, while the fingers should not touch the chest.

The arms should be extended to apply pressure with the full weight of the shoulder girdle. This will help make more effective massage, and also save strength for a long massage. The caregiver jerkily squeezes the sternum towards the spine so that the sternum sags by 4-5 cm. After each jerky movement, the hands are quickly relaxed without tearing them away from the sternum. Quantity massage movements when conducting external massage should be at least 60 per minute.

Cardiac massage will be useless if artificial respiration is not performed at the same time.

If the revival is performed by one person, he must, after two inflations of the lungs, make 15 massage movements. With such a sequence of actions, the pause between these two actions should be minimal. The performance of all actions by one person requires a lot of effort from him. If possible, an object is placed under the victim's shoulders: this helps to keep the head tilted back and facilitates the restoration of airway patency.

As a rule, two people should participate in the revival: one performs artificial respiration, the other - an external heart massage, while after one inflation of the lungs, five massage movements are made (five pressures on the sternum). If such manipulations are difficult, that is, the lungs do not swell enough, then the alternation can be done as follows: two air injections into the lungs and ten massage movements or three air injections and 15 massage movements (2:10, 3:15). When air is blown into the lungs, the massage is stopped, otherwise the air will not enter the respiratory tract. Periodically, the people conducting the revival can change places and alternately perform either massage or artificial respiration.

The paramedic conducting artificial respiration monitors the effectiveness of the massage. He must determine the pulsation in the carotid arteries and monitor the size of the pupils, which should narrow with effective resuscitation. Periodically, every 2-3 minutes, the massage is stopped for a few seconds and it is determined whether independent blood circulation has been restored. If cardiac activity is restored, a pulsation appears on the carotid arteries, the pupils narrowed, turned pink skin and mucous membranes of the lips, then the massage is stopped and artificial ventilation of the lungs is continued until adequate spontaneous breathing appears. With asphyxia, the pulse is restored with the onset of massage and artificial respiration.

Most common complication when conducting an external heart massage - fractures of the ribs in the cartilage area (especially in the elderly). Strong pressure on the sternum in the upper part of it can lead to a fracture of the sternum, if the pressure is applied too low, the liver can rupture.

Used to restore spontaneous circulation medications. After the start of the massage, adrenaline is administered intravenously as soon as possible, 1 ml (1 mg), if necessary, this dose is repeated several times.

Cardiac arrest and inadequate circulation are accompanied by acidosis. To restore the acid-base state of the body, it is necessary to administer intravenous sodium bicarbonate (500 ml of a 4% solution) or Tris buffer (300 ml) during resuscitation.

With significant blood loss, restoration of cardiac activity is possible if the volume of blood is compensated. Therefore, it is necessary to inject solutions such as polyglucin, gelatinol, glucose intravenously.

If possible, after the start of the massage, an electrocardiographic study is performed: ventricular fibrillation, asystole, or the presence of agonal complexes are determined. With ventricular fibrillation, defibrillation is indicated.

Ambulance health care, ed. B. D. Komarova, 1985