From this article you will learn: in what situations it is necessary to carry out artificial respiration and indirect cardiac massage, the rules for cardiopulmonary resuscitation, the sequence of actions when the heart is stopped by the victim. Common mistakes in the performance of closed heart massage and artificial respiration, ways to eliminate them.
Indications for CPR and diagnosis of clinical death
Indirect cardiac massage( abbreviated NMS) and artificial respiration( abbreviated to ID) are the main components of cardiopulmonary resuscitation( CPR) thatspend people when stopping breathing and circulation. These measures help to support the flow to the brain and heart muscle of the minimum amount of blood and oxygen that are necessary to preserve the vital functions of their cells.
However, even in countries with frequent courses on breathing techniques and indirect heart massage, resuscitation is carried out only in half of the cases of cardiac arrest outside the hospital. According to a large Japanese study, the results of which were published in 2012, approximately 18% of people with cardiac arrest who underwent CPR managed to restore spontaneous circulation. After a month, only 5% of the survivors remained alive, and only 2% had neurological disorders. Despite these not very optimistic figures, the implementation of resuscitation is the only chance for a person's life with cardiac arrest and respiration.
Current recommendations for CPR are on the way to maximizing the simplification of resuscitation. One of the goals of this strategy is to maximize the involvement of people who are close to the victim, to provide assistance. Clinical death is the situation where it is better to do something wrong than absolutely nothing to do.
It is because of this principle of maximum simplification of resuscitative measures that the recommendation makes it possible to carry out only NMSs without an ID.
Indications for CPR and Diagnosis of Clinical Death
Almost the only indication for performing ID and NMS is the state of clinical death, which lasts from the moment of circulatory arrest and until the onset of irreversible disorders in the cells of the body.
Before starting to do artificial respiration and indirect heart massage, you need to determine whether the victim is in a state of clinical death. Already on this - the very first stage - an unprepared person may have difficulties. The fact is that it is not as easy to determine the presence of a pulse as it seems at first sight. Ideally, the person who helps should feel the pulse on the carotid artery. In reality, he often does it wrong, moreover - takes the pulsation of his blood vessels in the fingers for the pulse of the victim. Precisely because of such mistakes, the point about carotid pulse testing was removed from modern recommendations when diagnosing clinical death, if people without medical education render help.
At present, the following steps should be taken before the NMS and ID begins:
- After finding the victim, who you think may be in a state of clinical death, check to see if there are any dangerous conditions around him.
- Then go up to him, shake him by the shoulder and ask if everything is all right with him.
- If he answered you or somehow reacted to your treatment, it means that he has no cardiac arrest. In this case, call an ambulance.
- If the victim does not react to your treatment, turn it on his back and open the airway. To do this, gently straighten the head in the neck and pull the upper jaw up.
- After the opening of the respiratory tract, assess the presence of normal breathing. Do not mix with normal breathing agonal sighs, which can still be observed after cardiac arrest. Agonal sighs are superficial and very rare, they are irregular.
- If the victim breathes normally, turn it to his side and call an ambulance.
- If a person does not breathe normally, call other people for help, call for an ambulance( or let someone else do it) and immediately begin CPR.
Cardiopulmonary resuscitation by the ABC principle That is, for the beginning of NMS and ID there is enough lack of consciousness and normal breathing.
Indirect heart massage
NMS is the basis of resuscitation. It is his holding that provides the minimum necessary blood supply to the brain and heart, so it is very important to know what actions are performed with indirect heart massage.
The NMS should be started immediately after the victim is diagnosed with a lack of consciousness and normal breathing. To do this:
- The base of the palm of your right hand( for left-handed people - left) is located on the center of the chest of the victim. It should lie exactly on the sternum, slightly below its middle.
- Place the second palm on top of the first, then twist their fingers. No part of your brush should touch the ribs of the victim, as in this case, when performing NMS, the risk of their fracture increases. The base of the lower palm should lie strictly on the sternum.
- Arrange your body so that your arms are raised above the victim's chest perpendicular and are bent at the elbow joints.
- Using the weight of your body( rather than the strength of your hands), squeeze the victim's chest to a depth of 5-6 cm, then allow her to restore her original shape, that is, fully straighten, without removing her palm from the sternum.
- The frequency of such compression is 100-120 per minute.
Modern guidelines for CPR allow only NMSs to be carried out.
The performance of NMS is hard physical work. It is proved that in about 2-3 minutes the quality of its conduct by one person is significantly reduced. Therefore, it is recommended that, if possible, the people who assisted change each other every 2 minutes.
The algorithm of indirect heart massage Errors in the performance of NMS
- Delay with the beginning of the exercise. For a person in a state of clinical death, every second of delay with the onset of CPR may turn out to be less likely to resume spontaneous circulation and worsen the neurological prognosis.
- Long breaks during NMS.Interrupt the compression is allowed no longer than 10 seconds. This is done for the conduct of ID, changing of assisting people or using a defibrillator.
- Insufficient or too much depth of compression. In the first case, the maximum possible blood flow will not be achieved, and in the second case, the risk of traumatic injuries of the chest increases.
Artificial respiration
Artificial respiration is the second element of CPR.It is designed to ensure the flow of oxygen into the blood, and then( subject to NMS) - in the brain, heart and other organs. It is the reluctance to perform ID by the "mouth to mouth" method in most cases explaining the failure to provide assistance to the injured people who are near them.
The current recommendations on CPR allow people who do not know how to do artificial respiration properly, do not do it. In such cases, resuscitation measures consist only of compression of the thorax.
Rules for performing the ID:
- The ID of the adult victim is performed after 30 chest compressions.
- If there is a handkerchief, gauze or some other material, letting air in, cover the victim's mouth with it.
- Open his airway.
- Pinch the victim's nostrils with your fingers.
- While retaining the opening of the airway, press firmly against his mouth with your lips and, while trying to maintain tightness, make your usual exhalation. At this point, look at the victim's chest, watching if it rises when you exhale.
- Do 2 such artificial inspiration, spending no more than 10 seconds on them, then immediately go to the NMS.
- The ratio of compression to artificial inspiration is 30 to 2.
Performing artificial respiration: a) extension of the head;b) excretion of the lower jaw;c) inhaling;d) on exhalation it is necessary to move away, giving an opportunity to leave the air. Errors in the execution of the ID:
- Attempted to hold without opening the respiratory tract properly. In such cases, the blown air gets either outward( which is better) or in the stomach( which is worse).The danger of ingress of air into the stomach is an increase in the risk of regurgitation.
- Insufficient tight gripping your mouth to the victim's mouth or uncovering the nose. This leads to a lack of tightness, which reduces the amount of air that enters the lungs.
- The pause in the NMS is too long, which should not exceed 10 seconds.
- Conducting an ID without discontinuing NMS.In such cases, the blown air will most likely not fall into the lungs.
It is because of the technical complexity of performing the ID that the possibility of unwanted contact with the victim's saliva is allowed( moreover - highly recommended) to people who have not received special courses on CPR, in case of assistance to adult victims with cardiac arrest, only NMS with a frequency of 100-120compression per minute. The higher efficiency of resuscitation measures performed in out-of-hospital settings by people without medical education, which consist only of chest compressions, compared with traditional CPR, including a combination of NMS and ID in a ratio of 30 to 2.
However, it should be remembered that conducting CPR, consisting only of chest compressions, can only adults. Children are recommended the following sequence of resuscitation:
- Detection of signs of clinical death.
- Opening of the respiratory tract and 5 artificial breaths.
- 15 chest compressions.
- 2 artificial inspiration, after which again 15 compressions.
Cessation of CPR
Discontinuation of resuscitation can be after:
- Appearance of signs of resumption of spontaneous circulation( the victim began to breathe normally, move or somehow react).
- Arrival of the ambulance brigade, which was continued by CPR.
- Complete physical exhaustion.
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