The ratio of pressures and breaths during artificial respiration. The technique of artificial lung ventilation and closed heart massage

When restoring breathing and cardiac activity of the victim, who is in an unconscious state, be sure to lay on the side to exclude his suffocation with his own sunken tongue or vomit.

The retraction of the tongue is often evidenced by breathing, resembling snoring, and sharply difficult inhalation.

Rules and technique artificial respiration And indirect massage hearts

If p Since two people carry out animation activities, one of them performs a heart massage, the other performs artificial respiration in the mode of one blowing every five clicks on the chest wall.

When to start resuscitation

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

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

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

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

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

What to do if there are no signs of life

1. Release the respiratory organs (mouth, nasal cavity, throat) from possible foreign bodies.
2. If there is a heartbeat, but the person is not breathing, only artificial respiration is done.
3. If there is no heartbeat, artificial respiration and chest compressions are performed.

How to do chest compressions

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

1. A person is laid on a hard surface, upper part the body is freed from clothing.

2. To perform a closed heart massage, the resuscitator kneels on the side of the victim.

3. The most extended palm with the base is placed in the middle of the chest two to three centimeters above the sternal end (the meeting point of the ribs).

4. Where is pressure applied to the chest during closed heart massage? The point of maximum pressure should be in the center, and not on the left, because the heart, contrary to popular belief, is located in the middle.

5. The thumb should be facing the person's chin or stomach. The second palm is placed on top crosswise. The fingers should not touch the patient, the palm should be placed on the base and be maximally unbent.

6. Pressing into the region of the heart is done with straight arms, the elbows do not bend. The pressure must be exerted with all the weight, not just with the hands. The shocks should be so strong that the chest of an adult drops by 5 centimeters.

7. With what frequency of pressures is an indirect heart massage performed? It is necessary to press the sternum with a frequency of at least 60 times per minute. It is necessary to focus on the elasticity of the sternum of a particular person, precisely on how it returns to the opposite position. For example, in an elderly person, the frequency of pressing can be no more than 40-50, and in children it can reach 120 or more.

8. How many breaths and pressures to do with artificial respiration?

Every 15 pressures helping blows air into the victim's lungs twice in a row and again performs a cardiac massage.

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

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

Artificial respiration "mouth to mouth"

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

How to do mouth-to-mouth artificial respiration?

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

Artificial respiration from mouth to nose

Mouth-to-nose artificial respiration is performed if the patient cannot open his mouth (for example, due to spasm).

1. Having laid the victim on a straight surface, tilt his head back (if there are no contraindications for this).
2. Check the patency of the nasal passages.
3. If possible, the jaw should be extended.
4. After a maximum breath, you need to blow air into the nose of the injured person, tightly closing his mouth with one hand.
5. After one breath, count to 4 and take the next.

Features of resuscitation in children

In children, the resuscitation technique is different from that in adults. The chest of babies up to a year old is very delicate and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect heart massage is performed not with palms, but with two fingers. The movement of the chest should be no more than 1.5-2 cm. The frequency of pressing is at least 100 per minute. At the age of 1 to 8 years, massage is done with one palm. The chest should move 2.5–3.5 cm. Massage should be performed at a frequency of about 100 pressures per minute. The ratio of inhalation to chest compressions in children under 8 years old should be 2/15, in children over 8 years old - 1/15.

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

How to determine if resuscitation is performed correctly

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

• When artificial respiration is performed correctly, you can notice the movement of the chest up and down during passive inspiration.
• 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.
• 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 carotid artery, similar to a pulse, which means that the pressing force is sufficient so that blood can flow to the brain.
2. With the correct implementation of resuscitation measures, the victim will soon have heart contractions, pressure will rise, spontaneous breathing will appear, the skin will become less pale, the pupils will narrow.

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

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

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

The correctness of the massage is determined by the appearance of a pulse on the carotid artery in time with pressing on the chest.

Article publication date: 07/17/2017

Article last updated: 12/21/2018

From this article you will learn: in what situations it is necessary to carry out artificial respiration and chest compressions, the rules for conducting cardiopulmonary resuscitation, the sequence of actions for the victim. Common mistakes when performing closed heart massage and artificial respiration, how to eliminate them.

Chest compressions (abbreviated as NMS) and artificial respiration (abbreviated as CPR) are the main components of cardiopulmonary resuscitation (CPR), which is performed on people with respiratory and circulatory arrest. These activities allow you to maintain the supply of the minimum amount of blood and oxygen to the brain and heart muscle, which are necessary to maintain the vital activity of their cells.

However, even in countries with frequent courses in artificial respiration and chest compressions, resuscitation is carried out in only half of the cases of cardiac arrest outside medical institution. According to a large Japanese study, the results of which were published in 2012, approximately 18% of people with cardiac arrest who received CPR were able to restore spontaneous circulation. A month later, only 5% of the victims remained alive, and only 2% had neurological disorders. Despite these not very optimistic numbers, resuscitation is the only chance for life for a person with cardiac and respiratory arrest.

Modern CPR guidelines are on the path to maximum simplification resuscitation. One of the goals of such a strategy is to maximize the involvement of people who are close to the victim in providing assistance. Clinical death is a situation where it is better to do something wrong than to do nothing at all.

It is because of this principle of maximum simplification of resuscitation that the recommendations include the possibility of performing only NMS, without ID.

Indications for CPR and Diagnosis of Clinical Death

Almost the only indication for performing ID and NMS is the condition clinical death, which lasts from the moment of circulatory arrest and until the onset of irreversible disorders in the cells of the body.

Before you start doing artificial respiration and chest compressions, you need to determine whether the victim is in a state of clinical death. Already at this - the very first - stage, an unprepared person may have difficulties. The fact is that determining the presence of a pulse is not as simple as it seems at first glance. Ideally, the person providing care should feel the pulse on the carotid artery. In reality, he often does it wrong, moreover, he takes the pulsation of his blood vessels in his fingers for the pulse of the victim. It is because of such errors that modern recommendations the item on checking the pulse on the carotid arteries was removed when diagnosing clinical death, if help is provided by people without medical education.

Currently, the following steps need to be taken prior to the commencement of the NMS and ED:

1. After finding a victim that you think may be near death, check for dangerous conditions around him.
2. Then go up to him, shake his shoulder and ask if he's okay.
3. If he answered you or somehow reacted to your appeal, this means that he does not have a cardiac arrest. In this case, call an ambulance.
4. If the victim did not respond to your appeal, turn him on his back and open Airways. To do this, carefully straighten your head in the neck and bring out upper jaw up.
5. After opening the airway, evaluate for normal breathing. Do not confuse with normal breathing agonal sighs, which can still be observed after cardiac arrest. Agonal sighs are superficial and very rare, they are not rhythmic.
6. If the victim is breathing normally, turn him on his side and call an ambulance.
7. If the person is not breathing normally, call other people for help, call an ambulance (or have someone else do it), and begin CPR immediately.

That is, the absence of consciousness and normal breathing are enough to start NMS and ID.

Indirect cardiac massage

NMS is the basis of resuscitation measures. It is its implementation that provides the minimum necessary blood supply to the brain and heart, so it is very important to know what actions are performed with an indirect heart massage.

The NMS should be started immediately after the victim is found to have no consciousness and normal breathing. For this:

• The base of your palm right hand(for left-handers - left) place 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 interlace their fingers. No part of your hand 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.
• Position your torso so that your arms rise above the victim's chest perpendicularly and are extended in elbow joints.
• Using your body weight (not arm strength), bend the victim's chest to a depth of 5-6 cm, then allow it to return to its original shape, that is, fully straighten without removing your hands from the sternum.
• The frequency of such compressions is 100-120 per minute.

Completion of NMS - heavy physical labor. It has been proven that after about 2-3 minutes the quality of its performance by one person is significantly reduced. Therefore, it is recommended that, if possible, the people providing assistance should change each other every 2 minutes.

Errors when performing NMS

• Delay to start. For a near-death person, every second of delay in initiating CPR can result in a lower chance of resuming spontaneous circulation and worse neurological prognosis.
• Long breaks during NMS. It is allowed to interrupt compressions for no longer than 10 seconds. This is done for ID, changing caregivers, or when using a defibrillator.
• Insufficient or too large compression depth. In the first case, the maximum possible blood flow will not be achieved, and in the second, the risk increases traumatic injuries chest.

Artificial respiration

Artificial respiration is the second element of CPR. It is designed to ensure the supply of oxygen to the blood, and subsequently (subject to NMS) to the brain, heart and other organs. It is the unwillingness to perform ID by the mouth-to-mouth method that in most cases explains the failure to provide assistance to victims by people who are next to them.

ID execution rules:

1. ID for adult victims is performed after 30 chest compressions.
2. If there is a handkerchief, gauze or some other material that allows air to pass through, cover the victim's mouth with it.
3. Open his airways.
4. Pinch the victim's nostrils with your fingers.
5. Keeping the airway open, press your lips tightly against his mouth and, trying to keep the tightness, exhale normally. At this moment, look at the victim's chest, watching whether it rises at the time of your exhalation.
6. Take 2 such artificial breaths, spending no more than 10 seconds on them, then immediately go to the NMS.
7. The ratio of compressions to artificial breaths is 30 to 2.

Errors while executing ID:

• Attempted conduction without proper opening of the airway. In such cases, the blown air enters either outside (which is better) or into the stomach (which is worse). The danger of inhaled air entering the stomach is to increase the risk of regurgitation.
• Insufficiently tight pressing of one's mouth to the victim's mouth or non-closure of the nose. This results in a lack of tightness, which reduces the amount of air that enters the lungs.
• Too long pause in the NMS, which should not exceed 10 seconds.
• Carrying out ID without termination of NMS. In such cases, the blown air is likely not to enter the lungs.

It is precisely because of the technical complexity of the implementation of ID that the possibility unwanted contact with the saliva of the victim, it is allowed (moreover, it is strongly recommended) for people who have not completed special CPR courses, in the case of assisting adult victims with cardiac arrest, do only NMS with a frequency of 100–120 compressions per minute. Proven over high efficiency out-of-hospital resuscitation by non-medical people that consists of chest compressions only, compared to conventional CPR, which includes a 30 to 2 combination of NMS and ID.

However, it should be remembered that CPR consisting only of chest compressions should only be performed by adults. Children are recommended the following sequence of resuscitation actions:

• Identification of signs of clinical death.
• Opening of airways and 5 rescue breaths.
• 15 chest compressions.
• 2 artificial breaths, after which again 15 compressions.

Termination of CPR

You can stop resuscitation after:

1. The appearance of signs of the resumption of spontaneous circulation (the victim began to breathe normally, move, or somehow react).
2. The arrival of the ambulance team, which continued CPR.
3. Complete physical exhaustion.

An indirect heart massage is performed to restore the work of the heart and blood circulation. Usually, mechanical impact carried out after cardiac arrest to restore its vital functions, as well as to maintain continuous blood flow. Absolutely all cases of stopping are indications for use.

What are the signs in case of sudden cardiac arrest:

• Loss of consciousness
• Sharp pallor of the face
• Cessation of breathing
• Loss of pulse in the carotid arteries
• The appearance of rare, convulsive breaths
• dilated pupils

Closed heart massage should be performed until the moment when independent cardiac activity is restored. Signs of independent cardiac activity are:

• The appearance of the pulse
• Reducing pallor and blueness
• Pupil constriction

Rules for external heart massage

As soon as a person is found to stop breathing and stop the work of the heart, regardless of the cause, a closed massage technique should be performed. But it should be borne in mind that a lot will depend on the correct implementation of the techniques. Untimely and incorrect technique can be ineffective.

The procedure is performed by rhythmic pressing on the heart through the chest. Pressure occurs on the relatively mobile part of the sternum, which is located below. Behind her is the heart. What happens in this case: blood is “squeezed out” from the cavity of the heart into blood vessels. Sufficient blood circulation in the absence of the work of the heart can be caused by 66-70 pressures per minute.

When carrying out the procedure, the victim must be laid with his back on a hard surface, expose his chest and relieve the body of squeezing things (belt, suspenders, etc.). Human. The caregiver should stand in such a way that it is convenient for him to bend over the victim. If the victim is located more than high level, the person being massaged should stand on a small chair, if on the contrary, at a lower level, you need to kneel.

Indirect cardiac massage technique

The first step is to determine the place where it is necessary to perform pushes. The point is located in the lower third of the sternum. The person being massaged should put the upper edge of the extended palm there, and put the other hand on top, as shown in the figure. The case, tilted forward, slightly helps with pressure. The pressure itself should be carried out with quick pushes so that the sternum goes down by 3-4 cm. The force of pressure should be concentrated in the lower part of the sternum. If you apply pressure to the upper part, a fracture may occur, since the upper part is fixedly attached to the bony ribs. Pressure should also be avoided on the ends of the lower ribs, as this can also lead to their fracture.

On soft tissues located below the chest, you can not press. This may damage internal organs that are located there. This is, first of all, the liver. The shocks are repeated approximately 1 time per second. If the massaged has an assistant, the second person should perform artificial respiration.

Artificial respiration and cardiac massage

Artificial respiration is performed by blowing air into the patient's mouth. Ventilation and chest compressions are performed to provide oxygen to the body when the heart is not working. Due to the fact that by means of pressure the expansion of the chest is difficult, artificial respiration is carried out in specially provided pauses, which are performed after 4-6 pressures.

Execution technique

1. Remove all restrictive clothing from the victim's body.
2. Clear your mouth of dirt, vomit and other contaminants.
3. The head of the victim should be tilted back as much as possible.
4. The lower jaw must be brought forward.
5. Take a deep breath and exhale into the victim's mouth. If possible, you need to exhale air through gauze or a handkerchief, after making a hole of 2-3 cm.
6. At the same time, the nose of the victim must be clamped.

If you did it right massage technique and artificial respiration, the victim should show the following signs:

• The appearance of independent signs of breathing
• Improved complexion, the appearance of a pinkish tint
• Pupil constriction

It is by the degree of constriction of the pupils that one can judge how correctly the ambulance. Narrow pupils indicate enough oxygen to the brain. Pupil dilation, on the contrary, indicates a slowdown in the supply of oxygen to the brain. If you notice this, you need to carry out effective measures to revitalize.

The above technique should be carried out before the appearance independent work heart and breathing signs. If there are slightly weak signs of breathing and a barely perceptible pulse, do not stop artificial respiration.

Recovery of the heart is judged by the appearance of the victim's own regular pulse. If the victim has no pulse, no heart rhythm, but spontaneous breathing and narrow pupils, this indicates heart fibrillation. In this case, all resuscitation measures should be continued until the doctor arrives. Even a short-term cessation of revival measures (1 minute or less) can lead to irreparable consequences.

Often the life and health of an injured person depends on how correctly first aid is provided to him.

According to statistics, during cardiac arrest and respiratory functions, it is precisely first aid increases the chance of survival by 10 times. After all oxygen starvation brain for 5-6 minutes. leads to irreversible death of brain cells.

Not everyone knows how resuscitation is carried out if the heart stops and there is no breathing. And in life, this knowledge can save a person's life.

The reasons that led to cardiac arrest and breathing can be:

• poisoning with toxic substances;
• electric shock;
• suffocation;
• drowning;
• trauma;
• severe illness;
• natural causes.

Before starting resuscitation measures, it is necessary to assess the risks for the victim and voluntary helpers - is there a threat of collapse of the building, explosion, fire, electric shock, gas contamination of the room. If there is no threat, then you can save the victim.

First of all, it is necessary to assess the patient's condition:

• whether he is in a conscious or unconscious state - whether he is able to answer questions;
• whether the pupils react to light - if the pupil does not narrow with increasing light intensity, then this indicates cardiac arrest;
• determination of the pulse in the area of ​​the carotid artery;
• check of respiratory function;
• study of the color and temperature of the skin and mucous membranes;
• assessment of the posture of the victim - natural or not;
• examination for injuries, burns, wounds and other external damage assessing their severity.

The person should be hailed, asked questions. If he is conscious, then it is worth asking about his condition, well-being. In a situation where the victim is unconscious, fainting should be carried out visual inspection and assess its condition.

The main sign of the absence of a heartbeat is the absence of pupillary reaction to light rays. IN normal condition the pupil constricts under the action of light and expands when the light intensity decreases. Extended indicates a violation of function nervous system and myocardium. However, the violation of the reactions of the pupil occurs gradually. Complete absence reflex occurs 30-60 seconds after a complete cardiac arrest. Some medicines can also affect the width of the pupils, narcotic substances, toxins.

The work of the heart can be checked by the presence of tremors of blood in large arteries. It is not always possible to feel the pulse of the victim. The easiest way to do this is on the carotid artery, located on the side of the neck.

The presence of breathing is judged by the noise coming out of the lungs. If breathing is weak or absent, then characteristic sounds may not be heard. It is not always at hand to have a fogging mirror, through which it is determined whether there is breathing. Chest movement may also be imperceptible. Leaning towards the mouth of the victim, note the change in sensations on the skin.

A change in the shade of the skin and mucous membrane from natural pink to gray or bluish indicates circulatory disorders. However, in case of poisoning with certain toxic substances pink color skin is saved.

Appearance cadaveric spots, waxy pallor indicates the inappropriateness of resuscitation. This is also evidenced by injuries and injuries incompatible with life. It is impossible to carry out resuscitation measures with a penetrating wound of the chest or broken ribs, so as not to pierce the lungs or heart with bone fragments.

After the condition of the victim has been assessed, resuscitation should immediately begin, since after the cessation of breathing and heartbeat, recovery vital functions takes only 4-5 minutes. If it is possible to revive after 7-10 minutes, then the death of part of the brain cells leads to mental and neurological disorders.

Insufficiently prompt assistance can lead to permanent disability or death of the victim.

Resuscitation algorithm

Before starting resuscitation pre-medical measures, it is recommended to call an ambulance team.

If the patient has a pulse but is in deep fainting, it will need to be laid on a flat, hard surface, the collar and belt should be loosened, turning the head to one side to prevent aspiration in case of vomiting, if necessary, it is necessary to clear the airways and oral cavity from accumulated mucus, and vomiting.

It should be noted that after cardiac arrest, breathing can continue for another 5-10 minutes. This is the so-called "agonal" breathing, which is characterized by visible movements neck and chest, but low productivity. Agony is reversible, and with properly performed resuscitation, the patient can be brought back to life.

If the victim does not show any signs of life, then the rescuing person must perform a series of the following steps in stages:

• put the victim on any flat, free, while removing the restrictive elements of clothing from him;
• throw back your head, put under your neck, for example, a jacket or sweater rolled up with a roller;
• pull down and push slightly forward lower jaw the victim;
• check if the airways are free, if not, then release them;
• try to recover respiratory function using the mouth-to-mouth or mouth-to-nose method;
• massage the heart indirectly. Before starting resuscitation of the heart, it is worthwhile to perform a "pericardial blow" in order to "start" the heart or increase the effectiveness of heart massage. A punch is applied to the middle part of the sternum. It is important to try not to get into lower part xiphoid process - a direct blow can worsen the situation.

Resuscitating the patient, periodically check the patient's condition - the appearance and frequency of the pulse, the light response of the pupil, breathing. If the pulse is palpable, but there is no spontaneous breathing, the procedure must be continued.

Only when breathing appears can resuscitation be stopped. In the absence of a change in state, resuscitation is continued until the arrival of the ambulance. Only a doctor can give permission to end the resuscitation.

The technique of carrying out respiratory resuscitation

Restoration of respiratory function is carried out by two methods:

• mouth to mouth;
• mouth to nose.

Both methods do not differ in technique. Before starting resuscitation, the patient's airway is restored. For this purpose, the mouth and nasal cavity are cleaned of foreign objects, mucus, and vomit.

If there are dentures, they are removed. The tongue is pulled out and held to avoid blocking the airways. Then proceed to the actual resuscitation.

The mouth-to-mouth method

The victim is held by the head, placing 1 hand on the forehead of the patient, the other - pressing the chin.

The patient's nose is squeezed with fingers, the resuscitator takes the deepest possible breath, presses his mouth tightly against the patient's mouth and exhales air into his lungs. If the manipulation is carried out correctly, then the chest rise will be noticeable.

If the movement is noted only in the abdomen, then the air has entered the wrong way - into the trachea, but into the esophagus. In this situation, it is important to ensure that air enters the lungs. 1 artificial breath is performed for 1 s, exhaling air strongly and evenly into the respiratory tract of the victim with a frequency of 10 “breaths” per 1 minute.

Mouth to nose technique

The mouth-to-nose resuscitation technique completely coincides with the previous method, except that the resuscitator exhales into the patient's nose, tightly clamping the victim's mouth.

After artificial inhalation, air should be allowed to exit the patient's lungs.

Respiratory resuscitation is carried out using a special mask from the first aid kit or by covering the mouth or nose with a piece of gauze or cloth, a handkerchief, but if they are not there, then there is no need to waste time looking for these items - rescue measures should be carried out immediately.

Method of cardiac resuscitation

To begin with, it is recommended to release chest area from clothes. The caregiver is located to the left of the resuscitated. Perform mechanical defibrillation or pericardial shock. Sometimes this measure triggers a stopped heart.

If there is no reaction, then an indirect heart massage is performed. To do this, you need to find the place where the costal arch ends and place the lower part of the palm of the left hand on the lower third of the sternum, and put the right one on top, straightening the fingers and lifting them up (the “butterfly” position). The push is carried out with arms straightened in the elbow joint, pressing with all the weight of the body.

The sternum is pressed to a depth of at least 3-4 cm. Sharp pushes are made with a frequency of 60-70 pressures per 1 minute. - 1 press on the sternum in 2 sec. Movements are performed rhythmically, alternating push and pause. Their duration is the same.

After 3 min. the effectiveness of the activity should be checked. The fact that cardiac activity has recovered is evidenced by probing the pulse in the carotid or femoral artery, as well as a change in complexion.

Carrying out simultaneous cardiac and respiratory resuscitation requires a clear alternation - 2 breaths per 15 pressures on the heart area. It is better if two people provide assistance, but if necessary, the procedure can be performed by one person.

Features of resuscitation in children and the elderly

In children and older patients, the bones are more fragile than in young people, so the force of pressing on the chest should be commensurate with these features. The depth of chest compression in elderly patients should not exceed 3 cm.

In children, depending on the age and size of the chest, massage is carried out:

• in newborns - with one finger;
• in infants - two;
• after 9 years - with both hands.

Newborns and infants are placed on the forearm, placing the palm under the back of the child and holding the head above the chest, slightly thrown back. The fingers are placed on the lower third of the sternum.

Also, in infants, you can use another method - the chest is covered with palms, and thumb located in the lower third of the xiphoid process. The frequency of shocks varies in children of different ages:

When performing resuscitation of breathing in children, it is done with a frequency of 18-24 "breaths" in 1 min. The ratio of resuscitation movements of the heart beat and "inspiration" in children is 30:2, and in newborns - 3:1.

The life and health of the victim depends on the speed of the start of resuscitation measures and the correctness of their implementation.

It is not worth stopping the return of the victim to life on your own, since even medical workers can not always determine the moment of death of the patient visually.

The main tasks in the return to life of a person who is in clinical death are in ensuring the patency of the respiratory tract, maintaining ventilation of the lungs and blood circulation.

Emergency restoration of patency of the upper respiratory tract. This method consists of several steps. First of all, the patient is laid horizontally on his back. The head is thrown back as much as possible, under shoulder girdle enclose a roller of fabric or a piece of wood (logs), or the rescuer puts one hand under the neck, and places the other on the patient's forehead. The need for this technique is due to the fact that in an unconscious state, a person relaxes the muscles of the neck and head. As a result of this, the root of the tongue and epiglottis recede and the airways are blocked. This phenomenon occurs when horizontal position the patient is on his back (even on his stomach), and when the head of the victim is tilted forward (sometimes ignorant people who provide assistance even put a pillow under his head), blockage occurs in 100% of cases. It is well known that a significant proportion of people who have fallen into unconsciousness, dies from suffocation with his own tongue. When the head is tilted back, the tongue moves forward and frees the airways.

After tilting the head back, a test breath is taken “from mouth to mouth” (the technique is described below). If the test breath is ineffective, the lower jaw is pushed forward and up as much as possible. To do this, either raise the chin with one hand, placing one finger in the mouth of the victim, or grab the lower jaw with both hands at the base, the teeth of the lower jaw should be located in front of the line of the teeth of the upper jaw.

Optimal conditions for ensuring the patency of the upper respiratory tract are created with the simultaneous tilting of the head, the maximum extension of the lower jaw and the opening of the patient's mouth.

The cause of blockage of the airways, in addition to the root of the tongue, may be foreign bodies (dentures, blood clots, mucus, etc.). They must be quickly removed with a handkerchief on your finger or a napkin, spending minimal time on this manipulation. The head of the victim at this time should be turned to one side to prevent foreign bodies from entering the respiratory tract.

Artificial lung ventilation. Popular in the past methods of artificial respiration (methods of Sylvester, etc.) are currently left as ineffective. People returned to the ancient method of resuscitation by breathing air into the nose or mouth of the victim. Quite naturally, the question arises: will there be any benefit from the fact that we fill the patient's lungs with our exhaust air? Scientists have calculated that the air exhaled by the rescuer gives the patient enough oxygen. If it is possible to choose a method, it is better to use the mouth-to-mouth method, because the narrowness of the nasal passages creates increased resistance to exhalation, in addition, they are often clogged with mucus and blood.

Technique of artificial lung ventilation by mouth-to-mouth method:

1. Stand on the side of the victim.

2. Put one hand on the forehead of the victim, and the other under the back of the head, tilt the patient's head, while the mouth, as a rule, opens. If the mouth does not open, then the lower jaw must be extended.

3. The rescuer takes a deep breath, slightly delays the exhalation, and, bending down to the victim, completely seals the area of ​​\u200b\u200bhis mouth with his lips, creating, as it were, an air-tight dome over the patient's mouth opening. In this case, the patient's nostrils should be clamped with the 1st and 2nd fingers of the hand lying on the forehead. Lack of tightness common mistake during resuscitation. Leakage of air through the nose or corners of the mouth of the victim negates all the efforts of the rescuer.

4. After sealing, you need to exhale quickly, blowing air into the victim's airways. This procedure should take about 1 second. The volume of air injected should be at least 1-1.5 liters, which is necessary for stimulation respiratory center. The rescuer should pay attention to how the patient's chest rises during artificial inspiration. If the amplitude of the movement of the chest is small, then this means that the volume of air is small, or the tongue sinks.

5. After the end of the exhalation, the rescuer unbends and releases the victim's mouth, in no case stopping the overextension of his head, because. otherwise, the tongue will sink and will prevent the victim from spontaneous exhalation, which occurs due to the elasticity of the lungs. The exhalation of the victim lasts about two seconds. It is necessary to ensure that the exhalation is 2 times longer than the inhalation.

6. During the exhalation of the victim, the rescuer makes 1-2 short breaths-exhalations for himself.

7. The cycle is repeated from the beginning, the frequency of such cycles is 12-15 per minute.

It should be borne in mind that when air is blown in, part of it enters the stomach, the swelling of which makes it difficult to revive. Therefore, periodically it is necessary to press on epigastric region the victim in order to free the stomach from air.

The technique of artificial ventilation of the lungs by the method of "mouth to nose":

1. Putting one hand on the forehead of the victim, and the other on his chin, unbend his head and at the same time press the lower jaw to the upper.

2. With the fingers of the hand supporting the chin, you need to press lower lip thus sealing the mouth.

3. After deep breath lips cover the victim's nose, creating an air-tight dome above it.

4. Produce a short strong blowing of air through the nostrils (1-1.5 l), while watching the movement of the chest. After the end of artificial inspiration, it is necessary to free not only the nose, but also the patient's mouth; the soft palate can prevent air from escaping through the victim's nose and then there will be no exhalation at all with the mouth closed.

When reviving children, air is blown in simultaneously through the nose and mouth.

Based on aesthetic and hygienic considerations, it is recommended to use a handkerchief or other fabric during artificial ventilation of the lungs, putting it on the victim's mouth.

Since artificial ventilation of the lungs according to the “mouth-to-mouth” or “mouth-to-nose” method is the only way to save the victim with respiratory arrest, and even more so with cardiac arrest, the use of this method moral duty of every person who is close to the dying.

Indirect (closed) heart massage. Since the 60s of the last century, with clinical death, indirect or closed heart massage has been used.

The heart can be compared to a pump that pumps oxygen-rich blood from the lungs to vital organs, primarily the brain. When the heart stops, blood circulation stops and oxygen is not supplied to the tissues.

The main task is the immediate restoration of blood flow. Restoration of blood circulation is carried out with the help of an indirect heart massage. As you know, the heart is located between two bone formations: the sternum and the spine. If a person in a state of clinical death is placed with the spine on a rigid base (floor, hard couch) and the lower third of the sternum is pressed with both hands with such force that the sternum sags by 4-5 cm, then the heart is squeezed between the two bone surfaces - an artificial compression of the heart occurs . This is systole (contraction of the heart muscle), during which blood is pushed out of the heart cavities into large vessels. As soon as the sternum is released, the heart, due to its elasticity, returns to its original volume and blood from large veins fills its cavities - diastole (relaxation) occurs. The frequency of pressure on the sternum should correspond to the natural frequency of heart contractions - 60-70 times per minute.

Technique of indirect heart massage:

1. The patient should be on his back, on a rigid basis (ground, floor, trestle bed, etc.). Massage on a soft base is ineffective and dangerous (you can damage the liver). Unfasten the waist belt or similar piece of clothing that tightens the upper abdomen to avoid injury to the liver. Unfasten outerwear on the chest.

2. The zone of application of the force of the rescuer's hands is located strictly along the midline on the lower third of the sternum, three to four transverse fingers above the place of attachment to the sternum of the xiphoid process. Any other place where the rescuer's hands are applied - to the left of the sternum, above the midline, at the level of the xiphoid process - is completely unacceptable. It is necessary to press on the sternum, and not on the area of ​​\u200b\u200bthe heart.

3. The rescuer stands on either side of the patient, puts one palm on the other and presses on the sternum. The rescuer's arms are straightened at the elbow joints, only the wrist produces pressure, the fingers of both hands are raised and do not touch the chest. The rescuer's arms should be perpendicular to the surface of the victim's chest. Chest compression is produced by the weight of the rescuer's torso. Only if these conditions are met, it is possible to achieve a displacement of the sternum towards the spine by 4-5 cm and cause compression of the heart.

4. The duration of one chest compression is 0.5 seconds. The interval between compressions is 0.5-1 seconds. Massage pace – 60 massage movements in 1 minute.

In intervals, the hands are not removed from the sternum, the fingers remain raised, the arms are fully extended at the elbow joints.

When resuscitation is carried out by one person, after two quick blows of air into the lungs of the victim, there are 10-12 chest compressions, i.e., the ratio of ventilation and massage is 2:12. If two people are involved in resuscitation, then this ratio is 1:5.

Children under 10 years of age are massaged with one hand, and infants with two fingers (2nd and 3rd) with a frequency of 100-120 pressures per minute.

When conducting an indirect massage, a complication is possible in the form of a fracture of the ribs, which is determined by the characteristic crunch during pressure. It's on its own unpleasant complication in no way should serve as a basis for stopping the massage.

A prerequisite heart massage is a constant monitoring of its effectiveness.

The criteria for the effectiveness of massage should be considered:

1. Change in skin color, it begins to turn pink.

2. The appearance of a pulse impulse on the carotid and femoral arteries, sometimes on the radial artery.

3. Narrowing of the pupils and the appearance of a reaction to light.

4. Sometimes - the appearance of independent respiratory movements.

If within 25-30 minutes signs of effectiveness do not appear, then revitalization measures should be considered of little promise. And yet it is better not to stop resuscitation until the doctor arrives. It is believed that resuscitation should be carried out before the appearance of cadaveric spots in sloping places (i.e., within two hours), if signs of life do not appear earlier.

It should always be remembered that the life of a person with sudden circulatory arrest is in the hands of the one who sees it first.

Special measures in the liquidation of the consequences of emergencies and their characteristics.

After reading this chapter, you should:

be able to carry out activities to ensure the life of people in conditions emergencies;

· have the skills to protect and disinfect food and water from radioactive, hazardous chemicals and bacterial agents.