Assessment of the victim's condition In case of severe injury, damage electric shock, drowning, suffocation, poisoning, a number of diseases, loss of consciousness may occur, that is, the state when the victim lies motionless, does not answer questions, does not respond to the actions of others. This occurs as a result of disruption of the activity of the central nervous system, mainly of the brain - the center of consciousness. To determine the nature and extent of damage, it is necessary to conduct a thorough examination, questioning (if possible) and careful examination (palpation) of the victim (head, torso, limbs). This will make it possible to determine the localization of the injury (bone fracture, bruise, wound) and assess its danger to the life and health of the victim. The severity of the victim's condition is assessed according to the degree of danger (threat) to his life. The critical condition for the life of the victim is the cessation of cardiac activity and respiratory arrest. Therefore, first of all, these vital functions of the body are subject to assessment (the time spent for these purposes is no more than 10 seconds).

This requires: 1. Assess consciousness. It is possible to determine the preservation of consciousness by lightly "shaking" the shoulders and by a loud hail or by the command "open your eyes". Signs of a lack of consciousness: no reaction to a call and touch - braking. 2. Rate breathing. Determine the presence of breath by motion chest and the movement of air from the upper respiratory tract (bring your face to the victim's respiratory tract). When breathing stops, the victim's chest does not rise, the air flow near the victim's mouth and nose is not felt. 3. Assess cardiac activity. The most reliable sign of cardiac arrest is the absence of a pulse in the carotid arteries. The pulse on the carotid artery is determined on one side of the neck on the lateral surface of the neck. To do this, you need to put the index and middle fingers of the hand on the victim's larynx, then they are slightly shifted to the side and gently pressed with the pads of the fingers on the neck for 5-10 seconds.

In case of cardiac arrest, the pulse on the carotid arteries is not determined.Severe conditions are also dangerous for the life of the victim, which are caused by large blood loss, trauma to the head, spine, chest, abdomen, fractures of large bones, extensive burns, various poisonings, etc., which are determined on the spot accidents based on their characteristic features.

Required: 1. If possible, ask the victim about the circumstances of the injury (this information can be obtained from witnesses of the incident) and complaints (the victim himself often indicates the localization of the injury). 2. Examine the skin for abrasions, bruises, wounds, burns, etc. 3. Compare the structure and shape of symmetrical parts of the body (for example, compare the injured limb with the healthy one). 4. Pay attention to the position of the body and limbs (active, passive, forced), the state of soft tissues (edema), the severity and symmetry of skin folds, the contours of the joints, etc.

Being in a passive position, the victim is motionless, cannot independently change the adopted posture, the head and limbs hang down. This situation happens with an unconscious state. The victim takes a forced position to alleviate a serious condition, relieve pain; for example, with damage to the lungs, the pleura, he is forced to lie on the affected side. The victim takes the supine position mainly with severe abdominal pain; with kidney damage, some victims keep the leg (from the side of the lesion) bent at the hip and knee joint, as this relieves the pain. The main indicators of the body's vital activity are preserved respiration and cardiac activity.

If the victim is unconscious (does not respond to touch and does not answer questions), it is necessary to lay him down on his back, tilt his head back, push the lower jaw forward and hold it in this position. Taken measures ensure airway patency of the victim and prevent tongue retraction, which can block Airways, thereby causing suffocation (asphyxiation). In this position, the presence of breathing is checked (breathing movements of the chest, the noise of inhalation and exhalation). If the restored breathing is not completely free (the presence of mucus, blood, fluid (during drowning), vomit in the respiratory tract, or foreign bodies) and accompanied by wheezing, noise and gurgling, then you need to clean oral cavity lying on the victim's side with a napkin, handkerchief, etc. It is not recommended to lay the victim on his stomach, since this restricts the breathing movements of the chest, which makes breathing difficult, and the face is turned down and is not available for observation or urgent assistance ...

For example, the main signs of cardiac arrest that make it possible to quickly assess the condition of the victim are: - loss of consciousness; - lack of pulse in the carotid and other arteries; - respiratory arrest; - lack of heart sounds; - dilated pupils; - pallor or cyanosis of the skin and mucous membranes; - seizures, which may appear at the time of loss of consciousness and be the first obvious sign of cardiac arrest.

Signs of life Signs of life are: - Presence of preserved breathing. It is determined by the movement of the chest and abdomen, fogging of the mirror applied to the nose and mouth, the movement of a cotton ball or bandage brought to the nostrils: - the presence of cardiac activity. It is determined by probing the pulse - jerky, periodic oscillations of the walls of peripheral vessels. The pulse can be determined on the radial artery, located under the skin between the styloid process of the radius and the tendon of the internal radius muscle. In cases where it is impossible to examine the pulse on the radial artery, it is determined either on the carotid or temporal artery, or on the legs (on the dorsal artery of the foot and posterior tibial artery). Usually the heart rate is healthy person 60 -75 beats / min, the rhythm of the pulse is correct, uniform, the filling is good (it is judged by squeezing the arteries with fingers with different strengths). The pulse increases with cardiac insufficiency as a result of trauma, with blood loss, during pain... A significant decrease in heart rate occurs when serious conditions(traumatic brain injury)

- the presence of a reaction of the pupils to light. It is determined by directing a beam of light from any source to the eye; constriction of the pupil indicates a positive reaction. In daylight, this reaction is checked as follows: cover the eye with a hand for 2-3 minutes, then quickly remove the hand; if the pupils are narrowed, then this indicates the preservation of the functions of the brain. The absence of all of the above is a signal for immediate resuscitation ( artificial respiration chest compressions) until signs of life return. Reanimation of the victim becomes impractical 20-25 minutes after the start of resuscitation, provided there are no signs of life. It should be remembered that the absence of a heartbeat, pulse, breathing and pupil response to light does not mean that the victim is dead. A similar complex of symptoms can be observed during clinical death, in which it is necessary to provide the victim with assistance in full.

Signs of death The onset of biological death - the irreversible cessation of the body's vital activity - is preceded by agony and clinical death. Agony is characterized by darkened consciousness, lack of pulse, respiratory distress, which becomes irregular, superficial, convulsive, decreased blood pressure... The skin becomes cold, with a pale or bluish tinge. After the agony, clinical death occurs. Clinical death- a short-term transitional stage between life and death, its duration is 3 - 6 minutes. Breathing and heartbeat are absent, the pupils are dilated, the skin is cold, there are no reflexes. In this short period, it is still possible to restore vital functions with the help of artificial respiration and chest compressions. At a later date, irreversible processes occur in the tissues, and clinical death becomes biological.

After this time, biological death occurs. The signs of death are: - lack of breathing; - lack of heartbeat; - lack of sensitivity to pain and thermal stimuli; - decrease in body temperature; - clouding and drying of the cornea of ​​the eye; the presence of the symptom "cat's eye" - when the eye is squeezed from the sides - the pupil is deformed and resembles a cat's eye; - lack of a gag reflex; - cadaveric spots of blue-violet or crimson-red color on the skin of the face, chest, abdomen; - rigor mortis, manifested 2-4 hours after death.

When rendering the first medical care should adhere to the following

General principles first aid

An accident, a sudden illness often occurs in conditions when there are no necessary medicines, dressings, helpers, and there are no means of immobilization and transportation. Therefore, the composure and activity of the first aid provider is especially important, so that he, to the best of his abilities and capabilities, is able to carry out a set of the most accessible and expedient measures to save the victim's life.

rules:

1. It is necessary to act expediently, deliberately, decisively, quickly and calmly.

2. First of all, you should assess the situation and take measures to stop the impact of damaging factors - to remove the victim from the water, fire, blockage, extinguish burning clothes, etc.

3. Quickly assess the condition of the victim, determine the severity of the injury, the presence of bleeding, etc.

4. Examine the victim, determine the method and sequence of first aid.

5. Decide what funds are needed to provide first aid, based on the specific conditions, circumstances, opportunities.

6. Provide first aid and prepare the victim for transportation.

7. Arrange the transportation of the victim to the hospital.

8. First aid to the maximum extent available to provide at the scene of the incident and on the way to the hospital.

9. To supervise the injured or suddenly ill before sending him to a medical institution.

In case of severe injury, suffocation, poisoning, drowning, a person may lose consciousness, lie motionless, and not answer questions. Impaired activity of the brain is possible with direct brain injury, poisoning, including alcoholic poisoning, etc.; violation of blood supply (fainting, blood loss, cardiac arrest, etc.); hypothermia or overheating of the brain (freezing, heatstroke, etc.).

The caregiver must be able to distinguish between loss of consciousness and death.

If minimal signs of life are found, it is necessary to start providing first aid and, above all, to revitalization.

The signs of life are:

1. The presence of a heartbeat. Listen with the ear in the nipple area.

2. The presence of a pulse in the arteries.

3. The presence of breathing. Breathing is determined by the movements of the chest, by the moistening of the mirror applied to the nose and mouth, by the movement of a piece of bandage brought to the nasal openings.

4. The presence of a reaction of the pupils to light. If you illuminate the eye with a flashlight (or close your eyes with the palm of your hand, and then quickly move your hand to the side), then there is a narrowing of the pupil.

The presence of signs of life signals the need for immediate recovery measures.

Lack of heartbeat, pulse, breathing and pupil response to light does not mean that the victim is dead. A similar complex of symptoms can be observed during clinical death, when it is necessary to provide the victim with assistance in full.

Providing assistance is pointless with obvious signs of death:

Clouding and drying of the cornea of ​​the eye;

Coldness of the body and the appearance of cadaveric spots;

Rigor mortis, which occurs 2-4 hours after death;

The presence of a symptom of "cat's eye" when, when the eye is compressed, the pupil is deformed and becomes vertical, like in a cat.

After assessing the condition of the victim (sick), they begin to provide him with first aid. At the same time, it is important not only to know the methods of assistance, but also to be able to properly handle the sick, so as not to cause him additional suffering.

The presence of a pulse in the carotid artery. To do this, the index and middle fingers are applied to the depression in the neck in front of the upper edge of the sterno-prickly-mastoid muscle, which stands out well on the neck.

The presence of spontaneous breathing is established by the movement of the chest, by the moistening of the mirror applied to the victim's mouth and nose.

Pupil reaction to light. If the open eye of the victim is covered with a hand, and then quickly take it to the side, then a constriction of the pupil is observed. If signs of life are found, you must immediately begin to provide first aid. First of all, it is necessary to identify, eliminate or weaken the life-threatening manifestations of the lesion - bleeding, respiratory and cardiac arrest, impaired airway patency, severe pain. It should always be remembered that the absence of heartbeat, pulse, breathing and pupil response to light does not mean that the victim (injured) is dead. At the same time, providing assistance is pointless with obvious signs of death, namely:

clouding and drying of the cornea of ​​the eyes;

when squeezing the eye from the sides with the fingers, the pupil narrows, and resembles a cat's eye;

the appearance of cadaveric spots and rigor mortis.

When providing assistance, it is necessary to take measures to restore breathing, inform by radio about what happened, and get advice (by radio), and if possible, deliver the patient to the shore. Calling specialists should not suspend the provision of medical care. It should always be remembered that there are risks involved in providing assistance. In contact with the victim (his blood and other secretions), in some cases, it is possible to contract infectious diseases, including syphilis, AIDS, infectious hepatitis, etc. This in no way relieves the ship's management and crew members from civil and moral responsibility for providing medical assistance to the victim, but requires knowledge and compliance with the simplest security measures. If contact with blood is necessary, wear rubber gloves or wrap your hands in a plastic bag. When assisting a drowning man, you need to swim up to him from behind or remove him from the hearth with the help of life-saving equipment (lifebuoy, vest, ropes, etc.) In case of a fire, measures should be taken to prevent poisoning by combustion products, for which urgently take the victim out of the zone burning or dangerous place.

Revitalization order

Resuscitation or revitalization is the restoration of vital body functions, especially respiration and blood circulation. Revitalization is carried out when breathing and cardiac activity are absent, or they are depressed, and do not provide the body's need. Revival is based on the fact that death never occurs immediately, it is always preceded by a transitional stage - a terminal state. The changes occurring in the body during dying are not immediately irreversible and with timely assistance can be eliminated, that is, the person is returned to life.

V terminal state distinguish between agony and clinical death. Agony is characterized by a darkening of consciousness, a sharp violation of cardiac activity, a drop in blood pressure, respiratory distress, and a lack of pulse. The victim's skin is cold, pale, or bluish. It must be borne in mind that after the agony clinical death occurs, in which there are no basic signs of life, breathing and heartbeat. It lasts 3-5 minutes. This time should be used for resuscitation. After the onset of biological death, revival is impossible. Several minutes separating the state of clinical death from biological does not leave time for conversations, consultations, reflections and any expectations. In the terminal state, timely assistance is more effective than the most complex medical procedures carried out subsequently, after clinical death, therefore, crew members, and even more so, the management staff need to know the basic techniques of resuscitation, assistance and be able to apply them correctly.

First of all, you need to make sure that there is a pulse on the carotid artery and respiration. If there is a pulse, but there is no breathing, they immediately begin to carry out artificial ventilation. At first - to ensure the restoration of the patency of the airways, for which the victim should be laid on his back, his head thrown back as much as possible and, grabbing the lower jaw with your fingers, push it forward so that the teeth of the lower jaw are located in front of the upper ones. Check and clean the oral cavity from foreign bodies (food pieces, phlegm, etc.). To do this, use a bandage, napkin, handkerchief, etc. All this must be done quickly, but carefully so as not to cause additional injury. You can open your mouth with a spasm of the masticatory muscles with a spatula, spoon handle, etc. After opening the mouth in the form of a spacer, insert a rolled bandage between the jaws. If the airway is clear, proceed with mouth-to-mouth or mouth-to-nose ventilation.

a) Artificial ventilation "mouth to mouth". Holding the victim's head thrown back and taking a deep breath, blow the exhaled air into the victim's mouth. Pinch the victim's nose with your fingers to prevent air from escaping.

b) Artificial ventilation lungs "mouth to nose". Blow air into the victim's nose, while closing his mouth. It is more hygienic to do this through a damp cloth or bandage. The effectiveness of artificial ventilation can be judged by the elevation of the victim's chest.

The absence of a pulse in the carotid artery indicates a cardiac arrest and respiratory arrest, which requires urgent cardiopulmonary resuscitation. In order to restore the work of the heart, sometimes it is enough to carry out a precordial stroke. To do this, place the palm of one hand on the lower third of the sternum and apply a short and sharp blow with the fist of the other hand on it, then re-check the presence of a pulse on the carotid artery and, if it is absent, conduct an external heart massage and artificial ventilation.

Lay the victim on a hard surface and place both palms on the lower third of the sternum with energetic jerks on the chest wall, using the weight of your own body. In the process of pushing, the chest wall, shifting to the spine by 4-5 cm, compresses the heart and pushes the blood out of its chambers along the natural bed. Heart massage is performed with a frequency of 60-80 pressures per minute. The results are determined by the appeared pulse on the carotid arteries in time with pressing on the chest. After every 15 pressures, the caregiver blows air into the victim's mouth twice and again performs cardiac massage. If resuscitation measures are carried out by a group of rescuers, then one performs a heart massage, and the other performs artificial respiration in the mode of two blowing of air after 5 pressing on the sternum. The effectiveness of resuscitation can also be judged by the constriction of the pupil, the appearance of reactions to light. When breathing is restored in the cardiac activity, the victim, who is in an unconscious or comatose state, must be laid on his side, in which there is no suffocation with his own sunken tongue, and in case of vomiting, with vomit. Breathing in the form of snoring and shortness of breath testify to the sinking of the tongue.

If there is no time to resolve this issue, then you should immediately take measures to revitalize in order to prevent the death of a still living person through negligence.

Similar cases are observed when falling from a great height, during transport and railway accidents, during collapses, when suffocating, drowning, when the victim is in a deep unconscious state. Most often this is observed with injuries to the skull, with compression of the chest or abdomen. The victim lies motionless, sometimes outwardly no signs of trauma can be found on him. Is he still alive or is he already dead? First you need to look for signs of life.

Signs of life

Determining the heartbeat by hand or by ear to the left, below the nipple is the first clear sign that the victim is still alive.

The pulse is determined on the neck, where the largest - the carotid - artery passes, or on the inside of the forearm.

Breathing is established by the movements of the chest, by moistening the mirror applied to the victim's nose, or by the movement of cotton wool brought to the nasal openings.

Under harsh lighting of the eyes pocket flashlight there is a narrowing of the pupils; a similar reaction can be seen in the event that the victim's open eye is covered with a hand, and then the hand is quickly taken to the side. However, with a deep loss of consciousness, there is no reaction to light.

The signs of life are unmistakable proof that immediate help can still be successful.

Signs of death

When the heart stops working and breathing stops, death occurs. The body lacks oxygen; lack of oxygen causes the death of brain cells. In this regard, when reviving, the main attention should be focused on the activity of the heart and lungs.

Death consists of two phases - clinical and biological death. During clinical death, which lasts 5-7 minutes, the person no longer breathes, the heart stops beating, but there are still no irreversible phenomena in the tissues. During this period, while serious disorders of the brain, heart and lungs have not yet occurred, the body can be revived. After 8-10 minutes, biological death occurs; in this phase it is no longer possible to save the victim's life.

When establishing whether the victim is still alive or already dead, they proceed from the manifestations of clinical and biological death, from the so-called dubious and obvious cadaveric signs.

Doubtful signs of death. The victim does not breathe, the heartbeat is not detected, there is no reaction to a needle prick, the reaction of the pupils to strong light is negative. Until there is full confidence in the death of the victim, assistance should be provided to him in full.

Explicit cadaveric signs. One of the first signs of the eye is corneal opacity and drying out. When the eyes are squeezed from the sides with the fingers, the pupil narrows and resembles a cat's eye.

Rigor mortis begins in the head, namely 2-4 hours after death. The cooling of the body is gradual; cadaveric bluish spots appear due to the flow of blood into the lower parts of the body. In a corpse lying on its back, cadaveric spots are observed on the lower back, buttocks and on the shoulder blades. When lying on the stomach, spots are found on the face, chest and on the corresponding parts of the limbs.

Being in a passive position, the victim is motionless, cannot independently change the adopted posture, the head and limbs hang down. Such a position of the victim happens with an unconscious state.

The victim takes a forced position to alleviate a serious condition, relieve pain; for example, with damage to the lungs, the pleura, he is forced to lie on the affected side. The victim takes the supine position mainly with severe abdominal pain. With kidney damage, some victims keep the leg (from the side of the lesion) bent at the hip and knee joints, as this will ease the pain. The main indicators of the body's vital activity are preserved respiration and cardiac activity.

Signs of life of an injured or injured person.

- Retained breath... It is determined by the movement of the chest and abdomen, by fogging applied to the nose and mouth, by the movement of a cotton ball or bandage brought to the nostrils.

- Preserved cardiac activity. It is determined by probing the pulse - jerky, periodic oscillations of the walls of peripheral vessels.

The pulse can be determined on the radial artery, located under the skin between the styloid process of the radius and the tendon of the internal radius muscle. In cases where it is impossible to examine the pulse on the radial artery, it is determined either on the carotid or temporal artery, or on the legs on the dorsal artery of the foot and posterior tibial artery.

Usually, the pulse rate in a healthy person is 60-75 beats / min, the pulse rhythm is correct, uniform, and the filling is good. It is judged by squeezing the arteries with the fingers with varying strength. The pulse quickens with cardiac insufficiency as a result of trauma, with blood loss, during pain. A significant decrease in heart rate occurs in severe conditions (traumatic brain injury).

- Pupil reaction to light. It is determined by directing a beam of light from any source to the eye; constriction of the pupil indicates a positive reaction. In daylight, this reaction is tested as follows. They close the eye with a hand for 2-3 minutes, then quickly remove the hand, if the pupils narrow, this indicates the preservation of brain functions.

The absence of all of the above is a signal for immediate resuscitation (artificial respiration, chest compressions) until the signs of life are restored. Reanimation of the victim becomes inappropriate 20-25 minutes after the start of resuscitation, if signs of life are still absent. The onset of biological death - the irreversible cessation of the body's life is preceded by agony and clinical death.

The agony of an injured, injured or traumatized person.

It is characterized by a darkened consciousness, a lack of pulse, respiratory distress, which becomes irregular, superficial, convulsive, and a decrease in blood pressure. The skin becomes cold, with a pale or bluish tinge. After the agony, clinical death occurs.

Clinical and biological death of an injured, injured or injured person.

Clinical death is a human condition in which the main signs of life are absent - heartbeat and breathing, but irreversible changes in the body have not yet developed. Clinical death lasts 5–8 minutes. This period must be used to provide resuscitation measures. After this time, biological death occurs.

Signs of biological death are.

- Lack of breathing.
- Lack of heartbeat.
- Lack of sensitivity to pain and thermal stimuli.
- Decrease in body temperature.
- Clouding and drying of the cornea of ​​the eye.
- Lack of gag reflex.
- Cadaverous spots of blue-violet or crimson-red color on the skin of the face, chest, abdomen.
- Rigor mortis, manifested 2–4 hours after death.