Questions about holding and termination of resuscitation measures regulate legislative acts. Cardiopulmonary resuscitation is shown in all cases sudden deathAnd only along the course of it clarify the circumstances of death and contraindications to resuscitation. The exception is:

injury, not compatible with life (head separation chest);

the presence of explicit signs biological death.

Contraindications for resuscitation activities

Cardiovary resuscitation is not shown in the following cases:

if death has come against the background of the use of a complete complex of intensive therapy shown by this patient, and was not sudden, but associated with incrarative for this level of development of medicine of the disease;

in patients with S. chronic diseases In the terminal stage, while the hopelessness and the futility of resuscitation must be recorded in advance in the history of the disease; These diseases are more often related to the IV stage of malignant neoplasms, heavy forces that are not compatible with injury;

if it is clearly found that more than 25 minutes have passed since the heart stop (at normal ambient temperatures);

if patients have recorded their reasonable refusal to conduct resuscitation activities in accordance with the procedure established by law.

First Aid when the breath and blood circulation

Before proceeding with cardiopulmonary resuscitation, it is necessary to determine the presence of signs of life from the victim as follows:

With the help of verbal contact appeal to make sure that or the absence of the consciousness of the victim.

The heartbeat at the victim to check the pulse at first on radiation arteries, and then on sleepy.

The presence of respiration in the victim to determine not by the movement of the chest, and by more subtle methods - on the fogging of the mirror, which caused to the nose or by the rhythmic deviation of the thread of the resulting nose.

Assess the pupil and his reaction to the light after the breeding age of the victim.

If there are no signs of life (breathing and heartbeat) from the victim, then you should make sure that it does not die "on at all", that is, whether he has signs of biological death (corpse spots and body stuffing). Making sure that the victim is in a state of clinical death, if possible, be called to the aid - scream: " Help!" Or use communication tools (mobile phone). After that, proceed to the cardiopulmonary resuscitation of the victim: to the IVL and the closed heart massage, putting it on a solid surface and freeing the chest from shocking clothes (with a sudden stop of the heart, it may be an effective pericardial strike.

Cardiovascular Resuscitation Technique

Cardiovascular intensive care technique consists of the following components:

« A. – airway."- ensuring the airways passability.

"IN -breathing.» - artificial respiration (IVL).

« C. – circulation» - artificial blood circulation ( closed massage Hearts).

The main elements of basic cardiovascular intensive care were formulated back in the 1960s by P. Safar.

Before performing the triple reception, the cavity of the mouth inspects and, if necessary, its toilet is produced (removal of vomit masses, foreign bodies, blood clots, broken teeth) - in community-friendly conditions, it is a finger wrapped with a nose handkerchief.

Triple reception

Patency upper respiratory tract The victim is ensured by a triple reception " A. – airway.».

Headsetset Supremeasad .

Lugged leaf .

The mouth is slightly open.

To restore the maintenance of the upper respiratory tract of the SMP and hospital brigade and hospitals have special tools (rotor sewer, lifter, air ducts).

Artificial lung ventilation (IVL)

IVL "B. – breathing.» the victims of the exploitation of the "mouth in the mouth" or "mouth to the nose" (directly or with the help of air ducts).

The victim lies on a solid surface, on the back. The chest is released from shocking clothes.

Resuscitation is located on the side of the victim.

After the toilet of the oral cavity and the completion of the triple reception, the resuscator makes a deep breath and with the force blows the air into the lungs of the victim, covering the mouth or the nose to him with a handkerchief, after making a hole in it. At blowing into the mouth, the nose hole is closed, upon blowing into the nose, on the contrary.

Artificial ventilation of the lungs can be carried out with the help of the duct (if available).

The air duct is a curved rubber tube (may be in the form of the letter S - the Safar tube or simply curved) with a restrictive panel in the middle, which limits the length of the tube entered and promotes the dense closure of the mouth.

The air duct is introduced into the mouth of the rotted cavity and performing the triple reception by the convex side down, and then rotated by this side up and moves along the back of the back of the tongue to the root, pressing the language to the bottom of the oral cavity (preventing it from stocking).

The outer end of the air duct resuscator takes in the mouth and blows the air into the light victim, covering the nose of the victim.

Artificial ventilation of the lungs is much facilitated by the use of manual devices.

IVL can be carried out using a manual portable apparatus "RDA-1" (type of bag of AMBU). This machine is a portable elastic bag or fur connected by the valve with a mask.

After the toilet of the oral cavity, the triple reception, the release of the respiratory tract and the introduction of the air duct to the victim to his face (on the mouth and nose) is tightly put on a rubber mask, which is connected with a bag (fur) of the device.

Rhythmic pressing hands on the bag (fur) are breathing with the desired depth and frequency. Inhalation occurs during the compression of the bag or fur with his hands, and the exhale is carried out passively into the atmosphere. During the exhalation, the self-seeping bag or fur due to stretching is filled with air or oxygen-air mixture. It is necessary to regulate the rhythm of breathing, and the inhale should be twice as shortened exhalation. The advantage of this apparatus is that it allows you to observe the infectious security to resuscitator, as well as produce an IVL with clean air and even oxygen. Conducting IVL with the help of a bag of AMBU is much easier, aesthetically and hygienic for resuscitation.

The efficiency of the IVL is controlled by visible raising the chest victim at the moment of inhalation. Exhaust takes place passive

When performing resuscitation by one person, the ratio of respiratory movements with pages on the chest should be 2:15 (two inhales and fifteen pages on the chest), and if there are two resuscitative intensive care, then this ratio will be 1: 5.

Closed heart massage

To perform a closed heart massage " C. – circulation» The victim should be on a solid surface (shield, floor, edge of bed, earth) after which:

resuscator is located on the side of the victim;

pressing is carried out in the center of the lower third of the sternum into two transverse fingers above the base of the sword-shaped process;

pressing is made by the palm surface of one hand imposed on it with another hand;

the fingers of the brush at the same time are raised and do not concern the ribs (preventing the rib fractures);

pressing is made by the entire severity of the bodies of the resuscitation, for this hand should be dispersed in the elbows and fixed;

pressing - strong, energetic, fast half-seconds - should cause sternum shifts by 4-5 cm;

hold hands - quickly half a second.

Resuscitation is carried out rhythmic and without interruptions. Resuscitation must be

on both sides of the victim and periodically change places, as the heart massage is heavy, exhausting.

The effectiveness of the closed massage of the heart is controlled by the appearance of a pulse on central or peripheral arteries at the time of pressing the injury of the victim.

Criteria for revitalization

Resuscitation is effective if notes:

visible inflating the chest at the time of the IVL;

pulse registration on sleepy and peripheral arteries with a heart massage;

definition arterial pressure, order (100/10 mm Hg in the form of peaks) during the massage of the heart;

narrowing of previously extended pupils;

the appearance of spontaneous breathing, heartbeat, hell, restoration of consciousness, pale pink color of the skin.

Under the term "resuscitation" means a set of measures carried out in order to restore vital functions in a person who has a clinical death recorded. They are carried out when stopping the pulse and respiration, the absence of the reaction of pupils into light. In addition, in a medical language, the resuscitation is called a specialized ambulance team and the separation of intensive therapy, intended for the treatment of seriously ill patients on the verge of life and death.

General

It has long been proven by the fact that after stopping the heart and the respiratory process, the human body lives a few more minutes, despite the fact that it does not come with oxygen. The first of hypoxia begins to suffer from the cerebral bark. Since its death, the biological death of man comes. This occurs in about 4 minutes after the cessation of vital processes. Thus, there is a short period of time in which it is possible to restore the blood circulation and human breathing. It is important to know that resuscitation - such events, the methodology of which is obliged to know each in order to provide a timely assistance to the patient before the arrival of doctors. The earlier they will be conducted, the higher the likelihood of a favorable outcome.

The recovery period of the patient is divided into 2 stages:

1. Cardiopulmonary resuscitation.
2. Intensive therapy.

In the first case it turns out emergency helpIn the second, the consequences of clinical death (stopping heart and respiration) are eliminated and the patological condition is treated, which led to it. In the period of maintaining vital activity, the patient is constantly in the resuscitation department.

Causes of clinical death

As a rule, the cardiac arrest is due to:

• Anaphylactic shock. This state is usually a consequence of allergies.
• Heart diseases, the flow of which negatively affects the work of the body.
• Permanent stay in a state of stress, as well as high intensity physical Loads. A natural consequence is a significant deterioration in the blood supply of the body.
• Blockage of blood vessels.
• Big bloodstures arising from injury or injury, including violent nature.
• Use inside or introducing unsafe medicines and dietary supplies. For example, after the inappropriate injections of Sintola in intensive care, any bodybuilder can fall.
• Toxic shock arising due to the actions of harmful chemical compounds.
• Asphyxia.
• Serious diseases Respiratory system.

Each person should understand that resuscitation is such a set of measures, the correctness of which not only medical workers should be aware, but also ordinary people.

Symptoms of clinical death

This state requires emergency care, so you need to be able to recognize it in a timely manner.

1. Unconscious state. It comes in a few seconds after stopping the blood circulation.
2. No pulse. This is the first sign that oxygen ceased to flow into the brain. The slightest delay can cost a person life.
3. No breathing. How to check it? It is necessary to pay attention to that, whether the chest person performs characteristic movements, then burn to his face with the left ear and try to catch any sounds. After that, you can try to feel his breathing with skin cover, bringing a hand to the patient's mouth. In a medical language, this method is called "I see, I hear, I feel."
4. Extended pupils, missing reaction.

When a person is detected, the symptoms of clinical death assistance must be reasons.

Cardiovascular Resuscitation

Its task is to resume respiratory and blood circulation processes. Liquid connective tissue It must be forced to enriched with oxygen and deliver it to the brain.

The algorithm of conducting pulmonary resuscitation is as follows:

1. Preparation of the patient. A person needs to be put back on a solid surface (floor, asphalt, etc.). The victim is necessary to bargain the chest, as various decorations may be under clothing, which in the process of resuscitation activities may result in additional injuries.
2. Restoration of respiratory tract. To do this, you need to wrap fabric to the index finger and release purph cavity victims of mucus, foreign items or vomit. Next, you need to throw a person's head to get rid of the vigorial language. To do this, it is necessary to put the roller from the clothes under the neck or the blades area (not under the back). Solid objects for these purposes are not suitable, since with further conducting an indirect massage of the heart, the likelihood of the victim of the spine is extremely large.
3. Applying a precondial strike. In the lower part of the sternum is a moving process. If you put your fingers on this zone, then slightly higher (2-3 cm) and there will be a point of making a blow. For its implementation, it is necessary to take such a position so that the elbow was on the stomach of the victim, and the edge of the palm pinned in the fist - over the sneaker. Next, you need to apply only one sharp blow on the point above the sword-shaped process. The goal is to shake the chest and again make the heart work. After making a strike, you need to check the pulse. When it detected the victim, it is necessary to put on the side, there is no lack - to perform the next item.
4. Indirect heart massage. Methods for the following: take the position to the right of a person, the left palm brush to set the above-moving process about 10 cm. It is important that the fingers do not touch the chest. Top to install the right brush. Both hands should not bend in elbow joints. Next, you need to rhythmically pressed on the sternum (the palms should be on it all the time) approximately 60-70 times per minute (in adults). During the execution of the jolts, it is important that they move to the spine by 3-5 cm. Massage can be alternating with artificial respiration. To do this, you need to hold the nose to the patient with your fingers, then gripped your mouth to the mouth of a person through the napkin and expose air with an effort.

It is important to know that resuscitation is such a set of measures that can be carried out simultaneously if there are several assistants. For example, one person makes the victim artificial respirationAnd the second conducts an indirect heart massage. Doctors perform revival activities in the same way, will additionally be used medications and defibrillator. Contrary to common delusion, during the resuscitation of adrenaline injection in the heart is not made, they are not recognized effective.

How is the children?

With a sudden stopping circulation, it is necessary to estimate the condition of the child within 5-10 seconds.

Signs of clinical death in children are:

• unconscious;
• pulse does not face;
• extended pupils;
• lack of reflex reactions.

Prior to the arrival of ambulance algorithm for the implementation of children's resuscitation, the following:

1. Provide respiratory tract (methods are similar to those used in adult victims).
2. Artificial lung ventilation. It is necessary to make 5 inhales of mouth in the mouth and check the presence of a pulse. With its absence, it is necessary to start alternate the indirect heart massage and the breath of the mouth in the mouth. At the same time, there should be 2 inhales for 15 strokes. The frequency of squeezing the chest is 100-120 per minute.

Events should be carried out up to the arrival of physicians.

Features of resuscitation of newborns

The algorithm of its holding is similar to that applied to children of older age. If the victim is a child up to 1 year, the difference lies in the method of implementing an indirect heart massage. It is carried out as follows: It is necessary to impose an index and middle fingers on the bottom of the sternum (just below the nipples) and make them quick sharp pressing (approximately 120 per minute).

Intensive therapy

Her task is to maintain the vital functions of the patient's body throughout the time of its location in a critical condition.

In medical institutions the main structural unit is the separation of intensive therapy. He is constantly being care for seriously ill patients, doctors observe the dynamics of changes in their health indicators. The translation into a regular ward is issued when eliminating states incompatible with life.

Termination of resuscitation events

All attempts to restore vital processes are completed in the following cases:

• Resuscitation for 30 minutes did not give results (10 minutes, if it comes to newborns).
• Fixed biological death.

In addition, it is necessary to know that resuscitation is such measures that are not implemented if clinical death is a consequence of the progression of incurable pathologies or the effects of injuries that are incompatible with life.

Finally

The return of a person to life can be conducted as doctors in medical institutionand ordinary people anywhere where the victim is located. To do this, you need to know the main stages and ways of implementing resuscitation activities.

20.06.2013

Indications, contraindications and deadlines for the resuscitation manual

The indication for the resuscitation benefit is the presence of a patient of pre-imaginal, agonal states or clinical death.

The actions of medical workers in the provision of resuscitation assistance to victims in our country are regulated by order of the Ministry of Health of the Russian Federation of 04.03.2003? 73 "On approval of the instructions for determining the criteria and the procedure for determining the moment of death of a person, stopping resuscitation activities."

Annex to the Order of the Ministry of Health Russian Federation

dated 04.03.03? 73.

Instructions for determining the criteria and procedure for determining the moment of death of a person, stopping resuscitation activities.

I. General.

The death of a person comes as a result of the death of the body as a whole. In the process of dying, stages are distinguished: agony, clinical death, brain death and biological death.

Agony is characterized by progressive fading external signs The livelihoods of the body (consciousness, blood circulation, breathing, motor activity).

In clinical death, pathological changes in all organs and systems are fully reversible.

The death of the brain is manifested by the development of irreversible changes in the brain, and in other organs and systems partially or completely reversible.

Biological death is expressed by posthumous changes in all organs and systems that are permanent, irreversible, body.

Posthumous changes have functional, instrumental, biological and body signs.

Functional signs.

Lack of consciousness.

No breathing, pulse, blood pressure.

The lack of reflex responses to all types of stimuli.

Instrumental signs.

Electricencephalographic.

Angiographic. Biological signs.

Maximum expansion of pupils.

Pallor and / or cyanosis, and / or marble (spotting) of the skin.

Reduced body temperature. Conduct changes.

Early signs.

Late signs.

II. The statement of the death of man.

The statement of human death occurs when the death of the brain or the biological death of a person (irreversible death of a person).

Biological death is established on the basis of the presence of corpus changes (early signs, late signs).

The diagnosis of "death of the brain" is established in health institutions with the necessary conditions for the establishment of brain death.

The death of a person on the basis of the death of the brain is established in accordance with the instructions for the establishment of a person's death on the basis of a diagnosis of the death of the brain, approved by the Order of the Ministry of Health of the Russian Federation of 20.12.2001? 460 "On approval of the instruction on the establishment of a person's death on the basis of the diagnosis of the death of the brain" (the order is registered by the Ministry of Justice of the Russian Federation on January 17, 2002? 3170).

III. Termination of resuscitation activities.

Resuscitation activities are terminated only when they recognize these measures are absolutely unpromising or the statement of biological death, namely:

When the death of a person's death on the basis of the death of a brain, including against the background of ineffective use of a full range of activities aimed at maintaining life;

With the ineffectiveness of resuscitation measures aimed at restoring vital functions for 30 minutes.

Resuscitation activities are not conducted.

If there are signs of biological death.

Upon the state of clinical death against the background of the progression of reliably established incurable diseases or incurable consequences of acute injury incompatible with life.

Note.This instruction does not determine the conditions for the refusal to apply resuscitation activities or their termination of newborn children and children under 5 years.

Forecast after the survey.

The favorable Exodus of the CPR in the hospital conditions currently ranges from 22 to 57%, the frequency of extracting patients is 5-29%, from this number 50% go with a neurological deficit. Exodus SLP chipboard An order of magnitude lower (Baltopoulos, 1999). The leading complication of the persons who have undergone clinical death is the development of post-indixion disease.

In conclusion of this chapter, it is necessary to note the following: the successful revival of the affected person is possible only with an indispensable combination of three are equivalent to important conditions:

Wish to help;

Know how to do it;

Be able to

The resuscitation benefit is shown to the patient, which is in a state of a pre-aromatic, agonal state or in a state of clinical death.

Contraindications for resuscitation

Resuscitation allowance does not turn out to be affected:

• having injuries incompatible with life;
• located in the terminal stage of the incurable disease;
• oncological patients with metastases.

Duration of resuscitation benefit

It should be said that the timing can fluctuate in large limits, from dozens of minutes to several hours. Much depends on the cause of death, the duration of the clinical death and the effectiveness of resuscitation actions.

Resuscitation cycle Called the complex of consecutive resuscitation activities (ABC techniques, medication and electrical incentive stimulation of the heart), which are performed for 4-5 minutes.

The resuscitation allowance is stopped if during a contract of 3-5 cycles has never received at least a short-term emergence of cardiac activity.

If the emergence of cardiac activity was obtained, then resuscitation activities are carried out either until the heart of the heart is fully restored, or before receiving in a row 3-5 completely inefficient cycles.

In practice, cases of successful resuscitation are described, followed by the complete recovery of the elderly, who had more than 50 defibrillations, and the resuscitation allowance was provided for 1-2 hours.

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As a result of the class

Topic: Cardiovascular Resuscitation Basic Complex: Indirect Heart Massage. Indications and contraindications to resuscitation, errors and complications of resuscitation.

1. Venue: Department of Emergency Emergency and Anesthetic-Resuscitation Aid (Corps No. 7 Clinical Hospital them. Peacemaster SGMU).

2. Duration: 3.5 hours. Of these, independent audit work - 1 hour

3. The purpose of the lesson:familiarize student S. various species Heart stops, cardiac restoration methods, massage complications as a basis for subsequent mastering practical skills of resuscitation

events; The duration of resuscitation, testimony and contraindications to it.

4. Motivational characteristics of the lesson:

Currently, worldwide is generally recognized that resuscitation activities initiated at the scene are beneficial and clinically, and economically, since they reduce mortality, accelerate the treatment time. All over the world there is a tendency to increase the number of different vehiclecreating high-tech enterprises in different areas Production, constantly arise local military conflicts, which often leads to the development of man-made catastrophes, injury and injuries that can lead to the development of clinical death. Based on the above, it becomes clear that students of the Medical University must be able to properly carry out resuscitation activities.

The student must know :

Basics of heart anatomy;

Causes and mechanisms of circulatory disorders during critical condition;

Physiology of indirect heart massage;

Indications and contraindications to resuscitation.

The student must be able to :

Carry out indirect heart massage;

Evaluate the effectiveness of indirect heart massage.

The student must familiarize himself:

With the equipment for indirect heart massage by specialized resuscitation teams (cardiopamp, lucas).

6. Graphic schemes, tables on this topic, educational elements on this topic:

Resuscitation (lat. Reanimacio - revival)

A complex of therapeutic and surgical measures built according to a specific plan, aimed at restoring and maintaining the functions lost by the body.

Indications to resuscitation are all cases of sudden death regardless of its causes.

Contraindications to resuscitation are considered all cases when it is useless and unpromising:

1. The occurrence of death due to a long depleting disease.

2. At the occurrence of death in patients with incults currently

diseases.

3. The primary elevation should not be carried out if more than 15-20 minutes passed from the moment of death.