Basic resuscitation
activities (BasisLifeSupport,
BLS) include provision
patency of the upper
respiratory tract, and
maintaining breathing and
circulation without
additional
devices other than simple
protective devices when
artificial
lung ventilation.

Examination of the victim determination of consciousness

Terminal state

clinical death

Resuscitation in translation means "revival".

The main signs of clinical death or sudden circulatory arrest (SCA):

Basic rules for cardiopulmonary resuscitation B A C

Indirect cardiac massage

chest compression

To free the airways, there are the following techniques:

Artificial ventilation of the lungs by methods:

Sequence of actions in case of circulatory arrest

Check the victim's reaction

The victim does not respond, does not respond ....

Notify the ambulance dispatcher

The victim is breathing normally

The victim is not breathing...

Help is provided by several rescuers

Cardiopulmonary resuscitation

• Cardiopulmonary resuscitation(CPR), cardiopulmonary resuscitation- an emergency medical procedure aimed at restoring the vital activity of the body and removing it from the state of clinical death. Includes artificial ventilation of the lungs (artificial respiration) and chest compressions (chest compressions). Start CPR on the victim as soon as possible. At the same time, the presence of two of the three signs of clinical death - the absence of consciousness and pulse - are sufficient indications for its onset. The founder of cardiopulmonary resuscitation is the Austrian doctor Peter Safar, after whom the triple reception Safar .

• Artificial heart massage indirect heart massage chest compression

Chest Compression Technique

• Circulation can be restored by pressing on the chest. In this case, the heart is squeezed between the sternum and the spine, and blood is pushed out of the heart into the vessels. Rhythmic pressing imitates heart contractions and restores blood flow. This massage is called indirect because the rescuer acts on the heart through the chest.
• The victim is laid on his back, always on a hard surface. If he is lying on the bed, he should be placed on the floor.
• The clothes on the patient's chest are unbuttoned, freeing the chest. The rescuer stands (in full height or on his knees) to the side of the victim. He places one palm on the lower half of the patient's sternum so that the fingers are perpendicular to it. Place the other hand on top. Raised fingers do not touch the body. The straight arms of the rescuer are located perpendicular to the chest of the victim. Massage is performed with quick pushes, the weight of the whole body, without bending the arms at the elbows. In this case, the patient's sternum should bend by 4-5 cm.

Action plan

1. Lay the casualty face up on a hard surface.

3. Take the patient 2 breaths using the mouth-to-mouth or mouth-to-nose method.

4. Check the pulse on the carotid artery. If not, continue resuscitation.

5. Begin chest compressions: Give 30 chest compressions in a row at a rate of approximately 100 compressions per minute.

6. 2 more breaths of artificial respiration. Do 4 such cycles (30 presses and 2 breaths each).

7. After that, check the pulse on the carotid artery again. If not, resuscitation continues. Repeat 5 cycles of 30 presses and 2 breaths. Continue CPR until 911 arrives or signs of biological death appear.

Artificial lung ventilation

• Artificial respiration(artificial ventilation of the lungs) - a set of measures aimed at maintaining the circulation of air through the lungs in a person who has stopped breathing. Can be done using ventilator, or a person (breathing from mouth to mouth). Usually, during resuscitation, it is combined with artificial heart massage. Typical situations in which artificial respiration is required: accidents from car accidents, accidents on the water, injury electric shock, drowning. Ventilator It is also used in surgical operations as part of an anesthetic apparatus.

Upper airway obstruction

Airway obstruction(from lat. obstructio- hindrance, obstacle) - obstruction syndrome respiratory tract. It can be observed at any level, from the pharynx to the bronchioles. In adults, the cause of obstruction may be an intraluminal or estramural tumor; acute obstruction of the upper respiratory tract can develop with trauma, burns, bleeding, etc.

Clinical signs.

• Leading signs of upper airway obstruction are stridor breath(inspiratory with obstruction at the extrathoracic level, expiratory - with intrathoracic obstruction); suprasternal retractions (decrease in the volume of the neck due to retraction), less often chest retraction; croupy cough; hoarse cry. Against the background of progressive obstruction of the upper respiratory tract, cyanosis develops, followed by bradycardia and respiratory arrest.

Treatment of upper airway obstruction

• With supraglottic localization of obstruction, a tracheostomy is performed. At the level of obstruction below the larynx, thoracotomy is preferred. It is possible to restore the patency of the respiratory tract by means of remote or contact radiotherapy while taking glucocorticoids.
• In case of impossibility of surgical intervention in case of endobronchial neoplastic process, photodynamic therapy (intravenous administration of a photosensitizing substance followed by visible light irradiation), as well as YAG laser coagulation, can be used.

Lower airway obstruction

• Lower airway obstruction is a common symptom of asthma obliterating bronchiolitis etc. Among the causes of obstruction is the formation of mucous plugs from thick, viscous mucus; wall hyperplasia bronchi and bronchioles, their infiltration and swelling of the glands; thickening and / or spasm of the muscular membrane of the bronchi; intraluminal polyposis; fibrosis of the walls of the bronchioles. The obstruction of the lower airways becomes more pronounced on expiration due to their dynamic narrowing.

Cardiopulmonary resuscitation

• The success of resuscitation largely depends on the time elapsed from the moment of circulatory arrest to the start of resuscitation. At the heart of measures to improve the survival rate of patients with circulatory and respiratory arrest is the concept of "chain of survival" [P. Basket, 1993]. It consists of a number of stages: at the scene, during transport, in the operating room of the hospital, in the intensive care unit and in the rehabilitation center. The weakest link in this chain is the effective provision of basic livelihood support at the scene. It is on him that the outcome largely depends. It should be remembered that the time during which you can count on the successful restoration of cardiac activity is limited [G. A. Ryabov, 1996]. Resuscitation in normal conditions can be successful if started immediately or in the first minutes after the onset of circulatory arrest [G. Groer, D. Cavallaro, 1996].
• The main principle of resuscitation at all stages of its implementation is the position that "resuscitation should prolong life, and not delay death." end results recovery largely depends on the quality of resuscitation. Errors in its implementation can subsequently accumulate on the primary damage that caused the terminal state.
• The main provisions of cardiopulmonary resuscitation were set out in the manual of P. Safar, created by order of the World Federation of Societies of Anesthesiologists (WFOA) in 1968. Subsequently, it was repeatedly supplemented and reprinted. The method of cardiopulmonary and cerebral resuscitation outlined below is based on the standards adopted by the WFOA and corresponds to the principles of resuscitation of the body accepted in our country.

TERMINAL CONDITIONS AND CLINICAL DEATH

• Usually there are three periods of dying - preagony, agony and clinical death.
• The preagonal state is characterized by the disintegration of all body functions, a critical level of blood pressure, impaired consciousness of varying severity, and respiratory disorders. The preagonal state can last from several minutes to several hours. Then comes the terminal pause, the main manifestations of which are the cessation of breathing (from a few seconds to 3-4 minutes) and the presence of an idioventricular or ectopic heart rhythm. The terminal pause is caused by a temporary increase in vagal tone, after which agonal breathing occurs, indicating the onset of agony (the appearance of a short series of breaths or one superficial breath).
• The duration of the agonal period is usually short. Heart contractions and breathing quickly stop. There are violations of the biomechanics of breathing - it is slow, superficial, auxiliary muscles are actively involved. Gas exchange is inefficient due to the simultaneous participation in the act of breathing of the muscles that provide inhalation and exhalation. There is a centralization of blood circulation (in favor of the brain, liver, kidneys, heart). The depletion of compensatory mechanisms quickly sets in and clinical death occurs.

clinical death

• clinical death- this is the period between life and death, when there are no visible signs of life, but life processes allowing the body to revive. The duration of this period at normal body temperature is 5-6 minutes, after which irreversible changes develop in the tissues of the body. Under special conditions (hypothermia, pharmacological protection), this period is extended to 15-16 minutes.
• 1. Circulatory arrest (lack of pulsation in the main arteries);
• 2. Lack of spontaneous breathing (no chest excursions);
• 3. Lack of consciousness;
• 4. Wide pupils;
• 5. Areflexia (no corneal reflex and pupillary reaction to light):
• 6. Type of corpse (pallor, acrocyanosis). The process of dying is characterized by the extinction of vital functions. important systems body (nervous, respiratory, circulatory, etc.).

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Defibrillation technique. The electrodes of an external defibrillator should be placed on the anterior surface of the chest: one electrode on the right in the 2nd intercostal space under the clavicle, the other in the projection of the apex of the heart. Recommended parameters for defibrillation in adults: first attempt - 200 J, if unsuccessful - 300 J, then 360 J. The time interval between attempts should be minimal and is required only to assess the effect of defibrillation and set, if necessary, the next discharge. I will not dwell on drug therapy within the framework of this article. However, it should be noted that the widespread opinion is that the optimal way to introduce medicines is intracardiac, has undergone changes, because this method carries a large number of complications. Intravenous or endotracheal routes of administration are by far the most optimal. It should be remembered that the dose of the drug for endotracheal administration should be increased by 2-2.5 times and diluted in saline (up to 10 ml). Below is the dosage of some drugs used in CPR (calculation for intravenous administration). Adrenaline - 1 ml of 0.1% solution (1 mg) every 3-5 minutes. until clinical effect is obtained. Accompany each dose with 20 ml of saline. Norepinephrine - 2 ml of 0.2% solution, diluted in 400 ml of saline. Atropine - 1.0 ml of 0.1% solution every 3-5 minutes. until the effect is obtained, but not more than 3 mg. Lidocaine (with extrasystole) - the initial dose is 80-120 mg (1-1.5 mg / kg).

The system of measures to support life under
sudden circulatory arrest (SCA)
proposed about 70 years ago
CPR methodology should be the same for all countries and
constantly improve. To this end
created international organization European
resuscitation council (ECR)
The ESR is part of the World Conciliation
resuscitation advice
In 2004, the National Council for
resuscitation (NSR), Russia was admitted to the ESR
All countries - members of the ESR must for training
use the methodological recommendations of the ESR,
which are accordingly recognized by the international
resuscitation standard
The first version of the guidelines was
published in 2000. Second in 2005.

ELEMENTS OF BASIC CPR

EXTENDED CPR

Establishing the fact of circulatory arrest

chest compressions

chest compressions

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

Ensuring the patency of the DP

IVL METHODS

Manual ventilation method (mask)

DEFIBRILLATION

DEFIBRILLATION

DEFIBRILLATION optimal technique

Routes of drug administration

Routes of drug administration

CPR Medications

CPR Medications

CPR must begin

CPR is not indicated if

Absolute (reliable) signs of biological death

CPR may be stopped

A set of signs that allows stating biological death before the appearance of reliable signs