Cardiac arrest resuscitation. Resuscitation for heart failure. Features of resuscitation measures in children

Cardiopulmonary resuscitation– a set of measures aimed at restoring the activity of the respiratory and circulatory organs in the event of their sudden cessation. There are quite a few of these measures. For ease of memorization and practical mastery, they are divided into groups. In each of the groups, stages are highlighted, memorized using mnemonic (sound-based) rules.

Resuscitation groups

Resuscitation measures are divided into the following groups:

• basic, or basic;
• extended.

Basic resuscitation measures should begin immediately when circulatory and respiratory arrest stops. They are trained by medical personnel and rescue services. The more ordinary people know about the algorithms for providing such care and are able to apply them, the more likely it is to reduce mortality due to accidents or acute painful conditions.
Advanced resuscitation measures are carried out by emergency doctors at subsequent stages. Such actions are based on deep knowledge of the mechanisms of clinical death and diagnosis of its cause. They mean comprehensive examination the victim, his treatment with drugs or surgical methods.
For ease of memorization, all stages of resuscitation are indicated by letters of the English alphabet.
Basic resuscitation measures:
A – air open the way – ensure passability respiratory tract.
B – breath of victim – ensure the victim’s breathing.
C – circulation of blood – ensure blood circulation.
Completing these measures before the ambulance arrives will help the victim survive.
Additional resuscitation measures are carried out by doctors.
In our article we will dwell in more detail on the ABC algorithm. These are fairly simple steps that anyone should know and be able to perform.

Signs of clinical death

To understand the importance of all stages of resuscitation, you need to have an idea of ​​what happens to a person when blood circulation and breathing stop.
After breathing and cardiac activity stop for any reason, blood stops circulating throughout the body and supplying it with oxygen. Under conditions of oxygen starvation, cells die. However, their death does not occur immediately. For a certain time, it is still possible to maintain blood circulation and breathing and thereby delay irreversible tissue damage. This period depends on the time of death of brain cells, and under normal temperature conditions environment and body is no more than 5 minutes.
So, the determining factor for the success of resuscitation is the time of its start. Before resuscitation begins, the following symptoms must be confirmed to determine clinical death:

• Loss of consciousness. It occurs 10 seconds after circulatory arrest. To check whether a person is conscious, you need to lightly shake his shoulder and try to ask a question. If there is no answer, you should stretch your earlobes. If the person is conscious, resuscitation measures are not necessary.
• Lack of breathing. It is determined upon examination. You should place your palms on your chest and see if there are breathing movements. There is no need to check for breathing by holding a mirror to the victim’s mouth. This will only lead to a waste of time. If the patient has short-term ineffective contractions of the respiratory muscles, reminiscent of sighs or wheezing, we are talking about agonal breathing. It stops very soon.
• Absence of pulse in the arteries of the neck, that is, in the carotid arteries. Don't waste time looking for a pulse on your wrists. You need to place your index and middle fingers on either side of the thyroid cartilage in the lower part of the neck and move them towards the sternocleidomastoid muscle, located diagonally from the inner edge of the collarbone to the mastoid process behind the ear.

ABC Algorithm

If there is a person in front of you without consciousness and signs of life, you need to quickly assess his condition: shake his shoulder, ask a question, stretch his earlobes. If there is no consciousness, the victim should be laid on a hard surface and quickly unfasten the clothes on the chest. It is very advisable to lift the patient’s legs; another assistant can do this. You need to call an ambulance as soon as possible.
It is necessary to determine the presence of breathing. To do this, you can place your palms on the victim's chest. If there is no breathing, it is necessary to ensure patency of the airways (point A - air, air).
To restore patency of the airway, place one hand on the top of the victim’s head and gently tilt his head back. At the same time, lift the chin with the other hand, pushing the lower jaw forward. If after this spontaneous breathing has not been restored, they proceed to ventilation of the lungs. If breathing appears, you need to go to point C.
Ventilation of the lungs (point B - breath, breathing) is most often carried out using the “mouth to mouth” or “mouth to nose” method. It is necessary to pinch the victim’s nose with the fingers of one hand and lower his jaw with the other hand, opening his mouth. It is advisable to place a handkerchief over your mouth for hygienic purposes. After inhaling air, you need to bend over, wrap your lips around the victim’s mouth, and exhale air into his respiratory tract. At the same time, it is advisable to look at the surface chest. With proper ventilation of the lungs, it should rise. Then the victim makes a passive full exhalation. Only after the air has escaped can ventilation be performed again.
After two air injections, it is necessary to assess the state of the victim’s blood circulation, make sure there is no pulse in the carotid arteries and move on to point C.
Point C (circulation) involves a mechanical effect on the heart, as a result of which its pumping function is manifested to some extent, and conditions are created for the restoration of normal electrical activity. First of all, you need to find a point of influence. To do this, move your ring finger from the navel up to the victim’s sternum until you feel an obstacle. This is the xiphoid process. Then the palm is turned, the middle and index fingers are pressed against the ring finger. The point located above the xiphoid process, above the width of three fingers, will be the site of chest compressions.
If the patient's death occurred in the presence of a resuscitator, a so-called precordial blow must be applied. A single blow with a clenched fist is applied to the found point with a quick sharp movement, reminiscent of hitting a table. In some cases, this method helps restore normal electrical activity of the heart.
After this, indirect cardiac massage begins. The victim must be on a hard surface. There is no point in performing resuscitation on the bed; you need to lower the patient to the floor. The base of the palm is placed on the found point above the xiphoid process, and the base of the other palm is placed on top. Fingers clasp and lift. The resuscitator's arms should be straight. Push movements are applied so that the chest bends by 4 centimeters. The speed should be 80 - 100 shocks per minute, the pressure period is approximately equal to the recovery period.
If there is only one resuscitator, then after 30 pushes he must make two blows into the victim’s lungs (ratio 30:2). Previously, it was believed that if there are two resuscitators, then there should be one injection for 5 pushes (ratio 5:1), but not so long ago it was proven that the ratio 30:2 is optimal and ensures maximum efficiency of resuscitation measures with both the participation of one and the same person. and two resuscitators. It is advisable that one of them raise the victim's legs, periodically monitor the pulse in the carotid arteries between chest compressions, as well as chest movements. Resuscitation is a very labor-intensive process, so its participants can change places.
Cardiopulmonary resuscitation lasts 30 minutes. After this, if it is ineffective, the death of the victim is declared.

Criteria for the effectiveness of cardiopulmonary resuscitation

Signs that may cause non-professional rescuers to stop resuscitation:

1. The appearance of a pulse in the carotid arteries during the period between chest compressions during chest compressions.
2. Constriction of the pupils and restoration of their reaction to light.
3. Restoring breathing.
4. The emergence of consciousness.

If normal breathing is restored and a pulse appears, it is advisable to turn the victim to one side to prevent the tongue from retracting. It is necessary to call an ambulance to him as soon as possible, if this has not been done earlier.

Advanced life support

Advanced resuscitation measures are carried out by doctors using appropriate equipment and medications.

• One of the most important methods is electrical defibrillation. However, it should be carried out only after electrocardiographic monitoring. For asystole, this treatment method is not indicated. It cannot be performed if consciousness is impaired due to other reasons, for example, epilepsy. Therefore, for example, “social” defibrillators for providing first aid, for example, at airports or other crowded places.
• The resuscitator must perform tracheal intubation. This will ensure normal airway patency, the possibility of artificial ventilation of the lungs using devices, as well as intratracheal administration of some medicines.
• Must be provided venous access, with the use of which most drugs are administered that restore circulatory and respiratory activity.

The following basic ones are used medications: adrenaline, atropine, lidocaine, magnesium sulfate and others. Their choice is based on the causes and mechanism of development of clinical death and is carried out by the doctor on an individual basis.

Official film of the Russian National Council for Resuscitation “Cardiopulmonary Resuscitation”:

It can save a person who has fallen into a state of clinical (reversible) death medical intervention. The patient will have only a few minutes before death, so those nearby are obliged to provide him with emergency pre-medical care. Cardiopulmonary resuscitation (CPR) is ideal in this situation. It is a set of measures to restore respiratory function and the circulatory system. Not only rescuers, but also ordinary people nearby can provide assistance. The reasons for carrying out resuscitation measures are manifestations characteristic of clinical death.

Cardiopulmonary resuscitation is a combination of primary methods saving the patient. Its founder is the famous doctor Peter Safar. He was the first to create the correct algorithm of actions emergency care to the victim, which is used by most modern resuscitators.

The implementation of the basic complex for saving a person is necessary when identifying clinical picture characteristic of reversible death. Its symptoms are primary and secondary. The first group refers to the main criteria. This:

• disappearance of the pulse in large vessels (asystole);
• loss of consciousness (coma);
• complete lack of breathing (apnea);
• dilated pupils (mydriasis).

The voiced indicators can be identified by examining the patient:

Secondary symptoms vary in severity. They help ensure the need for pulmonary-cardiac resuscitation. Acquainted with additional symptoms clinical death can be found below:

• pale skin;
• loss of muscle tone;
• lack of reflexes.

Contraindications

Basic form of cardiopulmonary resuscitation is performed by nearby people in order to save the patient’s life. An extended version of assistance is provided by resuscitators. If the victim has fallen into a state of reversible death due to a long course of pathologies that have depleted the body and cannot be treated, then the effectiveness and expediency of rescue methods will be in question. This usually results in the terminal stage of development oncological diseases, severe deficiency internal organs and other ailments.

There is no point in resuscitating a person if there are visible injuries that are incomparable to life against the background of a clinical picture of characteristic biological death. You can see its signs below:

• post-mortem cooling of the body;
• the appearance of spots on the skin;
• clouding and drying of the cornea;
• the emergence of the “cat’s eye” phenomenon;
• hardening of muscle tissue.

Drying and noticeable clouding of the cornea after death is called the “floating ice” symptom due to appearance. This sign is clearly visible. The "cat's eye" phenomenon is determined by light pressure on the sides eyeball. The pupil contracts sharply and takes the shape of a slit.

The rate at which the body cools depends on the ambient temperature. Indoors, the decrease occurs slowly (no more than 1° per hour), but in a cool environment everything happens much faster.

Cadaveric spots are a consequence of the redistribution of blood after biological death. Initially, they appear on the neck from the side on which the deceased was lying (front on the stomach, back on the back).

Rigor mortis is the hardening of muscles after death. The process begins with the jaw and gradually covers the entire body.

Thus, it makes sense to perform cardiopulmonary resuscitation only in the case of clinical death, which was not provoked by serious degenerative changes. Its biological form is irreversible and has characteristic symptoms, so people nearby will only need to call an ambulance for a team to pick up the body.

Correct procedure

The American Heart Association regularly provides advice on how to help better effective assistance sick people. Cardiopulmonary resuscitation according to new standards consists of the following stages:

• identifying symptoms and calling an ambulance;
• performing CPR according to generally accepted standards with an emphasis on chest compressions of the heart muscle;
• timely implementation of defibrillation;
• use of intensive care methods;
• carrying out complex treatment asystole.

The procedure for performing cardiopulmonary resuscitation is compiled according to the recommendations of the American Heart Association. For convenience, it was divided into certain phases, entitled in English letters “ABCDE”. You can see them in the table below:

The voiced stages of cardiopulmonary resuscitation are compiled for doctors. To ordinary people If you are near the patient, it is enough to carry out the first three procedures while waiting for an ambulance. The correct technique can be found in this article. Additionally, pictures and videos found on the Internet or consultations with doctors will help.

For the safety of the victim and the resuscitator, experts have compiled a list of rules and advice regarding the duration of resuscitation measures, their location and other nuances. You can find them below:

Time to make a decision is limited. Brain cells are rapidly dying, so pulmonary-cardiac resuscitation must be carried out immediately. There is only no more than 1 minute to make a diagnosis of “clinical death”. Next, you need to use the standard sequence of actions.

Resuscitation procedures

To a common man without medical education There are only 3 methods available to save the patient’s life. This:

• precordial stroke;
• indirect form of cardiac muscle massage;
• artificial ventilation.

Specialists will have access to defibrillation and direct cardiac massage. The first remedy can be used by a visiting team of doctors if they have the appropriate equipment, and the second only by doctors in the intensive care unit. The sound methods are combined with the administration of medications.

Precordial shock is used as a replacement for a defibrillator. Usually it is used if the incident happened literally before our eyes and no more than 20-30 seconds passed. The algorithm of actions for this method is as follows:

• If possible, pull the patient onto a stable and durable surface and check for the presence of a pulse wave. If it is absent, you must immediately proceed to the procedure.
• Place two fingers in the center of the chest in the area of ​​the xiphoid process. The blow must be applied slightly above their location with the edge of the other hand, gathered into a fist.

If the pulse cannot be felt, then it is necessary to move on to massage the heart muscle. The method is contraindicated for children whose age does not exceed 8 years, since the child may suffer even more from such a radical method.

Indirect cardiac massage

The indirect form of cardiac muscle massage is compression (squeezing) of the chest. This can be done using the following algorithm:

• Place the patient on a hard surface so that the body does not move during the massage.
• The side where the person performing resuscitation measures will stand is not important. You need to pay attention to the placement of your hands. They should be in the middle of the chest in its lower third.
• Hands should be placed one on top of the other, 3-4 cm above the xiphoid process. Press only with the palm of your hand (fingers do not touch the chest).
• Compression is carried out mainly due to the rescuer’s body weight. It is different for each person, so you need to make sure that the chest sag no deeper than 5 cm. Otherwise, fractures are possible.

• pressure duration 0.5 seconds;
• the interval between presses does not exceed 1 second;
• the number of movements per minute is about 60.

When performing cardiac massage in children, it is necessary to take into account the following nuances:

• in newborns, compression is performed with 1 finger;
• in infants, 2 fingers;
• in older children, 1 palm.

If the procedure turns out to be effective, the patient will develop a pulse, the skin will turn pink and the pupillary effect will return. It must be turned on its side to avoid tongue sticking or suffocation by vomit.

Before carrying out the main part of the procedure, you must try the Safar method. It is performed as follows:

• First, you should lay the victim on his back. Then tilt his head back. The maximum result can be achieved by placing one hand under the victim’s neck and the other on the forehead.
• Next, open the patient’s mouth and take a test breath of air. If there is no effect, push his lower jaw forward and down. If there are objects in the oral cavity that cause blockage of the respiratory tract, then they should be removed with improvised means (handkerchief, napkin).

If there is no result, you must immediately proceed to artificial ventilation. Without the use of special devices, it is performed according to the instructions below:

To avoid infection of the rescuer or patient, it is advisable to carry out the procedure through a mask or using special devices. Its effectiveness can be increased by combining it with indirect cardiac massage:

• When performing resuscitation measures alone, you should apply 15 pressures on the sternum, and then 2 breaths of air to the patient.
• If two people are involved in the process, then air is injected once every 5 presses.

Direct cardiac massage

The heart muscle is massaged directly only in a hospital setting. Often resort to this method in case of sudden cardiac arrest during surgical intervention. The technique for performing the procedure is given below:

• The doctor opens the chest in the area of ​​the heart and begins to rhythmically compress it.
• Blood will begin to flow into the vessels, due to which the functioning of the organ can be restored.

The essence of defibrillation is the use of a special device (defibrillator), with which doctors apply current to the heart muscle. This radical method is indicated for severe forms arrhythmias (supreventricular and ventricular tachycardias, ventricular fibrillation). They provoke life-threatening disruptions in hemodynamics, which often lead to death. If the heart stops, using a defibrillator will not bring any benefit. In this case, other resuscitation methods are used.

Drug therapy

Doctors administer special medications intravenously or directly into the trachea. Intramuscular injections are ineffective, so they are not carried out. The following medications are most commonly used:

• Adrenaline is the main drug for asystole. It helps start the heart by stimulating the myocardium.
• "Atropine" represents a group of M-cholinergic receptor blockers. The drug helps to release catecholamines from the adrenal glands, which is especially useful in cardiac arrest and severe bradysystole.
• "Sodium bicarbonate" is used if asystole is a consequence of hyperkalemia ( high level potassium) and metabolic acidosis (acid-base imbalance). Especially during a prolonged resuscitation process (over 15 minutes).

Other medications, including antiarrhythmic drugs, are used as appropriate. After the patient’s condition improves, they will be kept under observation in the intensive care unit for a certain period of time.

Consequently, cardiopulmonary resuscitation is a set of measures to recover from the state of clinical death. Among the main methods of providing assistance are artificial respiration and indirect cardiac massage. They can be performed by anyone with minimal training.

There are many situations that we call force majeure or extraordinary situations. These are circumstances when you need to be able to act quickly and competently, saving the life of another person. One of these situations is cardiac arrest in a person nearby. So, about the symptoms of stopping and the correct actions to resuscitate the victim.

Symptoms of cardiac arrest

There are several main signs that indicate cardiac arrest. Here they are:

1. Absence of pulse in large arteries. To determine the pulse, place two fingers on the carotid artery. If it is not palpable, then you need to start acting.
2. Lack of breathing. Its presence is determined by applying a mirror to the victim’s nose. This is done if movements of a person’s chest are not visually detected.
3. Dilated pupils do not respond to light. You should shine a flashlight into the person’s eyes, lifting the eyelids. If the pupils do not constrict, then there is no reaction, and this is evidence of the cessation of myocardial function.


4. Bluishness of the face or its gray, sallow color. A change in the natural color of a person’s skin is an important sign indicating a circulatory disorder.
5. Loss of consciousness by a person. It is associated with ventricular fibrillation or asystole. Loss of consciousness is determined by patting the victim on the face or sound effects. It could be screaming or clapping.

The causes of cardiac arrest can be hypothermia and electrical trauma, drowning or suffocation, ischemic disease hearts and arterial hypertension, anaphylactic shock and smoking.

How to save a person in cardiac arrest?

If a person has the above symptoms, then people who are nearby have only seven minutes to resuscitate the victim, that is, save his life. Delayed help can lead to a person’s disability.

The main tasks that need to be performed when providing assistance are to restore breathing to the victim’s heart rate and start the circulatory system.

Providing first aid after calling an ambulance and while waiting for it includes several sequential actions:

1. Laying a person down on a hard surface.
2. Throwing his head back.
3. Freeing the oral cavity from mucus and other contents.


4. Resuscitation of the victim's breathing through artificial ventilation. In this case, the resuscitator needs to draw air into the lungs (take a deep breath) and let it into the victim’s open mouth, pinching his nose.
5. External cardiac massage to the victim. It is done by sharp pressure on the heart area with the hands of a resuscitator. They should be folded perpendicularly over the heart, palm to palm. After one inhalation, 4-5 presses are made on the heart, and such actions are repeated until independent cardiac activity is restored (the appearance of a pulse) and breathing appears. It is sometimes recommended to perform a precordial beat before cardiac massage to enhance the action. It means a punch to the middle area of ​​the sternum. We must ensure that such a blow does not fall directly on the heart, because this will only worsen the situation of the victim. A precordial blow sometimes helps to instantly resuscitate a person or increase the effectiveness of cardiac massage.
6. If a person has a pulse, then resuscitation measures must be continued until the person begins to breathe on his own.
7. Heart massage is performed until the skin begins to acquire a natural shade.
8. The above measures are the initial stage of resuscitation of the victim until the ambulance arrives.
9. Upon arrival, doctors (if the resuscitator fails to start the heart) use a defibrillator. This medical device acts on the heart muscle with an electric current.

The consequences of cardiac arrest depend on the efficiency of resuscitation measures: the later the person is brought back to life, the more risk complications.

Heart failure

When cardiac activity stops or very sharply weakens, blood flow through the vessels stops. Main signs of cardiac arrest:

- loss of consciousness

- lack of pulse, dilated pupils

- respiratory arrest, convulsions

- pallor or bluishness of the skin and mucous membranes

Cardiac massage should be performed simultaneously with ventilation of the lungs. When you press on the heart, the blood is squeezed out and flows from the left ventricle into the aorta and further through the carotid arteries to the brain, and from the right ventricle to the lungs, where an important mechanism for revitalizing the body occurs - oxygen saturation of the blood. After the pressure on the chest stops, the cavities of the heart fill with blood again.

The person is placed on his back on a solid base. The person providing assistance stands on the side of the victim and, using the surfaces of his palms, which overlap each other, presses on the lower third of the chest. Heart massage is carried out in jerks, pressing the hand with the whole body up to 50 times per minute. The amplitude of oscillations in an adult should be about 4-5 cm. Every 15 presses on the sternum with an interval of 1 second, pause the massage, perform 2 strong artificial breaths using the “mouth to mouth” or “mouth to nose” method. With the participation of 2 revitalizing, it is necessary to inhale after every five presses. The rescuer performing compressions should count “1,2,3,4,5” loudly, and the rescuer performing ventilation should count the number of cycles completed. Early initiation of primary care improves outcome, especially if advanced care is delayed.

Artificial respiration

"mouth to mouth"- the rescuer pinches the victim’s nose, takes a deep breath, presses tightly to the victim’s mouth and exhales forcefully. Monitors the victim's chest, which should rise. Then he raises his head and watches the passive exhalation. If the victim’s pulse is well determined, then the interval between breaths should be 5 seconds, i.e. 12 times per minute. Care should be taken to ensure that the inhaled air enters the lungs and not the stomach. If air gets into the stomach, the victim must be turned on his side and gently pressed on the stomach between the sternum and the navel.

"mouth to nose" - The rescuer fixes the victim’s head with one hand, grabs his chin with the other, pushes the lower jaw forward a little and closes it tightly with the upper one. He pinches his lips with his thumb. Then he takes in air and tightly wraps his lips around the base of the nose, so as not to pinch the nasal openings and blow air vigorously. Having freed your nose, follow the passive exhalation.

If, an hour after the start of massage and ventilation, cardiac activity does not resume and the pupils remain wide, revitalization can be stopped.

Why does cardiac arrest occur?

First medical aid will be the same regardless of the reasons for which such a condition occurred. And yet, what must happen for the effective activity of the heart to stop? Everyone should know about this. The main reason is ventricular fibrillation. This is a condition in which chaotic contraction of muscle fibers occurs in the walls of the ventricles, which leads to interruptions in the blood supply to tissues and organs. Another reason is ventricular asystole - in this case, the electrical activity of the myocardium completely stops.

Coronary heart disease, left ventricular hypertrophy, arterial hypertension, atherosclerosis are also risk factors that can contribute to the cessation of the effective functioning of the main human organ. Cardiac arrest can also occur due to ventricular paroxysmal tachycardia, when there is no pulse in large vessels, or due to electromechanical dissociation, when in the presence of electrical activity of the heart, a corresponding contraction of the ventricles does not occur (that is, there is no mechanical activity). There is also such a pathology as Romano-Ward syndrome, which is associated with hereditary ventricular fibrillation - it can also cause sudden cardiac arrest.

In some cases, first aid is also required for people who have not previously had health problems.

External influence

The heart may stop due to:

How to determine if the heart has stopped working

When the heart muscle stops functioning, the following symptoms are found:

• Loss of consciousness - it occurs almost immediately after cardiac arrest, no later than five seconds. If a person does not react to any stimuli, then he is unconscious.
• Cessation of breathing - in this case there is no movement of the chest.
• There is no pulsation at the site of the carotid artery - it can be felt in the area thyroid gland, two or three centimeters away from her to the side.
• Heart sounds cannot be heard.
• The skin becomes bluish or pale.
• Pupil dilation - this can be detected by lifting the victim's upper eyelid and shining a light into the eye. If the pupil does not constrict when the light is directed, then one can suspect that sudden cardiac arrest has occurred. Emergency assistance in this case can save a person’s life.
• Convulsions - may occur at the moment of loss of consciousness.

All of these symptoms indicate the need for urgent resuscitation measures.

You can't hesitate!

If you find yourself near a person whose heart has stopped, the main thing you need to do is act quickly. There are only a few minutes to save the victim. If assistance for cardiac arrest is delayed, the patient will either die or remain incapacitated for life. Your main task is to restore breathing and heart rate, as well as start the circulatory system, since without this, vital organs (especially the brain) cannot function.

Emergency care for cardiac arrest is needed if the person is unconscious. First, stir him up, try calling out loudly. If no reaction is observed, proceed with resuscitation measures. They include several stages.

First aid for cardiac arrest. Artificial respiration

Important! Don't forget to call an ambulance immediately. This must be done before resuscitation begins, since then you will no longer have the opportunity to interrupt.

To open the airway, place the victim on a hard surface with their back. Anything that could interfere with a person’s normal breathing should be removed from the mouth (food, dentures, any foreign bodies). tilt the patient's head back so that the chin is in a vertical position. In this case, the lower jaw must be pushed forward to prevent the tongue from retracting - in this case, air may enter the stomach instead of the lungs, and then first-aid for cardiac arrest will be ineffective.

After this, immediately begin mouth-to-mouth breathing. Pinch the person's nose, draw air into your lungs, clasp the victim's lips with your lips and take two sharp exhalations. Please note that you need to completely and very tightly clasp the patient's lips, otherwise exhaled air may be lost. Don't exhale too deeply, otherwise you'll get tired quickly. If mouth-to-mouth artificial respiration is impossible for some reason, use the mouth-to-nose method. In this case, you should cover the victim’s mouth with your hand and blow air into his nostrils.

If medical care for cardiac arrest in the form of artificial respiration is provided correctly, then during inhalation the patient’s chest will rise, and during exhalation it will fall. If such movements are not observed, check the airway.

Heart massage

Chest compression (indirect cardiac massage) should be performed simultaneously with artificial respiration. One manipulation without the other will not make sense. So, after you have taken two breaths into the victim's mouth, place your left hand on the lower part of the sternum in the middle, and right hand place on top of the left one in a cross-shaped position. In this case, the arms should be straight, not bent. Next, begin to rhythmically press on the chest - this will cause compression of the heart muscle. Without lifting your hands, you should make fifteen pressing movements at a speed of one pressure per second. With proper manipulation, the chest should drop by about five centimeters - in this case, we can say that the heart pumps blood, that is, from the left ventricle, blood flows through the aorta to the brain, and from the right - to the lungs, where it is saturated oxygen. The moment the pressure on the sternum stops, the heart fills with blood again.

If the massage is given to a child preschool age, then pressing movements on the chest area should be done with the middle and index fingers of one hand, and if a schoolchild - with one palm. First aid for cardiac arrest should be provided to the elderly with special care. If you press too hard on the sternum, internal organ damage or a hip fracture may occur.

Continuation of resuscitation actions

Inhalations of air and pressure on the chest should be repeated until the victim begins to breathe and a pulse begins to be felt. If first aid in case of cardiac arrest is provided by two people at once, then the roles should be distributed as follows: one person takes one breath of air into the patient’s mouth or nose, after which the second makes five pressures on the sternum. Then the actions are repeated.

If, thanks to resuscitation measures, breathing has been restored, but the pulse is still not palpable, cardiac massage should be continued, but without ventilation. If a pulse appears, but the person is not breathing, it is necessary to stop the massage and continue to do only artificial respiration. If the victim begins to breathe and has a pulse, resuscitation should be stopped and the patient’s condition should be closely monitored until the doctor arrives. Never attempt to move a person who is experiencing symptoms of cardiac arrest. This can be done only after the organ’s functioning has been restored and in a special resuscitation machine.

Effectiveness of resuscitation measures

You can evaluate how correctly first aid for cardiac arrest was provided as follows:

When to stop resuscitation

If, after half an hour of manipulation, the respiratory function and cardiac activity of the victim have not resumed, and the pupils are still dilated and do not respond to light, we can say that first aid for cardiac arrest did not lead to the desired results and the person is already in the human brain irreversible processes have already occurred. In this case, further resuscitation measures are useless. If signs of death appear before the thirty-minute time has elapsed, resuscitation can be stopped earlier.

Consequences of cardiac arrest

According to statistics, of all the people who experienced cardiac arrest, only 30 percent survived. And even fewer victims returned to normal life. Irreparable harm to health was mainly caused due to the fact that first aid was not provided in a timely manner. In the event of cardiac arrest, immediate resuscitation is very important. The patient’s life depends on how quickly they are produced. The later cardiac activity is resumed, the greater the likelihood of developing serious complications. If oxygen does not reach vital organs for a long time, ischemia or oxygen starvation occurs. As a result, the kidneys, brain, and liver are damaged, which subsequently has an extremely adverse effect on a person’s life. If you perform a massage and compress the chest very vigorously, you can break the patient’s ribs or provoke a pneumothorax.

This page will teach you practical skills in primary cardiopulmonary resuscitation in acute cardiovascular failure with cardiac arrest. Knowing the correct algorithm of actions, you will be able to independently provide emergency medical care by giving the victim chest compressions and artificial ventilation.

It often happens that none of the people surrounding the victim have the necessary knowledge, and upon the arrival of the ambulance team, the doctors can only confirm the death of the patient. After studying the materials in this article, you will be able to artificially support the life of the victim until emergency medical assistance arrives.

It is absolutely important for absolutely all people to have the skills of first medical care. Bookmark this page and share it with your friends.

For those who are too lazy to read, at least check out this video. It is quite detailed and even examines the main errors, however, to fully study the issue, we still recommend reading this entire page and its appendix.

Dangerous symptoms of cardiovascular diseases

The following signs may be harbingers of critical, life-threatening conditions:

• Sudden, sharp pain in the heart area that has never been experienced before.
• Severe weakness, severe shortness of breath, dizziness, loss of consciousness.
• A sudden attack of very strong or, conversely, weak heartbeat.
• Blue skin, cold sweat, swelling of the neck veins.
• Choking, wheezing of the lungs, bubbling breathing, cough with foamy reddish/pink sputum.
• Nausea and vomiting.

Having discovered such symptoms in yourself, especially for the first time, you should immediately call and find a person who would monitor your condition and be able to provide assistance.

What can cause your heart to stop?

• As a complication cardiovascular diseases.
• Drowning.
• Electric shock.
• Hypothermia.
• Anaphylactic and hemorrhagic shock.
• Lack of oxygen, for example due to suffocation.
• Sudden cardiac arrest of unknown cause.
• And some other reasons.

If indicated (more on this below), you can help all these victims by performing primary cardiopulmonary resuscitation.

Indications for cardiac massage (signs of clinical death)

The following symptoms are direct indications for starting primary resuscitation measures (cardiopulmonary resuscitation):

• Unconscious state.
• Absence of pulse in the peripheral and carotid arteries.
• Lack of breathing or its agonal type (frequent, superficial, convulsive, hoarse).

Additional signs: significant dilation of the pupils (weak reaction to light) and pale or blue discoloration skin.

CPR Action Plan

1. We pay attention to the safety of the approach to the victim.
2. We check the victim's consciousness - no.
3. We call an ambulance.
4. We examine the oral cavity.
5. We check for the presence of heartbeat and breathing - none.
6. We perform indirect cardiac massage with artificial ventilation of the lungs until the ambulance arrives or the person regains consciousness (reacts to your actions, coughing, groaning, breathing and heartbeat appear).

1. Security check

We check whether there is a threat from above, below and on the sides - heavy objects that can fall on you, wires, wild animals, slippery floors and many other factors that can not only prevent you from performing resuscitation, but also put your life at risk.

2. Test of consciousness

The first step is to make sure that the victim is unconscious. To do this, you don’t need to hit him in the face, just grab him by the shoulders and loudly ask him something. Immediately pay attention to the people around you and ask them to assist you in saving the person.

Attention! If the victim feels bad in front of you, then after you are convinced that he is unconscious, you should immediately check the pulse in the carotid artery (more details in the fifth paragraph). When absence of pulse (exclusively in the absence of pulse) you should apply to the victim.

3. Calling an ambulance

From a landline number 03, from a cell phone 103 or 112. Learn more about this and talk to the dispatcher correctly.

4. Inspection of the oral cavity

We examine the oral cavity to determine whether there are foreign objects in it that impede breathing. If there are foreign objects (including vomit, mucus, pieces of food), we clean it with gentle movements of a finger wrapped in gauze or any other fabric. Pay attention to the position of the tongue so that it does not fall into the throat, thereby closing the path for air.

5. Check for pulse and breathing

Absence of heartbeat indicates cardiac arrest. The pulse should be checked in large arteries - to do this, place a couple of fingers on the common carotid artery (to the left or right of the Adam's apple, two centimeters under the jaw). Practice on yourself. Please note that in infants, the heartbeat should be checked by pressing the fingers to the inside of the arm, slightly above the cubital fossa.

Indications for resuscitation measures:

• Artificial ventilation of the lungs - in the absence of breathing for 5 seconds.
• Indirect cardiac massage - in the absence of a pulse for 10 seconds.

To test breathing, gently tilt the victim's head back (by pressing on the forehead and lifting the chin), then place your cheek against their nostrils to feel, hear, or surprise their breathing. Position your head on the patient so that your gaze is directed at his chest so that you can see its movement.

In addition, the presence of breathing can be checked by holding a mirror to the patient’s nostrils - if condensation does not form on it, then there is no breathing. However, this method can let you down; it is much more reliable to use your own senses - sight, hearing and touch.

Indirect cardiac massage and artificial respiration (AVL)

Heart massage can be direct or indirect. Direct is when the heart is squeezed by hand through an incision in the chest. Indirect involves rhythmic pressing on the chest.

The procedure for performing chest compressions and artificial ventilation:

1. The victim lies on his back. The surface on which it lies must be hard and flat so as not to sag under your pressure. Under no circumstances should it be a sofa or something soft.
2. Place something under the victim's shins so that his straight legs in the foot area are raised 20-30 centimeters above his head.
3. Free your chest from clothing.
4. Determine the point for cardiac massage - draw a mental line between the nipples and place your palm exactly in the middle, or put two or three fingers of one hand on the xiphoid process, and then put the palm of the other hand on them. This is the right position.
5. Clasp your hands and begin rapid compressions on the chest (at a frequency of 100-120 compressions per minute).
6. Every 30 compressions, you should exhale 2 times into the victim’s mouth, then again move on to cardiac massage.

Cardiac massage and ventilation should be started as soon as possible. Continue until the patient regains consciousness or more qualified medical assistance arrives.

Want to explore the issue in more detail? Read the appendix to this article - which thoroughly explains the technique of performing chest compressions and artificial ventilation, as well as about precordial stroke (a punch to the heart in order to restore normal heartbeat).

Don't be afraid to make things worse for the victim. In extreme cases, you can accidentally break your ribs, which you will know by the characteristic crunch. Even in this case, you should only once again make sure that your hands are positioned correctly on the sternum and continue resuscitation measures.

An algorithm of actions in case of cardiac and respiratory arrest is described.

Cardiopulmonary resuscitation (abbreviated as CPR) is a set of emergency measures in case of cardiac and respiratory arrest, with the help of which they try to artificially support the vital activity of the brain until spontaneous circulation and breathing are restored. The composition of these activities directly depends on the skills of the person providing assistance, the conditions under which they are carried out and the availability of certain equipment.

Ideally, resuscitation performed by a person who does not have a medical education consists of closed heart massage, artificial respiration, and the use of an automatic external defibrillator. In reality, such a complex is almost never performed, since people do not know how to properly carry out resuscitation measures, and external external defibrillators are simply not available.

Determination of vital signs

In 2012, the results of a huge Japanese study were published, in which more people were recorded with cardiac arrest occurring outside medical institution. In approximately 18% of those victims who underwent resuscitation measures, spontaneous circulation was restored. But only 5% of patients remained alive after a month, and with preserved functioning of the central nervous system– about 2%.

It should be borne in mind that without CPR, these 2% of patients with a good neurological prognosis would have no chance of life. 2% of victims are lives saved. But even in countries with frequent resuscitation training, cardiac arrest is treated outside the hospital in less than half of cases.

It is believed that resuscitation measures, correctly carried out by a person located close to the victim, increase his chances of revival by 2-3 times.

Physicians of any specialty, including nurses and doctors, must be able to perform resuscitation. It is desirable that people without medical education can do it. Anesthesiologists and resuscitators are considered the greatest professionals in restoring spontaneous circulation.

Indications

Resuscitation should be started immediately after identifying a victim who is in a state of clinical death.

Clinical death is a period of time that lasts from cardiac and respiratory arrest to the occurrence of irreversible disorders in the body. The main signs of this condition include absence of pulse, breathing and consciousness.

It must be recognized that not all people without medical education (and even those with it) can quickly and correctly determine the presence of these signs. This can lead to an unjustified delay in the start of resuscitation measures, which greatly worsens the prognosis. Therefore, modern European and American recommendations for CPR take into account only the absence of consciousness and breathing.

Resuscitation techniques

Before starting resuscitation, check the following:

• Is the environment safe for you and the victim?
• Is the victim conscious or unconscious?
• If you think the patient is unconscious, touch him and ask loudly, “Are you okay?”
• If the victim does not respond, and there is someone else besides you, one of you should call an ambulance, and the second should begin resuscitation. If you are alone and you have mobile phone– before starting resuscitation, call an ambulance.

To remember the procedure and technique for performing cardiopulmonary resuscitation, you need to learn the abbreviation “CAB”, in which:

1. C (compressions) – closed cardiac massage (CCM).
2. A (airway) – opening of the airways (OP).
3. B (breathing) – artificial respiration (AR).

1. Closed heart massage

Carrying out ZMS allows you to ensure blood supply to the brain and heart at a minimal - but critically important - level, which supports the vital activity of their cells until spontaneous circulation is restored. Compression changes the volume of the chest, resulting in minimal gas exchange in the lungs even in the absence of artificial respiration.

The brain is the organ most sensitive to reduced blood supply. Irreversible damage to its tissues develops within 5 minutes after the blood flow stops. The second most sensitive organ is the myocardium. Therefore, successful resuscitation with a good neurological prognosis and restoration of spontaneous circulation directly depends on the high-quality performance of VMS.

The victim with cardiac arrest should be placed in a supine position on a hard surface, with the person providing assistance placed at his side.

Place the palm of your dominant hand (depending on whether you are left- or right-handed) in the center of your chest, between your nipples. The base of the palm should be placed exactly on the sternum, its position should correspond to the longitudinal axis of the body. This focuses the compression force on the sternum and reduces the risk of rib fracture.

Place your second palm on top of the first and interlace their fingers. Make sure that no part of your palms touches your ribs to minimize pressure on them.

To transfer mechanical force as efficiently as possible, keep your arms straight at the elbows. Your body position should be such that your shoulders are vertical over the victim's sternum.

The blood flow created by closed cardiac massage depends on the frequency of compressions and the effectiveness of each of them. Scientific evidence has demonstrated the existence of a relationship between the frequency of compressions, the duration of pauses in the performance of VMS and the restoration of spontaneous circulation. Therefore, any interruptions in compression should be minimized. It is possible to stop VMS only at the time of performing artificial respiration (if it is carried out), assessing the recovery of cardiac activity and for defibrillation. The required frequency of compressions is 100–120 times per minute. To get an approximate idea of ​​the tempo of the ZMS, you can listen to the rhythm in the song “Stayin’ Alive” by the British pop group BeeGees. It is noteworthy that the title of the song itself corresponds to the goal of emergency resuscitation - “Staying Alive.”

The depth of the chest deflection during VMS should be 5–6 cm in adults. After each pressing, the chest should be allowed to fully straighten, since incomplete restoration of its shape worsens blood flow. However, you should not remove your palms from the sternum, as this can lead to a decrease in the frequency and depth of compressions.

The quality of the CMS performed sharply decreases over time, which is associated with the fatigue of the person providing assistance. If resuscitation is carried out by two people, they should change every 2 minutes. More frequent shifts may result in unnecessary interruptions in the health service.

2. Opening the airways

In a state of clinical death, all a person’s muscles are in a relaxed state, which is why, in a supine position, the victim’s airways can be blocked by the tongue moving towards the larynx.

To open the airway:

• Place the palm of your hand on the victim's forehead.
• Tilt his head back, straightening it in cervical spine spine (this technique should not be done if there is a suspicion of spinal damage).
• Place the fingers of your other hand under your chin and push your lower jaw up.

3. Artificial respiration

Modern recommendations for CPR allow people who have not undergone special training not to perform ID, since they do not know how to do this and only waste precious time, which is better to devote entirely to closed cardiac massage.

People who have undergone special training and are confident in their ability to perform high-quality ID are recommended to carry out resuscitation measures in the ratio of “30 compressions - 2 breaths.”

Rules for conducting ID:

• Open the victim's airway.
• Pinch the patient's nostrils with the fingers of your hand on his forehead.
• Press your mouth firmly against the victim's mouth and exhale as usual. Make 2 such artificial breaths, watching the rise of the chest.
• After 2 breaths, immediately begin ZMS.
• Repeat the cycles of “30 compressions - 2 breaths” until the end of resuscitation measures.

Algorithm for basic resuscitation in adults

Basic resuscitation measures (BRM) are a set of actions that can be carried out by a person providing assistance without the use of drugs or special medical equipment.

The cardiopulmonary resuscitation algorithm depends on the skills and knowledge of the person providing assistance. It consists of the following sequence of actions:

1. Make sure there is no danger in the area of ​​care.
2. Determine whether the victim is conscious. To do this, touch him and ask loudly if he is okay.
3. If the patient reacts in any way to the call, call an ambulance.
4. If the patient is unconscious, turn him onto his back, open his airway, and assess for normal breathing.
5. In the absence of normal breathing (do not confuse it with rare agonal sighs), begin CMS with a frequency of 100–120 compressions per minute.
6. If you know how to do ID, carry out resuscitation measures in a combination of “30 compressions - 2 breaths”.

Features of resuscitation measures in children

The sequence of this resuscitation in children has slight differences, which are explained by the peculiarities of the causes of cardiac arrest in this age group.

Unlike adults, in whom sudden cardiac arrest is most often associated with cardiac pathology, in children the most common causes of clinical death are breathing problems.

The main differences between pediatric intensive care and adult intensive care:

• After identifying a child with signs of clinical death (unconscious, not breathing, no pulse in the carotid arteries), resuscitation measures should begin with 5 artificial breaths.
• The ratio of compressions to artificial breaths during resuscitation in children is 15 to 2.
• If assistance is provided by 1 person, an ambulance should be called after performing resuscitation measures for 1 minute.

Using an automated external defibrillator

An automated external defibrillator (AED) is a small, portable device that delivers an electrical shock (defibrillation) to the heart through the chest.

Automatic external defibrillator

This shock has the potential to restore normal cardiac activity and restore spontaneous circulation. Since not all cardiac arrests require defibrillation, the AED has the ability to assess the victim's heart rhythm and determine whether a shock is needed.

Most modern devices are capable of reproducing voice commands that give instructions to people providing assistance.

AEDs are very easy to use and were specifically designed to be used by people without medical training. In many countries, AEDs are placed in crowded areas such as stadiums, train stations, airports, universities and schools.

Sequence of actions for using an AED:

• Turn on the power to the device, which then begins to give voice instructions.
• Expose your chest. If the skin is damp, dry the skin. The AED has sticky electrodes that need to be attached to your chest as shown on the device. Attach one electrode above the nipple, to the right of the sternum, the second - below and to the left of the second nipple.
• Make sure the electrodes are firmly attached to the skin. Connect the wires from them to the device.
• Make sure no one is touching the victim and click the “Analyze” button.
• After the AED analyzes your heart rhythm, it will give you instructions on what to do next. If the device decides that defibrillation is needed, it will alert you. No one should touch the victim while the shock is being applied. Some devices perform defibrillation on their own, while others require you to press the “Shock” button.
• Resume resuscitation immediately after delivering the shock.

Termination of resuscitation

CPR should be stopped in the following situations:

1. Arrived ambulance, and her staff continued to provide assistance.
2. The victim showed signs of resumption of spontaneous circulation (he began to breathe, cough, move, or regained consciousness).
3. You are completely exhausted physically.

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Cardiac arrest

Tachycardia will go away on its own if you drink a cup of hot food at night.

Sudden cardiac death, or cardiac arrest, is a serious, emergency condition that can occur even in apparently healthy young people. Up to 90% of cases of cardiac arrest lead to cessation of breathing and death despite resuscitation measures, which are often delayed. Only early diagnosis and treatment of cardiac problems, which affect many people in one way or another, will help prevent the consequences of cardiac arrest and prevent the situation from reoccurring in the future.

Causes of cardiac arrest

The heart is a real pump in our body. It “pumps” the blood, directing it through the arteries, arterioles, capillaries, and then through the veins and venules it lifts the blood upward. The heart is located at the level of 4-8 vertebrae to the left of the chest; on top it is “dressed” in a bag - the pericardium, which protects the organ from damage. The walls of the heart are represented by the epicardium (outer layer), myocardium (muscle layer), and endocardium (inner layer of the epithelium). The cavities of the heart are two atria and two ventricles, separated by septa and valves. The functioning of the heart can be impaired for various reasons and with the participation of different mechanisms, and the most severe disturbance is sudden cardiac arrest.

Cardiac arrest syndrome is understood as the cessation of functioning (bioelectric activity) of an organ, caused by many factors and leading to clinical death (potentially reversible condition), and then to the biological death of a person. The result is the end of blood circulation throughout the body, hypoxia of brain tissue, and acute heart failure. To restore the activity of the heart, the patient’s relatives and doctors have only 7 minutes or less, since in a later period the person develops irreversible disorders throughout the body.

Highlight the following types conditions during which the heart stops, and they all have the same Clinical signs and differ only according to ECG data:

1. Asystole, or the end of the electrical activity of an organ. Up to 90% of cases of cardiac arrest due to asystole occur during diastole, a period of relaxation. Primary asystole can be a reflex due to irritation of the vagus, impaired potassium metabolism, etc. Secondary asystole develops with certain types of arrhythmias, with severe heart disease left without treatment.
2. Ventricular fibrillation. This condition is uncoordinated, multidirectional contractions of the heart muscle fiber bundles. Fibrillation leads to disruption of the pumping function of the organ and can be large-wave or small-wave. The causes of the pathology lie in the intake large quantity dangerous pills (for example, with an overdose of cardiac glycosides) may be associated with electrical injury and drowning. In these cases we are talking about primary fibrillation. Secondary fibrillation occurs against the background of an existing acute heart disease- myocardial infarction, conduction disorders, etc.
3. Electromechanical dissociation, or the absence of mechanical work of the heart while maintaining eclectic activity. Other names for the pathology are ineffective heart, idioventricular rhythm, cardiovascular collapse. In this case, temporary or permanent cessation of blood circulation is associated with cessation of heart movements.

The vast majority of cardiac arrests are due to serious heart disease. Sudden cardiac death can occur for the following reasons (all of the following conditions can develop into one of the types of cardiac arrest, more often into ventricular fibrillation):

• fast (frequent) ventricular extrasystole;
• paroxysmal ventricular tachycardia;
• myocardial infarction;
• cardiogenic shock;
• arrhythmogenic shock;
• cardiac ischemia;
• complete heart block;
• Brugada syndrome;
• TELA;
• acute heart failure;
• rupture of aortic aneurysm;
• cardiac tamponade;
• myocarditis and endocarditis;
• cardiomyopathy.

Extracardiac or extracardiac conditions can also cause complete cardiac arrest or a short-term disruption in its activity. These include:

• advanced oncological process;
• severe diseases of the lungs and respiratory tract, including pneumothorax;
• old age;
• asphyxia when a foreign body enters the respiratory system;
• all types shock states(painful, anaphylactic, toxic shock);
• burn disease;
• overdose of a drug, alcohol, drugs (among the drugs the most dangerous are beta-blockers, cardiac glycosides,
• phenothiazine derivatives, barbiturates, anesthetic drugs);
• drowning, trauma, stroke electric current, severe hypothermia, violent causes of death;
• metabolic failures;
• hypovolemia;
• acute hypercalcemia;
• hypoxia;
• hypothermia.

Researchers identify several risk factors that can increase the likelihood of cardiac arrest. Among them, especially noteworthy are elderly age, alcoholism and smoking, obesity, intense sports (cardiac arrest sometimes occurs in professional athletes), stress and overwork, arterial hypertension. Cause serious heart disease, which can then cause cardiac arrest, can also diabetes, high blood cholesterol, left ventricular hypertrophy.

Of particular note is SIDS, or sudden infant death syndrome, which affects children under one year old and, for the most part, occurs when the child is 2-4 months old. This syndrome associated with nocturnal cardiac and respiratory arrest without serious health problems. Risk factors for cardiac arrest in an infant are:

• sleeping on your stomach;
• being in a room that is too hot;
• sleeping on soft, fluffy linen;
• tobacco smoke in the room;
• multiple pregnancy, premature birth;
• delayed fetal development, hypoxia during gestation;
• family history - when the child’s brothers or sisters died at the same age;
• infectious diseases that were suffered in the first 2 months after birth.

Symptoms and diagnosis

If a person experiences cardiac arrest at home, at work, or in other conditions, but not in medical institution, it is difficult to assume a diagnosis and begin resuscitation measures, but this should be done as early as possible, ideally within the first minute. Particularly great difficulties arise if the symptoms of the pathology occur during sleep, because then the chances of saving the patient are minimal. The clinical picture of cardiac arrest includes several signs. The main symptom is the absence of breathing and pulse. A person’s chest does not rise and fall, and fogged marks do not remain on the mirror that is brought to the nose.

Also, one of the signs of cardiac arrest is the cessation of pulsation of large arteries. To determine, you should attach the average and index fingers on the area of ​​the carotid artery for a few seconds: if there is no pulsation, you should urgently emergency assistance person and call an ambulance. Suspicion of cardiac arrest should also arise with the following symptoms:

• dilation of the pupils, cessation of their response to light;
• grayness, blueness of the face, which occurs due to the end of blood circulation;
• loss of consciousness, short (for seconds), which is caused by ventricular fibrillation or asystole, or long-term, which, as a rule, means clinical death;
• a dull sound of the heart slowing down and stopping, which may be noted when listening to heart sounds with the ear;
• muscle cramps are also possible;
• there is no reaction to screaming, slaps, pinches and other external stimuli.

Diagnosis must be carried out on site by a person who is able to assess the patient's vital signs. Conventional diagnostic methods for cardiac arrest are not suitable, since the time required is too great. Pressure measurements and cardiograms are not performed even when a person is in a medical facility: it is enough to only detect the absence of pulsation of the common carotid artery, which is easy to find between the cervical muscles and the larynx, or in the area of ​​the femoral artery.

The duration of listening to the pulse is no more than 5 seconds; approximately the same amount of time is needed for patting the patient on the cheeks and for other attempts to bring him to his senses (this will allow him to distinguish ordinary fainting from cardiac arrest). At the same time, you should ask for help from people around you or call an ambulance for the patient yourself. An assessment of the condition of the pupils is also performed after the start of emergency care to analyze the dynamics. Pressure begins to be measured after the restoration of cardiac activity begins during the course of medical care for the person.

First aid

To begin resuscitation, the patient should be immediately placed on a hard surface, after which the full range of measures to help the person should be applied. The ABC emergency care algorithm includes the following actions:

1. A - restoration of normal patency of the respiratory system. The person providing assistance wraps his finger with a cloth, pushes the patient’s lower jaw forward, tilts his head back, and then removes all foreign bodies from the mouth (if any). You should also remove the sunken tongue.
2. B - performing artificial respiration measures. Use the mouth-to-mouth technique. The nose is pinched with two fingers, air is blown into the mouth, and the results of PMP (first aid) are monitored by the movement of the chest - the rise of the ribs and passive exhalation. To avoid contact with the patient’s biological fluids, you need to cover the victim’s mouth with a handkerchief, gauze, etc.
3. C - indirect cardiac massage. This type of first aid or measures carried out by emergency doctors is the most important in case of cardiac arrest. Before the massage begins, a precordial blow is made (more often such a blow is performed by doctors for ventricular fibrillation) with a fist in the sternum area, and the fist is retracted to a distance of cm. Since the blow is effective only within half a minute from the moment the cardiac activity ceases and threatens bone fractures, it should not be carried out by a non-specialist.

The technique of heart massage is as follows. You should visually find the lower third of the sternum, measure the distance approximately two fingers above the lower edge. For medical assistance, the fingers are locked, the hands are placed on a certain place on the sternum and vigorous compression is made with a frequency of approximately 100 per minute. If there is such a possibility, then the second person should simultaneously blow air into the lungs. You need to act carefully so as not to break the person’s ribs, which can seriously disrupt intrathoracic pressure. Resuscitation is continued until there is a pulse and breathing, either within 30 minutes or until the ambulance arrives.

Doctors also use other measures to restore the heartbeat. These include the administration of medications - Adrenaline, Atropine, Norepinephrine, Epinephrine, Sodium bicarbonate, which are often administered intracardially. Calcium preparations, magnesium sulfate, Lidocaine and many others can also be used. To restore breathing, mask ventilation or tracheal intubation are used. To start the heart if the above measures have no effect, defibrillation must be undertaken. For this purpose, they use a device that starts the heart - a defibrillator, which is always in the ambulance. With the help of an electrical discharge, there is a great chance of restoring cardiac activity while the patient is being transported to the hospital.

Further treatment

If a person was saved after cardiac arrest, then further treatment is carried out only in intensive care. When first aid or resuscitation measures in the ambulance were successful and restored the heartbeat in 5-6 minutes (sometimes more), then the person can return to full life. In the future, it is necessary to carefully monitor the patient’s condition, because cardiac arrest may recur.

A thorough examination is also required - ECG, chest x-ray, ultrasound, Holter monitoring, blood tests, etc. Diagnostic methods will help identify the causes of cardiac arrest and prevent the progression of the underlying disease and further episodes of clinical death. At the same time, correction of complications that have arisen is carried out, especially cerebral hypoxia, for which nootropic drugs, vitamins, and antioxidants are recommended. Many patients will require surgery to install a pacemaker if, during the examination, serious disturbances in the functioning of the pacemaker were found. Upon returning home, you must urgently refuse bad habits, avoid stress, eat right, physical exercise carry out only as prescribed by a doctor.

Possible complications

The vast majority of people die after cardiac arrest. But of the survivors, of whom there are few (no more than 25%), only 10% can return to life as it was before terrible disease. The reasons for the development of complications lie in the untimely provision of medical care, because not every family member or work colleague is able to perform a cardiac massage or other activities. The main cause of pathological complications is ischemia of body tissues, especially the brain. The most common problems are with memory, behavior, paralysis and paresis, kidney and liver damage, which greatly shorten future life.

Neurological symptoms are more severe the later the heart was started: after 6-7 minutes of being without a pulse or breathing, a person can develop severe brain damage. Post-resuscitation illness of varying severity occurs in almost 80% of cases of successful resuscitation. Some patients fall into a coma and subsequently enter a vegetative state.

Preventive measures

The prognosis for cardiac arrest is unfavorable. In this regard, the prevention of pathology, as well as the diseases that cause it, is extremely important. Prevention measures are:

• early initiation of therapy for heart and vascular diseases;
• stopping smoking, giving up large amounts of alcohol;
• preservation physical activity to old age;
• blood pressure control;
• proper, healthy nutrition;
• reduction in body weight, cholesterol levels;
• prevention of injuries, drowning, hypothermia, exposure to electric current;
• preventing drug overdoses.

To prevent sudden death The baby should be put to sleep only in a ventilated room, on a firm mattress, without thick blankets and toys. You should not swaddle your baby tightly at night, nor should you place him on his stomach to sleep at night. It is strictly forbidden to smoke in the apartment so that the smoke does not penetrate the child’s body, which causes irreparable damage to him.

Are you one of the millions who have heart disease?

Have all your attempts to cure hypertension been unsuccessful?

Have you already thought about radical measures? It’s understandable, because strong heart is an indicator of health and a reason for pride. In addition, this is at least human longevity. And the fact that a person protected from cardiovascular diseases looks younger is an axiom that does not require proof.

The materials presented are general information and cannot replace medical advice.

Cardiopulmonary resuscitation: algorithm, terminal conditions

The border between life and death, called a terminal state by doctors, can be within one breath, one heartbeat, one moment... At such moments, all vital systems undergo significant changes. The most severe disorders lead them to a state where the body loses the ability to recover without outside help. Cardiopulmonary resuscitation (CPR), which arrives on time and is performed according to all the rules, in most cases is successful and brings the victim back to life if his body has not crossed the limit of its capabilities.

Unfortunately, it doesn't always work out as we would like. This happens for a number of reasons that do not depend on the wishes of the patient, his relatives or the ambulance team; all misfortunes can happen far from the city (highway, forest, pond). At the same time, the damage may turn out to be so serious, and the case so urgent, that rescuers may not be able to make it in time, because sometimes seconds decide everything, and besides, the possibilities of pulmonary-cardiac resuscitation are not unlimited.

"Don't think down on seconds..."

The terminal state is accompanied by deep functional disorders and requires intensive care. In case of slow development of changes in vital important organs, first responders have time to stop the dying process, which consists of three stages:

• Preagonal with the presence of a number of disorders: gas exchange in the lungs (the appearance of hypoxia and Cheyne-Stokes respiration), blood circulation (fall blood pressure, changes in the rhythm and number of heart contractions, lack of blood volume), acid-base status ( metabolic acidosis), electrolyte balance (hyperkalemia). Cerebral disorders also begin to register at this stage;
• Agonal - characterized as a residual manifestation of the functional abilities of a living organism with the aggravation of those disorders that began in the preagonal phase (a decrease in blood pressure to critical figures - 20 - 40 mm Hg, a slowdown in cardiac activity). This condition precedes death and if the person is not helped, then the final stage of the terminal condition begins;
• Clinical death, when cardiac and respiratory activity stops, but for another 5-6 minutes the possibility remains with timely cardiopulmonary resuscitation of the body returning to life, although in conditions of hypothermia this period is extended. A set of measures to restore life activity is advisable during this period, since more long time casts doubt on the effectiveness of cerebral resuscitation. The cerebral cortex, as the most sensitive organ, may be so damaged that it will never function normally again. In a word, the death of the cortex (decortication) will occur, resulting in its connection with other brain structures will become disunited and “man will turn into a vegetable.”

Thus, situations that require cardiopulmonary and cerebral resuscitation can be combined into a concept corresponding to stage 3 of thermal conditions, called clinical death. It is characterized by cardiac arrest and respiratory activity, and there are only about five minutes left to save the brain. True, in conditions of hypothermia (cooling of the body), this time can actually be extended to 40 minutes or even an hour, which sometimes gives an extra chance for resuscitation measures.

What does clinical death mean?

Various dangerous for human life situations can cause clinical death. Often this is a sudden cardiac arrest caused by a violation of the heart rhythm:

It should be noted that in modern concepts, cessation of cardiac activity is understood not so much as mechanical cardiac arrest, but rather as insufficiency of the minimum blood circulation necessary for the full functioning of all systems and organs. However, this condition can occur not only in people who are registered with a cardiologist. More and more cases of sudden death of young men are being recorded, even those who do not have an outpatient card at the clinic, that is, who consider themselves absolutely healthy. In addition, diseases not related to heart pathology can stop blood circulation, therefore the causes of sudden death are divided into 2 groups: cardiogenic and non-cardiogenic origin:

• The first group consists of cases of weakened contractility of the heart and impaired coronary circulation.
• Another group includes diseases caused by significant impairments in the functional and compensatory abilities of other systems, and acute respiratory, neuroendocrine and heart failure are a consequence of these impairments.

We should not forget that often a sudden death in the midst of “full health” does not allow even 5 minutes to think. Complete cessation of blood circulation quickly leads to irreversible phenomena in the cerebral cortex. This time will be even shorter if the patient has already had problems with the respiratory, cardiac and other systems and organs. This circumstance prompts the start of cardiopulmonary and cerebral resuscitation as early as possible in order not only to bring the person back to life, but also maintain his mental integrity.

The last (final) stage of the existence of a once living organism is considered biological death, in which irreversible changes occur and the complete cessation of all life processes. Its signs are: the appearance of hypostatic (cadaveric) spots, a cold body, rigor.

Everyone should know this!

When, where and under what circumstances death may occur is difficult to predict. The worst thing is that a doctor who knows the procedure for basic resuscitation cannot appear suddenly or be already present nearby. Even in a big city, an ambulance may not be an ambulance at all (traffic jams, distance, station congestion and many other reasons), so it is very important for any person to know the rules of resuscitation and first aid, because there is very little time to return to life (about 5 minutes ).

The developed cardiopulmonary resuscitation algorithm begins with general questions and recommendations that significantly affect the survival of victims:

1. Early recognition of the terminal condition;
2. Immediately call an ambulance with a brief but clear explanation of the situation to the dispatcher;
3. Providing first aid and emergency initiation of primary resuscitation;
4. The fastest (as possible) transportation of the victim to the nearest hospital with an intensive care unit.

The cardiopulmonary resuscitation algorithm is not only artificial respiration and chest compressions, as many people think. The basics of measures to save a person lie in a strict sequence of actions, starting with assessing the situation and condition of the victim, providing him with first aid, carrying out resuscitation measures in accordance with the rules and recommendations, specially developed and presented as an algorithm for cardiopulmonary resuscitation, which includes:

• Assessing the situation (time, place, remoteness of medical institutions, crowded conditions) and eliminating possible danger for the rescuer and the person being resuscitated (busy highway);
• Determining the patient’s consciousness, for which you should lightly shake him by the shoulder and ask as loudly as possible what’s wrong with him and if he needs help. If the victim is conscious, everything is simpler: calling an ambulance, providing first aid, observing the patient until the doctors arrive;
• In cases of absence of consciousness, you should immediately determine the presence of breathing, pulse in the carotid artery, reaction of the pupils to light (10 seconds are allotted for all). To hear breathing, it is necessary to tilt the victim’s head back, raise his chin, try to detect exhaled air and chest excursion.

An ambulance is called in any case, the behavior of the rescuer depends on the situation. If there are no signs of life, the rescuer immediately begins pulmonary-cardiac resuscitation, strictly observing the stages and order of these activities. Of course, if he knows the basics and rules of basic resuscitation.

Stages of resuscitation measures

The greatest effectiveness of cardiopulmonary resuscitation can be expected in the first minutes (2-3). If trouble happens to a person outside a medical institution, of course, you should try to provide him with first aid, but for this you need to be proficient in equipment and know the rules for conducting such events. Primary preparation for resuscitation involves placing the patient in a horizontal position, removing tight clothing and accessories that interfere with the implementation of basic life-saving techniques.

The basics of cardiopulmonary resuscitation include a set of measures, the task of which is:

1. Removing the victim from a state of clinical death;
2. Restoration of life support processes;

Basic resuscitation is designed to solve two main problems:

• Ensure airway patency and ventilation;
• Maintaining blood circulation.

The prognosis depends on time, so it is very important not to miss the moment of cardiac arrest and the beginning of resuscitation (hours, minutes), which is carried out in 3 stages while maintaining the sequence for pathology of any origin:

1. Emergency maintenance of patency of the upper respiratory tract;
2. Restoration of spontaneous cardiac activity;
3. Prevention of post-hypoxic cerebral edema.

Thus, the cardiopulmonary resuscitation algorithm does not depend on the cause of clinical death. Of course, each stage includes its own methods and techniques, which will be described below.

How to make your lungs breathe?

Techniques for immediately restoring airway patency work especially well if the victim’s head is thrown back at the same time as the lower jaw extends to the maximum and the mouth opens. This technique is called the triple Safar maneuver. However, about the first stage in order:

• The victim must be placed on his back in a horizontal position;
• To tilt the patient’s head back as much as possible, the rescuer needs to place one hand under his neck and place the other on his forehead, while taking a test breath “from mouth to mouth”;
• If the test breath is not effective, try to push the victim’s lower jaw forward as much as possible, then upward. Objects that cause the closure of the respiratory tract (dentures, blood, mucus) are quickly removed using any means at hand (handkerchief, napkin, piece of cloth).

It should be remembered that it is permissible to spend the minimum amount of time on these activities. And periods for reflection are not included at all in the emergency care protocol.

Recommendations for emergency rescue measures are useful only to ordinary people who do not have a medical education. The ambulance team, as a rule, knows all the techniques and, in addition, in order to restore the patency of the airways, uses different kinds air ducts, vacuum aspirators, and, if necessary (obturation of the lower parts of the DP), performs tracheal intubation.

Tracheostomy in pulmonary-cardiac resuscitation is used in very rare cases, since this is a surgical intervention that requires special skills, knowledge and a certain time. The only absolute indication for it is obstruction of the airways in the area of ​​the vocal cords or at the entrance to the larynx. This manipulation is more often performed in children with laryngospasm, when there is a danger of the child dying on the way to the hospital.

If the first stage of resuscitation is unsuccessful (patency is restored, but breathing movements do not resume), apply simple techniques, which we call artificial respiration, the technique of which is very important for any person to master. Mechanical ventilation (artificial pulmonary ventilation) without the use of a “breathing apparatus” (breathing apparatus - all ambulances are equipped with them) begins by blowing the rescuer’s own exhaled air into the nose or mouth of the person being resuscitated. It is, of course, more advisable to use the “mouth to mouth” technique, since narrow nasal passages can be clogged with something or simply become an obstacle at the inhalation stage.

Step-by-step ventilation will look something like this:

1. The person who revives takes a deep breath and at the same time, in order to create a tightness, pinches the victim’s nostrils with his fingers, exhales air and monitors the movement of the chest: if its volume increases, then the process is going in the right direction and will be followed by a passive exhalation with a decrease in chest volume cells;
2. The frequency of respiratory cycles is 12 movements per minute, and the pause between them is 5 seconds. The volume of inhalation created artificially should be about 1 liter;
3. The most significant assessment positive effect artificial respiration is the movement (expansion and collapse) of the chest. If, when performing artificial respiration techniques, the epigastric region expands, one may suspect that air has entered not into the lungs, but into the stomach, which can lead to the movement of gastric contents upward and obstruction of the airways.

At first glance, it seems that such a method of mechanical ventilation cannot be highly effective, so some are skeptical about it. Meanwhile, this wonderful technique has saved and continues to save more than one life, although it is quite tedious for the one who revives. In such cases, if possible, various devices and ventilators help, improving the physiological basis of artificial respiration (air + oxygen) and observing hygienic rules.

Video: artificial respiration and first aid for adults and children

Resumption of spontaneous cardiac activity is an inspiring sign

The basics of the next stage of resuscitation (artificial circulatory support) can be represented as a two-step process:

• Techniques that constitute the first urgency. This - closed heart massage;
• Primary intensive therapy, which involves the administration of drugs that stimulate the heart. As a rule, this is an intravenous, intratracheal, intracardiac injection of adrenaline (with atropine), which can be repeated if the need arises during resuscitation measures (a total of 5-6 ml of the drug is acceptable).

A resuscitation technique like cardiac defibrillation, is also carried out medical worker, who arrived to the call. Indications for it are conditions caused by ventricular fibrillation (electric shock, drowning, coronary heart disease, etc.). However ordinary people they do not have access to a defibrillator, so it is inappropriate to consider resuscitation from this point of view.

performing cardiac defibrillation

The most accessible, simple and at the same time effective method of emergency restoration of blood circulation is considered to be indirect cardiac massage. According to the protocol, it should be started immediately as soon as the fact of acute cessation of blood circulation is recorded, regardless of the causes and mechanism of its occurrence (unless it is a polytrauma with a rib fracture and a lung rupture, which is a contraindication). It is necessary to carry out a closed massage all the time until the heart begins to work on its own, in order to ensure blood circulation at least to a minimum extent.

How to make your heart work?

A closed heart massage is started by a random passer-by who happens to be nearby. And since any of us can become this passerby, it would be nice to familiarize ourselves with the methodology for carrying out such important procedure. You should never wait until the heart stops completely or hope that it will restore its activity on its own. The ineffectiveness of heart contractions is a direct indication for starting CPR and closed cardiac massage in particular. The effectiveness of the latter is due to strict adherence to the rules for conducting it:

1. Laying the patient in a horizontal position on a hard surface (a springy, soft surface will facilitate the displacement of the body under the influence of the hands of the resuscitator).
2. The location of the area where the force of the rescuer’s hands is applied is on the sternum (lower third), in no case deviating from the midline. In this case, it does not matter at all on which side of the victim the rescuer will stand.
3. Hands folded crosswise are placed on the sternum (3-4 fingers below the xiphoid process) and apply pressure with the wrists (without the use of fingers).

Video: performing chest compressions

The effectiveness of revitalizing measures. Criteria for evaluation

If CPR is performed by one person, then two rapid injections of air into the victim’s lungs alternate with chest compressions and, thus, the ratio of artificial respiration: closed cardiac massage will be = 2:12. If resuscitation is carried out by two rescuers, the ratio will be 1:5 (1 inflation + 5 chest compressions).

Indirect cardiac massage is carried out under mandatory control over effectiveness, the criteria of which should be considered:

• Change in skin color (“face comes to life”);
• The appearance of pupillary reaction to light;
• Resumption of pulsation of the carotid and femoral arteries (sometimes radial);
• Increased blood pressure domm. rt. Art. (when measured in the traditional way - on the shoulder);
• The patient begins breathe on your own, which, unfortunately, does not happen often.

One should remember to prevent the development of cerebral edema, even if the cardiac massage lasted only a couple of minutes, not to mention the absence of consciousness for a couple of hours. In order for the victim’s personal qualities to be preserved after the restoration of cardiac activity, he is prescribed hypothermia - cooling to 32-34 ° C (meaning above-zero temperature).

When is a person declared dead?

It often happens that all efforts to save lives are in vain. At what point do we begin to understand this? Resuscitation measures lose their meaning if:

1. All signs of life disappear, but symptoms of brain death appear;
2. Half an hour after the start of CPR, even reduced blood flow does not appear.

However, I would like to emphasize that the duration of resuscitation measures also depends on a number of factors:

• The reasons leading to the sudden death;
• Duration of complete cessation of breathing and blood circulation;
• The effectiveness of efforts to save a person.

It is believed that any terminal condition is an indication for CPR, regardless of the cause of its occurrence, so it turns out that resuscitation measures, in principle, have no contraindications. In general, this is true, but there are some nuances that to some extent can be considered contraindications:

1. Polytraumas received, for example, in a road accident, can be accompanied by fractures of the ribs, sternum, and rupture of the lungs. Of course, resuscitation in such cases should be carried out by a high-class specialist who will be able to recognize at a glance serious violations that can be considered contraindications;
2. Diseases when CPR is not performed due to inappropriateness. This applies to cancer patients terminal stage tumors, patients who have suffered a severe stroke (hemorrhage in the trunk, large hemispheric hematoma), who have severe dysfunction of organs and systems, or patients who are already in a “vegetative state”.

In conclusion: separation of duties

Everyone may think to themselves: “It would be nice not to encounter such a situation that it would be necessary to carry out resuscitation measures.” Meanwhile, this does not depend on our desire, because life sometimes presents various surprises, including unpleasant ones. Perhaps someone’s life will depend on our composure, knowledge, and skills, therefore, remembering the algorithm for cardiopulmonary resuscitation, we can cope with this task brilliantly, and then be proud of ourselves.

The procedure for carrying out resuscitation measures, in addition to ensuring the patency of the airway (ventilator) and resuming blood flow (closed heart massage), also includes other techniques used in an extreme situation, but they are already within the competence of qualified medical workers.

The beginning of intensive therapy involves the administration of injection solutions not only intravenously, but also intratracheally and intracardiacly, and for this, in addition to knowledge, dexterity is also needed. Carrying out electrical defibrillation and tracheostomy, using ventilators and other devices for pulmonary-cardiac and cerebral resuscitation - such capabilities are available to a well-equipped ambulance team. An ordinary citizen can only use his hands and available means.

When you find yourself next to a dying person, the main thing is not to get confused: quickly call an ambulance, begin resuscitation and wait for the team to arrive. The rest will be done by the hospital doctors, where the victim will be delivered with a siren and flashing lights.