It often happens that a random passerby on the street may need help on which his life depends. In this regard, any person, even if he does not have a medical education, must know and be able to correctly and competently, and most importantly, immediately, provide assistance to any victim.
That is why training in the methods of such activities as indirect cardiac massage and artificial respiration begins at school during life safety lessons.

Cardiac massage is a mechanical effect on the heart muscle in order to maintain blood flow through the large vessels of the body at the time of cardiac arrest caused by a particular disease.

Heart massage can be direct or indirect:

• Direct massage is carried out only in the operating room, during heart surgery with an open chest cavity, and is carried out through squeezing movements of the surgeon’s hand.
• Execution technique indirect (closed, external) heart massage anyone can master it, and it is carried out in combination with artificial respiration. (T.n.z.).

However, according to the current legislation of the Russian Federation, a person providing emergency care (hereinafter referred to as a resuscitator) has the right not to perform artificial respiration using the “mouth to mouth” or “mouth to nose” method in cases where there is a direct or hidden threat to his health. So, for example, in the case when the victim has blood on his face and lips, the resuscitator may not touch him with his lips, since the patient may be infected with HIV or viral hepatitis. An antisocial patient, for example, may turn out to be a patient with tuberculosis. Due to the fact that it is impossible to predict the presence of dangerous infections in a particular unconscious patient, artificial respiration may not be performed until emergency medical assistance arrives, and assistance to a patient with cardiac arrest is provided through chest compressions. Sometimes in specialized courses they teach that if the resuscitator has a plastic bag or napkin, you can use them. But in practice, we can say that neither a bag (with a hole for the victim’s mouth), nor a napkin, nor a medical disposable mask purchased at a pharmacy protect against a real threat of transmission of infection, since contact of mucous membranes through the bag or wet (from breathing) resuscitator) the mask still happens. Contact of mucous membranes is a direct route of transmission of the virus. Therefore, no matter how much the resuscitator wants to save the life of another person, one should not forget about one’s own safety at this moment.

After doctors arrive at the scene, artificial pulmonary ventilation (ALV) begins, but with the help of an endotracheal tube and an Ambu bag.

Algorithm for external cardiac massage

So, what to do before the ambulance arrives if you see an unconscious person?

Firstly, do not panic and try to correctly assess the situation. If a person has just fallen in front of you, or has been injured, or has been pulled out of the water, etc., the need for intervention should be assessed, since indirect cardiac massage is effective in the first 3-10 minutes from the onset of cardiac arrest and breathing. If a person has not been breathing for a long time (more than 10-15 minutes) according to the people nearby, resuscitation can be performed, but most likely it will be ineffective. In addition, it is necessary to assess the presence of a threatening situation for you personally. For example, you cannot provide assistance on a busy highway, under falling beams, near an open fire during a fire, etc. Here you need to either move the patient to a safer place, or call an ambulance and wait. Of course, the first option is preferable, since minutes count for someone else’s life. The exception is for victims who are suspected of having a spinal injury (diver injury, car accident, fall from a height), it is strictly forbidden to carry them without a special stretcher, however, when saving lives is at stake, this rule can be neglected. It is impossible to describe all situations, so in practice you have to act differently each time.

After you see a person unconscious, you should shout out to him loudly, lightly hit him on the cheek, in general, attract his attention. If there is no reaction, we place the patient on his back on a flat, hard surface (on the ground, floor, in the hospital we lower the recumbent gurney to the floor or transfer the patient to the floor).

NB! Artificial respiration and cardiac massage are never performed on a bed; its effectiveness will obviously be close to zero.

Next, we check the presence of breathing in a patient lying on his back, focusing on the rule of three “Ps” - “look-listen-feel.” To do this, you should press on the patient’s forehead with one hand, “lift” the lower jaw upward with the fingers of the other hand and bring the ear closer to the patient’s mouth. We look at the chest, listen to breathing and feel the exhaled air with our skin. If this is not the case, let's start.

After you have made the decision to perform cardiopulmonary resuscitation, you need to call one or two people from the environment to you. Under no circumstances do we call an ambulance ourselves—we don’t waste precious seconds. We give the command to one of the people to call the doctors.

After visually (or by touching with your fingers) an approximate division of the sternum into three thirds, we find the border between the middle and lower. According to the recommendations for complex cardiopulmonary resuscitation, this area should be struck with a fist with a swing (precordial blow). This is the technique that is practiced by medical professionals at the first stage. However, an ordinary person who has not made such a blow before can cause harm to the patient. Then, in the event of subsequent proceedings regarding broken ribs, the actions of NOT the doctor may be regarded as an abuse of authority. But in the case of successful resuscitation and broken ribs, or when the resuscitator does not exceed his authority, the outcome of the court case (if one is initiated) will always be in his favor.

start of cardiac massage

Then, to begin a closed cardiac massage, the resuscitator, with clasped hands, begins to perform rocking, pressing movements (compressions) on the lower third of the sternum with a frequency of 2 presses per second (this is a fairly fast pace).

We fold our hands into a lock, while the leading hand (right for right-handers, left for left-handers) wraps its fingers around the other hand. Previously, resuscitation was carried out simply by putting hands on top of each other, without grip. The effectiveness of such resuscitation is much lower; now this technique is not used. Only hands interlocked.

hand position during cardiac massage

After 30 compressions, the resuscitator (or a second person) exhales two times into the victim’s mouth, while closing his nostrils with his fingers. At the moment of inhalation, the resuscitator should straighten up to inhale completely, and at the moment of exhalation, bend over the victim again. Resuscitation is carried out in a kneeling position next to the victim. It is necessary to perform indirect cardiac massage and artificial respiration until cardiac activity and breathing resume, or in the absence of such, until rescuers arrive who can provide more effective mechanical ventilation, or within 30-40 minutes. After this time, there is no hope for restoration of the cerebral cortex, since biological death usually occurs.

The real effectiveness of chest compressions consists of the following facts:

According to statistics, successful resuscitation and complete restoration of vital functions in 95% of victims is observed if the heart was able to “start” in the first three to four minutes. If a person was without breathing and heartbeat for about 10 minutes, but resuscitation was still successful, and the person began to breathe on his own, he will subsequently survive resuscitation illness, and, most likely, will remain deeply disabled with an almost completely paralyzed body and a violation of higher nervous activity. Of course, the effectiveness of resuscitation depends not only on the speed of performing the described manipulations, but also on the type of injury or disease that led to it. However, if chest compressions are necessary, first aid should be started as soon as possible.

Video: performing chest compressions and mechanical ventilation

Once again about the correct algorithm

Unconscious person → “Are you feeling bad? Can you hear me? Do you need help? → No response → Turn over onto your back, lay on the floor → Pull out the lower jaw, look, listen, feel → No breathing → Note the time, start resuscitation, instruct a second person to call an ambulance → Precordial blow → 30 compressions on the lower third of the sternum/2 exhale into the victim’s mouth → After two to three minutes, assess the presence of respiratory movements → No breathing → Continue resuscitation until doctors arrive or within thirty minutes.

What can and cannot be done if resuscitation is necessary?

According to the legal aspects of first aid, you have every right to assist an unconscious person, since he cannot give his consent or refuse. Regarding children, it is a little more complicated - if the child is alone, without adults or without official representatives (guardians, parents), then you are obliged to start resuscitation. If the child is with parents who actively protest and do not allow touching the unconscious child, all that remains is to call an ambulance and wait for the rescuers to arrive on the sidelines.

It is strictly not recommended to provide assistance to a person if there is a threat to your own life, including if the patient has open, bloody wounds and you do not have gloves. In such cases, everyone decides for themselves what is more important to them - to protect themselves or to try to save the life of another.

Do not leave the scene if you see a person unconscious or in serious condition– this will be qualified as leaving in danger. Therefore, if you are afraid to touch a person who may be dangerous to you, you must at least call him an ambulance.

Video: presentation on cardiac massage and mechanical ventilation by the Ministry of Health of the Russian Federation

Situations when a person may require artificial respiration and cardiac massage do not happen as rarely as we imagine. This can be depression or arrest of the heart and breathing in accidents such as poisoning, drowning, foreign objects entering the respiratory tract, as well as in traumatic brain injuries, strokes, etc. Providing assistance to the victim should be carried out only with full confidence in one’s own competence, because incorrect actions often lead to disability and even death of the victim.

How to perform artificial respiration and provide other first aid in emergency situations is taught at special courses run by units of the Ministry of Emergency Situations, in tourist clubs, and in driving schools. However, not everyone is able to apply the knowledge gained in courses in practice, much less determine in which cases it is necessary to perform cardiac massage and artificial respiration, and when it is better to abstain. You need to start resuscitation measures only if you are firmly convinced of their feasibility and know how to properly perform artificial respiration and external cardiac massage.

Sequence of resuscitation measures

Before starting the procedure of artificial respiration or indirect external cardiac massage, you must remember the sequence of rules and step-by-step instructions for their implementation.

1. First you need to check whether the unconscious person is showing signs of life. To do this, put your ear to the victim's chest or feel the pulse. The easiest way is to place 2 closed fingers under the victim’s cheekbones; if there is pulsation, it means the heart is working.
2. Sometimes the victim’s breathing is so weak that it is impossible to detect it by ear; in this case, you can observe his chest; if it moves up and down, it means breathing is functioning. If movements are not visible, you can put a mirror on the victim’s nose or mouth; if it fogs up, it means there is breathing.
3. It is important that if it turns out that an unconscious person has a functioning heart and, albeit weakly, respiratory function, it means that he does not need artificial ventilation and external cardiac massage. This point must be strictly observed for situations where the victim may be in a state of heart attack or stroke, because in these cases any unnecessary movements can lead to irreversible consequences and death.

If there are no signs of life (most often the respiratory function is impaired), resuscitation measures should be started as soon as possible.

Basic methods of providing first aid to an unconscious victim

The most frequently used, effective and relatively uncomplicated actions:

• mouth-to-nose artificial respiration procedure;
• mouth-to-mouth artificial respiration procedure;
• external cardiac massage.

Despite the relative simplicity of the activities, they can only be carried out by mastering special implementation skills. The technique of performing artificial ventilation of the lungs, and, if necessary, cardiac massage, carried out in extreme conditions, requires physical strength, precision of movements and some courage from the resuscitator.

For example, it will be quite difficult for an unprepared, fragile girl to perform artificial respiration, and especially to perform cardiac resuscitation on a large man. However, mastering the knowledge of how to properly perform artificial respiration and how to perform cardiac massage allows a resuscitator of any size to carry out competent procedures to save the life of the victim.

The procedure for preparing for resuscitation actions

When a person is unconscious, he should be brought back to his senses in a certain sequence, having previously clarified the need for each of the procedures.

1. First, clear the airways (throat, nasal passages, mouth) of foreign objects, if any. Sometimes the victim’s mouth may be filled with vomit; it must be removed using gauze wrapped around the hand of the resuscitator. To facilitate the procedure, the victim’s body should be turned to one side.
2. If the heart rhythm is detected, but breathing does not work, only mouth-to-mouth or mouth-to-nose artificial respiration is required.
3. If both the heartbeat and respiratory function are inactive, artificial respiration alone cannot be done, and indirect cardiac massage will have to be done.

List of rules for performing artificial respiration

Artificial respiration techniques include 2 methods of mechanical ventilation (artificial pulmonary ventilation): these are methods of pumping air from the mouth into the mouth and from the mouth into the nose. The first method of performing artificial respiration is used when it is possible to open the victim’s mouth, and the second - when it is impossible to open his mouth due to spasm.

Features of the mouth-to-mouth ventilation technique

A serious danger for a person performing artificial respiration using the mouth-to-mouth technique may be the possibility of the release of toxic substances from the victim’s chest (especially in case of cyanide poisoning), infected air and other toxic and dangerous gases. If such a possibility exists, the mechanical ventilation procedure should be abandoned! In this situation, you will have to make do with indirect cardiac massage, because mechanical pressure on the chest also contributes to the absorption and release of about 0.5 liters of air. What actions are performed during artificial respiration?

1. The patient is placed on a hard horizontal surface and the head is thrown back, placing a bolster, a twisted pillow or a hand under the neck. If there is a possibility of a neck fracture (for example, in an accident), throwing your head back is prohibited.
2. Pull the patient's lower jaw down, open the oral cavity and free it from vomit and saliva.
3. Hold the patient's chin with one hand, and tightly pinch his nose with the other, take a deep breath through the mouth and exhale air into the victim's mouth. In this case, your mouth must be pressed firmly against the patient’s mouth so that air passes into his respiratory tract without escaping (for this purpose, the nasal passages are pinched).
4. Artificial respiration is performed at a rate of 10-12 breaths per minute.
5. To ensure the safety of the resuscitator, ventilation is performed through gauze; control of the pressure density is mandatory.

The artificial respiration technique involves gentle air injections. The patient needs to be provided with a powerful, but slow (over one to one and a half seconds) supply of air to restore the motor function of the diaphragm and smoothly fill the lungs with air.

Basic rules of the “mouth to nose” technique

If it is impossible to open the victim’s jaw, artificial respiration from the mouth to the nose is used. The procedure for this method is also carried out in several stages:

• first, the victim is laid horizontally and, if there are no contraindications, the head is thrown back;
• then check the nasal passages for patency and, if necessary, clean them;
• if possible, extend the jaw;
• take as full a breath as possible, cover the patient’s mouth and exhale air into the victim’s nasal passages.
• count 4 seconds from the first exhalation and take the next inhalation and exhalation.

How to perform artificial respiration on young children

Performing the mechanical ventilation procedure for children is somewhat different from the previously described actions, especially if you need to perform artificial respiration for a child under 1 year old. The face and respiratory organs of such children are so small that adults can ventilate them simultaneously through the mouth and through the nose. This procedure is called “mouth to mouth and nose” and is performed similarly:

• first the baby's airways are cleared;
• then the baby’s mouth is opened;
• The resuscitator takes a deep breath and exhales slowly but powerfully, covering both the child’s mouth and nose with his lips at the same time.

The approximate number of air blows for children is 18-24 times per minute.

Checking the correctness of mechanical ventilation

When carrying out resuscitation efforts, it is necessary to constantly monitor the correctness of their implementation, otherwise all efforts will be in vain or will further harm the victim. Methods for monitoring the correctness of mechanical ventilation are the same for adults and children:

• if, while blowing air into the victim’s mouth or nose, a rise and fall of his chest is observed, it means that passive inhalation is working and the mechanical ventilation procedure is carried out correctly;
• if the chest movements are too sluggish, it is necessary to check the tightness of the compression when exhaling;
• if artificial injection of air moves not the chest, but the abdominal cavity, this means that the air does not enter the respiratory tract, but into the esophagus. In this situation, it is necessary to turn the victim’s head to the side and, pressing on the stomach, allow air to burp.

It is necessary to check the effectiveness of mechanical ventilation every minute; it is advisable that the resuscitator has an assistant who would monitor the correctness of actions.

Rules for performing indirect cardiac massage

The procedure for chest compressions requires somewhat more effort and caution than mechanical ventilation.

1. The patient should be placed on a hard surface and the chest should be freed from clothing.
2. The person resuscitating must kneel to the side.
3. You need to straighten your palm as much as possible and place its base on the middle of the victim’s chest, about 2-3 cm above the end of the sternum (where the right and left ribs “meet”).
4. Pressure on the chest should be applied centrally, because This is where the heart is located. Moreover, the thumbs of the massaging hands should be directed towards the stomach or chin of the victim.
5. The other hand should be placed on the lower one - crosswise. The fingers of both palms should be kept pointing upward.
6. The resuscitator's arms must be straightened when applying pressure, and the center of gravity of the entire weight of the resuscitator must be transferred to them so that the shocks are strong enough.
7. For the convenience of the resuscitator, before starting the massage, he needs to take a deep breath, and then, as he exhales, make several quick presses with crossed palms on the patient’s chest. The frequency of shocks should be at least 60 times per minute, while the victim’s chest should drop by about 5 cm. Elderly victims can be resuscitated with a frequency of 40-50 shocks per minute; for children, cardiac massage is done faster.
8. If resuscitation measures include both external cardiac massage and artificial ventilation, then they need to be alternated in the following sequence: 2 breaths - 30 pushes - 2 breaths - 30 pushes and so on.

Excessive zeal of the resuscitator sometimes leads to broken ribs of the victim. Therefore, when performing a cardiac massage, one should take into account the individual’s own strengths and characteristics. If this is a person with thin bones, a woman or a child, efforts should be moderated.

How to give a heart massage to a child

As has already become clear, cardiac massage in children requires special care, since the children’s skeleton is very fragile, and the heart is so small that it is enough to massage with two fingers, and not with the palms. In this case, the child’s chest should move in the range of 1.5-2 cm, and the frequency of compressions should be 100 times per minute.

For clarity, you can compare the measures for resuscitation of victims depending on age using the table.

Important: cardiac massage must be carried out on a hard surface so that the victim’s body is not absorbed into soft ground or other non-solid surfaces.

Monitoring the correct execution - if all actions are performed correctly, the victim develops a pulse, cyanosis (blue discoloration of the skin) disappears, respiratory function is restored, and the pupils return to normal sizes.

How long does it take to resuscitate a person?

Resuscitation measures should be carried out for the victim for at least 10 minutes or exactly as long as it takes for signs of life to appear in the person, and ideally until the doctors arrive. If the heartbeat continues and respiratory function is still impaired, mechanical ventilation must be continued for quite a long time, up to an hour and a half. The likelihood of a person returning to life in most cases depends on the timeliness and correctness of resuscitation actions, however, there are situations when this cannot be done.

Symptoms of biological death

If, despite all efforts to provide first aid, they remain ineffective for half an hour, the victim’s body begins to become covered with cadaveric spots, the pupils, when pressed on the eyeballs, take on the appearance of vertical slits (“cat pupil syndrome”), and signs of rigor also appear, which means further actions are meaningless. These symptoms indicate the onset of biological death of the patient.

No matter how much we would like to do everything in our power to bring a sick person back to life, even qualified doctors are not always able to stop the inevitable passage of time and give life to a patient doomed to death. This is, unfortunately, life, and you just have to come to terms with it.

Artificial respiration (AR) is an urgent emergency measure if a person’s own breathing is absent or impaired to such an extent that it poses a threat to life. The need for artificial respiration may arise when providing assistance to those who have received sunstroke, drowned, suffered from electric current, as well as in case of poisoning with certain substances.

The purpose of the procedure is to ensure the process of gas exchange in the human body, in other words, to ensure sufficient saturation of the victim’s blood with oxygen and the removal of carbon dioxide from it. In addition, artificial ventilation has a reflex effect on the respiratory center located in the brain, as a result of which independent breathing is restored.

Mechanism and methods of artificial respiration

Only through the process of breathing does a person’s blood become saturated with oxygen and carbon dioxide is removed from it. After air enters the lungs, it fills the lung sacs called alveoli. The alveoli are pierced by an incredible number of small blood vessels. It is in the pulmonary vesicles that gas exchange takes place - oxygen from the air enters the blood, and carbon dioxide is removed from the blood.

If the body's supply of oxygen is interrupted, vital activity is at risk, since oxygen plays the “first fiddle” in all oxidative processes that occur in the body. That is why, when breathing stops, artificially ventilating the lungs should be started immediately.

The air entering the human body during artificial respiration fills the lungs and irritates the nerve endings in them. As a result, nerve impulses are sent to the respiratory center of the brain, which are a stimulus for the production of response electrical impulses. The latter stimulate contraction and relaxation of the diaphragm muscles, resulting in stimulation of the respiratory process.

Artificially supplying the human body with oxygen in many cases makes it possible to completely restore the independent respiratory process. In the event that cardiac arrest is also observed in the absence of breathing, it is necessary to perform a closed cardiac massage.

Please note that the absence of breathing triggers irreversible processes in the body within five to six minutes. Therefore, timely artificial ventilation can save a person’s life.

All methods of performing ID are divided into expiratory (mouth-to-mouth and mouth-to-nose), manual and hardware. Manual and expiratory methods are considered more labor-intensive and less effective compared to hardware methods. However, they have one very significant advantage. They can be performed without delay, almost anyone can cope with this task, and most importantly, there is no need for any additional devices and instruments, which are not always at hand.

Indications and contraindications

Indications for the use of ID are all cases where the volume of spontaneous ventilation of the lungs is too low to ensure normal gas exchange. This can happen in many urgent and planned situations:

1. For disorders of the central regulation of breathing caused by impaired cerebral circulation, tumor processes of the brain or brain injury.
2. For medicinal and other types of intoxication.
3. In case of damage to the nerve pathways and neuromuscular synapse, which can be caused by trauma to the cervical spine, viral infections, the toxic effect of certain medications, and poisoning.
4. For diseases and damage to the respiratory muscles and chest wall.
5. In cases of lung lesions of both obstructive and restrictive nature.

The need to use artificial respiration is judged based on a combination of clinical symptoms and external data. Changes in pupil size, hypoventilation, tachy- and bradysystole are conditions that require artificial ventilation. In addition, artificial respiration is required in cases where spontaneous ventilation is “turned off” using muscle relaxants administered for medical purposes (for example, during anesthesia for surgery or during intensive care for a seizure disorder).

As for cases where ID is not recommended, there are no absolute contraindications. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. So, for example, if venous return of blood is difficult, artificial respiration modes are contraindicated, which provoke even greater disruption. In case of lung injury, ventilation methods based on high-pressure air injection, etc., are prohibited.

Preparing for artificial respiration

Before performing expiratory artificial respiration, the patient should be examined. Such resuscitation measures are contraindicated for facial injuries, tuberculosis, poliomelitis and trichlorethylene poisoning. In the first case, the reason is obvious, and in the last three, performing expiratory artificial respiration puts the person performing resuscitation at risk.

Before starting expiratory artificial respiration, the victim is quickly freed from clothing squeezing the throat and chest. The collar is unbuttoned, the tie is undone, and the trouser belt can be unfastened. The victim is placed supine on his back on a horizontal surface. The head is tilted back as much as possible, the palm of one hand is placed under the back of the head, and the other palm is pressed on the forehead until the chin is in line with the neck. This condition is necessary for successful resuscitation, since with this position of the head the mouth opens and the tongue moves away from the entrance to the larynx, as a result of which air begins to flow freely into the lungs. In order for the head to remain in this position, a cushion of folded clothing is placed under the shoulder blades.

After this, it is necessary to examine the victim’s oral cavity with your fingers, remove blood, mucus, dirt and any foreign objects.

It is the hygienic aspect of performing expiratory artificial respiration that is the most delicate, since the rescuer will have to touch the victim’s skin with his lips. You can use the following technique: make a small hole in the middle of a handkerchief or gauze. Its diameter should be two to three centimeters. The fabric is placed with a hole on the victim’s mouth or nose, depending on which method of artificial respiration will be used. Thus, air will be blown through the hole in the fabric.

To carry out artificial respiration using the mouth-to-mouth method, the person who will provide assistance must be on the side of the victim’s head (preferably on the left side). In a situation where the patient is lying on the floor, the rescuer kneels. If the victim's jaws are clenched, they are forced apart.

After this, one hand is placed on the victim’s forehead, and the other is placed under the back of the head, tilting the patient’s head back as much as possible. Having taken a deep breath, the rescuer holds the exhalation and, bending over the victim, covers the area of ​​his mouth with his lips, creating a kind of “dome” over the patient’s mouth. At the same time, the victim’s nostrils are pinched with the thumb and index finger of the hand located on his forehead. Ensuring tightness is one of the prerequisites for artificial respiration, since air leakage through the victim’s nose or mouth can nullify all efforts.

After sealing, the rescuer quickly, forcefully exhales, blowing air into the airways and lungs. The duration of exhalation should be about a second, and its volume should be at least a liter for effective stimulation of the respiratory center to occur. At the same time, the chest of the person receiving assistance should rise. If the amplitude of its rise is small, this is evidence that the volume of air supplied is insufficient.

Exhaling, the rescuer unbends, freeing the victim’s mouth, but at the same time keeping his head thrown back. The patient should exhale for about two seconds. During this time, before taking the next breath, the rescuer must take at least one normal breath “for himself.”

Please note that if a large amount of air enters the patient's stomach rather than the lungs, this will significantly complicate his rescue. Therefore, you should periodically press on the epigastric region to empty the stomach of air.

Artificial respiration from mouth to nose

This method of artificial ventilation is carried out if it is not possible to properly unclench the patient’s jaws or there is an injury to the lips or oral area.

The rescuer places one hand on the victim’s forehead and the other on his chin. At the same time, he simultaneously throws back his head and presses his upper jaw to the lower. With the fingers of the hand that supports the chin, the rescuer must press the lower lip so that the victim’s mouth is completely closed. Taking a deep breath, the rescuer covers the victim’s nose with his lips and forcefully blows air through the nostrils, while watching the movement of the chest.

After artificial inspiration is completed, you need to free the patient's nose and mouth. In some cases, the soft palate may prevent air from escaping through the nostrils, so when the mouth is closed, there may be no exhalation at all. When exhaling, the head must be kept tilted back. The duration of artificial exhalation is about two seconds. During this time, the rescuer himself must take several exhalations and inhalations “for himself.”

How long does artificial respiration last?

There is only one answer to the question of how long ID should be carried out. You should ventilate your lungs in this mode, taking breaks for a maximum of three to four seconds, until full spontaneous breathing is restored, or until the doctor appears and gives other instructions.

At the same time, you should constantly ensure that the procedure is effective. The patient's chest should swell well, and the facial skin should gradually turn pink. It is also necessary to ensure that there are no foreign objects or vomit in the victim’s respiratory tract.

Please note that due to the ID, the rescuer himself may experience weakness and dizziness due to a lack of carbon dioxide in the body. Therefore, ideally, air blowing should be done by two people, who can alternate every two to three minutes. If this is not possible, the number of breaths should be reduced every three minutes so that the person performing resuscitation normalizes the level of carbon dioxide in the body.

During artificial respiration, you should check every minute to see if the victim’s heart has stopped. To do this, use two fingers to feel the pulse in the neck in the triangle between the windpipe and the sternocleidomastoid muscle. Two fingers are placed on the lateral surface of the laryngeal cartilage, after which they are allowed to “slide” into the hollow between the sternocleidomastoid muscle and the cartilage. This is where the pulsation of the carotid artery should be felt.

If there is no pulsation in the carotid artery, chest compressions in combination with ID should be started immediately. Doctors warn that if you miss the moment of cardiac arrest and continue to perform artificial ventilation, it will not be possible to save the victim.

Features of the procedure in children

When performing artificial ventilation for babies under one year of age, the mouth-to-mouth and nose technique is used. If the child is older than one year, the mouth-to-mouth method is used.

Small patients are also placed on their back. For babies under one year old, place a folded blanket under their back or slightly raise their upper body, placing a hand under their back. The head is thrown back.

The person providing assistance takes a shallow breath, seals her lips around the child’s mouth and nose (if the baby is under one year old) or just the mouth, and then blows air into the respiratory tract. The volume of air blown in should be less, the younger the patient. So, in the case of resuscitation of a newborn, it is only 30-40 ml.

If a sufficient volume of air enters the respiratory tract, chest movement occurs. After inhaling, you need to make sure that the chest drops. If you blow too much air into your baby's lungs, this can cause the alveoli of the lung tissue to rupture, causing air to escape into the pleural cavity.

The frequency of insufflations should correspond to the breathing frequency, which tends to decrease with age. Thus, in newborns and children up to four months, the frequency of inhalations and exhalations is forty per minute. From four months to six months this figure is 40-35. In the period from seven months to two years - 35-30. From two to four years it is reduced to twenty-five, in the period from six to twelve years - to twenty. Finally, in a teenager aged 12 to 15 years, the respiratory rate is 20-18 breaths per minute.

Manual methods of artificial respiration

There are also so-called manual methods of artificial respiration. They are based on changing the volume of the chest due to the application of external force. Let's look at the main ones.

Sylvester's method

This method is most widely used. The victim is placed on his back. A cushion should be placed under the lower part of the chest so that the shoulder blades and the back of the head are lower than the costal arches. In the event that artificial respiration is performed using this method by two people, they kneel on either side of the victim so as to be positioned at the level of his chest. Each of them holds the victim’s hand in the middle of the shoulder with one hand, and with the other just above the level of the hand. Next, they begin to rhythmically raise the victim’s arms, stretching them behind his head. As a result, the chest expands, which corresponds to inhalation. After two or three seconds, the victim’s hands are pressed to the chest, while squeezing it. This performs the functions of exhalation.

In this case, the main thing is that the movements of the hands are as rhythmic as possible. Experts recommend that those performing artificial respiration use their own rhythm of inhalation and exhalation as a “metronome”. In total, you should do about sixteen movements per minute.

ID using the Sylvester method can be performed by one person. He needs to kneel behind the victim’s head, grab his arms above the hands and perform the movements described above.

For broken arms and ribs, this method is contraindicated.

Schaeffer method

If the victim's arms are injured, the Schaeffer method can be used to perform artificial respiration. This technique is also often used for the rehabilitation of people injured while on the water. The victim is placed prone, with his head turned to the side. The one who performs artificial respiration kneels, and the victim’s body should be located between his legs. Hands should be placed on the lower part of the chest so that the thumbs lie along the spine and the rest rest on the ribs. When exhaling, you should lean forward, thus compressing the chest, and while inhaling, straighten, stopping the pressure. The elbows are not bent.

Please note that this method is contraindicated for fractured ribs.

Laborde method

The Laborde method is complementary to the Sylvester and Schaeffer methods. The victim's tongue is grabbed and rhythmically stretched, imitating breathing movements. As a rule, this method is used when breathing has just stopped. The resistance of the tongue that appears is evidence that the person’s breathing is being restored.

Kallistov method

This simple and effective method provides excellent ventilation. The victim is placed prone, face down. A towel is placed on the back in the area of ​​the shoulder blades, and its ends are passed forward, threaded under the armpits. The person providing assistance should take the towel by the ends and lift the victim’s torso seven to ten centimeters from the ground. As a result, the chest expands and the ribs rise. This corresponds to inhalation. When the torso is lowered, it simulates exhalation. Instead of a towel, you can use any belt, scarf, etc.

Howard's method

The victim is positioned supine. A cushion is placed under his back. Hands are moved behind the head and extended. The head itself is turned to the side, the tongue is extended and secured. The one who performs artificial respiration sits astride the victim’s thigh area and places his palms on the lower part of the chest. With your fingers spread, you should grab as many ribs as possible. When the chest is compressed, it simulates inhalation; when the pressure is released, it simulates exhalation. You should do twelve to sixteen movements per minute.

Frank Eve's method

This method requires a stretcher. They are installed in the middle on a transverse stand, the height of which should be half the length of the stretcher. The victim is placed prone on the stretcher, the face is turned to the side, and the arms are placed along the body. The person is tied to the stretcher at the level of the buttocks or thighs. When lowering the head end of the stretcher, inhale; when it goes up, exhale. Maximum breathing volume is achieved when the victim's body is tilted at an angle of 50 degrees.

Nielsen method

The victim is placed face down. His arms are bent at the elbows and crossed, after which they are placed palms down under the forehead. The rescuer kneels at the victim’s head. He places his hands on the victim’s shoulder blades and, without bending them at the elbows, presses with his palms. This is how exhalation occurs. To inhale, the rescuer takes the victim’s shoulders at the elbows and straightens, lifting and pulling the victim towards himself.

Hardware artificial respiration methods

For the first time, hardware methods of artificial respiration began to be used back in the eighteenth century. Even then, the first air ducts and masks appeared. In particular, doctors proposed using fireplace bellows to blow air into the lungs, as well as devices created in their likeness.

The first automatic ID machines appeared at the end of the nineteenth century. At the beginning of the twenties, several types of respirators appeared at once, which created intermittent vacuum and positive pressure either around the entire body, or only around the patient’s chest and abdomen. Gradually, respirators of this type were replaced by air-injection respirators, which had less solid dimensions and did not impede access to the patient’s body, allowing medical procedures to be performed.

All ID devices existing today are divided into external and internal. External devices create negative pressure either around the patient's entire body or around his chest, thereby inhaling. Exhalation in this case is passive - the chest simply collapses due to its elasticity. It can also be active if the device creates a positive pressure zone.

With the internal method of artificial ventilation, the device is connected through a mask or intubator to the respiratory tract, and inhalation is carried out by creating positive pressure in the device. Devices of this type are divided into portable, intended for work in “field” conditions, and stationary, the purpose of which is long-term artificial respiration. The former are usually manual, while the latter operate automatically, driven by a motor.

Complications of artificial respiration

Complications due to artificial respiration occur relatively rarely and even if the patient is on artificial ventilation for a long time. Most often, undesirable consequences concern the respiratory system. Thus, due to an incorrectly chosen regimen, respiratory acidosis and alkalosis can develop. In addition, prolonged artificial respiration can cause the development of atelectasis, since the drainage function of the respiratory tract is impaired. Microatelectasis, in turn, can become a prerequisite for the development of pneumonia. Preventative measures that will help avoid the occurrence of such complications are careful respiratory hygiene.

If a patient breathes pure oxygen for a long time, this can cause pneumonitis. The oxygen concentration should therefore not exceed 40-50%.

In patients who have been diagnosed with abscess pneumonia, alveolar ruptures may occur during artificial respiration.

Each of us is not immune from a situation where a loved one or just a passer-by receives an electric shock or heat stroke, which leads to respiratory arrest, and often to the cessation of heart function. In such a situation, a person’s life will depend only on the instant reaction and assistance provided. Already schoolchildren should know what artificial heart massage is and with the help of which you can bring the victim back to life. Let's figure out what these techniques are and how to perform them correctly.

Causes of respiratory arrest

Before you deal with first aid, you need to find out in what situations breathing may stop. The main reasons for this condition include:

• strangulation, which is a consequence of carbon monoxide inhalation or attempted suicide by hanging;
• drowning;
• electric shock;
• severe cases of poisoning.

These reasons are most common in medical practice. But you can name others - everything happens in life!

Why is it necessary?

Of all the organs in the human body, the brain needs oxygen the most. Without it, cell death begins in about 5-6 minutes, which will lead to irreversible consequences.

If first aid, artificial respiration and cardiac massage are not provided in a timely manner, then the person who has returned to life can no longer be called full-fledged. The death of brain cells will subsequently lead to the fact that this organ will no longer be able to function as before. A person can turn into a completely helpless creature that will require constant care. It is for this reason that the quick reaction of others who are ready to provide first aid to the victim is very important.

Features of adult resuscitation

How to perform artificial respiration and cardiac massage is taught in biology classes in secondary schools. Only most people are sure that they will never find themselves in such a situation, so they do not particularly delve into the intricacies of such manipulations.

Finding themselves in such a situation, many get lost, cannot find their way, and precious time is wasted. Resuscitation of adults and children has its differences. And they are worth knowing. Here are some features of resuscitation measures in adults:

When all these factors are taken into account, resuscitation measures can begin, if necessary.

Actions before artificial respiration

Quite often a person loses consciousness, but breathing remains. In such a situation, it is necessary to take into account that in an unconscious state all the muscles of the body relax. This also applies to the tongue, which, under the influence of gravity, slides down and can close the larynx, leading to suffocation.

The first step when you find a person unconscious is to take measures to ensure the free flow of air through the larynx. You can put the person on his side or throw his head back and open his mouth slightly, pressing on the lower jaw. In this position there will be no danger that the tongue will completely block the larynx.

After this, you need to check whether spontaneous breathing has resumed. Almost everyone knows from films or biology lessons that to do this, it is enough to bring a mirror to your mouth or nose - if it fogs up, it means the person is breathing. If you don't have a mirror, you can use your phone screen.

It is important to remember that while all these checks are being carried out, the lower jaw must be supported.

If the victim is unable to breathe due to drowning, strangulation with a rope, or a foreign body, it is necessary to urgently remove the foreign object and clean the oral cavity if necessary.

If all the procedures have been carried out, and breathing has not been restored, it is necessary to immediately perform artificial respiration and cardiac massage if it has stopped working.

Rules for performing artificial respiration

If all the reasons that caused the respiratory arrest have been eliminated, but it has not recovered, then it is urgently necessary to begin resuscitation. Artificial respiration can be performed using different methods:

• inhaling air into the victim’s mouth;
• blowing into the nose.

The first method is most often used. Unfortunately, not everyone knows how to perform artificial respiration and cardiac massage. The rules are quite simple, you just need to follow them exactly:

If the victim, after all the efforts, does not come to his senses and does not begin to breathe on his own, then he will have to urgently perform a closed heart massage and artificial respiration at the same time.

Artificial respiration technique " mouth V nose»

This method of resuscitation is considered the most effective, as it reduces the risk of air entering the stomach. The procedure is as follows:

Most often, if all manipulations are performed correctly and in a timely manner, it is possible to bring the victim back to life.

The effect of cardiac muscle massage

Most often, artificial heart massage and artificial respiration are combined when providing first aid. Almost everyone can imagine how such manipulations are carried out, but not everyone knows what their meaning is.

The heart in the human body is a pump that vigorously and constantly pumps blood, delivering oxygen and nutrients to cells and tissues. When performing an indirect massage, pressure is applied to the chest, and the heart begins to contract and push blood into the vessels. When the pressure stops, the myocardial chambers straighten and venous blood enters the atria.

In this way, blood flows through the body, which carries everything the brain needs.

Algorithm for cardiac resuscitation

To make cardiac resuscitation more effective, it is necessary to lay the victim on a hard surface. In addition, you will have to unbutton your shirt and other clothes. The belt on men's trousers must also be removed.

• the point is located at the intersection of the internipple line and the middle of the sternum;
• you need to step back from the chest to the thickness of two fingers to the head - this will be the desired point.

Once the desired pressure point has been determined, resuscitation measures can begin.

Cardiac massage and artificial respiration techniques

The sequence of actions during resuscitation procedures should be as follows:

It is necessary to take into account that performing artificial respiration and chest compressions requires considerable effort, so it is advisable to have someone else nearby who can relieve you and provide assistance.

Features of providing assistance to children

Resuscitation measures for young children have their own differences. The sequence of artificial respiration and cardiac massage in babies is the same, but there are some nuances:

Signs of effective help

When performing it, you need to know the signs by which you can judge its success. If artificial respiration and external cardiac massage are performed correctly, then, most likely, after some time the following signs can be observed:

• the pupils react to light;
• the skin becomes pinkish in color;
• the pulse is felt in the peripheral arteries;
• the victim begins to breathe on his own and regains consciousness.

If artificial cardiac massage and artificial respiration do not produce results within half an hour, then resuscitation is ineffective and must be stopped. It should be noted that the earlier cardiopulmonary resuscitation is started, the more effective it will be in the absence of contraindications.

Contraindications to resuscitation

Artificial heart massage and artificial respiration set the goal of returning a person to a full life, and not just delaying the time of death. Therefore, there are situations when such resuscitation is pointless:

The rules of artificial respiration assume that resuscitation is started immediately after cardiac arrest is detected. Only in this case, if there are no contraindications, can we hope that the person will return to a full life.

We figured out how to do artificial respiration and cardiac massage. The rules are quite simple and clear. Don't be afraid that you won't succeed. Here are some tips to help save a person's life:

• If things don’t work out with artificial respiration, then you can and should continue doing cardiac massage.
• In most adults, breathing stops due to the cessation of myocardial function, so massage is more important than artificial respiration.
• There is no need to worry that you will break the victim's ribs as a result of excessive pressure. Such an injury is not fatal, but a person’s life will be saved.

Each of us may need such skills at the most unexpected moment, and it is very important in such a situation not to get confused and do everything possible, because life often depends on the correctness and timeliness of actions.

Manual artificial respiration methods in mines

If first aid is provided by one person, then artificial respiration is better and easier to carry out using the Schaefer or Nilson method, the advantage of which is simplicity and ease and which is not difficult to learn after short exercises.

To apply artificial respiration using the Schaefer method, you need to put the victim face down on overalls (jacket), place one of his hands under his head, turn his head to the side, and extend the other hand forward, along the head, as shown in Fig. 53. After this, you should kneel over the victim facing his head so that the victim’s hips are between the knees of the person performing artificial respiration. Place your palms on the victim’s back, on the lower ribs, clasping them from the sides with your fingers.

Rice. 53. Artificial respiration using the Schaefer method:
a - exhale; b - inhale

Counting “one, two, three,” gradually lean forward so that the weight of your body leans on your outstretched arms, thus pressing on the victim’s lower ribs, squeezing his chest and stomach, and exhale. Then, without removing your hands from the victim’s back, also lean back in the count of “four, five, six,” allowing the victim’s chest and stomach to straighten, and inhale. Having inhaled again in a count of “one, two, three”, gradually bend forward, exhaling, etc.

When artificial respiration is used correctly using the Schaefer method, a sound (like a slight groan) is usually produced as air passes through the victim's windpipe as the chest compresses and expands. This sound indicates that air is actually entering the victim's lungs. If such a sound is not heard, you need to look again to see if there is anything in the victim’s respiratory organs that is blocking the passage of air, or if the tongue has sunk into the larynx.

It is also necessary to remember that if the victim’s ribs are compressed very strongly, food may be squeezed out of the stomach, and then again it will be necessary to clean his mouth and nose.

Breathing movements (exhalation and inhalation) should be performed approximately 12-18 times per minute.

Nilson method

Artificial respiration using the Nilson method is performed by one person. Place the victim on his stomach, his head on his hands, palms down. The person providing assistance kneels behind the victim’s head (Fig. 54) facing his feet, puts his hands on the victim’s shoulder blades and, in a count of “one, two, three, four,” slowly leans forward, squeezing the chest with the weight of his body—exhale.

Rice. 54. Artificial respiration using the Nilson method:
a - exhale; b - inhale

On the count of “five, six, seven, eight”, the person performing artificial respiration leans back, moves his hands to the middle of the victim’s shoulders and, holding them, lifts the victim’s arms up with his elbows - inhale.

Howard method

The victim is placed on his back, under which a cushion is placed. The victim's arms are thrown back to the top, his head is turned to the side. The person providing assistance kneels over the victim’s pelvis and thighs, placing their palms on the lower ribs on either side of the xiphoid process. Then he leans forward and, using his palms, presses his mass on the victim’s chest for 2 - 3 s (exhale). Then the pressure on the chest is immediately stopped, the victim’s chest expands - inhalation occurs.

Carrying out artificial respiration manually (according to Sylvester, Schaefer, etc.) does not provide sufficient air into the lungs and is excessively tiring.

Mouth to mouth method

The simplest and best method of artificial respiration is “mouth to mouth” or “mouth to nose”. This method of artificial respiration - blowing air from the mouth of the person providing assistance into the mouth or nose of the victim - provides significantly greater ventilation of the lungs and allows breathing to be restored more quickly. In addition, the increased content of carbon dioxide in the air blown into the victim stimulates the breathing process.

The victim is placed on his back on a hard surface. The person providing assistance tilts the victim’s head sharply back (place a cushion, a bundle of clothes, a folded blanket, etc. under the shoulders) and holds it in this position. Then the person providing assistance takes a deep breath, brings his mouth closer to the victim’s mouth and, pressing his lips tightly (through gauze from a bandage or an individual bag) to the victim’s mouth, blows the collected air into his lungs (Fig. 55).

Rice. 55. Artificial respiration using the mouth-to-mouth method

If there is a rubber tube or air duct, then air is blown through them. When blowing air through the mouth, the victim's nose is pinched so that the blown air does not escape out. When air is blown into the victim's lungs, his chest expands. After this, the person providing assistance leans back; at this time the chest collapses - exhalation occurs. Such air injections are performed from 14 to 20 times per minute, which corresponds to the rhythm of normal breathing. It is better to breathe at a less frequent rhythm, but with a greater depth of inspiration; this is not so tiring and better ensures ventilation of the victim's pulmonary air.

The effectiveness of artificial respiration is checked by the expansion of the victim’s chest each time air is blown into the mouth. If this does not happen, it is necessary to ensure a more complete sealing of the openings of the mouth and nose when inhaling and check the position of the victim’s head.

Artificial respiration should be carried out until the victim regains his own deep and rhythmic breathing. The appearance of the first weak breaths does not provide grounds for stopping artificial respiration. You should only time the artificial inhalation to coincide with the start of spontaneous inhalation.