Indirect cardiac massage is performed when it is necessary to resuscitate a person in case of cardiac arrest and lack of breathing.

At the same time, they compress by pressing (pressing), chest and perform artificial respiration, that is, the victim is given first aid along with artificial lung ventilation (IV).

Physiology of blood circulation

The heart consists of four chambers: 2 atria and 2 ventricles. The atria provide blood flow to the ventricles from the vessels. The right ventricle ejects blood into the vessels of the lungs (pulmonary circulation), the left ventricle into the aorta, tissues and organs (systemic circulation).

Through the pulmonary circulation occur metabolic processes gases: enters the lungs from the blood carbon dioxide, and oxygen from the lungs into the blood by binding to the hemoglobin of red blood cells. Reverse metabolic processes occur in big circle blood circulation, and in addition, micronutrients are supplied. Metabolic products are removed from the tissues by the kidneys, skin and lungs into the blood of the aorta.

What happens when blood circulation stops?

When blood circulation stops, tissue and gas exchange will stop. The cells will accumulate metabolic products, and the blood will accumulate carbon dioxide. Metabolism will stop, and the cells will die from poisoning with waste products and oxygen starvation.

What does indirect cardiac massage give?

Immediately after cardiac arrest, indirect cardiac massage (closed cardiac massage) is performed to restore its activity. This will maintain continuous blood flow until the functional functioning of the heart is restored.

The chest is compressed, which means that the chambers of the heart and blood will exit from the atria into the ventricles through the opened valves, then enters the vessels. Indirect cardiac massage activates its own electrical activity and normalizes the functioning of the vascular center. Closed heart massage helps restore the functional functioning of the heart.

Causes of cardiac arrest

• spasm of coronary vessels;
• acute heart failure;
• myocardial infarction;
• electric shock or lightning;
• severe injuries.

Cardiac arrest is characterized by:

• severe pallor;
• loss of consciousness;
• disappearance of the pulse;
• cessation of breathing or the appearance of convulsive and rare breaths with dilated pupils.

Closed (or external) cardiac massage - technique

Indirect cardiac massage (or external) is combined with other resuscitation measures to move blood from the heart into the vessels and restore breathing.

• one hand is placed with the palm on the sternum in the lower part, with the main emphasis on the metacarpus;
• the other hand is placed on top and both arms are straightened at the elbows to perform rhythmic pressure on the sternum;
• when the sternum is lowered by 3-4 cm, the pressure force is considered normal, with a wide sternum - by 5-6 cm.

Algorithm cardiopulmonary resuscitation consists of a sequence of rapid resuscitation measures. Closed heart massage is combined with mechanical ventilation (tempo - 15x2). Add 2 breaths to 15 compressions if resuscitation is performed by 2 people. If there is one person, then the pace is 4x1.

The rules state that the combination indirect massage hearts with defibrillation allow you to stop the massage only for 5-10 seconds, no more.

1. The technique of indirect cardiac massage involves determining the location of the xiphoid process.
2. The victim should lie on a hard and flat surface: board, ground, floor. A soft bed is not suitable. The resuscitator stands on the patient's left or right. His palms are on the lower end of the sternum.
3. The resuscitator palpates the compression point. Its location from the xiphoid process is at a distance of 2 fingers strictly in the vertical center of the body axis. The resuscitator places the palms with the base on the compression point. Increases pressure with the second hand and the weight of the body. Movements should be fast and rhythmic. The shock frequency is one shock per second.
4. To deoxygenated blood freely filled the heart, and the flow of venous blood to the heart was facilitated, the resuscitator should raise his hands above the sternum after each pressure, and the victim’s legs should be placed on a bolster to give them an elevated position.

External cardiac massage is performed strictly vertically at 101-112 compressions per minute.

External cardiac massage is performed for infants using the pads of the second and third fingers, for adolescents - with the palm of one hand. Adults with pressure thumb directed strictly at the head or legs, which depends on which side the resuscitator is standing on. During a closed massage, the fingers are raised so as not to touch the ore cell.

The technique of external cardiac massage for children depends on the age of the baby. The procedure is as follows: the baby is placed with his back on a hard surface with his head facing him. Press on the sternum with two fingers, and place your thumbs on the front of the chest. The other two fingers are held under the back.

For children under 7 years of age, it is more convenient to perform indirect cardiac massage using the base of the palm of the hand, standing on the side. In newborns, the deflection of the chest should be 1-1.5 cm, in infants up to one year - 2-2.5 cm, in toddlers over a year old- by 4-4 cm.

The number of sternum compressions per minute always corresponds to the child's pulse rate in accordance with age. That's why:

During the massage, the resuscitator alternates two breaths (performs artificial ventilation of the lungs) with 15 compressions.

To determine the effectiveness of mechanical ventilation and chest compressions, the resuscitator monitors the pulse in the carotid artery and the reaction of the pupils to bright light.

Performing chest compressions and mechanical ventilation should be performed by 2 resuscitators. First aid to a victim can save his life. It is carried out before the doctor arrives.

To restore the function of the cardiac system after stopping its central organ and maintaining blood circulation, artificial, i.e., indirect cardiac massage is performed, which is a set of measures.

The essence of the procedure

This is a resuscitation measure that is effective in the first 3-15 minutes after the heartbeat stops. Subsequently, irreversible consequences occur, leading to clinical death.

Closed heart massage and direct impact are not the same thing.

1. In the first situation, pressure occurs on the chest mechanically, as a result of which the heart chambers are compressed, which allows blood to enter first the ventricles and then into the circulatory system. Thanks to this rhythmic effect on the sternum, the flow of blood does not stop.
2. Direct is produced at the moment surgical intervention when opening the chest cavity, and the surgeon squeezes the heart with his hand.

Indoor massage should be correctly combined with artificial ventilation. The depth of pressure is at least 3, maximum 5 cm, which promotes the release of air in the range of 300-500 ml.

After compression is completed, the same volume is returned to the lungs. As a result, active-passive inhalation and exhalation occurs.

Indications for use

Before you start external massage heart, it is important to assess how necessary it is for the victim. There is only one indication for its implementation - stopping the heartbeat.

Signs of this condition are:

• sudden onset of sharp pain in the area of ​​the heart, which has never happened before;
• dizziness, loss of consciousness, weakness;
• pallor skin with a bluish tint, cold sweat;
• wide pupils, swelling of neck veins.

This is also indicated by the absence of pulsation in the carotid artery, the disappearance of breathing or convulsive breaths.

As soon as such symptoms arise, you must immediately seek help from any person (neighbor, passer-by on the street) and call a medical team.

Cardiac arrest is possible due to hemorrhagic or anaphylactic shock, due to lack of oxygen, hypothermia, and other unidentified factors.

First aid algorithm

Before resuscitation begins, you must immediately call ambulance. In the future, the algorithm of actions is based on belief:

• in the absence of heart beats and pulse, for which the carotid arteries are felt with the fingers, audible with the ear left area chest;
• there are other indicators of clinical death - no reaction to any actions, no breathing, fainting, pupils are dilated and do not respond to light.

The presence of such signs is an indication for a cardiac massage procedure.

Methodology and sequence

After the final conclusion that there is no heartbeat, resuscitation begins.

The technique consists of several stages:

1. Place the patient on a hard, flat surface (the floor is optimal). The massage rules do not allow the victim to be placed on a bed, sofa or other soft place, so there should be no deflection when applying pressure, otherwise the effectiveness of the procedure will be zero.
2. Use a napkin or handkerchief to clean the patient’s mouth from foreign objects (residues vomit, blood).
3. Tilt the victim's head back; you can place a cushion of things under the neck, which will prevent the tongue from sinking. Free the massage area from clothing.
4. Kneel on the left side (or to the right, if the rescuer is left-handed) of the patient, place your palms on the lower third of the sternum and above the xiphoid process by two folded fingers.
5. Determine the position of the hands so that one palm is perpendicular to the axis of the chest, and the second is on the back surface of the bottom, at 90 degrees to it. The fingers do not touch the body, but on the lower palm they are directed upward, towards the head.
6. Using straight arms, using the strength of the whole body, rhythmic, jerk-like pressure is applied to the chest until it deflects by 3-5 cm. At the maximum point, you need to hold your palms for at least 1 second, then stop the pressure, leaving your hands in place. In one minute, the frequency of pressing should not be less than 70, optimally 100-120. Every 30 compressions, artificial respiration is needed into the victim’s mouth: 2 exhalations, which will saturate the lungs with oxygen.

During massage, pressure should be applied strictly vertically, along the line connecting the spine and sternum. The compression is smooth and not harsh.

Duration and signs that determine the effectiveness of massage

The procedure should be done until the heart rate and breathing resume, or if they do not, until the ambulance arrives, or within 20-30 minutes. After this period of time, if there is no positive reaction from the victim, biological death often occurs.

The effectiveness of massage is determined by the following criteria:

• change in skin color (pallor, grayish or bluish tint decreases);
• constriction of the pupils, their reaction to light;
• the occurrence of pulsation on carotid arteries;
• return respiratory function.

The effect of resuscitation measures depends both on the speed and order of implementation, and on the severity of the illness or injury that provoked cardiac arrest.

Massage for infants

It happens that an indirect heart massage is required for a child, even a newborn. It must be carried out immediately to prevent irreversible consequences.

In a baby, heartbeat and breathing may stop due to:

• drowning while swimming;
• complicated neurological diseases;
• acute bronchospasm, pneumonia;
• sepsis.

Similar conditions occur in babies as a result of the syndrome sudden death or primary cardiac arrest.

The symptoms of cessation of respiratory and cardiac work are the same as in an adult, the same technique and sequence of activities, but with individual nuances.

For infants, pressure is applied not with the palm, but with two folded fingers - the middle and index fingers, for children 1-7 years old - with one hand, for victims over 7 years old - in the same way as for an adult - with 2 palms. When pressing, the fingers are located lower than the nipple line; the compression should not be strong, since the chest is quite elastic.

During massage, its deflection is:

• from 1 to 1.5 cm in a newborn child;
• from 2 to 2.5 cm in babies older than 1 month and up to a year;
• from 3 to 4 cm in children after 12 months.

In one minute, the number of clicks should correspond to the child’s heart rate: up to 1 month - 140 beats, up to a year - 135-125.

Basics for massage

For the procedure to be effective, it is important to follow the basic rules:

1. When compressing the chest, the next pressure should be after returning it to its normal position.
2. The elbows do not bend.
3. In an adult victim, the sternum deflection is at least 3 cm, in newborns - 1.5 cm, in children over a year old - 2 cm. Otherwise, there will be no normal circulation blood and will not be released into the aorta. Consequently, blood flow will not be established, and brain death will begin due to oxygen starvation.

The first aid technique prohibits the procedure in the absence of breathing, but the presence of a pulse. In such a situation, only artificial respiration is used.

Render necessary help allowed to a person who is in a fainting state, since he cannot give consent or refuse. If the victim is a child, then such measures can be used if he is alone and there are no people close to him (parents, guardians, accompanying persons). Otherwise, their consent is required.

It is important to remember that emergency care begins immediately in any situation. But it is highly not recommended to carry it out if there is a threat own life.

Complications and errors during massage

The main negative aspect of a massage may be a rib fracture. The fact that this happened is indicated by a characteristic rather loud crunch and subsidence of the chest.

If such a complication occurs, resuscitation should not be interrupted; it is enough to reduce the frequency of compressions on the sternum.

In such a situation, the priority becomes restoring the heartbeat, not broken ribs..

Often the effectiveness of resuscitation is low due to mistakes made:

• compressions are performed higher or lower the right place;
• positioning the patient on a soft rather than a hard surface;
• there is no control over the victim’s condition, and impulsive twitching is mistaken for a meaningful body movement.

When cleaning the oral cavity before a massage, do not rinse it with water, since the liquid will fill the lungs and bronchi and will not allow breathing to be restored (the condition of drowned people).

After regaining consciousness, patients often behave inappropriately. This normal reaction. It is necessary to prevent them from excessive activity and mobility until the ambulance arrives.

Efficiency forecast

The effectiveness of resuscitation has a different prognosis - from 5 to 95%. Typically, 65% of victims manage to restore cardiac activity, which allows them to save their lives.

Complete restoration of all functions is possible in 95% of cases when resuscitation measures were effective in the initial 3-5 minutes after the heartbeat stopped.

If breathing and heartbeat the victim recovered after 10 minutes or more, then there is a considerable probability that the functioning of the central nervous system, as a result of which he will remain disabled.

If the victim does not have a pulse, the following cardiac dysfunctions are possible:

• A sharp weakening or even complete cessation of heart contractions, which can be a consequence long stay victim under the influence of current, as well as lack of timely assistance in case of primary respiratory damage;
• Education under Action electric current scattered and multi-temporal (fibrillar) contractions separate groups fibers of the heart muscle, which cannot ensure the functioning of the heart as a pump that forces blood into the vessels, which occurs under the influence of high-power alternating current even when the victim is under voltage for a short time; in this case, breathing may still continue for some time after the victim is released from the action of the current, but the work of the heart is not effective and is not capable of supporting life.

Therefore, if the victim does not have a pulse, in order to maintain the vital functions of the body (to restore blood circulation), it is necessary, regardless of the reason that caused the cessation of heart function, to carry out external cardiac massage simultaneously with artificial respiration (air injection). It should be borne in mind that without proper and timely preliminary assistance to the victim before the doctor arrives medical assistance may turn out to be late and ineffective.

External (indirect) massage is performed by rhythmically compressing the heart through the anterior wall of the chest while pressing on the relatively mobile bottom part the sternum, behind which the heart is located. In this case, the heart is pressed against the spine and blood is squeezed out of its cavities into blood vessels. By repeating pressure at a frequency of 66 - 70 times per minute, you can ensure sufficient blood circulation in the body in the absence of heart function.

The possibility of such an imitation of the work of the heart arises as a result of a deep loss muscle tone(tension) in a dying person, as a result of which his chest becomes more mobile and pliable than that of a healthy person.

To perform external cardiac massage, the victim should be laid with his back on a hard surface (low table, bench or floor), his chest should be exposed, and his belt, suspenders and other items of clothing that would restrict breathing should be removed. The person providing assistance should stand on the right or left side of the victim and take a position in which a more or less significant bend over the victim is possible. If the victim is laid on a table, the person providing assistance should stand on a low chair, and if the victim is on the floor, the person providing assistance should kneel next to the victim.

Having determined the position of the lower third of the sternum (Figure 6, a), the person providing assistance should place the upper edge of the palm of an extended arm on it, and then put the other hand on top of the hand (Figure 6, b) and press on the victim’s chest, while slightly helping tilting your body. The pressure should be applied with a quick push so as to move the lower part of the sternum down towards the spine by 3 - 4 cm, and fat people– by 5–6 cm. The pressure when pressing should be concentrated on the lower part of the sternum, which, due to its attachment to the cartilaginous ends of the lower ribs, is mobile. Top part The sternum is fixedly attached to the bony ribs and can break if pressure is applied to it. You should also avoid pressing on the end of the lower ribs, as this can lead to their fracture. Under no circumstances should you apply pressure below the edge of the chest (on soft fabrics), since it is possible to damage the organs located here, primarily the liver.

Pressing on the sternum should be repeated approximately once per second.

After a quick push, the arms remain in the achieved position for approximately one-third of a second. After this, the hands should be removed, freeing the chest from pressure, in order to allow it to straighten. This facilitates the suction of blood from the large veins into the heart and its filling with blood.

If there is an assistant, one of those providing assistance, less experienced in this matter, should perform artificial respiration by insufflating air as a less complex procedure, and the second, more experienced one should perform indirect cardiac massage. To provide the body with a sufficient amount of oxygen in the absence of heart function, artificial respiration should be performed simultaneously with cardiac massage by blowing air into the victim’s lungs.

Since pressing on the chest makes it difficult to expand during inhalation, inflation should be done in the intervals between compressions or during a special pause provided every 4 to 6 compressions on the chest.

If the person providing assistance does not have an assistant and is forced to carry out artificial respiration and external cardiac massage alone, the above operations should be alternated in the following order: after 2–3 deep blows into the victim’s mouth or nose, make 15–20 pressures on the chest, then again makes 2 - 3 deep blows and again makes 15 - 20 pressures for the purpose of cardiac massage, etc. In this case, the air blowing should be timed to coincide with the end of the pressure on the chest or interrupting the heart massage for the duration of the blowing (about 1 second).

If the persons providing assistance are equally qualified, it is advisable for each of them to perform artificial respiration and external cardiac massage, alternately replacing each other every 5-10 minutes. Such alternation will be less tiring than continuously performing the same procedure, especially cardiac massage.

The effectiveness of external cardiac massage is manifested primarily in the fact that each pressure on the sternum leads to the appearance of a pulsating oscillation of the artery walls in the victim (checked by another person).

At correct implementation artificial respiration and cardiac massage, the victim appears the following signs of revival:

1. Improvement in complexion, acquiring a pinkish tint instead of the gray-sallow color with a bluish tint that the victim had before receiving assistance;
2. The emergence of independent breathing movements, which become more uniform as relief (resuscitation) activities continue;
3. Constriction of the pupils.

The degree of pupil constriction can serve the most a true indicator effectiveness of assistance provided. The narrow pupils of the person being revived indicate a sufficient supply of oxygen to the brain, and conversely, the beginning dilation of the pupils indicates a deterioration in the blood supply to the brain and the need to take more effective measures to revive the victim. This can be helped by raising the victim's legs approximately 0.5 m from the floor and leaving them in an elevated position during the entire time of external cardiac massage. This position of the victim’s legs promotes better blood flow to the heart from the veins of the lower body. To support your legs in an elevated position, you should put something under them.

Artificial respiration and external cardiac massage should be carried out until spontaneous breathing and heart function appear, however, the appearance of weak breaths (in the presence of a pulse) does not provide grounds for stopping artificial respiration.

In this case, as already mentioned above, the injection of air should be timed to coincide with the moment the victim begins to inhale. The recovery of the victim’s heart activity is judged by the appearance of his own regular pulse, which is not supported by massage. To check the pulse, interrupt the massage for 2 - 3 seconds, and if the pulse persists, this indicates independent work hearts. If there is no pulse during the break, the massage must be resumed immediately.

A prolonged absence of pulse and heart rhythm with spontaneous breathing and narrow pupils indicates cardiac fibrillation. In these cases, it is necessary to continue measures to revive the victim until the arrival of a doctor or until the victim is delivered to medical institution with continuous continuation of revitalization measures in the car.

It should be remembered that even a short-term cessation of revitalizing activities (1 minute or less) can lead to irreparable consequences.

After the first signs of revival appear, external cardiac massage and artificial respiration should be continued for 5 to 10 minutes, timing the insufflation to coincide with the moment of one’s own inhalation.

Heart massage: types, indications, closed (indirect) with mechanical ventilation, rules

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 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, providing emergency assistance(hereinafter referred to as the 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 predicting the presence dangerous infections it is impossible for a specific patient to be unconscious until the ambulance arrives medical care artificial respiration may not be performed, 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 protects against real threat transmission of infection, since contact of mucous membranes through a bag or a wet (from the resuscitator’s breath) mask still occurs. 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 paramedics arrive at the scene, the artificial ventilation lungs (ventilator), 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, press on the patient’s forehead with one hand and “lift” it with the fingers of the other hand. lower jaw upward 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 exactly the technique that is practiced at the first stage. medical workers. Nevertheless, a common person who has not made such a blow before can harm 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, the success of resuscitation and full recovery vital functions are observed in 95% of victims 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 similar 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 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

Resuscitation measures are a set of actions aimed at restoring and maintaining effective blood circulation and respiratory function to save a person’s life. Cardiac arrest requires immediate response and recovery measures. This procedure is considered indirect cardiac massage - artificial stimulation of cardiac movements with a closed chest through decompression, that is, compression. This movement imitates systole - the contraction of the heart, and relaxation - the second phase, or diastole. When should chest compressions be used, read further in the article.

When should chest compressions be used?

Cardiac arrest is a situation in which gas exchange and nutrition of all tissues and organs stop. Necrosis occurs - cell death associated with the accumulation of metabolic products and lack of oxygen supply. It is believed that the higher the metabolic rate in an organ, the less time it takes for it to die due to stopping effective blood circulation. For example, for brain cells this period is only 5-7 minutes.

Providing first aid is actions that can save a person. However, it is necessary to know when to use your cardiopulmonary resuscitation (CPR) skills and when, unfortunately, it is pointless.

The main indication in this case is clinical death - transition period between life and biological death, the reversible stage of dying. Vital signs completely disappear, which is important to check when assessing the need for external cardiac massage.

Characteristic features of such a state that need to be recorded at the scene of events:

• There is no pulse in the radial and carotid arteries. It is more important to detect the second option without feeling the victim’s neck characteristic features pulse wave.
• Respiratory movements do not occur at all or are similar to agonal movements - sharp and strong inhalations and exhalations, or short and frequent ones. To check a sign, you do not need to hold a mirror or a pen to a person’s mouth - searching for them will take up precious time. Experts recommend simply looking at the movements of the chest, and this can be done while trying to feel the pulse.
• The pupils are maximally dilated, there is no reaction to light - reflex constriction of the pupil.

If this description fits, then you should immediately try to restore hemodynamics - the effective movement of blood by performing chest compressions.

However, it may happen that the victim experiences:

• Signs biological death. This indicates that too much time has passed since the circulatory arrest. Cooling of the skin with the appearance of characteristic violet-blue cadaveric spots, numbness of the limbs, a pupil in the form of “ cat eye» – a thin gap.
• Severe polytrauma, when there are multiple fractures of the ribs or separation of the limbs.
• The presence of a pulse means that the heart is still working, even if the person is unconscious.

These conditions are contraindications to CPR.

Technique for performing indirect cardiac massage

It is not by chance that massage is called external - there is no direct contact with the structures of the heart; the action occurs with the chest closed.

The first step is to assess the condition and the presence of indications for resuscitation, after which it is important not to forget to call an ambulance. It's better if someone nearby calls.

Before performing chest compressions, it is important to ensure the right conditions:

• The victim should lie on a horizontal, hard surface. A universal place can be considered a hard floor or the ground if the incident occurred outdoors.
• The oral cavity must be cleaned. The head is turned to the side to allow vomit, blood or foreign bodies go out.
• Next, it is important to tilt your head back - this will prevent your tongue from retracting and free you Airways. It is ideal to place an improvised cushion under your neck.

The preparatory stage should last a few seconds, since each of them counts.

The technique itself consists of the following actions:

1. The position of the resuscitator is on the side of the victim at chest level.
2. The position of the hands during chest compressions is on the border between the lower and middle third of the sternum. Approximately this point is located two fingers above the lower edge of the sternum, but it is better to conditionally divide the bone into three parts and find the necessary border.
3. Hands should be connected one on top of the other, the point of application of forces is inner part elevations between thumb and little finger. It is better not to straighten the fingers of the other hand - when “locking”, the force of influence increases.
4. Movements must be rhythmic, at least 100 per minute. The degree of pressure is 3-5 cm deep, for this it is necessary to apply a sufficiently noticeable force.
5. After every 30 compressions, you need to take 2 breaths. In this case, the tidal volume should be greater than usual - you should first take a deep breath.
6. The pulse in the carotid arteries is monitored every minute.

Important! The main rule is not to bend your elbows! Movements should be made with the body, not with the hands, otherwise the depth of compression will be insufficient. The hands should be a kind of transmission lever.

Actions of one person

If there is only one resuscitator, then he has to cope with everything alone. Recommended ratios vary: previously it was believed that one rescuer could take two breaths every 15 chest compressions, now this figure still does not change, it remains in the form of a 30:2 rule.

It is very difficult to perform indirect cardiac massage alone, however, the reason for stopping resuscitation efforts is considered to be exhaustion of the rescuer’s strength.

Actions of two people

The help of a second witness to the tragedy is necessary in order to call an ambulance and provide the most effective CPR.

If we talk about the recommendations of the European Association of Reanimatologists, the ratio of 30:2 does not change regardless of the number of participants. However, the “old school” says something else - two people can take the tempo 5:1, and then one rescuer does chest compressions, and the second does artificial respiration.

Another option is to carry out the entire algorithm alone and change after a while; this significantly saves effort and increases the chances of waiting for specialists.

Rules for resuscitation of children

A child’s body is different from an adult’s, and therefore requires special actions when performing chest compressions:

• The hands are located at the lower edge of the sternum.
• Pressing is carried out not with two hands, but with one or even two fingers - depending on the age of the child.
• The tidal volume should not be very large. It will be enough for infants to inhale the air contained in the oral cavity.
• The ratio in children is allowed 5:1, while the depth of pressure is about 1.5-2 cm, but the rate remains at 100 per minute.

Forecast

According to various sources, it is worth performing closed cardiac massage until:

• pulse recovery;
• arrival of specialized assistance;
• exhaustion of the resuscitators' strength.

The average duration of rhythmic pressure on the sternum is about 30 minutes, after which we can reliably talk about the death of brain structures.

The prognosis depends on the time of initiation of CPR, the quality of its implementation and the characteristics of the patient’s body. Statistics show too contradictory figures - from 5 to 65% of cases end in the restoration of vital functions. However, the inverse relationship is obvious - without appropriate procedures, cardiac arrest leads to death in 100%. Therefore, it is the duty of every person to make every effort to save the life of the victim.