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Question 11. Resuscitation (revitalization)

It is a system of measures aimed at restoring the vital functions of an organism and removing it from a terminal state. These activities provide primarily effective breathing and blood circulation.

Indirect cardiac massage. (NMS) An indication for heart massage is to stop the effective contractions of the ventricles of the heart with asystole, ventricular fibrillation, or terminal bradycardia. These conditions require an immediate start of heart massage in combination with mechanical ventilation.

Therapeutic effect An effective cardiac massage provides sufficient blood supply to vital organs and often leads to the restoration of the independent work of the heart. The mechanical ventilation carried out at the same time provides sufficient oxygen saturation of the blood.

In pre-medical resuscitation, only indirect, or closed, cardiac massage is used (i.e., without opening the chest). A sharp pressure on the sternum of the palm of the hand leads to compression of the heart between the spine and sternum, a decrease in its volume and the release of blood into the aorta and pulmonary artery, i.e., it is an artificial systole.

At the time of the cessation of pressure, the rib cage straightens, the heart takes on a volume corresponding to diastole, and blood from the vena cava and pulmonary veins enters the atria and ventricles of the heart. The rhythmic alternation of contractions and relaxations thus in some way replaces the work of the heart, that is, one of the types of cardiopulmonary bypass is performed.

Technique for indirect heart massage. When conducting indirect heart massage, the patient should lie on a hard surface; if the patient is on the bed, then he needs to quickly put a shield under his back or put a stool under the bed net so that the thoracic spine rests on a hard surface; if the patient is on the ground or on the floor, it is not necessary to transfer the victim. The medical practitioner should stand on the side of the patient, placing his palm (the part closest to the wrist joint) on the lower third of the patient’s sternum. The second hand is placed on top of the first, so that the straight arms and shoulders of the massager are above the patient’s chest. A sharp pressure on the sternum with straight arms using body weight, leading to compression of the chest by 3-4 cm and compression of the heart between the sternum and spine, should be repeated 50-60 times in 1 minute. Carrying out a heart massage requires sufficient strength and endurance, therefore

It is desirable to change the massaging every 5-7 minutes, carried out quickly, without stopping the rhythmic massage of the heart. Given the fact that at the same time as cardiac massage, artificial ventilation is necessary, at least 3 people should participate in resuscitation.

The reason for the inefficiency of closed cardiac massage is the loss of cardiac muscle tone. In such cases, intracardiac administration of drugs that eliminate myocardial atony is necessary. A needle 10-12 cm long, put on a syringe, puncture the heart in the third or fourth intercostal space, 2 cm backward from the edge of the sternum. The direction of needle injection is strictly vertical. It should be established that the needle is in the cavity of the heart (blood should easily enter the syringe) and there is no danger of introducing the drug into the thickness of the myocardium. Only after that 0.3-1 ml of 0.1% solution of adrenaline or norepinephrine diluted in 10-15 ml of isotonic sodium chloride solution and 5-10 ml of 10% solution of calcium chloride or gluconate are injected intracardially.

Signs of the effectiveness of heart massage. Signs of the effectiveness of the massage are a change in previously dilated pupils, a decrease in cyanosis, pulsation of large arteries (primarily the carotid), according to the frequency of the massage, the appearance of independent respiratory movements.
Continue the massage until the restoration of independent heart contractions, ensuring adequate blood circulation. An indicator of the latter is the pulse determined on the radial arteries and an increase in systolic blood pressure to 80-90 mm Hg. Art. The lack of independent activity of the heart with the undoubted signs of the effectiveness of the massage is an indication for the continuation of the massage of the heart.

ARTIFICIAL LUNG VENTILATION

An indication for artificial ventilation (assisted and artificial respiration) of the lungs is a sharp weakening or lack of spontaneous breathing, which usually occurs in terminal conditions.

The task of artificial ventilation is the rhythmic pumping of air into the lungs in a sufficient volume, while exhalation is carried out due to the elasticity of the lungs and chest, that is, passively.

General characteristic of the mouth-to-mouth or mouth-to-nose artificial respiration method. The most accessible and widespread in the conditions of pre-resuscitation resuscitation is a simple method of artificial respiration "mouth to mouth" or "mouth to nose". At the same time, a double “physiological norm” can be blown into the patient’s lungs - up to 1200 ml of air.

This is quite enough, since a healthy person breathes in about 600-700 ml of air with calm breathing. The air blown by the carer is quite suitable for revitalization, as it contains 16% oxygen (at 21% in atmospheric air).

A condition for the effectiveness of artificial respiration. Artificial ventilation is effective only in cases where there are no mechanical obstructions in the upper respiratory tract and air tightness. In the presence of foreign bodies, vomit in the throat, larynx, it is first of all necessary to remove them (with a finger, clamps, suction, etc.) and restore airway patency.

The technique of artificial respiration is mouth-to-mouth and mouth-to-nose. When conducting artificial ventilation “mouth to mouth” or “mouth to nose”, the patient’s head should be thrown back as far as possible. In this position of the head due to the displacement of the root of the tongue and epiglottis anteriorly, the larynx opens and free access of air through it to the trachea is provided. The medical worker performing artificial respiration is located on the side of the victim, with one hand squeezes the nose, and the other opens his mouth, slightly pressing on the patient's chin. It is advisable to cover the patient’s mouth with gauze or bandage, after which the paramedical technician takes a deep breath, presses his lips tightly on the victim’s mouth and exhales vigorously. Then he takes his lips from the patient’s mouth and puts his head to the side. Artificial breath is well controlled. At first, air blowing is easy, but as the lungs fill and stretch, resistance increases.

Similarly to the mouth-to-mouth method, mouth-to-nose breathing is performed, while the patient’s mouth is closed with the palm of his hand or the lower lip is pressed against the upper finger.

With effective artificial respiration, one can clearly see how the chest expands during the "inhalation".

The technique of simultaneous artificial respiration and indirect heart massage. Effective artificial respiration, carried out in combination with indirect heart massage, requires a rhythmic repetition of vigorous blowing with a frequency of 12-15 per minute, that is, one "breath" for 4-5 compressions of the chest. In this case, one should alternate these manipulations in such a way that the blowing does not coincide with the moment of chest compression during cardiac massage. In cases of preserved independent work of the heart, the frequency of artificial breaths should be increased to 20-25 per minute.
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Question 11. Resuscitation (revitalization)

  1. Cardiopulmonary resuscitation (revitalization methods)
    I. Control and restoration of airway patency. II. Simultaneous indirect heart massage and mechanical ventilation. III. Monitoring the effectiveness of cardiopulmonary resuscitation. Cardiopulmonary resuscitation includes measures to restore impaired respiratory and circulatory functions. We should strive to revive man as a social being.
  2. PRIVATE QUESTIONS OF INTENSIVE THERAPY AND REANIMATION
    PARTICULAR QUESTIONS OF INTENSIVE THERAPY AND
  3. Revitalization with direct heart massage
    Direct cardiac massage should not be used as a normal, routine CPR method, as indirect massage is quite effective. At the same time, in some cases, due to the impossibility of resuscitation with the help of external compressions of the sternum, direct cardiac massage is required. In animal experiments, it was shown that direct cardiac massage performed after a short
  4. REVIVAL WITH THE DIRECT HEART MASSAGE
    Direct cardiac massage should not be used as a normal, routine CPR method, as indirect massage is quite effective. At the same time, in some cases, due to the impossibility of resuscitation with the help of external compressions of the sternum, direct cardiac massage is required. In animal experiments, it was shown that direct cardiac massage performed after a short
  5. Cardiopulmonary resuscitation - CLP (primary resuscitation in clinical death)
    Indications: lack of spontaneous breathing, pulse in the carotid arteries, consciousness, corneal reflex. Equipment: gauze napkin, scarf or duct. Algorithm of actions Touch, pat the victim on the shoulder and ask if everything is in order. If there is no answer, proceed with assistance. Stage I - restoration of airway obstruction Put the patient on his back
  6. The concept of resuscitation. Resuscitation Stages
    Types of resuscitation: 1. elementary indirect heart massage, mechanical ventilation, state of unconsciousness, but a person is alive (This is a coma, head injury) First aid: Should not lie on your back. The tone of the subclinical muscles, soft palate, cough and swallowing reflexes (dropping of the tongue => blocks the airways) is sharply weakened> we turn on the stomach 2.
  7. Resuscitation
    Resuscitation is the restoration of vital body functions (primarily respiration and blood circulation). Resuscitation is carried out when there is no breathing and cardiac activity ceases or both of these functions are so depressed that practically breathing and blood circulation do not satisfy the needs of the body. The mechanism of dying is extremely complex and; resuscitation is based on
  8. Resuscitation of newborns
    Risk factors that can make delivery difficult include: gestational age less than 36 weeks; instrumental or operational benefits in childbirth; pathological presentation of the fetus; multiple pregnancy; fetal distress and meconium coloration of amniotic fluid; Rhesus incompatibility; revealed by ultrasound examination of fetal malformation; violation of labor. Most
  9. Resuscitation. General concepts
    It has been established that the human body continues to live for some time after stopping breathing and the cessation of cardiac activity, despite the fact that the flow of oxygen into the body stops, without which the existence of a living organism is impossible. The cerebral cortex is most sensitive to oxygen starvation of the human body. In the absence of oxygen in the body
  10. Concepts of resuscitation.
    Rean-tion is a complex of measures aimed at revitalizing the body. Resuscitation is most effective in those cases when death occurred suddenly (electric shock, etc.). Clinical death is a reversible stage of the body's death, in which a return to human life as a person is possible. It starts from the moment of stopping breathing and blood circulation and ends with the appearance of irreversible
  11. Cardiopulmonary resuscitation
    Cardiopulmonary resuscitation is a set of measures aimed at revitalizing the body in case of circulatory and / or respiratory failure, that is, when clinical death occurs. Clinical death is a kind of transitional state between life and death, which is not death yet, but can no longer be called life. Pathological changes in all organs and systems at the same time
  12. Primary cardiopulmonary resuscitation of children
    With the development of terminal conditions, timely and correct conduct of primary cardiopulmonary resuscitation allows, in some cases, to save the lives of children and return the victims to normal life. Mastering the elements of emergency diagnostics of terminal conditions, a solid knowledge of the methods of primary cardiopulmonary resuscitation, extremely clear, "automatic" implementation of all
  13. Cardiopulmonary resuscitation
    Cardiopulmonary resuscitation (CPR) methods are constantly being improved, so students of medical universities and doctors of all specialties should receive continuous information about new views and achievements in this area. There is no need to talk about the importance of CPR in first aid practice. Timely and correct conduct of CPR will, in some cases, save lives and return victims to
  14. ABC is a cardiopulmonary and cerebral resuscitation program.
    Sudden circulatory arrest leads to a state of clinical death, which without assistance lasts no more than a few minutes. Then comes brain death from anoxia, severe hypoxic damage to other internal organs, and death is already defined as biological. Each person, and a medical professional, must first be able and always be ready to provide qualified
  15. Legal aspects of resuscitation
    In accordance with the Russian legislation on health protection, cardiopulmonary resuscitation is not indicated: • • if death occurred against the background of a full range of intensive care, which was ineffective in this pathology due to imperfections in medicine; • • for a chronic disease in the terminal stage of its development (malignant neoplasm, cerebrovascular accident
  16. PRINCIPLES AND RESOURCES METHODS
    Purpose of work: to consolidate and deepen theoretical information about the terminal state, to master the methods of revitalizing the body. Content 1. Learn the techniques of revitalization according to the ABC program: 1.1 Emergency restoration of airway patency; 1.2 Artificial ventilation of the lungs in the mouth or mouth in the nose; 1.3 Simultaneous restoration of blood circulation using closed massage
  17. Basic principles of resuscitation
    Since survival decreases exponentially as the time elapsed from the moment of cardiac arrest to the start of resuscitation (Fig. 20.2), the greatest success was achieved in patients who used CPR for a period of 5 to 10 minutes. Given the need for urgent resuscitation, the first to detect respiratory arrest and heart failure should call for help, start artificial ventilation, and how
  18. Cardiopulmonary resuscitation
    Cardiopulmonary resuscitation (CPR) methods are constantly being improved, so students of medical universities and doctors of all specialties should receive continuous information about new views and achievements in this area. There is no need to talk about the importance of CPR in first aid practice. Timely and correct conduct of CPR will, in some cases, save lives and return victims to
  19. Consequences of resuscitation
    DIRECT POST-RESERVATION PERIOD Cardiopulmonary resuscitation initially restores blood circulation function in 40–50% of patients who underwent resuscitation. (This percentage for sudden death outside the hospital and Above in a hospital setting, especially if respiratory cardiac arrest has occurred in the intensive care unit.) 1 With this position, it is difficult to unconditionally
  20. The purpose of resuscitation
    The ultimate goal is to return the patient to a state of normal function of the nervous system with a stable heart rhythm and normal hemodynamics. This will require further resuscitation, adapted to the individual needs of each patient. The postresuscitation period begins from the moment when the ICS is reached, and the stabilized patient is transferred to the most appropriate area
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