Medical training. Resuscitation measures. Indirect cardiac massage: technique of execution. Cardiac massage and artificial respiration

The uninterrupted functioning of the heart is a prerequisite for the continuation of life. 5 minutes after it stops, the cerebral cortex begins to die, so it is extremely important to start performing artificial or indirect cardiac massage (ICM) as early as possible, even if you are not entirely sure of the correctness of your actions.

The information, drawings, photos and videos in this article are of a general educational nature and are intended for absolutely all people who have reached the age of majority. We will tell you about the rules for performing chest compressions and artificial respiration, according to new instructions European Resuscitation Council from 2015, in the most difficult situation, when the person providing assistance is one-on-one with a person whose cardiac activity has stopped.

The main task of cardiac massage is to artificially replace myocardial contractions in cases where they have been stopped.

This can be achieved in two ways:

performing chest compressions by non-specialists, rescuers or emergency medical personnel;
manual manipulation by a cardiac surgeon directly on the heart during surgery.

Massage manipulations are aimed at maintaining blood circulation through large vessels of the brain, lungs and myocardium. The correct frequency and depth of indirect impact on the heart through the chest wall can provide a 60% release of blood volume compared to the blood flow that occurs with self-contracting myocardium.

Pressure imitates contraction of the heart muscle (systole), and its cessation during complete weakening of the chest - relaxation (diastole).

The basic set of resuscitation measures also includes ensuring airway patency and performing artificial ventilation lungs (ventilator). Their the main objective– this is the maintenance of gas exchange by forced renewal of air.

On a note. It has been established that the main factor in the success of resuscitation is adequate actions during chest compressions. If you are afraid or disdainful to do artificial respiration, then be sure to give the victim chest compressions according to the rules described below.

Conditions under which external cardiac massage can be performed

Indications for chest compressions are the cessation of heartbeats - the onset of clinical death, recognized by the following characteristics:

persistent loss of consciousness;
lack of pulse;
respiratory arrest;
huge pupils that do not respond to light.

For heart pain and/or other symptoms observed with cardiovascular diseases, for example, slowing down inhalations and exhalations, indirect massage and mechanical ventilation are prohibited.

Attention. Artificial massage for the heart, “for future use” can end either in stopping its work, or in a significant deterioration in the condition of the sick person.

How to start the indirect myocardial massage procedure

Before we talk directly about the technique of heart massage itself, we will pay attention to the preparatory actions, which will simultaneously serve as permission to perform it:

Quickly inspect the scene to avoid getting into a similar situation yourself, for example, getting an electric shock from a bare wire.
Check the victim's consciousness. It is forbidden to shake him violently, hit him on the cheeks, pour water on him, let him sniff ammonia or ammonia, or waste time looking for and applying a mirror to his lips. Firmly squeeze the person who you think is lifeless by the arm or leg, carefully jog and call out to him loudly.
If there is no reaction, make sure the victim is lying on a hard, level surface and turn him onto his back. If there is no need, then once again do not move or carry a person in trouble anywhere.
Open the victim’s mouth slightly and tilt your ear towards him so that you can see his chest from the side and above; if you can, then try to feel the pulse where you can and know how. For 10 seconds, examine your breathing using the “SOS – listen, feel, see” method (see photo above). Here's what it is:
1. C – listen with your ear for sounds of inhalation and exhalation;
2. O – try to feel the presence of exhalation with your cheek;
3. C – look at the chest, whether it moves or not.

Why is the need for cardiac massage primarily determined by the absence of respiratory cycles, and not by cardiac arrest?

Firstly, it is difficult for ordinary people to quickly find a “healthy” pulse on the wrist even in normal situations, let alone extreme conditions in which, in addition to weak beating and/or too rare beats, it is recommended to palpate the heart rate at carotid artery.
Secondly, a frightened person may be afraid to open the victim’s eyes to determine the size of the pupils, moisture and transparency of the cornea, or may not be able to correctly assess these characteristics.
Third, because loss of breathing quite quickly ends in cardiac arrest and loss of consciousness. If there is no breathing, the main thing is to ensure access of blood to the brain and prevent its cortex from dying.

Indirect cardiac massage technique

Currently, not for doctors or rescuers, but for ordinary people who, due to the current circumstances, are forced to provide assistance in starting the heart and restoring respiratory cycles, the following procedure is recommended:

C (circulacion) – performing a cycle of external cardiac massage;
A (airwey) – control and ensure free passage of air into the lungs;
B (breathe) – artificial ventilation of the lungs.

How to do indirect cardiac massage correctly

The position of the hands of the person providing assistance should be perpendicular to the victim’s chest, and he himself should be on the side of it.
The palms should be folded one on top of the other, and the fingers should be raised, or the fingers should be interlocked.
In order not to injure the lower extremity of the sternum - the xiphoid process, the base of the “lower” palm should be rested in its middle.
The frequency of compressions during chest compressions is the optimal rate for an adult from 100 to 120 compressions per second.
When doing presses, do not bend your elbows! The pressure occurs due to the weight of the body during its tilt.
The number of massage pressures in one continuous cycle is 30 times.
The pressure should be such that the palms “sink down” by 5-6 cm.

On a note. It is imperative to ensure that the ratio of the time of pressing and the time of returning the hands to the starting position is the same. This is extremely important for filling the heart chambers with a sufficient volume of blood.

Ensuring access of air to the lungs and artificial ventilation of the lungs

Since cardiac massage only provides blood movement and cannot prevent hypoxia of the tissues of the cerebral cortex, massage should be combined with mechanical ventilation to ensure gas exchange.

Before starting artificial respiration, you need to relieve Free access air into the lungs.

First, place the victim’s head in a position that prevents the tongue from retracting (see picture above):

tilt your head back - at the same time press on your forehead with one hand and lift your neck with the other (1);
push forward lower jaw– pick up the lower jaw with your fingers and align the lower and upper teeth in one plane (2);
open your mouth, pulling your chin down a little (3);
Check the position of the tongue, and if it is stuck, pull it out with two fingers.

Then check the position of the tongue and the presence of mucus. If necessary, the tongue is pulled out with 2 fingers, like tongs, and the mucus is collected with the index finger, acting as a spatula.

Important. If a neck fracture is suspected, the head is not thrown back, and when performing artificial inhalation, in order not to further move the vertebrae, they try not to strong pressure on the mouth.

Mechanical ventilation techniques and rules

If, after the first 30 rhythmic pressures on the middle of the sternum and restoration of airway patency, cardiac activity has not resumed, alternating mechanical ventilation with the mouth-to-mouth technique and IMS begins:

Do it yourself deep breath, pinching the victim’s nose with two fingers.
Within 1 second, exhale your air completely into his mouth. At this time, squint your eyes and look at the chest to see if it has expanded or not.
Pause for 2-4 seconds. It will simulate passive exhalation.
Repeat the exhalation into your mouth for a second, controlling the movements of your chest.
Straighten up and begin doing 30 presses to the middle of the chest.

Number of artificial breaths

There is no need to make more than 2 exhalations into the victim’s mouth. Their excess amount increases tidal volume, which leads to a decrease in cardiac output and blood circulation.

Artificial respiration techniques

The “mouth to mouth” method is replaced by “mouth to nose” if a person has an injury to his mouth or is unable to open it. In this case, you need to monitor the tightness of the ventilator, supporting your chin with your fingers just in case.

Reasons for the ineffectiveness of mechanical ventilation

If at first artificial breaths rib cage does not inflate, then this may be due to:

insufficient sealing of the respiratory tract - the nose (or mouth) is not tightly closed;
weak exhalation force of the person providing assistance;
availability in oral cavity affected by mucus or foreign objects.

What to do in the first two cases is clear, but when trying to remove a foreign object using a large and index finger, act extremely carefully so as not to push it even deeper.

Features of cardiopulmonary resuscitation in children

To help children, you should remember a few simple and easy to remember rules:

Algorithm for performing cardiopulmonary resuscitation, tempo and frequency of compressions during chest compressions for everyone age categories, starting from birth, is the same, as is its ratio with mechanical ventilation – 30 to 2.
U infant tilting your head back should be easy. Strong neck deflection in infants leads to airway obstruction!
For a child aged 1 to 10 years, pressing on the middle of the sternum is carried out with only one hand. In newborns and infants, indirect heart massage is performed with bundles of 2 (middle and ring) or 3 (+ index) fingers.
Air is blown into the infant's mouth and nose at the same time. This technique is also recommended for use in older children, as long as the size of the facial skull allows such a girth to be made without violating its tightness.
Be careful! The force, depth and volume of air during passive inspiration should not be large, especially if mechanical ventilation is performed on an infant. Conventionally, the volume should be equal to the amount of air that fits “between your cheeks,” taken without a deep breath, and the exhalation should be like a blow.

On a note. The recommended force (depth) of pressure in children and newborns is approximately 1/3 of the chest diameter. There is no need to be afraid of breaking bones. At this age, they are still pliable and have not completely ossified.

When you can and should call for help

It is absolutely impossible to delay starting external cardiac massage, but when can you be distracted by calls for help and calling an ambulance?

Presence of people and age of the unconscious person	Procedure
	Call loudly and briefly to those you see. Do this without stopping pressing on the sternum. After their arrival, quickly ask to call an ambulance, continuing resuscitation efforts. After the call, they can help, for example, you continue to do mechanical ventilation, and they, alternating with each other, do IMS.
	After performing “SOS”, first call an ambulance. Otherwise, all your efforts to maintain blood flow in the cerebral cortex may be pointless if professional medical assistance is not provided in a timely manner.
	No calls! First of all, do 4-5 cycles of IMS + ventilation. And only after that, stop to call an ambulance.

Duration of the IC and actions performed after it

It is necessary to continue resuscitation measures until you are relieved by a medic or rescuer who arrives on call.

If your actions were successful - signs of life appeared, then you need to follow the “Actions after resuscitation” protocol:

Lay the person down as in the picture above. While in it, he will not be able to accidentally tip over on his back. This will save him from choking on vomit, which quite often begins to erupt after IMS. For insurance, you can put a pillow, a rolled blanket or any other object, even a hard one, under your back, and cover it with a blanket on top. Note:
1. the left palm is placed under the cheek, but it is better for the left forearm to serve as a cushion for the neck;
2. the left leg is bent and rests the knee on the floor;
3. The entire body is not clearly positioned on its side, but its stomach is slightly turned toward the floor.
The infant should be held in your arms, in a position on your side, so that you can see his face and chest at all times.
Do not give medications, drink, eat or give injections under any circumstances.
Do not leave a person unattended, monitoring the continuity of his breathing.

And at the end of this article, in order to convince you that doing cardiac massage and artificial respiration is not very difficult, watch a short video with correct technique performing these resuscitation procedures. The price of your composure, overcoming uncertainty and fears is a saved human life.

How to give an indirect cardiac massage to yourself September 2nd, 2017

Imagine that it is evening and you are walking home alone after a very have a hard day. You are very tired and your strength has left you. Suddenly you start to feel severe pain in your chest, which begins to radiate into your arm and up towards your jaw. You are several kilometers from the nearest hospital.

And you don't know whether you can reach it or not.

Have you taken a first aid course or, like most people, have forgotten or do not know the skills of indirect cardiac massage. But even if you remember, they didn’t tell you how to make it yourself.

Because many people are alone when a heart attack occurs, the person only has about 10 seconds before they lose consciousness after their heart begins to beat irregularly and they begin to feel like they are going to pass out.
You can help yourself. It is necessary to cough repeatedly and very vigorously.

Before each cough, take a deep breath. The cough should be deep and prolonged, as if coughing up mucus from the depths of the lungs. Inhalation and coughing should be repeated approximately every 2 seconds without interruption until help arrives or until you feel that the heart has begun to beat normally again.

Taking deep breaths brings oxygen to the lungs, while coughing compresses the heart and keeps the blood circulating. Compressive pressure on the heart also helps it restore its normal rhythm. This way, heart attack victims can get time to get to the hospital.

Here is an interesting and informative story about how you can do self-reanimation:

"The boy lived in a remote village with his grandmother on her pension. There was an abandoned village nearby. He decided that since no one had lived there for a long time, he could remove the copper wires from the poles that remained in this village and earn a little money. The boy, apparently, was very young and uneducated, because he believed that electricity was not supplied to the abandoned village. He climbed onto a pole and extended his hand with wire cutters towards the wire. He woke up a day later because it was raining on him.

Of course, the 3000 volt line was in good condition. Once in the area of the electric field, the boy received a severe electric shock followed by cardiac arrest. But the impact on the ground when falling from a pole was a kind of massage of the heart (it is called a precordial blow), very effective in stopping it reflexively."

Drawing a conclusion, we can say that even when falling to the ground, you can give yourself an indirect heart massage. With such meaning and logical reasoning, you can beat yourself in the chest with your fist. Or even go up to a pole or tree and bang your chest against it.

How to give chest compressions to another person yourself

Lay the patient with his back on a hard surface, unbutton his clothes, freeing the chest. Stand on the side of the victim so that you are comfortable - on your knees or at full height. Then you should put it on bottom half chest with your palm so that your fingers are perpendicular to the victim’s chest. Place your other hand on top, but your fingers should not touch your body. Straighten your arms and place them perpendicular to your chest. Make quick thrusts without bending your elbows. Be careful, during your actions the sternum should bend by 4 cm. You need to carry out the massage for at least half an hour, during which time you will have time to arrive “ ambulance"and the doctors will continue resuscitation measures for you.

If you are performing an indirect massage on an adult, then pressure must be applied at a frequency of 70 times per minute, not forgetting to maintain rhythm. For children under 12 years of age, heart massage is performed with only one hand, and for very young children - with the chest, external massage done with the tips of two fingers. Do not put too much pressure on the sternum and ribs, because there is a danger of breaking them. Infants need 100 - 120 compressions per minute, and older ones - 70 - 80.

When the following signs, resuscitation measures can be stopped:

The presence of a pulse in the femoral, carotid and radial arteries;

The appearance of a reaction to light;

Constriction of the pupils;

Promotion blood pressure in the patient up to 70-80 mm Hg;

Disappearance of pallor and bluish coloration skin;

Restoring breathing.

If the pulse in the carotid artery is palpable, then indirect cardiac massage can be completed. If the patient is not breathing, only pulmonary resuscitation should be continued. In most cases, your doctor will give you permission to stop CPR.
Signs of cardiac arrest are:

Absence of pulse - to check the pulse you need to place two fingers (index and middle) on the carotid artery

Stopping breathing - to determine, look at the chest to see if it is in breathing movement, or bring a mirror to your nose, if it sweats, then there is breathing;

Dilated pupils that do not respond to the glow of a flashlight and other light sources;

Loss of consciousness if a person does not come to his senses when he is tapped on the face or loud sounds(cry and others);

Change in skin color to a bluish tint.

If you do healthy person If you are conscious, artificial respiration and cardiac massage can break ribs, which can then cause damage to internal organs. According to the rules, you must first make sure that the person does not react to external stimuli, is not breathing, and has no pulse. Only then begin cardiopulmonary resuscitation.

Heart massage - what is it for?

Cardiac massage involves squeezing the heart with a certain frequency, which, firstly, promotes artificial pumping of blood, and secondly, activation of its own electrical activity, which together helps restore heart function.

Depending on the method, a distinction is made between direct and indirect cardiac massage. Direct cardiac massage is based on a direct impact on it - direct access to the heart is provided and the hands begin to compress and unclench it.

Indirect massage Cardiac compression is based on pressing on the chest in the area where the heart is located. Thus, in fact, the pressure on the heart is exerted by the chest.

In most cases, in case of cardiac arrest, the victim is given an indirect massage, since only a doctor can perform direct cardiac massage, and then only with the help of special equipment.

Tell as many people as possible about this. This could save their life!

Sources:

Clinical death is a condition in which human body no heartbeat and respiratory functions, but at the same time irreversible processes haven't started yet. During this period, correctly carried out resuscitation actions can save a human life, so each of us should know what indirect cardiac massage is (technique). Quite often, pathologies such as stroke, heart attack, thrombosis, hemorrhage and other diseases associated with the functioning of the heart lead to cardiac arrest. of cardio-vascular system and brain. Providing first medical care is the duty of every conscientious person, and it must be carried out in accordance with medical standards. Therefore, below we will consider a step-by-step technique for performing chest compressions, and will also tell you how to perform artificial ventilation.

Let's turn to physiology: what happens after the heart stops

Before we figure out how to properly perform artificial respiration and cardiac massage, let’s turn to human physiology and consider how the heart and vascular system, and what are the consequences of stopping blood flow in the body.

The human heart has a four-chamber structure and consists of two atria and two ventricles. Thanks to the atria, blood enters the ventricles, which, during systole, push it back into the pulmonary and systemic circulation to distribute oxygen and nutrients throughout the body.

The work of blood is as follows:

blood flow: passing through big circle blood flow, carries vital important substances for cells, while taking away decay products from them, which are then excreted from the body through the kidneys, lungs and skin;
the task of the small circle of blood flow is to replace carbon dioxide with oxygen; this exchange occurs in the lungs during inhalation and exhalation.

When the heart stops, blood stops flowing through the arteries, veins and vessels. The entire process described above stops. Decay products accumulate in the cells, and the lack of respiration leads to the saturation of the blood exclusively with carbon dioxide. Metabolism stops and cells die as a result of “intoxication” and lack of oxygen. For example, to kill brain cells, it is enough to stop the blood flow for up to 3–4 minutes, in exceptional cases this period is slightly increased. Therefore, it is so important to carry out resuscitation actions for the first time minutes after the heart muscles stop working.

Indirect cardiac massage: technique

To perform an indirect cardiac massage, you need to place one hand (palm down) on 1/3 of the lower part of the sternum. The main center of pressure should be on the metacarpus. Place your other palm on top. The main condition is that both hands must be kept straight, then the pressure will be rhythmic with equal force. The optimal force is considered to be when the sternum drops 3–4 cm during chest compressions.

What happens in the body during resuscitation? When exposed to the chest, the chambers of the heart are compressed, while the interchamber valves open, and blood penetrates from the atria into the ventricles. The mechanical effect on the heart muscles helps push blood into the vessels, which prevents the blood flow from stopping completely. If the actions are synchronous, then the heart’s own electrical impulse is activated, thanks to which the heart “starts” and blood flow is restored.

Rules for conducting resuscitation massage

Before performing indirect cardiac massage, it is necessary to find out whether there is a pulse, and also respiratory processes. If they are absent, a number of mandatory actions should be performed before starting cardiac massage and ventilation.

Place the person straight, preferably on a flat, hard surface.
Loosen clothing and determine the pressure point.
Kneel next to him on the side that is comfortable for you.
Clear Airways from possible vomit, mucus, and foreign objects.
An adult is given a heart massage with two hands, a child with one, and an infant with two fingers.
Repeated pressure is applied only after the sternum has completely returned to its original position.
The norm is considered to be 30 impacts on the chest, per 2 breaths, this is justified by the fact that when impacting the sternum, passive inhalations and exhalations occur.

How to resuscitate a victim: the actions of one person

One person can perform indirect cardiac massage and artificial respiration himself. Initially, the “preparatory” actions described above are performed, after which the execution technique algorithm should be as follows:

Initially, two air injections are made, each lasting 1–2 seconds. After the first blowing, you need to make sure that the chest drops (the air comes out) and only then make the second blow. It can be done by blowing through the mouth or nose. If artificial ventilation of the lungs is carried out through the mouth, then the nose is pinched with the hand, if through the nose, then the mouth is secured with the hand. In order to protect yourself from the possibility of pathogenic microflora entering your body, you need to inflate through a napkin or handkerchief.
After the second injection of air, begin chest compressions. Your arms should be straight, their correct position is described above. Controlling the strength, apply 15 pressures.
Repeat the steps from the beginning. Resuscitation should continue until arrival emergency care. If 30 minutes have passed since the person began to “revive”, and no signs of life (pulse, breathing) have appeared, then biological death is declared.

If indirect cardiac massage and artificial respiration are performed by 1 person, the frequency of effects on the chest should normally be about 80–100 compressions per minute.

How should a victim be resuscitated? Actions of two people

If indirect cardiac massage and artificial respiration are performed by 2 people, then the algorithm and technique are different. Firstly, it is much easier for two people to perform resuscitation, and secondly, each of those providing assistance is responsible for a separate process, cardiac massage or ventilation of the lungs. The technique for performing resuscitation is as follows:

The person performing artificial respiration kneels at the head of the victim.
The person responsible for the process of indirect massage places the hands on the patient’s sternum.
Initially, two injections are made into the mouth or nose.
Afterwards, two impacts on the sternum.
Insufflations are repeated again after pressing.

The normal frequency of compressions during resuscitation by two people is about 80 times per minute.

Features of children's resuscitation

The main differences (features) of resuscitation in children are as follows:

using only one pussy or only two fingers;
the frequency of pressure for infants should be about 100 times per minute;
the depth of breast descent during compression is no more than 1–2 cm;
During resuscitation, children are given air blowing through the oral cavity and through the nasal canals, the frequency of blowing is about 35–40 times per minute;
Since the volume of the child’s lungs is small, the air blown in should not exceed the volume that can be accommodated in the resuscitator’s mouth.

Remember that you can bring a person back to life only for the first few minutes after cardiac arrest, so do not hesitate, but immediately begin resuscitation actions.

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Resuscitation actions are carried out when a person is found to have no pulse or breathing. Resuscitation measures include chest compressions and artificial ventilation (artificial respiration). Every person must be trained in these skills in order to provide timely assistance to the victim and save his life.

Resuscitation measures must be carried out correctly, in accordance with medical standards and algorithms. Only if cardiopulmonary resuscitation is performed correctly is it possible to restore vital functions.

Technique for performing indirect cardiac massage and artificial ventilation of the lungs

External (indirect) cardiac massage is a compression that leads to compression of the heart muscle and pumping blood throughout the body. The indication for closed cardiac massage is the absence of a pulse. Moreover, the pulse must be determined only in large arteries (femoral, carotid).

Rules and procedure for performing indirect (external) heart massage:

The second hand is placed on top of the working hand;
It is necessary to perform compressions only with your arms straight at the elbows. In this case, you need to press with your whole body, and not just with your hands. Only in this case will there be sufficient force to compress the heart;
Only the sternum is pressed down by 3–5 centimeters; the ribs cannot be touched;
Compressions should be rhythmic and equal in strength. The frequency of compressions is from 100 to 120 per minute.

Artificial respiration can be performed in several ways: mouth to mouth, the most commonly used method, mouth to nose, mouth to mouth and nose, used in small children and with an Ambu bag.

Algorithm for performing artificial respiration:

Lay the person down on a flat surface and place a small cushion under the neck. Open your mouth and check if there is foreign bodies in him;
Place a handkerchief or gauze pad on the victim’s mouth or nose. This will protect the rescuer from contact with the victim’s secretions and possible infection;
Pinch the patient's nose;
Inhale, cover the patient’s open mouth with your lips and press them tightly so that the air does not escape. And exhale in the usual volume;

Monitor the correct performance of artificial respiration. While blowing air, pay attention to the person's chest. It must rise;
Inhale and exhale again into the victim’s mouth. It should be noted that the rescuer should not breathe frequently or deeply. Otherwise, he will become dizzy and may lose consciousness.

First perform artificial respiration. It is necessary to take 2 breaths in a row, the time taken is 10 seconds, and then begin indirect massage.

The ratio of artificial respiration (ventilation) to chest compressions is 2:15.

Resuscitation actions of one person

Resuscitation measures are a labor-intensive and energy-consuming process. Therefore, it is recommended that 2 rescuers perform them. But this condition is not always feasible. Therefore, in some situations, 1 person has to perform rescue procedures. How to act in such conditions?

This
healthy
know!

Technique for performing chest compressions and mechanical ventilation by one person:

Lay the victim on his back on a flat surface, place a cushion under his neck;
First, mechanical ventilation is performed using the mouth-to-mouth or mouth-to-mouth method. If blowing is done through the nose, then you should close your mouth and fix it by the chin. If artificial respiration is performed through the mouth, then the nose is pinched;
2 breaths are taken;
Then the rescuer immediately begins performing indirect massage. He must perform all manipulations clearly, quickly and correctly;
15 compressions (pressures) are performed on the chest. Then artificial respiration again.

One person to perform cardiopulmonary resuscitation difficult, so in this case the number of compressions should not be less than 80 - 100 per minute.

The rescuer performs resuscitation actions until: the appearance of a pulse and breathing, the arrival of an ambulance, and the expiration of 30 minutes.

Carrying out cardiopulmonary resuscitation by two rescuers

If there are two rescuers, then resuscitation actions are much easier to perform. One person does artificial respiration, and the second does indirect massage.

Algorithm for performing indirect (external) cardiac massage 2rescuers:

The victim is placed correctly (on a hard and flat surface);
1 rescuer is located at the head, and the second puts his hands on the sternum;
First you need to make 1 injection and check that it is performed correctly;
Then 5 compressions, after which the activities are repeated;
The compressions are counted audibly so that the second person prepares in time to perform mechanical ventilation. In this case, resuscitation is carried out continuously.

The rate of compressions when providing cardiopulmonary resuscitation by 2 people is 90 - 120 per minute. Rescuers must change so that the effectiveness of resuscitation efforts does not decrease over time. If the rescuer who performs the massage wants to change, then he must warn the second rescuer in advance (for example, during the count: “switched”, 2, 3, 4.5).

Features of external cardiac massage and mechanical ventilation in children

The technique for performing resuscitation in children directly depends on their age.

Child's age	Artificial respiration	Indirect cardiac massage
Newborns and infants	Mouth to mouth and nose method. The adult should cover the baby's mouth and nose with his lips; Insufflation frequency – 35; Air volume – adult buccal air	It is carried out by pressing 2 fingers (index and middle) on the middle of the child’s sternum; Compression frequency – 110 – 120 per minute; Depth of sternum compression – 1 – 2 centimeters
Preschool children	Mouth to mouth and nose method, less often mouth to mouth; The frequency of injections is at least 30 per minute; The volume of air blown in is the amount that fits in the oral cavity of an adult.	Compressions are performed with the base of 1 palm (working hand); Compression frequency – 90 – 100 per minute; Depth of sternum compression – 2 – 3 centimeters
School age children	Mouth to mouth or mouth to nose method; Number of injections per minute – 20; The volume of air is the normal exhalation of an adult.	Compressions are performed 1 (at junior schoolchildren) or 2 (for teenagers) hands; Compression frequency – 60 – 80 per minute; Depth of sternum compression – 3 – 5 centimeters

Signs of effectiveness of cardiopulmonary resuscitation

It should be remembered that only effective and correct resuscitation can save a person’s life. How to determine the effectiveness of rescue procedures? There are several signs that will help you assess whether CPR is being performed correctly.

Signs of the effectiveness of chest compressions include::

The appearance of a pulse wave in large arteries (carotid femoral) at the time of compression. This can be tracked by 2 rescuers;
The dilated pupil begins to narrow, a reaction to light appears;
The skin changes its color. Blueness and pallor are replaced by a pinkish tint;
Gradual increase in blood pressure;
Independent breathing activity appears. If there is no pulse, then you must continue to perform only actions without ventilation.

Main mistakes when performing resuscitation actions

For cardiopulmonary resuscitation to be effective, it is necessary to eliminate all errors that could lead to death or serious consequences.

The main mistakes when performing rescue operations include:

Delay in providing assistance. When a patient has no vital signs, namely a pulse and breathing, a matter of minutes can decide his fate. Therefore, resuscitation should be started immediately;
Insufficient strength when performing compressions. In this case, the person presses only with his hands, and not with his body. The heart does not compress enough and therefore blood is not pumped;

Too much pressure. Especially in young children. This may cause damage internal organs and separation of the sternum from the costal arches and its fracture;
Incorrect hand placement and pressure with the entire hand lead to fracture of the ribs and damage to the lungs;
Long break between compressions. It should not be longer than 10 seconds.

Further rehabilitation of the person

A person who even a short time respiratory and cardiac arrest was observed and it was necessary to be hospitalized. In the hospital, the doctor will determine the severity of the patient’s condition and prescribe appropriate treatment.

In hospital in mandatory carry out:

Laboratory and instrumental examination;
If necessary, maintaining vital functions in intensive care unit. If the patient does not breathe on his own, then a ventilator is connected;
Physical therapy and parenteral nutrition if necessary;
Symptomatic therapy (maintaining the functioning of the cardiac, respiratory, cerebral, urinary systems).

The duration of rehabilitation depends on many factors:

Cause of cardiac and respiratory arrest. How more serious pathology, the longer the recovery takes;
Duration of clinical death;
Patient's age;
The general condition of his body before development pathological condition(presence of chronic, congenital diseases).

When should chest compressions be used?

Indirect cardiac massage is performed when the patient has no pulse, that is, clinical death. This is the only thing absolute reading. There are many causes of cardiac arrest (acute coronary insufficiency, anaphylactic, pain, hemorrhagic shock, effects on the body low temperatures and so on).

It should be noted that it is important to provide resuscitation assistance only in the absence of a pulse. If heartbeat weak and rare, then indirect cardiac massage cannot be done. Since in this case this manipulation will only lead to cardiac arrest.

If a person is found on the street, then you need to approach and ask if he needs help. If the person does not respond, call an ambulance and determine the presence of breathing and pulse. If they are absent, immediately begin performing cardiopulmonary resuscitation.

External signs that indicate cardiac arrest:

Loss of consciousness;
Pale and cyanotic skin and mucous membranes;
Dilated pupils do not respond to light;
Swelling of the neck veins.

In case of any accident, be it loss of consciousness, drowning or poisoning carbon monoxide at , Assistance to the victim must begin with restoring breathing and heart function.. This can be done using cardiopulmonary resuscitation. However, as practice shows, in most cases, eyewitnesses of the incident either do not know what to do or provide first aid incorrectly. Let's figure it out how to do artificial respiration and cardiac massage correctly in case of clinical death.

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Fact . After breathing stops and heartbeats stop, clinical death occurs. It lasts only 5-6 minutes, during which you can bring a person back to life. After this period, due to the lack of oxygen, irreversible changes occur in the tissues. After which, with extremely rare exceptions, it is no longer possible to resuscitate the victim.

To bring a person out of clinical death and restore respiratory and cardiac activity need to perform cardiopulmonary resuscitation, which includes two main procedures - artificial respiration (ventilation) and chest compressions (chest compression).

Procedure for cardiopulmonary resuscitation

1. Determine the presence or absence of signs of life: breathing, heartbeat, reaction of the pupils to light.

Signs of respiratory arrest

Bring your ear to your mouth and place your hand on your chest: if you don’t feel the movement of air and don’t feel your chest heaving, there is no breathing, which means lungs need artificial ventilation.

Signs of cardiac arrest

Check your pulse by placing your index finger and middle finger to the carotid artery (on the side of the larynx under the chin), or put your ear to your chest: if no pulsation is observed - the heart needs an indirect massage.

2. Lay the victim on his back, and use a hard surface: floor, asphalt or earth. Performing cardiac massage on the beach or on a bed is not effective– the pressure will be on the sand or mattress, and not on the heart. So, if the scene is a sandy shore or a bed, you need to move the body to a more hard area, or put something like a board under your back.

3. If breathing and heartbeat are not observed, immediately begin resuscitation. You need to start with artificial respiration, and then start cardiac massage. Keep the ratio - 2 to 30, that is 2 exhalations for 30 chest pushes. And so on in a circle until signs of life are detected, or until an ambulance arrives. Remember to check for a pulse or breathing every minute.

How to do artificial respiration correctly

1. After you have placed the victim on his back, tilt his head back– this is necessary for unhindered access of air to the lungs. To fix this position, place a cushion of folded clothing or a towel under your shoulders. Keep in mind: You should not tilt your head back if there is a suspicion of a neck fracture..

2. With a finger wrapped in a napkin or handkerchief, in a circular motion clear internal cavity mouth from foreign objects: sand, pieces of food, blood, mucus, vomit.

3. After making sure that the airways are not clogged with anything, begin artificial respiration using the mouth-to-mouth method, or if the jaw cannot be opened due to spasm, use the “mouth to nose” method.

4. With the “mouth to mouth” method, you need to hold the open jaw with one hand, and with the other hold your nose tightly. Take a deep breath and blow the air into the rescued person's mouth. It is important that your lips are pressed tightly against the victim's mouth, to eliminate “leakage” between the lips. With the “mouth to nose” method, everything is the same, only now you need to close your mouth tightly with your palm, and blow air into it accordingly.

5. You need to blow air hard, but smoothly. In no case in short bursts, because with such a pressure of air, the diaphragm in the throat will not open, and oxygen will not flow into the lungs, but into the stomach, which can lead to vomiting.

6. Frequency: 10-12 blows per minute or 1 exhale for 5 seconds. Inhale (1-1.5 seconds), release your nose and count to 4. Then repeat the procedure, remembering to tightly close the victim’s nose during inhalations. You need to count not quickly, but as expected. If pulmonary resuscitation is performed one year old child, inhalation is done more often, 1 exhalation for three seconds.

7. Watch for chest rise during inflation– this is your control. If the chest does not rise, it means that air is not entering the lungs. This may indicate that the tongue is stuck due to an incorrect position of the head, or that there are foreign objects. If so, then correct the situation.

8. If the air still goes through the esophagus and the stomach is inflated, you need to gently press on it in top point so that the air comes out. Be prepared to vomit afterwards– turn your head to the side and quickly clean your mouth.

How to do indirect cardiac massage correctly

1. Borrow correct posture. You should be on the side of the person lying down, sitting on your knees- this way the center of gravity of your body will be stable.

2. Determine the place where compression will be performed. Contrary to popular belief, a person’s heart is not located on the left, but in the center of the chest. You need to put pressure on the heart, not higher and not lower. This is very important, since compression in the wrong place can not only have minimal effect, but also cause harm. The required point is located in the center of the chest, at a distance of two longitudinal fingers from the end of the sternum (this is where the ribs touch).

3. Place the heel of your palm on this point so that thumb looked either at the chin or at the stomach of the victim, depending on which side you sat on. On top of the first, place the second palm crosswise. Only the base of the palm should be in contact with the patient’s body, the fingers should be angled. In the case of children from 1 to 8 years old, only one palm is used, with infants under 1 year old, the massage is done with only two fingers.

4. Do not bend your elbows during compression. The line of your shoulders should be strictly above the lying one and parallel to the body. The main force of pressure should come from your weight, and not from the muscles of the arms, otherwise you will quickly get tired, and the compression will not be effective or the same in each push.

5. When pressed, the victim's chest should drop 4-5 cm, so the shocks must be quite strong. Otherwise, the compression of the heart will not be sufficient to disperse blood throughout the body to deliver oxygen to the body.

6. The compression frequency should be 100 shocks per minute. Please note that this is the frequency of punches, not the number of punches. Just a reminder, need to do 30 times, replacing compression with artificial ventilation. After which, we again move on to cardiac massage. Remember to check every minute for signs of life: pulse, breathing and pupil reaction to light.

7. Very often, ribs break during compression of the heart.. There is no need to be afraid of this. The ribs will heal later, now the main thing is to revive the person. So, when you hear a characteristic crackling sound, do not stop and continue the heart massage.

We invite you to watch a video from a seminar on first aid for cardiac and respiratory arrest. A professional rescuer clearly explains and shows in detail how to properly perform cardiopulmonary resuscitation.

We wish you that accidents will bypass both you and your loved ones. However, in any case, knowledge of how to perform artificial respiration and cardiac massage will never be superfluous. To practice, we recommend taking a couple of first aid classes; it won’t hurt. Good luck.