Physicians of all speci alties have to teach others and themselves to perform manipulations related to emergency care and saving the patient's life. This is the very first thing a medical student hears at university. Therefore, special attention is paid to the study of such disciplines as anesthesiology and resuscitation. Ordinary people who are not related to medicine also do not hurt to know the protocol of actions in a life-threatening situation. Who knows when it might come in handy.
Cardiopulmonary resuscitation is an emergency care procedure aimed at restoring and maintaining the body's vital functions after clinical death. It includes several required steps. The SRL algorithm was proposed by Peter Safar, and one of the patient rescue techniques is named after him.
Ethical issue
It's no secret that doctors are constantly faced with the problem of choosing what is best for their patient. And often it is he who becomes a stumbling block for further therapeutic measures. The same goes for CPR. The algorithm is modified depending on the conditions for providing assistance, the preparation of resuscitationteam, patient age and current condition.
There have been many discussions about whether children and adolescents should be taught the complexity of their condition, given the fact that they do not have the right to make decisions about their own treatment. An issue has been raised about organ donation from victims undergoing CPR. The algorithm of actions in these circumstances should be somewhat modified.
When is CPR not performed?
In medical practice, there are cases when resuscitation is not carried out, since it is already meaningless, and the patient's injuries are not compatible with life.
- When there are signs of biological death: rigor mortis, cooling, cadaveric spots.
- Signs of brain death.
- The end stages of incurable diseases.
- Fourth stage of oncological diseases with metastasis.
- If doctors know for sure that more than twenty-five minutes have passed since respiratory and circulatory arrest.
Signs of clinical death
There are major and minor signs. The main ones include:
- lack of pulse on large arteries (carotid, femoral, brachial, temporal);
- lack of breathing;- persistent pupil dilation.
Minor signs include loss of consciousness, pallor with a bluish tint, lack of reflexes, voluntary movements and muscle tone, strange, unnatural position of the body in space.
Stages
Conventionally, the CPR algorithm is divided into three large stages. Andeach of them, in turn, branches into stages.
The first stage is carried out immediately and consists in maintaining life at a level of constant oxygenation and airway patency. It excludes the use of specialized equipment, and life is supported solely by the efforts of the resuscitation team.
The second stage is specialized, its purpose is to preserve what non-professional rescuers have done and ensure constant blood circulation and oxygen supply. It includes the diagnosis of the work of the heart, the use of a defibrillator, the use of drugs.
Third stage - carried out already in the ICU (intensive care unit). It is aimed at preserving brain functions, restoring them and returning a person to normal life.
Procedure of actions
In 2010, a universal CPR algorithm was developed for the first stage, which consists of several stages.
- A - Airway - or air traffic. The rescuer examines the external respiratory tract, removes everything that interferes with the normal passage of air: sand, vomit, algae, water. To do this, you need to perform the Safar triple technique: throw back your head, move your lower jaw and open your mouth.
- B - Breathing - breathing. Previously, it was recommended to perform mouth-to-mouth or mouth-to-nose artificial respiration, but now, due to the increased risk of infection, air enters the victim exclusively through the Ambu bag.
- C -Circulation - blood circulation or chest compressions. Ideally, the rhythm of chest compressions should be 120 beats per minute, then the brain will receive a minimum dose of oxygen. Interruption is not recommended, as during the blowing of air, a temporary cessation of blood circulation occurs.
- D – Drugs are medicines that are used at the stage of specialized care to improve blood circulation, maintain heart rhythm or blood rheology.
- E - electrocardiogram. It is carried out to monitor the work of the heart and check the effectiveness of measures.
Drowning
There are some peculiarities of CPR for drowning. The algorithm changes somewhat, adjusting to environmental conditions. First of all, the rescuer must take care to eliminate the threat to his own life, and if possible, do not go into the reservoir, but try to bring the victim to the shore.
If, nevertheless, help is provided in the water, then the rescuer must remember that the drowning person does not control his movements, so you need to swim up from the back. The main thing is to keep a person's head above the water: by the hair, grabbing it under the armpits or throwing it back onto your back.
The best thing a rescuer can do for a drowning person is to start blowing air right in the water, without waiting for transport to shore. But technically, this is only available to a physically strong and prepared person.
As soon as you have removed the victim from the water, you need to check if he haspulse and spontaneous breathing. If there are no signs of life, resuscitation should be started immediately. They must be carried out according to the general rules, since attempts to remove water from the lungs usually lead to the opposite effect and aggravate neurological damage due to oxygen starvation of the brain.
Another feature is the time span. You should not focus on the usual 25 minutes, since in cold water the processes slow down, and brain damage occurs much more slowly. Especially if the victim is a child.
Resuscitation can be stopped only after the restoration of spontaneous breathing and blood circulation, or after the arrival of an ambulance team that can provide professional life support.
Expanded CPR, a drug-assisted algorithm, includes inhalations of 100% oxygen, lung intubation, and mechanical ventilation. In addition, antioxidants are used, fluid infusions to prevent a drop in systemic pressure and repeated cardiac arrest, diuretics to prevent pulmonary edema, and active warming of the victim so that the blood is evenly distributed throughout the body.
Breathing stop
The CPR algorithm for respiratory arrest in adults includes all stages of chest compressions. This makes life easier for rescuers, as the body will distribute the incoming oxygen on its own.
There are two ways to artificially ventilate the lungs without helpersfunds:
- mouth to mouth;- mouth to nose.
For better air access, it is recommended to tilt the head of the victim, push the lower jaw and free the airways from mucus, vomit and sand. The rescuer should also take care of his he alth and safety, so it is advisable to carry out this manipulation through a clean handkerchief or gauze, in order to avoid contact with the patient's blood or saliva.
The rescuer pinches his nose, tightly wraps his lips around the lips of the victim and exhales the air. In this case, you need to watch if the epigastric region is inflated. If the answer is yes, this means that the air enters the stomach, and not the lungs, and there is no sense in such resuscitation. Between exhalations, you need to take breaks of a few seconds.
During a well-conducted mechanical ventilation, chest excursion is observed.
Circulation arrest
It is logical that the CPR algorithm for asystole will include everything except ventilation. If the victim is breathing on his own, do not put him on artificial respiration. This complicates the work of doctors in the future.
The cornerstone of proper cardiac massage is the technique of laying on hands and the coordinated work of the rescuer's body. Compression is done with the base of the palm, not the wrist, not the fingers. The hands of the resuscitator should be straightened, and compression is carried out due to the tilt of the body. Hands are perpendicular to the sternum, they can be taken in the castle or the palms lie in a cross (in the form of a butterfly). Fingers do not touch the surface of the chestcells. The algorithm for performing CPR is as follows: for thirty clicks - two breaths, provided that resuscitation is carried out by two people. If the rescuer is alone, then fifteen compressions and one breath are given, as a long break without blood circulation can damage the brain.
Resuscitation of pregnant women
CPR of pregnant women also has its own characteristics. The algorithm includes saving not only the mother, but also the child in her womb. A doctor or bystander providing first aid to an expectant mother should remember that there are many factors that worsen the survival prognosis:
- increased oxygen consumption and its rapid utilization;
- reduced lung volume due to compression by the pregnant uterus;
- high probability of aspiration of gastric contents;- decrease area for mechanical ventilation, as the mammary glands are enlarged and the diaphragm is raised due to an increase in the abdomen.
If you are not a doctor, the only thing you can do for a pregnant woman to save her life is to lay her on her left side so that her back is at an angle of about thirty degrees. And move her belly to the left. This will reduce pressure on the lungs and increase airflow. Be sure to start chest compressions and don't stop until the ambulance arrives or some other help arrives.
Saving the Children
CPR in children has its own characteristics. The algorithm resembles an adult, but due to physiological characteristics, it is difficult to carry it out, especially for newborns. You can divide the resuscitation of children by age: up to a year and up to eight years. All older people receive the same amount of assistance as adults.
- Ambulance should be called after five unsuccessful resuscitation cycles. If the rescuer has assistants, then it is worth entrusting them immediately. This rule only works if there is one reanimating person.
- Tip your head back even if you suspect a neck injury, as breathing is a priority.
- Start ventilation with two breaths of 1 second each.
- Up to twenty breaths should be delivered per minute.
- When blocking the airway with a foreign body, the child is slapped on the back or hit on the chest.
- The presence of a pulse can be checked not only on the carotid, but also on the brachial and femoral arteries, because the skin of the child is thinner.
- When performing chest compressions, the pressure should be just below the nipple line, as the heart is slightly higher than in adults.
- Press on the sternum with the base of one hand (if the victim is a teenager) or two fingers (if it is a baby).
- The force of pressure is a third of the thickness of the chest (but not more than half).
General rules
Every adult should know how to perform basic CPR. Its algorithms are quite simple to remember and understand. This could save someone's life.
There are several rules that can make it easier for an untrained person to carry out rescue operations.
- After five cycles of CPR, you can leave the victim to call the servicesalvation, but only on the condition that the person providing assistance is one.
- Determining signs of clinical death should not take more than 10 seconds.
- The first rescue breath should be shallow.
- If after the first breath there was no movement of the chest, it is worth throwing back the victim's head again.
The rest of the recommendations for which the CPR algorithm is carried out have already been presented above. The success of resuscitation and the further quality of life of the victim depend on how quickly the eyewitnesses orient themselves, and how competently they can provide assistance. So don't shy away from the lessons that describe CPR. The algorithm is quite simple, especially if you remember the letter cheat sheet (ABC), as many doctors do.
Many textbooks say to stop CPR after forty minutes of unsuccessful resuscitation, but in reality only signs of biological death can be a reliable criterion for the absence of life. Remember: while you pump the heart, the blood continues to feed the brain, which means that the person is still alive. The main thing is to wait for the arrival of an ambulance or rescuers. Believe me, they will thank you for this hard work.
