Resuscitation is a set of measures aimed at restoring the vital functions of the human body. Translated from Latin, “reanimation” means “re-giving life.”
A set of resuscitation actions can be performed by both doctors and ordinary people who find themselves next to a person who is in a state of clinical death. Often the term “resuscitation” is applied to the department where doctors carry out intensive care measures. This term also includes a specialized emergency team that responds to calls to people who are in a state of clinical death.
Contraindications to resuscitation measures
The resuscitation procedure has several contraindications:
- severe illness and critical condition of the body, in which resuscitation actions do not make sense;
- the presence of cadaveric spots on the body;
- the presence of rigor mortis;
- changes in the color of the iris, clouding of the cornea, cat's eye syndrome.
Severe and non-life-threatening injuries are also a reason to refuse resuscitation measures. These include, for example, the tearing off of a large part of the torso with massive bleeding, and the tearing off of the head.
Resuscitation of adults, children and newborns
Cardiopulmonary resuscitation in adult patients is carried out according to a single algorithm, regardless of gender. Its main task is to restore airway patency and independent breathing. Resuscitation efforts may be difficult due to the patient's large body weight. The ratio of the frequency of artificial respiration in relation to chest compressions should be 2:30. The optimal frequency of chest compressions during resuscitation is 80 times per minute.
Pediatric resuscitation is carried out by pediatricians and neonatologists. Before performing it, it is important to check for foreign objects in the mouth by examining the visible part of the pharynx. It is better for a child to perform artificial respiration “mouth to nose”, alternating it with indirect cardiac massage. For children under 10 years of age, the frequency of chest compressions should reach 10 times per minute. Pressing is performed with one hand. The amplitude of chest oscillations should not exceed 3-4 cm.
Restoring the vital functions of the body of newborn babies is the responsibility of neonatologists and pediatric nurses. The complex of resuscitation actions of these specialists has been worked out to the point of automation and is aimed at restoring full blood circulation in the baby.
Criteria for assessing the effectiveness of resuscitation measures
The effectiveness of resuscitation measures is assessed based on the following criteria:
- restoration of the reaction of the pupils to light, their narrowing;
- improvement of skin color;
- reduction or complete disappearance of cyanosis of nails and lips;
- presence of respiratory movements;
- the presence of a pulse in the area of the carotid artery;
- the ability to listen to the heartbeat through the chest.
The patient may remain unconscious even after resuscitation is completed. The main criteria for the life of his body are the resumption of free breathing and heart function. In some cases, the heart rhythm is restored, but breathing is not. Then artificial respiration is required until the emergency team arrives.
Intensive care unit patients
The following categories of patients are admitted to the intensive care unit:
- after surgical operations;
- those who were treated in a specialized department after their condition worsened;
- those who experienced clinical death before hospitalization;
- patients in serious condition, on the verge between life and death, in a coma, after severe poisoning, massive bleeding and injuries, in a state of shock, after a stroke or myocardial infarction.
After stabilizing the condition of patients from intensive care, they are usually sent to specialized departments (therapy, gynecology, surgery, oncology).
Behavior rules
Providing first aid in the absence of consciousness, cessation of breathing and circulation.
The main signs of life in the victim
The main signs of life include the presence of consciousness, independent breathing and blood circulation. They are checked during the CPR algorithm.
Causes of respiratory and circulatory disorders
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Sudden death (respiration and circulatory arrest) can be caused by diseases (myocardial infarction, heart rhythm disturbances, etc.) or external influences (trauma, electric shock, drowning, etc.). Regardless of the reasons for the disappearance of signs of life, cardiopulmonary resuscitation is carried out in accordance with a specific algorithm recommended by the Russian National Council for Resuscitation and the European Council for Resuscitation.
Methods for checking consciousness, breathing, and blood circulation in a victim
When providing first aid, the simplest methods are used to check for the presence or absence of signs of life:
- to check consciousness, the first aid participant tries to enter into verbal and tactile contact with the victim, checking his reaction to this;
— touch, hearing and vision are used to check breathing (the technique for testing consciousness and breathing is described in more detail in the next section);
- the lack of blood circulation in the victim is determined by checking the pulse in the main arteries (simultaneously with determining breathing and with appropriate preparation). Due to the insufficient accuracy of checking the presence or absence of blood circulation by determining the pulse in the main arteries, it is recommended to focus on the absence of consciousness and breathing when making a decision on performing cardiopulmonary resuscitation.
Modern algorithm for performing cardiopulmonary resuscitation (CPR). Technique for applying manual pressure to the victim’s sternum and performing artificial respiration during CPR
At the scene of an incident, the first aid provider should assess the safety for himself, the victim(s) and others. After this, threatening factors should be eliminated or the risk of injury to oneself, the risk to the victim(s) and others should be minimized.
Next, it is necessary to check the victim’s consciousness. To check consciousness, you need to gently shake the victim by the shoulders and ask loudly: “What’s wrong with you? Do you need help? A person who is in an unconscious state will not be able to react and answer these questions.
In the absence of signs of consciousness, it is necessary to determine whether the victim is breathing. To do this, it is necessary to restore the patient’s airway: place one hand on the victim’s forehead, take the chin with two fingers of the other, throw back the head, lift the chin and lower jaw. If a cervical spine injury is suspected, tilting should be performed as carefully and gently as possible.
To check breathing, lean your cheek and ear toward the victim’s mouth and nose and hold for 10 seconds. try to hear his breathing, feel the exhaled air on your cheek and see the movements of the victim’s chest. In the absence of breathing, the victim’s chest will remain motionless, the sounds of his breathing will not be heard, and the exhaled air from the mouth and nose will not be felt by the cheek. Lack of breathing determines the need to call an ambulance and perform cardiopulmonary resuscitation.
If the victim is not breathing, the first aid provider should arrange for an ambulance to be called. To do this, you need to loudly call for help, addressing a specific person located near the scene of the incident and give him appropriate instructions. Instructions should be given briefly, clearly, and informatively: “The person is not breathing. Call an ambulance. Let me know you've been called."
If it is not possible to attract an assistant, you should call emergency medical help yourself (for example, using the speakerphone function on your phone). When calling, be sure to provide the dispatcher with the following information:
• location of the incident, what happened;
• number of victims and what happened to them;
• what kind of assistance is provided.
Be the last to hang up the phone after the dispatcher answers.
Emergency medical services and other special services can be called by calling 112 (can also be made by calling 01, 101; 02, 102; 03, 103 or regional numbers).
Simultaneously with calling emergency medical services, it is necessary to begin applying pressure with your hands on the sternum of the victim, who should be lying on his back on a hard, flat surface. In this case, the base of the palm of one hand of the first aid participant is placed in the middle of the victim’s chest, the second hand is placed on top of the first, the hands are clasped, the arms are straightened at the elbow joints, the shoulders of the first aid participant are positioned above the victim so that the pressure is applied perpendicular to the plane sternum.
Hand pressure on the victim’s sternum is performed with the weight of the torso of the first aid participant to a depth of 5-6 cm with a frequency of 100-120 per minute.
After 30 manual pressures on the victim’s sternum, artificial respiration must be performed using the “mouth-to-mouth” method. To do this, open the victim’s airways (throw back his head, raise his chin), pinch his nose with two fingers, and take two breaths of artificial respiration.
Inhalations of artificial respiration are performed as follows: you need to take your normal breath, seal your lips around the victim’s mouth and exhale evenly into his airways for 1 second, observing the movement of his chest. The benchmark for a sufficient volume of injected air and effective artificial respiration inhalation is the beginning of the rise of the chest, determined visually by the first aid participant. After this, while continuing to maintain patency of the airways, it is necessary to allow the victim to exhale passively, and then repeat the inhalation of artificial respiration in the manner described above. No more than 10 seconds should be spent on 2 breaths of artificial respiration. You should not make more than two attempts to inhale artificial respiration in between manual pressures on the victim’s sternum.
In this case, it is recommended to use a device for artificial respiration from a first aid kit or bed.
If it is impossible to perform artificial respiration using the “mouth-to-mouth” method (for example, the victim’s lips are damaged), artificial respiration is performed using the “mouth-to-nose” method. In this case, the technique differs in that the first aid participant closes the victim’s mouth while throwing back his head and covers the victim’s nose with his lips.
Next, resuscitation measures should be continued, alternating 30 compressions on the sternum with 2 breaths of artificial respiration.
Errors and complications that arise when performing resuscitation measures
The main mistakes when performing resuscitation measures include:
— violation of the sequence of cardiopulmonary resuscitation measures;
- incorrect technique for applying manual pressure on the victim’s sternum (incorrect placement of hands, insufficient or excessive depth of pressure, incorrect frequency, lack of full elevation of the chest after each pressure);
— incorrect technique for performing artificial respiration (insufficient or incorrect opening of the airways, excessive or insufficient volume of blown air);
— incorrect ratio of manual pressure on the sternum and artificial respiration breaths;
- the time between manual pressure on the victim’s sternum exceeds 10 seconds.
The most common complication of cardiopulmonary resuscitation is fracture of the chest bones (mainly ribs). Most often this occurs when there is excessive force of hand pressure on the victim’s sternum, an incorrectly determined position of the hands, or increased bone fragility (for example, in elderly and senile victims).
The frequency of these errors and complications can be avoided or reduced with regular and high-quality training.
Indications for stopping CPR
Resuscitation measures continue until the arrival of ambulance or other special services, whose employees are required to provide first aid, and the order of the employees of these services to stop resuscitation, or until the appearance of obvious signs of life in the victim (the appearance of spontaneous breathing, coughing, voluntary movements).
In case of prolonged resuscitation measures and physical fatigue occurs in the first aid participant, it is necessary to involve an assistant in the implementation of these measures. Most modern domestic and foreign recommendations for cardiopulmonary resuscitation provide for changing its participants approximately every 2 minutes, or after 5-6 cycles of pressure and inhalation.
Resuscitation measures may not be carried out for victims with obvious signs of non-viability (decomposition or injury incompatible with life), or in cases where the absence of signs of life is caused by the outcome of a long-term incurable disease (for example, cancer).
