Artificial respiration (AR) is an urgent emergency measure if a person’s own breathing is absent or impaired to such an extent that it poses a threat to life. The need for artificial respiration may arise when providing assistance to those who have received sunstroke, drowned, suffered from electric current, as well as in case of poisoning with certain substances.

The purpose of the procedure is to ensure the process of gas exchange in the human body, in other words, to ensure sufficient saturation of the victim’s blood with oxygen and the removal of carbon dioxide from it. In addition, artificial ventilation has a reflex effect on the respiratory center located in the brain, as a result of which independent breathing is restored.

Mechanism and methods of artificial respiration

Only through the process of breathing does a person’s blood become saturated with oxygen and carbon dioxide is removed from it. After air enters the lungs, it fills the lung sacs called alveoli. The alveoli are pierced by an incredible number of small blood vessels. It is in the pulmonary vesicles that gas exchange takes place - oxygen from the air enters the blood, and carbon dioxide is removed from the blood.

If the oxygen supply to the body is interrupted, vital activity is at risk, since oxygen plays the “first fiddle” in all oxidative processes that occur in the body. That is why, when breathing stops, artificially ventilating the lungs should be started immediately.

The air entering the human body during artificial respiration fills the lungs and irritates the nerve endings in them. As a result, nerve impulses are sent to the respiratory center of the brain, which are a stimulus for the production of response electrical impulses. The latter stimulate contraction and relaxation of the muscles of the diaphragm, resulting in stimulation of the respiratory process.

Artificially supplying the human body with oxygen in many cases makes it possible to completely restore the independent respiratory process. In the event that cardiac arrest is also observed in the absence of breathing, it is necessary to perform a closed cardiac massage.

Please note that the absence of breathing triggers irreversible processes in the body within five to six minutes. Therefore, timely artificial ventilation can save a person’s life.

All methods of performing ID are divided into expiratory (mouth-to-mouth and mouth-to-nose), manual and hardware. Manual and expiratory methods are considered more labor-intensive and less effective compared to hardware methods. However, they have one very significant advantage. They can be performed without delay, almost anyone can cope with this task, and most importantly, there is no need for any additional devices and instruments, which are not always at hand.

Indications and contraindications

Indications for the use of ID are all cases where the volume of spontaneous ventilation of the lungs is too low to ensure normal gas exchange. This can happen in many urgent and planned situations:

1. For disorders of the central regulation of breathing caused by impaired cerebral circulation, tumor processes in the brain or brain injury.
2. For medicinal and other types of intoxication.
3. In case of damage to the nerve pathways and neuromuscular synapse, which can be caused by trauma to the cervical spine, viral infections, the toxic effect of certain medications, and poisoning.
4. For diseases and damage to the respiratory muscles and chest wall.
5. In cases of lung lesions of both obstructive and restrictive nature.

The need to use artificial respiration is judged based on a combination of clinical symptoms and external data. Changes in pupil size, hypoventilation, tachy- and bradysystole are conditions that require artificial ventilation. In addition, artificial respiration is required in cases where spontaneous ventilation is “turned off” with the help of muscle relaxants administered for medical purposes (for example, during anesthesia for surgery or during intensive care for a seizure disorder).

As for cases where ID is not recommended, there are no absolute contraindications. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. So, for example, if venous return of blood is difficult, artificial respiration modes are contraindicated, which provoke even greater disruption. In case of lung injury, ventilation methods based on high-pressure air injection, etc., are prohibited.

Preparing for artificial respiration

Before performing expiratory artificial respiration, the patient should be examined. Such resuscitation measures are contraindicated for facial injuries, tuberculosis, poliomelitis and trichlorethylene poisoning. In the first case, the reason is obvious, and in the last three, performing expiratory artificial respiration puts the person performing resuscitation at risk.

Before starting expiratory artificial respiration, the victim is quickly freed from clothing squeezing the throat and chest. The collar is unbuttoned, the tie is undone, and the trouser belt can be unfastened. The victim is placed supine on his back on a horizontal surface. The head is tilted back as much as possible, the palm of one hand is placed under the back of the head, and the other palm is pressed on the forehead until the chin is in line with the neck. This condition is necessary for successful resuscitation, since with this position of the head the mouth opens and the tongue moves away from the entrance to the larynx, as a result of which air begins to flow freely into the lungs. In order for the head to remain in this position, a cushion of folded clothing is placed under the shoulder blades.

After this, it is necessary to examine the victim’s oral cavity with your fingers, remove blood, mucus, dirt and any foreign objects.

It is the hygienic aspect of performing expiratory artificial respiration that is the most delicate, since the rescuer will have to touch the victim’s skin with his lips. You can use the following technique: make a small hole in the middle of a handkerchief or gauze. Its diameter should be two to three centimeters. The fabric is placed with a hole on the victim’s mouth or nose, depending on which method of artificial respiration will be used. Thus, air will be blown through the hole in the fabric.

To carry out artificial respiration using the mouth-to-mouth method, the person who will provide assistance must be on the side of the victim’s head (preferably on the left side). In a situation where the patient is lying on the floor, the rescuer kneels. If the victim's jaws are clenched, they are forced apart.

After this, one hand is placed on the victim’s forehead, and the other is placed under the back of the head, tilting the patient’s head back as much as possible. Having taken a deep breath, the rescuer holds the exhalation and, bending over the victim, covers the area of ​​his mouth with his lips, creating a kind of “dome” over the patient’s mouth. At the same time, the victim’s nostrils are pinched with the thumb and index finger of the hand located on his forehead. Ensuring tightness is one of the prerequisites for artificial respiration, since air leakage through the victim’s nose or mouth can nullify all efforts.

After sealing, the rescuer quickly, forcefully exhales, blowing air into the airways and lungs. The duration of exhalation should be about a second, and its volume should be at least a liter for effective stimulation of the respiratory center to occur. At the same time, the chest of the person receiving assistance should rise. If the amplitude of its rise is small, this is evidence that the volume of air supplied is insufficient.

Exhaling, the rescuer unbends, freeing the victim’s mouth, but at the same time keeping his head thrown back. The patient should exhale for about two seconds. During this time, before taking the next breath, the rescuer must take at least one normal breath “for himself.”

Please note that if a large amount of air enters the patient's stomach rather than the lungs, this will significantly complicate his rescue. Therefore, you should periodically press on the epigastric region to empty the stomach of air.

Artificial respiration from mouth to nose

This method of artificial ventilation is carried out if it is not possible to properly unclench the patient’s jaws or there is an injury to the lips or oral area.

The rescuer places one hand on the victim’s forehead and the other on his chin. At the same time, he simultaneously throws back his head and presses his upper jaw to the lower. With the fingers of the hand that supports the chin, the rescuer must press the lower lip so that the victim’s mouth is completely closed. Taking a deep breath, the rescuer covers the victim’s nose with his lips and forcefully blows air through the nostrils, while watching the movement of the chest.

After artificial inspiration is completed, you need to free the patient's nose and mouth. In some cases, the soft palate may prevent air from escaping through the nostrils, so when the mouth is closed, there may be no exhalation at all. When exhaling, the head must be kept tilted back. The duration of artificial exhalation is about two seconds. During this time, the rescuer himself must take several exhalations and inhalations “for himself.”

How long does artificial respiration last?

There is only one answer to the question of how long ID should be carried out. You should ventilate your lungs in this mode, taking breaks for a maximum of three to four seconds, until full spontaneous breathing is restored, or until the doctor appears and gives other instructions.

At the same time, you should constantly ensure that the procedure is effective. The patient's chest should swell well, and the facial skin should gradually turn pink. It is also necessary to ensure that there are no foreign objects or vomit in the victim’s respiratory tract.

Please note that due to the ID, the rescuer himself may experience weakness and dizziness due to a lack of carbon dioxide in the body. Therefore, ideally, air blowing should be done by two people, who can alternate every two to three minutes. If this is not possible, the number of breaths should be reduced every three minutes so that the person performing resuscitation normalizes the level of carbon dioxide in the body.

During artificial respiration, you should check every minute to see if the victim’s heart has stopped. To do this, use two fingers to feel the pulse in the neck in the triangle between the windpipe and the sternocleidomastoid muscle. Two fingers are placed on the lateral surface of the laryngeal cartilage, after which they are allowed to “slide” into the hollow between the sternocleidomastoid muscle and the cartilage. This is where the pulsation of the carotid artery should be felt.

If there is no pulsation in the carotid artery, chest compressions in combination with ID should be started immediately. Doctors warn that if you miss the moment of cardiac arrest and continue to perform artificial ventilation, it will not be possible to save the victim.

Features of the procedure in children

When performing artificial ventilation for babies under one year of age, the mouth-to-mouth and nose technique is used. If the child is older than one year, the mouth-to-mouth method is used.

Small patients are also placed on their back. For babies under one year old, place a folded blanket under their back or slightly raise their upper body, placing a hand under their back. The head is thrown back.

The person providing assistance takes a shallow breath, seals her lips around the child’s mouth and nose (if the baby is under one year old) or just the mouth, and then blows air into the respiratory tract. The volume of air blown in should be less, the younger the patient. So, in the case of resuscitation of a newborn, it is only 30-40 ml.

If a sufficient volume of air enters the respiratory tract, chest movement occurs. After inhaling, you need to make sure that the chest drops. If you blow too much air into your baby's lungs, this can cause the alveoli of the lung tissue to rupture, causing air to escape into the pleural cavity.

The frequency of insufflations should correspond to the breathing frequency, which tends to decrease with age. Thus, in newborns and children up to four months, the frequency of inhalations and exhalations is forty per minute. From four months to six months this figure is 40-35. In the period from seven months to two years - 35-30. From two to four years it is reduced to twenty-five, in the period from six to twelve years - to twenty. Finally, in a teenager aged 12 to 15 years, the respiratory rate is 20-18 breaths per minute.

Manual methods of artificial respiration

There are also so-called manual methods of artificial respiration. They are based on changing the volume of the chest due to the application of external force. Let's look at the main ones.

Sylvester's method

This method is most widely used. The victim is placed on his back. A cushion should be placed under the lower part of the chest so that the shoulder blades and the back of the head are lower than the costal arches. If artificial respiration is performed using this method by two people, they kneel on either side of the victim so as to be positioned at the level of his chest. Each of them holds the victim’s hand in the middle of the shoulder with one hand, and with the other just above the level of the hand. Next, they begin to rhythmically raise the victim’s arms, stretching them behind his head. As a result, the chest expands, which corresponds to inhalation. After two or three seconds, the victim’s hands are pressed to the chest, while squeezing it. This performs the functions of exhalation.

In this case, the main thing is that the movements of the hands are as rhythmic as possible. Experts recommend that those performing artificial respiration use their own rhythm of inhalation and exhalation as a “metronome”. In total, you should do about sixteen movements per minute.

ID using the Sylvester method can be performed by one person. He needs to kneel behind the victim’s head, grab his arms above the hands and perform the movements described above.

For broken arms and ribs, this method is contraindicated.

Schaeffer method

If the victim's arms are injured, the Schaeffer method can be used to perform artificial respiration. This technique is also often used for the rehabilitation of people injured while on the water. The victim is placed prone, with his head turned to the side. The one who performs artificial respiration kneels, and the victim’s body should be located between his legs. Hands should be placed on the lower part of the chest so that the thumbs lie along the spine and the rest rest on the ribs. When exhaling, you should lean forward, thus compressing the chest, and while inhaling, straighten, stopping the pressure. The elbows are not bent.

Please note that this method is contraindicated for fractured ribs.

Laborde method

The Laborde method is complementary to the Sylvester and Schaeffer methods. The victim's tongue is grabbed and rhythmically stretched, imitating breathing movements. As a rule, this method is used when breathing has just stopped. The resistance of the tongue that appears is evidence that the person’s breathing is being restored.

Kallistov method

This simple and effective method provides excellent ventilation. The victim is placed prone, face down. A towel is placed on the back in the area of ​​the shoulder blades, and its ends are passed forward, threaded under the armpits. The person providing assistance should take the towel by the ends and lift the victim’s torso seven to ten centimeters from the ground. As a result, the chest expands and the ribs rise. This corresponds to inhalation. When the torso is lowered, it simulates exhalation. Instead of a towel, you can use any belt, scarf, etc.

Howard's method

The victim is positioned supine. A cushion is placed under his back. Hands are moved behind the head and extended. The head itself is turned to the side, the tongue is extended and secured. The one who performs artificial respiration sits astride the victim’s thigh area and places his palms on the lower part of the chest. With your fingers spread, you should grab as many ribs as possible. When the chest is compressed, it simulates inhalation; when the pressure is released, it simulates exhalation. You should do twelve to sixteen movements per minute.

Frank Eve's method

This method requires a stretcher. They are installed in the middle on a transverse stand, the height of which should be half the length of the stretcher. The victim is placed prone on the stretcher, the face is turned to the side, and the arms are placed along the body. The person is tied to the stretcher at the level of the buttocks or thighs. When lowering the head end of the stretcher, inhale; when it goes up, exhale. Maximum breathing volume is achieved when the victim's body is tilted at an angle of 50 degrees.

Nielsen method

The victim is placed face down. His arms are bent at the elbows and crossed, after which they are placed palms down under the forehead. The rescuer kneels at the victim’s head. He places his hands on the victim’s shoulder blades and, without bending them at the elbows, presses with his palms. This is how exhalation occurs. To inhale, the rescuer takes the victim’s shoulders at the elbows and straightens, lifting and pulling the victim towards himself.

Hardware artificial respiration methods

For the first time, hardware methods of artificial respiration began to be used back in the eighteenth century. Even then, the first air ducts and masks appeared. In particular, doctors proposed using fireplace bellows to blow air into the lungs, as well as devices created in their likeness.

The first automatic ID machines appeared at the end of the nineteenth century. At the beginning of the twenties, several types of respirators appeared at once, which created intermittent vacuum and positive pressure either around the entire body, or only around the patient’s chest and abdomen. Gradually, respirators of this type were replaced by air-injection respirators, which had less solid dimensions and did not impede access to the patient’s body, allowing medical procedures to be performed.

All ID devices existing today are divided into external and internal. External devices create negative pressure either around the patient's entire body or around his chest, thereby inhaling. Exhalation in this case is passive - the chest simply collapses due to its elasticity. It can also be active if the device creates a positive pressure zone.

With the internal method of artificial ventilation, the device is connected through a mask or intubator to the respiratory tract, and inhalation is carried out by creating positive pressure in the device. Devices of this type are divided into portable, intended for work in “field” conditions, and stationary, the purpose of which is long-term artificial respiration. The former are usually manual, while the latter operate automatically, driven by a motor.

Complications of artificial respiration

Complications due to artificial respiration occur relatively rarely and even if the patient is on artificial ventilation for a long time. Most often, undesirable consequences concern the respiratory system. Thus, due to an incorrectly chosen regimen, respiratory acidosis and alkalosis can develop. In addition, prolonged artificial respiration can cause the development of atelectasis, since the drainage function of the respiratory tract is impaired. Microatelectasis, in turn, can become a prerequisite for the development of pneumonia. Preventative measures that will help avoid the occurrence of such complications are careful respiratory hygiene.

Speciality: infectious disease specialist, gastroenterologist, pulmonologist.

Total experience: 35 years old.

Education:1975-1982, 1MMI, san-gig, highest qualification, infectious disease doctor.

Scientific degree: doctor of the highest category, candidate of medical sciences.

Time is of the essence in life-threatening emergencies. If the brain doesn't get oxygen within a few minutes after breathing stops, permanent brain damage or death occurs: 0 minutes- breathing has stopped, the heart will soon stop; 4-6 minutes- possible brain damage; 6-10 minutes- probable brain damage; more than 10 minutes- irreversible brain damage

The need for artificial respiration occurs in cases where breathing is absent or impaired to such an extent that it threatens the life of the victim. Artificial respiration is an emergency first aid measure for drowning, suffocation, electric shock, heat and sunstroke, and some poisonings. In case of clinical death, that is, in the absence of spontaneous breathing and heartbeat, artificial respiration is carried out simultaneously with cardiac massage. The duration of artificial respiration depends on the severity of respiratory disorders, and it should continue until independent breathing is completely restored. When the first signs of death appear, for example, cadaveric spots, artificial respiration should be stopped.

The best The method of artificial respiration, of course, is to connect special devices to the victim’s respiratory tract ( respirators), which can blow into the victim up to 1000-1500 ml of fresh air for each breath. But non-specialists, of course, do not have such devices at hand. Old methods of artificial respiration (Sylvester, Schaeffer, etc.), which are based on various chest compression techniques, are not effective enough, since, firstly, they do not clear the airways from a sunken tongue, and secondly, with their with help, no more than 200-250 ml of air enters the lungs in 1 breath. Currently, the most effective methods of artificial respiration are mouth-to-mouth and mouth-to-nose blowing. The rescuer forcefully exhales air from his lungs into the victim’s lungs, temporarily becoming a “respirator.” Of course, this is not the fresh air with 21% oxygen that we breathe. However, as studies by resuscitators have shown, the air exhaled by a healthy person still contains 16-17% oxygen, which is enough to carry out full artificial respiration, especially in extreme conditions.

So, if the victim does not have his own breathing movements, then artificial respiration must be started immediately! If there is any doubt whether the victim is breathing or not, then you should, without hesitation, start “breathing for him” and not waste precious minutes looking for a mirror, applying it to the court, etc.
In order to blow “the air of your exhalation” into the victim’s lungs, the rescuer is forced to touch his face with his lips. From hygienic and ethical considerations, the following technique, consisting of several operations, can be considered the most rational:
1) take a handkerchief or any other piece of cloth (preferably gauze);
2) bite a hole in the middle of the gauze;
3) expand it with your fingers to 2-3 cm;
4) place the fabric with the hole on the victim’s nose or mouth (depending on the choice of artificial respiration method);
5) press your lips tightly to the victim’s face through the gauze, and blow through the hole in it.

Artificial breathing from mouth to mouth. The rescuer stands to the side of the victim’s head (preferably on the left). If the victim is lying on the floor, then you have to kneel. Quickly clears the victim's mouth and throat of vomit. If the victim's jaws are tightly clenched, he moves them apart. Then, placing one hand on the victim’s forehead and the other on the back of the head, he hyperextends (that is, tilts back) the victim’s head, while the mouth, as a rule, opens. The rescuer takes a deep breath, slightly holds his exhalation and, bending over the victim, completely seals the area of ​​his mouth with his lips, creating a kind of air-impermeable dome over the victim’s mouth. In this case, the victim’s nostrils must be closed with the thumb and forefinger of the hand lying on his forehead, or covered with his cheek, which is much more difficult to do. Lack of tightness is a common mistake during artificial respiration. In this case, air leakage through the nose or corners of the victim’s mouth negates all the efforts of the rescuer. After sealing, the rescuer exhales quickly, forcefully, blowing air into the victim's airways and lungs. The exhalation should last about 1 s and reach 1.0-1.5 liters in volume in order to cause sufficient stimulation of the respiratory center. In this case, it is necessary to continuously monitor whether the victim’s chest rises well during artificial inhalation. If the amplitude of such respiratory movements is insufficient, it means that the volume of air blown in is small or the tongue sinks. After the end of exhalation, the rescuer unbends and frees the victim’s mouth, in no case stopping the hyperextension of his head, otherwise the tongue will sink and there will be no full independent exhalation. The victim’s exhalation should last about 2 seconds, in any case it is better that it be twice as long as the inhalation. In the pause before the next inhalation, the rescuer needs to take 1-2 small regular inhalations and exhalations “for themselves.” The cycle is repeated at a frequency of 10-12 per minute. If a large amount of air enters not into the lungs, but into the stomach, swelling of the latter will complicate the rescue of the victim. Therefore, it is advisable to periodically empty his stomach of air by pressing on the epigastric (epigastric) region.

Artificial breathing from mouth to nose carried out if the victim has clenched teeth or has an injury to the lips or jaws. The rescuer, placing one hand on the victim’s forehead and the other on his chin, hyperextends his head and simultaneously presses his lower jaw to his upper jaw. With the fingers of the hand supporting the chin, he should press the upper lip, thereby sealing the victim’s mouth. After a deep breath, the rescuer covers the victim’s nose with his lips, creating the same air-tight dome. Then the rescuer performs a strong blowing of air through the nostrils (1.0-1.5 l), while monitoring the movement of the victim’s chest.
After the end of artificial inhalation, it is necessary to free not only the nose, but also the victim’s mouth: the soft palate can prevent air from escaping through the nose and then, with the mouth closed, there will be no exhalation at all. When exhaling like this, you need to keep your head hyperextended (that is, tilted back), otherwise a sunken tongue will interfere with exhalation. The duration of exhalation is about 2 s. During the pause, the rescuer takes 1-2 small breaths “for himself.”
Artificial respiration should be carried out without interruption for more than 3-4 seconds until spontaneous breathing is completely restored or until a doctor appears and gives other instructions. It is necessary to continuously check the effectiveness of artificial respiration (good inflation of the victim’s chest, absence of bloating, gradual pinkening of the facial skin). You should constantly ensure that vomit does not appear in the mouth and nasopharynx, and if this happens, then before the next inhalation, use a finger wrapped in a cloth to clear the victim’s airways through the mouth. As artificial respiration is performed, the rescuer may become dizzy due to the lack of carbon dioxide in his body. Therefore, it is better for two rescuers to inflate the air, changing every 2-3 minutes. If this is not possible, then every 2-3 minutes you should reduce your breaths to 4-5 per minute, so that during this period the level of carbon dioxide in the blood and brain of the person performing artificial respiration rises.
When performing artificial respiration on a victim with respiratory arrest, it is necessary to check every minute whether he has also suffered cardiac arrest. To do this, you should feel the pulse in the neck with two fingers in the triangle between the windpipe (laryngeal cartilage, which is sometimes called the Adam's apple) and the sternocleidomastoid (sternocleidomastoid) muscle. The rescuer places two fingers on the lateral surface of the laryngeal cartilage, and then “slides” them into the hollow between the cartilage and the sternocleidomastoid muscle. It is in the depths of this triangle that the carotid artery should pulsate. If there is no pulsation of the carotid artery, you must immediately begin chest compressions, combining it with artificial respiration. If you miss the moment of cardiac arrest and perform only artificial respiration on the victim for 1-2 minutes, then, as a rule, it will not be possible to save him.

Situations when a person may require artificial respiration and cardiac massage do not happen as rarely as we imagine. This can be depression or arrest of the heart and breathing in accidents such as poisoning, drowning, foreign objects entering the respiratory tract, as well as in traumatic brain injuries, strokes, etc. Providing assistance to the victim should be carried out only with full confidence in one’s own competence, because incorrect actions often lead to disability and even death of the victim.

How to perform artificial respiration and provide other first aid in emergency situations is taught at special courses run by units of the Ministry of Emergency Situations, in tourist clubs, and in driving schools. However, not everyone is able to apply the knowledge gained in courses in practice, much less determine in which cases it is necessary to perform cardiac massage and artificial respiration, and when it is better to abstain. You need to start resuscitation measures only if you are firmly convinced of their feasibility and know how to properly perform artificial respiration and external cardiac massage.

Sequence of resuscitation measures

Before starting the procedure of artificial respiration or indirect external cardiac massage, you must remember the sequence of rules and step-by-step instructions for their implementation.

1. First you need to check whether the unconscious person is showing signs of life. To do this, put your ear to the victim's chest or feel for the pulse. The easiest way is to place 2 closed fingers under the victim’s cheekbones; if there is pulsation, it means the heart is working.
2. Sometimes the victim’s breathing is so weak that it is impossible to detect it by ear; in this case, you can observe his chest; if it moves up and down, it means breathing is functioning. If movements are not visible, you can put a mirror on the victim’s nose or mouth; if it fogs up, it means there is breathing.
3. It is important that if it turns out that an unconscious person has a functioning heart and, albeit weakly, respiratory function, it means that he does not need artificial ventilation and external cardiac massage. This point must be strictly observed for situations where the victim may be in a state of heart attack or stroke, because in these cases any unnecessary movements can lead to irreversible consequences and death.

If there are no signs of life (most often the respiratory function is impaired), resuscitation measures should be started as soon as possible.

Basic methods of providing first aid to an unconscious victim

The most frequently used, effective and relatively uncomplicated actions:

• mouth-to-nose artificial respiration procedure;
• mouth-to-mouth artificial respiration procedure;
• external cardiac massage.

Despite the relative simplicity of the activities, they can only be carried out by mastering special implementation skills. The technique of performing artificial ventilation of the lungs, and, if necessary, cardiac massage, carried out in extreme conditions, requires physical strength, precision of movements and some courage from the resuscitator.

For example, it will be quite difficult for an unprepared, fragile girl to perform artificial respiration, and especially to perform cardiac resuscitation on a large man. However, mastering the knowledge of how to properly perform artificial respiration and how to perform cardiac massage allows a resuscitator of any size to carry out competent procedures to save the life of the victim.

The procedure for preparing for resuscitation actions

When a person is unconscious, he should be brought back to his senses in a certain sequence, having previously clarified the need for each of the procedures.

1. First, clear the airways (throat, nasal passages, mouth) of foreign objects, if any. Sometimes the victim’s mouth may be filled with vomit; it must be removed using gauze wrapped around the resuscitator’s palm. To facilitate the procedure, the victim’s body must be turned to one side.
2. If the heart rhythm is detected, but breathing does not work, only mouth-to-mouth or mouth-to-nose artificial respiration is required.
3. If both the heartbeat and respiratory function are inactive, artificial respiration alone cannot be done, and indirect cardiac massage will have to be done.

List of rules for performing artificial respiration

Artificial respiration techniques include 2 methods of mechanical ventilation (artificial pulmonary ventilation): these are methods of pumping air from the mouth into the mouth and from the mouth into the nose. The first method of performing artificial respiration is used when it is possible to open the victim’s mouth, and the second - when it is impossible to open his mouth due to spasm.

Features of the mouth-to-mouth ventilation technique

A serious danger for a person performing artificial respiration using the mouth-to-mouth technique may be the possibility of the release of toxic substances from the victim’s chest (especially in case of cyanide poisoning), infected air and other toxic and dangerous gases. If such a possibility exists, the mechanical ventilation procedure should be abandoned! In this situation, you will have to make do with indirect cardiac massage, because mechanical pressure on the chest also contributes to the absorption and release of about 0.5 liters of air. What actions are performed during artificial respiration?

1. The patient is placed on a hard horizontal surface and the head is thrown back, placing a bolster, a twisted pillow or a hand under the neck. If there is a possibility of a neck fracture (for example, in an accident), throwing your head back is prohibited.
2. Pull the patient's lower jaw down, open the oral cavity and free it from vomit and saliva.
3. Hold the patient's chin with one hand, and tightly pinch his nose with the other, take a deep breath through the mouth and exhale air into the victim's mouth. In this case, your mouth must be pressed firmly against the patient’s mouth so that air passes into his respiratory tract without escaping (for this purpose, the nasal passages are pinched).
4. Artificial respiration is performed at a rate of 10-12 breaths per minute.
5. To ensure the safety of the resuscitator, ventilation is performed through gauze; control of the pressure density is mandatory.

The artificial respiration technique involves gentle air injections. The patient needs to be provided with a powerful, but slow (over one to one and a half seconds) supply of air to restore the motor function of the diaphragm and smoothly fill the lungs with air.

Basic rules of the “mouth to nose” technique

If it is impossible to open the victim’s jaw, artificial respiration from the mouth to the nose is used. The procedure for this method is also carried out in several steps:

• first, the victim is laid horizontally and, if there are no contraindications, the head is thrown back;
• then check the nasal passages for patency and, if necessary, clean them;
• if possible, extend the jaw;
• take as full a breath as possible, cover the patient’s mouth and exhale air into the victim’s nasal passages.
• count 4 seconds from the first exhalation and take the next inhalation and exhalation.

How to perform artificial respiration on young children

Performing the mechanical ventilation procedure for children is somewhat different from the previously described actions, especially if you need to perform artificial respiration for a child under 1 year old. The face and respiratory organs of such children are so small that adults can ventilate them simultaneously through the mouth and through the nose. This procedure is called “mouth to mouth and nose” and is performed similarly:

• first the baby's airways are cleared;
• then the baby’s mouth is opened;
• The resuscitator takes a deep breath and exhales slowly but powerfully, covering both the child’s mouth and nose with his lips at the same time.

The approximate number of air blows for children is 18-24 times per minute.

Checking the correctness of mechanical ventilation

When carrying out resuscitation efforts, it is necessary to constantly monitor the correctness of their implementation, otherwise all efforts will be in vain or will further harm the victim. Methods for monitoring the correctness of mechanical ventilation are the same for adults and children:

• if, while blowing air into the victim’s mouth or nose, a rise and fall of his chest is observed, it means that passive inhalation is working and the mechanical ventilation procedure is carried out correctly;
• if the chest movements are too sluggish, it is necessary to check the tightness of the compression when exhaling;
• if artificial injection of air moves not the chest, but the abdominal cavity, this means that the air does not enter the respiratory tract, but into the esophagus. In this situation, it is necessary to turn the victim’s head to the side and, pressing on the stomach, allow air to burp.

It is necessary to check the effectiveness of mechanical ventilation every minute; it is advisable that the resuscitator has an assistant who would monitor the correctness of actions.

Rules for performing indirect cardiac massage

The procedure for chest compressions requires somewhat more effort and caution than mechanical ventilation.

1. The patient should be placed on a hard surface and the chest should be freed from clothing.
2. The person resuscitating must kneel to the side.
3. You need to straighten your palm as much as possible and place its base on the middle of the victim’s chest, about 2-3 cm above the end of the sternum (where the right and left ribs “meet”).
4. Pressure on the chest should be applied centrally, because This is where the heart is located. Moreover, the thumbs of the massaging hands should be directed towards the stomach or chin of the victim.
5. The other hand should be placed on the lower one - crosswise. The fingers of both palms should be kept pointing upward.
6. The resuscitator's arms must be straightened when applying pressure, and the center of gravity of the entire weight of the resuscitator must be transferred to them so that the shocks are strong enough.
7. For the convenience of the resuscitator, before starting the massage, he needs to take a deep breath, and then, as he exhales, make several quick presses with crossed palms on the patient’s chest. The frequency of shocks should be at least 60 times per minute, while the victim’s chest should drop by about 5 cm. Elderly victims can be resuscitated with a frequency of 40-50 shocks per minute; for children, cardiac massage is done faster.
8. If resuscitation measures include both external cardiac massage and artificial ventilation, then they need to be alternated in the following sequence: 2 breaths - 30 pushes - 2 breaths - 30 pushes and so on.

Excessive zeal of the resuscitator sometimes leads to broken ribs of the victim. Therefore, when performing a cardiac massage, one should take into account the individual’s own strengths and characteristics. If this is a person with thin bones, a woman or a child, efforts should be moderated.

How to give a heart massage to a child

As has already become clear, cardiac massage in children requires special care, since the children’s skeleton is very fragile, and the heart is so small that it is enough to massage with two fingers, and not with the palms. In this case, the child’s chest should move in the range of 1.5-2 cm, and the frequency of compressions should be 100 times per minute.

For clarity, you can compare the measures for resuscitation of victims depending on age using the table.

Important: cardiac massage must be carried out on a hard surface so that the victim’s body is not absorbed into soft ground or other non-solid surfaces.

Monitoring the correct execution - if all actions are performed correctly, the victim develops a pulse, cyanosis (blue discoloration of the skin) disappears, respiratory function is restored, and the pupils return to normal sizes.

How long does it take to resuscitate a person?

Resuscitation measures should be carried out for the victim for at least 10 minutes or exactly as long as it takes for signs of life to appear in the person, and ideally until the doctors arrive. If the heartbeat continues and respiratory function is still impaired, mechanical ventilation must be continued for quite a long time, up to an hour and a half. The likelihood of a person returning to life in most cases depends on the timeliness and correctness of resuscitation actions, however, there are situations when this cannot be done.

Symptoms of biological death

If, despite all efforts to provide first aid, they remain ineffective for half an hour, the victim’s body begins to become covered with cadaveric spots, the pupils, when pressed on the eyeballs, take on the appearance of vertical slits (“cat pupil syndrome”), and signs of rigor also appear, which means further actions are meaningless. These symptoms indicate the onset of biological death of the patient.

No matter how much we would like to do everything in our power to bring a sick person back to life, even qualified doctors are not always able to stop the inevitable passage of time and give life to a patient doomed to death. This is, unfortunately, life, and you just have to come to terms with it.

occurs when breathing stops or when breathing is incorrect. The most common way of breathing is " mouth to mouth" or " from mouth to nose».

The victim is placed on his back. His head is thrown back, causing the respiratory tract, closed with a sunken tongue. The mouth is opened by pressing on the chin. After taking a deep breath, the person providing assistance breathes all the air from his lungs into the victim’s mouth. At the same time, cover the victim’s nose.

In the same way, artificial respiration is performed using the “mouth to nose” method. For small children, artificial respiration can be performed simultaneously in the mouth and nose.

Air is inhaled at a frequency of 16-18 per minute.

Heart massage

performed during cardiac arrest, which can occur due to a blow to the heart area, suffocation, electric shock, heat stroke, blood loss, etc.

At indirect cardiac massage contraction and stretching are performed by pressing on the lower third of the sternum with the inside of the wrist of the left hand, which is additionally pressed with the right hand.

The pressure on the chest should be rhythmic and jerky. After each pressure, the person providing assistance quickly removes his hands. Pressure is produced at a frequency of 60-70 per minute, i.e. on the count of “one and two.”

Rhythmic compression of the chest causes the heart to contract, and the cessation of pressure causes it to stretch. Cardiac massage is performed until self-recovery cardiac activity.

When providing first aid to the victim, you must simultaneously call an ambulance doctor from the nearest medical facility.

Place your other hand on the patient's forehead. Using the thumb and forefinger of this hand, pinch the patient's nostrils to prevent air from leaking through the nose.

Continue to apply pressure to the patient's forehead with the palm of this hand to keep the head as tilted back as possible.

Take a deep breath, then tightly clasp your lips around the patient's mouth.

Give four quick, vigorous breaths into the patient's airway. Watch the movement of the chest as you blow in air.

With proper artificial respiration, the chest should rise and fall. Move your head to the side so that the victim exhales passively.

If you are in the right position, you can feel the movement of exhaled air with your cheek.

Take another deep breath, close your lips tightly around the victim's mouth and breathe vigorously again.

Repeat this procedure 10-12 times per minute (every 5 seconds) when helping adults and children over four years of age.

If there is no air movement and the airway remains obstructed, remove foreign objects from the victim's mouth and throat with your fingers and then begin artificial respiration again. The presence of a foreign body should be suspected if you are unable to inflate the victim's lungs despite proper artificial respiration.

Artificial respiration "mouth to nose"

Mouth-to-nose breathing should be used in situations where it is impossible to open the victim’s mouth, when the mouth is severely damaged, and when the rescuer cannot tightly cover the victim’s mouth with his lips.

Forcefully tilt the victim's head back with one hand. With your other hand, press the victim's lower jaw to the upper jaw, thereby tightly closing his mouth.

Take a deep breath, tightly wrap your lips around the victim’s nose and inhale vigorously, watching the movement of the chest. Repeat this blowing quickly four times. Move your head to the side, giving the victim the opportunity to exhale passively.

Do 10-12 blows per minute.

Alternative method of artificial respiration (Sylvester method)

In some situations, it is not possible to perform artificial respiration using the mouth-to-mouth method. This occurs when the victim is poisoned by toxic or caustic substances, which are also dangerous for the rescuer, as well as in case of severe facial injuries, which preclude the use of mouth-to-mouth and mouth-to-nose methods. In such cases, you can resort to an alternative method of artificial respiration. It should be remembered, however, that this method is much less effective than the two described above, and should only be used if it is impossible to use the mouth-to-mouth method.

Artificial respiration must be continued as long as the victim retains signs of life; sometimes it takes 2 hours or more.

Indirect cardiac massage

When trying to bring back to life a person who is not breathing and whose heart has stopped, in addition to artificial respiration, indirect (closed) cardiac massage must be performed.

Artificial respiration provides oxygen to the victim's lungs. From there, oxygen is carried by the blood to the brain and other organs. Effective indirect cardiac massage allows you to artificially maintain blood circulation for some time until the heart begins to work again.

Indirect cardiac massage technique

Compression of the sternum creates some artificial ventilation of the lungs, which, however, is not sufficient to fully enrich the blood with oxygen. For this reason, along with chest compressions, artificial respiration is always necessary.

For effective chest compressions, the lower end of the victim’s sternum must shift by 4-5 cm (in adults). The victim must be placed on a hard surface. If he is in bed, a flat, hard object, such as a board, should be placed under his back. However, you cannot put off cardiac massage in search of such an item.

Kneel at the victim's side and place the palm of one hand on the lower half of the sternum. You should not place your hand on the xiphoid process of the sternum, which is located above the upper abdomen. Pressure on the xiphoid process can lead to rupture of the liver and cause severe internal bleeding.

Feel the end of the sternum and place your palm about 4 cm closer to the victim's head. Your fingers should not press on the victim's ribs, as this increases the likelihood of them breaking.

The head is completely thrown back. Folded clothes are placed under the shoulders.

A. Place the victim's back on a hard surface.

Place folded clothing or another object under your shoulders.

B. Kneel on the sides of the patient's head. If necessary, turn his head to the side to clear his mouth. Take the patient's wrists and cross them over the lower part of his chest.

B. Lean forward and press on the patient's chest. Then, in an arcuate motion, tilt the patient's arms as far back and to the sides as possible. Repeat this procedure rhythmically (12 times per minute). Make sure that the patient's mouth is free.

Place your second hand on the back of your first hand. Lean forward so that your shoulders are almost under the victim's chest.

Straighten your arms and press on the sternum so that its lower end moves towards the spine by 4-5 cm.

When assisting an adult, apply approximately 60 chest compressions per minute (if a second rescuer is performing artificial respiration). This is usually enough to maintain blood circulation and fill the heart with venous blood. The massage should be uniform, smooth and continuous, the duration of pressure and relaxation should be the same. Under no circumstances should heart massage be interrupted for more than 5 seconds. It is advisable that two rescuers provide assistance to the victim, since artificial circulation must be combined with artificial respiration. Ideally, there should be five compressions on the sternum for one air blow. When providing assistance by two rescuers, the frequency of compressions on the sternum should be 60 times per minute. One rescuer performs chest compressions, while the second holds the victim's head tilted back and performs artificial respiration. Insufflation of air must be done without interrupting the cardiac massage, since any pause leads to cessation of blood circulation and a drop in blood pressure to zero.

If one rescuer is assisting the victim, there should be approximately 15 compressions on the sternum for 2 air injections. After every 15 compressions on the sternum, you need to take two very quick breaths of air, without waiting for a complete exhalation. In order to provide 50-60 chest compressions per minute, one rescuer must perform chest compressions at a rate of about 80 per minute, since he has to interrupt the massage and blow air into the lungs.

TRANSFER OF FRACTURE VICTIMS (LIMB AND SPINE)

A SPINAL FRACTURE IS A POTENTIALLY VERY SEVERE INJURY. IF A SPINEAL FRACTURE IS SUSPECTED, ASK THE VICTIM TO LYE WITHOUT MOVEMENT AND DO NOT ALLOW OTHERS TO MOVE THEM UNTIL THEY ARE POSITIONED ON A FLAT, HARD SURFACE. Any careless movement by a person with a spinal fracture can cause damage or rupture of the spinal cord, resulting in permanent paralysis, loss of sensation in the legs, and lifelong urinary and fecal incontinence.

The most common cause of spinal fracture in sailors is a fall from a height. Always keep in mind the possibility of a spinal fracture if the victim falls from a height of more than two meters. Ask him if he feels pain in his back. Most people with a spinal fracture feel pain, but a very small number experience no pain. Therefore, carefully find out all the circumstances of the injury and, if in doubt, treat the victim as if he had a spinal fracture. First of all, ask him to move his toes to check if he has paralysis, also find out if he can feel your touch on his toes.

A victim with a spinal fracture should lie still and straight. In no case should his body be bent like a jackknife, lifting it under the knees and under the armpits. The victim, however, can be turned onto his left or right side without harm, since with careful turning the movements of the spine are very small. The goal of first aid is to place the victim on a flat, hard surface and thereby keep him completely safe until x-rays can be taken.

As soon as you suspect a spinal fracture, ask the victim to lie still. An attempt to drag the victim or otherwise carelessly move him can cause permanent paralysis.

Tie the victim's feet and ankles together and ask him to lie still and straight. In order to straighten his body, you need to stretch his head and feet. Don't bend it. The victim can lie straight on his back as long as necessary. So don't rush to move it. Prepare a hard stretcher. A Neil-Robertson stretcher is suitable for carrying victims with a spinal fracture. Canvas stretchers can only be used if they are reinforced with transverse wooden pads that provide rigid support for the back. Some models of Neil-Robertson stretchers also require additional rigidity. If a Neil-Robertson stretcher is not available, a wide wooden board can be used to immobilize the victim. This improvised method can also be used to immobilize a victim in case of suspected pelvic fracture. Another method of lifting a victim with a spinal injury is shown. First, very carefully place the victim on a spread blanket. Then roll both edges of the blanket very tightly so that the bolsters are as close to the victim’s body as possible. Prepare a stretcher in advance, reinforced with wooden pads. To maintain two deflections of the spine (one in the cervical, the second in the lumbar regions), place two pillows on the stretcher. The lumbar pillow should be larger than the neck pillow. Now prepare to lift the victim. At least two people should hold the blanket on each side; one person should pull the victim by the head, the other by the feet. Rescuers lifting the blanket should be positioned so that the main lifting force falls on the victim's head and torso. Another assistant is needed to move the stretcher under the victim once he is lifted on the blanket.

Start lifting by stretching your head and feet. Pull by the lower jaw, grabbing the sides of the head, and by the ankles. Once confident traction has been achieved, begin to slowly lift the victim.

Very slowly and carefully lift the victim to a height of about half a meter, i.e. just wide enough to move the stretcher underneath him. Be careful to keep the victim's body extended at all times.

Slide the stretcher between the legs of the person pulling the victim's ankles towards the head so that it is positioned directly under the victim. Adjust the pillows so that they are directly under the cervical and lumbar curves of the spine.

Now very, very slowly lower the victim onto the stretcher. Continue traction until the victim is securely placed on the stretcher.

Now the victim can be evacuated. If it has to be laid on any other surface, the latter must be rigid and flat. During the evacuation process, it is necessary to follow all the rules described above for handling the victim and be sure to pull his body by the head and ankles.

Since the placement and evacuation of a casualty involves many people who must act with great care, it is helpful to have one of them read the instructions aloud before each operation.