The term “resuscitation” refers to a set of measures taken to restore vital functions in a person who has been clinically dead. They are carried out when the pulse and breathing stop, and the pupils do not react to light. In addition, in medical parlance, intensive care is the name given to a specialized ambulance team and intensive care unit designed to treat seriously ill patients who are on the verge of life and death.

General information

It has long been proven that after the heart stops and the breathing process stops, the human body lives for several more minutes, despite the fact that oxygen does not enter it. The cerebral cortex is the first to suffer from hypoxia. From the moment of her death, the biological death of a person occurs. This occurs approximately 4 minutes after the cessation of vital processes. Thus, there is a short period of time in which it is possible to restore a person’s blood circulation and breathing. It is important to know that resuscitation is an event that everyone must know how to carry out in order to provide timely assistance to the patient before the doctors arrive. The sooner they are carried out, the higher the likelihood of a favorable outcome.

The period of revival of the patient is divided into 2 stages:

1. Cardiopulmonary resuscitation.
2. Intensive care.

In the first case, emergency assistance is provided, in the second, the consequences of clinical death (cardiac and respiratory arrest) are eliminated and the pathological condition that led to it is treated. During the period of life support, the patient is constantly in the intensive care unit.

Causes of clinical death

Typically, cardiac arrest occurs due to:

• Anaphylactic shock. This condition is usually the result of an allergy.
• Heart diseases, the course of which negatively affects the functioning of the organ.
• Constantly being in a state of stress, as well as high intensity physical activity. A natural consequence is a significant deterioration in the blood supply to the organ.
• Blockage of blood vessels with blood clots.
• Large blood loss resulting from injury or injury, including a violent one.
• Ingestion or administration of unsafe medications and dietary supplements. For example, after inappropriate injections of Synthol, any bodybuilder can end up in intensive care.
• Toxic shock resulting from the action of harmful chemical compounds.
• Asphyxia.
• Serious diseases of the respiratory system.

Every person should understand that resuscitation is a set of measures, the correctness of which not only medical workers, but also ordinary people should be aware of.

Symptoms of clinical death

This condition requires emergency care, so it is necessary to be able to recognize it in a timely manner.

1. Unconscious state. It occurs a few seconds after blood circulation stops.
2. No pulse. This is the first sign that oxygen has stopped flowing to the brain. The slightest delay can cost a person his life.
3. Lack of breathing. How can I check this? You need to pay attention to whether the person’s chest makes characteristic movements, then bend over to his face with your left ear and try to catch any sounds. After this, you can try to feel his breathing on the skin by raising your hand to the patient’s mouth. In medical language, this method is called “see, hear, feel.”
4. Dilated pupils, no reaction to light.

If symptoms of clinical death are detected in a person, assistance should be provided immediately.

Cardiopulmonary resuscitation

Its task is to resume the processes of breathing and blood circulation. Liquid connective tissue must be forcibly enriched with oxygen and deliver it to the brain.

The algorithm for performing pulmonary-cardiac resuscitation is as follows:

1. Preparing the patient. The person must be laid with his back on a hard surface (floor, asphalt, etc.). The victim needs to expose his chest, as there may be various jewelry under his clothes, which can lead to additional injuries during resuscitation.
2. Restoration of airway patency. To do this, you need to wrap the cloth around your index finger and free the victim’s mouth from mucus, foreign objects or vomit. Next, you need to tilt the person’s head back to get rid of the tongue sinking. To do this, you need to place a roll of clothing under his neck or shoulder blade area (not under the back of his head). Hard objects are not suitable for these purposes, since with further chest compressions there is an extremely high probability of breaking the victim’s spine.
3. Delivery of a precordial blow. At the bottom of the sternum is the xiphoid process. If you place your fingers on this zone, then a little higher (2-3 cm) will be the point of impact. To carry it out, you need to take a position so that the elbow is above the victim’s stomach, and the edge of the palm clenched into a fist is above the sternum. Next, you need to apply just one sharp blow to the point above the xiphoid process. The goal is to shake the chest and get the heart pumping again. After the blow is made, you need to check your pulse. If it is detected, the victim must be laid on his side; if he is absent, follow the next step.
4. Indirect cardiac massage. The technique is as follows: take a position to the right of the person, place the left palm about 10 cm above the xiphoid process. It is important that the fingers do not touch the chest. Place the right brush on top. Both arms should not bend at the elbow joints. Next, you need to rhythmically press on the sternum (palms should be on it all the time) approximately 60-70 times per minute (in adults). When making pushes, it is important that they move towards the spine by 3-5 cm. Massage can be alternated with artificial respiration. To do this, you need to pinch the patient’s nose with the fingers of your left hand, then press your mouth tightly against the person’s mouth through a napkin and forcefully exhale the air.

It is important to know that resuscitation is a set of measures that can be carried out simultaneously with the presence of several assistants. For example, one person performs artificial respiration on the victim, and the second performs chest compressions. Doctors carry out revitalization measures according to the same scheme; in addition, medications and a defibrillator can be used. Contrary to popular belief, epinephrine injections into the heart are not given during resuscitation and have not been found to be effective.

How is it done in children?

If there is a sudden stop in blood circulation, you need to assess the child’s condition within 5-10 seconds.

Signs of clinical death in children are:

• unconscious state;
• pulse cannot be felt;
• dilated pupils;
• lack of reflex reactions.

Before the ambulance arrives, the algorithm for resuscitating children is as follows:

1. Ensure airway patency (methods are similar to those used in adult victims).
2. Artificial ventilation. You need to take 5 mouth-to-mouth breaths and check for a pulse. In its absence, it is necessary to begin alternating chest compressions and mouth-to-mouth breathing. In this case, 2 breaths should be taken for 15 beats. The frequency of chest compressions is 100-120 per minute.

Activities should be carried out until the arrival of doctors.

Features of neonatal resuscitation

The algorithm for its implementation is similar to that applicable to older children. If the victim is a child under 1 year old, the difference lies in the method of performing chest compressions. It is carried out as follows: you need to place your index and middle fingers on the lower part of the sternum (just below the level of the nipples) and make quick, sharp pressures with them (about 120 per minute).

Intensive care

Its task is to maintain the vital functions of the patient’s body throughout the entire time he is in critical condition.

In medical institutions, the main structural unit is the intensive care unit. Seriously ill patients are constantly cared for, and doctors monitor the dynamics of changes in their health indicators. Transfer to a regular ward is issued when conditions incompatible with life are eliminated.

Termination of resuscitation measures

All attempts to restore vital human processes are completed in the following cases:

• CPR for 30 minutes did not produce results (10 minutes for newborns).
• Biological death was recorded.

In addition, you need to know that resuscitation is a measure that is not carried out if clinical death is a consequence of the progression of incurable pathologies or the consequences of injuries that are incompatible with life.

In conclusion

Bringing a person back to life can be carried out both by doctors in a medical institution and by ordinary people anywhere where the victim is. To do this, you need to know the main stages and methods of resuscitation measures.

A person must be able to perform resuscitation, since medical assistance cannot always arrive before biological death occurs in the victim. The dying process does not occur in one stage. At first the person is in a state of agony. This period is characterized by a sharp decrease in blood pressure, blackouts, disturbances in heart function, absence of pulse, and shallow breathing. The skin in this state immediately turns pale and acquires a bluish tint. Then the body goes into a state of clinical death. Respiratory and cardiac activity stop completely. During this period it is still possible to return to life. After 3–5 minutes, biological pain sets in, when it is almost impossible to bring a person back to life. Even if the heartbeat and breathing are restored, the person becomes disabled, the brain dies, and doctors can only support vital functions.

If a person is injured due to an electric shock, a precordial shock should be performed first. Place the person's back on a hard surface. Find the xiphoid, place your middle and index fingers on it. Place the fist of your other hand above your fingers, pointing your elbow along your body. Hit this area sharply with your fist. After this, the heart may begin to beat. If this does not happen, then proceed to the next stage, which is suitable for any case of breathing and heartbeat problems.

Throw the victim's head back, push the lower jaw forward, opening his mouth. Wrap your finger in a bandage or any rag. Clean the person’s mouth from any foreign matter, free the tongue, as in such cases it often sinks and blocks breathing. Start mouth-to-nose or mouth-to-mouth artificial respiration. If you do mouth-to-nose breathing, your air comes out through the victim's open mouth, so you need to close it completely. The same thing when breathing “mouth to mouth”, pinch the nose of the person being resuscitated.

Supplement artificial respiration with indirect cardiac massage. Place your palm in the lower third of the victim's sternum, pointing your finger down or towards the face. Place your other palm on top of the cross. Raise your fingers slightly above the surface so as not to break the victim’s ribs. The massage occurs by pressing with all your weight on the designated area so that the person’s chest goes inward by 3–5 cm. The interval between pressures is 1 second.

Combine artificial respiration and chest compressions in a ratio of 1:5. Give the victim 1 breath through the airways, then apply 5 compressions to the sternum. It’s good if 2–3 people will resuscitate. It is necessary to make the process harmonious: you cannot simultaneously inhale air into the lungs and press on the chest, as this can damage the integrity of the lungs. Continue performing these manipulations for at least 5 minutes. An ambulance should arrive by this time. Without special equipment, longer resuscitation becomes useless.

Nowadays, you can often hear from the media that people die “out of the blue,” the so-called sudden death. In fact, anyone can face sudden death at any time and anywhere. And in order to be able to save a dying person, you need to master some basic skills, which include CPR.

Cardiopulmonary resuscitation (CPR)- this is a set of emergency measures that are carried out to bring a person out of clinical death (to revive a person).

Clinical death- This is a reversible condition in which breathing and blood circulation completely stop. The reversibility of this condition ranges from 3 to 7 minutes (this is how long our brain can live without oxygen). It all depends on the ambient temperature (survival increases in the cold) and the initial condition of the patient.

It is important that resuscitation measures are started immediately after clinical death is diagnosed. Otherwise, the cerebral cortex will die and then, even if it is possible to resume cardiac activity, we will lose the person as an individual. A person will turn into a vegetable who will no longer be able to regulate any vital processes. Only his body will exist, which will be able to breathe only with the help of an apparatus, and feed exclusively through special systems.

Signs of clinical death

Any capable person facing clinical death can become a resuscitator. Signs of clinical death include:

Stages of CPR

If you see these signs, you should immediately begin resuscitation.

It is necessary to lay the victim on a flat horizontal surface;

If possible, you need to elevate the dying person's legs (put them on a chair or other accessible object);

Activities that improve blood supply to the brain

Free the chest from clothing, unfasten the belt and other elements of clothing that tighten the chest and abdominal region;

It is necessary to determine the area where indirect cardiac massage will be performed.
Location of the xiphoid process Press on the chest 3-5 cm above the xiphoid process and strictly along the midline (i.e., on the sternum). In men, this area can be identified by drawing a line along the nipples. Where this line crosses the sternum is the desired point. Placement of the palm during CPR The palm of one hand must be placed on the back of the other hand (to create a lock) and the arms straightened at the elbows;



Direct cardiac massage. Without bending your elbows, press on the sternum in the designated place with such force that it bends 5-6 cm (this is felt quite well), after which the sternum is allowed to fully straighten (i.e. return to its original position). We press not with our hands, but with our whole body.
Straight arms when pressing on the sternum. The thrusts should be rhythmic and quite sharp. Moreover, for an effective massage, the frequency of compressions on the chest should be at least 100 per minute (you should aim for 120). Those. per second you should make 1.5-2 clicks.
There should be 30 such clicks at once.

After 30 presses, you need to switch to artificial ventilation (blowing air from your mouth into the victim’s mouth or nose). To do this you need:

Then you need to move on to direct air injection. To protect yourself, blow air through a cloth (handkerchief or napkin). To ensure that all your air enters the victim's airway, you must press your lips tightly to his mouth (open your mouth wide, cover his lips so that his mouth is in yours) and pinch his nose.

Before doing this, breathe air into your lungs, but not very deeply. The exhalation should be sharp. Do not exhale all of your air from your lungs (exhalation should include about 80% of your air in your lungs). You need to make two such exhalations. Then start heart massage again.

1. Thus, you perform CPR cycles consisting of 30 chest compressions and 2 mouth-to-mouth breaths. (30:2). After 3-5 such cycles, it is necessary to re-evaluate the victim’s pulse and breathing. If you feel the beating of the carotid artery and see the person taking spontaneous breaths, of course, resuscitation should be stopped. If cardiac activity has not resumed, continue CPR until help arrives.

Addition

If no one is near you, try to call for help as you prepare for CPR. If no one responds, start resuscitating the patient and call an ambulance during the break between cycles (i.e. after 3-5 cycles).

P.S. If you doubt the correctness of your actions, immediately dial the ambulance number and turn on the speakerphone. This way, you can be given the instructions you need and your hands will be free to follow those instructions.

If no one can help you and you are unable to call an ambulance, continue CPR as long as you can. But when you feel completely exhausted, your head is spinning, your eyes are darkening, immediately stop all your actions. Otherwise, you risk lying next to a dying person, and then they will find not one corpse, but two.

If there are people near you, then try to organize them to save the person. It is necessary to quickly distribute roles: one calls an ambulance, another holds the victim’s legs up (preferably, but if this is not possible, then do not touch the legs), the third does a cardiac massage, the fourth performs artificial ventilation.

In the case when there are two resuscitators, one immediately performs 30 compressions on the chest, after which it stops and the second resuscitator blows air into the victim, then the first begins cardiac massage again. After several cycles, resuscitators should switch places so as not to quickly become exhausted.

If you suspect or know that the victim has a disease transmitted by airborne droplets or nutrition (for example, tuberculosis in the active phase) or if he is clearly an antisocial person, you can limit yourself to just a cardiac massage without blowing air.

The more people who have basic knowledge of how to revive the human body, the more victims can be saved.

Reanimation(from lat. reanimation– revival) is a set of measures aimed at restoring sharply depressed vital functions of the body, primarily breathing and cardiac activity. The primary measures to revive the body are indirect cardiac massage and artificial respiration.

For the body to function, it requires a continuous supply and consumption of oxygen and the release of carbon dioxide. These processes are provided by the respiratory and circulatory systems under the control of the central nervous system. Therefore, their defeat leads to death. Between death and life there are transitional states in which death has not yet occurred, but there can no longer be a full life. Such states are called terminal ( from lat. terminalis – final). Terminal states include 3 stages: preagonal state, terminal pause (since it does not always happen - it is not included in the classification, but it is still worth taking into account), agonal state and clinical death.

The dying process and its periods. Death (cessation of the body's vital functions) can occur suddenly (in accidents) or become a natural consequence of an incurable disease. Clinically, the dying process is manifested by a sequence of pathological processes: cessation of cardiac activity, cessation of blood circulation, impaired brain function, fainting (within 1-2 s), dilated pupils (20-30 s), respiratory arrest, and the onset of clinical death.

Predagonia– this is the patient’s condition when the physiological mechanisms of the body’s vital functions are in a state of decompensation: the central nervous system is depressed, possibly in a comatose state; heart activity is weakened, the pulse is thready, blood pressure is below critical (70 mm Hg); the functions of external respiration and parenchymal organs are impaired. Predagonia lasts from several hours to several days. During this time, the patient's condition worsens even more and ends with a terminal pause. The patient loses consciousness, the skin is pale with a cyanotic tint, a thread-like pulse is detected only in the carotid and femoral arteries; tachycardia is observed, systolic pressure is less than 70 mm Hg. Breathing is frequent and shallow.

Terminal pause characterized by a temporary decline in the function of the cerebral cortex, respiratory center, and heart; blood pressure drops to zero, breathing stops. This period lasts from 10 seconds to 4 minutes.

Agony (struggle) – This is a patient’s condition when, as a result of depletion of higher-order vital activity centers, the bulbar centers and reticular formation go out of control (activate). The patient's muscle tone and reflexes are restored, and external breathing appears (random, with the participation of auxiliary muscles). The patient seems to be trying to take in air with his open mouth, but breathing is ineffective because the muscles of inhalation and exhalation contract simultaneously. The heart increases its work for a while, systolic pressure can increase to 100 mm Hg. A pulse is palpated above the main arteries. Often patients' consciousness becomes clearer. However, at this time, metabolic disorders in the body's cells become irreversible. After this, the patient’s condition worsens - the last reserves of energy accumulated in the high-energy ligaments quickly burn out, and after 20-40 s clinical death occurs.

Clinical death- this is the state in which the body finds itself within a few minutes after the cessation of blood circulation and breathing, when all external manifestations of vital activity (stopping breathing and heartbeat) completely disappear, but irreversible changes have not yet occurred in the tissues.

In this condition, the patient can still be saved if he is given immediate assistance. Only 4-6 minutes after the onset of clinical death, as a result of oxygen starvation of the brain and the death of nerve cells that control the vital functions of the body, biological death occurs.

The cause of the development of a terminal condition may be the development of shock, stroke, myocardial infarction, severe poisoning, electric shock, drowning and other conditions requiring immediate assistance.

The main signs of clinical death:

· lack of spontaneous breathing;

· absence of pulsation over the main arteries (carotid and femoral) and heartbeat;

· persistent pupil dilation with absence of photoreaction.

Additional signs:

· change in skin color (pale, deathly gray or bluish);

· lack of consciousness;

· lack of reflexes and muscle tone;

· the lower jaw drops;

· lack of blood pressure;

· gradual cooling of the body;

· ECG shows asystole or fibrillation;

· involuntary urination and defecation.

The state of clinical death lasts from 4 to 6 minutes. An important factor influencing the duration of clinical death is ambient temperature. In case of sudden cardiac arrest, clinical death in conditions of normothermia lasts up to 5 minutes, at sub-zero temperatures – up to 10 minutes or more. A prolonged period of dying significantly impairs the effectiveness of resuscitation.

If biological death occurs as a result of irreversible changes in the body, and primarily in the central nervous system, then returning to life is impossible.

Complex of emergency measures (resuscitation)

The main goal of resuscitation measures is to maintain the patient’s life until the arrival of an ambulance, which must begin immediately after respiratory arrest and cessation of cardiac activity (terminal pause) and are aimed at eliminating cardiac and respiratory disorders (indirect cardiac massage, mouth-to-mouth artificial respiration or mouth to nose) .

Resuscitation is carried out in a draft for at least 40 minutes or until the arrival of an ambulance, or until the patient begins to have an independent heartbeat, or until signs of biological death appear (the appearance of cadaveric spots). The victim is placed face up on a solid base, preferably with the upper body down. A savior not involved in resuscitation raises the victim’s legs 50-60 cm upward to drain blood from them and increase blood supply to the heart.

The main resuscitation measures in case of circulatory arrest are cardiac massage and artificial respiration., which must be carried out simultaneously, because it is necessary to saturate the circulating blood with oxygen.

Artificial ventilation. Artificial ventilation is performed using the mouth-to-nose method (Fig. 8.7).

Inhale Exhale

Rice. 8.7. Artificial respiration: a) “mouth to mouth”; b) according to Sylvester.

Indications: respiratory arrest, pathological type of breathing.

Before starting artificial ventilation, you must ensure that the upper airway is open. You need to quickly open the patient’s mouth and remove the mucus or liquid with a handkerchief, napkin, or best of all, suction. Removable dentures are removed. Unbutton tight clothing.

In the first minutes of clinical death, the root of the tongue sinks and blocks the entrance to the upper respiratory tract. To allow air to pass into the victim’s lungs, you need to tilt his head back as much as possible. You can put a cushion of clothing or your hand under your shoulders. For hygienic reasons, artificial ventilation of the lungs using the mouth-to-mouth or mouth-to-nose method is carried out through a scarf, a piece of gauze or clothing. When blowing air into the mouth, it is recommended to place one hand under the neck and the other on the victim’s forehead. While blowing air, at the same time pinch the nostrils with your free fingers to prevent air from escaping through the nose. If the mouth contracts convulsively, insufflation is carried out through the nose. When blowing air into the nose, the hand from under the back of the head is moved to the lower jaw, which is pressed against the upper jaw to ensure sealing of the upper respiratory tract. The frequency of injections is 12 times per 1 minute. The ventilator must breathe deeply to ensure a sufficient volume of air is delivered.

It must be remembered that the movement of the chest in time with the blowing is a sign of the correct application of the method. If there is an airway tube, the person performing artificial ventilation stands at the head of the victim and inserts the airway into the mouth. To do this, you need to pull back the tongue with a tongue holder or press it with the end of the tube to the lower jaw, turning it 90° so that the bend of the tube corresponds to the spherical surface of the back of the tongue.

The shield on the tube is pressed tightly against the lips to prevent the blown air from escaping. The shield is pressed with the free finger, and the lower jaw is brought forward with fingers II and III. Air is blown through the tube at the moment of maximum tilt of the head back.

Artificial ventilation can be performed using a mask.

Various manual breathing apparatuses are also used for artificial ventilation of the lungs. When using these devices, inhalation occurs by squeezing the bag or bellows with your hands under a pressure of 3.3-3.9 kPa (25-30 cm of water column), and you can blow in from 400 to 1500 ml of air, depending on the age of the victim. Exhalation occurs passively due to the elastic traction of the chest. During exhalation, the bag is filled with atmospheric air or an oxygen-air mixture independently (straightening of the bag, bellows). You need to pay attention to the breathing rhythm: inhalation should be half as long as exhalation.

Indirect (closed) cardiac massage. Indications: circulatory arrest at the stage of clinical death.

Indirect cardiac massage is performed on a hard surface (board, floor, hard couch, etc.). In the region of the lower third of the sternum, the heart is closer to the anterior surface of the chest. Since the basis of the massage is the removal of blood from the cavity of the heart, compression (pressure) is carried out in this area, and not to the left (the area of ​​the apex of the heart), not lower (the stomach area), not higher (the area of ​​the vessels that extend from the heart). The depth of displacement (indentation) of the sternum in an adult is 3-4 cm. The lower third of the sternum is easy to find using the following landmarks: in the upper part of the abdomen, a cartilaginous formation, the so-called xiphoid process, can be easily felt (it easily moves when pressed with fingers); 1.5-2 cm above this place in the center of the chest there is a zone of the sternum that does not give in when pressed with fingers. This is the area of ​​the lower third of the sternum (Fig. 8.8 and 8.9).

Rice. 8.8. Indirect cardiac massage (a); in combination with artificial respiration (b).

Rice. 8.9. Scheme of performing indirect cardiac massage.

In adults, pressure is applied with both hands. To increase the pressure, place your hands on top of each other, avoiding tension in the muscles of your arms, as if you are “dumping” the weight of your chest onto your hands. To do this, the hand on which the pressure is applied does not need to be bent at the elbow joint.

Pressing during massage should be carried out with a jerk lasting from 0.5 to 0.75 s, 1 time in 1 s, that is, 60 times in 1 minute. Alternately blowing air and pressing on the sternum in a ratio of 1:4, that is, for 4-5 pressures on the chest, one vigorous blowing of air is carried out. At the moment of air insufflation, the cardiac massage is stopped, but for no more than 3 s.

Signs of correct resuscitation measures: constriction of the pupils, the appearance of short respiratory movements, normalization of skin color, sensation of arterial pulsation under the fingers, synchronous with the massage; sometimes blood pressure is even determined. In some cases, cardiac activity may resume. These activities should be carried out before the arrival of a specialized medical team.

If resuscitation measures are ineffective, after 30 minutes from their start, severe brain damage can be suspected and further resuscitation is inappropriate.