Doctors of any specialties have to teach others and themselves perform manipulations related to emergency care and saving the patient's life. This is the first thing a medical student hears at a university. Therefore, special attention is paid to the study of disciplines such as anesthesiology and resuscitation. Ordinary people who are not related to medicine will also be interested in knowing the protocol of actions in a life-threatening situation. Who knows when this might come in handy.
Cardiopulmonary resuscitation is an emergency care procedure aimed at restoring and maintaining the body's activity after a clinical death. It includes several mandatory steps. The SRL algorithm was proposed by Peter Safar, and one of the methods for saving the patient was named in his honor.
Ethical issue
It is no secret that doctors are constantly faced with the problem of choice: what is best for their patient. And often it is he who becomes a stumbling block for further therapeutic measures. The same goes for CPR. The algorithm changes depending on the conditions of assistance, preparation of the resuscitation team, the age of the patient and his current condition.
There was a lot of discussion about whether it was worth explaining to children and adolescents the complexity of their condition, given the fact that they did not have the right to make decisions regarding their own treatment. The question was raised about organ donation from victims who underwent CPR. The algorithm of actions in these circumstances should be somewhat modified.
When is CPR not performed?
In medical practice, there are cases when resuscitation is not performed, since it is already meaningless, and the patient’s injuries are not compatible with life.
- When there are signs of biological death: rigor mortis, cooling, cadaveric spots.
- Signs of brain death.
- The final stages of incurable diseases.
- The fourth stage of cancer with metastasis.
- If doctors know for sure that more than twenty-five minutes have passed after stopping breathing and blood circulation.
Signs of Clinical Death
There are primary and secondary symptoms. The main ones include:
- lack of pulse in large arteries (carotid, femoral, brachial, temporal);
- lack of breathing;
- persistent dilated pupils.
Secondary symptoms include loss of consciousness, pallor with a bluish tinge, lack of reflexes, voluntary movements and muscle tone, strange, unnatural body position in space.
Stages
Conventionally, the CPR algorithm is divided into three large stages. And each of them, in turn, branches out into stages.
The first stage is carried out immediately and consists in maintaining life at the level of constant oxygenation and airway patency. It eliminates the use of specialized equipment, and life is supported exclusively by the efforts of the resuscitation team.
The second stage is specialized, its purpose is to preserve what unprofessional rescuers have done and to ensure constant blood circulation and oxygen access. It includes the diagnosis of the heart, the use of a defibrillator, the use of drugs.
The third stage is carried out already in the ICU (intensive care unit and intensive care unit). It is aimed at preserving the functions of the brain, their recovery and the return of a person to normal life.
Procedure
In 2010, a universal CPR algorithm was developed for the first stage, which consists of several stages.
- A - Airway - or air permeability. The rescuer examines the external airways, removes everything that interferes with the normal passage of air: sand, vomit, algae, water. To do this, you need to perform a triple reception of Safar: throw back your head, move your lower jaw and open your mouth.
- In - Breathing - breathing. Earlier it was recommended to perform the “mouth-to-mouth” or “mouth-to-nose” artificial respiration technique, but now due to the increased risk of infection, air enters the victim solely through the Ambu bag.
- C - Circulation - blood circulation or indirect heart massage. Ideally, the rhythm of pressing the chest should be 120 beats per minute, then the brain will receive a minimum dose of oxygen. It is not recommended to be interrupted, since during the blowing of air a temporary stop of blood circulation occurs.
- D - Drugs - drugs that are used at the stage of specialized care to improve blood circulation, maintain heart rate or rheological properties of blood.
- E is an electrocardiogram. It is carried out to monitor the work of the heart and verify the effectiveness of measures.
Drowning
There are some features of CPR during drowning. The algorithm changes somewhat, adapting to environmental conditions. First of all, the rescuer must take care to eliminate the threat to his own life, and if there is such an opportunity, do not enter the reservoir, but try to take the victim ashore.
If, nevertheless, help is provided in the water, then the rescuer must remember that the drowning person does not control his movements, so you need to swim from the back. The main thing is to keep the person’s head above the water: by the hair, grabbing under the armpits or throwing it on your back.
The best thing a lifeguard can do for a drowning person is to start blowing air right in the water, without waiting for transportation to the shore. But technically it is available only to a physically strong and trained person.
As soon as you remove the victim from the water, you need to check for the presence of a pulse and spontaneous breathing. If there are no signs of life, you need to immediately begin resuscitation. They need to be carried out according to general rules, since attempts to remove water from the lungs usually lead to the opposite effect and exacerbate neurological damage due to oxygen starvation of the brain.
Another feature is the time span. You should not focus on the usual 25 minutes, since in cold water the processes slow down and brain damage occurs much more slowly. Especially if the victim is a child.
Stop resuscitation is possible only after the restoration of spontaneous breathing and blood circulation, or after the arrival of the ambulance team, which will be able to provide professional support for life.
Extended CPR, the algorithm of which is carried out using medications, includes inhalation of 100% oxygen, intubation of the lungs and mechanical ventilation. In addition, antioxidants are used, fluid infusions to prevent a fall in systemic pressure and cardiac arrest, diuretics to prevent pulmonary edema, and active warming of the victim so that blood is evenly distributed throughout the body.
Respiratory arrest
The CPR algorithm for respiratory arrest in adults includes all stages of the blood of indirect heart massage. This facilitates the work of rescuers, as the body itself will distribute the incoming oxygen.
There are two ways of artificial ventilation without improvised means:
- mouth to mouth;
- mouth to nose.
For better air access, it is recommended that the victim’s head be thrown back, the lower jaw should be pulled out and the airways clear of mucus, vomit and sand. The rescuer should also worry about his health and safety, therefore it is advisable to carry out this manipulation through a clean scarf or gauze, in order to avoid contact with the patient’s blood or saliva.
The lifeguard pinches the nose, tightly wraps lips around the victim’s lips and exhales air. In this case, you need to look if the epigastric region is not inflated. If the answer is yes, it means that the air enters the stomach, not the lungs, and there is no sense in such resuscitation. Between exhalations, you need to take breaks in a few seconds.
During a quality ventilation, a chest excursion is observed.
Circulatory arrest
It is logical that the CPR algorithm for asystole will include everything except
lung ventilation. If the victim is breathing on his own, do not transfer him to artificial mode. This complicates the work of doctors in the future.
The cornerstone of proper heart massage is the technique of laying on hands and the coordinated work of the lifeguard's body. Compression is done with the base of the palm, not with the wrist, not with the fingers. The hands of the resuscitator should be straightened, and compression is carried out due to the inclination of the body. Hands are located perpendicular to the sternum, they can be taken in the castle or palms lie cross (in the form of a butterfly). Fingers do not touch the surface of the chest. The CPR execution algorithm is as follows: for thirty clicks - two breaths, provided that two people carry out resuscitation. If there is one lifeguard, then fifteen compressions and one breath are made, since a long break without blood circulation can damage the brain.
Pregnant resuscitation
The CPR of pregnant women has its own characteristics. The algorithm includes the salvation of not only the mother, but also the child in her womb. A doctor or a random witness who provides first aid to an expectant mother should remember that there are many factors that worsen the prognosis of survival:
- increased oxygen consumption and its rapid utilization;
- reduced lung volume due to compression by their pregnant uterus;
- high probability of aspiration of gastric contents;
- reduced area for mechanical ventilation, as the mammary glands are enlarged and the diaphragm is raised due to an increase in the abdomen.
If you are not a doctor, the only thing you can do for a pregnant woman to save her life is to put her on her left side so that her back is at an angle of about thirty degrees. And move her belly to the left. This will reduce pressure on the lungs and increase airflow. Be sure to start an indirect heart massage and do not stop until the ambulance team arrives or any other help arrives.
Child rescue
CPR in children has its own characteristics. The algorithm resembles an adult, but due to physiological characteristics it is difficult to conduct it, especially for newborns. It is possible to divide resuscitation of children by age: up to a year and up to eight years. All older people receive the same amount of assistance as adults.
- You need to call an ambulance after five unsuccessful resuscitation cycles. If the rescuer has assistants, then it is worth entrusting them with this right away. This rule only works on condition of one resuscitating person.
- Throw back your head even if you suspect a neck injury, since breathing is a priority.
- Start ventilation with two injections for 1 second.
- Up to twenty injections should be made per minute.
- When the respiratory tract is blocked by a foreign body, the child is slapped on the back or hit on the chest.
- The presence of a pulse can be checked not only on the carotid, but also on the brachial and femoral arteries, because the child’s skin is thinner.
- When conducting an indirect massage of the heart, the pressure should be immediately below the nipple line, since the heart is slightly higher than in adults.
- Press on the sternum with the base of one palm (if the adolescent is injured) or with two fingers (if it is a baby).
- Pressure force - a third of the thickness of the chest (but not more than half).
General rules
Absolutely all adults should know how basic CPR is performed. Its algorithms are simple enough to remember and understand. It can save someone's life.
There are several rules that can facilitate the conduct of rescue operations by an untrained person.
- After five cycles of CPR, you can leave the victim to call the rescue service, but only on condition that the person providing assistance is alone.
- Identification of signs of clinical death should not take more than 10 seconds.
- The first artificial breath should be shallow.
- If after the first inhalation there was no movement of the chest, it is worth throwing back the victim’s head again.
Other recommendations on which the CPR algorithm is carried out have already been presented above. The success of resuscitation and the further quality of life of the victim depend on how quickly the eyewitnesses orient themselves and how competently they can provide assistance. Therefore, do not shy away from the lessons that describe CPR. The algorithm is quite simple, especially if you remember by the letter cheat sheet (ABC), as many doctors do.
Many textbooks say that it is necessary to stop CPR after forty minutes of unsuccessful resuscitation, but in fact only signs of biological death can be a reliable criterion for the absence of life. Remember: while you pump the heart, blood continues to feed the brain, which means that the person is still alive. The main thing is to wait for the ambulance or rescuers to arrive. Believe me, they will be grateful to you for this hard work.