In emergency situations, when you can save a person’s life, you just need to know the basics of first aid. One of these fundamental skills is indirect cardiac massage, the technique of which is described in this publication. Having studied some of the methods of its application, you can save a human life.
Indirect heart massage
First of all, sudden cardiac arrest is determined : lack of breathing, consciousness, and then they begin resuscitation, simultaneously calling an ambulance team. First, the patient is placed on a hard surface.
Resuscitation should be carried out immediately at the place of detection of the victim, if this is not dangerous for the resuscitator.
If assistance is provided by an unprofessional resuscitator, then only pressure on the sternum is allowed. Indirect cardiac massage, the technique of which is described below, includes the following points.
Sequencing
- To begin with, determine the place of compression in the lower third of the sternum.
- Have one arm protrusion of the palmar surface ("fifth brush") almost on the lower part of the sternum. On top of it in the same way set the other hand. It is possible to place the palms on the principle of a castle.
- Squeezing movements are performed with the arms straightened at the elbows, while also transferring the mass of one’s body when pressed. During the compression, the arms are not torn from the chest.
- The frequency of pressure on the sternum should be no less than 100 times per minute or about 2 compressions per second. The displacement of the chest in depth is at least five centimeters.
- If artificial respiration is performed , then two respiratory movements should occur in 30 compressions.
It is highly desirable that the periods of pressure on the sternum and lack of compression in time be the same.
Nuances
Indirect cardiac massage, the technique of which is familiar to every doctor, requires that if tracheal intubation is performed, movements should be performed with a frequency of up to 100 times per minute without interruption in respiratory resuscitation. It is carried out in parallel, while 8-10 breaths per minute are performed.
Next, take a break for five seconds to determine the restoration of the heart (the presence of a pulse in the peripheral vessels).
Compression of the sternum in children under ten to twelve years of age is performed with one hand, and the ratio of the number of compressions should be 15: 2.
Since fatigue of the resuscitator can lead to a decrease in the quality of compression and death of the patient, in the presence of two or more people providing assistance, it is advisable to replace the one performing pressure on the chest every two minutes to prevent a decrease in the quality of indirect heart massage. Replacement of the resuscitator should last no longer than five seconds.
It must be remembered that the rules for indirect heart massage require to ensure the passage of the respiratory system.
Persons with a lack of consciousness develop muscle atony and airway obstruction by the epiglottis and the root of the tongue. Obturation occurs in any position of the patient, even lying on his stomach. And if the head is tilted by the chin to the chest, then this condition occurs in 100% of cases.
The following initial steps precede an indirect heart massage:
- The first thing to do: establish a lack of consciousness - call (ask to open your eyes, ask - what happened?).
- Next, beat on the cheeks, gently shake the shoulders.
- When the lack of consciousness is established, it is necessary to normalize the movement of air in the airways.
Triple intake and tracheal intubation are the gold standard in breathing recovery.
Triple Reception
Safar has developed three sequential actions that improve resuscitation effectiveness:
- Throw back your head.
- Open patient’s mouth.
- Pull the lower jaw of the patient forward.
When performing such a heart massage and artificial respiration, the front muscles of the neck are pulled, after which the trachea opens.
Caution
You need to be careful and careful, since it is possible to damage the spine in the neck when performing actions on the airways.
Most likely, spinal injuries can occur in two groups of patients:
- victims of road crashes;
- in case of a fall from a height.
Such patients should not bend their neck, turn their heads to the side. You need to moderately pull your head toward yourself, and then hold your head, neck, torso in the same plane with minimal head tipping back, as indicated in Safar's technique. Indirect cardiac massage, the technique of which in such cases requires special care, is performed only subject to these recommendations.
Opening the oral cavity, its revision
Airway patency after tilting the head is not always fully restored, because in some patients unconscious with muscle atony, the nasal passages are closed by a soft palate during breathing.
It may also be necessary to remove foreign objects from the oral cavity (blood clot, tooth fragments, vomit, false teeth)
Therefore, first, in such patients, they examine the oral cavity and release it from foreign objects.
To open your mouth, use the "crossed fingers". The doctor stands near the patient’s head, opens and examines the oral cavity. If there are foreign objects, they must be removed. With the right index finger, the angle of the mouth is taken from right to down, this helps to independently release the oral cavity from the liquid contents. Wrapped fingers with a cloth, carry out cleaning of the mouth and throat.
An attempt is made to intubate the trachea with air ducts (no more than 30 seconds). If the goal is not achieved, stop trying and continue ventilating with a face mask or Ambu bag. Mouth-to-mouth and mouth-to-nose techniques are also used. Heart massage and artificial respiration in such cases are carried out depending on the result.
After 2 minutes of resuscitation, it is necessary to repeat the attempt to intubate the trachea again.
When an indirect heart massage is performed, the technique of which is described here, then during the “mouth-to-mouth” breathing, the duration of each breath should be 1 second. This method is considered effective if there are movements of the chest of the victim during artificial respiration. It is important to avoid excessive ventilation of the lungs (not more than 500 milliliters), since it can cause complications such as refluxing from the stomach and swallowing or getting into the lungs of its contents. In addition, excessive ventilation increases the pressure in the chest cavity, which in turn reduces the return of venous blood to the heart and survival in case of sudden cardiac arrest.