Basic cardiopulmonary resuscitation: algorithm of actions, rules for first aid, medical advice

Cardiopulmonary resuscitation (CPR) is a group of surgical and therapeutic measures that aim to preserve a person’s life. These actions are possible only in the absence of conditions incompatible with life in the patient. The algorithm of basic cardiopulmonary resuscitation should be known not only to medical professionals. Anyone may be faced with the need to provide first aid.

Given the importance of proper emergency care for a person with signs of clinical death, each student after graduating from a medical university must undergo accreditation for basic cardiopulmonary resuscitation.

When you can and cannot do CPR

The need to provide resuscitation occurs when there are three of the following symptoms:

• It is impossible to feel the pulse in the carotid artery.
• The person is unconscious.
• There are no signs of breathing.

Contraindications for CPR are as follows:

• The terminal stages of severe chronic, incurable diseases (cancer patients).
• The presence of injuries incompatible with life.
• The appearance of signs of biological death, which is irreversible (cadaveric spots, rigor mortis).

Basic principles of CPR

For the most effective resuscitation, it is necessary to adhere to the technique of basic cardiopulmonary resuscitation. Maximum efforts should be directed to:

• Presses on the chest to ensure blood supply to the internal organs.
• Blowing air into the airways for oxygen to enter the bloodstream.
• Providing access to a vein for drug injection.
• The introduction of drugs after a certain time with the ineffectiveness of previous resuscitation measures.
• Carrying out specific measures (defibrillation, tracheal intubation, tracheostomy).

The main stages of CPR

For about 50 years now, the Safar alphabet has been used in first aid to people in a state of clinical death. This is an alphabet of English letters that displays the basic cardiopulmonary resuscitation algorithm step by step.

• A - airway - resumption of airway patency.
• In - breathing - performing artificial respiration.
• C - circulation - ensuring the flow of blood and oxygen to internal organs due to indirect heart massage.
• D - drugs - intravenous administration of drugs.
• E - electrocardiograph - diagnosis of changes in heart rhythm.
• F - fibrillation - the use of a defibrillator.
• G - gauging - evaluation of the results after the above activities.
• H - hypothermia - cooling the patient's head.
• I - intensive care - hospitalization of the patient in the intensive care unit for further treatment and observation.

Steps D to I are performed only by qualified ambulance staff or doctors in the hospital. Basic cardiopulmonary resuscitation includes the first three points: the resumption of airway patency, the injection of air into the lungs and heart compression. These stages will be discussed in more detail in this article.

Resuscitation assessment

When conducting basic cardiopulmonary resuscitation, you first need to assess whether the victim needs it at all. After all, he can just sleep or lie with his eyes closed.

It is necessary to examine the person and evaluate if he has any injuries. Indeed, in the presence of injuries of the cervical vertebrae, it is strictly forbidden to move the patient's head. Next, it is worth loudly addressing the victim. If he does not respond and there is no damage, it is necessary to bruise his shoulders or hit him on the cheeks. In the absence of any reaction, it can be confirmed that the victim is unconscious.

The pulse on the carotid artery is checked on one side with two fingers located anterior to the sternocleidomastoid muscle. This muscle is easily felt on the neck, if you turn the person’s head in the opposite direction. The muscle immediately stretches and bulges, passing from top to bottom and back to front. If pulsation in the carotid artery cannot be felt, then the heart is not able to pump blood.

Assessment of breathing during basic cardiopulmonary resuscitation is carried out by placing one hand with a palm on the chest, and the other on the stomach of the victim. If there are no oscillatory movements of the arms up and down, then he does not breathe. You can also evaluate breathing by putting the ear to the patient's mouth. Having carefully concentrated, in the presence of breathing, you can feel the heat of exhaled air.

The presence of all of the signs listed above provides the basis for basic cardiopulmonary resuscitation.

Airway Assessment

This stage corresponds to the letter A - airway. For its implementation, the victim is placed on a flat surface on his back. If the patient has contents in the oral cavity, it is necessary to clean it with the index and middle fingers wrapped in a napkin or piece of tissue.

Further airway management for basic cardiopulmonary resuscitation includes three rules. They got the name Safar's reception:

• Maximum head tipping back (if there is a suspicion of damage to the cervical vertebrae, this step is missed).
• Lower jaw down with two thumbs.
• The lower jaw must be extended with two fingers forward.

If you perform the above steps in stages, the airways will be clear.

After that, you must again check for the presence of respiratory movements in the patient. Sometimes breathing is restored after cleansing the airways. If the victim's breathing has resumed, it must be turned on its side to prevent liquid from entering the trachea and bronchi.

Turning a person unconscious on their side is not as easy as it seems at first glance. It is necessary not only to rotate it, but to fix it in this position in order to prevent the reverse throwing on the back. Therefore, in the algorithm for conducting basic cardiopulmonary resuscitation, it is phased out how to do this correctly:

1. Kneel next to a person unconscious.
2. One hand of the assisted person should lie at right angles, with the back to the ground.
3. The other hand should hug the patient, that is, go through the torso, touching the ear with your palm from the opposite side.
4. The far leg of the patient must be bent at an angle of 90 °.
5. Only now can a person be turned on their side by pulling a leg bent at the knee.

If the victim's breathing has not recovered after cleansing the airways, he should continue to lie on his back. Then proceed to the next stage - artificial respiration.

Artificial respiration

Injection of air into the lungs during basic cardiopulmonary resuscitation is carried out by the mouth-to-mouth method. The method is considered the most effective. The ambulance has special equipment for artificial respiration - Ambu bag. This apparatus consists of a mask that covers the patient’s mouth and nose, an air filter and a bag that pumps air.

The main shortcoming of mouth-to-mouth breathing is a person’s unwillingness to lean against the patient’s face. This is especially unpleasant if the victim had vomiting or secretion of saliva from the mouth. In any case, this method is recommended to be done through gauze or a cloth that is placed between the victim’s mouth and the person who provides first aid.

With one hand they hold the patient’s head in an upturned position, and with the other they compress their nose so that the air does not leave the nasal passages. Next, take a breath and blow air into the victim's mouth. The common belief that the more air you inhale, the better, is not true. The entire volume of air does not enter the lungs, most of it still goes to the gastrointestinal tract. And too much air in the stomach leads to vomiting, which can lead to vomiting in the airways. Therefore, the breath should be practically the same volume as the usual one.

Blowing air must be carried out at a frequency of 12 cycles per minute, which is 1 blowing in 5-6 seconds. With effective artificial respiration, the rhythmic movements of the chest are visible.

The cause of the ineffectiveness of artificial respiration may be the presence of obstruction below the level of the oral cavity. For example, with laryngeal edema or the presence of a foreign body in the trachea. In such cases, the help of qualified emergency medical personnel is needed. They should have a laryngoscopy followed by tracheal intubation. If it is also ineffective, a conicotomy is done.

Do not immediately stop providing assistance with the appearance of independent movements of the respiratory movements. Artificial respiration should be continued until the respiratory rate increases to 12-15 times per minute.

Indirect cardiac massage

The main stage of the algorithm of action for basic cardiopulmonary resuscitation is chest compression. Massage is called indirect, as it is carried out through the tissues of the chest. Direct massage on an open heart is possible when it stops during cardiac surgery, when the chest is open.

To resume blood circulation, you need to correctly place your hands on the chest. Conditionally divide the sternum into two parts, put their hands between the lower and middle third. A less accurate, but simpler way - hands put two fingers above the end of the sternum. The hands are laid parallel to the ribs, one on top of the other or in the "castle".

If a person faints and is given first aid within the first 30 seconds, a pericardial stroke may be effective. It is carried out with the help of a sharp blow with a fist on the area of ​​the projection of the heart on the chest. This method can be effective, but only if it is provided to the victim immediately after loss of consciousness.

The basic rules for applying a precardial stroke:

• Before striking, you need to make sure that the pulse on the carotid artery is absent. It is forbidden to strike even at the slightest ripple!
• Before the blow, remove all clothing from the chest. If this is not possible, you need to make sure that there are no buttons, objects made of metal.
• With a hand that does not strike, cover the xiphoid process, as it can easily break off if you hit directly on it.
• The blow is carried out with a fist above the attachment of the xiphoid process to the sternum. The blow should be sharp and strong enough.
• You can do a precardial stroke only once. Immediately after it, pulsation on the carotid artery is checked.
• If the pulsation is not detected, proceed to an indirect heart massage.

In the first aid algorithm of basic cardiopulmonary resuscitation, it is indicated that it is contraindicated to inflict a precardial stroke in children under 7 years of age!

The frequency of pressing the chest is 100 times in 1 minute, is carried out to a depth of 2-2.5 cm. In this case, the elbows should be straightened, the bulk is directed to the hands. When conducting indirect massage, you can’t take your hands off the patient’s chest.

Compression Efficiency Criteria:

• Reducing pallor and cyanotic skin.
• Narrowing of the pupils.
• Palpation of the pulse on the carotid artery.
• The ability to breathe independently (not always an indicative symptom).

Indirect massage is carried out either before the effect or before the signs of biological death. As a rule, if the resuscitation measures are ineffective for 30 minutes, they are stopped. The effectiveness of further indirect massage and artificial respiration is almost zero.

Indirect massage and artificial respiration simultaneously

Most often, these two events are held in parallel. Old recommendations say that first you need to take two breaths and start artificial respiration. According to the latest recommendations, if there is one resuscitator, only compressions should be done at a frequency of 100 per minute, without wasting time inhaling. Therefore, the algorithm of actions for basic cardiopulmonary resuscitation of ABC is more correctly called ASV.

However, many recommend combining indirect massage with breaths even in the presence of only one resuscitator. Then the ratio of the frequency of compressions on the chest to the inhalation of air should be 15: 2. Therefore, this basic complex of cardiopulmonary resuscitation is still debatable.

If there are two resuscitators, then it is necessary to combine compression with breaths. The frequency in this case is 5: 1 (compression: breaths).

The algorithm of resuscitation measures for the primary accreditation of specialists

Young doctors must prove their knowledge on primary accreditation. One of the proven practical skills is basic cardiopulmonary resuscitation. The demonstration of the skill takes place in a separate room, the student shows the principles of first aid to the victim on a mannequin. At the same time, he must clearly pronounce all his actions so that the examiner understands what the student is doing.

Below is an algorithm for conducting practical skills in basic cardiopulmonary resuscitation:

1. The student enters the room and first inspects the place of assistance, turning his head left and right. At the same time, he must say: "I assess the danger and examine the scene of the incident. There is no danger for me and the patient."
2. Next, you need to check the consciousness of the victim. The student voices that he checks consciousness, while kneeling on the side of the mannequin. The student takes the mannequin in the shoulder area and shakes it softly. It is necessary to ensure that his head does not hit the floor.
3. Calls for help, shouting: "Help someone! Unconscious man!"
4. Detects signs of breathing and blood circulation. If pulsation in the carotid artery could not be detected, it releases the airways. He puts one hand on his forehead and throws the mannequin's head back, and the other picks up the lower jaw using only two fingers.
5. The student must determine the ability to spontaneously breathe. To do this, he looks at the mannequin's chest, and then puts an ear to his mouth. At the same time, it further supports airway patency. Aloud, the student comments: "I check for breathing." And counts to 10 out loud.
6. The student "calls" an ambulance. He must tell the address, gender and age of the victim. Report that the victim is unconscious and not breathing. The student is waiting for the answer "Call accepted." If it is not there, after a second it does the next step.
7. The student does not comment on this stage. Kneeling on the side of the mannequin and facing his face, the student unbuttones his shirt to free his chest. He places one hand with his palm at the level of the nipples. This is the projection of the lower third of the sternum onto the front wall of the chest.
8. The second palm is placed on the first, hands are connected as a "lock". In this case, the fingers do not touch the chest, all efforts fall on the base of the palm.
9. The student makes 30 clicks, while counting out loud to 30. Hands at the elbows do not bend. It is necessary to make sure that after each pressing the mannequin's chest cage returns to its original position, but hands should not be torn off. Compression is carried out to a depth of 5 cm. The frequency is 100 in 1 minute.
10. Then the student says: "I do artificial ventilation." At the same time, he puts a mask with a valve on the mannequin's mouth for his own protection. Fingers of one hand closes the nasal passages, the palm of the same hand lies on the forehead of the victim. With the index and middle fingers of the second hand, he holds the lower jaw. It takes in air (its standard inspiratory volume) and exhales it into the mannequin's mouth through a special device on the mask.
11. He takes his lips away from the mannequin's mouth for 1 second, and then exhales one more time.
12. It repeats the compression and ventilation cycle in a ratio of 30: 2.

At the end of the accreditation for basic cardiopulmonary resuscitation, the first command sounds: "One minute is left." At the same time, the student continues to provide assistance. When “time is up” sounds, the student leaves the room. This concludes the demonstration of practical skill.

Monitoring the success of resuscitation

When conducting basic measures of cardiopulmonary resuscitation, it is necessary to check its effectiveness.After making 4 cycles of compressions and air inflations, you need to palpate the pulse on the carotid artery for 3-5 seconds. When a pulse appears, compressions are stopped and the patient’s ability to breathe on their own is checked. If breathing is also restored, you need to maintain airway and carefully monitor the patient's condition before the ambulance arrives.

To maximize the effectiveness of basic cardiopulmonary resuscitation, it begins immediately. Irreversible changes in the brain tissue begin within 5-6 minutes after the heartbeat stops. Before starting resuscitation, they must call an ambulance. Assist before her arrival.