Rules for cardiopulmonary resuscitation
Sudden illnesses, exacerbations of severe chronic diseases, massive blood loss, severe trauma and other causes can lead to the arrest of breathing, cardiac activity and to clinical death.
Immediately after this, cardiopulmonary resuscitation should be started.
Later, other signs of clinical death appear - cyanosis, dilated pupils, lack of reflexes, muscle atony, but they should not wait for their onset. It is generally believed that the duration of clinical death in normothermia is 5-6 minutes, after which the restoration of CNS functions becomes impossible, and biological death occurs.
Main responsibilities of the nurse monitor station:
• strict adherence to safety regulations;
• ensuring constant high quality of registered curves;
• systematic registration of observed parameters and their recording.
First of all, it is necessary to hold a closed heart massage and artificial respiration.
For this patient it is necessary to lay on a firm surface( if he lies in bed - quickly move to the floor).Then apply a precardial punch from a height of approximately 30 cm to the middle third of the sternum. After that, start holding a closed heart massage. For this purpose the paramedic puts one hand on the other and with a sharp push presses on the sternum of the patient in her lower third. The goal is to squeeze the heart between the sternum and the spine for passive pumping. At each push, the sternum should move 4-6 cm toward the spine, then return to its original position. The frequency of jerks is 60-80 per minute. Hands reanimated should be straightened in the elbows, for pressure should use the weight of their own body otherwise quickly comes to fatigue.
Newborns and young children should be slightly pressed on the middle part of the sternum with one brush, thumb or index and middle fingers with a frequency of 80-100 strokes per minute.
Simultaneously, use artificial respiration.
To do this, the person who is assisting kneels at the head of the victim, puts one hand under the neck, the other on the forehead and throws his head back. In this case, the horn of the patient opens, the respiratory tract becomes passable. If the patient's mouth contains dentures, other foreign bodies or vomit, they must be removed. The head of the patient should be turned aside in this case because of the danger of aspiration.
If you suspect a trauma to the cervical spine, throwing your head back is not recommended. It is necessary to push the lower jaw forward as much as possible. For this, it is grasped on both sides at the base( with two hands) and displaced so that the teeth of the lower jaw are in front of the line of the teeth of the upper jaw.
To prevent the rooting of the tongue of the tongue, the patient should enter the airway in the unconscious state. Its size is determined by the distance from the earlobe of the patient to the angle of the mouth. The air duct is taken so that its bend is looked down towards the tongue, and the hole is upward, towards the palate;It is injected into the mouth and promoted deeper, touching the end of the palate. Introducing the airway by 1/2 length, it is rotated 180 ° and advanced further until the flange on the outer end rests against the lips.
Having taken a deep breath, the helper clamps the patient's nose with the thumb and forefinger, presses his mouth tightly against his mouth and exhales sharply until the patient's chest starts to rise. Then it is necessary to pull away, holding the patient's head in a thrown back position, and let passive exhalation take place. At the same time, the chest is lowered. This cycle should be repeated 12 times per minute.
In the presence of a duct, exhalation is carried out into it. If it is impossible to open for any reason, the mouth of the victim should be exhaled in the nose. But this is less desirable, since the nasal passages are narrow and can often be clogged with mucus or blood.
It is possible to diagnose a clinical death on the basis of the following symptoms.
1. Lack of consciousness.
2. Lack of breath.
3. Lack of cardiac activity.
For young children, artificial respiration is carried out through the mouth and nose simultaneously. The use of ventilators greatly facilitates and increases the effectiveness of artificial respiration. If they are absent from hygienic and aesthetic considerations, the patient's mouth should be covered with a napkin or a handkerchief.
With one person after 15 compressions of the sternum, two breaths should be taken. When the help is given by two, after every five compressions, one breath follows. It is necessary to coordinate the actions to exclude simultaneous injection of air and compression of a thorax. To do this, one who helps( usually the one who carries out a heart massage) loudly feels aloud pressing on the sternum: "One! Two! Three! Four! Five! ", Then commands:" Breathe! "The second conducts an air injection, after which the cycle repeats.
To stimulate the heart, inject adrenaline 1% - 1 ml intravenously. If it is impossible to get into the vein, an injection is made into the base of the tongue( under the tongue through the rogo), there is a rich capillary network. In the presence of an airway, a mixture of 1% 2 ml adrenaline and sodium chloride of 0.9% 5-7 ml can be injected into it( ie, intratracheally).If there is no effect, you can inject epinephrine in the same dosage again after 2-5 minutes( up to 5-6 ml in total).
The feasibility of conducting intracardiac injections is currently controversial, since it is believed that this causes significant mechanical damage to the heart.
Symptoms of cardiopulmonary resuscitation are: pupillary narrowing, the appearance of their response to light, skin porosity, the appearance of a pulse on the peripheral arteries, the restoration of independent breathing and consciousness.
If the resuscitation is ineffective within 30 minutes, it is stopped.
In a patient in a state of clinical death, resuscitation should begin immediately. In the course of resuscitation, the presence or absence of indications for its conduct is revealed. If resuscitation is not indicated, it is discontinued.
Cardiopulmonary resuscitation is not indicated:
• chronic patient in the terminal stages of severe chronic diseases( there must be medical documents confirming the presence of these diseases);
• if it is reliably established that more than 30 minutes have passed after cardiac arrest.
Biological death can be ascertained on the basis of reliable attributes and by a combination of symptoms. Reliable signs of biological death.
1. Cadaver spots( occur after 2-4 h with normothermia).
2. Cadaveric rigor mortis( with normothermia occurs in 2-4 hours, reaches a maximum at the end of the first day, spontaneously passes on the 3rd-4th day).
In the absence of these signs, the diagnosis of biological death is based on the combination of the following features:
• no pulse on the main arteries, no heartbeats, independent breathing for more than 30 minutes;
• pupils are wide, do not respond to light;
• no corneal reflex( no reaction to touching the cornea, for example, a piece of cotton wool);
• presence of blood hypostasis spots( skin integument is pale, and blue-violet spots appear in the lower lying parts of the body, may disappear under pressure).
After the appearance of signs of restoration of the vital functions of the patient or the victim with ongoing resuscitation should be transported to the nearest hospital with a resuscitation department.