Presentation on the topic of cardiopulmonary resuscitation. Cardiopulmonary resuscitation No matter what they say, there is something extraordinary in a person - something that no scientists can explain Jean-Baptiste Moliere

In children under 1 year of age, the head is tilted back moderately to open the airways. Avoid overextension! When performing ventilation, the rescuer covers the child's mouth and nose with his mouth and carefully exhales a small amount of air, which is placed in the oral cavity. This volume of air is called buccal. The massage point is located on the lower half of the sternum. Heart massage is performed with two fingers. The pulse in children under one year of age is determined on the brachial artery. In children over one year of age, ventilation is performed mouth-to-mouth. The respiratory rate in children is higher than in adults and is at least 20 breaths per minute. The frequency of compressions on the chest is at least 100 compressions per 1 minute. The pulse in children over one year of age is determined, just like in adults, in the carotid artery. Cardiac massage is performed with one or two hands. Cardiopulmonary resuscitation is carried out in a ratio of 2:30 before the arrival of emergency medical services

Cardiopulmonary resuscitation No matter what they say, there is something extraordinary in a person - something that no scientists can explain Jean-Baptiste Moliere Jean-Baptiste Moliere No matter what they say, there is something extraordinary in a person - something that no one can explain scientists cannot explain Jean-Baptiste Moliere Jean-Baptiste Moliere

Clinical death is a reversible (potentially) cessation of the body’s vital activity. Clinical death is a kind of transitional state between life and death, which is not yet death, but cannot be called life. In a state of clinical death, reversible inhibition of all parts of the central nervous system occurs due to cerebral hypoxia

Clinical picture There is no consciousness, spontaneous breathing and pulsation in the central arteries (blood circulation) are not detected. There are no reflexes, the pupils are wide, the skin is bluish or very pale. The duration of clinical death under normal conditions without resuscitation measures is no more than 4-6 minutes, since irreversible death of cells of organs and tissues of the body (primarily the brain) occurs. The duration of clinical death increases to minutes under conditions of hypothermia, with the introduction of antihypoxants, antioxidants, and against the background of the use of drugs that depress the activity of the central nervous system (hypnotics, tranquilizers). Carrying out adequate resuscitation measures prolongs clinical death for a longer period - a case of resuscitation lasting up to 2 days is described. The state of clinical death develops as a consequence of either acute cardiac arrest or acute respiratory arrest.

Etiology of clinical death Etiology of clinical death Extraordinary causes - conditions not associated with diseases or damage to the heart: Hypoxia Hypoxia Hypercapnia Hypercapnia Reflex (vagal) stop Reflex (vagal) stop Hyperadrenalineemia Hyperadrenalineemia Exposure to electric current Exposure to electric current Exogenous and endogenous poisoning and intoxication Exogenous and endogenous poisonings and intoxications Sharp decrease in blood volume Sharp decrease in blood volume Thromboembolism of the main trunk and large branches of the pulmonary artery Thromboembolism of the main trunk and large branches of the pulmonary artery Intra-radial causes - diseases of the heart muscle, endocardium, pericardium, valve system, heart damage (wounds), cardiac tamponade , electrical effects on the heart, heart rhythm and conduction disorders.

Mechanisms of acute cardiac arrest Mechanisms of acute cardiac arrest 1. Flutter and ventricular fibrillation (VF) 2. Cardiac asystole 3. Hemodynamically ineffective electrical activity of the heart - absence of pulse in the presence of electrical activity different from VF and ventricular tachycardia: - Electro-mechanical dissociation (ineffective heart, EMD) - Electro-mechanical dissociation (ineffective heart, EMD) - Pseudo - EMD - Pseudo - EMD - Bradyarrhythmias - Bradyarrhythmias - Complete transverse atrioventricular block 3rd degree or incomplete atrioventricular block 2nd degree Mobitz type 2 with a rare ventricular rate - Complete transverse atrioventricular block 3rd degree or incomplete atrioventricular block 2nd degree Mobitz type 2 with a rare ventricular rate - Slow idioventricular (ventricular) rhythm - Slow idioventricular (ventricular) rhythm - Pulseless sinus bradycardia (rare) - Pulseless sinus bradycardia (rare) 4. Pulseless ventricular tachycardia (sustained hemodynamically ineffective ventricular tachycardia) 5. Pulseless supraventricular tachycardia (very rare and only in out-of-hospital conditions)

Clinical picture of acute cardiac arrest Clinical picture of acute cardiac arrest Disappearance of pulse and blood pressure - at 5 seconds Disappearance of pulse and blood pressure - at 5 seconds Disturbance of consciousness - at 10 seconds. Impaired consciousness - for 10 sec. Convulsions - for 15 sec. Convulsions - for 15 sec. Pupil dilation - per sec. Pupil dilation - per sec. Breathing disturbance - for sec. Breathing disturbance - for sec.

Etiology of acute respiratory arrest Etiology of acute respiratory arrest Depression of the respiratory center Depression of the respiratory center Insufficient oxygen concentration in the air (death in a confined space) Insufficient oxygen concentration in the air (death in a confined space) Obstructive asphyxia - obstruction (closing) of the respiratory openings and respiratory tract (including drowning, foreign bodies, swelling of the mucous membranes (acute allergic stenosis of the larynx with Quincke's edema, acute stenotic laryngotracheitis in children), diphtheria, tumors of the respiratory tract, bronchospasm, obstruction with the contents of the tracheobronchial tree, retraction of the root of the tongue onto the posterior wall pharynx) O obstructive asphyxia - obstruction (closing) of the respiratory openings and respiratory tract (including drowning, foreign bodies, swelling of the mucous membranes (acute allergic stenosis of the larynx with Quincke's edema, acute stenosing laryngotracheitis in children), diphtheria, tumors of the respiratory tract, bronchospasm , obstruction with the contents of the tracheobronchial tree, retraction of the root of the tongue onto the back wall of the pharynx) C trangulation asphyxia - compression of the organs of the neck from outside (hanging, strangulation with a noose, strangulation by hands) C trangulation asphyxia - compression of the organs of the neck from the outside (hanging, strangulation with a noose, strangulation by hands) Compression asphyxia - compression of the chest and abdomen Compression asphyxia - compression of the chest and abdomen Total pneumonia Total pneumonia Extensive atelectasis Extensive atelectasis Collapse of the lungs Collapse of the lungs Respiratory distress syndrome of adults Respiratory distress syndrome of adults

Clinical picture of acute respiratory arrest Clinical picture of acute respiratory arrest The symptoms of clinical death in acute respiratory arrest have much in common with the picture of clinical death in acute cardiac arrest, however, the rate of development of symptoms of clinical death in acute respiratory arrest is not as rapid as in acute cardiac arrest The symptoms of clinical death in acute respiratory arrest have much in common with the picture of clinical death in acute cardiac arrest, however, the rate of development of clinical death symptoms in acute respiratory arrest is not as rapid as in acute cardiac arrest. Ultimately, death at the cellular level occurs from hypoxia , disorders of tissue gas exchange and metabolism in general. Ultimately, death at the cellular level occurs from hypoxia, disorders of tissue gas exchange and metabolism in general. Primary respiratory arrest is extremely rarely diagnosed at the prehospital stage, since by the time assistance is most often already present asystole or fibrillation ventricles Primary respiratory arrest is extremely rarely diagnosed at the prehospital stage, since by the time assistance is provided, most often there is already asystole or ventricular fibrillation

Resuscitation measures are not carried out: Resuscitation measures are not carried out: 1) If there are signs of biological death 2) When a state of clinical death occurs against the background of progression of reliably established incurable diseases or incurable consequences of acute injury incompatible with life.

The history of resuscitation goes back centuries The history of resuscitation goes back centuries Back in 1543, Vesalius described artificial ventilation with intermittent positive pressure Back in 1543, Vesalius described artificial ventilation with intermittent positive pressure However, the set of measures that can be called cardiopulmonary resuscitation was formed in the middle twentieth century and has not undergone fundamental changes to date. However, the set of measures that can be called cardiopulmonary resuscitation was formed in the mid-twentieth century and has not undergone fundamental changes to date

Assessing status of consciousness Assessing status of consciousness Assess for injury, especially to the head or neck (if injury is suspected, move the victim only if absolutely necessary) Assess for injury, especially of the head or neck (if injury is suspected, move the victim only if absolutely necessary necessary) Pat or lightly shake the victim’s shoulders, while loudly asking a question like “Are you okay?” Pat or lightly shake the victim by the shoulders, while loudly asking a question like “Are you okay?”

Assessing the presence of spontaneous breathing (Hear, See, Feel) (Hear, See, Feel) Free the oropharynx from liquid contents (index and middle fingers wrapped in a piece of cloth) and solid foreign bodies (index finger bent in the shape of a hook) Free the oropharynx from liquid contents (with the index and middle fingers wrapped in a piece of cloth) and solid foreign bodies (with the index finger bent in the shape of a hook) Ensure patency of the upper respiratory tract by tilting the head (if a head or neck injury is suspected, try not to tilt the head), extension forward of the lower jaw and opening the victim’s mouth (triple Safar maneuver) Ensure patency of the upper respiratory tract by tilting the head (if you suspect a head or neck injury, try not to tilt your head back), pushing the lower jaw forward and opening the victim’s mouth (triple Safar maneuver) Place the ear above the victim’s mouth and nose Place your ear over the victim’s mouth and nose Simultaneously assess the movements of the chest during inhalation and exhalation (see), the presence of noise of exhaled air (hear) and the sensation of air movement (feel) Simultaneously assess the movements of the chest during inhalation and exhalation ( see), the presence of exhaled air noise (hear) and the sensation of air movement (feel) Remember that spontaneous breathing is ineffective during upper airway obstruction or agonal convulsive sighs. Remember that spontaneous breathing is ineffective during upper airway obstruction or agonal convulsive sighs. Assessment should take no more than seconds The assessment should take no more than seconds

Assessing the presence of independent blood circulation Assessing the presence of independent blood circulation Make sure that the patient is unconscious Make sure that the patient is unconscious Determine the pulsation on the carotid or femoral arteries (preferably on the carotid - the middle and index fingers are placed on the anterior surface of the thyroid cartilage (Adam's apple) of the victim, slide into side and apply light pressure with two fingers in the hole between the lateral surface of the larynx and the muscle roll on the lateral surface of the neck. Determine the pulsation on the carotid or femoral arteries (preferably on the carotid - the middle and index fingers are placed on the front surface of the thyroid cartilage (Adam's apple) of the victim, slide into side and apply light pressure with two fingers in the hole between the lateral surface of the larynx and the muscle roll on the lateral surface of the neck. The assessment should take no more than s. The assessment should take no more than s.

Position of the patient during resuscitation measures Rotate the patient as a “single whole”, without allowing body parts to move relative to each other or rotate them Turn the patient as a “single whole”, without allowing body parts to move relative to each other or their rotation When carrying out resuscitation measures, the patient should lie on a hard, flat surface on the back, arms extended along the body. When carrying out resuscitation measures, the patient should lie on a hard, flat surface on the back, arms extended along the body. In the absence of consciousness, but in the presence of spontaneous breathing and pulsation in the large arteries, the patient can be placed in a stable position. position on the side (if injury is not suspected) In the absence of consciousness, but in the presence of spontaneous breathing and pulsation in the large arteries, the patient can be placed in a stable position on the side (if injury is not suspected)

Basic life-sustaining measures Basic life-sustaining measures Include ensuring patency of the upper respiratory tract, artificial respiration and maintaining blood circulation Include ensuring patency of the upper respiratory tract, artificial respiration and maintaining blood circulation Begin to be carried out only after establishing the fact of lack of consciousness, independent breathing, circulatory arrest Begin to be carried out only after establishing the fact of absence of consciousness, spontaneous breathing, circulatory arrest Must be carried out continuously until function is restored Must be carried out continuously until function is restored Without their implementation, all subsequent more differentiated interventions are ineffective Without their implementation, all subsequent more differentiated interventions are ineffective

Logical sequence of the most important techniques when carrying out the primary resuscitation complex Logical sequence of the most important techniques when carrying out the primary resuscitation complex (ABCD rule) For ease of remembering, resuscitation measures are divided into 4 groups, designated by the letters of the English alphabet: A (Air way open - “give way to air”) – ensuring airway patency B (Breath for victum - “air for the victim”) - artificial ventilation of the lungs C (Circulation of blood - “blood circulation”) - restoration of blood circulation, chest compressions D (Drugs therapy - drug therapy) - is the exclusive prerogative of doctors

ARTIFICIAL PULMONARY VENTILATION ARTIFICIAL PULMONARY VENTILATION Ensure patency of the upper respiratory tract by throwing back the head and lifting the chin or pushing the lower jaw forward, triple Safar maneuver, insertion of an air duct (rubber or metal or removal of foreign bodies (mucus, pus, etc.); Ensure patency of the upper respiratory tract by throwing back the head and lifting the chin or pushing forward the lower jaw, triple Safar maneuver, insertion of an air duct (rubber or metal or removal of foreign bodies (mucus, pus, etc.); Maintain patency of the upper respiratory tract during inhalation and , if possible, with passive exhalation; Maintain patency of the upper respiratory tract during inhalation and, if possible, during passive exhalation; Use the “mouth to mouth” method (or “mouth to nose” in case of trauma to the mouth, inability to open the mouth, inability to seal it tightly ); Use the “mouth to mouth” method (or “mouth to nose” in case of injury to the mouth, inability to open the mouth, inability to seal it tightly); Create a seal between the respiratory tract of the victim and the resuscitator. To do this, the resuscitator grabs the victim’s lips with his lips, pinches the victim’s nasal passages with his fingers and inhales; Create a seal between the respiratory tract of the victim and the resuscitator. To do this, the resuscitator grabs the victim’s lips with his lips, pinches the victim’s nasal passages with his fingers and inhales; Inhale ml (at least) of your exhaled air (the volume of deep exhalation) for 1-2 s with a frequency of up to once per minute - on average 16 times per 1 minute (or once every s); Inhale ml (at least) of your exhaled air (the volume of deep exhalation) for 1-2 s with a frequency of up to once per minute - on average 16 times per 1 minute (or once every s); Passive exhalation must be complete (time does not matter); Passive exhalation must be complete (time does not matter); The next air injection can be done when the chest has dropped; The next air injection can be done when the chest has dropped; It is necessary to determine the effectiveness of artificial respiration - the presence of chest movements during inhalation and exhalation, the sound of exhaled air and the sensation of its movement; It is necessary to determine the effectiveness of artificial respiration - the presence of chest movements during inhalation and exhalation, the sound of exhaled air and the sensation of its movement; If one or two breaths are ineffective, change the position of the head and take another breath; if unsuccessful, resort to methods of removing the foreign body from the upper respiratory tract. If one or two breaths are ineffective, change the position of the head and take another breath; if unsuccessful, resort to methods of removing the foreign body from the upper respiratory tract. You can use hardware manual breathing methods - using an Ambu bag or the bellows of an anesthesia machine. You can use hardware manual breathing methods - using an Ambu bag or the bellows of an anesthesia machine.

A B

INDIRECT HEART MASSAGE INDIRECT HEART MASSAGE When carrying out resuscitation measures, the patient should lie on a hard, flat surface on his back, with his arms extended along the body. When carrying out resuscitation measures, the patient should lie on a hard, flat surface on his back, with his arms extended along the body. A precordial blow is performed, which in some cases plays the role of defibrillation, although the feasibility of its use is still being discussed. The blow should be of medium strength and it is applied to the sternum. A precordial blow is performed, which in some cases plays the role of defibrillation, although the feasibility of its use is still being discussed. The blow should be of medium strength and applied to the sternum. Compress the chest in the anterior-posterior direction by 3.5-6 cm (in the absence of a massage effectiveness criterion, a little more is possible) with a compression frequency of 1 minute. The pressure force should be about 9-15 kg. Compress the chest in the anterior-posterior direction by 3.5-6 cm (in the absence of a massage effectiveness criterion, a little more is possible) with a compression frequency of 1 minute. The pressure force should be about 9-15 kg. Apply force strictly vertically to the lower third of the sternum (2 transverse fingers above the xiphoid process) using crossed wrists and arms straightened at the elbows, without touching the chest with your fingers. The fulcrum is the tener and hypotener of the right (working) hand. The base of the left hand rests on the back of the right. The arms at the elbow joints should be straight. Apply force strictly vertically to the lower third of the sternum (2 transverse fingers above the xiphoid process) using crossed wrists with arms straightened at the elbows, without touching the chest with your fingers. The fulcrum is the tener and hypotener of the right (working) hand. The base of the left hand rests on the back of the right. The arms in the elbow joints should be straightened. Squeezing and stopping the compression should take equal time; when the compression stops, do not tear your hands off the chest. Squeezing and stopping the compression should take equal time; when the compression stops, don’t tear your hands off the chest. Determine the effectiveness of chest compressions - presence pulsations in the carotid or femoral arteries when the chest is compressed Determine the effectiveness of chest compressions - the presence of pulsations in the carotid or femoral arteries when the chest is compressed Do not interrupt chest compressions for more than 5 seconds. Do not interrupt chest compressions for more than 5 seconds. An alternative method of resuscitation is the method of active compression - decompression using a Cardiopamp. An alternative method of resuscitation is the method of active compression - decompression using a Cardiopamp

The person providing assistance stands to the left or right of the victim, places his palm on the victim’s chest so that the base of the palm is located at the lower end of his sternum. Places another on top of this palm to increase pressure, and with strong, sharp movements, while helping with the entire weight of the body, perform quick rhythmic shocks once per second

Method of simultaneous artificial respiration and closed cardiac massage Initially, in the absence of spontaneous breathing, take two breaths (while assessing their effectiveness) Initially, in the absence of spontaneous breathing, take two breaths (while assessing their effectiveness) If the resuscitator acts alone, alternate 15 chest compressions with two with breaths If the resuscitator acts alone, alternate 15 chest compressions with two breaths. With two resuscitators, alternate 5 chest compressions with one breath, stopping chest compressions for 1-2 s while blowing air into the lungs (except for intubated patients). With two resuscitators. Alternate 5 chest compressions with one breath, stopping chest compressions for 1-2 s while blowing air into the lungs (except for intubated patients)

METHODS OF MONITORING THE PATIENT'S CONDITION Re-assess the pulsation in the carotid artery (within 3-5 s) after 4 cycles of artificial respiration and chest compressions (when performing cardiopulmonary resuscitation by two resuscitators, the person performing artificial respiration monitors the patient's condition and the effectiveness of chest compressions ) Re-evaluate the pulsation in the carotid artery (within 3-5 s) after 4 cycles of artificial respiration and chest compressions (when performing cardiopulmonary resuscitation with two resuscitators, the person performing artificial respiration monitors the patient’s condition and the effectiveness of chest compressions) When a pulse appears stop indirect cardiac massage and assess the presence of spontaneous breathing. When a pulse appears, stop indirect cardiac massage and assess the presence of spontaneous breathing. In the absence of spontaneous breathing, perform artificial respiration and determine the presence of pulsation in the carotid artery after every 10 blows of air into the lungs. In the absence of spontaneous breathing, perform artificial respiration and determine the presence of pulsation in the carotid artery after every 10 blows of air into the lungs. Periodically assess the color of the skin (decreased cyanosis and pallor) and the size of the pupil (narrowing, if they were dilated, with the appearance of a reaction to light). Periodically assess the color of the skin (decreased cyanosis and pallor) and pupil size (constriction, if they were dilated, with the appearance of a reaction to light) Maintaining SBP when measured on the shoulder at the level of mmHg. Maintaining SBP when measured on the upper arm at the level of mmHg. When spontaneous breathing is restored and there is no consciousness, maintain patency of the upper respiratory tract and carefully monitor the presence of breathing and pulsation in the carotid artery. When spontaneous breathing is restored and there is no consciousness, maintain patency of the upper respiratory tract and carefully monitor the presence of breathing and pulsation in the carotid artery.

Resuscitation measures are stopped only when these measures are recognized as absolutely futile or biological death is declared, namely: When a person is declared dead on the basis of brain death, including against the background of ineffective use of the full range of measures aimed at maintaining life When a person is declared dead on the basis of death brain, including against the background of ineffective use of the full range of measures aimed at maintaining life If resuscitation measures aimed at restoring vital functions within 30 minutes are ineffective If resuscitation measures aimed at restoring vital functions within 30 minutes are ineffective

Starting mechanical ventilation with a breathing bag or mouth to mouth Stopping breathing and circulation Ensuring airway patency Obturation Direct laryngoscopy and attempt to remove the obstructing body. In the absence of this possibility, use the Heimlich maneuver. Restoration of spontaneous breathing. Lack of spontaneous breathing. The paths are passable. Triple Safar maneuver Indirect cardiac massage. ECG - clarification of the cause of circulatory arrest. There is no pulse in the carotid artery. There is a pulse in the carotid artery. Tracheal intubation. Continuation of mechanical ventilation

Specialized resuscitation measures require the use of resuscitation equipment and medications, but do not exclude, but only complement the main ones. The main one is electrical external defibrillation. It is important that every minute of delay in defibrillation increases the risk of death of the patient by 10%. It is necessary to pay special attention to the position of the defibrillator electrodes on chest Modern models use electrodes that must be applied to the anterior and anterolateral surface of the chest

Every minute of delay in defibrillation increases the patient's risk of death by 10% Midclavicular line Proper position of the sternal electrode Anterior axillary line Middle axillary line Correct position of the apical electrode (two options)

Ventricular fibrillation or pulseless ventricular tachycardia Continue mechanical ventilation, Cardiac massage Intubation Adrenaline 1 mg every 5 minutes Lidocaine 1.5 mg/kg If ineffective - amiodarone 300 mg or procainamide 100 mg 200 J 360 J 300 J Venous access 360 J Continue mechanical ventilation, Massage hearts

Asystole Continuation of mechanical ventilation, cardiac massage Intubation Continuation of mechanical ventilation. Temporary pacemaker Hypoxia? Hyperkalemia? Acidosis? Adrenaline 0.05-0.1 mg/kg every 5 minutes. Adrenaline 1 mg every 5 minutes. Sodium bicarbonate 1 mEq/kg (80 mg/kg) - as indicated Calcium chloride 1 g - as indicated Atropine 1 mg every 5 minutes. up to 3 times Venous access

In case of successful resuscitation measures, it is necessary: ​​1. Make sure that there is adequate ventilation of the lungs (airway patency, symmetry of breathing and chest excursion, evaluate the color of the skin) 2. Start an infusion of lidocaine at a rate of 2-3 mg/min. 3. If possible, identify the pathological condition that led to circulatory arrest and begin treatment of the underlying disease

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Developed by teacher Golyzhbin Oleg Petrovich, Gelendzhik 2018, GBPOU “Gelendzhik Medical College” OP.11 “Life Safety” 02.34.01. “Nursing” Topic: “First aid for cardiac arrest.” electronic textbook

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Contents Relevance of the development of the provisions of the algorithms for Cardiopulmonary Resuscitation Causes of cardiac arrest. Diagnosis of cardiac arrest. Definition of the term “terminal state”. Phases of the terminal state. Pregonal state. Terminal pause. Agony. Clinical death. Biological death. "Brain Death" Educational and methodological manual “Cardiopulmonary and cerebral resuscitation.” Indications and contraindications for cardiopulmonary resuscitation. Classic sequence of resuscitation measures according to P. Safar Basic cardiopulmonary resuscitation (I complex of CPR). Recommended reading. Repetition of the CPR lesson algorithm, test.

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Relevance Relevance of the study: Most cases of sudden death occur, as a rule, outside of medical institutions. Ambulance medical assistance, even with good organization, can arrive at the scene no earlier than in 15 - 20 minutes. It is clear that this time will be enough for irreversible changes to occur in the victim’s cerebral cortex. Therefore, the timing of assistance is key. In a real situation, only a person nearby (an eyewitness) can help the victim until the ambulance or rescuers arrive, and only if he is trained and proficient in practical first aid techniques.

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Development of provisions for Cardiopulmonary Resuscitation algorithms 1. A complete algorithm for Cardiopulmonary Resuscitation, taking into account modern international changes in 2005 (The international community is not satisfied with the results of CPR; “true” survival rate for death in the prehospital stage is 6.4% revision of international algorithms in 2000) 2. Resuscitation 2006 (Norway) - first analysis of the new algorithm 3. European Congress of Cardiology (Austria 2007) - new aspects, prospects 4. World Congress of Cardiology (Argentina 2008) ways to improve efficiency 5. American Heart Association (AHA) 2015 - latest revision of the algorithm

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Resuscitation Resuscitation is a set of measures aimed at restoring lost vital functions of the body: breathing, blood circulation and consciousness; It is effective only in cases of sudden death and has no prospects for gradually fading patients with long-term debilitating and incurable diseases. Resuscitation should be carried out as quickly as possible to avoid irreversible brain death (3-5 minutes).

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Causes of cardiac arrest Primary causes (cardiac) Secondary causes (extracardiac) Acute ischemia Acute respiratory failure Cardiomyopathy Shock Congenital and acquired conduction disorders Drowning Aortic stenosis Hypo/-hyperkalemia Myocarditis Intoxication Dissection of aortic aneurysm Tension pneumothorax

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Diagnosis of cardiac arrest Definition of the term “terminal condition”. Phases of the terminal state. A terminal state is a borderline state between life and death, when there is a pronounced disruption in the functioning of the basic life systems, and the body of the affected person itself is not able to cope with these disturbances. Phases of the terminal state: 1. Predagonal state 2. Terminal pause 3. Agony 4. Clinical death.

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Preagonal state Characterized by the extinction of vital functions of the body. The duration of the period depends on the pathological process and on the compensatory reactions of the body. Consciousness is sharply depressed or absent. The skin is pale or cyanotic. Blood pressure usually does not exceed 60-70 mmHg, the pulse is frequent and weak. Breathing is frequent and shallow, then rare and noisy breathing (bradypnea) - progressive respiratory failure.

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Terminal pause-state Duration up to 4 minutes. Breathing stops, bradycardia develops, and sometimes asystole, the pupil's reactions to light, corneal (corneal) and other brainstem reflexes disappear (areflexia - the absence of one or more brainstem reflexes), the pupils dilate.

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Agony The duration of the period is no more than 3 minutes. Agonal breathing - weak, frequent respiratory movements of small amplitude, or short maximum inhalations and rapid full exhalations with large amplitude and a frequency of 2-6 per minute. In the extreme stage of agony, the muscles of the neck and torso participate in breathing - the head is thrown back, the mouth is wide open, and foam may appear at the mouth. Agonal breathing can turn into pre-death stridor breathing (wheezing, noisy breathing). In a state of agony, the heart rate and blood pressure increase, consciousness may briefly recover, convulsions, involuntary urination and defecation often develop, the pupils’ reaction to light gradually fades, and the face takes on the appearance of a “Hippocratic mask.”

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Clinical death A reversible stage of dying, a transitional state from life to death. The duration of the period is up to 6 minutes (in summer), in winter up to 10 minutes. Lack of consciousness and spontaneous breathing. Dilated pupils (develops within 1 minute after circulatory arrest). Areflexia (lack of corneal reflex and pupillary reaction to light). Severe pallor/cyanosis of the skin In the absence of absolute signs of biological death, in all cases a diagnosis of “CLINICAL DEATH” is made! Resolution of the Russian Federation No. 950 dated September 20, 2012. Federal Law on the protection of citizens' health.

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Biological death. Biological death is an irreversible stage of dying, expressed by posthumous changes in all organs and systems that are permanent, irreversible, cadaveric in nature. Cadaveric spots Early sign Late signs Drying and clouding of the cornea of ​​the eye Cadaveric spots Positive Beloglazov symptom Rigor mortis, decomposition

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"Brain Death" Brain death is the irreversible death of brain tissue, leading to its complete inability to provide any independent activity and vital functions of the body (breathing, maintaining arterial (blood) pressure). The diagnosis of “Brain Death” is established in healthcare institutions that have the necessary conditions for ascertaining brain death “Instructions for ascertaining the death of a person based on the diagnosis of brain death”, order M3 of the Russian Federation dated December 20, 2001 No. 460.

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Educational and methodological manual “Cardiopulmonary and cerebral resuscitation” Research staff of the Research Institute of General Reanimatology named after. V.A. Negovsky RAMS and teachers of the Department of Anesthesiology and Reanimatology of the Moscow State Medical University developed an educational manual “Cardiopulmonary and cerebral resuscitation.” This educational and methodological manual covers the current state of the problem of circulatory arrest, cardiopulmonary and cerebral resuscitation. The manual was developed in accordance with the “Guidelines for Cardiopulmonary Resuscitation” of the European Resuscitation Council 2010 and the results of domestic studies. The educational and methodological manual was approved at a meeting of the Scientific Council of the Scientific Research Institute of Oral Medicine of the Russian Academy of Medical Sciences on March 22, 2011 (Minutes No. 4) and agreed with the Secretariat of the European Resuscitation Council (Copyright European Resuscitation Council - www.erc.edu - 2010/0034).

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Indications and contraindications for cardiopulmonary resuscitation. Indications for resuscitation: terminal phases. Indications for resuscitation are all cases of sudden death, regardless of the causes that caused it. At the same time, many emphasize if clinical death is detected in an unknown person. Why exactly in an unknown person becomes clear when discussing contraindications to resuscitation. Contraindications to CPR: a) in the presence of signs of biological death; . The onset of death due to a long-term debilitating disease, when the patient has already used all modern methods of treatment. For example, with sepsis, cirrhosis of the liver and some infectious diseases. Usually, in such patients, when using the entire complex of CPR, it is possible to achieve short-term (within a few minutes or even hours) restoration of cardiac activity, but this will no longer be an extension of life, but an extension of the dying process or, as many now say, an extension of death. When death occurs in patients with currently incurable diseases and conditions, advanced forms of malignant neoplasms, injuries and developmental defects , incompatible with life, terminal stages of cerebral circulatory disorders (stroke) However, in these situations, it is desirable that in the event of the death of the patient, the refusal to carry out resuscitation measures should be recorded in advance in the medical history in the form of a decision of a council of doctors b) when a state of clinical death occurs against the background of progression reliably established incurable diseases or incurable consequences of acute injury incompatible with life. c) primary CPR should not be performed and it will be absolutely useless if it is known for sure that more than 15-20 minutes have passed since death (under normal temperature conditions), if the victim has signs of rigor mortis or even decomposition

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The classic sequence of resuscitation measures according to P. Safar The ABC algorithm is a sequence of actions that gives the victim the maximum chance of survival. (urgent oxygenation) Stage I. A (Airways) - restoration of airway patency. - B (Breathing) - maintaining breathing. - C (Circulation) - maintaining blood circulation. Further maintenance of life (restoration of spontaneous circulation) stage II. - D (Drugs) - administration of medications and liquids. E (ECG) - electrocardiography. - F (Fibrillation) - treatment of fibrillation. Long-term life support (cerebral resuscitation and treatment in the post-resuscitation period) stage III. - G - assessment of the condition in the post-resuscitation period - N - brain protection - I - complex intensive care in the intensive care unit.

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Basic cardiopulmonary resuscitation (CPR complex I). Ensure safety for yourself, the victim and others; eliminate possible risks (electricity, gas, unstable brick walls, traffic, aggressive animals, etc.). Place the victim on a hard, flat surface. Assess the condition of the victim: determine consciousness, perform a triple Safar maneuver to ensure that the airways are clear, if necessary, clean the oral cavity, determine the presence of breathing, the reaction of the pupils to light, corneal reflexes, Beloglazov’s symptom (“cat’s eye”)

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Basic cardiopulmonary resuscitation (CPR complex I). If the victim responds, breathing is steady If the victim does not respond, but there is breathing and heartbeat If the victim has a pathological type of breathing or is absent, leave the victim in the same position, try to find out the reasons for what is happening and call for help, regularly assess the condition of the victim, if necessary, repeat the triple Safar maneuver, put in a standard lateral position, regularly assess the condition of the victim, ask others to call for help and bring an automatic external defibrillator, if necessary, repeat the triple Safar maneuver, start chest compressions

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Basic cardiopulmonary resuscitation (CPR complex I). Indirect cardiac massage 1) Kneel on the side of the victim; 2) Perform a precordial punch to the sternum area, then check the pulse in the carotid artery. 3) Place the base of one palm two fingers higher from the xiphoid process (i.e., on the lower third of the sternum); 4) Place the heel of the other palm on top of the first palm. 5) Close your fingers in a “lock” and make sure that you are not putting pressure on the ribs; 6 Bend your arms at the elbow joints; 7) Do not apply pressure to the upper abdomen or xiphoid area; 8) Position the body body vertically above the victim’s chest and apply pressure to a depth of at least 5 cm, but not more than 6 cm; 9) Ensure complete decompression of the chest without losing hand contact with the sternum after each compression; 10) Continue chest compressions at a rate of 100 to 120/min; 11) Chest compressions and decompressions should take equal time.

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Basic cardiopulmonary resuscitation (CPR complex I). Before starting chest compressions, it is recommended to perform mechanical defibrillation, i.e. apply a “precordial blow” - a sharp blow with a fist to the middle part of the sternum, and then immediately begin cardiac massage. Position the victim on his back, on a flat, rigid base (floor, ground, etc.). 1.Arms are extended along the body, pressed. 2.Loosen the belt. 3. Loosen your tie and collar.

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30 compressions after determining the pulse in the carotid artery and breathing. Every 2-3 minutes, for several seconds, the effectiveness of the resuscitation is monitored: determining the pulse in the carotid artery, the condition of the pupils, restoring spontaneous breathing. If the pulse and breathing have recovered, it is necessary to monitor their parameters until the ambulance arrives. If cardiac activity is restored, but breathing is not, mechanical ventilation is continued. If there is no breathing or pulse, CPR is performed until the ambulance arrives.

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Basic cardiopulmonary resuscitation (CPR complex I). Artificial ventilation. Artificial ventilation. after 30 compressions, open the airways as described above and take 2 breaths; pinch the wings of the nose with the thumb and forefinger of the hand located on the forehead; open your mouth, lifting your chin; take a normal breath and tightly cover the victim’s mouth with your lips; inhale evenly into the affected person for 1 second, while observing the rise of the chest, which corresponds to a tidal volume of about 500-600 ml (a sign of effective inhalation); Keeping your airways open, raise your head and watch your chest fall as you exhale.

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Basic cardiopulmonary resuscitation (CPR complex I). After this, do 30 chest compressions and then continue CPR at a compression: ventilation ratio of 30:2. Chest compressions should be performed with minimal interruption. Assess the patient's condition every 2 minutes.

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The ratio of pressing and breathing movements in children can be either 30:2, or if there are two resuscitators - 15:2. In newborns, the ratio is 3 clicks per breathing movement. If there are two rescuers - change roles every 5 cycles (30:2 x 5) Or every 2 minutes (200-240 compressions) if ventilation is not carried out

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Basic resuscitation
events (BasisLifeSupport,
BLS) include collateral
patency of the upper
respiratory tract, as well as
maintaining breathing and
blood circulation without
use of additional
devices other than simple ones
protective devices for
carrying out artificial
ventilation of the lungs.

Examination of the victim to determine consciousness

Terminal state

Clinical death

Resuscitation in translation means “revival”.

The main signs of clinical death or sudden circulatory arrest (SCA):

Basic rules for cardiopulmonary resuscitation B A C

Indirect cardiac massage

Chest compression

To clear the airways, there are the following techniques:

Artificial ventilation methods:

Sequence of actions when stopping blood circulation

Check the victim's reaction

The victim does not react, does not respond….

Notify the emergency medical dispatcher

The victim is breathing normally

The victim is not breathing...

Several rescuers provide assistance

System of measures to support life during
sudden circulatory arrest (SCA)
proposed about 70 years ago
The CPR technique should be uniform for all countries and
constantly improve. To this end
the international organization European was created
resuscitation council (ERC)
The ESR is part of the World Conciliation
resuscitation council
In 2004, the National Council for
resuscitation (NSR), Russia was admitted to the ESR
All ESR member countries must for training
use the methodological recommendations of the ESR,
which are accordingly recognized by international
resuscitation standard
The first version of the methodological recommendations was
published in 2000. Second - in 2005.

ELEMENTS OF BASIC CPR

ADVANCED CPR

Establishing the fact of circulatory arrest

Chest compressions

Chest compressions

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

Ensuring DP passability

VENTILATION METHODS

Manual ventilation method (mask)

DEFIBRILLATION

DEFIBRILLATION

DEFIBRILLATION optimal technique

Routes of drug administration

Routes of drug administration

Medicines for CPR

Medicines for CPR

CPR should begin

CPR is not indicated if

Absolute (reliable) signs of biological death

CPR may be discontinued

A set of signs that makes it possible to ascertain biological death before the appearance of reliable signs