Acute heart failure, cardiac arrest.
In terminal states, ie predagonii, agony and death experiences, only the immediate resuscitation, aimed primarily at restoring breathing and circulation, may return to the patient's life. Initial resuscitation is sometimes called the cardio-pulmonary resuscitation: These include mechanical ventilation and cardiac massage. Cardiac arrest is extremely important to immediately begin resuscitation as reversibility period upon the occurrence of clinical death lasts no longer than 4-5 minutes.
It is extremely important to the development of all health care workers and people skills for resuscitation. Only then will find themselves at the scene people can before the arrival of medical workers to start resuscitation. Especially important for every health care worker to learn resuscitation techniques.
Massage the heart is directed at restoring blood flow in the non-working heart. Restoring the pumping of the heart and thus blood circulation during the massage is the result of compression of the heart jogging between the front and the rear surface of the chest. Indications for cardiac massage are the lack of momentum in the peripheral and carotid arteries, dilated pupils, lack of or type of agonal breathing, rapid blanching of the skin, unconsciousness. In the hospital should not wait for the disappearance of electrical activity of the heart if the patient is in the monitor observation. Electrical complexes on the ECG and even the weakened heart sounds can be saved, while the peripheral circulation has ceased.
The patient should be installed on a hard surface, on the floor, ground, solid shield. Heart massage on a soft bed is not very effective. Animator is a way that his hands perpendicular dropped in a straight position on the patient's chest. If the patient lie on the floor or ground, rescuer kneels down, if the patient lies on a bed with a shield - stands for any base. Otherwise, the rescuer would not be able to use the gravity of the upper half of his body will be forced to work only with hands, quickly get tired and can not achieve effective cardiac massage.
Hands have one on the other hands down. Prokamalnuyu part of the lower hand is placed on the lower third of the sternum (over the area of the heart ventricles), slightly raising his fingers. Straight arms make jerky pressure on the lower third of the sternum, pushing it to 5 - see Do not put pressure on the edges to avoid fracture Jerks do at 60 in 1 minute, not allowing a break! a massage more than 5 seconds. At the same time begin to IW Value massage shocks and artificial breathing depends on the number of aid providers. If a rescuer, he does massage 12-15 shocks, then quickly change the position and make two quick consecutive artificial inspiration to the greatest possible depth, then again doing cardiac massage (12-15 impulses), and so on until when) yes the second rescuer. If resuscitation is carried out two people, the rhythm of the other: after every 5-6 jolt of massage is carried out breath.
During the first 30-60 with resuscitation should determine the efficacy of cardiac massage, as evidenced by synchronous pulsation shocks with massage of the carotid and peripheral arteries, the measurement of blood pressure - the disappearance of such a surge in systolic blood pressure of at least 60 mm Hg. Art. , Pupillary constriction, the patient porozovenie skin and other signs of recovery in the peripheral circulation. Evidence of high efficiency cardiac massage is to restore consciousness and breathing.
Effective cardiac massage and artificial ventilation
can maintain the life of a patient without cardiac activity for quite a long time it takes to ambulance arrival and delivery of a patient in a hospital, to prevent the development of irreversible changes in the body, primarily in the cerebral cortex. Should not stop heart massage and artificial ventilation, if you can not quickly restore cardiac function and spontaneous breathing, although long-term cardiac massage - hard physical work, quickly tiring resuscitation. It is desirable therefore to perform cardiac massage alternately by 3.2 health workers, providing optimal conditions for the effectiveness of massage as necessary to conduct long-term (there are special devices for automatic external cardiac massage). If the closed chest can not quickly restore the peripheral circulation, it must be immediately clarified the reasons for its ineffectiveness, the easiest way to do with electrocardiography. Common cause of failure cardiac massage is ventricular fibrillation, successfully fight which can only be applying electrical defibrillation.
Another reason for the ineffectiveness of closed cardiac massage is the loss of cardiac muscle tone. In such cases, intracardiac administration of drugs that eliminate atony infarction. Needle length of 10-12 cm, worn on the syringe, the dotted line in the heart of the third or fourth intercostal space, 2 cm away from the edge of the sternum. Destination vkola needle vertically. Should establish that the needle is in the cavity of the heart (in the syringe should be easy to enter the blood) and there is no danger to introduce the drug into the thickness of the myocardium. Only after intracardiac injected 0,3 - 1 ml 0.1% solution of epinephrine or norepinephrine diluted in 10-15 ml isotonic sodium chloride, and 5-10 ml 10% solution of chloride or calcium gluconate.
Open cardiac massage is indicated for severe chest injuries and multiple broken ribs, sometimes with atony infarction if intracardiac introduction of the above drugs have led to the restoration of peripheral circulation. Produce left-sided anterolateral thoracotomy in the fourth or fifth intercostal space. Heart contracts between the palmar surface of both hands and palm and palmar surface of 1 finger of one hand. It is necessary to avoid contraction of the heart ends of the fingers, as this is injured myocardium.
Termination of cardiac massage and other resuscitative measures can be justified if the patient in a state of clinical death can not be achieved by using cardiac massage restore peripheral circulation within 20-30 minutes. If properly implemented with heart massage and artificial ventilation pulsation of the carotid and peripheral arteries is absent, the pupils are dilated, breathing and heart activity can not be restored, skin patients remain dramatically pale or cyanotic, can be ascertained biological death and resuscitation stopped.
