When it is necessary to immediately apply a precordial blow and begin performing cardiopulmonary resuscitation. Precordial stroke: indications, application technique, features Is it possible to apply a precordial stroke

This article reveals in detail the technology and subtleties of methods for performing cardiopulmonary resuscitation during cardiac and respiratory arrest. It is strongly recommended to read it.

This page is a supplement to the article about (you should read it first).

Beat to the heart - should I use a precordial beat?

Often, in case of cardiac arrest, people are advised to strike the heart area with a fist, which, according to the plan, should restore normal heart function. You should be aware that this may not only be useless, but also dangerous.

You can use a precordial beat only if you have all at the same time the following indications:

• Less than 1 minute has passed since the cardiac arrest. The blow should be delivered as soon as possible - the sooner, the greater the likelihood of starting a normal heart rhythm.
• You do not have an electric defibrillator at your disposal.
• The age of the victim is over 8 years old, more than 15 kilograms.

Precordial beat technique

If you are in doubt and never know the exact technology and indications for a cardiac stroke, then abandon this method and immediately begin chest compressions.

Lay the patient down on a hard surface - this is extremely important; no sofas are suitable. Place your index and middle fingers on the xiphoid process (marked with an arrow in the picture), then use the edge of your clenched fist to hit the sternum firmly above the fingers.

Your elbow should be directed along the spine.. The blow is carried out from a height of about 20 centimeters (for physically weak people from 30 cm), with the hand withdrawn from chest.

Only one blow should be applied (although some researchers suggest two blows); if the heartbeat has not recovered (check on the carotid artery), then proceed to chest compressions.

Precautionary measures

• You cannot strike if there is a pulse on the carotid artery - the heart is already working and, in this case, a strike can only stop it.
• In no case do not strike at the xiphoid process.
• It is very important that your elbow is directed along the spine when striking, this will make the strike more effective and minimize the likelihood of damage to the chest.
• If you have thin fingers and the victim is large, then place your ring finger (three fingers at once) on the xiphoid process.

Technique of indirect heart massage. How to put pressure on the heart?

The starting position of the patient is lying on his back, on a hard and flat horizontal surface. Place something under the shins to raise the victim's straight legs 20-30 centimeters above the head.

Which area to press on?

You should press with straight arms exactly perpendicular to the victim’s chest to ensure sufficient pressing force (the sternum of an adult should bend by 5 centimeters) and save your own strength. At the same time, it is also important not to overdo it - the maximum compression depth is 6 cm.

The easiest and most acceptable way is to mentally draw a line and place your palms exactly in the middle. Another option is to determine the end of the xiphoid process, then place two or three fingers (depending on the thickness of your fingers) of one hand on it and place the palm of the other hand close to them. This is the right point for pressure, which will allow you to minimize the risk of damage to the sternum and fracture of the victim’s ribs, and will also increase the effectiveness of cardiac massage.

Correct position of the palms during cardiac massage

When pressing, the hands can be taken in a “lock” or one on top of the other “crosswise”. We strongly recommend using the “lock”, because it becomes completely inconvenient to put pressure on the chest using flexion-extension movements of the arms - this ensures correct pressure with straight arms.

In addition, when placing your hands “crosswise”, you should additionally control the position of your fingers - they should be raised and should not touch the chest.

How to increase the effectiveness of cardiac massage?

After each pressing, the chest should be allowed to restore its shape. This means that you need to move your hands far enough, but at the same time do not lift them away from the body and do not slow down the frequency of compressions below 100 per minute.

You should be able to do 30 compressions in no more than 20 seconds. Ideally, you need to make them in 15 seconds, but better keep an eye on the quality. After this, proceed to artificial respiration (two of your exhalations into the victim).

Ideal scheme: 30 high-quality compressions (in 15-18 seconds), then two of your exhalations into the victim and again compressions until the patient regains consciousness or ambulance arrives.

Precautionary measures

• You should apply pressure specifically to the sternum; if you put pressure on the ribs, there is a risk of breaking them.
• Keep in mind that newborns should be massaged with only one finger, infants - two, older children - one palm. Press with such force that the chest is compressed to one-third of its original position.

How to do artificial respiration correctly?

1. The starting position of the patient is lying on his back, on a hard and flat horizontal surface.
2. You should tilt the victim's head back by pressing one hand on the victim's forehead and lifting his chin with the other.
3. Next, inhale in proportion to the victim’s requirements. For example, if you are a hefty man, then you should not inhale for slaughter if your victim is a fragile girl or child. And in general, the inhalation should be normal, not full.
4. Immediately after inhaling, exhale into the victim’s mouth through the protective barrier. In this case, you should definitely pinch his nose with your fingers, and also try to tightly clasp his mouth with your lips, and not touch them like when kissing. Do not forget about the correct position of the victim's head.
5. Watch for the rise of the chest and abdomen (to do this, position your head correctly so that you can see the victim’s chest) - if your exhalation is successful, they will expand. Wait until the chest returns to its normal position (this will take a maximum of 5 seconds) and exhale a second time into the victim.

Correct position of the victim's head during artificial respiration

In each case of performing artificial breaths for the victim, you definitely need to lift his chin (with one hand we press on the forehead, with the other we lift the chin). In this position, the tongue does not overlap Airways. However, you should not tilt your head back too much, otherwise the abdomen will swell, which will seriously reduce the effectiveness of artificial ventilation.

Is it possible to get infected during artificial ventilation?

During artificial respiration, transmission of infection is possible (both for you and for the victim), so you should use a special barrier device placed on the patient’s open mouth. Car first aid kits contain special valves. In the complete absence of any means, use any fabric, at least to protect against possible vomit.

Keep in mind that without using special protective equipment, you can catch such a serious disease as tuberculosis. Therefore, if the victim does not inspire confidence, then it would be better to limit himself to one cardiac massage (without performing artificial respiration).

Is it possible to train resuscitation skills on a healthy person?

In no case.

Artificial ventilation of the lungs is only possible for a person who is not breathing, and indirect massage heart surgery should be done only if the victim has no pulse in the carotid artery.

Many readers have seen more than once how artificial respiration and chest compressions are performed - such a tense moment could not help but become one of the most covered in the film industry. Alas, when shooting feature films, authenticity is not always in trend, which, along with a number of common myths (for example, about the obligatory nature of rib fractures during this event), sometimes creates rather strange ideas about cardiopulmonary resuscitation (CPR) among the population. In this article we will tell you how to do CPR correctly.

Let us immediately stipulate that even the most competent article on the Internet will never replace “live” training. Therefore, if in your locality are there any courses first medical care- be sure to visit them to see at least once the technique of performing indirect (closed) cardiac massage. Better yet, try it yourself on a special phantom doll, which, if everything is done correctly, immediately signals this.

Why is CPR done?

As practice shows, if it does not occur due to old age or long-term chronic disease, which has depleted the body's reserves, is often a reversible process.

We can live a long time without food, some without water. But without air, without fresh oxygen, which is constantly necessary for normal life, death occurs within a few minutes. If, for some reason, the basic “workers of life” of our body, the heart and lungs, refuse to work, then oxygen stops flowing into the blood and being carried by it to the organs in need. The first to suffer from this deficiency is the brain, which can survive without oxygen for an average of five minutes. Or rather, not so much the brain itself, as its cortex, in which our personality is hidden somewhere. Simpler and more ancient parts of the brain can live longer, but in this case, even if it is possible to start breathing and blood circulation, the body will remain in a “vegetable” state - it will function, but will never regain consciousness. This state is called social death.

The main task of CPR- provide the brain with the oxygen necessary for its minimal support. With proper resuscitation, spontaneous breathing and heartbeat can be resumed. But even if this does not happen - CPR must be carried out for up to 30 minutes after loss of consciousness - passive breathing movements and at the very least deliver oxygen to the “addressee”, which can allow the body to survive alive until the arrival of the ambulance team, which always has medications and equipment for more effective activities.

According to statistics, timely provision of correct first aid for sudden stop heart from myocardial infarction triples survival

Indications for CPR

• Lack of consciousness. The person does not respond to calls or other external stimuli, including pain. The pupils do not react to light - be sure to check this reflex. To do this, you just need to open your eyes, stretching your eyelids, and shine something with light, or turn the patient’s head towards an artificial or natural light source. If the pupil does not shrink, it is at least a coma.
• Lack of breathing. When you need to determine whether a person is breathing, you do not need to bring your hand, a mirror or anything else to his lips or nostrils. Just put your ear to his mouth, nose or chest and listen. Sometimes a short-term presence of the so-called. agonal breathing, when the muscles responsible for inhalation and exhalation simultaneously contract. The movements of the chest are convulsive, while breathing inside her is not audible.
• No heartbeat. There are conditions when the heart is working, but the pulse in the hands is difficult to determine. To find out whether there is blood circulation, you need to check the pulse in the carotid arteries. To do this, press your fingers between the Adam's apple and the long cervical muscle, which begins at the interclavicular fossa and goes to the skull behind the ear (sternocleidomastoid muscle). Try to carefully feel the pulse of your carotid arteries right now, it’s easy. Just don't press your fingers too hard - you may feel dizzy or even faint.

You need to hold your fingers on the carotid artery for up to 5 seconds, because sometimes it is not cardiac arrest, but a slowdown in its contractions

CPR technique: preparation

The first step is to call an ambulance and get someone to help - extra hands will add efficiency.

Place the person on a hard surface. Raise his legs and, if possible, place them on something so that their level is higher than his body. Kneel next to the patient to the side of the chest. Unbutton his clothes.

First you need ensure airway patency. If a person is lying on his back and there is no consciousness, then an overly relaxed tongue can fall back and block the path of air. There may also be, for example, vomit in the mouth, making it difficult to breathe.

If there is no injury to the cervical spine, tilt the patient’s head back, One hand supports the neck from below, while the other lightly presses on the forehead. Take your lower jaw and move it forward so that your lower teeth are in front of your upper teeth, or at least level with them. The mouth should be open. See if there is anything foreign inside that is making breathing difficult. If there is any, remove it with your fingers wrapped in a handkerchief or napkin (if it’s a napkin, be careful not to tear it).

In case of injury to the cervical spine or suspicion of it, limit yourself to moving your jaw and opening your mouth.

Place a cushion under the patient's neck, to maintain a tilted head position. Pinch his nose and take two test deep breaths mouth-to-mouth, preferably through a handkerchief that is well-permeable to air for hygiene reasons. At this time, watch the victim’s chest - it should rise when inhaling. If this is not the case, look for an air barrier. There may be a foreign body in the respiratory tract, such as a piece of food.

To remove a foreign body, you can try with a sharp movement, as with an indirect cardiac massage (see below), to press through the upper abdomen towards the chest.

If the chest moves during the control inhalation, proceed to stimulating heart contractions.

CPR Technique: Precordial Strike

If a person has lost consciousness in front of you or it is reliably known that less than a minute has passed since loss of consciousness, it is advisable to begin influencing the heart with a precordial beat.

The purpose of the precordial beat is to convert the mechanical energy from the shock of the chest and the heart inside it into electrical impulses, which will resume the independent heartbeat. Therefore, the precordial blow should not have the goal of causing damage - it should be massive, but not hard. About like hitting the table of an angry man. should be applied to chests that are completely free of clothing or jewelry such as medallions.

The xiphoid process continues down the sternum from the point where the ribs meet. Cover it with one hand so that it does not break off from the blow. With your other hand, from a height of about thirty centimeters, concussively hit the sternum with the edge of your fist five centimeters above the xiphoid process. After the impact, check the carotid pulse. If the heart fails to start, repeat the beat after 3-5 seconds and check the pulse again. If it is absent, proceed directly to chest compressions.

What has been written above should not only be read passively, but also imagine the sequence of actions, well organized. Due to the fact that in such a situation every moment is precious, you must firmly understand that you cannot spend more than 20-30 seconds on all the initial measures described above, from the determination of clinical death to the precordial stroke inclusive. Every action you take should be quick and confident, without unnecessary fussiness and excitement.

It is strictly prohibited to conduct precordial beat training on living people - this can cause cardiac arrest!

CPR technique: chest compressions and artificial respiration

so called because the resuscitator does not put pressure on the heart directly, as happens with surgical operations, and through the chest wall. The goal is to use mechanical contractions of the heart to restore its electrical potential and independent functioning.

Let us repeat once again that a person must lie on a flat, hard surface.

Extend your arms completely, place your palm on your palm crosswise or clasp your fingers into a “lock”, as in the figure. If crosswise, then the fingers should not touch the chest to prevent rib fractures. Your shoulders should be directly above the patient's sternum, parallel to it. Hands are perpendicular to the sternum. The place of application of force is approximately 3-4 cm above the xiphoid process. Apply pressure with the wrist part of the palm, which directly continues the line of the arms, perpendicular to the sternum.

Let us emphasize once again that the arms must be fully extended at all times. The pushes must be made with the body - not forcefully, but at the same time sharply, rhythmically and energetically bending it; thus, the required force must be created by part of your own weight. Make test pushes to evaluate the elasticity and resistance of the chest. Here it is important to find the moment between non-influence and “overdoing”. The depth of the required compression (i.e. how much the chest should bend) is 5 cm. The frequency of chest contractions is one hundred per minute, i.e. about 2/3 of a second per push. This frequency is very important, and therefore cardiac resuscitation is quite debilitating for untrained people.

Movements must be precise and identical. The patient's body should not sway. You cannot lift your hands from the sternum or move them.

In the United States, since 2010, it is not recommended that untrained people perform both artificial respiration and chest compressions at the same time, limiting themselves to only the second. There is an explanation for this - the blood at the time of clinical death most often stores a certain amount of oxygen, and even inside the lungs its supply is far from exhausted. However, the nuance is that, alas, ambulances in the USA often arrive faster than ours. Therefore, you need to be prepared for any possible development of the situation. Let's put it this way - if you are sure that the ambulance will arrive in the next five minutes, then you can limit yourself to only chest compressions. If you are not sure, then perform artificial respiration in parallel.

You need to breathe mouth-to-mouth through a handkerchief or napkin. Take two breaths after 30 pushes.

Previously, the ratio of pushes to breaths was 5:1, later 15:2; according to latest research 30:2 is enough - this provides a minimum sufficient amount of oxygen in the lungs, and the accumulated carbon dioxide additionally stimulates the respiratory center

In this rhythm, you need to do three “massage-breathing” cycles, and then check the pulse in the carotid arteries. If it is absent, continue resuscitation, checking the pulse every three cycles. CPR must be performed either before the ambulance arrives or within 30 minutes after loss of consciousness.

If in the process you break the patient’s ribs (a feeling of crunching under the arms and a corresponding sound), slightly reduce the frequency and amplitude of the shocks, but under no circumstances stop resuscitation.

If it appears, the patient begins to turn pink, and the pupils react to light - that means you are doing everything right. In this case, you can stop resuscitation by completing it with several mouth-to-mouth breaths at intervals of five seconds. But do not lose your vigilance - then you will need to monitor whether the patient is breathing on his own (if not, continue artificial respiration) and whether the pulse in the carotid arteries is stable (if it disappears again, continue cardiac massage).

When performing artificial respiration, make sure that air does not enter the stomach (in this case there will be a protrusion under the xiphoid process). If this happens, turn the patient's head to the side and lightly press on the stomach with a sharp movement to provoke a belch. At the same time, do not overdo it so that the person does not choke on vomit.

The most common mistakes when performing CPR

To summarize, we list the most that inexperienced resuscitators do. These are the points that you need to pay maximum attention to when learning CPR techniques.

• improper surface under the patient (soft, uneven, or sloped)
• incorrect position of the hands during compression (pressure is applied inaccurately, not stimulating the heart normally and causing complications in the form of fractures of the ribs and sternum)
• insufficient chest compression (less than 5 cm, but here you need to understand the differences in body type different people; the figure is for the average person - but for, for example, heavyweight weightlifters it is a little more, and for thin women it is a little less)
• poor ventilation of the lungs (insufficient inspiration or obstructions in the airways)
• delay in CPR or interruption of more than ten seconds

If all technical aspects are followed correctly, you have a very high chance of snatching a person from the clutches of death. Remember this, and, in addition to the material you just read, take a first aid course if possible.

Video about performing cardiac massage

A retained heartbeat can kill a person.

Attention! Remember: precordial beat when

The human heart is a four-chambered pump, small in size but with unique capabilities. No tissue created by nature or man has such contractility. Over 70 years of life at a heart rate of

standing at rest 70 beats per minute, the heart muscles will make 2,575,440 000 abbreviations. This is truly incredible performance! The heart muscle, like any other muscle, consists of a huge number of muscle fibers, and they all work as a single unit. For a number of reasons, the synchronicity of contraction of muscle fibers is disrupted, they begin to work uncoordinated, which leads to cardiac arrest and death. With the help of a precordial blow to the sternum, you can force the heart to beat as synchronously as before. The purpose of delivering such a blow is to shake the chest as much as possible, which can be an impetus to “start” the stopped heart. Often the blow restores the heartbeat and returns consciousness. A simple but very effective way.

The precordial blow is delivered to a point located on the sternum 2-3 cm above the xiphoid process with the edge of the palm clenched into a fist. The blow should be short and sharp enough. In this case, the elbow of the hand delivering the blow should be directed along the victim’s body. Immediately after the blow, you need to find out whether the heart has resumed its work, for which you place 2-3 fingers on the projection of the carotid artery. If the heart starts working, they begin artificial ventilation of the lungs; if not, they move on to chest compressions.

3.3. Indirect cardiac massage

Indirect cardiac massage (direct massage is performed by open-heart surgeons) begins as soon as it becomes clear that the precordial stroke has not brought the expected result. The effectiveness of this method largely depends on strict adherence to the following rules:

The palms, placed one on top of the other, should be located in a strictly defined place: 2-3 cm above the xiphoid process at the point of precordial impact;

Jerky pressure on the chest should be done with such force that the chest is compressed by 5 cm in an adult, 3 cm in a teenager, one year old child- by 1 cm;

The rhythm of chest compressions should correspond to the heart rate at rest - approximately 1 time per second. Each correctly performed pressure on the sternum corresponds to one heartbeat;

The minimum time for chest compressions, even in the absence of signs of its effectiveness, should not be less than 15-20 minutes.

The effect of chest compressions in combination with artificial ventilation can be observed within 1-2 minutes: the skin of the face gradually acquires a normal color, the pupils react to light (they narrow) and pulsation is noted in the carotid artery.

\/ Indirect cardiac massage technique:

Place the person on a hard surface (if the victim is lying on a bed or sofa, he must be placed on the floor); then kneel on the left side of the victim parallel to the longitudinal axis of his body;

Place the palm of one hand at the projection point of the heart on the sternum, and the other palm on top (palms one on top of the other), fingers should be raised, thumbs should look in different directions;

It is necessary to press on the sternum only with straight arms, using the weight of the body (shoulder girdle, back and upper half of the body); when performing indirect massage on a child, you can use one hand, and on a newborn - one thumb;

The palms should not leave the victim’s sternum, and each subsequent movement should be made only after the chest returns to its original position.

3.4. Artificial ventilation

Artificial ventilation is carried out in two cases: when there is no heartbeat and breathing, i.e. the person is in a state of clinical death, and also when the heartbeat and spontaneous breathing are preserved, but the frequency of respiratory movements does not exceed 10 times per minute.

Mechanical ventilation technique:

ensure patency of the upper respiratory tract ways. Ensuring patency of the upper respiratory tract is carried out with the index and middle fingers, which must be wrapped in a clean handkerchief or gauze. Quickly clean oral cavity from foreign bodies - blood, mucus. Then tilt the victim’s head back, placing a small dense cushion made of any available material under his shoulders;

exhale into the victim’s lungs. Exhalation into the lungs is carried out using the mouth-to-mouth method. In this case, you need to take a deep breath and, tightly clasping the victim’s lips with your lips, exhale into his lungs. Simultaneously, when inhaling, the index and thumb One hand should seal the victim's nostrils tightly. There should be no gaps in the closed system formed in this way, otherwise air will not enter the lungs;

make sure that the chest moves (rises) when you exhale into the victim’s lungs. If this does not happen, it means that the airways are obstructed, air is not entering the lungs and your efforts are in vain. In this case, it is necessary to re-clear the airways and slightly change the position of the victim’s head.

The effectiveness of resuscitation will depend not only on the accuracy of the technique of chest compressions and artificial ventilation, but also on their relationship in the process of your actions. If one person performs resuscitation, you need to do about 80

compressions per minute, for every 10-12 pressure on the sternum should be 2-3 exhalations (for preschool children, the intensity of pressure is 100 once a minute and for every 5 pressures there is 1 exhalation). Of course, it is better to carry out resuscitation with two or three people. In this case, for every 5 pressures there is 1 breath, and one of the participants presses quite hard on the victim’s stomach, since this excludes a significant volume of blood from the blood circulation (in the pelvis and lower limbs) and are created good conditions for complete blood supply to the brain.

If your actions are successful (the independent activity of the heart and lungs is restored,

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Precordial stroke

Precordial beat -
quick save strike

It is enough to resort to sports statistics, or rather boxing, to strongly doubt the reality of killing with one blow of the fist. For a million match-fights on the entire planet withThere are no more than 3-5 deaths per year. If we consider that a boxer of average weight and average level of training receives about 30-50 blows to the body, then the probability of being killed by a fist blow is no more than 1 case in 10 million.

At the same time, if the blow is struck in the first minute after cardiac arrest, then revival occurs in 7 out of 10 cases of sudden death. How can one deny the experience of domestic medicine, which has been successfully using

Why, according to some officials, only a certified doctor has the right to inflict a precordial blow? Which is more dangerous?— a series of 30 pressures on the chest with a force of more than 40 kg during chest compressions or a single blow with a fist with a swing of 20-30 cm? But for some reason, precordial stroke should be prohibited, and every graduate must master the technique of chest compressions high school.
This is no longer absurd, this is malicious intent and a real crime!

As it turned out, in the National Project for 2025, officials have allocated many billions of rubles to ensure the possibility of using a defibrillator (electric shock) in every case of sudden death. It will be great when rescue devices are within walking distance at airports and train stations, at stadiums and shopping centers, at public transport stops, in every workshop and gym. The price of the device is five thousand euros. But in this case, the end justifies the means.

As a doctor, I fully support this project.If a defibrillator shock is available within 3-5 minutes, this means thousands of lives saved. However, it should be taken into account that the effectiveness of its use is limited to 10-15 minutes of cardiopulmonary resuscitation, and today this life-saving device appears at the scene only with the arrival of an ambulance. How many of our fellow citizens are doomed to die until a brighter future arrives? But what abundant “cuts” are included in this project!

REMEMBER!
Where purity begins, conscience not only ends, but also common sense: mortal danger for the deceased.
The result of such nonsense is thousands of lost lives.

Rules for striking the sternum

UNACCEPTABLE!
Apply a precordial blow and perform chest compressions
to a living person and, especially, to practice the skills of carrying them out
on your comrades.

First rule
Before striking, you must make sure there is no pulse on the carotid artery. The probability of cardiac arrest, although negligible, is stillYou shouldn't tempt fate. Death on football and hockey fields, albeit extremely rare,but it does occur.

IT IS FORBIDDEN!
Strike when there is a pulse in the carotid artery.

Second rule
Before striking, the chest should be freed from clothing.or at least make sure that there are no buttons, medallions orother items. Even a pectoral cross can play a fatal role in this case.

IT IS FORBIDDEN!
To strike without freeing the chest from clothing

Third rule
It is necessary to cover the xiphoid process with two fingers of the left hand,to protect him from being hit. The xiphoid process is easily broken off from the sternumand injures the liver, which can lead to a tragic outcome.

IT IS FORBIDDEN!
Strike the xiphoid process.

Fourth Rule
The blow should be delivered with the edge of the palm clenched into a fist, slightly higherthe xiphoid process, covered by two fingers of the other hand. A blow to the sternum resemblesan angry boss hitting the table with his fist. In this case, the target of the strike will not be “broken”chest, and shake it. The elbow of the hand striking should be directed to the sidethe victim's abdomen. Otherwise, the blow will be delivered across the sternum, whichcan lead to injury in older people.

IT IS FORBIDDEN!
Strike across the sternumwhen the elbow of the striking hand is directed towards the rescuer.

Fifth rule
For children under 7-8 years of age, the blow can be fatal.The chest at this age does not have a sufficiently reliable rib and muscle framework, whichmay lead to injury to internal organs.

IT IS FORBIDDEN!

Hit children under 5-7 years of age.

sixth rule
After the impact it is necessary check pulse on the carotid artery.If after a blow to the sternum there is no revival, then it is necessary to proceed to the complexcardiopulmonary resuscitation, which consists of chest compressions and breathsartificial respiration.

Complex of resuscitation measures

Procedure for resuscitation

Indications for CPR

§ Lack of consciousness

§ Lack of breathing

§ Lack of blood circulation (in such a situation it is more effective to check the pulse in the carotid arteries)

Actions of medical workers when providing resuscitation care victims in Russia are regulated by Order of the Ministry of Health of the Russian Federation dated April 4, 2003 No. 73 “On approval of instructions for determining the criteria and procedure for determining the moment of death of a person and cessation of resuscitation measures.”

If the resuscitator (the person performing resuscitation) does not determine the pulse in the carotid artery (or does not know how to determine it), then it should be assumed that there is no pulse, that is, circulatory arrest has occurred.

According to the AHA CPR recommendations from 2011. The procedure for performing cardiopulmonary resuscitation has been changed from ABCDE to CABED. Mnemonic “memo” - ABCDE, according to the first letters of the English alphabet. The order, phasing and sequence of activities is very important.

Airway, air permeability.

Examine the oral cavity - if there is vomit, silt, sand, remove them, that is, ensure access of air to the lungs. Carry out the triple Safar maneuver: throw back your head, extend your lower jaw and open your mouth slightly.

Breathing, that is, “breathing.”

Breathing "mouth to mouth" or "mouth to nose" "mouth to nose and mouth." See below for the technique.

Circulation, ensuring blood circulation.

Provided by cardiac massage, direct or indirect. Properly performed indirect cardiac massage (by moving the chest) provides the brain with the minimum required amount of oxygen; a pause for artificial respiration impairs the supply of oxygen to the brain, so you must breathe through at least 30 compressions on the sternum, or not pause to inhale at all.

Drugs, medications.

Adrenalin. The medicine is administered intravenously with a syringe through a catheter installed in a vein or a needle. The previously used endotracheal (as well as intracardiac) route of drug administration is considered ineffective (According to the AHA recommendations on CPR from 2011). In the presence of arrhythmia, the use of amiodarone is indicated. Also, the previously recommended soda solution is not used.

Electrocardiogram, monitoring the effectiveness of resuscitation measures.

The components of the complex of resuscitation measures are listed

Scheme of indirect cardiac massage.

The only indication for a precordial shock is circulatory arrest that occurs in your presence if less than 10 seconds have passed and when there is no electric defibrillator ready for use. Contraindication: child's age is less than 8 years, body weight is less than 15 kg.

The victim is placed on a hard surface. Index finger and middle finger must be placed on the xiphoid process. Then, with the edge of the palm clenched into a fist, hit the sternum above the fingers, while the elbow of the striking hand should be directed along the victim’s torso. If after this there is no pulse in the carotid artery, then it is advisable to move on to chest compressions.

Currently, the precordial shock technique is considered insufficiently effective, but some experts insist that it is clinically effective enough for use in emergency resuscitation.

Chest compressions (indirect cardiac massage)

Indirect heart massage for a child.

Assistance is provided on a flat, hard surface. When compressing, the emphasis is on the bases of the palms. Hands in elbow joints must not be bent. During compression, the line of the rescuer's shoulders should be in line with the sternum and parallel to it. The position of the hands is perpendicular to the sternum. During compression, the hands can be held in a “lock” or one on top of the other “crosswise”. During compression, with the arms positioned “crosswise”, the fingers should be raised and not touch the surface of the chest. The location of the hands during compression is on the sternum, 2 transverse fingers above the end of the xiphoid process. Compression can be stopped only for the time necessary to perform artificial ventilation and to determine the pulse in the carotid artery. Compression should be performed to a depth of at least 5 cm (for adults) (AHA CPR 2011 recommendations).

The first compression should be a test to determine the elasticity and resistance of the chest. Subsequent compressions are performed with the same force. Compression should be performed at a frequency of at least 100 per minute, rhythmically if possible. Compressions are carried out in the anteroposterior direction along the line connecting the sternum to the spine.

When performing compression, you must not lift your hands from the sternum. Compression is performed in a pendulum-like manner, smoothly, using the weight of the upper half of your body. Push hard, push often (AHA recommendations for CPR 2011) Displacement of the base of the palms relative to the sternum is unacceptable. Violation of the relationship between compressions and forced breaths is not allowed:

The breath/compression ratio should be 2:30, regardless of the number of people performing CPR.

For non-medics, when finding the compression point, it is possible to place your hands in the center of the chest, between the nipples.

For newborn babies, indirect cardiac massage is performed with one finger. For infants - two fingers, for older children - with one palm. The depth of pressing is 1/3 of the height of the chest.

Signs of effectiveness:

§ appearance of a pulse on the carotid artery

§ pinking of the skin

§ pupillary reflex to light