Basic rules of indirect heart massage. Rules for external (indirect) heart massage

Cardiac massage is a mechanical effect on the heart after it has stopped in order to restore its activity and maintain continuous blood flow until it resumes. work of the heart.

Signs of sudden cardiac arrest are as follows:

sharp pallor,

Loss of consciousness,

The disappearance of the pulse on the carotid arteries, the cessation of breathing or the appearance of rare convulsive breaths (agonal breathing),

Pupil dilation.

The heart is located between the posterior surface of the sternum and the anterior surface of the spine, i.e. between two hard surfaces. By reducing the space between them, you can compress the region of the heart and cause artificial systole. In this case, blood from the heart is ejected into the large arteries of the large and small circles of blood circulation. If the pressure is stopped, then the contraction of the heart stops and the blood is sucked into it. This is artificial diastole. The rhythmic alternation of chest compressions and the cessation of pressure replaces cardiac activity, providing the necessary blood circulation in the body. This is the so-called indirect heart massage - the most common method of revitalization, carried out simultaneously with mechanical ventilation.

Indications for cardiac massage are all cases of cardiac arrest.

ACTION ALGORITHM:

1. Lay the victim on their back on a hard base.

2. Stand to the left of the victim and place your palms on the lower third of the sternum 2 transverse fingers above the xiphoid process.

Place the palm of one hand perpendicular to the axis of the sternum, the palm of the other hand - on the back surface perpendicular to the first.

3. Bring both hands to the position of maximum extension, fingers should not touch the chest. hand fingers,

located below, should be directed upwards (towards the head).

4. With the effort of the whole body with the help of the hands (the hands should remain straight during the massage), jerkily, rhythmically press on

breastbone so that it bends 4-5 cm. In the position of maximum deflection, it must be held for a little less than 1 second. Then

stop pressing, but do not take your palms off the sternum.

REMEMBER! The number of chest compressions should average 70 per minute.

Criteria for the effectiveness of chest compressions

1. Change in the color of the skin (they become less pale, gray, cyanotic)

2. Constriction of the pupils with the appearance of a reaction to light

3. The appearance of a pulse on large arteries(sleepy, femoral)

4. The appearance of blood pressure at the level of 60-8 mm Hg.

5. Subsequent restoration of spontaneous breathing.

Complications of chest compressions

Fracture of the ribs and sternum with injury to the heart, lung and pleura, development of pneumo- and hemothorax.

REMEMBER! CPR must be started immediately in any setting where respiratory and cardiac arrest occurs. The main condition for successful revival is the correct combination of free airway patency, mechanical ventilation and heart massage. Only the combined use of 3 stages ensures sufficient oxygen supply to the blood and its delivery to the organs, primarily to the brain.

The indirect method of cardiac massage is one of the methods of resuscitation carried out by pressing on the chest. This event must be performed as a result of stopping the heartbeat to restore blood circulation.

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The concept of indirect massage

Getting injuries associated with blood loss entails shutting down the functioning of the heart muscle. To prevent cell death, resuscitation of the victim must be applied.

In terms of time it takes no more than 0.5 hour, but if this period has expired, then clinical death occurs.

In total, there are two ways to provide first aid to the victim - indirect and direct massage heart muscle. When blood circulation ceases to circulate, the exchange of gases in the tissues at the intercellular level in the body stops.

Cells begin to die and poisoning occurs internal organs decay products. Cell death depends on the speed of synthesis of useful components. This especially affects the brain, it gradually dies after 4 minutes after cessation of access to the brain blood.

Circumstances of resuscitation

External cardiac massage should be performed if the injured person has the following:

• lack of consciousness;
• pupils during forced opening do not react to light;
• no signs of a heartbeat;
• breath is not felt.

Chest compression is the most acceptable way to show signs of life, especially if drugs are not used for this.

If a person is in a state of clinical death, it is easy to move the chest, during the event, the pressure in the heart muscle simultaneously increases and its volume decreases.

When performing movements in a given rhythm, the blood pressure in the cavities of the heart and in the vessels becomes unequal. From the left ventricle, blood enters the aorta of the brain, and from the right ventricle - to the lungs, where the cells of the organs are saturated with oxygen.

Important! When the pressure on the chest stops, the muscle expands and fills with blood, and when pressed, it is pushed out again. Thus, the heartbeat created artificially is maintained.

How to restore blood circulation

External cardiac massage is performed rib compression method. The following happens in the body:

• passing from the atrial region through the cavities of the valves, the blood fluid enters the region of the ventricles, and then spreads through the vessels;
• since the pressure is applied periodically, the circulation of the blood is not inhibited, and the blood continues to spread.

How to do a heart massage

This technique is necessary to create an electrical impulse of the heart muscle, which ensures the restoration of the functioning of the organ. If this process is not stopped, then within 0.5 hours you can regain consciousness, but you should know how to do chest compressions and have basic skills.

Advice! Be sure to perform these steps when performing artificial inhalations and exhalations. The force of pressure on the chest should not exceed 3 to 5 cm, which ensures the release of air masses in an amount of approximately 500 ml with each press. In this case, IVL is carried out.

What actions are performed with an indirect heart massage?

Performing indirect massage

Every person should know the rules for conducting an indirect heart massage for an adult.

chest compressions training

Execution technique contains the following information:

1. The injured person lies on a solid foundation or on the ground. If the first aid provider is right-handed, then it will be preferable for him to kneel on the right to perform the precordial strike with his right hand. If, on the contrary, you are left-handed, then the location on the left will be most convenient.
2. The maximum result from a closed massage will be provided if the victim is found on a flat and firm surface.
3. To carry out pressure, the palm of the right hand must be placed about 4 cm above the xiphoid process, but at the same time, the location thumb you need to focus on the stomach or chin of the victim. The other palm should be placed on the first at a right angle.
4. When directly performing the event, you do not need to bend your elbows, and the center of gravity should be kept relative to the chest. Restoring the work of the heart is a rather difficult task, as it would seem, and therefore one must be able to maintain the strength to conduct, and when bending the elbows, one can quickly become exhausted. To make sure that brings results, you should periodically check the presence of a pulse in an injured person. The number of clicks in one minute 60 - 100 times is the optimal pace of chest compressions.
5. The pressure between the ribs should not exceed 3 to 5 cm. This depends on how elastic the bones are. Do not take your hands off the body of an injured person. The chest should return to its previous position, but if you remove your palms and put them back, then such an action is equivalent to a powerful blow. So can injure the victim even more.
6. For 30 pressures, 2 breaths should be taken. As a result, inhalation and passive exit occur, which contributes to the saturation of the lungs with oxygen.

As mentioned earlier, after 0.5 hours, signs of life should appear, but if this does not happen, then death comes.

heartbeat

To know how to do chest compressions correctly, must be remembered following:

1. If the ribs are broken, you should not stop working, you can only reduce the number of pressures, but the depth of pressure should be left the same.
2. When performing resuscitation, it is worth paying more attention to pressing, and not to artificial inhalation of air.
3. Before performing resuscitation directly, make a precardinal punch from a height of about 0.3 m and only after that carry out the prescribed measures.

Resuscitation of children

What sequence of actions should be followed when providing first aid to children under the age of one year and older?

Helping kids is different than helping adults. The difference is in the depth of pressure and the area of ​​impact on the body area. Actions should be performed with one palm. For newborn babies, perform compression using two fingers.

Where to learn to do chest compressions

Indirect cardiac massage in children produced in this way:

1. Place your fingers below the level of the nipples and start pressing, with a frequency of more than 120 times per minute, the depth of pushing from 1.5 to 2 cm, while air inlets should be performed at least one in 5 presses.
2. If the baby is one year old and not more than 7 years old, then the optimal pace of indirect heart massage is from 100 to 200 pressures with a depth of 3 to 4 cm. The number of breaths is 1 with 5 pressures. Before holding, 2 fingers are placed higher from the xiphoid process.
3. If the child is over 7 years old, then the location of the fingers is the same as in the previous version, the depth of pressing is from 4 to 5 cm with a frequency of 80 to 100 times. Air is blown in at the rate of 2 times for 15 pressures.

Important nuances

When indirect massage should not be used hearts? It depends on a number of circumstances. The technique of resuscitation is associated with cardio - vascular system, so there are a number of contraindications:

1. Fractured ribs and other chest injuries.

2. If the heart muscle does not work for half an hour.

3. In the presence of a heartbeat, even if it is weak.

4. With an increased degree of risk to one's own life.

5. With open wounds and bleeding you have to make your own decision for such first aid.

Advice! It is necessary to massage the heart muscle according to the technology. In the regulatory framework, there is an article on the right of everyone to provide first aid, but only in relation to an adult. If you resuscitate the baby, then it should be consent from parents. The effectiveness of the event depends on the readiness for action and skills.

Video: Performing chest compressions

In the event of an accident or finding a person in an unconscious state, this area of ​​\u200b\u200bthe area must not be left until the ambulance arrives. Correctly performed indoor massage hearts, and timely assistance to the victim contribute to the preservation of life.

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In the absence of a pulse in the victim, in order to maintain the vital activity of the body (to restore blood circulation), it is necessary, regardless of the reason that caused the cessation of the heart, to carry out an external heart massage simultaneously with artificial lung ventilation (artificial respiration). At the same time, it should be borne in mind that without correct and timely preliminary assistance to the victim, the help of the arriving doctor may be belated and ineffective.

External (indirect) massage is performed by rhythmic contractions through the anterior chest wall with pressure on the relatively mobile lower part of the sternum, behind which the heart is located. In this case, the heart is pressed against the spine, and the blood from its cavities is squeezed out into blood vessels. By repeating pressure at a frequency of 60-70 times per minute, you can ensure sufficient blood circulation in the body in the absence of heart work.

To conduct an external heart massage, the victim should be laid with his back on a hard surface (low table, bench or floor), expose his chest, remove the belt, suspenders and other items of clothing that restrict breathing. The person providing assistance should stand on the right or left side of the victim and take a position in which a more or less significant inclination over the victim is possible. Having determined the position of the lower third of the sternum, the assisting person should put on it the upper edge of the palm of the arm extended to failure, and then put the other hand on top of the arm and press on the victim’s chest, while slightly helping by tilting his body.

Pressing should be done with a quick push so as to move the lower part of the sternum down towards the spine by 3-4 cm, and in fat people- by 5-6 cm. The pressing force should be concentrated on the lower part of the sternum, which, due to its attachment to the cartilaginous ends of the lower ribs, is mobile. The upper part of the sternum is fixedly attached to the bone ribs and can break when pressed. Pressure on the end of the lower ribs should also be avoided, as this can lead to their fracture. In no case should you press below the edge of the chest (on soft tissues), since it is possible to damage the organs located here, primarily the liver. Pressing on the sternum should be repeated approximately 1 time per second.

After a quick push, the hands remain in the reached position for about one third of a second. After that, the hands should be removed, releasing the chest from pressure to allow it to straighten out. This favors the flow of blood from the large veins into the heart and its filling with blood.

Since pressure on the chest makes it difficult to expand during inspiration, insufflation should be performed in the intervals between pressures or during a special pause provided every 4-6 pressures on the chest.

If the assisting person does not have an assistant and is forced to perform artificial respiration and external heart massage alone, these operations should be alternated in the following order: after two or three deep blows into the mouth or nose of the victim, the assisting person produces 4-6 pressures on the chest , then again makes 2-3 deep blows and again repeats 4-6 pressures in order to massage the heart, etc.

If there is an assistant, one of the caregivers - less experienced in this matter - should carry out artificial respiration by blowing air as a less complicated procedure, and the second - more experienced - should perform an external heart massage. At the same time, air blowing should be timed to coincide with the time of cessation of pressure on the chest or interrupting the heart massage for the time of blowing (for about 1 s).

With equal qualifications of persons providing assistance, it is advisable for each of them to carry out artificial respiration and external heart massage, alternately replacing each other every 5-10 minutes. Such an alternation will be less tiring than the continuous performance of the same procedure, especially heart massage.

The effectiveness of external heart massage is manifested primarily in the fact that each pressure on the sternum leads to the appearance of a pulsating oscillation of the walls of the arteries in the victim (checked by another person).

With proper artificial respiration and heart massage, the victim has the following signs of recovery:

• improvement in the complexion, acquiring a pinkish tint instead of a gray-earthy color with a bluish tinge, which the victim had before assistance;
• the emergence of independent respiratory movements, which become more and more uniform as the measures to provide assistance (revival) continue;
• constriction of the pupils.

The degree of pupillary constriction can serve as the most accurate indicator of the effectiveness of the assistance provided. Narrow pupils in the person being revived indicate a sufficient supply of oxygen to the brain, and the beginning expansion of the pupils indicates a deterioration in the supply of blood to the brain and the need to take more effective measures to revive the victim. To do this, incl., you should raise the victim's legs by about 0.5 m from the floor and leave them in a raised position during the entire time of external heart massage. This position of the victim's legs contributes to a better blood flow to the heart from the veins of the lower body. To keep the legs in a raised position, something should be placed under them.

Artificial respiration and external cardiac massage should be carried out until independent breathing and heart work appear, however, the appearance of weak sighs (in the presence of a pulse) does not give grounds for stopping artificial respiration. In this case, as already mentioned above, the blowing of air should be timed to coincide with the start of the victim's own inhalation.

The recovery of heart activity in the victim is judged by the appearance of his own regular pulse, not supported by massage. To check the pulse, the massage is interrupted for 2-3 seconds, and if the pulse persists, this indicates an independent work of the heart. If there is no pulse during the break, you must immediately resume the massage.

It should be remembered that even a short-term cessation of revitalizing activities (1 minute or less) can lead to irreparable consequences.

After the appearance of the first signs of revival, external heart massage and artificial respiration should be continued for 5-10 minutes, timing the blowing to the moment of one's own inspiration.

An indirect heart massage (closed, external) is one of the methods of resuscitation, which is based on a mechanical effect on a stopped heart to restore its function. When a patient is diagnosed with respiratory arrest, this method is used in conjunction with artificial lung ventilation (ALV) - this complex is called cardiopulmonary resuscitation.

What is closed heart massage for?

The essence of indirect heart massage is to compress the heart, which is filled with blood, between two surfaces - the chest and spine. When pressed, blood is evacuated from the ventricles, when released - into the atria.

Why is chest compressions necessary? Properly performed manipulation allows you to maintain the upper (systolic) arterial pressure(BP) at the level of 60-80 mm. rt. Art., and the lower (diastolic) - 40 mm. rt. Art. The value of cardiac output is 30%. This level of pressure is sufficient to maintain the life of the systems most necessary for the body - the cardiovascular, pulmonary, and central nervous system (central nervous system).

The indication for this manipulation is clinical death, the signs of which are:

• Absence of pulsation of the central arteries (carotid, femoral, subclavian).
• Absence of breathing movements.
• A wide pupil that does not react to light.
• Lack of consciousness.
• Blueness of the skin (cyanosis).
• No reflexes.
• Absence of bleeding from the wound (if any).
• Disappearance of the corneal reflex (with mechanical irritation of the cornea of ​​the eye, there is no closure of the eyelids).

Execution technique

The technique of indirect heart massage consists of the following points:

1. Lay the patient in a horizontal position.
2. Place a cushion under the patient's neck (this can be folded clothes, a narrow pillow).
3. Stand on the left side of the patient. The place of application of the resuscitator's hands should be located along the midline of the sternum in the area that is 2-3 transverse fingers above the xiphoid process. The left palm should be perpendicular to the sternum, and the right, covering the left, parallel to the chest (provided that the resuscitator is right-handed).
4. The palms should be extended as much as possible, and the fingers should not touch the patient.
5. Pressure on the chest should be carried out under the weight of your body, jerkily, rhythmically.
6. If necessary, mechanical ventilation is produced by two methods - from mouth to mouth or from mouth to nose.

Performing an indirect heart massage while maintaining breathing is equal to 80-100 clicks per minute. In the absence of respiratory movements, the ratio between the number of shocks and breaths is 30:2, regardless of the number of resuscitators.

In the event of a fatal outcome, in the presence of medical staff, a precordial blow is performed - this is a sharp blow to the chest area with a fist at a distance of 25-30 cm with a force of approximately 10 kg (mechanical defibrillation method).

The criteria for the effectiveness of resuscitation are:

• Restoration of normal skin color.
• Constriction of the pupils, the appearance of their reaction to light; closure of the eyelids.
• The appearance of pulsation of the central arteries.
• The appearance of pulsation of the peripheral arteries, which allows you to measure blood pressure.
• Restoration of independent respiratory movements.
• The appearance of reflexes of the upper respiratory tract (upper respiratory tract) - cough, vomiting.
• Restoration of normal consciousness.

Important! The start of resuscitation should be carried out as early as possible, since the delay in the implementation of CPR (cardio- pulmonary resuscitation) reduces her success rate by 10% for 1 minute.

Rules and features of the

There are several rules for conducting an indirect heart massage:

• The victim during the manipulation must be on a hard surface.
• During the heart massage, the arms should be in an extended state.
• The pressure on the sternum is made only with the palms, the fingers should be raised up.
• During the external massage, the hands should not come off the surface of the chest.
• The displacement of the sternum towards the spine in an adult is 4-6 cm.
• When conducting mechanical ventilation, it is necessary to restore the patency of the airways. For this purpose, index and middle fingers must be wrapped in a scarf or gauze and cleaned oral cavity(vomit may be in the mouth, sand - when drowning).

Resuscitation measures are carried out for at least 30 minutes. Before this period, the provision of assistance is terminated upon the arrival of an ambulance or after ascertaining biological death.

Features of closed heart massage in pediatrics:

• Heart massage is performed with two fingers or thumb. The place of application of the fingers of the resuscitator is the area located 1 cm below the line of the nipples.
• The frequency of pressing in newborns is 120-130 per minute, in children under 10 years old - up to 100 per minute.
• The displacement of the sternum is 1.5 - 2 cm.
• If necessary, mechanical ventilation is carried out simultaneously through the nasal and oral cavity of the child.
• Before IVL Airways released with one finger.

Contraindications for chest compressions

There are times when closed heart massage is prohibited. Contraindications to this manipulation are:

• Multiple fractures of the ribs or bones of the sternum.
• Suspicion of intrathoracic (pulmonary) bleeding.
• Open chest wound.
• The presence of deep penetrating wounds.
• The appearance of symptoms of biological death.
• Cardiac arrest in patients suffering from severe incurable diseases.
• Presence of intravital brain death syndrome.
• Severe poisoning incompatible with life.
• Refusal of resuscitation in writing.

Conclusion

Each person needs to know the technique of conducting an indirect heart massage. After all, if the manipulation is performed correctly, massage will be the most effective, and the chances of saving human life will increase.

How to do artificial respiration and chest compressions: video

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An indirect heart massage is an artificial method of resuming blood circulation. In this case, the procedure is carried out by rhythmic and gentle pressure on the chest. During this process, the heart contracts between the sternum and spine.

Indications and contraindications

The main and only indication for an indirect heart massage is the absence of signs of contraction of the heart muscle: a pulse in the carotid arteries, pupil dilation, abnormal breathing, or even its disappearance.

However, there are cases when this resuscitation is not effective - these are injuries that are incompatible with life, in particular, brain damage.

Technique for chest compressions

First of all, the victim on a hard surface, then the effect of the massage will be great. It is necessary to put your hands on the lower third of the sternum: it is under it that the muscular formations of the heart are located - the ventricles.

Pressing should not be done with the entire surface of the palm, but only with the part that is closer to the joint. In order to increase the pressure, you can attach the brush of the other to the back of one hand. And with quick pushes, press on the sternum. After each push, the hands must be taken away. At that time rib cage will straighten out, and the ventricles of the heart will be filled with blood.

Massage is considered effective, carried out simultaneously with artificial respiration. For one air blowing, 4-5 massage pressures should be performed. It is convenient if two different people do heart massage and artificial respiration.

Signs of the effectiveness of resuscitation

Signs of the effectiveness of indirect heart massage are: the appearance of pulsation of the femoral, carotid and brachial arteries, less often the radial ones, as well as a decrease in skin pallor, constriction of the pupils.

If the procedure is not effective enough, it is necessary to improve blood flow to the victim's heart. To do this, it is necessary to raise the patient's limbs, and also apply tourniquets on them (for no more than an hour and a half) or inject 1-2 ml of ephedrine or adrenaline.

According to experts, resuscitation should be carried out within 10-15 minutes. If during this time the condition of the victim has not improved or cadaveric spots have appeared on the body, resuscitation advisable to stop.