Acute cardiovascular failure and cardiac arrest

In terminal states, ie, trauma, agony and clinical death, only immediate resuscitation measures, primarily aimed at restoring breathing and circulation, can bring the patient back to life. Primary resuscitation is sometimes called cardiopulmonary resuscitation: they include mechanical ventilation and cardiac massage. When cardiac arrest is extremely important, immediately begin resuscitation, as the period of reversibility on the onset of clinical death lasts no more than 4-5 minutes.

It is extremely important that all medical workers and the population master the practical skills of primary resuscitation. Only then people who are at the scene of the accident can begin resuscitation before the arrival of the medical worker. It is all the more important for every medical worker to learn the methods of resuscitation.

Heart massage is aimed at restoring blood circulation in conditions of a heart that is not working. Restoration of the pumping work of the heart and thereby blood circulation during the massage occurs as a result of jerking the heart between the anterior and posterior surface of the chest. Indications for heart massage are absence of pulse on peripheral and carotid arteries, pupil dilatation, absence or agonal type of breathing, abrupt palliation of skin, unconsciousness. In a hospital, you should not wait for the disappearance of the electrical activity of the heart if the patient is on a monitor. Electrical complexes on the ECG and even weakened heart sounds can persist, while the peripheral circulation has already stopped.

The patient should be laid on a hard surface-on the floor, the ground, a solid shield. Massage of the heart on a soft bed is ineffective. The reanimator becomes so that his arms perpendicularly fall in a forward position on the patient's chest. If the patient is lying on the floor or on the ground, the resuscitator kneels, if the patient lays on the bed with a shield - rises on any support. Otherwise, the reanimator will not be able to use the gravity of the upper half of his body, will have to work only with his hands, quickly become tired and will not be able to achieve an effective massage of the heart.

Hands place one on the other palms downward. Prokamalnuyu part of the lower palm is placed on the lower third of the sternum (above the area of ​​the ventricles of the heart), lifting slightly your fingers. Straight arms make jerky pressure on the lower third of the sternum, displacing it by 5 cm. Do not press on the ribs to avoid their fracture. The jerks are done at a frequency of 60 in 1 min, not allowing a break! In massage for more than 5 seconds. At the same time, the IW begins. The ratio of massage tremors and artificial breaths depends on the number of assistants. If the rescuer is alone, then he makes 12-15 massage jerks, then quickly changes position and makes 2 quickly following one after another artificial inhalation as deep as possible, then again he does massage of the heart (12-15 tremors), etc., until) Yes, the second reanimator. If the resuscitation is carried out by two people, then the rhythm of the work is different: after every 5-6 jolts of the massage, inhale.

During the first 30-60 s of resuscitation, it is necessary to establish the effectiveness of heart massage, as evidenced by pulsation of the carotid and peripheral arteries synchronous with massage shocks, while measuring AD - the disappearance of such pulsations at a systolic pressure of not less than 60 mm Hg. Art. , Narrowing of pupils, porozovenie skin of the patient and other signs of restoration of peripheral blood circulation. Evidence of the high efficiency of heart massage is the restoration of consciousness and breathing.

Effective cardiac and ventilatory massage can support the life of a patient without cardiac activity for quite a long time, which is necessary for the arrival of an ambulance team and delivery of the patient to the hospital, preventing the development of irreversible changes in the body, especially in the cerebral cortex. Do not stop cardiac and ventilatory massage if it is not possible to quickly restore cardiac activity and independent breathing, although prolonged heart massage is a heavy physical work that quickly tires the reanimator. It is therefore desirable to perform cardiac massage alternately by the forces of 2-3 medical workers, which ensures optimal conditions for the effectiveness of the massage if it is necessary to prolong it (there are special devices for automatic external massage of the heart). If closed heart massage fails to quickly restore peripheral circulation, then the reasons for its ineffectiveness should be immediately clarified, which is easiest to do with electrocardiography. A frequent cause of ineffectiveness of heart massage is ventricular fibrillation, which can be successfully controlled only by using electric defibrillation.

Another cause of ineffectiveness of closed heart massage is loss of cardiac muscle tone. In such cases, intracardiac administration of drugs that eliminate atony of the myocardium is necessary. A needle 10-12 cm long, put on a syringe, punctures the heart in the third or fourth intercostal space, receding 2 cm from the edge of the sternum. The direction of needle pricking is strictly vertical. It should be established that the needle is in the heart cavity (the blood should be easily injected into the syringe) and there is no danger of injecting the drug into the myocardium. Only after this, 0.3-1 ml of 0.1% solution of adrenaline or norepinephrine diluted in 10-15 ml of isotonic sodium chloride solution and 5-10 ml of 10% chloride solution or calcium gluconate are intracardiacally administered.

Open heart massage is indicated for severe chest injury and multiple rib fractures, sometimes with atony of the myocardium, if intracardiac administration of the above drugs does not lead to recovery of peripheral circulation. Produce a left-sided anterolateral thoracotomy in the fourth or fifth intercostal space. The heart is compressed between the palms of two hands or the palm and the palm surface of one finger of one hand. It is necessary to avoid the compression of the heart with the ends of the fingers, as the myocardium is injured.

The termination of cardiac and other resuscitation can be considered justified if the patient, who is in a state of clinical death, can not achieve with the help of cardiac massage the restoration of peripheral circulation within 20-30 minutes. If there is no pulsation of the carotid and peripheral arteries with properly performed cardiac and ventricular pulsations, the pupils remain enlarged, breathing and cardiac activity are not restored, the patient's skin remains pale or cyanotic, biological death can be detected and resuscitation can be terminated.