Clinical death is the medical term for cessation of blood circulation and breathing, the two necessary criteria to sustain life. It occurs when the heart stops beating in a regular rhythm, a condition called cardiac arrest.
Cardiac pulmonary resuscitation (CPR) beginning with signs of clinical death.
1. Clinical features:
- No pulse on the carotid artery;
- Absence of breathing;
- Dilated pupils, not reacting to light.
2. Additional features:
- Lack of awareness;
- Pallor (earthy-gray), cyanosis, or marbling of skin;
- Atony, weakness, areflexia.
According to the latest recommendations of the American Heart Association and European Resuscitation Council (2005), with sudden circulatory stopping the complex of cardiopulmonary and cerebral resuscitation (SLTSR), developed by P. Safar, which consists of three consecutive stages.
Critical, on the basis of the foregoing, gets emergency care at the beginning place . Its methods must possess not only doctors, but also persons who, because of his profession before all are near the event (law enforcement workers, transport drivers, etc.).
The initial stage SLTSR - this event on elemental life support, whose primary purpose is emergency oxygenation. She performed in three successive stages:
• monitoring and restoration of the airway;
• artificial maintenance of respiration;
• Artificial maintenance of circulation.
To restore the airway using a triple reception P. Safar, including crowding the head, mouth opening and pushing the lower jaw forward.
The first thing that needs to be done - is to ensure the absence of the event consciousness: to call him loudly ask: "What happened?", Saying: "Open your eyes!" Slap in the face, gently shake the shoulders.
The main problem that occurs in individuals without consciousness, is the obturation of the respiratory tract the tongue and epiglottis in laryngo-pharyngeal region due to muscle atonia. These phenomena occur at any position of the patient (even if he/she lays in the abdomen), and at an inclination of the head (chin to chest) obturation of the respiratory tract occurs in virtually 100% of cases.
Therefore, once established that the injured is unconscious, it is necessary to ensure the airway.
During manipulation of the airway should be mindful of possible spinal injuries in the cervical region. The greatest likelihood of such injuries can occur when:
• road injuries (men or was struck by a car during a crash in the car);
• falling from a height (including the diver).
So the injured can not tilt (bend the neck forward) and turn your head to the side. In these cases it is necessary to make a modest extension of themselves and then holding the head, neck and chest in the same plane, except when performing a triple reception reextansion neck, with minimum tilting of the head and simultaneous mouth opening and extension of the lower jaw forward. When providing first aid shows the use of fixing the neck ruff.
AV carried out by the "mouth-to mouth. "
After the triple admission to the respiratory tract with one hand placed on the forehead of the injured, providing the crowding of the head. Clutching fingers animated nose and tightly pressed his lips around his mouth, you need to blow in the air, watching the chest and the patient. When it picked up to release the injured's mouth, giving him the opportunity to make a complete passive exhalation. Tidal volume should be 500-600 ml (6-7 ml / kg), respiratory rate - 10 per minute to avoid hyperventilation.
Errors during mechanical ventilation.
• Do not secured airway
• Not guaranteed by blowing air tightness
• Upside (late onset) or overestimation (beginning SLTSR with intubation) value ALV
• Lack of control chest excursion
• Lack of control air into the stomach
• Attempts to drug stimulation of respiration
To ensure the maintenance of an artificial blood used an algorithm for compression of the thorax (chest compressions).
1. Correctly put the patient on a flat hard surface. Determine the compression point - palpation xiphoid process and the retreat of the two transverse finger up. Arm placed palm surface between the middle and lower third of the sternum, fingers parallel to the edges, but it - the other arm.
2. Variants of palms "lock" the figure.
3. Proper conduct of compression: tremors in the run straightened elbows with your hands and transfer to them of the weight of his body.
The ratio of compressions and the number of artificial breaths for one and for two animators should be 30:2. Chest compressions carried out at 100 clicks per minute, with a depth of 4-5 cm, pausing for breath (in non-intubated patients is unacceptable inject air at the time of chest compression - the danger of air into the stomach).
Criteria for termination of resuscitation.
1. The appearance of the pulse on the major arteries (stop chest compressions) and / or breathing (mechanical ventilation is stopped) is a sign of restoration of independent circulation
2. Ineffectiveness of resuscitation for 30 minutes. The exception is a condition in which you want to prolong the intensive care unit:
• hypothermia (hypothermia);
• Drowning in ice water;
• overdose of drugs or narcotics;
• electric shock and lightning stroke.
Signs of the correctness and effectiveness of compression is the presence of pulse wave on the main and peripheral arteries.
To detect the possible restoration of self-circulation in the affected every 2 minutes ventilation-compression cycle pause (5 seconds) to determine if the pulse on the carotid arteries.
After the restoration of blood flow the patient lying on a stretcher, transported (by kardiomonitornym supervision) to the nearest cardiac resuscitation, provided further therapeutic measures, providing the support.
Obvious signs of biological death: the maximum dilation of the pupils with the advent of so-called dry herring light (due to drying of the cornea and tearing termination); emergence of positional cyanosis, cyanotic when staining is detected on the trailing edge of the ears and back of the neck, back, muscle rigidity of limbs, not reaching the intensity of rigor mortis.
In conclusion, it should be noted that the most significant factor influencing the outcome of sudden cardiac stopping is a better organization to assist with this condition. Therefore, the American Heart Association proposed algorithm organizing first aid, called the "chain of survival". It will save the lives of many injured.\
American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care // Circulation. — 2005— Vol. 112, 24 Supplement; 13.
The European Resuscitation Council Advanced Life Support Manual. Published 2001. Obtainable from the European Resuscitation Council, University of Antwerp, P0 Box 113, B-2610 Antwerp (Wilrijk), Belgium.