Basic concepts and definitions

Laboratory work 11

First aid in case of accident.
A complex of cardiopulmonary resuscitation.

Objective: studying the signs of clinical death and coma; studying the concepts: artificial ventilation, indirect cardiac massage, precordial impact; Get practical skills in performing artificial ventilation, indirect heart massage and cardiopulmonary resuscitation.

 

Basic concepts and definitions

 

Concept of clinical death and coma

In various emergency situations, a person may suddenly have a sudden cardiac arrest (or blood circulation) and stop breathing. To save a person in this situation is possible only with the help of methods of cardiopulmonary resuscitation. The time when the victim can still be brought back to life does not exceed three to four minutes. The borderline between life and death is called clinical death.

The signs of clinical death include:

1. Loss of consciousness – when a person has no reaction to what is happening and to sound and pain stimulus.

2. Absence of the pupil's reaction to light. If the pupils remain wide and do not narrow with repeated lifting of the eyelid, then we can say that the pupil does not react to light.

3. Absence of a pulse on the carotid artery is an indisputable proof of the absence of blood circulation and breathing. To determine the pulse on the carotid artery, it is necessary to place four fingers on the neck of the victim between the cartilages of the larynx and the masticatory muscle and gently press them towards the spinal column. Pulse should be determined within 10 seconds, so as not to err in the presence of a pulse. If the victim has a very rare pulse, carrying out a cardiopulmonary resuscitation complex can lead to his death.

Visually, clinical death can be confused with a coma (Greek κώμα – deep sleep). The condition of a coma is accompanied by a loss of consciousness for more than 5 minutes with the preservation of the pulse on the carotid artery. Pulse may be quite weak and poorly tapped, so the determination of the pulse is very important in assessing the condition of the victim.

When providing first aid to the victim in a coma, it is necessary not to lose time to turn him on his stomach, putting his head on his side. Carrying out a cardiopulmonary resuscitation complex to the victim in a coma may lead to his death.

Indirect heart massage

Indirect massage of the heart allows you to partially restore blood circulation in the body of the victim. Each correctly performed pressure on the sternum replaces one cardiac contraction. Correct conduction of indirect heart massage in the rhythm of 60 strokes per minute provides up to 30-40% of the volume of normal circulation.

The effectiveness of indirect heart massage can be judged after 12 minutes. The skin of the face should become pink and the pupils of the eyes should narrow. The appearance of these signs in the absence of a pulse on the carotid artery indicates the correctness of carrying out an indirect massage of the heart.

For effective performance of indirect cardiac massage, the following rules must be strictly observed:

1. Indirect cardiac massage can be performed only on a hard flat surface.

2. Press on the sternum can only be in a strictly defined place: 2 – 3 centimeters above the xiphoid appendix (at the point of application of the precordial impact).

3. The palm is located on the middle line of the sternum so that the thumb is pointed at either the chin or the stomach of the victim.

4. Press on the chest only with straight hands using the entire shoulder girdle, moving the center of gravity to the hands.

5. With each jerky pressure, the chest should bend by 3 – 4 centimeters.

6. The frequency of pressure is determined by the elasticity of the chest of the patient and should be 40 – 60 pressure per minute.

7. Interrupt indirect cardiac massage for more than 15 – 20 seconds is impossible, even if the ribs are broken it must be continued.

8. To stop the indirect massage of the heart before the appearance of a pulse on the carotid artery is impossible.

Indirect heart massage, even in the absence of its effectiveness, should be held for at least 20 – 30 minutes.

 

I The training mode.

It used for testing individual elements of resuscitation. Procedure:

1. Ensure the correct tilting of the head of the simulator (at a tipping angle of 15° – 20°, the green signal «Correct position» is activated).

2. Unfasten the belt (the green signal «Belt is unbuttoned» is turned on).

3. The hands of the rescuer, when practicing the skills of indirect heart massage, should be above the end of the xiphoid process of the sternum, approximately at a distance of 2 diameters of the fingers of the hand. In case of an incorrect position, the red signal «Hand position» is turned on, and the actions of the rescuers will be considered incorrect.

4. Conduct an indirect cardiac massage according to the rules of the first medical aid. With an applied force of 25 ± 2 kg and a punching depth of 3 – 5 cm, the green signal  «Hand position» is activated.

5. With an effort greater than 32 kg (sternal displacement more than 5 cm), 2 red signals «Rib fracture» are activated.

6. Conduct according to the rules of first aid medical ventilation ALV. With a sufficiently intense airflow into the lungs (air speed of at least 2 l/s and a volume of at least 400– 500 cm³), a green signal «Normal air volume» is activated.

7. Control the carotid artery of the simulator, the presence of a pulse can be enabled by turning on the «Pulse» button.

8. Check the condition of the pupils of the «Victim’s» eye, pulling the eyelid upward. In this case, the pupils of the eyes will be expanded «The victim» is in a state of clinical death. When the «Pulse» button is turned on, the pupils' eyes of the simulator become normal. The «Victim» functions are restored. In addition, every pressing, when performing indirect heart massage, is accompanied by a narrowing of the pupils of the «Victim’s» eye.

9. On the demonstration board, all light signaling about the actions of the rescuers is identical to the signaling on the electronic panel.

Attention!

After completing all the training activities, you must press the «Reset» button, and the green «Reset» signal is turned on.

 

IV Cardiopulmonary resuscitation, proposed by the European Council for Resuscitation (ERC) («2 – 30»)

It is used if it is impossible to determine the time of the victim's being in a state of clinical death.

Procedure:

1. Click the «Reset» button.

2. Make sure the head is positioned correctly (green signal).

3. Unfasten the belt to the «Victim» (green signal).

4. Select the «2– 30» mode by pressing the corresponding button.

5. Start resuscitation according to the rules of the first medical aid
(2 breath ALV + 30 pressures, 2 cycles for a minute).

6. In case of incorrect actions, one of the red signals on the control panel and the red signal «Mode failure» are switched on.

With correct actions for 1 minute the simulator «comes to life»: a pulse appears on the carotid artery, the pupils of the eyes narrow.

V Cardiopulmonary resuscitation, proposed by the European Council on Reanimation (ERC) («30 – 2»)

Applicable if the victim is in a state of clinical death no more than 1 minute, or it has come before your eyes.

Procedure:

1. Click the «Reset» button.

2. Make sure the head is positioned correctly (green signal).

3. Unfasten the belt to the «Victim» (green signal).

4. Select the «30 – 2» mode by pressing the corresponding button.

5. Start resuscitation according to the rules of the first medical aid
(30 pressures + 2 breath ALV, 2 cycles for a minute).

6. In case of incorrect actions, one of the red signals on the control panel and the red signal «Mode failure»are switched on.

With correct actions for 1 minute the simulator «comes to life»: a pulse appears on the carotid artery, the pupils of the eyes narrow.

After finishing work with the simulator  turn off the power switch on the rear panel, the green signal «On» will turn off.  Disconnect the power supply of the simulator.

 

Control questions for self-examination:

 

1. What is clinical death?

2. During what time after the onset of clinical death, it is necessary to begin the implementation of a cardiopulmonary resuscitation complex?

3. How does clinical death differ from coma?

4. What activities include a cardiopulmonary resuscitation complex?

5. What ratio of ventilation and chest pressure is optimal?

6. How correctly to place hands on the chest during an indirect massage of the heart?

7. What measures need to be taken before the implementation of the cardiopulmonary resuscitation complex?

8. How many resuscitation participants are optimal?

 

Laboratory work 11

First aid in case of accident.
A complex of cardiopulmonary resuscitation.

Objective: studying the signs of clinical death and coma; studying the concepts: artificial ventilation, indirect cardiac massage, precordial impact; Get practical skills in performing artificial ventilation, indirect heart massage and cardiopulmonary resuscitation.

 

Basic concepts and definitions