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.

A complex of cardiopulmonary resuscitation (CPR)

The cardiopulmonary resuscitation complex includes precordial impact, artificial lung ventilation (ALV) and indirect cardiac massage. The outcome of resuscitation depends entirely on three factors:

• time elapsed after cardiac arrest;

• techniques for performing resuscitation techniques;

• severity of damage to internal organs and brain.

For a successful outcome of resuscitation, it is necessary to proceed to their implementation no later than 4 minutes after cardiac arrest.

When you are convinced of the absence of a pulse on the carotid artery, you need to strike with your fist on the sternum (precordial impact). Its purpose is to shake the stunted heart. Inthe most cases it causes to contract the heart again. If the precordial impact is applied within the first minute after cardiac arrest, then its effectiveness exceeds 70 – 80%.

When applying a precordial stroke, the following rules should be observed:

1. Make sure there is no pulse on the carotid artery.

2. Release the chest from clothing or at least make sure that there are no buttons, medallions or other objects in the place of the impact.

3. It is necessary to hide the xiphoid appendix in order to protect it from impact. The xiphoid appendix easily breaks off of the sternum and can injure the liver.

4. The impact is applied with a rib in the fist of the palm, just above the xiphoid appendix, covered with the two fingers of the other hand.

5. After the impact, it is necessary to monitor the pulse on the carotid artery. If there is no recovery after a precordial stroke, then an indirect heart massage and ventilation should be started.

Do not put a precordial impact on children under 7 years old!

 

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.