Artificial lung ventilation (ALV)
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.
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.
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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).
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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.
Artificial lung ventilation (ALV)
Breathing is a physiological process in which there is an exchange of gases between the body and the environment. In this case, the body receives oxygen, which is necessary for all its cells and tissues, and releases carbon dioxide that accumulates as a result of the vital activity of the organism.
Deficiency of oxygen leads to hypoxia – oxygen starvation of cells and organs. This is the cause of accumulation in the blood and tissues of unoxidized metabolic products, which causes the development of acidosis (Latin acidus – acidic). At the same time, the permeability of capillaries sharply increases. This leads to the redistribution of fluid from the bloodstream into interstitial spaces, and as a result, edema (swelling) of tissues occurs. The most dangerous one is cerebral edema.
Acidosis, hypoxia, congestion and thickening of blood causes thrombus formation in the capillary network, necrosis of the tissues of the organs develops. All this factors lead to intoxication of the body, developing renal, hepatic and cardiopulmonary insufficiency.
Thus, when breathing is stopped, it is necessary to proceed as soon as possible to carry out artificial ventilation of the victim's lung.
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When starting ventilation ALV, whenever possible, it is necessary to ensure the influx of fresh air to the victim – unfasten the collar, belt and other tight-fitting parts of clothing. Turn the victim to the stomach and release the patient's airway. Then return it to the supine position on the back and ensure airway patency from the tongue.
The most simple and at the same time the most effective is artificial respiration by the method of «mouth to mouth».
The technique of performing ventilation by the method «mouth to mouth»:
The victim's mouth should be slightly open. To do this, put your left hand on his forehead, tilt his head so an obtuse angle forms between the lower jaw and neck, and the lower jaw is wrapped around with the thumb and forefinger of your right hand and push it forward.
Put a handkerchief or a piece of gauze on victim’s mouth. Then, taking a deep breath, tightly press your lips to the lips of the patient and exhale with the maximum effort the entire volume of your lungs in the victim’s lungs.
At the same time, with fingers of the hand holding the head, tightly clamp the nose to the victim. An indicator of the effectiveness of inspiration is the rise of the thorax. When the thorax subsides, exhalation takes place. Air should be injected at a frequency corresponding to the respiratory rate of a healthy person. If the patient's thorax does not rise when inhaled, it is necessary to change the position of the head and take a repeated inhalation.
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