The purpose of artificial respiration, as well as normal natural breathing, is to provide gas exchange in the body, i.e., saturate the blood of the victim with oxygen and remove carbon dioxide from the blood. In addition, artificial respiration, acting reflexively on the respiratory center of the brain, thereby contributes to the restoration of independent breathing of the victim.
Gas exchange occurs in the lungs, the air entering them fills many lung vesicles, the so-called alveoli, to the walls of which blood saturated with carbon dioxide flows. The walls of the alveoli are very thin, and their total area in humans reaches an average of 90 m2. It is through these walls that gas exchange takes place, that is, oxygen passes from air to blood, and carbon dioxide passes from blood to air.
Blood, saturated with oxygen, is sent by the heart to all organs, tissues and cells, in which normal oxidative processes, i.e. normal functioning, continue due to this.
The impact on the respiratory center of the brain is carried out as a result of mechanical irritation by the incoming air of nerve endings located in the lungs. The nerve impulses arising at the same time enter the center of the brain, which is responsible for the respiratory movements of the lungs, stimulating its normal activity, i.e., the ability to send impulses to the lung muscles, as happens in a healthy body.
There are many different ways to perform artificial respiration. All of them are divided into two groups, hardware and manual. Manual methods are significantly less efficient and much more time consuming than hardware ones. However, they have the important advantage that they can be performed without any devices and equipment, that is, immediately after the occurrence of respiratory failure in the victim.
Among the many existing manual methods, the most effective is the mouth-to-mouth method of artificial respiration. It is that the carer blows air from his lungs into the victim's lungs through his mouth or nose.
The advantages of the “mouth to mouth” method are as follows, as practice has shown, it is more effective than other manual methods. The volume of air blown into the lungs of an adult reaches 1000 - 1500 ml, that is, several times more than with other manual methods, and is quite sufficient for artificial respiration. This method is very simple, and it can be mastered in a short time by every person, including those without a medical education. With this method, the risk of damage to the organs of the victim is eliminated. This method of artificial respiration allows you to simply control the flow of air into the lungs of the victim - by expanding the chest. It is much less tiring.
The disadvantage of the "mouth-to-mouth" method is that it can cause mutual infection (infection) and a sense of disgust from the carer. In this regard, air is blown through gauze, a handkerchief and other loose tissue, as well as through a special tube:
Artificial respiration preparation
Before proceeding to artificial respiration, it is necessary to quickly perform the following operations:
a) to release the victim from clothing restricting breathing - unfasten the collar, untie the tie, unfasten the belt of trousers, etc.,
b) lay the victim on his back on a horizontal surface - a table or floor,
c) throw back the victim’s head as much as possible, placing the palm of one hand under the back of the head and pressing the other hand on the forehead until the victim’s chin is in line with the neck. With this position of the head, the tongue moves away from the entrance to the larynx, thereby ensuring free passage of air into the lungs, the mouth usually opens. To maintain the achieved head position under the shoulder blades, a roller of folded clothes should be placed,
d) examine the oral cavity with your fingers, and if foreign contents (blood, mucus, etc.) are found in it, remove it by simultaneously removing the dentures, if any. To remove mucus and blood, it is necessary to turn the victim’s head and shoulders to the side (you can bring your knee under the victim’s shoulders), and then use your handkerchief or the edge of the shirt wound on your index finger to clean the mouth and throat. After this, you should give the head its original position and tilt it as far as possible, as described above.
Performing artificial respiration
At the end of the preparatory operations, the carer takes a deep breath and then exhales forcefully into the victim's mouth. In this case, he must cover his mouth with the entire mouth of the victim, and with his cheek or fingers pinch his nose. Then the caretaker leans back, releasing the victim’s mouth and nose, and takes a new breath. During this period, the chest of the victim falls and a passive exhalation occurs.
For young children, air can be blown simultaneously into the mouth and nose, while the carer should cover the mouth and nose of the victim with his mouth.
Control of airflow into the lungs of the victim is carried out by the expansion of the chest with each blowing. If, after blowing in the air, the victim’s chest does not straighten, this indicates airway obstruction. In this case, it is necessary to push the lower jaw of the victim forward, for which the assisting person should place four fingers of each hand behind the corners of the lower jaw and, resting his thumbs on its edge, extend the lower jaw forward so that the lower teeth are in front of the upper ones.
The best airway of the victim is ensured under three conditions: the maximum bending of the head back, opening the mouth, advancing the lower jaw.
Sometimes it is impossible to open the victim’s mouth as a result of jaw contraction. In this case, artificial respiration should be performed according to the “from mouth to nose” method, closing the victim’s mouth while blowing air into the nose.
With artificial respiration, an adult should be injected sharply 10–12 times per minute (that is, after 5–6 s), and a child should be injected 15–18 times (that is, after 3–4 s). Moreover, since the child has less lung capacity, the injection should be incomplete and less sharp.
When the first weak breaths appear in the patient, the artificial breath should be timed to the beginning of an independent breath. Artificial respiration must be performed before the restoration of deep rhythmic independent breathing.
When assisting with the affected current, a so-called indirect or external cardiac massage is performed - rhythmic pressure on the chest, i.e., on the front wall of the chest of the victim. As a result of this, the heart contracts between the sternum and the spine and pushes blood from its cavities. After the cessation of pressure, the chest and heart are straightened and the heart is filled with blood coming from the veins. In a person in a state of clinical death, the chest cell due to loss of muscle tension easily shifts (squeezed) when pressed on it, providing the necessary compression of the heart.
The purpose of heart massage is to artificially maintain the blood circulation in the body of the victim and restore normal normal heart contractions.
Blood circulation, i.e., the movement of blood through the system of blood vessels, is necessary for the blood to deliver oxygen to all organs and tissues of the body. Therefore, the blood must be enriched with oxygen, which is achieved by artificial respiration. Thus, at the same time as cardiac massage, artificial respiration should be performed.
The restoration of normal natural contractions of the heart, i.e., its independent work, during massage occurs as a result of mechanical irritation of the heart muscle (myocardium).
The blood pressure in the arteries arising as a result of indirect heart massage reaches a relatively high value - 10–13 kPa (80–100 mm Hg) and is sufficient for the blood to flow to all organs and tissues of the victim’s body. This saves the life of the body for the entire time that a heart massage (and artificial respiration) is performed.
Preparation for a heart massage is at the same time a preparation for artificial respiration, since the massage of the heart must be carried out together with artificial respiration.
To perform the massage, it is necessary to lay the victim on his back on a hard surface (bench, floor or, in extreme cases, put a board under his back). It is also necessary to expose his chest, unfasten his breath-taking clothing items.
In the production of heart massage, the carer rises on either side of the victim and occupies a position in which a more or less significant inclination above him is possible.
Having groped out the place of pressure (it should be about two fingers above the soft end of the sternum), the carer should put the lower part of the palm of one hand on it, and then put the second on top of the upper arm at a right angle and put pressure on the victim’s chest, slightly helping with this tilt of the whole body.
The forearms and humerus of the caretaker's hands should be extended to the full. The fingers of both hands should be brought together and should not touch the victim’s chest. Pressing should be done with a quick push, so that the lower part of the sternum is shifted down by 3–4, and in full people by 5–6 cm. The pressure should be concentrated on the lower part of the sternum, which is more mobile. Pressure should be avoided on the upper part of the sternum, as well as on the ends of the lower ribs, as this can lead to their fracture. You can not press below the edge of the chest (on soft tissues), since it is possible to damage the organs located here, especially the liver.
The pressure (push) on the sternum should be repeated approximately 1 time per second or more often to create sufficient blood flow. After a quick push, the position of the hands should not change for about 0.5 s. After this, you should slightly straighten and relax your hands, without taking them from the sternum.
In children, massage is done with only one hand, pressing 2 times per second.
To enrich the victim’s blood with oxygen at the same time as cardiac massage, it is necessary to perform artificial respiration using the “from mouth to mouth” (or “from mouth to nose”) method.
If there are two assistants, then one of them should produce artificial respiration, and the other - a heart massage. It is advisable for each of them to do artificial respiration and heart massage alternately, replacing each other every 5 to 10 minutes. The procedure for providing assistance should be as follows: after one deep injection, five pressure is applied to the chest if it turns out that after injection, the victim’s chest remains motionless (and this may indicate an insufficient amount of blown air), it is necessary to provide assistance in a different order, after two deep blows do 15 pressures. You should be careful not to press on the sternum during inspiration.
If the assistance provider does not have an assistant and performs artificial respiration and external cardiac massage alone, it is necessary to alternate these operations in the following order: after two deep blows into the victim’s mouth or nose, the care provider presses the chest 15 times, then again produces two deep blows and repeats 15 pressures for heart massage, etc.
The effectiveness of external heart massage is manifested primarily in the fact that with every pressure on the sternum in the carotid artery, a pulse is clearly felt.
Other signs of the effectiveness of the massage are narrowing of the pupils, the appearance of independent breathing in the victim, and a decrease in the blueness of the skin and visible mucous membranes.
Monitoring the effectiveness of the massage is carried out by the person producing artificial respiration. To increase the effectiveness of the massage, it is recommended that the legs of the victim be raised (by 0.5 m) during the external massage of the heart. This position of the legs contributes to a better flow of blood to the heart from the veins of the lower body.
Artificial respiration and external cardiac massage should be performed before spontaneous breathing and restoration of heart activity or before transferring the injured to medical personnel.
The restoration of the victim's heart activity is judged by the appearance of his own regular pulse, which is not supported by massage. To check the pulse every 2 minutes, interrupt the massage for 2 to 3 seconds. Preserving the pulse during a break indicates the restoration of the independent work of the heart.
If there is no pulse during the break, you must immediately resume the massage. A prolonged absence of a pulse with the appearance of other signs of revitalization of the body (spontaneous breathing, narrowing of the pupils, the victim’s attempt to move his arms and legs, etc.) is a sign of heart fibrillation. In this case, it is necessary to continue providing assistance to the victim until the doctor arrives or until the victim is delivered to the medical institution where cardiac defibrillation will be performed. On the way, artificial respiration and cardiac massage should be continuously performed until the transfer of the victim to medical personnel.
In preparing the article, materials from the book by P. A. Dolin, "Fundamentals of Electrical Safety in Electrical Installations," were used.
Indications for CPR and the diagnosis of clinical death
Almost the only indication for performing ID and NMS is the state of clinical death, which lasts from the moment the circulation stops and until the onset of irreversible disorders in the cells of the body.
Before you start artificial respiration and indirect heart massage, you need to determine whether the victim is in a state of clinical death. Already at this - the very first - stage, an unprepared person may have difficulties. The fact is that determining the presence of a pulse is not as simple as it seems at first glance. Ideally, the carer should sense the pulse in the carotid artery. In reality, he often does it wrong, moreover, he takes the pulsation of his vessels in his fingers for the pulse of the victim. It is precisely because of such errors that the point on checking the pulse on the carotid arteries in diagnosing clinical death was removed from modern recommendations if people without medical education provide assistance.
Currently, before the start of the NMS and ID, the following steps should be taken:
- After finding a victim who you think may be in a state of clinical death, check to see if there are any dangerous conditions around him.
- Then approach him, shake his shoulder and ask if everything is okay with him.
- If he answered you or somehow reacted to your appeal, it means that he has no cardiac arrest. In this case, call an ambulance.
- If the victim did not respond to your appeal, turn him on his back and open the airways. To do this, carefully bend the head in the neck and bring the upper jaw up.
- After opening the airways, assess for normal breathing. Do not confuse agonal sighs, which can still be observed after cardiac arrest, with normal breathing. Agonal sighs are superficial and very rare, they are irregular.
- If the victim is breathing normally, turn him on his side and call an ambulance.
- If the person is not breathing normally, call other people for help, call an ambulance (or let someone else do it) and immediately begin CPR.
That is, to start NMS and ID, a lack of consciousness and normal breathing is enough.
Indirect cardiac massage
NMS is the basis of resuscitation. It is its conduct that provides the minimum necessary blood supply to the brain and heart, so it is very important to know what actions are performed with indirect heart massage.
NMS should be started immediately after identifying the victim with a lack of consciousness and normal breathing. For this:
- Place the base of the palm of your right hand (for lefties - the left) on the center of the chest of the victim. It should lie exactly on the sternum, slightly below its middle.
- Place the second palm on top of the first, then intertwine their fingers. No part of your hand should touch the victim’s ribs, as in this case, when performing NMS, the risk of fracture increases. The base of the lower palm should lie strictly on the sternum.
- Position your torso so that your arms rise above the chest of the victim perpendicularly and be extended in the elbow joints.
- Используя вес своего тела (а не силу рук), прогните грудную клетку потерпевшего на глубину 5–6 см, затем позвольте ей восстановить свою изначальную форму, то есть полностью выпрямиться, не снимая ладони с грудины.
- Частота таких компрессий – 100–120 в минуту.
Current CPR guidelines only allow for NMS.
Doing NMS is hard physical work. It is proved that after about 2-3 minutes the quality of its conduct by one person is significantly reduced. Therefore, it is recommended that assisting people replace each other whenever possible 2 minutes.
Indirect heart massage algorithm
Errors in the performance of NMS
- Delay in starting. For a person in a state of clinical death, every second of delay with the onset of CPR may turn out to be less likely to resume spontaneous circulation and worsen the neurological prognosis.
- Long breaks during the NMS. Interruption of compression is allowed no longer than 10 seconds. This is done to conduct ID, shift assisting people, or when using a defibrillator.
- Insufficient or too deep compression. In the first case, the maximum possible blood flow will not be achieved, and in the second, the risk of traumatic injuries of the chest increases.
Mechanism and methods of artificial respiration
Only due to the process of respiration, human blood is saturated with oxygen and carbon dioxide is removed from it. After air enters the lungs, it fills the pulmonary vesicles called alveoli. The alveoli penetrate an incredible multitude of small blood vessels. It is in the pulmonary vesicles that gas is exchanged - oxygen enters the blood from the air, and carbon dioxide is removed from the blood.
In the event that the supply of oxygen to the body is interrupted, life activity is at risk because oxygen plays the “first violin” in all oxidative processes that occur in the body. That is why when you stop breathing, you should begin to artificially ventilate your lungs instantly.
The air entering the human body through artificial respiration fills the lungs and irritates the nerve endings in them. As a result, nerve impulses enter the respiratory center of the brain, which are an incentive for the generation of response electrical impulses. The latter stimulate the contraction and relaxation of the muscles of the diaphragm, resulting in stimulation of the respiratory process.
Artificial provision of the human body with oxygen in many cases allows you to completely restore the independent respiratory process. In the event that, in the absence of breathing, cardiac arrest is also observed, it is necessary to conduct its closed massage.
Please note that lack of breathing triggers irreversible processes in the body within five to six minutes. Therefore, the time spent artificial ventilation of the lungs can save a person's life.
All methods of performing ID are divided into expiratory (mouth-to-mouth and mouth-to-nose), manual and hardware. Manual and expiratory methods are considered more labor intensive and less effective than hardware methods. However, they have one very significant advantage. You can perform them without delay, almost any person can cope with this task, and most importantly, there is no need for any additional devices and devices that are far from always at hand.
Indications and contraindications
Indications for the use of ID are all cases when the volume of spontaneous ventilation of the lungs is too low in order to ensure normal gas exchange. This can happen in many urgent and planned situations:
- With disorders of the central regulation of breathing caused by a violation of cerebral circulation, tumor processes of the brain or its trauma.
- With medical and other types of intoxications.
- In case of damage to the nerve pathways and the neuromuscular synapse, which can provoke an injury to the cervical spine, viral infections, the toxic effect of certain drugs, poisoning.
- With diseases and injuries of the respiratory muscles and chest wall.
- In cases of lung lesions of both obstructive and restrictive nature.
The need to use artificial respiration is judged on the basis of a combination of clinical symptoms and external data. Changes in the size of the pupils, hypoventilation, tachy- and bradyisystole are conditions in which mechanical ventilation is necessary. In addition, artificial respiration is required in cases when spontaneous ventilation of the lungs is “turned off” with the help of muscle relaxants introduced for medical purposes (for example, during anesthesia during surgery or during intensive care of the convulsive syndrome).
As for the cases when the ID is not recommended, there are no absolute contraindications. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. So, for example, if venous return of blood is difficult, artificial respiration regimes are contraindicated, which provoke an even greater violation of it. In case of lung injury, ventilation methods based on high pressure air blowing, etc., are prohibited.
Preparing for rescue breathing
Before conducting expiratory artificial respiration, the patient should be examined. Such resuscitation measures are contraindicated in case of facial injuries, tuberculosis, poliomyelitis and trichlorethylene poisoning. In the first case, the reason is obvious, and in the last three, conducting expiratory artificial respiration endangers the person who carries out resuscitation.
Before embarking on expiratory artificial respiration, the victim is quickly released from squeezing the throat and chest of clothing. The collar is unfastened, the tie is untied, the trouser belt can be unfastened. The victim is laid back on a horizontal surface. The head is thrown back as far as possible, the palm of one hand is laid under the back of the head, and the second palm is pressed on the forehead until the chin is in line with the neck. This condition is necessary for successful resuscitation, since with this position of the head the mouth opens and the tongue moves away from the entrance to the larynx, as a result of which air begins to flow freely into the lungs. In order to keep the head in this position, a roll of folded clothes is placed under the shoulder blades.
After that, it is necessary to examine the oral cavity of the victim with your fingers, remove blood, mucus, dirt and any foreign objects.
It is the hygienic aspect of performing expiratory artificial respiration that is the most delicate, since the rescuer will have to touch the victim’s skin with his lips. You can use the following technique: make a small hole in the middle of a handkerchief or gauze. Its diameter should be two to three centimeters. The tissue is superimposed with a hole on the victim’s mouth or nose, depending on which artificial respiration method will be used. Thus, air will be blown through an opening in the tissue.
Artificial respiration is the second element of CPR. It is designed to ensure the flow of oxygen into the bloodstream, and subsequently (subject to NMS) to the brain, heart, and other organs. It is the unwillingness to perform ID by mouth-to-mouth method that in most cases is explained by the failure to provide assistance to the victims by people who are near them.
Existing CPR guidelines allow people who don’t know how to do artificial respiration properly to not. In such cases, resuscitation measures consist only of chest compressions.
Rules for performing ID:
- Adult victim ID is performed after 30 chest compressions.
- If there is a scarf, gauze or some other material that lets air through, cover the victim’s mouth with it.
- Open his airways.
- Hold the victim’s nostrils with your fingers.
- Keeping the opening of the airways, press your lips tightly against his mouth and, trying to maintain tightness, make your usual exhale. At this moment, look at the victim’s chest, observing whether it rises at the time of your exhalation.
- Take 2 such artificial breaths, spending no more than 10 seconds on them, then immediately go to the NMS.
- The ratio of compressions to artificial breaths is 30 to 2.
Errors while executing ID:
- An attempt to conduct without the correct opening of the respiratory tract. In such cases, the injected air enters either the outside (which is better) or the stomach (which is worse). The danger of blowing air into the stomach is to increase the risk of regurgitation.
- Insufficiently tight pressing with his mouth to the victim's mouth or non-closure of the nose. This leads to a lack of tightness, which reduces the amount of air that enters the lungs.
- A pause in the NMS is too long, which should not exceed 10 seconds.
- Carrying out ID without termination of NMS. In such cases, the blown air is likely to get into the lungs.
It is because of the technical complexity of performing the ID, the possibility of unwanted contact with the saliva of the victim is allowed (moreover, it is highly recommended) to people who have not taken special courses on CPR, in the case of helping adult victims with cardiac arrest, do only NMS with a frequency of 100-120 compressions per minute. The higher efficiency of resuscitation measures performed in out-of-hospital settings by people without a medical education, which consist only of chest compressions, is proved in comparison with traditional CPR, which includes a combination of NMS and ID in the ratio of 30 to 2.
However, it should be remembered that CPR, consisting only of chest compressions, can only be done by adults. Children are recommended the following sequence of resuscitation:
- Identification of signs of clinical death.
- Opening of the airways and 5 artificial breaths.
- 15 chest compressions.
- 2 artificial breaths, after which again 15 compressions.
How long do artificial respiration take?
There is only one answer to the question about how long it takes to conduct an ID. Ventilate the lungs in a similar mode, taking breaks for three to four seconds maximum, should be until the moment when full independent breathing is restored, or until the doctor who appears gives further instructions.
In this case, you should constantly ensure that the procedure is effective. The chest of the patient should swell well, the skin of the face should gradually turn pink. It is also necessary to ensure that there are no foreign objects or vomit in the airways of the victim.
Please note that due to the ID, the rescuer himself may appear weak and dizzy due to a lack of carbon dioxide in the body. Therefore, ideally, two people should blow in air, which can alternate every two to three minutes. In the event that this is not possible, the number of breaths should be reduced every three minutes, so that the person who is resuscitating normalizes the level of carbon dioxide in the body.
During rescue breathing, you should check every minute to see if the victim’s heart has stopped. To do this, two fingers feel the pulse on the neck in a triangle between the respiratory throat and sternocleidomastoid muscle. Two fingers are placed on the lateral surface of the laryngeal cartilage, after which they allow them to “slip” into the hollow between the sternocleidomastoid muscle and the cartilage. It is here that the pulsation of the carotid artery should be felt.
In the event that pulsation on the carotid artery is absent, an indirect cardiac massage should be started immediately in combination with an ID. Doctors warn that if you miss the moment of cardiac arrest and continue to do artificial lung ventilation, you will not be able to save the victim.
Features of the procedure in children
When conducting artificial ventilation for babies up to one year old, they use the technique from mouth to mouth and nose. If the child is over one year old, the mouth-to-mouth method is used.
Small patients are also placed on their backs. For babies up to a year, a folded blanket is placed under their backs or the upper part of the body is slightly lifted, bringing a hand under the back. The head is thrown back.
The caretaker takes a shallow breath, hermetically covers the lips of the child’s mouth and nose (if the baby is under the age of one) or only the mouth, after which it blows air into the respiratory tract. The volume of injected air should be the less, the younger the patient. So, in the case of resuscitation of a newborn, it is only 30-40 ml.
If a sufficient volume of air enters the respiratory tract, chest movements occur. After inhalation, you need to make sure that the chest is lowering. If too much air is blown into the baby's lungs, this can cause rupture of the alveoli of the lung tissue, as a result of which the air will escape into the pleural cavity.
The frequency of injections should correspond to the respiratory rate, which tends to decrease with age. So, in newborns and children up to four months, the frequency of inspirations-expirations is forty per minute. From four months to six months, this figure is 40-35. In the period from seven months to two years - 35-30. From two to four years, it is reduced to twenty-five, in the period from six to twelve years, to twenty. Finally, in a teenager aged 12 to 15 years, the respiratory rate is 20-18 breaths-exhalations per minute.
This method is most widely used. The victim is placed on his back. A roller should be placed under the lower chest so that the shoulder blades and nape are lower than the costal arches. In the event that two people make artificial respiration using this technique, they kneel down on either side of the victim so as to be at the level of his chest. Each of them with one hand holds the victim’s hand in the middle of the shoulder, and with the other just above the level of the brush. Then they begin to rhythmically raise the victim’s hands, pulling them behind his head. As a result, the rib cage expands, corresponding to inspiration. After two to three seconds, the victim’s hands are pressed to the chest, while squeezing it. This acts as an exhale.
Moreover, the main thing is that the movements of the hands should be as rhythmic as possible. Experts recommend that those producing artificial respiration use their own rhythm of inhalation and exhalation as a "metronome". A total of about sixteen movements per minute should be done.
ID method Sylvester can produce and one person. He needs to kneel behind the victim’s head, grab his hands above his hands and make the movements described above.
In case of fractures of the arms and ribs, this method is contraindicated.
In the event that the victim has damaged hands, the Schaeffer method can be used to perform artificial respiration. Also, this technique is often used to rehabilitate people injured during a stay on the water. The victim is placed face down, the head is turned on its side. Anyone who does artificial respiration kneels, and the victim’s body should be located between his legs. Hands should be placed on the lower part of the chest so that the thumbs lie along the spine, and the rest lie on the ribs. When exhaling, you should lean forward, thus compressing the chest, and during inhalation, straighten, stopping the pressure. Hands at the elbows do not bend.
Please note that with a fracture of the ribs, this method is contraindicated.
Laborde's method is complementary to the methods of Sylvester and Schaeffer. The victim's tongue is captured and produced rhythmic stretching, simulating respiratory movements. As a rule, this method is used when breathing has only stopped. The emerging resistance of the tongue is proof that the person’s breathing is restored.
This simple and effective method provides excellent ventilation. The victim is disposed face down. A towel is placed on the back in the area of the shoulder blades, and its ends are held forward, threading under the armpits. Those who provide assistance should take the towel by the ends and raise the body of the victim seven to ten centimeters from the ground. As a result, the rib cage expands and the ribs rise. This corresponds to a breath. When the body is lowered, it simulates an exhalation. Instead of a towel, you can use any belt, scarf, etc.
The victim is disposed back. A roller is placed under his back. Hands are pulled behind the head and extended. The head itself is turned to the side, pulled out and fixed the tongue. Those who produce artificial respiration, sit astride the femoral zone of the victim and have their palms on the lower chest. Spread fingers should grab as many ribs as possible. When the chest is squeezed, it corresponds to inhalation, when the pressure is stopped, it simulates an exhalation. Twelve to sixteen movements should be done per minute.
Way Frank Willow
This method requires a stretcher. Их устанавливают серединой на поперечную подставку, высота которой должна быть в половину длины носилок. На носилки укладывают пострадавшего ничком, лицо поворачивают в сторону, руки размещают вдоль тела. Человека привязывают к носилкам на уровне ягодиц или бедер. При опускании головного конца носилок осуществляется вдох, когда он идет вверх — выдох.The maximum volume of breathing is achieved when the victim’s body is tilted at an angle of 50 degrees.
The victim is placed face down. His hands are bent at the elbows and crossed, after which they are laid down with his palms down under his forehead. The rescuer is on his knees standing at the victim’s head. He puts his hands on the shoulder blades of the victim and, without bending them at the elbows, crushes his palms. So there is an exhalation. To inhale, the rescuer takes the victim’s shoulders at the elbows and straightens, lifting and pulling the victim to himself.
Hardware Respiratory Techniques
For the first time, hardware methods of artificial respiration began to be used in the eighteenth century. Already then the first air ducts and masks appeared. In particular, doctors suggested using fireplace bellows, as well as devices created in their likeness, for blowing into lungs of air.
The first automatic devices for ID appeared in the late nineteenth century. At the beginning of the twentieth, several types of respirators appeared at once, which created an alternating depression and positive pressure either around the whole body, or only around the patient's chest and abdomen. Gradually, respirators of this type were superseded by air-breathing respirators, which differed in less solid dimensions and at the same time did not impede access to the patient's body, allowing medical manipulations.
All existing ID devices are divided into external and internal. External devices create negative pressure either around the patient’s entire body or around his chest, thereby inhaling. The exhalation in this case is passive - the chest simply subsides due to its elasticity. It can also be active if the device creates a zone of positive pressure.
With the internal method of artificial ventilation, the device is connected through a mask or intubator to the respiratory tract, and inhalation is carried out by creating positive pressure in the device. Devices of this type are divided into portable, designed to work in the "field" conditions, and stationary, the purpose of which is a long-term artificial respiration. The former are usually manual, while the latter operate automatically, the motor drives them.
Complications of artificial respiration
Complications due to artificial respiration are relatively rare even if the patient is on mechanical ventilation for a long time. Most often, undesirable effects concern the respiratory system. So, due to an improperly chosen regimen, respiratory acidosis and alkalosis can develop. In addition, prolonged artificial respiration can cause the development of atelectasis, since the drainage function of the respiratory tract is impaired. Microatelectases, in turn, can become a prerequisite for the development of pneumonia. Preventive measures to help avoid the occurrence of such complications are thorough hygiene of the respiratory tract.
If the patient breathes pure oxygen for a long time, this can cause pneumonitis. The oxygen concentration therefore should not exceed 40-50%.
In patients who have been diagnosed with abscessed pneumonia, alveoli ruptures may occur during artificial respiration.
Methods and basic rules of mechanical ventilation
Before performing resuscitation measures, you need to call emergency assistance and try to find a number of people who will participate in the rescue of the victim. It is also required to ensure safe conditions for resuscitation.
The algorithm of artificial respiration:
Before proceeding with artificial respiration, it is necessary to clear the airways
- Release the airways. It is forbidden to breathe when they are damaged, if there is a foreign object in them. In such cases, air does not enter the lungs, but into the stomach. If water has accumulated in the paths, then it can be removed: bend a person face down through the thigh of a bent leg, compress the chest from the sides with sharp shocks.
- Kneel on the right side of the victim.
- Throw back the victim’s head, bring the lower jaw forward. To fix the jaw, you can insert a rolled bandage into your mouth.
- Pinch a person’s nose.
- Breathe in the air. The depth of inspiration should be maximum.
- Press lips tightly to the victim’s mouth, trying to ensure tightness.
- Exhale. Assess whether the chest is moving at this point.
- If it is impossible to open the mouth and open the jaw, air is blown into the nose. The lips should be closed.
- If the chest does not rise, then the person’s head should be thrown back even more and repeated blowing.
- If the chest moves, then you need to make 2 such exhalations, then immediately start indirect heart massage.
- Resuscitation is continued until the person begins to breathe on his own or until help arrives.
Artificial respiration techniques:
- Mouth to mouth breathing.
- Mouth breathing in the nose with spasm of the masticatory muscles.
- For young children, mechanical ventilation is performed both in the mouth and nose.
In those cases when artificial ventilation of the lungs is impossible, they immediately start indirect heart massage.
When to start resuscitation
Before resuscitation, the person is turned on his back and the airways open
It is important to understand in which cases artificial respiration is performed in cases of suspected clinical death:
- The person is turned on his back on a hard surface and open the airways.
- The head is gently thrown back.
- The clothes are unfastened to see the chest.
- Assess the state of respiration. If it is not audible, the sternum does not rise, urgently begin resuscitation. It is important not to confuse breathing with rare agonal sighs. It takes 10 seconds to evaluate, then mechanical ventilation is required.
- Based on the situation, choose the method of artificial respiration.
How to do artificial respiration with a closed heart massage
If the victim does not have breathing and pulse, then resuscitation measures include indirect indoor heart massage. You need to know what actions are performed during artificial respiration in conjunction with a massage of the heart muscle so as not to harm a person. Indeed, in the event of an error, the blown air will not enter the lungs.
Technique for artificial lung ventilation with closed heart massage:
Artificial lung ventilation with closed heart massage
- Place the victim on a hard, hard surface.
- Release chest from clothing.
- Perform mechanical ventilation in an affordable way.
- Then proceed with indirect heart massage.
- The palms are placed on the center of the sternum, the fingers are intertwined. It is important not to touch the ribs with your hands, otherwise there is a risk of fracture.
- The patient is bent over so that his arms rise above his sternum perpendicularly.
- Using body weight, the rescuer bends the chest of the victim down by 5-6 cm, then awaits its full recovery.
- The frequency of compression is 100-120 per minute.
- It is important to observe a ratio of 30: 2. After 2 breaths, 30 pressures on the sternum are performed.
- Cardiopulmonary resuscitation is performed until consciousness is restored.
Mechanical ventilation and closed cardiac muscle massage are allowed to be carried out separately from each other.
Cardiopulmonary resuscitation is a difficult process, so it is better to perform it with assistants.
How to perform artificial respiration for young children
It is more difficult for small children to perform CPR, since there is a high risk of rib fracture. If the child does not show signs of life, then holding a ventilator to postpone is unacceptable. Artificial respiration of the child is performed simultaneously in the mouth and nose, covering them with their lips. Pressure on the sternum is carried out with fingers or with one hand.
Technique for resuscitation of children:
IVL technique for young children
- Organize airway patency, open the chest.
- Remove foreign objects from the oral cavity.
- Run ID. If it is not possible to cover the nose and mouth at the same time, then mechanical ventilation is performed in an affordable way. Blowing air into the airways of a young child takes 1-1.5 seconds.
- It is necessary to make 5 injections, after each they are removed in order to control the movement of the chest.
- If the sternum does not rise, another 5 exhalations are performed.
- If even after that the chest does not move, this is a sign that the child has a foreign object in the airways. We must try to extract it. To do this, make 5 sharp strokes of the palm between the shoulder blades in the direction from the back to the head. Then again inspect the mouth for the presence of a foreign body.
- If the sternum moves, then begin the massage of the heart muscle. It is performed by pressure on the center of the chest.
- Children under one year old are pressed on the chest with their fingers, older than one year - with the hand.
- The depth of pressure is one third of the thickness of the chest, it is important not to overdo it and not to push too hard. Intervals between clicks are minimal.
- It is necessary to press often, up to 100 compressions per minute. After 30 pressures, ventilation is repeated, 2 breaths are taken. Repeat as many times as necessary to restore consciousness.
- In anticipation of doctors, you can not leave the child alone, you need to keep him warm, in a position on his side.
- You should be prepared to resume CPR at any time.
Providing first aid to a child is an adult's responsibility.
Typical errors during mechanical ventilation
An untrained person can perform CPR with errors that will exacerbate the problem:
- Postponement of resuscitation. In a difficult situation, you can’t hesitate, the rescuer has a maximum of 8 minutes until the patient’s vital systems stop working.
- Incorrect ventilation sequence. First, the airways are released, the oral cavity is cleaned, and only then the lungs are ventilated.
- Lack of pressing lips to the lips of the victim, lack of tightness. This results in less air entering the lungs.
- Extra time is spent trying to open the patient’s jaw. If the mouth cannot be opened, then resuscitation of the mouth into the nose begins.
- Long pauses between breaths and insufficient volume of injected air. Take breaks for the purpose of a short rest, you need to work at a fast pace. The optimal blowing during artificial respiration lasts 1.5-2 seconds with a frequency of 120 times per minute.
- The rescuer does not check the correctness of artificial respiration, does not control the movement of the sternum.
- The carer does not stop artificial respiration and at the same time begins a closed massage. Injections in this case do not make sense, since oxygen does not enter the blood.
It is impossible to be as prepared as possible for a difficult situation, but every person is obliged to be able to perform resuscitation actions to help the victim survive before the arrival of professionals.