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OCCUPATIONAL SAFETY AND HEALTH
Methods of carrying out artificial respiration and external heart massage. Occupational Safety and Health
Occupational Safety and Health / Providing first aid to the injured Artificial respiration. It is carried out in cases where the victim does not breathe or breathes very badly (rarely, convulsively, as if with a sob), and also if his breathing constantly worsens, regardless of what caused it: electric shock, poisoning, drowning, etc. d. The most effective method of artificial respiration is the "mouth-to-mouth" or "mouth-to-nose" method, since this ensures that a sufficient volume of air enters the victim's lungs. The "mouth-to-mouth" or "mouth-to-nose" method is based on the use of air exhaled by the caregiver, which is forced into the victim's airways and is physiologically suitable for the victim to breathe. Air can be blown through gauze, a handkerchief, etc. This method of artificial respiration makes it easy to control the flow of air into the lungs of the victim by expanding the chest after blowing and then subsiding as a result of passive exhalation. To carry out artificial respiration, the victim should be laid on his back, unfasten clothing that restricts breathing and ensure the patency of the upper respiratory tract, which, in the supine position when unconscious, is closed by a sunken tongue. In addition, there may be foreign contents in the oral cavity (vomit, slipped dentures, sand, silt, grass, if a person was drowning, etc.), which must be removed with the index finger wrapped in a scarf (cloth) or bandage, turning the head the victim on one side (Fig. 19).
After that, the assisting person is located on the side of the victim’s head, slips one hand under his neck, and with the palm of the other hand presses on his forehead, throwing his head back as much as possible (Fig. 20).
In this case, the root of the tongue rises and frees the entrance to the larynx, and the victim's mouth opens. The person providing assistance leans towards the victim’s face, takes a deep breath with his mouth open, then fully covers the victim’s open mouth with his lips and exhales vigorously, blowing air into his mouth with some effort; at the same time, he closes the nose of the victim with his cheek or fingers of the hand located on the forehead (Fig. 21). In this case, it is imperative to observe the chest of the victim, which should rise. As soon as the chest has risen, the air injection is stopped, the assisting person raises his head, and the victim passively exhales. In order for the exhalation to be deeper, you can gently press the hand on the chest to help the air out of the lungs of the victim. If the victim has a well-defined pulse and only artificial respiration is necessary, then the interval between artificial breaths should be 5 s, which corresponds to a respiratory rate of 12 times per minute.
In addition to the expansion of the chest, a good indicator of the effectiveness of artificial respiration can be the pinking of the skin and mucous membranes, as well as the exit of the victim from an unconscious state and the appearance of independent breathing. When performing artificial respiration, the assisting person must ensure that the blown air enters the lungs, and not into the stomach of the victim. When air enters the stomach, as evidenced by bloating "under the spoon", gently press the palm of your hand on the stomach between the sternum and navel. This may cause vomiting, so it is necessary to turn the head and shoulders of the victim to the side (preferably to the left) to clear his mouth and throat. If the chest does not rise after blowing in air, it is necessary to push the victim's lower jaw forward (see Fig. 18). If the victim's jaws are tightly clenched and it is not possible to open his mouth, artificial respiration should be performed according to the mouth-to-nose method (Fig. 22). In the absence of spontaneous breathing and the presence of a pulse, artificial respiration can also be carried out in a sitting or vertical position if the accident occurred in the basket of the tower, on a support or on a mast (Fig. 23 and 24). At the same time, the head of the victim is thrown back as much as possible or the lower jaw is pushed forward. The rest of the tricks are the same. Small children are blown into the mouth and nose at the same time, covering the child's nose with their mouth (Fig. 25). The smaller the child, the less air he needs to inhale and the more often he should be blown compared to an adult (up to 15-18 times per minute).
The volume of air in the mouth of an adult is enough for a newborn. Therefore, the inflation should be incomplete and less abrupt, so as not to damage the child's airways. When the first weak breaths appear in the victim, an artificial breath should be timed to the moment he begins to breathe independently. Cease artificial respiration after the victim recovers sufficiently deep and rhythmic spontaneous breathing. External cardiac massage. If not only breathing is absent, but also the pulse on the carotid artery, artificial respiration alone is not enough when providing assistance, since oxygen from the lungs cannot be carried by blood to other organs and tissues. In this case, it is necessary to resume blood circulation artificially, for which external heart massage should be performed. The human heart is located in the chest between the sternum and the spine. The sternum is a movable flat bone. In the position of a person on his back (on a hard surface), the spine is a rigid fixed base. If you press on the sternum, the heart will be compressed between the sternum and the spine and the blood from its cavities will be squeezed into the vessels. If you press on the sternum with jerky movements, then the blood will be pushed out of the cavities of the heart in much the same way as it happens during its natural contraction. This is called an external (indirect, closed) heart massage, in which blood circulation is artificially restored. Thus, when artificial respiration is combined with external heart massage, the functions of respiration and blood circulation are imitated. An indication for resuscitation is cardiac arrest, which is characterized by a combination of the following symptoms: pallor or cyanosis of the skin, loss of consciousness, absence of a pulse in the carotid arteries, cessation of breathing or convulsive, incorrect breaths. In case of cardiac arrest, without wasting a second, the victim must be laid on a flat hard base: a bench, a floor, in extreme cases, put a board under his back. If assistance is provided by one person, he is located on the side of the victim and, bending over, makes two quick energetic blows (according to the “mouth-to-mouth” or “mouth-to-nose” method), then unbends, remaining on the same side of the victim, palm puts one hand on the lower half of the sternum, retreating two fingers higher from its lower edge (Fig. 26 and 27), and raises the fingers (see Fig. 17). He puts the palm of the second hand on top of the first across or along and presses, helping by tilting his body. When pressing, the arms should be straightened at the elbow joints. It should be pressed in quick crowds so as to displace the sternum by 4-5 cm, the duration of pressure is not more than 0,5 s, the interval between individual pressures is not more than 0,5 s.
During pauses, the hands are not removed from the sternum (if two people provide assistance), the fingers remain raised, the arms are fully extended at the elbow joints. If the revival is carried out by one person (Fig. 28), then for every two deep blows, he makes 15 pressures on the sternum, then again makes two blows and again repeats 15 pressures, etc. At least 60 pressures and 12 blows must be done per minute , i.e., perform 72 manipulations, so the pace of resuscitation should be high. Experience shows that most of the time is spent on artificial respiration. It is impossible to delay the blowing, as soon as the chest of the victim has expanded, it must be stopped.
With the participation of two people in resuscitation (Fig. 29), the ratio of breathing - massage is 1: 5, i.e. after one deep blowing, five chest compressions are performed. During artificial inhalation to the victim, the one who massages the heart does not perform pressure, since the forces developed during pressure are much greater than during inhalation (pressure during inhalation leads to ineffective artificial respiration, and consequently, resuscitation measures). When resuscitation is carried out together, it is advisable for two assisting people to change places after 5-10 minutes. With the correct performance of external heart massage, each pressure on the sternum causes a pulse to appear in the arteries. The caregivers should periodically monitor the correctness and effectiveness of external heart massage by the appearance of a pulse on the carotid or femoral arteries. When carrying out resuscitation by one person, he should interrupt the heart massage for 2-2 seconds every 3 minutes to determine the pulse on the carotid artery (see Fig. 17). If two people are involved in resuscitation, then the pulse on the carotid artery is controlled by the one who conducts artificial respiration. The appearance of a pulse during a massage break indicates the restoration of the activity of the heart (the presence of blood circulation). At the same time, heart massage should be immediately stopped, but artificial respiration should be continued until stable independent breathing appears. In the absence of a pulse, it is necessary to continue to massage the heart. Artificial respiration and external cardiac massage should be carried out until the patient is restored to stable independent breathing and heart activity or until he is transferred to medical personnel. If resuscitation is effective (the pulse is determined on large arteries during pressure on the sternum, pupils narrow, the cyanosis of the skin and mucous membranes decreases), cardiac activity and independent breathing in the victim are restored. A prolonged absence of a pulse with the appearance of other signs of revitalization of the body (spontaneous breathing, constriction of the pupils, attempts by the victim to move his arms and legs, etc.) is a sign of cardiac fibrillation. In these cases, it is necessary to continue to give artificial respiration and heart massage to the victim before transferring him to medical personnel. Resuscitation measures in children under 12 years of age have their own peculiarities. For children from one to 12 years old, heart massage is performed with one hand (Fig. 30) and from 70 to 100 pressures are made per minute, depending on age, for children under one year old - from 100 to 120 pressures per minute with two fingers (index and middle) in the middle sternum (Fig. 31) or with the thumbs of both hands, clasping the child's torso with the rest of the fingers.
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