Principles and methods of resuscitation

FUNDAMENTALS OF FIRST AID
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Principles and methods of resuscitation

Fundamentals of First Aid (OPMP)

Clinical resuscitation (From Lat. D - again, anima- life) is closely related to physiology, pathological anatomy, surgery, therapy and other medical specialties. Its task is to study the mechanisms of those processes that occur in the body when dying, with the development of a terminal state.

It has been established that the human body continues to live for some time even after stopping breathing and cardiac activity, however, this stops the supply of oxygen to the cells, without which the existence of a living organism is impossible. Different tissues react differently to the lack of blood and oxygen supply to them, and their death does not occur at the same time. Therefore, the timely restoration of blood circulation and respiration with the help of a set of measures called resuscitation can bring the patient out of the terminal state.

Terminal conditions can be the result of various causes: shock, myocardial infarction, massive blood loss, blockage of the respiratory tract or asphyxia, electrical injury, drowning, flooding, etc. terminal state there are three phases or stages: 1) pre-agonal state; 2) agony; 3) clinical death.

В preagonal state the consciousness of the patient is still preserved, but it is confused. Blood pressure drops to zero, the pulse sharply quickens and becomes thready, breathing is shallow, labored, the skin is pale.

During agony blood pressure and pulse are not determined, eye reflexes (corneal; pupil reaction to light) disappear, breathing takes on the character of swallowing air.

Clinical death - short-term transitional stage between life and death lasting 3-6 minutes. Breathing and cardiac activity are absent, the pupils are dilated, the skin is cold, there are no reflexes. In this short period, it is still possible to restore vital functions with the help of resuscitation. At a later date, irreversible changes in tissues occur, and clinical death turns into biological, true. Clinical death differs from the biological absence of cadaveric spots and rigor mortis.

In a terminal state, regardless of its cause, general changes occur in the body, without understanding which it is impossible to understand the essence and meaning of resuscitation methods. These changes affect all organs and systems of the body (brain, heart, metabolism, etc.) and occur earlier in some organs and later in others. Considering that the organs continue to live for some time even after respiratory and cardiac arrest, with timely resuscitation, it is possible to achieve the effect of reviving the patient.

The most sensitive to hypoxia (low oxygen content in the blood and tissues) is the cerebral cortex, therefore, in terminal conditions, the functions of the higher part of the central nervous system, the cerebral cortex, are turned off first of all: a person loses consciousness. If the duration of oxygen starvation exceeds 3-4 minutes, then the restoration of the activity of this section of the central nervous system becomes impossible. Following the shutdown of the cortex, changes also occur in the subcortical regions of the brain. Last of all, the medulla oblongata dies, in which the automatic centers of respiration and blood circulation are located. Irreversible brain death occurs.

Increasing hypoxia and dysfunction of the brain in the terminal state lead to a breakdown in the activity of the cardiovascular system. In the preagonal period, the pumping function of the heart drops sharply and the amount of blood ejected by it decreases - the so-called cardiac output. Reducing the blood supply to organs and especially the brain accelerates the development of irreversible changes. Due to the presence in the heart of its own system of automatism, its contractions can continue for quite a long time. However, these contractions are ineffective: the filling of the pulse falls, it becomes filiform; blood pressure drops sharply, and then ceases to be determined. In the future, the rhythm of contractions of the heart is significantly disturbed, and cardiac activity stops.

In the initial phase of the terminal state - preagony - breathing quickens and deepens. During the period of agony, along with a drop in blood pressure, breathing becomes uneven, shallow and, finally, completely stops - a terminal pause occurs.

In the terminal state in the body, there are sharp shifts in metabolism. They are expressed, first of all, in a decrease in oxidative processes, which leads to the accumulation of organic acids (lactic and pyruvic) and carbon dioxide in the body. As a result, the acid-base balance of the body is disturbed. Normally, the reaction of the blood and tissues of the body is neutral. The attenuation of oxidative processes during the period of the terminal state shifts the reaction to the acid side - acidosis occurs.

After the body exits the state of clinical death, first the activity of the heart is restored, then spontaneous breathing, and only later, when abrupt changes in metabolism and acid-base state disappear, can brain function be restored. The period of recovery of the function of the cerebral cortex is the longest. Even after short-term hypoxia and clinical death (less than a minute), consciousness may be absent for a long time.

The main tasks of resuscitation of a patient in a state of clinical death are the fight against hypoxia and the stimulation of fading body functions. According to the degree of urgency, resuscitation measures can be divided into two groups: maintenance of artificial respiration and artificial blood circulation and intensive therapy aimed at restoring independent blood circulation and respiration, normalizing the functions of the central nervous system, liver, kidneys, and metabolism.

Authors: Aizman R.I., Krivoshchekov S.G.

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