External cardiac massage technique

FUNDAMENTALS OF FIRST AID
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External cardiac massage technique

Fundamentals of First Aid (OPMP)

Meaning outdoor massage consists in the rhythmic contraction of the heart between the sternum and the spine. In this case, blood is expelled from the left ventricle into the aorta and enters, in particular, into the brain, and from the right ventricle into the lungs, where it is saturated with oxygen. After the pressure on the sternum stops, the cavities of the heart are filled with blood again (Fig. 71).

External cardiac massage technique

Rice. 71. The mechanism of external heart massage: a - artificial systole (heart contraction); b - diastole (relaxation of the heart and filling of the ventricles with blood)

During an external massage of the patient's heart, the patient is placed on a solid foundation (floor, earth). Do not massage on a mattress or soft surface. The resuscitator stands on the side of the patient and with the palmar surfaces of the hands laid one on top of the other, presses on the sternum with such force as to bend it towards the spine by 4-5 cm. The frequency of pressing is 50-70 per minute. Hands should lie on the lower third of the sternum, i.e. two fingers above the xiphoid process (Fig. 72).

External cardiac massage technique

Rice. 72. Technique of external heart massage: a - the location of the hands during the heart massage; b, c - proper hand placement for massage

In children, heart massage should be performed with only one hand, and in infants - with the tips of two fingers with a frequency of 100-120 pressures per minute. The point of application of the fingers in children under 1 year old is at the lower end of the sternum. When performing a massage, adults need not only to apply the strength of the hands, but also to press with the whole body. Such a massage requires considerable physical exertion and is very tiring. If resuscitation is carried out by one person, then every 15 compressions of the sternum with an interval of one second, he must, stopping the massage, take two strong breaths using the mouth-to-mouth, mouth-to-nose methods or with a special manual respirator. With the participation of two people in resuscitation, one inflation of the lungs should be performed after every five compressions of the sternum (Fig. 73).

External cardiac massage technique

Rice. 73. Simultaneous artificial respiration and external massage

The effectiveness of heart massage is evaluated according to the following criteria: 1) the appearance of a pulse in the carotid, femoral and radial arteries; 2) increase in blood pressure up to 60-80 mm Hg. Art.; 3) constriction of the pupils and the appearance of their reaction to light; 4) the disappearance of cyanotic color and "dead" pallor; 5) subsequent restoration of spontaneous breathing.

It should be remembered that a rough external heart massage can lead to serious complications - rib fractures with damage to the lungs and heart. With strong pressure on the xiphoid process of the sternum, a rupture of the stomach and liver can occur. Particular care should be taken when massaging children and the elderly.

If after 30-40 minutes from the start of heart massage, artificial respiration and drug therapy, cardiac activity is not restored, the pupils remain wide, there is no reaction to light, we can assume that irreversible changes and brain death have occurred in the body, and it is advisable to stop resuscitation. If there are clear signs of death, resuscitation can be stopped earlier.

In some severe diseases and traumatic injuries (malignant tumors with metastases, severe skull trauma with brain crush), resuscitation will not make sense and should not be started. In other cases of sudden death, there is always hope for the revival of the patient, and for this all possible measures must be taken.

Transportation of a patient with respiratory and cardiac arrest can be carried out only after the restoration of cardiac activity and respiration or in a specialized ambulance in which resuscitation can be continued.

It should be remembered that revival should be carried out immediately after the cessation of breathing and cardiac activity. Resuscitation at a later date (later than 5 minutes) can restore breathing and cardiac activity, but normal brain activity will not resume.

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

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