Cardiac resuscitation
Last reviewed: 23.04.2024
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Cardiac resuscitation is less favorable in outcomes than pulmonary, as the cardiac arrest quickly stops respiratory function.
Signs of cardiac arrest are: lack of pulsation on the carotid arteries, total cyanosis of the body, wide pupils, lack of reflexes, loss of consciousness, rapid cessation of independent breathing.
Cardiac resuscitation, both at a prehospital and hospital level, in the form of a basic element, consists in a closed cardiac massage (open-only in the operating room).
The main conditions for a closed heart massage are: the position of the patient on his back and on a hard surface; the position of the doctor's hands is the palm of the right hand in the lower third of the sternum, the fingers should be located on the fifth intercostal space to the left, the palm of the left hand is placed over the top; prolapse is carried out by a sharp jerk to a depth of 6-8 cm with a frequency of 16-18 per minute. This ensures optimal blood flow, which is only 20-40% of the norm, but is sufficient for life support of the brain. Cardiac resuscitation with deeper prolapse may be complicated by fractures of the ribs, often with bone fragments of the lungs; liver. Rapid massage leads to a decrease in blood flow.
In carrying out these activities, the doctor periodically has to monitor the pulse on the carotid artery - its presence during the prolapse testifies to the effectiveness of the measures. Cardiac resuscitation is considered qualitative if there is a decrease in cyanosis, a narrowing of the pupils, the appearance of attempts at independent breathing and elements of consciousness.
Hospital cardiac resuscitation includes closed cardiac massage, pharmacotherapy and defibrillation. It is the main component of these measures, since defibrillation with myocardial hypoxia is ineffective.
Cardiac resuscitation must necessarily be combined with pharmacotherapy. Its objectives are:
- relief of hypovolemic syndrome;
- elimination of acidosis;
- cardiostimulation;
- defibrillation.
Defibrillation is performed only against the background of the ongoing elimination of acidosis. If these conditions are not observed, cardiac resuscitation is ineffective. The safety precautions should be strictly observed: hands dry, completely isolated from the patient and the table, with the registration and respiratory equipment disconnected. Electrodes can be placed in two ways:
- One - on the right in the second intercostal space, the second - in the region of the apex of the heart (the fifth intercostal space on the left).
- Passive (flat electrode) is located under the left shoulder blade, active (on the insulating handle) - in the region of the apex of the heart.
Skin in the area of application of electrodes is degreased with alcohol, under them are put gauze napkins moistened with saline solution. They should fit tightly to the patient's body. Current discharges are cascaded, increasing each discharge by 500 V. The massage is stopped only for the period of defibrillation. Pulmonary and cardiac resuscitation includes a combined IVL and massage in a ratio of 1: 4 (one inhalation - four prolapses).
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