Pulmonary resuscitation

Pulmonary resuscitation at the prehospital stage is determined by the implementation of artificial ventilation of the lungs at the scene of the incident using the "mouth-to-mouth" method. The advantages of the technique are: the possibility of application in any conditions; with the correct technique, sufficient gas exchange is ensured. Artificial ventilation irritates the respiratory tract and the respiratory center with carbon dioxide and the flow of air from the resuscitator (the Hering-Brayer reflex). Pulmonary resuscitation has the most favorable outcomes, since it is carried out with preserved cardiac activity.

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Mouth-to-mouth ventilation

It is performed in the case of complete respiratory arrest, which is recognized by the following signs: loss of consciousness, cyanosis of the skin, especially the upper half of the body, dilated pupils, decreased reflexes and muscle activity, lack of chest excursions, lack of bilateral respiratory conduction during auscultation.

This pulmonary resuscitation is quite simple. The victim is placed on a hard surface: horizontal or, optimally, in the Fowler position with the head end lowered - for better blood flow to the brain. In this case, pulmonary resuscitation has stages:

1. They clear the airways of foreign bodies: silt, algae, vomit, blood clots, etc.
2. Provide patency of the respiratory tract itself, which is impaired due to the tongue sinking in during loss of consciousness. To do this, throw your head back - you can put a cushion of any hard material under your shoulders - clothing, a blanket, etc.; ensure the tongue is brought out, throwing your head back gives an effect only in 80% of people, ineffective in obese patients; to be completely sure of patency, you need to additionally push your lower jaw forward, open your mouth, which ensures complete patency in 100% of cases (simple Safar technique).
3. Conducting a test exhalation into the victim to ensure patency. With proper preparation and fulfillment of all conditions, the chest should rise. If this does not happen, air is blown into the stomach of the resuscitated person, up to its rupture. If the airways are not cleared of foreign objects, they can be blown into the bronchi with complete occlusion. When performing this stage, the patient's mouth is covered with some material (for example, a handkerchief), the nose is pinched and 4-5 test inhalations are performed. In obese and elderly people, with pulmonary emphysema, rigidity of the chest, exhalation may be difficult. Elimination of this moment is achieved by squeezing the chest or pressing on the upper part of the sternum.
4. Directly pulmonary resuscitation. If the airways are normally patency, continue artificial ventilation. The ventilation mode should be maintained at an optimal level. The respiratory volume should not exceed 800 ml, and the frequency should not exceed 18 per minute, which, under these conditions, ensures maximum gas exchange.

Pulmonary resuscitation is effective if the following signs are observed: active chest excursion, decreased cyanosis of the skin, constriction of the pupils, the appearance of attempts at independent breathing and elements of consciousness.

Pulmonary resuscitation may have complications, which are mainly caused by violation of the technique of artificial ventilation. Strong forward pulling of the lower jaw may lead to its dislocation, which is quite remediable. Insufficient clearing of the airways may result in blowing of foreign bodies into the bronchi with their occlusion, which leads to the ineffectiveness of subsequent artificial ventilation. Insufficient provision of patency will lead to the entry of inhaled air into the stomach, up to its rupture.

Severe complications develop with forced breathing with a large volume, which can lead to a rupture of the lung and the formation of pneumothorax, the occurrence of bleeding from the lungs, etc. Rapid breathing reduces gas exchange in the alveoli of the lungs and also determines the ineffectiveness of artificial ventilation. In addition, if it is deep and frequent, carbon dioxide, which is the main irritant to the respiratory center, is washed out of the blood of the resuscitator himself, up to loss of consciousness and switching off his own breathing.

In the conditions of polyclinics and hospitals, pulmonary resuscitation is more effective, since it is possible to simultaneously conduct artificial ventilation and pharmacotherapy. For this, special kits must be formed, which are usually stored in procedure rooms or at posts, but must be available for immediate use.

Pulmonary resuscitation begins with the usual "mouth-to-mouth" method. In hospital conditions, it is possible to use special airways: laryngeal mouthpieces, S-shaped tubes - to ensure patency of the airways and prevent the tongue from falling back. The best conditions are created when performing artificial ventilation with an Ambu bag or other respirators; In specialized resuscitation departments, artificial ventilation is performed using breathing apparatus through an intubation tube.

Pharmacotherapy is complex, aimed at stopping all pathogenetic links of acute respiratory failure. First of all, the patient is connected to intravenous drip infusion of 4% soda solution - 200-400 ml, to eliminate acidosis and 5% glucose, as a solvent for other drugs. Intravenously administered: 10 ml of 2.4% euphyllin, as a bronchodilator, steroid hormones (prednisolone 90 mg); antihistamines 2-4 ml, respiratory analeptics to increase tissue resistance to hypoxia. To stimulate the respiratory center, intravenously administered up to 1 ml of cytitone. The listed primary pulmonary resuscitation is sufficient in all cases to maintain respiratory function and gas exchange until the arrival of resuscitation specialists.