Pulmonary resuscitation

Pulmonary resuscitation at the prehospital stage is determined by conduction; artificial ventilation at the scene by the method of "mouth to mouth". Advantages of the technique are: the possibility of application in any conditions; with proper technique of execution, sufficient gas exchange is ensured. IVL causes irritation of the respiratory tract and the center of breathing with carbon dioxide and a stream of air of the reanimator (the Goering-Brier reflex). Pulmonary resuscitation is most favorable in outcomes, since it is performed with still preserved cardiac activity.

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IVL "from mouth to mouth"

It is carried out with a complete stop of breathing, which is recognized by the following signs: loss of consciousness, cyanosis of the skin, especially the upper half of the trunk, dilated pupils, decreased reflexes and muscle activity, lack of chest excursions, cells, absence of bilateral breath conduction in auscultation.

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

1. Free airway from foreign bodies: mud, algae, vomit, blood clots, etc.
2. Ensure the passability of the respiratory tract itself, which is disturbed by the loss of consciousness of the tongue. For this, the head is thrown back - you can put a roller from any solid material under your shoulders - clothes, blanket, etc; provide the removal of the tongue, tilting the head gives an effect only in 80% of people, is ineffective in obese patients; for complete confidence in the patency, you must additionally push forward the lower jaw, open your mouth, which provides full patency in 100% of cases (simple reception Safar).
3. Conduct a trial exhalation in the victim to persuade in the patency. With the correct preparation and implementation of all conditions, the chest should rise. If this does not happen - the air is blown into the stomach reanimated, until its rupture. If the airways are not cleaned of foreign objects, they can be injected into the bronchi with complete occlusion. When this stage is completed, the patient's mouth is closed with some material (for example, a handkerchief), the nose is squeezed and produces 4-5 test breaths. In obese and elderly people, with emphysema of the lungs, the stiffness of the chest can be a difficult exhalation. Elimination of this moment is achieved by squeezing the chest or pressing on the upper part of the sternum. .
4. Direct pulmonary resuscitation. With the normal patency of the airways, continue to ventilation. The ventilation mode must be kept optimal. The volume of breathing should not exceed 800 ml, and the frequency - no more than 18 per minute, which, under given conditions, ensures maximum gas exchange.

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

Pulmonary resuscitation may have complications, which are mainly caused by a violation of the technique of ventilation. A strong stretching forward of the lower jaw can lead to its dislocation, which is completely eliminable. With insufficient purification of the airways, it is possible to inject foreign bodies into the bronchi with their occlusion, which leads to ineffectiveness of the subsequent IVL. Insufficient provision of patency will lead to the intake of inhaled air in the stomach, until its rupture.

Severe complications develop with forced breathing with a large volume, which can lead to rupture of the lung and the formation of pneumothorax, the emergence of bleeding from the lungs, etc. Rapid breathing reduces gas exchange in the alveoli of the lungs and also determines the inefficiency of the ventilator. In addition, if it is deep and frequent, carbon dioxide is washed out of the bloodstream by the reanimator itself, which is the main stimulus of the respiratory center, down to loss of consciousness and shutting off of one's own breathing.

In conditions of polyclinics and hospitals, pulmonary resuscitation is more effective, since it is possible to carry out simultaneous ventilation and pharmacotherapy. To do this, special piling should be formed, which are usually stored in treatment rooms or in posts, but are necessarily available for immediate use.

Pulmonary resuscitation begins with the usual method of "mouth to mouth". Under the conditions of the hospital, there are opportunities to use special air ducts: laryngeal mouthpiece, S-shaped tube - to ensure the patency of the airways and prevent the tongue lingering. The best conditions are created when the ventilator is administered with an Ambo bag or other respirators; In the conditions of specialized intensive care units, ventilation is carried out with the help of breathing apparatus through the intubation tube.

Pharmacotherapy is carried out complex, aimed at stopping all pathogenetic links of acute respiratory failure. First of all, the patient is connected by intravenous drip injection of 4% solution, soda - 200-400 ml, to eliminate acidosis and 5% glucose, as a solvent of other medicinal substances. Intravenously injected: 10 ml of 2.4% euphillin, as a bronchodilator, steroid hormones (prednisolone 90 mg); antihistamines on 2-4 ml, respiratory analeptics for increase of resistance of tissues to hypoxia. To stimulate the respiratory center, intravenously inject up to 1 ml of cititone. The listed primary pulmonary resuscitation is sufficient in all cases to maintain the function of respiration and gas exchange before the arrival of resuscitation specialists.