The urgent help on the absence of consciousness, sharp respiratory insufficiency. Ensure of passable of respiratory ways

Methodical references for practical lesson

Subject: The urgent help on the absence of consciousness, sharp respiratory insufficiency. Ensure of passable of respiratory ways

Specialty: 051301 - General medicine

Course: 2

Almaty, 2012y.

The urgent help on the absence of consciousness, sharp respiratory insufficiency. Ensure of passable of respiratory ways

Purpose: Working off of practical skills on urgent medicine.

Problems of training: At violation of breath it is necessary to estimate character and severity of its frustration, then to restore passage of respiratory ways.

Main questions of a subject:

1. Restoration of a passage of respiratory ways

At emergence of an urgent conditions passable of respiratory ways is often broken because of a fall of language, which covers an entrance in a throat and air can't get to lungs. Besides, patient without the conscious always has a danger of and obstruction of respiratory ways by foreign matters and emetic masses [S. V. Vasilyev and coauthors, 1987]. It is necessary to make for restoration of a passable of respiratory ways “threefold reception on respiratory ways”

2. Technique of performance of threefold reception of Safar:

a. head supports in thrown back;

b. promote forward of the bottom jaw;

c. open a mouth.

The V fingers of both hands grasp an ascending branch of the bottom jaw of the patient about an auricle and push it with force forward (up), displacing the bottom jaw so, that the bottom teeth acted ahead of an upper teeth.

3. Geymlikh's reception.

At obstruction of respiratory ways a foreign matter the victim should give a prone position on one side and in interscapular area to make 3 — 5 sharp blows with the lower part of a palm. It is need to try clear a mouth cave, to remove a foreign matter by the fingers, then to do attempt of artificial breath. If there is no effect, it’s need carry out pressing on a stomach. Thus a palm of one hand put to a stomach on the average line between a navel and a xiphoid shoot. The second hand put over the first and press on a stomach with fast movements up on the average line.

Due to the danger of infection of the resuscitator at direct contact with mucous a mouth and a nose of the victim artificial breath is expedient for carrying out special devices. Air lines, the device concern simplest of them for artificial ventilation of UDR, obverse masks, etc.

4. Support of passable of respiratory ways can be carried out a way:

- head is support in thrown back, and the bottom jaw in situation is deduced forward;

- a line of introduction air, (Guedel's postoral tube) or nasopharyngeal tube;

- intubation (most last way of prevention of a regurgitation, aspiration).

5. Methods of carrying out IVL:

- a mouth in a nose (optimum);

- a mouth in a mouth;

- a mouth in a nose and a mouth (children of chest and younger age);

- a mouth in an air line;

- IVL of AMBU bag (danger of an aspiration);

- IVL through an intubation tube;

- therapy with oxygen.

6. The intubation tubes and trachea intubation

An intubation of trachea more preferable in urgent situations as it can be made quicker.

Essence of a method is introduction of an elastic air line (An intubation tube) in a trachea under control laryngoscope. The intubation of a trachea can be carried out “a blind method” (on a finger). There are a wide choice of intubation tubes of different length and diameter.

Technique of carrying out an oral trachea intubation the bent blade of the tube Mackintosh [according to A.A.Bunyatyan, 1984]:

1) to open a mouth of the patient with the right hand;

2) to place larynx – scope in the left hand and to enter a blade into the right corner of a mouth of the patient, having displaced his language to the left so, that it was possible to examine an oral cavity of the patient;

3) to carry out a blade larynx scope), forward on the average line (doing traction a handle axis larynx scope), to examine a mouth of the patient, a uvula, a throat and epiglottis;

4) to examine arytenoids cartilages, an entrance in a throat and vocal chords, to lift a epiglottis with a blade larynx scope),;

5) to enter an trachea tube with the conductor the right hand through the right corner of a mouth of the patient under sight control, that the air pillow settled down behind vocal chords;

6) to take the conductor and to begin ventilation of lungs;

7) to take laryngoscope, to inflate air pillow for achievement of tightness, to fix a tube by means of an outset or an adhesive plaster.

For prevention of a regurgitation of gastric contents it is necessary to use Sellik's reception, which consists in gullet squeezing by pressing a cricoids cartilage.

7. Artificial breath.

Artificial breath — this inflation of air or the mix enriched with oxygen in lungs of the patient, carried out without or with use of special devices, that is temporary replacement of function of external breath [D. Benson et al., 1996]. Air exhaled by the person contains from 16 to 18 % of oxygen that allows to use it for artificial breath at carrying out reanimation.

It should be noted that patients to respiratory standstill and warm activity have a fall of a pulmonary fabric that promoted substantially by carrying out indirect massage of heart [ P.E. Pelé, 1994]. Therefore it is necessary to carry out adequate ventilation of lungs at heart massage. Each inflation should take 1 — 2 seconds, as at longer forced inflation air can get to a stomach. Inflation should be made sharply and until the thorax of the patient won't start to rise considerably.

The exhalation at the victim thus occurs passively thanks to the created elevated pressure in lungs, their elasticity and mass of a thorax [A. Gilston, 1987]. The passive exhalation should be full. Frequency of respiratory movements should make 12 — 16 in a minute. Adequacy of artificial breath is estimated on periodic expansion of a thorax and passive exhalation of air.

Auxiliary ventilation use against kept independent, but inadequate breath at the patient. Synchronously to a breath of the patient through 1 — 3 respiration movements additional inflation of air is made. The breath should be smooth and on time to correspond to a breath of the patient.

8. Conicotomy

Conicotomiy (krikotireotomiy) consists in opening (puncture) of a cricoids membrane at impossibility of an intubation of a trachea or obstruction existence in a throat. The main advantage of this method consists in simplicity of technical performance and speed of performance (in comparison with a trachea stoma).

The cricoids membrane settles down between the bottom edge thyroid and upper edge of a cricoids cartilage of a throat. In this area there are no large vessels and nerves. Conikotomiy is carried out in the provision of the maximum head supports in thrown back. It is better to put the small roller in subscapular area. It is necessary to fix a throat for lateral surfaces of a thyroid cartilage with a big and middle fingers. Over a cricoids membrane the skin cross-section becomes. A scalpel punch a membrane on a forefinger nail, then through an opening to a trachea carry out plastic or metal cannula.

Equipment: sterile syringes, needles, scalpel, diapers, wadded balls, gloves, ethyl alcohol, plait, roller,

garbage container, tray for the fulfilled ampoules, bottles, capacity with disinfectant solution for the fulfilled wadded balls, laryngoscope, trachea tube with the conductor, Ambu's bag.

Training and teaching methods: small groups, discussion, situational tasks, work in pairs.

Literature

1. Person and extreme. (Specialist grant), 2003. Sharipov K.Sh., Dzhell.L., Berdibayev D. K.,

2. A medical care in a population life support system at elimination of consequences of an emergency. (Specialist grant), 2003. Sharipov K.Sh., Dzhel L. L., Bekturganov T.A.

3. Medical forces and agents at earthquakes. (specialist grant), 2003. Sharipov K.Sh., Dzhel L. L., etc.

4. Sharipov K.Sh., etc. «The medical care organization in a population life support system at elimination of consequences of emergency situations». "Medicine" No. 6, 2003.

5. Slesarev V. G., Vysochin A.S., Dzhel L.L., Ahmetov B. A., Botabekova L.M., Rakhmettullina G. B. «Experience on elimination of medical consequences of earthquake at station Meadow Zhambylsky area of the Republic of Kazakhstan»., «Problems of economy and social medicine», 2003.

6. Slesarev V. G, Dzhel L.L., Smooth L.V., Rakhmettulina G. B., Botabekova L.M. Prognosticated losses of the population of Almaty at earthquakes of various degree of intensity a mater. "Strategy of development of health care of the Republic of Kazakhstan" of Almaty. - 2003. – Page 125-128.

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