Methodical references for practical lesson

Methodical references for practical lesson

Subject: Signs of clinical death. Carrying out pulmonary and cardiac reanimation.

Specialty: 051301-General medicine

Course: 2

Almaty, 2012y.

Signs of clinical death. Carrying out pulmonary and cardiac reanimation

Purpose: Working off of practical skills on urgent medicine.

Problems of training:

- To train in carrying out pulmonary and heart reanimation.

- Signs of clinical death.

Main questions of a subject:

1. The success of reanimation in many respects depends on time which has passed from the moment of a stop of blood circulation prior to the beginning of reanimation.

The clinical death — is the period between life and death, when there is no visible signs of life, but the vital processes, giving the chance organism revival still proceed. Duration of this period at usual body time makes 5 - 6 minutes, then irreversible changes in organism fabrics [N develop. Paradis, 1996]

a) A blood circulation stop (lack of a pulsation on the main arteries);

b) Absence of independent breath (there are no thorax excursions);

c) Absence of consciousness;

d) Wide pupils;

e) Reflexes are absent (there are no сorneal reflex and reaction of pupils to light);

f) Type of a corpse (pallor, acrocyanosis). Cyanic.

Process of dying is characterized by fading of functions of the vital systems of an organism (nervous, breath, blood circulation, etc.).

Other mechanism of development of a stop of blood circulation is fibrillation of ventricles. At it arise separate, chaotic, occurring at different times and that the most important inefficient reductions of separate muscular bunches.

Artificial breath. Trachea’s intubation:

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

2) to place laryngoscope 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) 3) to carry out a blade laryngoscope forward on the average line (doing traction on a handle axis laryngoscope to examine a mouth of the patient, a uvula, a throat and a higher- larynx;

4) 4) to examine arytenoids cartilage, an entrance in a throat and vocal chords, having lifted a higher- larynx a blade laryngoscope;

5) to enter an tracheal 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 a 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. Blood circulation supporting stage.

After a blood circulation stop within 20 — 30 minutes in heart automatism and conductivity functions that allows to "start" it are kept. Irrespective of the mechanism of a stop of heart activity, heart and pulmonary reanimation for the prevention of development of irreversible defeat of fabrics of an organism (a brain, a liver, heart, etc.) and approaches of biological death [S. V. Vasilyev and other should be immediately begun., 1987]. A main objective of massage of heart is creation of an artificial blood-groove.

Heart and pulmonary reanimation closed massage of heart.

The area hypothenarand the tenor of one of palms is put on a thorax surface on 2,5 cm above a xiphoid shoot, hands are straightened in elbows, pressing strictly perpendicular to a backbone on depth of 3-5 cm, frequency 80-100 1 minute is made. To children aged till 10 years the closed massage carry out one hand of 75-90 massage movements in a minute, chest – tips of the 2nd fingers - 100.

Ratio of number of breathes and massage movements at carrying out reanimation by one person 2:15; a ratio of number of breathes and massage movements at carrying out reanimation by two человеками 1:5;

However heart emission and a blood-groove created by external massage of heart, makes no more than 30 % from norm [P. Safar, 1997] and only 5 % of a normal brain blood-groove [P. Marino, 1996]. As a rule, it happens enough for maintenance of viability of the central nervous system during heart and pulmonary and cerebral reanimation under condition of achievement of sufficient oxygenation of an organism throughout several tens minutes.

Medicine means and infusion therapy

For restoration of independent blood circulation it is necessary to begin as soon as possible introduction of medicines preparations and infusion therapy [V.V.Moroz, 1996]. Introduction of preparations should be begun as soon as possible and to repeat each 5 minutes.

The preparations used at carrying out primary resuscitation complex and their dosage

Adrenaline. Adrenomimetic, who most often is applying at carrying out heart and pulmonary, and cerebral reanimation. Improves a coronary and brain blood-groove, increases excitability and a myocardium’s contractility. Primary dose of adrenaline makes 1 mg [To. lender, 1991]. At an inefficiency adrenaline is entered in the same dose every 3 — 5 minutes [A.P. Zilber, 1995]. After restoration of heart activity there is a high risk of recurrence of fibrillation of the ventricles, caused by an inadequate coronary perfusion [To. Under, 1991]. For this reason use "aggressive" doses of vessel -press [P.E.Pepe, 1994]. Now there is tactics of use of big doses of adrenaline (5 mg and more) during carrying out resuscitation actions [P. Basket, 1993]. The purpose of this therapy is achievement of spontaneous and stable blood - dynamic: at systolic pressure not less than 100 — 110 mm of mercury.

Sodium hydrocarbon. Now the relation to use of a hydrocarbon of sodium is reconsidered during carrying out reanimation [P.E.Pepe, 1992]. It is not recommended to apply it before restoration of independent work of heart. It is connected with that acidosis at introduction of a hydrocarbon of sodium will be reduced only in case of removal through lungs being formed at its dissociation. In case of inadequacy of a pulmonary blood-groove and ventilation of CO 2 strengthens out of - and cellular acidosis. However it is considered shown introduction of a hydrocarbon of sodium in a dose 0, 5 — 1, 0 mmol/kg, if process of reanimation is tightened over 15 — 20 minutes.

Chloride calcium. Now use of preparations of calcium at heart and pulmonary reanimation in connection with possible development of reperfusion defeats and violation of production of energy is also limited. Introduction of preparations of calcium at carrying out resuscitation actions is shown in the presence of K more, and overdose of antagonists of calcium [to A.P.Zilber, 1995].

Atropine. Application of atropine is shown at an absent and a rare of a rhythm. Primary dose should make 1 mg. At an inefficiency repeated introduction in 3 — 5 minutes.

Lidocaine. The loading dose of Lidocaine of 80 — 100 mg (1, 5 mg/kg) intravenously very quickly is entered. After achievement of independent blood circulation supporting infusion of Lidocaine in a dose of 2 — 4 mg/minutes is carried out.

Glucose solution. Now it is not recommended to use glucose infusion at carrying out resuscitation actions because it arrives in ischemic area of a brain where joining in an anaerobe exchange, is split to dairy acid. Local accumulation in a brain fabric of a lactate increases its damage [to P. Marina, 1996]. Use of physiological solution or Ringer's solution is more preferable.

Already during carrying out primary resuscitation complex it is necessary to apply measures for prevention of injury of a brain. Usually are for this purpose entered oxybutyrate sodium (2 — 4 g), seduxen (20 — 40 mg), barbiturates (2 — 5 mg/kg). A certain value can receive in this plan use of blockers of calcium channels (verapamil in a dose 0, 1 mg/kg) and sulfate magnesium.

Electric defibrillation

For carrying out electric defibrillation are used defibrillator both constant, and an alternating current. The first are more effective and safe.

At carrying out an external defibrillation one of electrodes have on a forward surface of a thorax below a clavicle at the right edge of a breast, and another — in the field of a heart top. Electrodes should be greased with special paste or are wrapped up by several layers of the gauze moistened with physiological or hypertensive salt solution for reduction of thorax resistance. Electrodes are necessary for pressing densely to a body of the patient. Before a defibrillation strongly to squeeze a thorax electrodes for reduction of chest resistance very important. With the same purpose the defibrillation should be carried out in an exhalation phase that the sizes of a thorax were minimum (it provides decrease in thorax tension on 15 — 20 %). The size of a current should be sufficient force to suppress the ectopic centers of excitement in a myocardium. At carrying out an external defibrillation the initial category makes 3 — 3, 5 thousand volts (about 200 J). If the first attempt wasn't successful, she is necessary for repeating, increasing tension each time on 30 – 50 J.

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, e tracheal tube with the conductor, Ambu's bag, defibrillator, gel for greasing of a surface of plates of a defibrillator, adrenaline (to 5 mg), sodium hydrocarbon, airline.

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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