Intra-arterial blood injection is a powerful means of improving hemodynamics with prolonged hypotension, especially in patients with blood loss, and also significantly improves the effectiveness of heart massage. It is carried out by infusion of blood or plasma substitutes ( polyglucin , gelatin, etc.) at a pressure of 200-250 mm Hg. Art. in one of the peripheral arteries (preferably in the left radial). If the patient had massive blood loss, then you should pour in significant amounts of blood (1-2 liters). If there was no blood loss, then you can limit 250-500 ml and add 0.3-0.5 ml of a 0.1% solution of epinephrine. The most common mistakes are: pumping through a thin needle (significantly reduces the infusion rate), artery ligation after infusion without stopping bleeding from the puncture site by prolonged compression.
At clinical death, especially with prolonged dying, myocardial atony develops. To increase the tone of the heart muscle, intracardiac injections of adrenaline (0.3-0.5 ml of 0.1% solution) and calcium chloride (5.0-10.0 ml of a 1% solution) are used. Injections should be made with a long needle in the IV intercostal space near the left edge of the sternum. Carrying the needle inward, you should always sip the piston, inject the solution, when blood appeared in the syringe . The most common mistakes: the introduction of the solution into the myocardium (rather than into the heart cavity), a prolonged interruption of the heart massage during the injection.
In some cases ( electrotrauma , asphyxia , drowning , coronary spasm), the circulatory arrest may come as a result of ventricular fibrillation (erratic contraction of the myocardial fibers). In addition to heart massage and artificial respiration, defibrillation is necessary, which is carried out with a special apparatus - defibrillator, affecting the heart with a single capacitor discharge of electric current (voltage 3500-5500 V, duration 0.01 sec.). The most common mistake: the use of defibrillation without a preliminary heart massage.
If cardiac activity is not restored, resuscitation should be continued as long as they are effective. Signs of effectiveness: the disappearance of cyanosis , the appearance of spontaneous breaths (the earlier they appeared, the better the prognosis), the pulsation of large vessels in the rhythm of the massage, the narrowing of the pupils. If these signs are not present within 20-25 minutes, the animation can be stopped.The
Heart massage in children should be done with greater caution. In newborns, massage is done not with the palm of your hand, but with your fingertips. According to age, the dosage of all medicines and the defibrillation voltage are reduced (see also Neonatal Resuscitation ).
In newborn asphyxiation, the most effective method of removing them from the terminal state is artificial respiration, which can be carried out by mouth-to- mouth or by injecting air into a catheter inserted into the trachea. For the same purpose, special devices are used (DP-5, RDA-1).
A vigorous organism needs careful observation and care. First of all, artificial respiration should not be stopped, intubation of the trachea or tracheotomy should be performed and artificial ventilation of the lungs should be continued with special devices (RO-1, Ruben's bag or anesthetic bag) until the consciousness is completely restored and all signs of respiratory insufficiency disappear. To combat acidosis, intravenous sodium bicarbonate (200.0-400.0 ml 4% solution drip), prednisolone (150-180 mg) or cortisone (600-800 mg per day), glucose (400.0-600, 0 ml of 20% solution per day drip) with insulin and vitamins. A thorough prophylaxis of pneumonia is necessary, strict account of diuresis, fight against hyperthermia. With the development of convulsions, hypothermia is shown up to t ° 30-32 °, the introduction of GHB (sodium oxybutyrate), relaxants . Contraindicated in the use of respiratory analeptics (bemegrid, corazole, lobelia), pressor amines (noradrenaline, mezaton) and diuretics "to combat brain edema."
Revitalization of the body can be carried out not only by a doctor, but also by an average paramedic. There are many cases when medical assistants and nurses , as well as trained non-specialists, independently performed heart massage and artificial respiration, saving patients and victims. Particularly great is the role of nurses in the recovery period, when careful care and strict performance of appointments can be a decisive factor in the final outcome of the revitalization.