terminal states. clinical death

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First aid

When assisting the victim, he should be laid on a flat surface, while the head should be lower than the body, all limbs raised (blood self-transfusion), which achieves a temporary increase in the amount of circulating blood in the lungs, brain, kidneys, and other organs due to a decrease in the systemic circulation (centralization of blood circulation).

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Terminal pause

The transitional state from the preagonal state to agony is the so-called terminal pause. It is clearly expressed when dying from blood loss.

It is characterized by the fact that after a sharp tachypnea (frequent breathing), breathing suddenly stops.

The duration of the terminal pause ranges from 5-10 seconds. up to 3-4 min.

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Agony

A sign of the onset of agony after the terminal pause is the appearance of the first breath. Breathing, at first weak, then significantly intensifies, passes into convulsive intermittent Cheyne-Stokes breathing with pauses between respiratory cycles of 10-30 seconds. and, having reached a certain maximum, gradually weakens and stops. Participation in the act of inhalation of all respiratory muscles, including auxiliary ones (musculature of the mouth and neck), is characteristic. There is an increase in heart rate, a slight increase in blood pressure (30-40 mm Hg) and a pulse on the carotid arteries. Then heart contractions and breathing stop, clinical death occurs.

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The victim, who is in a state of agony, must be given artificial respiration and closed heart massage.

First aid

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clinical death

There are no external signs of life: consciousness, respiration, blood circulation, complete areflexia sets in, pupils are maximally dilated. The organism as a whole no longer lives. At the same time, sharply weakened vital processes can be detected in individual tissues and organs. The extinction of metabolic processes occurs in a certain sequence.

The term of clinical death is 3-4, maximum 5-6 minutes. With prolonged dying followed by cardiac arrest, the duration of clinical death does not exceed 1-3 minutes. This time is determined by the ability of brain cells to exist in the absence of blood circulation, and hence, complete oxygen starvation. After 4-6 min. after cardiac arrest, these cells die. Resuscitation is possible if resuscitation is initiated within the first 4 minutes. clinical death in 94%, within 5-6 minutes. at 6%.

Since the onset of irreversible changes in the cells of the cerebral cortex, true, or biological death begins.

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The main signs of clinical death:

• loss of consciousness;
• absence of a pulse in the carotid artery;
• lack of breathing;
• lack of pupillary response to light.

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Detection of signs of life

• a - by breathing with the help of a mirror and a ball of cotton wool;
• b - according to the reaction of the pupil to the action of light

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resuscitation

A set of measures aimed at restoring the vital functions of the body, primarily respiration and blood circulation.

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Resuscitation tasks

*Combating hypoxia and stimulating fading body functions.

According to the degree of urgency, resuscitation measures are divided into two groups:

1) maintenance of artificial respiration and artificial circulation;

2) conducting intensive therapy aimed at restoring independent blood circulation and respiration, normalizing the functions of the central nervous system, liver, kidneys, and metabolism.

* Resuscitation in circulatory arrest

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Cardiopulmonary resuscitation

Primary resuscitation includes three stages "ABC": "A" (airway) - restoration and maintenance of airway patency;

• "B" (breathing) - artificial lung ventilation;
• "C" (circulation) - external heart massage.

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Restoration and maintenance of airway patency

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Artificial lung ventilation

IVL - active blowing of air into the lungs of the victim using the methods of "mouth to mouth", "mouth to nose", a bag through a mask, etc.

1. Inspiration time 1-1.5 sec.

2. Inhalation is accompanied by a rise of the anterior chest wall, and not the abdominal wall.

3. Allow passive exhalation.

4. The ratio of breaths to chest compressions is 2:15, regardless of the number of rescuers.

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Mouth to nose method

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Mouth to nose method

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Mouth to mouth method

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External cardiac massage

1. Maximum compression on the lower third of the sternum.

2. Depth of pressure 4-5 cm or about 30% of the anterior-posterior size of the chest.

3. Technique: for adults - with two hands, for children under one year old - with the thumbs of both hands, for children 1-8 years old - with one hand; shoulders should be directly above closed hands; arms at the elbows should be kept straight.

Description of the presentation on individual slides:

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Description of the slide:

terminal states. First resuscitation aid. Performed by the teacher of MBOU "OOSH s. Dubovka" Golodnov Alexey Vladimirovich

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Description of the slide:

Terminal states are the borderline states of the body between life and death, the last stages of life. At the same time, a characteristic five-link chain of events can be distinguished: shock, pre-agony, terminal pause, agony, clinical death (the last four links develop over a period of time not exceeding 8-9 minutes). In all terminal states, a full-fledged revival is possible. In practical situations, most often you have to deal with the first resuscitation care in case of clinical death. This assistance is of great importance, since immediately after clinical death, irreversible biological death occurs. Clinical death is characterized by five main features: 1. Lack of consciousness. 2. Absence of breath. 3. No pulse in the carotid or femoral arteries. 4. Pupil dilation. 5. Lack of pupillary reaction to light.

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Description of the slide:

Stages of first resuscitation. Resuscitation is the revival of a dying person, bringing him out of a state of clinical death, preventing the occurrence of biological death. The purpose of resuscitation: saving the life of a person as a social subject, a full-fledged member of society. Tasks of resuscitation: * prevention of death, support, restoration of brain functions; * removing the body from terminal states; * prevention of their return (relapse); * prevention or limitation of the number of possible complications; *reducing the severity of their course.

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Description of the slide:

There are five stages of first resuscitation. 1. Diagnostic - solves five questions, whether a person is alive or dead; sick or healthy (being in a state of intoxication); whether he is in a state of clinical death or in severe shock; what kind of medical care the victim needs or is not subject to treatment at all.

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Description of the slide:

Diagnostic stage. Determination of the state of consciousness, reaction to external influences (shake by the shoulder, call out) There is a reaction There is no reaction If necessary, position the victim more comfortably; eliminate the possibility of blockage of the respiratory tract, provide first aid, call for help Check the condition of the cervical vertebrae. Exclude fractures, fracture-dislocations of the vertebrae, neck and head injuries. Clear the airways; throw back the head, push the lower jaw forward; if necessary, remove foreign bodies. Call for help. Stop external bleeding. Call an ambulance. Check the victim's breathing by the sound, the sensation of the outgoing air, by the rise of the anterior wall of the chest during inhalation. Breathing is preserved. Breathing is sharply weakened. according to the state of the pupils Perform artificial ventilation of the lungs Blood circulation is preserved No blood circulation No breathing. Circulatory failure Carry out a full cycle of resuscitation

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Description of the slide:

Stages of preparatory and initial. Preparatory stage Initial stage Place the victim on a hard base (on the floor, on the ground, etc.) on the back (stretch the arms along the body) Tilt the victim's head back Loosen the collar, belt. Release the bra. Mouth open Mouth closed Open the mouth using one of the following methods: - bilateral lower jaw grip, - front lower jaw grip, - lateral lower jaw grip. Check airway patency. Absent Saved Restore airway patency

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Description of the slide:

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Description of the slide:

stage of resuscitation. Artificial ventilation of the lungs External heart massage Oral methods Precardinal blow before external heart massage at the beginning of each cycle ) breaths at the fastest pace, without pauses. Inhalation volume - 400-500 ml Inspiration cycle: ventilation frequency - 8 per 1 minute; inspiratory time is not more than 1 s. Checking the effectiveness of the measures taken by the pulse on the carotid artery, the state of the pupils. With no effect. Cycles of external heart massage: frequency of shocks - 100 per 1 minute; depth of deflection of the sternum - 4-5 cm. Resuscitation ratio (ventilator + external heart massage) With one rescuer - 2:15 With two rescuers - 1:5 In children - 1:4 In all cases, ensuring constant monitoring of the condition of the victim, the effectiveness of resuscitation with amendments

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Description of the slide:

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Types of terminal states Predagonal state Terminal pause (not always noted) Agony Clinical death

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Predagonal state Consciousness is oppressed or absent. The skin is pale or cyanotic. BP drops to zero. The pulse is stored in the carotid and femoral arteries. Breathing is a bradyform. The severity of the condition is explained by the increasing oxygen starvation and severe metabolic disorders.

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Terminal pause Terminal pause is not always the case. After vagotomy, it is absent. Respiratory arrest, periods of asystole 1-15 sec.

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Agony The forerunner of death. The regulatory function of the higher parts of the brain ceases. The bulbar centers control the life processes.

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Clinical death The activity of the heart and respiration ceases, but there are still no irreversible changes in organs and systems. On average, the duration is no more than 5-6 minutes, depending on the ambient temperature, atm. pressure, etc.

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3 types of circulatory arrest 1. Asystole - cessation of atrial and ventricular contractions (complete blockade, irritation of the vagus nerves, exhaustion, endocrine diseases, etc.). 2. Ventricular fibrillation - discoordination in myocardial contraction. 3. Myocardial atony - loss of muscle tone (hypoxia, blood loss, shock).

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3 types of cessation of respiratory activity Hypoxia. Hypercapnia. Hypocapnia is a respiratory alkalosis.

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Signs of clinical death Coma - dilated pupils and lack of reaction to light. Apnea is the absence of breathing movements. Asystole is the absence of a pulse in the carotid arteries. A huge role in this condition is played by time factors, so it is necessary to strive to perform an EEG, ECG, acid-base balance is not necessary, but it is necessary to move on to resuscitation methods.

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Resuscitation methods Air way open - restore airway patency. Breathe por victim - start ventilation. Circulation his blood - start heart massage.

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Rules of ABC 1. Unbend the cervical region, remove the lower jaw (Fig. 23.24), free the oral cavity and pharynx, air duct - IVL (Fig. 25.26). 2. a) external (external) - compression of the chest. b) blowing air into the lungs.

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Methods for conducting IVL IVL through an S-shaped air duct. IVL through a gauze bandage (1-2 layers) or a handkerchief. IVL "mouth to mouth" 10-12 in 1 min (at the expense of 4-5). IVL "mouth to nose".

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Ways to restore cardiac activity 1. Indirect cardiac massage. After 2-3 breaths - punch in the area of ​​the heart and then massage between the sternum and spine 1:5 ratio of massage to mechanical ventilation.

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2. Medical stimulation. Repeats every 5 minutes. Adrenomimetics - adrenaline 1.0 0.1% + 10.0 physical. solution in / in, in / cardio until a clinical effect is obtained. Antiarrhythmic drugs - lidocaine 80-120 mg. Sodium bicarbonate 2 ml 1% per 1 kg. Magnesium sulfate 1-2 g in 100 ml of 5% glucose. Atropine 1.0 0.1% solution. Calcium chloride 10% - 10.0

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3. Electropulse therapy 200J, 200-300, 360, 2500V, 3500V. The resuscitation allowance is not provided to patients with injuries that are not compatible with life, who are in the terminal stage of incurable diseases, or to cancer patients with metastases.

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Types of shock Hypovolemic (posthemorrhagic, burn - these are varieties) shock. Cardiogenic shock. Vascular shock (septic and anaphylactic).

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Clinical signs of shock cold, moist, pale cyanotic or marbled skin; sharply slowed blood flow of the nail bed; darkened consciousness; dipnea; oiguria; chycardia; decrease in arterial and pulse pressure.

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Pathogenetic classification, main clinical symptoms and compensatory mechanisms of hypovolemic shock (according to G.A. Ryabov, 1979)

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Shock control criteria Shock index - the ratio of heart rate to systolic pressure (PG Bryusov, 1985). The normal value of SI = 60/120 = 0.5 In shock I st. (blood loss 15-25% of the BCC) SI = 1 (100/100) In case of shock II st. (blood loss of 25-45% of the BCC) SI = 1.5 (120/80) In case of shock III st. (blood loss more than 50% of BCC) SI = ” (140/70)

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Principles of treatment of hypovolemic shock Immediate control of bleeding, adequate pain relief. Subclavian vein catheterization and adequate infusion therapy. Relief of signs of acute respiratory failure. Constant supply of oxygen in the inhaled mixture in the amount of 35-45%. Relief of signs of acute heart failure. Bladder catheterization

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Infusion therapy program depending on blood loss (V.A. Klimansky, A.Ya. Rudaev, 1984)

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Principles of treatment of septic shock Elimination of signs of ARF and OSHF, transfer to mechanical ventilation according to indications. Normalization of central hemodynamic parameters by using intravenous infusions of dextrans, crystalloids, glucose under the control of CVP and hourly diuresis. Correction of the main indicators of acid-base balance and water-electrolyte balance. Preventive treatment of pulmonary distress syndrome inevitable for this pathology. Antibacterial therapy (preferably bacteriostatic drugs). Relief of DIC-syndrome. Treatment of the allergic component of the disease by prescribing glucocorticoids. Sanitation of the focus of infection. Symptomatic therapy.

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Principles of treatment of anaphylactic shock Resuscitation if indicated. If possible, avoid contact with the allergen, although this is not always possible. If this is not possible, a tourniquet is placed above the allergen injection site or the injection site is pricked with a diluted adrenaline solution. In/venous jet infusion therapy under the control of CVP and hourly diuresis. Slowly in / vein 1 ml 0.1% solution of adrenaline + 20.0 physical. r-ra (you can under the tongue). Relief of bronchospasm, slow intravenous administration of 5-10 ml of a 2.4% solution of aminophylline. The administration of glucocorticoids is indicated as desensitizing drugs and stabilizers of cell membranes. When using prednisolone, the dose should be 90-120 mg. At the same time, hydrocortisone 125-250 mg is prescribed, which has the ability to retain sodium and water in the body.

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Criteria for successful treatment of shock Recovery of BCC and elimination of hypovolemia. Restoration of UOS, MOS. Elimination of disorders of microcirculation.

The terminal state is a critical level of life dysfunction with a catastrophic drop in blood pressure, profound disorders of gas exchange and metabolism. During the provision of surgical care and intensive care, acute development of respiratory and circulatory disorders of extreme degrees with severe, rapidly progressive hypoxia of the brain is possible.

The second feature of the dying process is a common pathophysiological mechanism that occurs regardless of the cause of dying - one form or another of hypoxia, which in the course of dying becomes mixed with a predominance of circulatory disorders, often combined with hypercapnia. The cause of the disease largely determines the course of the dying process and the sequence of extinction functions of organs and systems (respiration, circulation, central nervous system). If the heart is initially affected, then in the process of dying, the phenomena of heart failure prevail, followed by damage to the function of external respiration and the central nervous system. The second feature of the dying process is a common pathophysiological mechanism that occurs regardless of the cause of dying - one form or another of hypoxia, which in the course of dying becomes mixed with a predominance of circulatory disorders, often combined with hypercapnia. The cause of the disease largely determines the course of the dying process and the sequence of extinction functions of organs and systems (respiration, circulation, central nervous system). If the heart is initially affected, then in the process of dying, the phenomena of heart failure prevail, followed by damage to the function of external respiration and the central nervous system.

Clinical picture preagonal state General lethargy Disturbance of consciousness up to stupor or coma Hyporeflexia Decrease in systolic blood pressure below 50 mm Hg Pulse on the peripheral arteries is absent, but palpable on the carotid and femoral arteries Severe shortness of breath Cyanosis or pallor of the skin General lethargy Disturbance of consciousness up to to stupor or coma Hyporeflexia Decrease in systolic blood pressure below 50 mm Hg No pulse in the peripheral arteries, but palpable in the carotid and femoral arteries Severe shortness of breath Cyanosis or pallor of the skin

Terminal pause This transitional period lasts from 5-10 seconds to 3-4 minutes and is characterized by the fact that after tachypnea, the patient experiences apnea, the cardiovascular activity deteriorates sharply, conjunctival and corneal reflexes disappear. It is believed that the terminal pause occurs as a result of the predominance of the parasympathetic nervous system over the sympathetic one under conditions of hypoxia.

Clinical death is fixed from the moment of complete cessation of breathing and cessation of cardiac activity. If it is not possible to restore and stabilize vital functions within 5–7 minutes, then the death of the most sensitive to hypoxia cells of the cerebral cortex occurs, and then biological death.

Primary clinical signs Clearly detected in the first 10-15 seconds from the moment of circulatory arrest Sudden loss of consciousness Disappearance of the pulse on the main arteries Clonic and tonic convulsions Clearly detected in the first 10-15 seconds from the moment of circulatory arrest Sudden loss of consciousness Disappearance of the pulse on the main arteries Clonic and tonic convulsions

Symptom complex of clinical death * lack of consciousness, circulation and respiration * areflexia * lack of pulsation in large arteries * adynamia or small-amplitude convulsions * dilated pupils that do not respond to light * cyanosis of the skin and mucous membranes with an earthy tint * lack of consciousness, blood circulation and respiration * areflexia * absence pulsations in large arteries * adynamia or small-amplitude convulsions * dilated pupils that do not respond to light * cyanosis of the skin and mucous membranes with an earthy tint

Elementary life support. 1. Restoration of airway patency. 2. Artificial maintenance of breathing. 3. Artificial maintenance of blood circulation. The purpose of emergency oxygenation, the resumption of blood circulation, sufficiently saturated with oxygen, primarily in the basins of the cerebral and coronary arteries

Upper airway management Head tilt with neck hyperextension Mandible protrusion Use of a breathing tube (nasal or oral S-shaped airway) Tracheal intubation (in an operating room or intensive care unit)

Preparation for artificial respiration: push the lower jaw forward (a), then move the fingers to the chin and, pulling it down, open the mouth; with the second hand placed on the forehead, tilt the head back (b). Preparation for artificial respiration: push the lower jaw forward (a), then move the fingers to the chin and, pulling it down, open the mouth; with the second hand placed on the forehead, tilt the head back (b).

The place of contact of the arm and the sternum The place of contact of the arm and the sternum The position of the patient and assisting with chest compressions. Scheme of indirect heart massage: a - laying hands on the sternum b - pressing on the sternum a - laying hands on the sternum b - pressing on the sternum

Stage 2 Further maintenance of life. Stages: Drug therapy. Electrocardiography or electrocardioscopy. Defibrillation Purpose: restoration of spontaneous circulation, consolidation of the success of resuscitation if it is achieved and spontaneous circulation is restored as a result of the pumping function of the patient's myocardium.

Below is the dosage of some drugs used in CPR Adrenaline - 1 ml of 0.1% solution (1 mg) every 3-5 minutes. until clinical effect is obtained. Accompany each dose with 20 ml of saline. Norepinephrine - 2 ml of 0.2% solution, diluted in 400 ml of saline. Atropine - 1.0 ml of 0.1% solution every 3-5 minutes. until the effect is obtained, but not more than 3 mg. Lidocaine (with extrasystoles) - the initial dose is mg (1-1.5 mg / kg).

INDICATIONS AND CONTRAINDICATIONS FOR CPR Lack of consciousness, breathing, pulse on the carotid arteries, dilated pupils, lack of pupillary response to light; Unconsciousness, rare, weak, thready pulse, shallow, rare, fading breathing.

Criteria for the end of CPR Establishment of the irreversibility of brain damage Prolonged absence of restoration of spontaneous circulation Clinical indicators of the effectiveness of resuscitation measures · The appearance of pulsations in large vessels - the carotid, femoral and ulnar arteries. - systolic blood pressure not lower than 60 mm Hg. - constriction of the pupils - pinking of the skin and visible mucous membranes - registration of cardiac complexes on the ECG

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