The position of the hands during heart massage. Basic rules for conducting a closed heart massage

06.06.2020

From this article you will learn: what is an indirect heart massage, why, to whom and who can do it. Is it possible to harm a person by performing this procedure, and how to make it really help.

Date of publication of the article: 08.02.2017

Date of article update: 05/29/2019

Indirect cardiac massage is called resuscitation. emergency care, aimed at replacing and restoring arrested cardiac activity.

This procedure is the most important for saving the life of a person whose heart has stopped and who is in a state of clinical death. Therefore, every person must be able to do cardiac massage. Even if you are not a specialist, but at least approximately know how this procedure should take place, do not be afraid to do it.

You will not harm the patient if you do something not quite right, and if you do nothing, it will lead to his death. The main thing is to make sure that there are really no heartbeats. Otherwise, even a perfectly performed massage will hurt.

The essence and meaning of heart massage

The purpose of heart massage is to artificially recreate, replace cardiac activity in case of its arrest. This can be achieved by squeezing the cavities of the heart from the outside, which imitates the first phase of cardiac activity - contraction (systole) with a further weakening of pressure on the myocardium, which imitates the second phase - relaxation (diastole).

This massage can be done in two ways: direct and indirect. The first is possible only when surgical interventionwhen there is direct access to the heart. The surgeon takes it in his hand and performs a rhythmic alternation of compression with relaxation.

Indirect cardiac massage is therefore called indirect because there is no direct contact with the organ. Compression is through the wall chestsince the heart is located between the spine and the sternum. Effective pressure on this area is capable of ejecting about 60% of the blood volume into the vessels compared to the self-contracting myocardium. Thus, blood will be able to circulate through the largest arteries and vital important bodies (brain, heart, lungs).

Indications: who really needs this procedure

The most important thing in a heart massage is to determine whether a person needs it or not. There is only one indication - complete. This means that even if the unconscious patient has pronounced rhythm disturbances, but at least some cardiac activity is preserved, it is better to refrain from the procedure. Compression of the beating heart can stop it.

The exceptions are cases of severe ventricular fibrillation, in which they seem to tremble (about 200 times per minute), but do not perform a single full contraction, as well as weakness of the sinus node and, in which the heart rate is less than 25 beats per minute. If such patients are not helped, the condition will inevitably worsen and cardiac arrest will occur. Therefore, they can also be given an indirect massage if there is no way to help in another way.

The rationale for the expediency of this procedure is described in the table:

Clinical death is the stage of dying after the cessation of cardiac activity lasting 3-4 minutes. After this time, irreversible processes occur in the organs (primarily in the brain) - biological death occurs. Therefore, the only time when you need to do cardiac massage is the period of clinical death. Even if you don't know when the cardiac arrest occurred and are not sure if there is a heartbeat, look for other signs of the condition.

The sequence of actions that make up the technique of chest compressions includes:

1. Determine if the patient has a pulse and heartbeat:

Feel the anterolateral surfaces of the neck with your fingers in the projection of the location of the carotid arteries. The absence of pulsation indicates cardiac arrest.
Listen to the left side of the chest with your ear or phonendoscope.

2. If you are in doubt about the absence of palpitations, before doing chest compressions, identify other signs of clinical death:

3. If these signs take place, feel free to start an indirect heart massage, observing the technique of performing:

Lay the patient on their back, but only on a hard surface.
Open the patient's mouth if there is mucus, vomit, blood or any foreign bodies, clear oral cavity fingers.
Throw the victim's head back well. This will prevent the tongue from sinking. It is advisable to fix it in this position by placing any roller under the neck.
Stand to the right of the patient at chest level.
Place both hands on the sternum at a point two fingers above the lower end of the sternum (the border between the middle and lower third).
The hands should lie in this way: the fulcrum of one hand is the soft part of the palm in the area of \u200b\u200belevation of the thumb and little finger just below the wrist. Place the second brush on the one that is located on the chest and interlace their fingers in a lock. The fingers should not rest on the ribs, as they can cause fractures during the massage.
Bend over the victim in such a way that with correctly positioned hands you seem to be resting on the sternum. The arms should be straight (extended at the elbows).

The technique for performing pressure on the chest should be as follows:

At least 100 times per minute.
So that it is pressed in 3-5 cm.
Do the compressions not by flexing and extending your elbows, but by applying pressure from your entire body. Your hands should be a kind of transmission lever. This way you will not get tired and will be able to massage as much as you need. This procedure requires a lot of strength and energy.

Click on the photo to enlarge

An indirect cardiac massage can take about 20 minutes. Evaluate every minute if there is a pulse in the carotid arteries. If, after this time, the heartbeats have recovered, further massage is inappropriate.

It is not necessary to do artificial respiration at the same time as cardiac massage, but it is possible. The correct technique for performing in this case: after 30 pressures, take 2 breaths.

Forecast

The effectiveness of an indirect heart massage is unpredictable - from 5 to 65% end in the restoration of cardiac activity and saving a person's life. The prognosis is better when carried out in young people without concomitant diseases and injuries. But cardiac arrest without indirect massage in 100% ends in death.

Indirect heart massage (NMC) - the first health care upon termination of his work, the provision of which can be carried out without professional medical training.

Resuscitation actions differ depending on the number of participants and the condition of the resuscitated person. However, discrepancies in the technique are visible only at the last stages - during compression. Preparation for massage is the same in all cases.

The rules also depend on age: an infant, a child under 8 years old, a teenager and an adult are reanimated in different ways. The procedure increases the chances of survival and makes it possible to wait for the ambulance to arrive.

Indirect heart massage (also external, or closed) in medicine is called resuscitation, the purpose of which is to maintain blood circulation.

The principle of the procedure is that the rhythmic squeezing of an organ imitates its natural work and helps to restore cardiac activity.

Problems with blood circulation can provoke congenital and acquired diseases, drug overdose or medication, accident, electric shock, etc.

The indication for the beginning of the revitalization of the body is clinical death - the process of dying, which is characterized by the absence of external signs of life, while the metabolism in tissues and brain function is still preserved.

The transition period lasts up to ten minutes after the heart stops working, then the brain is destroyed and the restoration of vital activity becomes impossible.

How to determine whether clinical death has occurred in a person or has it already entered the biological stage?

The main reason for resuscitation is always complete cardiac arrest. The rescuer must make sure that there is no heartbeat and only then begin to revive the body. And also, a prerequisite for the procedure is a constant assessment of the condition of the resuscitated person.

The effectiveness of the procedure is assessed by returning the body to normal.

The resuscitated person must:

the pulse can be felt (the pulse is considered stable if it does not stop within a few minutes);
rise arterial pressure;
move the pupils (constriction);
normalize skin tone;
restore the ability to breathe.

Algorithm and rules of execution

How effective the resuscitation will be depends on the execution technique.

Incorrect hand position and a broken sequence of stages can lead to complications: rib fractures, pneumothorax, ruptures internal organs (Incorrect posture will also lead to a decrease in the frequency of pressure and subsequent cessation of recovery due to fatigue of the resuscitator). It is the correct position of the hands that often determines the success of the event.

A training video is an instruction in which a medical assistant tells how many clicks and in what rhythm you need to do:

Some complications (tamponade, pneumothorax, funnel-shaped sternum) may become contraindications for further assistance.

Closed heart massage is a specific algorithm of actions that should be followed for the greatest efficiency and avoidance of complications:

the victim should lie on his back, on a hard surface with his head thrown back and legs raised;
the chest, neck and abdomen should not be squeezed, so undo the buttons on the throat, loosen the belt;
ensure airway patency - the oral cavity must be clean and free of mucus, vomit, blood;
the resuscitator should be positioned on the side so that the shoulders are above his chest (you can stand on either side, but for right-handers it is more convenient to position on the right, and for left-handers on the left);
the correct location of the hands is chosen in stages: find the junction of the lower ribs with the sternum, step back two fingers up and put the base of the palm on the found point;
before the start of the revitalization of the body, a precordial blow is performed - a manipulation performed once along the nipple line to the center of the sternum is applied with a fist from a height of no more than 30 centimeters, without a swing (sometimes even one blow made can restore blood circulation so that the heart works, but if the condition does not improve followed, then proceed to resuscitation);
clasp fingers in the lock ( thumb the main hand must be positioned in such a way that it points either to the chin or to the legs).

Compression technique:

should be pressed strictly perpendicularly and with straightened hands;
the place of application of the hands should not change (displacement of the point of application of pressure can cause fractures, hematomas, ruptures);
the chest should be pressed 3-5 centimeters, the optimal pressure rate is 60-100 per minute;
you need to keep your hands tightly pressed to your chest;
it is necessary to resume pressing only after returning the chest to its original position;
it is important to observe the rhythm of the pressure and the pressure applied when pressing.

External heart massage is inseparable from mechanical ventilation, and together they are called cardiopulmonary resuscitation (CPR).

Depending on the number of rescuers, the resuscitation methodology is modified:

Rules for conducting by one resuscitator

Rules for conducting by two resuscitators

resuscitation actions begin with two blows of air;
after 15 pressure is made;
then the actions are repeated (the ratio of 15 clicks and 2 breaths) either until the condition of the resuscitated person improves, or until ascertaining biological death;
the frequency of pressing is 80-100 per minute.

one person stands at the head, the other at the side;
one injection is performed;
followed by five pressures;
actions are alternated until the condition improves, or until biological death is ascertained (if the victim's chest does not heave during mechanical ventilation, it is necessary to change the resuscitation tactics and go to the ratio of sighs and presses 2 to 15);
the frequency of pressing is 80 per minute.

The time of the procedure depends only on the success of the actions taken, the arrival of an ambulance or your physical condition (broken ribs do not affect the duration of resuscitation). At 80-100 pressing on the sternum per minute, the minimum massage period is 15-20 minutes. The maximum period depends on the improvement of the condition or the onset of biological death.

Another way to revitalize the body is also used -. With it, the resumption of blood flow is carried out using a surgical intervention.

An operation is performed on the open sternum, in which the doctor imitates the work of the heart, squeezing the organ in his hands with a frequency of 60-70 squeezes per minute. These resuscitation actions are prohibited in the absence of professional training and outside the conditions of the hospital.

At the moment, preference for resuscitation is given to indirect massage, and the use of direct massage may be due to:

circulatory disorders in the early postoperative period;
circulatory disorders due to trauma;
circulatory disorders during breast surgery.

Features of carrying out in children

A number of parameters of closed heart massage are performed in different ways, depending on the age of the resuscitated person. Several age boundaries can be drawn: a child under one year old, up to 8 years old, everyone over 8 years old (resuscitation of adolescents does not differ from an adult). Different approaches to resuscitation of children and adults are due to the size of the internal organs, bone structure and physiological characteristics (eg, heart rate). Moreover, the procedure for preparing for resuscitation is the same for all cases.

Newborns and children under one year old are placed on the forearm of a resuscitator. A palm is placed under the back, so that the head is above the body and thrown back. With children under 8 years old, they immediately switch to massage and mechanical ventilation, without a precordial stroke.

Infant resuscitation technology:

held by the middle and index fingers;
pressure speed - 140 per minute;
punching depth 1-2 centimeters;
Mechanical ventilation - about 40 breaths per minute.

Resuscitation technology for children under 8 years old:

held with one hand;
pressing speed is 120 per minute;
punching depth 3-4 centimeters;
Mechanical ventilation - 30-35 breaths per minute.

The success of chest compressions is characterized by the restoration of the basic functions of the body, which a person loses after stopping blood circulation.

The indicator of effectiveness is the body returning to normal. The criterion for the effectiveness of the revitalization of the body in children and adults is the same (this is evidenced by: normalizing skin tone, movement of the pupil and its shape, palpable pulse). A massage performed incorrectly can lead to complications (for example, ribs are most often broken), but its absence is always fatal.

Therefore, with the onset of clinical death, it is necessary to urgently begin urgent resuscitation actions. The main thing is to make sure that there are no palpitations and severe chest injuries. At the moment, there are many opportunities to learn how to properly perform heart massage. If you are not confident in your abilities, watch video tutorials on the topic or purchase an illustrated manual in which the resuscitation is displayed in pictures and photos.

If the victim does not have a pulse, the following violations of the heart are possible:

A sharp weakening or even complete cessation of heart contractions, which is a consequence of the long-term presence of the victim under the influence of current, as well as the lack of timely assistance in the event of a primary respiratory injury;
The formation, under the influence of electric current, of scattered and multi-temporal (fibrillar) contractions of individual groups of fibers of the heart muscle, which cannot ensure the work of the heart as a pump that pumps blood into the vessels, which occurs under the action of a large alternating current, even with a short stay of the victim under voltage; in this case, breathing for some time after the release of the victim from the action of the current can still continue, however, the work of the heart is not effective and is not able to support life.

Therefore, if the victim does not have a pulse, to maintain the vital activity of the body (to restore blood circulation), it is necessary, regardless of the reason that caused the cessation of the work of the heart, simultaneously with artificial respiration (air injection), to carry out external heart massage. It should be borne in mind that without proper and timely preliminary assistance to the victim before the arrival of the doctor medical assistance may be overdue and ineffective.

External (indirect) massage is performed by rhythmic squeezing of the heart through the front wall of the chest with pressure on a relatively mobile lower part sternum, behind which the heart is located. In this case, the heart is pressed against the spine and the blood from its cavities is squeezed into blood vessels... By repeating the pressure at a frequency of 66 to 70 times per minute, you can ensure sufficient blood circulation in the body in the absence of heart function.

The possibility of such imitation of the work of the heart arises as a result of a deep loss of muscle tone (tension) in a dying person, as a result of which his chest becomes more mobile and pliable than in a healthy person.

For external heart massage, the victim should be laid with his back on a hard surface (low table, bench or on the floor), exposed his chest, remove the belt, braces and other items of clothing that restrict breathing. The person providing assistance should stand on the right or left side of the victim and take a position in which a more or less significant tilt over the victim is possible. If the victim is laid down on the table, the caregiver should stand on a low chair, and when the victim is on the floor, the caregiver should kneel next to the victim.

Having determined the position of the lower third of the sternum (Figure 6, a), the caregiver should put on it the upper edge of the palm of his extended arm, and then put his other hand over the hand (Figure 6, b) and press on the victim's chest, slightly helping tilting your body. Pressing should be done with a quick push so as to move the lower part of the sternum down towards the spine by 3 - 4 cm, and in obese people - by 5 - 6 cm. Pressing force should be concentrated on the lower part of the sternum, which, due to its attachment to the cartilage, should be the cheek ends of the lower ribs is mobile. Top part the sternum is attached motionlessly to the bony ribs and can break when pressed on it. You should also avoid pressure on the end of the lower ribs, as this can lead to their fracture. In no case should you press below the edge of the chest (on soft tissue), since you can damage the organs located here, primarily the liver.

The pressure on the sternum should be repeated about once a second.

After a quick push, the arms remain in the reached position for about one third of a second. After that, the hands should be removed, releasing the chest from the pressure in order to allow it to straighten. This facilitates the suction of blood from the large veins into the heart and its filling with blood.

If there is an assistant, one of the helpers, less experienced in this matter, should perform artificial respiration by blowing air as a less complicated procedure, and the second, more experienced one, should perform chest compressions. To provide the body with a sufficient amount of oxygen in the absence of heart function, artificial respiration should be carried out simultaneously with a heart massage by blowing air into the lungs of the victim.

Since the pressure on the chest makes it difficult to expand during inhalation, the inflation should be carried out in the intervals between the pressures or during a special pause, provided every 4 to 6 pressures on the chest.

If the caregiver does not have an assistant and is forced to perform artificial respiration and external heart massage alone, the indicated operations should be alternated in the following order: after 2 - 3 deep blows into the mouth or nose of the victim, he makes 15 - 20 pressure on the chest, then again makes 2 - 3 deep blows and again makes 15 - 20 pressures in order to massage the heart, etc. In this case, the blowing of air should be timed to the time the pressure on the chest is stopped or interrupting the heart massage for the duration of the blowing (about 1 second).

With equal qualifications of the persons providing assistance, it is advisable for each of them to carry out artificial respiration and external heart massage, alternately replacing each other every 5-10 minutes. This alternation will be less tiring than continuously performing the same procedure, especially a heart massage.

The effectiveness of external heart massage is manifested primarily in the fact that each pressure on the sternum leads to the appearance of a pulsating vibration of the arterial walls in the victim (checked by another person).

With proper artificial respiration and heart massage, the victim has the following signs of revival:

Improvement of the complexion, acquiring a pinkish tint instead of the gray-earthy color with a bluish tinge, which was the victim before the assistance was provided;
The appearance of independent respiratory movements, which become more and more even as the relief measures (revitalization) continue;
Constriction of the pupils.

The degree of pupillary constriction can be the most reliable indicator of the effectiveness of the assistance provided. Narrow pupils in a person being revived indicate a sufficient supply of oxygen to the brain, and vice versa, the beginning dilation of the pupils indicates a deterioration in the supply of blood to the brain and the need to take more effective measures to revive the victim. This can be helped by raising the victim's legs about 0.5 m from the floor and leaving them in a raised position during the entire time of external cardiac massage. This position of the victim's legs promotes better blood flow to the heart from the veins of the lower body. Something should be placed underneath to keep the legs raised.

Artificial respiration and external heart massage should be carried out before the appearance of spontaneous breathing and heart work, however, the appearance of weak breaths (in the presence of a pulse) does not give grounds for stopping artificial respiration.

In this case, as already indicated above, the blowing in of air should be timed to the moment the victim begins to inhale. The restoration of heart activity in the victim is judged by the appearance of his own, not supported by massage, regular pulse. To check the pulse, the massage is interrupted for 2 to 3 seconds, and if the pulse persists, then this indicates the independent work of the heart. If there is no pulse during the break, you must immediately resume the massage.

Prolonged absence of pulse and heart rate during spontaneous breathing and narrow pupils indicates cardiac fibrillation. In these cases, it is necessary to continue measures to revive the victim until the arrival of the doctor or until the victim is delivered to medical institution with uninterrupted continuation of revitalization activities in the car.

It should be remembered that even a short-term cessation of revitalizing activities (1 minute or less) can lead to irreparable consequences.

After the first signs of revival appear, external cardiac massage and artificial respiration should be continued for 5 to 10 minutes, timing the inflation to the moment of your own inhalation.

Technique of indirect heart massage

Blood circulation can be restored by pressing on the chest. In this case, the heart is squeezed between the sternum and the spine, and blood is pushed out of the heart into the vessels. Rhythmic presses mimic heartbeats and restore blood flow. This massage is called indirect because the lifeguard acts on the heart through the chest.

The victim is laid on his back, always on a hard surface. If it is lying on the bed, it should be placed on the floor.

The clothes on the patient's chest are unbuttoned, freeing the chest. The rescuer stands (at full height or on his knees) to the side of the victim. He puts one palm on the lower half of the patient's sternum so that the fingers are perpendicular to it. Place the other hand on top. The raised fingers do not touch the body. The rescuer's straight arms are positioned perpendicular to the victim's chest. The massage is performed with quick jerks, with the weight of the whole body, without bending the elbows. At the same time, the patient's sternum should bend by 4-5 cm.

Reanimator's scheme of actions

Place the victim face up on a hard surface.
Throw his head back.
Give the patient 2 breaths in the mouth-to-mouth or mouth-to-nose method.
Check your pulse on carotid artery... If not, continue resuscitation.
Begin chest compressions: press 15 times on the sternum in a row at 1 second intervals.
2 more breaths of artificial respiration. Do 4 of these cycles (30 presses and 2 breaths).
Then check the carotid pulse again. If it is not there, resuscitation continues. Repeat 5 cycles of 30 presses and 2 breaths.

Diagram of actions of two rescuers

Lay the victim on their back on a hard surface.
Throw your head back.
Stand to the side of the patient: the first rescuer is at the head of the bed (he breathes for the patient), the second is opposite the chest (he massages the heart).
The first rescuer takes 2 breaths of artificial respiration.
A second rescuer checks the carotid pulse. If it is not there, resuscitation continues.
The second rescuer presses the chest five times in a row with an interval of 1 second, massaging the patient's heart.
After that, the first rescuer takes 1 breath to the victim.
So in turn, the rescuers carry out 10 cycles - each cycle includes 5 clicks and 1 breath.
The pulse is then checked on the carotid artery. If it is not there, resuscitation is continued: 10 cycles of 5 presses and 1 breath are repeated.

What is a closed heart massage for?

The essence of chest compressions is to compress the heart, which is filled with blood, between two surfaces - the chest and the spine. When pressed, blood is evacuated from the ventricles, when released - into the atria.

Why is an indirect heart massage necessary? Correctly performed manipulation allows maintaining the upper (systolic) blood pressure (BP) at the level of 60-80 mm. rt. Art., and the lower (diastolic) - 40 mm. rt. Art. The quantity cardiac output is 30%. This level of pressure is sufficient to support the life of the most essential systems for the body - cardiovascular, pulmonary, and central nervous system (central nervous system).

The indication for this manipulation is clinical death, the signs of which are:

Lack of pulsation of the central arteries (carotid, femoral, subclavian).
Lack of breathing movements.
Wide pupil that does not respond to light.
Lack of consciousness.
Cyanosis skin (cyanosis).
Lack of reflexes.
Absence of bleeding from the wound (if any).
Disappearance of the corneal reflex (with mechanical irritation of the cornea of \u200b\u200bthe eye, there is no closure of the eyelids).

Execution technique

The technique of chest compressions is as follows:

Place the patient in a horizontal position.
Place a roller under the patient's neck (this can be rolled clothes, a narrow pillow).
Stand on the left side of the patient. The resuscitator's hands should be placed in the midline of the sternum in the area that is 2-3 transverse fingers above xiphoid process... The left palm should be perpendicular to the sternum, and the right palm, covering the left, should be parallel to the chest (provided that the resuscitator is right-handed).
The palms should be extended as far as possible, and the fingers should not touch the patient.
Pressure on the chest should be carried out under the weight of your body, jerky, rhythmically.
If necessary, mechanical ventilation is performed in two ways - mouth-to-mouth or mouth-to-nose.

Performing an indirect heart massage with preserved breathing is equal to 80-100 clicks per minute. In the absence of breathing movements, the ratio between the number of shocks and breaths is 30: 2, regardless of the number of rescuers.

In case of death, in the presence of medical personnel, a precordial blow is performed - this is a sharp blow to the chest area with a fist at a distance of 25-30 cm with a force of about 10 kg (mechanical defibrillation method).

The criteria for the effectiveness of resuscitation are:

Recovery normal color skin.
Constriction of the pupils, the appearance of their reaction to light; closing of the eyelids.
The appearance of pulsation of the central arteries.
Ripple appearance peripheral arteries, which allows you to measure blood pressure.
Recovery of independent respiratory movements.
The appearance of reflexes of the upper respiratory tract (upper respiratory tract) - cough, vomiting.
Restoration of normal consciousness.

Important! The start of resuscitation measures should be carried out as early as possible, since a delay in CPR (cardiopulmonary resuscitation) by 1 minute reduces its success by 10%.

Rules and features of the

There are several rules for performing chest compressions:

During the manipulation, the victim must be on a hard surface.
During the implementation of the massage of the heart, the hands should be in an extended position.
Pressure on the sternum is made only with the palms, the fingers should be raised up.
During the external massage, the hands should not come off the surface of the chest.
The displacement of the sternum towards the spine in an adult is 4-6 cm.
When carrying out mechanical ventilation, it is necessary to restore the patency of the airways. For this purpose, the index and middle fingers must be wrapped in a scarf or gauze and the oral cavity cleaned (there may be vomit in the mouth, sand - when drowning).

Resuscitation measures are carried out for at least 30 minutes. Earlier this period, the provision of assistance is terminated upon the arrival of an ambulance or after the establishment of biological death.

Features of the closed heart massage in pediatrics:

Heart massage is performed with two fingers or thumb. The resuscitator's fingers are applied to the area 1 cm below the nipple line.
The frequency of pressing in newborns is 120-130 per minute, in children under 10 years of age - up to 100 per minute.
The displacement of the sternum is 1.5 - 2 cm.
If necessary, mechanical ventilation is carried out simultaneously through the nasal and oral cavity of the child.
Before mechanical ventilation airways release with one finger.

Contraindications to chest compressions

There are times when closed heart massage is prohibited. Contraindications to this manipulation are:

Multiple fractures of the ribs or bones of the sternum.
Suspected intrathoracic (pulmonary) bleeding.
Open chest wound.
The presence of deep penetrating wounds.
The onset of symptoms of biological death.
Cardiac arrest in patients suffering from severe inaccurate diseases.
The presence of a syndrome of intravital brain death.
Severe poisoning, incompatible with life.
Refusal of resuscitation in writing.

Conclusion

Every person needs to know the technique of chest compressions. After all, when correct execution massage manipulation will prove to be most effective, and the chances of saving human life will increase.

How to do artificial respiration and chest compressions: video

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