Artificial respiration

Artificial respiration (AI) is an immediate emergency measure in the event that a person’s own breathing is absent or impaired to such an extent that it poses a threat to life. The need for artificial respiration may arise when assisting those who have received sunstroke, drowned, electric shock, as well as poisoning with certain substances.

The purpose of the procedure is to ensure the process of gas exchange in the human body, in other words, to ensure sufficient saturation of the blood of the victim with oxygen and the removal of carbon dioxide from it. In addition, artificial ventilation of the lungs has a reflex effect on the respiratory center located in the brain, as a result of which spontaneous breathing is restored.

Mechanism and methods of artificial respiration

Only due to the process of respiration, human blood is saturated with oxygen and carbon dioxide is removed from it. After air enters the lungs, it fills the air sacs called alveoli. The alveoli are permeated by an incredible number of small blood vessels. It is in the pulmonary vesicles that gas exchange takes place – oxygen from the air enters the blood, and carbon dioxide is removed from the blood.

In the event that the supply of oxygen to the body is interrupted, vital activity is threatened, since oxygen plays the “first violin” in all oxidative processes that occur in the body. That is why when breathing stops, artificial ventilation of the lungs should begin immediately.

The air entering the human body during artificial respiration fills the lungs and irritates the nerve endings in them. As a result, nerve impulses enter the respiratory center of the brain, which are a stimulus for the production of response electrical impulses. The latter stimulate the contraction and relaxation of the muscles of the diaphragm, resulting in stimulation of the respiratory process.

Artificial provision of the human body with oxygen in many cases allows you to completely restore an independent respiratory process. In the event that, in the absence of breathing, cardiac arrest is also observed, it is necessary to carry out its closed massage.

Please note that the absence of breathing triggers irreversible processes in the body after only five to six minutes. Therefore, timely artificial ventilation of the lungs can save a person’s life.

All methods of performing ID are divided into expiratory (mouth-to-mouth and mouth-to-nose), manual and hardware. Manual and expiratory methods compared to hardware are considered more labor-intensive and less effective. However, they have one very significant advantage. You can perform them without delay, almost anyone can cope with this task, and most importantly, there is no need for any additional devices and devices that are far from always at hand.

Indications and contraindications

Indications for the use of ID are all cases when the volume of spontaneous ventilation of the lungs is too low to ensure normal gas exchange. This can happen in many both urgent and planned situations:

1. With disorders of the central regulation of respiration caused by a violation of cerebral circulation, tumor processes in the brain or its injury.
2. With medication and other types of intoxication.
3. In case of damage to the nerve pathways and neuromuscular synapse, which can be provoked by trauma to the cervical spine, viral infections, the toxic effect of certain drugs, poisoning.
4. With diseases and injuries of the respiratory muscles and chest wall.
5. In cases of lung lesions, both obstructive and restrictive.

The need to use artificial respiration is judged based on a combination of clinical symptoms and external data. Changes in the size of the pupils, hypoventilation, tachy- and bradysystole are conditions in which artificial ventilation of the lungs is necessary. In addition, artificial respiration is required in cases where spontaneous ventilation of the lungs is “turned off” with the help of muscle relaxants introduced for medical purposes (for example, during anesthesia during surgery or during intensive care for a convulsive syndrome).

As for cases when ID is not recommended, there are no absolute contraindications. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. So, for example, if the venous return of blood is difficult, artificial respiration regimes are contraindicated, which provoke an even greater violation of it. In case of lung injury, lung ventilation methods based on high-pressure air injection, etc. are prohibited.

Preparation for artificial respiration

Before performing expiratory artificial respiration, the patient should be examined. Such resuscitation measures are contraindicated for facial injuries, tuberculosis, polio, and trichlorethylene poisoning. In the first case, the cause is obvious, and in the last three, performing expiratory ventilation endangers the resuscitator.

Before proceeding with the implementation of expiratory artificial respiration, the victim is quickly released from clothes that are squeezing the throat and chest. The collar is unbuttoned, the tie is untied, you can unfasten the trouser belt. The victim is placed supine on his back on a horizontal surface. The head is thrown back as much as possible, the palm of one hand is placed under the back of the head, and the forehead is pressed with the second palm until the chin is in line with the neck. This condition is necessary for successful resuscitation, since with this position of the head, the mouth opens, and the tongue moves away from the entrance to the larynx, as a result of which air begins to flow freely into the lungs. In order for the head to remain in this position, a roll of folded clothes is placed under the shoulder blades.

After that, it is necessary to examine the victim’s oral cavity with your fingers, remove blood, mucus, dirt and any foreign objects.

It is the hygienic aspect of performing expiratory artificial respiration that is the most delicate, since the rescuer will have to touch the victim’s skin with his lips. You can use the following technique: make a small hole in the middle of a handkerchief or gauze. Its diameter should be two to three centimeters. The tissue is applied with a hole to the mouth or nose of the victim, depending on which method of artificial respiration will be used. Thus, air will be blown through the hole in the fabric.

Artificial respiration from mouth to mouth

For mouth-to-mouth artificial respiration, the one who will provide assistance should be on the side of the victim’s head (preferably on the left side). In a situation where the patient is lying on the floor, the rescuer kneels down. In the event that the jaws of the victim are clenched, they are forcefully pushed apart.

After that, one hand is placed on the forehead of the victim, and the other is placed under the back of the head, tilting the patient’s head back as much as possible. Having taken a deep breath, the rescuer holds the exhalation and, bending over the victim, covers the area of ​​his mouth with his lips, creating a kind of “dome” over the patient’s mouth opening. At the same time, the victim’s nostrils are clamped with the thumb and forefinger of the hand located on his forehead. Ensuring tightness is one of the prerequisites for artificial respiration, since air leakage through the victim’s nose or mouth can nullify all efforts.

After sealing, the rescuer exhales rapidly, forcefully, blowing air into the airways and lungs. The duration of the exhalation should be about a second, and its volume should be at least a liter in order for effective stimulation of the respiratory center to occur. At the same time, the chest of the one who is being helped should rise. In the event that the amplitude of its rise is small, this is evidence that the volume of air supplied is insufficient.

After exhaling, the rescuer unbends, freeing the victim’s mouth, but at the same time keeping his head tilted back. The exhalation of the patient should last about two seconds. During this time, the rescuer must take at least one normal “for himself” breath before taking the next breath.

Please note that if a large amount of air does not enter the lungs, but into the patient’s stomach, this will make it much more difficult to save him. Therefore, periodically you should press on the epigastric (epigastric) region to free the stomach from air.

Artificial respiration from mouth to nose

With this method, artificial ventilation of the lungs is carried out if it is not possible to properly open the patient’s jaws or if there is an injury to the lips or mouth area.

The rescuer places one hand on the victim’s forehead, and the other on his chin. At the same time, he simultaneously throws back his head and presses his upper jaw to the lower one. With the fingers of the hand that supports the chin, the rescuer must press the lower lip so that the victim’s mouth is completely closed. After taking a deep breath, the rescuer covers the victim’s nose with his lips and blows air through the nostrils with force, while watching the movement of the chest.

After artificial inspiration is completed, the patient’s nose and mouth must be released. In some cases, the soft palate can prevent air from escaping through the nostrils, so when the mouth is closed, there may be no exhalation at all. When exhaling, the head must be kept tilted back. The duration of artificial expiration is about two seconds. During this time, the rescuer himself must make several exhalations-breaths “for himself.”

How long is artificial respiration

To the question of how long it is necessary to carry out ID, there is only one answer. Ventilate the lungs in a similar mode, taking breaks for a maximum of three to four seconds, should be until the moment when full spontaneous breathing is restored, or until the doctor who appears gives other instructions.

In this case, you should constantly monitor that the procedure is effective. The chest of the patient should swell well, the skin of the face should gradually turn pink. It is also necessary to ensure that there are no foreign objects or vomit in the victim’s airways.

Please note that due to the ID, the rescuer himself may become weak and dizzy due to a lack of carbon dioxide in the body. Therefore, ideally, two people should perform the blowing of air, which can alternate every two to three minutes. In the event that this is not possible, the number of breaths should be reduced every three minutes so that the person who performs resuscitation normalizes the level of carbon dioxide in the body.

During artificial respiration, you should check every minute if the victim’s heart has stopped. To do this, feel the pulse on the neck in the triangle between the windpipe and the sternocleidomastoid muscle with two fingers. Two fingers are placed on the lateral surface of the laryngeal cartilage, after which they are allowed to “slide” into the hollow between the sternocleidomastoid muscle and the cartilage. It is here that the pulsation of the carotid artery should be felt.

In the event that there is no pulsation on the carotid artery, chest compressions should be started immediately in combination with ID. Doctors warn that if you miss the moment of cardiac arrest and continue to do artificial ventilation of the lungs, it will not be possible to save the victim.

Features of the procedure in children

When carrying out artificial ventilation, babies under one year old use the mouth-to-mouth and nose technique. If the child is over a year old, the mouth-to-mouth method is used.

Small patients are also placed on their backs. For babies up to a year old, they put a folded blanket under their backs or slightly raise their upper body by placing a hand under their backs. The head is thrown back.

The person providing assistance takes a shallow breath, hermetically covers the mouth and nose of the child (if the baby is under one year old) or only the mouth with his lips, after which he blows air into the respiratory tract. The volume of air blown should be the smaller, the younger the young patient. So, in the case of resuscitation of a newborn, it is only 30-40 ml.

If sufficient air enters the respiratory tract, chest movements appear. It is necessary to make sure after inhalation that the chest is lowered. If too much air is blown into the lungs of the baby, this can cause the alveoli of the lung tissue to rupture, as a result of which air will escape into the pleural cavity.

The frequency of breaths should correspond to the respiratory rate, which tends to decrease with age. So, in newborns and children up to four months, the frequency of inhalations-exhalations is forty per minute. From four months to six months, this figure is 40-35. In the period from seven months to two years – 35-30. From two to four years, it is reduced to twenty-five, from six to twelve years – to twenty. Finally, in a teenager aged 12 to 15 years, the respiratory rate is 20-18 breaths per minute.

Manual methods of artificial respiration

There are also so-called manual methods of artificial respiration. They are based on a change in the volume of the chest due to the application of an external force. Let’s consider the main ones.

Sylvester’s way

This method is the most widely used. The victim is placed on his back. A cushion should be placed under the lower part of the chest so that the shoulder blades and the back of the head are lower than the costal arches. In the event that two people perform artificial respiration using this technique, they kneel on either side of the victim so as to be at the level of his chest. Each of them holds the victim’s hand in the middle of the shoulder with one hand, and a little above the level of the hand with the other. Then they begin to rhythmically raise the victim’s arms, stretching them behind his head. As a result, the chest expands, which corresponds to inhalation. After two or three seconds, the victim’s hands are pressed to the chest, while squeezing it. This performs the function of exhalation.

In this case, the main thing is that the movements of the hands should be as rhythmic as possible. Experts recommend that those who perform artificial respiration use their own rhythm of inhalations and exhalations as a “metronome”. In total, about sixteen movements per minute should be done.

ID by the Sylvester method can be produced by one person. He needs to kneel behind the head of the victim, intercept his hands above the hands and perform the movements described above.

With fractures of the arms and ribs, this method is contraindicated.

Schaeffer’s method

In the event that the victim’s hands are injured, the Schaeffer method can be used to perform artificial respiration. Also, this technique is often used to rehabilitate people injured while on the water. The victim is placed prone, the head is turned to the side. The one who does artificial respiration kneels, and the body of the victim should be located between his legs. Hands should be placed on the lower part of the chest so that the thumbs lie along the spine, and the rest lie on the ribs. When exhaling, you should lean forward, thus compressing the chest, and while inhaling, straighten up, stopping the pressure. The arms do not bend at the elbows.

Please note that with a fracture of the ribs, this method is contraindicated.

Laborde method

The Laborde method is complementary to the methods of Sylvester and Schaeffer. The victim’s tongue is grasped and rhythmic stretching is performed, simulating respiratory movements. As a rule, this method is used when breathing has just stopped. The appeared resistance of the tongue is proof that the person’s breathing is being restored.

Kallistov’s method

This simple and effective method provides excellent lung ventilation. The victim is placed prone, face down. A towel is placed on the back in the area of ​​the shoulder blades, and its ends are carried forward, passing under the armpits. The one who provides assistance should take the towel by the ends and raise the body of the victim seven to ten centimeters from the ground. As a result, the chest expands and the ribs rise. This corresponds to the breath. When the torso is lowered, it simulates exhalation. Instead of a towel, you can use any belt, scarf, etc.

Howard’s way

The victim is positioned supine. A cushion is placed under his back. Hands are taken behind the head and pulled out. The head itself is turned to the side, the tongue is extended and fixed. The one who performs artificial respiration sits astride the victim’s femoral area and places his palms on the lower part of the chest. Spread fingers should capture as many ribs as possible. When the chest is compressed, it corresponds to inhalation; when the pressure is stopped, it simulates exhalation. Twelve to sixteen movements should be done per minute.

Frank Yves method

This method requires a stretcher. They are installed in the middle on a transverse stand, the height of which should be half the length of the stretcher. The victim is laid prone on the stretcher, the face is turned to the side, the arms are placed along the body. A person is tied to a stretcher at the level of the buttocks or thighs. When lowering the head end of the stretcher, inhale, when it goes up – exhale. The maximum breathing volume is achieved when the victim’s body is tilted at an angle of 50 degrees.

Nielsen method

The victim is placed face down. His arms are bent at the elbows and crossed, after which they are placed palms down under the forehead. The rescuer kneels at the head of the victim. He puts his hands on the shoulder blades of the victim and, without bending them at the elbows, presses with his palms. This is how exhalation happens. To inhale, the rescuer takes the shoulders of the victim at the elbows and straightens up, lifting and pulling the victim towards himself.

Hardware methods of artificial respiration

For the first time, hardware methods of artificial respiration began to be used in the eighteenth century. Even then, the first air ducts and masks appeared. In particular, doctors suggested using bellows for blowing air into the lungs, as well as devices created in their likeness.

The first automatic devices for ID appeared at the end of the nineteenth century. At the beginning of the twentieth, several varieties of respirators appeared at once, which created an intermittent vacuum and positive pressure either around the entire body, or only around the chest and abdomen of the patient. Gradually, respirators of this type were replaced by air blowing respirators, which differed in less solid dimensions and at the same time did not impede access to the patient’s body, allowing medical manipulations to be carried out.

All currently existing ID devices are divided into external and internal. External devices create negative pressure either around the entire body of the patient or around his chest, which causes inspiration. Exhalation in this case is passive – the chest simply subsides due to its elasticity. It can also be active if the apparatus creates a positive pressure zone.

With the internal method of artificial ventilation, the device is connected through a mask or intubator to the respiratory tract, and inhalation is carried out due to the creation of positive pressure in the device. Devices of this type are divided into portable, designed to work in the “field” conditions, and stationary, the purpose of which is prolonged artificial respiration. The former are usually manual, while the latter operate automatically, driven by a motor.

Complications of artificial respiration

Complications due to artificial respiration occur relatively rarely even if the patient is on mechanical ventilation for a long time. Most often, undesirable effects relate to the respiratory system. So, due to an incorrectly chosen regimen, respiratory acidosis and alkalosis can develop. In addition, prolonged artificial respiration can cause the development of atelectasis, since the drainage function of the respiratory tract is impaired. Microatelectasis, in turn, can become a prerequisite for the development of pneumonia. Preventive measures that will help avoid the occurrence of such complications are meticulous respiratory hygiene.

If the patient breathes pure oxygen for a long time, this can cause pneumonitis. The oxygen concentration therefore should not exceed 40-50%.

In patients who have been diagnosed with abscessing pneumonia, ruptures of the alveoli may occur during artificial respiration.

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