Massage of the heart

Injuries, wounds, poisoning can provoke a stop of the main “motor” of the body – the human heart. Circulatory arrest entails the cessation of tissue and gas exchanges. Without blood flow, metabolic products accumulate inside the cells, and carbon dioxide accumulates in the blood. Metabolism stops, cells begin to die due to lack of oxygen and intoxication with metabolic products.

In this case, it is very important to at least try to carry out resuscitation measures – heart massage. This procedure has a limited time of only thirty minutes. After this period, clinical death becomes irreversible.

Symptoms of cardiac arrest

Signs indicating cardiac arrest are: Pulse arrest (inability to feel the pulse on the carotid artery); respiratory arrest (the patient’s chest is motionless, the mirror brought to the mouth and nose does not fog up); dilated pupils that do not respond to light; loss of consciousness, moreover, a person does not wake up with loud sounds, pats on the face; bluish-gray skin tone.

If there are fresh wounds on the body, then when the heart stops, the bleeding from them stops.

Types of heart massage

To date, there are two ways to massage the heart: direct (open) and indirect (closed).

Direct massage is performed exclusively by qualified medical professionals and only under certain conditions: in particular, during surgery on the organs of the chest or abdominal cavity. The essence of the procedure is the direct compression of the heart muscle with the hands through an incision in the chest or abdomen (in this case, the massage is carried out through the diaphragm). Due to the complexity of performing direct massage of the heart muscle, it cannot be performed by people without appropriate medical education and training.

Indirect (closed) massage of the heart muscle can be performed in any conditions. This is the easiest way to help restore cardiac activity. No medical devices are required for its implementation.

An indirect heart massage provides that during pressure on the chest, the chambers of the heart will also be compressed. As a result, blood through the valves will enter the ventricles from the atria, and then go to the vessels. Due to rhythmic pressure on the chest, the movement of blood through the vessels will not stop. As a result, its own electrical activity and independent work of the organ are activated.

Of course, a heart massage can only be successful if the algorithm of action is carefully followed, and the rescuer follows the approved technique for resuscitation. Massage is necessarily combined with artificial ventilation of the lungs. Each pressure on the chest of the victim provokes the release of about five hundred milliliters of air. When the compression stops, the same portion of air is sucked into the lungs. As a result, passive inhalation and exhalation occur.

The essence and algorithm of massage

External cardiac massage is a rhythmic compression of the heart by compression between the sternum and the spine. Experts note that the chest in a person with cardiac arrest becomes more pliable due to the loss of muscle tone, as a result of which compression is easy to perform. The caregiver, while following the NMS methodology, can easily displace the chest by three to five centimeters. Compression of the heart leads to a decrease in its volume and an increase in intracardiac pressure.

Rhythmic pressing on the chest area leads to the fact that there is a difference in pressure inside the heart cavities, blood vessels that extend from the heart muscle. Blood from the left ventricle travels down the aorta to the brain, while blood from the right ventricle travels to the lungs, where it is oxygenated.

After the pressure on the chest stops, the heart muscle expands, intracardiac pressure decreases, and the chambers fill with blood. As a result, artificial circulation is recreated.

You can perform a closed massage of the heart muscle only on a hard surface. The person must be placed on the floor. After this, it is necessary to perform the so-called precordial punch. It should be directed to the middle third of the chest. The height of the impact should be thirty centimeters. However, according to recent data, the value of precordial shock is significantly reduced, and many experts do not recommend starting resuscitation with it. In order to conduct a closed heart massage, the assisting person puts the palm of one hand on the other, after which he begins to carry out uniform shocks according to the established methodology.

Massage rules

In order for the emergency measures taken to be effective, it is extremely important to observe the technique of heart massage. Only in this case, the efforts made to restore the victim’s cardiac activity can justify themselves.

When performing a heart massage, the following rules should be observed:

1. The rescuer kneels in front of the victim lying on the ground or on the floor. Which side it is from does not matter. However, if the rescuer is right-handed, it will be more convenient for him to do a precordial blow if he is positioned with his right hand to the victim.
2. Place the base of the right palm slightly above the xiphoid process. In this case, the thumb should be directed either towards the chin or towards the victim’s abdomen.
3. The arms of the person performing chest compressions should be fully extended. When the chest is displaced, the center of gravity must be moved to the chest of the person who is being assisted. As a result, the rescuer will be able to save strength. If you bend your arms at the elbow joints, they will quickly get tired.
4. In order for resuscitation to be successful, first aid must arrive within half an hour. The frequency of pressure on the chest of the victim is from sixty times per minute.
5. The depth to which chest compressions must be performed is three to five centimeters. At the same time, the assisting person should not take his hands off the chest of the victim.
6. The next pressure on the chest must be done only after it returns to its original position.
7. During NMS, a fracture of the ribs is possible. This is not a reason to stop resuscitation measures. The only clarification is that pressure should be performed a little less often, but their depth should remain the same.
8. Simultaneously with NMS, artificial respiration is also carried out. The ratio of chest compressions to ventilation should be 30:2. Compression on the victim’s chest provokes exhalation, and the return of the chest to its original position is a passive breath. As a result, the lungs are saturated with oxygen.
9. During resuscitation, more attention should be paid to closed heart massage, and not to artificial respiration.

Algorithm for performing chest compressions

Closed heart massage will be effective only if it is performed in accordance with the algorithm. You need to act as follows:

1. First of all, determine the place where the compression will be performed. There is a widespread belief that the human heart is on the left. This is not entirely true. In fact, the pressure should not be on the left side, but on the center of the chest. This is extremely important, because when compression is applied to the wrong place, you can not only not achieve the desired effect, but also harm. The point we need is in the center of the chest, at a distance of two fingers from the center of the sternum (the place where the ribs meet).
2. Place the base of the palm on this point so that the thumb of the hand “looks” either at the stomach or at the chin of the victim, depending on which side you are from him. Place the second palm crosswise on top of the first. Please note that only the base of the palm should be in contact with the body of the person you are helping. Fingers should remain hanging.
3. Don’t bend your elbows. It is necessary to press due to your own weight, and not the strength of the muscles of the hands, because otherwise you will quickly get tired, and the pressure force at each point will be different.
4. With each pressure, the chest of the victim should fall to a depth of up to five centimeters. In other words, the compression must be strong, because only in this way will you be able to properly disperse the blood through the body so that it delivers oxygen to the brain.
5. Artificial ventilation of the lungs is carried out between pressing. Its cycle is two breaths for every fifteen pushes.

Signs that resuscitation has been successful are the appearance of a pulse in the carotid artery, as well as the reaction of the person’s pupils to light.

Conducting a closed heart massage to a child

Regrettably, sometimes there are situations when, for one reason or another, a cardiac arrest occurs in a child. In this case, the reaction of people who are nearby should be immediate – the baby must immediately begin to conduct a closed heart massage, since every second of the lost time brings the tragic outcome closer.

In infants, clinical death can be caused not only by sudden death syndrome, but also by neurological diseases, sepsis, drowning, airway obstruction, acute bronchospasm, pneumonia, severe injuries or serious burns, and other diseases.

Indications for indirect heart massage for infants and older children are: a sudden deterioration in the child’s condition, fainting, lack of heartbeat when probing the carotid artery, cessation of respiratory activity, lack of pupillary response to light.

Features of the procedure for children

Resuscitation of children has a number of features.

First of all, indirect heart massage for babies should be started immediately after signs of clinical death have been detected. In parallel, artificial respiration is carried out, before which it is necessary to make sure that air passes freely through the respiratory tract.

Indirect heart massage for newborns is performed with little effort. Babies are laid on their backs, with their shoulders to themselves. The thumbs should touch the front of the chest, and their base will be on the lower third of the chest.

In addition, a closed massage of the heart muscle of a newborn can be carried out by placing it on your forearm, and holding its head slightly tilted back in the palm of your hand.

When implementing NMS, children under one year old should use only two fingers for pressure – the second and third. The frequency of compressions should be between eighty and one hundred per minute.

Heart massage for babies aged from one to seven is done, standing to the side of them, using the base of the palm.

When resuscitating children from eight years old, massage is done with both hands. The main thing when performing NMS for a child is to carefully calculate the forces. Too much pressure can lead to damage to the chest, which, in turn, is fraught with injuries to internal organs and the development of hemo- and pneumothorax.

Technique for performing NMS for children

When performing resuscitation of a child, a strict sequence of actions must be carefully observed.

The child should be placed on any hard surface, infants can be placed on their own forearm. Hands are placed 1,5-2,5 cm above the xiphoid process. Pressing is performed rhythmically, the time of maximum chest deflection should not exceed one second. The amplitude of pressure and their frequency varies depending on the age of the child. Babies up to five months of age should do up to one hundred and forty pressures per minute, the sternum should bend to a depth of one and a half centimeters. Children aged six months to a year should do 130-135 clicks, and the sternum should bend two to two and a half centimeters. The frequency of pressing from one to two years – 120-125, from two to three – 110-115, from three to four – 100-105, from four to six – 90-100, from six to eight – 85-90, from eight to ten – 80-85, from ten to twelve – about 80, from twelve to fifteen – 75.

Resuscitation can be considered successful if the baby’s condition improves: his pupils narrow, reacting to light, eyelid tone appears, reflex movements of the larynx are recorded, a pulse can be detected in the carotid and femoral arteries, skin color and mucous membranes improve.