Resuscitation

The recovery of the organism (reanimation) - restoration of dying or just faded functions viable organism at the time of death from accidental causes (blood loss, asphyxia, shock, and so on).
For the purposes of recovery of the organism or the treatment of terminal States applies a complex of special treatment. The study of the pathophysiology and treatment of the final stages of the life of the organism, and the identification of common and private laws in different types of dying has led to the creation of a science about the revival of the body - reanimatology (from lat. reanimare to life), which arose on the crossroads of interests of a number of disciplines: biology, surgery, obstetrics, anesthesiology, therapy and other Sensing data of these Sciences related to the problem of intensive care, resuscitation, in turn, enriches biology, surgery, anesthesiology, etc. the results of their own research.
To a terminal States (the final stages of life) are: Pagonia, agony (see) and clinical death.
For Prearalie (perianalnogo state) are characterized by the decrease and change in the functional activity of the Central and peripheral nervous system, as well as reflex excitability of tissues. Breathing in this period, frequent and surface, the maximum blood pressure does not exceed 60-70 mm RT. Art., pulse frequent and small filling. Of hemodynamics and respiration determine the development of hypoxia (see), which is gradually progressing.
All these pathological factors adversely effect on the function of many organs and systems, compounding the frustration of hemodynamics and respiration, and facilitates the transition perianalnogo state in agony, characterized by the absence of consciousness, ocular reflexes and reactions to external stimuli. With increasing hypoxia gradual extinction of electrical activity in the pores of the brain. In the period of agony b under off cortical regulation celebrated the maximum activity of the centers of the medulla oblongata, which at this time mobilize the body's defense mechanisms to combat developing dying. Breathing in the period of agony is a rare, deep and convulsions. Tachycardia followed atonal bradycardia. ECG, there are different violations atrioventricular and intraventricular conduction, sometimes oppression sinus Avtomatiki, politopnaya arrythmia. Blood pressure usually is not specified, the heart sounds deaf. Identify the characteristic features of hypoxic metabolism in the tissues of the brain begins to prevail, a more primitive form of exchange - glycolysis, the processes of disintegration prevail over the processes of synthesis, to expose violations elektrolitnogo balance. The blood accumulates a large number of non-completely oxidized products of metabolism - organic acid (acidosis). To metabolic disorders acid-base balance can join shifts the pH of gas origin.
After the agony comes clinical death. In the period of clinical death there are no external signs of life - the heart activity and respiration, but on the ECG for a long time (20-30 minutes) can register biopotentials heart in a rare bilateral or monophasic complexes. Sometimes in the course of dying coordinated activities of the ventricles is broken and develops fibrillation of the heart. In this case, the QRs complexes on ECG change fibrillar oscillations, dying under increasing hypoxia.
During the clinical death of Central nervous system function now. However, in the tissues remain metabolic processes occurring at a low level. First, there is an increased glycolysis, as measured by the accumulation of lactic acid, then the intensity of the glycolytic processes falls. In normal conditions of temperature and energy resources of the brain exhausted after a 5-b minutes after stopping the heart and respiration (dying from blood loss); at the sudden stopping of the flow (e.g. in atrial ventricular heart) time of dying extended to 8-10 min. After full restoration of the vital functions of human organism is impossible because of irreversible changes in organs and tissues, primarily in the Central nervous system. Clinical death replaces the biological death.
The duration of clinical death, therefore, is very limited. Experimental studies conducted in the laboratory to revive the body of the AMS of the USSR, has shown that the most effective method of extension of clinical death - deep cooling of the body. In experiments on dogs was the possibility of persistent restore the vital functions of animals after two hours of clinical death, provided they cooling in the process of dying to 10-8 degrees.
In the treatment of terminal States should combine measures to combat hypoxia and towards normalization of metabolism stimulation functions of vital organs and systems. Currently, a complex method of resuscitation, including heart massage (direct and external), artificial respiration, blood discharge of blood and blood fluids and defibrillation heart.
The most significant component of the complex method of resuscitation - heart massage applied with sudden cardiac arrest any etiology, including in destructive processes in the attack (myocardial infarction, krupnooptovye myocarditis) or damage valve apparatus.
Methodology of external cardiac massage is rhythmic (with frequency 50 to 70 in 1 min) pressure proximal part of the palm on the lower third of the sternum, a shift in direction to the spine on 3-6 see If this patient is placed on a hard surface (floor, shield and others) and freed from the constraints of clothing. If indirect massage gives positive results, you should go to a direct massage. With this purpose the chest opened in IV-V intercostal space (Lefort). Exposing the pericardium, providing assistance covers the heart is right or left hand and starts rhythmically to squeeze the ventricles with frequency 60-80 every 1 minutes In order to avoid damage of myocardium massage carry out the Palmar surface of the fingers and hand. During the massage the blood of the cavities of the heart enters the vessels of large and small circle of blood circulation, blood pressure rises up to 60-80 mm RT. degree and higher. Heart massage - both direct and exterior combined with artificial respiration (see). Both of these activities contribute to the elimination of hypoxia and normalization of metabolism, which in turn leads to the restoration of independent breathing and heart rate, and later the functions of the Central nervous system.


Artificial ventilation of the lungs is carried out with the help of special breathing apparatus [DP-1, DP-2, "RPR" (France), "Angstrem" (Sweden), HERAULT, RPA-1 and others] or a bag of anaesthesia apparatus. In addition to hardware, apply also expiratory artificial respiration (blowing air into the lungs of the victim "mouth-to mouth or mouth to the nose). The air is blown into through the layer of gauze (a handkerchief) using incubator or special duct made of plastic. To ensure the airway head of the patient should tip ago.
Arterial injection is carried out in order reflex stimulation of the cardiovascular system, as well as improving the trophic processes in the myocardium by delivery in coronary vessels oxygenated blood. Arterial injection is carried out by centripetal the introduction of blood or blood fluid under pressure 180-220 mm RT. Art. this purpose reveal one of peripheral arteries - beam, shoulder or back of the tibia. Method of arterial pressure is particularly important for the prevention of clinical death in severe bleeding, shock III and IV degree. During clinical death simultaneous application of cardiac massage and blood pressure promotes faster recovery self heart.
With the development of ventricular fibrillation recovery coordinated myocardial contractions carried out with the help of a special apparatus - defibrillator. Experience has shown that the most effective defibrillation discharge of the capacitor voltage 1500-2000 In (with the naked heart) or 3000-4500 In (without opening the chest).
In addition to these components of a complex method of resuscitation, in clinical practice have found dissemination and other methods of limited scope of application: electrical stimulation of the heart in full cross-blockade (illness Morgagni - Adams - Stokes equations), electro therapy for some disorders of cardiac rhythm (attack paroxysmal tachycardia, atrial fibrillation). In severe atopic postpartum hemorrhage very promising electrical stimulation of the uterus. The perspective should be considered as a development of the method of artificial blood circulation through perfusion devices (see artificial Circulation) for the purposes of prevention and treatment of terminal States.
The restoration of the vital functions of the organism in the intensive care unit (normalization of metabolic processes, recovery heart activity and respiration functions of the Central nervous system, the dynamics of EEG and ECG) mainly occurs in the reverse order to that place at the time of death, although varies depending on the development of pathological process and duration of clinical death.
One of the most responsible stages of resuscitation and rehabilitation period. The further fate of the patient depends on the correctness of the chosen therapeutic management. The priority actions recommended regardless of etiology and pathogenesis of the main disease, caused the development of terminal States, are in the normalization of hemodynamics and respiration, decrease of acidosis, in the struggle with swelling of the brain.