i.ya. horbachevsky ternopil state medical university lecture 2 lecture 2 modern methods of...

I.Ya. HORBACHEVSKY TERNOPIL I.Ya. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITYSTATE MEDICAL UNIVERSITY

Lecture 2Lecture 2

Modern methods of Modern methods of provision of airway provision of airway

patency.patency.

SpeakerSpeaker:: R.M. LyakhovychR.M. Lyakhovych

……to confirm or to confirm or oppose the oppose the circulatory arrest.circulatory arrest.

Patient’s responsePatient’s response Provide patency of Provide patency of

airways supportairways support Check respiration Check respiration

and pulse (not more and pulse (not more than 10 sec)than 10 sec)

Provide patency of airways support, find out if there are signs of life

Patency of airways supportPatency of airways support

Suction units (aspirators)

Three stages of ABC-Three stages of ABC-reanimation. Algorithm of its reanimation. Algorithm of its realization by one and two realization by one and two medical men. Testimony to medical men. Testimony to defibrillation and defibrillation and technique of technique of its execution. Cardiac shock of its execution. Cardiac shock of feature of clinical dynamics, first feature of clinical dynamics, first aid. aid.


Respiratory mask


Laryngeal mask

Laryngeal tube

First aid at the terminal First aid at the terminal states. states.

Concept about the Concept about the terminal states, purpose terminal states, purpose and task the first medical and task the first medical aid, first-aid and medical aid, first-aid and medical rescue.rescue.


laryngeal tubes

laryngeal tubes


Combitube

General principles, legal, General principles, legal, organizational, medical and organizational, medical and deontological deontological features of features of giving the first aid in giving the first aid in extraordinary situation. extraordinary situation. Algorithm of primary Algorithm of primary inspection of the patient in inspection of the patient in the place of event.the place of event.

Patency of airways supportPatency of airways supportRespiratory mask and Ambu bag


A set for conicopuncture

BASIC CONCEPTS BASIC CONCEPTS inin REANIMATOLOGREANIMATOLOGYY

Reanimatology Reanimatology is science about is science about the revival of organism, which the revival of organism, which studies etiology, pathogenesis, studies etiology, pathogenesis, diagnostics and treatment of the diagnostics and treatment of the terminal states.terminal states.

A reanimation A reanimation (abroad widespread (abroad widespread is a term of rescucitation) is a is a term of rescucitation) is a process of replacement and process of replacement and proceeding in the functions of proceeding in the functions of organism by the leadthrough of organism by the leadthrough of the special reanimation measures. the special reanimation measures.

Portable set of respiratory equipmentPortable set of respiratory equipment

Support of artificial ventilation of lungs

Oxygen therapy

Training equipment for developing skills of patency of airways support

Clinical death -| Clinical death -| it is the state it is the state which circulation of blood which circulation of blood and spontaneous breathing and spontaneous breathing absent in the conditions of, absent in the conditions of, but there yet were irrecurent but there yet were irrecurent changes in the human brain, changes in the human brain, when it is yet possible to when it is yet possible to return a patient to life return a patient to life without a clinically without a clinically meaningful neurological meaningful neurological deficit.deficit.

The case of Fabrice Muamba versus the case of Hank GathersThe case of Fabrice Muamba versus the case of Hank GathersСлучай Фабриса Муамба против случая Хэнка Гатерса.Случай Фабриса Муамба против случая Хэнка Гатерса.

Fabrice Muamba collapses at March, 2012 Soccer Fabrice Muamba collapses at March, 2012 Soccer match in U.K. resuscitation for 78 minutesmatch in U.K. resuscitation for 78 minutesФабрис Муамба, март 2012, реанимация длилась Фабрис Муамба, март 2012, реанимация длилась 78 минут78 минут

Success Success Fabrice Muamba with ICD leaving Hospital after Fabrice Muamba with ICD leaving Hospital after

successful over 1 hour on field resuscitationsuccessful over 1 hour on field resuscitation УспехУспех

Фабрис Муамба покидает госпиталь после успешно, Фабрис Муамба покидает госпиталь после успешно, длившейся более 1 часа реанимации.длившейся более 1 часа реанимации.

Versus the TragicVersus the Tragic23 yo Hank Gathers collapses in 1990 basketball game and has brief seizure….not 23 yo Hank Gathers collapses in 1990 basketball game and has brief seizure….not

recognized as v fib arrest until too laterecognized as v fib arrest until too late Трагедия Трагедия

23 летний Хэнк потерял сознание в 1990г. Во время баскетбольного матча, 23 летний Хэнк потерял сознание в 1990г. Во время баскетбольного матча, приступ не был определен как остановка сердца, было поздноприступ не был определен как остановка сердца, было поздно

Biological death Biological death is consisting is consisting of irreversible changes above of irreversible changes above all things of CNS, when to life all things of CNS, when to life turning a man is impossible. turning a man is impossible. To the clinical signs of To the clinical signs of biological death take drying biological death take drying out and dimness of cornea, of out and dimness of cornea, of a corpse spots and of a corpse.a corpse spots and of a corpse.

Such concepts utillize in Such concepts utillize in rescucitationrescucitation, as a decortication , as a decortication (social death) is death of cortex (when (social death) is death of cortex (when somatic functions can recommence somatic functions can recommence almost in full, but the function of almost in full, but the function of cortex does not recommence) a that cortex does not recommence) a that decerebration is death of cerebrum.decerebration is death of cerebrum.

By the clinical signs of decortication ñ By the clinical signs of decortication ñ absence of свідо мості and purchased absence of свідо мості and purchased reflexes. There is a timber-toe by the reflexes. There is a timber-toe by the dead bark of the brain on condition dead bark of the brain on condition of valuable supervision can live yet of valuable supervision can live yet long time. To set the exact diagnosis long time. To set the exact diagnosis of decortication heavily, as there are of decortication heavily, as there are eventsevents, when after the protracted , when after the protracted comma a man came to consciousness.comma a man came to consciousness.

A decerebration arises up A decerebration arises up after more protracted total after more protracted total ischemia of brain (20 ischemia of brain (20 minmin and and anymore), sometimes can anymore), sometimes can develop on a background a develop on a background a decortication in the case of decortication in the case of progress of іprogress of іschemicalschemical--reperfusion reperfusion defeats. defeats.

TYPES OF STOP OF TYPES OF STOP OF the the HEARTHEART Fibrillation of Fibrillation of ventriclesventricles

The most widespread The most widespread type of uneffective type of uneffective circulation of blood in circulation of blood in not hospital terms is all not hospital terms is all of to 2/3 cases. of to 2/3 cases.

During During fibrillationfibrillation of ventricles there is of ventricles there is a desynchronization of reductions of a desynchronization of reductions of myo-fibriles myo-fibriles myocardium with the loss myocardium with the loss of pumping function of of pumping function of the the heart. On heart. On EKG EKG fibrillation fibrillation of ventricles shows up of ventricles shows up alike on a wave the curve of differentalike on a wave the curve of different amplitude in default of auricle and amplitude in default of auricle and gastric gastric ccomplexesomplexes..

Unpulsive gastric Unpulsive gastric tachycardiatachycardia

The most widespread The most widespread type of uneffective type of uneffective circulation of blood is in circulation of blood is in the conditions of the conditions of permanent permanent establishmentestablishment. .

AsystoleAsystole Practical absence of electric and Practical absence of electric and

mechanical activity of myocardium. mechanical activity of myocardium. On EKG appears as an almost On EKG appears as an almost straight linestraight line

The most frequent reason of asystole The most frequent reason of asystole is ischemic heart (IKHS) trouble, it is ischemic heart (IKHS) trouble, it can develop on a background can develop on a background fibrilationfibrilation of ventricles which are an of ventricles which are an unfavorable unfavorable prognosticprognostic sign sign..

Electromechanic dissociation Electromechanic dissociation (EMD) and bradiarythmia with (EMD) and bradiarythmia with

the uneffective mechanical activity the uneffective mechanical activity of heartof heart

At the transferred At the transferred states electric states electric activity of heart is activity of heart is stored, but it is not stored, but it is not accompanied accompanied effective reductions effective reductions of myocardium. On of myocardium. On EKG discover typical EKG discover typical and off type gastric and off type gastric complexes with a complexes with a different rhythm. different rhythm.

off type gastric complexes atelectromechanical dissociation

Diagnostics of uneffective Diagnostics of uneffective circulation of bloodcirculation of blood

The element of The element of pneumocardial pneumocardial reanimation is very reanimation is very important. On timely important. On timely diagnostics of stop of diagnostics of stop of circulation of blood a circulation of blood a prognosis depends often.prognosis depends often.

But more frequent But more frequent all uneffective all uneffective circulation of circulation of blood is diagnosed blood is diagnosed only after clinical only after clinical signs. To them signs. To them absence of pulse absence of pulse belongs, foremost, belongs, foremost, on central arteries on central arteries (sleepy and thigh). (sleepy and thigh). The method of The method of research of pulse research of pulse is resulted the way is resulted the way of of palpation.palpation.

Research of pulse by means of palpation on a. carotis

To the early signs of unefficiency of To the early signs of unefficiency of circulation of blood circulation of blood paralytic paralytic mydriasis mydriasis belongs also: at raising of belongs also: at raising of overhead eyelid a pupil remains wide overhead eyelid a pupil remains wide and irresponsive on lightand irresponsive on light

Research of pulse by Research of pulse by palpationpalpation and estimation of the state of and estimation of the state of pupilpupillala it is possible it is possible to to perform perform simultaneously.simultaneously.

As already marked higher, the As already marked higher, the obligatory signs of uneffective obligatory signs of uneffective circulationcirculation is absence of is absence of consciousness and rhythmic consciousness and rhythmic independent breathing.independent breathing.

PNEUMOCARDIAL PNEUMOCARDIAL REANIMATIONREANIMATION

Complex of measures which are Complex of measures which are executed during the leadthrough of executed during the leadthrough of CPR, CPR, it is possible it is possible to divide to divide on three on three basic groups:basic groups:

base sustentation - after the English base sustentation - after the English letters of Aletters of ABCBC::

A (airway ореn) A (airway ореn) providing of providing of communicating of respiratory tracts communicating of respiratory tracts

BB (breeth) (breeth) artificial respiration artificial respiration CC (сirculation) a massage of heart (сirculation) a massage of heart

Must be conducted any man which is Must be conducted any man which is alongside;alongside;

subsequent methods of subsequent methods of CPCPR, the purpose R, the purpose of which is proceeding in independent of which is proceeding in independent circulation of blood for a patient: electric circulation of blood for a patient: electric defibrilationdefibrilation, medicinal therapy;, medicinal therapy;

stabilizing of basic vitally important stabilizing of basic vitally important functions of organism sick, above all functions of organism sick, above all things it touches activity of cerebrum, things it touches activity of cerebrum, heart and vessels, intensive therapy.heart and vessels, intensive therapy.

If a patient is in the swoon If a patient is in the swoon state (absence of reaction on state (absence of reaction on asking asking and mechanical and mechanical irritation), it is necessary to irritation), it is necessary to performperform the followings actions: the followings actions:

To cause the brigade of To cause the brigade of medical first-aid, if there is medical first-aid, if there is possibility possibility (it is better) - (it is better) - reanimation brigade.reanimation brigade.

Providing of communicating of Providing of communicating of respiratory tractsrespiratory tracts

A patient A patient at stop of at stop of circulation of blood circulation of blood has a presence of has a presence of extraneous bodies extraneous bodies reasons of violation reasons of violation of communicating of of communicating of respiratory tracts in respiratory tracts in the cavity of mouth the cavity of mouth and and swallowswallow; ; supra-supra-larynx larynx and the root and the root of of tongue tongue is is recovered included recovered included in a larynx in a larynx

Violation of communicating of overhead respiratory tracts in event of stopping of circulation of blood

The next stage is The next stage is providing of providing of communicating of communicating of larynx. As a result larynx. As a result of that a of that a tongue tongue is is anatomically anatomically related to the related to the lower jaw, it is lower jaw, it is necessary to show necessary to show out a lower jaw out a lower jaw how it is indicated how it is indicated on a figon a figureure

Variants of leading-out of lower jaw for proceeding in communicating of overhead respiratory tracts

More professional More professional methods of methods of providing of providing of communicating of communicating of respiratory tracts respiratory tracts is is intubationintubation of of trachea, use of trachea, use of laringeal laringeal mask mask or or combined air-combined air-tube tube - combitube - combitube

Laringeal mask

IntubaIntubationtion of trachea is the most of trachea is the most reliable reliable method of method of providing of providing of

communicating of respiratory tracts, communicating of respiratory tracts, but it but it must do it must do it professional which professional which

will be able to execute manipulation in will be able to execute manipulation in short short period period (30-40 (30-40 s s).).

Urgent methods of artificial Urgent methods of artificial ventilation of lightsventilation of lights

The methods of AB can be divided The methods of AB can be divided

into 2 groups: inciter and expiration. into 2 groups: inciter and expiration. Unfortunately, the inciter methods of Unfortunately, the inciter methods of AB, which almost reproduce the AB, which almost reproduce the physiology mechanism of the physiology mechanism of the spontaneous breathing, did not find spontaneous breathing, did not find the wide use in clinical practice the wide use in clinical practice through some inconveniences and through some inconveniences and difficult equipment for their difficult equipment for their leadthrough.leadthrough.

If the leadthrough of If the leadthrough of AB AB is uneffective is uneffective (what absence of (what absence of excursionexcursion of thorax of thorax testifies to), it is testifies to), it is needed to suspect needed to suspect the presence of the presence of extraneous body in extraneous body in lower respiratory lower respiratory tracts (below vocal tracts (below vocal connection). At that connection). At that rate it follows rate it follows to use to use reception reception byby GeymlikhGeymlikh – under- – under-diaphragmatic shodiaphragmatic shove ve

Indirect mIndirect massage of heartassage of heart A method is based on the A method is based on the

compression of ventricles compression of ventricles of heart between of heart between sternum sternum and and and and columncolumn..

Circulation Circulation the the leadthrough of the leadthrough of the external external massage of heart massage of heart provided due to two provided due to two mechanisms: to the effect mechanisms: to the effect of pectoral pump and of pectoral pump and direct compression of direct compression of ventricles of heart, that is ventricles of heart, that is why more expedient would why more expedient would be to talk about the be to talk about the massage of thorax.massage of thorax.

Reanimator becomes from Reanimator becomes from one side from a patient, one side from a patient, places basis of one palm places basis of one palm on on middle part of sternum middle part of sternum approximately on 2 approximately on 2 fingers higher from to fingers higher from to basis of basis of sworden out-sworden out-growthgrowth and along and along brest-brest-bone bone disposes the second disposes the second palm.palm.

Then by direct hands, not Then by direct hands, not bending them in elbow bending them in elbow joints (it saves forces), joints (it saves forces), reanimator reanimator executes executes pressure on pressure on sternum sternum on a on a depth 4-6 sdepth 4-6 smm for adults. for adults.

Rhythms not to defibrilationAsystolia/PEA

Reasons of unefficiency of the Reasons of unefficiency of the closed massage of heart can be closed massage of heart can be hypovolemyhypovolemy, , hemopericarditis, hemopericarditis, anatomic defects of thorax.anatomic defects of thorax.

It should be remembered that It should be remembered that during the leadthrough of the during the leadthrough of the closed massage of heart it is closed massage of heart it is impossible to do the protracted impossible to do the protracted (over 5-10 (over 5-10 ss) pauses.) pauses.

Many thanks!Many thanks!

i.ya. horbachevsky ternopil state medical university lecture 2 lecture 2 modern methods of...

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