Cardiovary Resuscitation (SLR) - First Aid - EMERCOM of Russia

Rules of behavior

First aid in the absence of consciousness, stopping the breath and blood circulation

The main signs of life at the victim

The main signs of life include the presence of consciousness, independent respiration and blood circulation. They are checked during the implementation of the cardiovascular intensive care algorithm.

Causes of respiratory disorders and blood circulation я

A sudden death (stopping respiration and blood circulation) can be caused by diseases (myocardial infarction, heart rate disorders, etc.) or external influence (injury, electric shock, drowning, etc.). Regardless of the reasons for the disappearance of signs of life, cardiopulmonary resuscitation is carried out in accordance with a certain algorithm recommended by the Russian National Resuscitation Council and the European Council for Resuscitation.

Methods for checking consciousness, breathing, blood circulation at the victim

When first aid, the simplest ways of checking the presence or absence of signs of life are used:

- To verify the consciousness, the first aid participant is trying to join the victims of verbal and tactile contact, checking his reaction to it;

- To test the respiration, tanging, hearing and vision (more detail the technique of verification of consciousness and respiration is described in the next section);

- The absence of blood circulation in the victim is determined by checking the pulse on the main arteries (simultaneously with the definition of respiration and in the presence of appropriate training). In view of the insufficient accuracy of checking the presence or absence of blood circulation by the method of determining the pulse on the main arteries, it is recommended to focus on the lack of consciousness and respiration to make a decision on conducting cardiopulmonary resuscitation.

Modern algorithm for conducting cardiovascular resuscitation (SLR). Technique of pressure with hands on the sternum of victim and artificial respiration during the COM

At the scene, the participant in providing first aid should evaluate the security for himself, affected (victims) and others. After that, threatening factors should be eliminated or minimize the risk of own damage, the risk for the affected (victims) and others.

Next, it is necessary to check the presence of consciousness from the victim. To verify consciousness, it is necessary to accurately stretch the victim of the shoulders and loudly ask: "What is with you? Do you need help? ". A person who is unconscious will not be able to respond and respond to these questions.

In the absence of signs of consciousness, it is necessary to determine the presence of breathing from the victim. To do this, it is necessary to restore the passability of the respiratory tract near the victim: put one hand on the forehead of the victim, the other fingers to take over the chin, throw the head, raise the chin and lower jaw. If you suspect the injury of the cervical spine, the folding should be made as accurately and gentle as possible.

To test the respiration should be leaning the cheek and the ear to the mouth and the nose of the victim and for 10 seconds. Try to hear his breath, feel the exhaled air on your cheek and see the movements of the chest from the victim. In the absence of breathing, the chest of the victim will remain stationary, the sounds of his breathing will not be heard, exhaled air from the mouth and the nose will not be felt cheek. The absence of breathing determines the need to call emergency medical care and conducting cardiovascular intensive care.

In the absence of breathing, the victim first aid participant should organize a challenge for emergency medical care. To do this, it is necessary to look loudly for the rescue, referring to a specific person near the scene and give it the appropriate instructions. Instructions should be brief, it is clear, informative: "The person does not breathe. Call an ambulance. Tell me what caused. "

In the absence of the possibility of attracting an assistant, an ambulance care should be called independently (for example, using the speakerphone function in the phone). When the call, it is necessary to inform the manager to the following information:

• the scene of the incident that happened;

• number of victims and what with them;

• What help is it.

Put the handset last, after the dispatcher response.

The challenge of emergency medical care and other special services is made by calling 112 (can also be carried out by phone 01, 101; 02, 102; 03, 103 or regional numbers).

Simultaneously with the challenge of emergency medical care, it is necessary to proceed to the pressure of the victim to the sternum of the victim, which should be located on the back on a solid level surface. At the same time, the base of the palm of one hand of the participant's first aid is placed on the middle of the injury of the victim, the second hand is placed on top of the first, the hands of the hands are taken to the lock, the hands are straightened in the elbow joints, the shoulders of the first aid participant are located above the victims so that the pressure is carried out perpendicular to the plane. Breasts.

The pressure on the sternum of the victim is performed by weight of the body of the first aid to the depth of 5-6 cm with a frequency of 100-120 per minute.

After 30 pressed hands on the sternum of the victim, it is necessary to carry out artificial respiration by the "Roth-Co-Mouth" method. To do this, open the respiratory paths of the victim (throw back the head, raise the chin), clamping his nose with two fingers, make two breaths of artificial respiration.

Inhalation of artificial respiration is performed as follows: It is necessary to make their normal breath, hermetically clapped with their lips of the victim's mouth and perform a uniform exhale in its respiratory tract for 1 second, watching the movement of his chest. The reference point of a sufficient volume of blowing air and an effective breath inhalation is the beginning of the raising of the chest, determined by the participant in providing first aid visually. After that, continuing to support the passability of the respiratory tract, it is necessary to give the victim to make a passive exhale, after which it is possible to repeat the breath of artificial respiration in the way. For 2 inhalation of artificial respiration should be spent no more than 10 seconds. You should not make more than two attempts to breathe artificial respiration in the interruptions between the pressure on the sternum of the victim.

It is recommended to use a device for artificial respiration from a first-aid kit or laying.

In case of the impossibility of performing artificial respiration by the "Roth-Co-Mouth" (for example, damage to the lips of the victim), artificial respiration is made by the method of "mouth-to-nose". At the same time, the execution technique is characterized by the fact that the first aid participant closes his mouth to the victim when thumbling the head and worst his lips the victim's nose.

Next, resuscitation activities should be continued, alternating 30 pressing on the sternum with 2 breaths of artificial respiration.

Errors and complications arising when performing resuscitation activities

The main errors in the implementation of resuscitation activities include:

- violation of the sequence of cardiovascular intensive care measures;

- incorrect technique for performing pressure with hands on the sternum of the victim (improper arrangement of hands, insufficient or excessive depth of pressure, incorrect frequency, lack of full raising of the chest after each pressing);

- incorrect technique for performing artificial respiration (insufficient or improper opening of the respiratory tract, redundant or insufficient volume of air intake);

- the wrong ratio of pressing hand to the sternum and inhalation of artificial respiration;

- The time between the pressed hands on the sternum of the victim exceeds 10 seconds.

The most common complication of cardiovascular intensive care is the fracture of the chest bones (mainly ribs). It is most often happening with an excessive pressure by hand to the sternum of the victim, an incorrectly defined point of arms, increased fragility of bones (for example, in victims of elderly and senile age).

You can avoid or reduce the frequency of these errors and complications with regular and high-quality training.

Indications for the termination of the elev

Resuscitation activities are continuing before the arrival of emergency medical care or other special services, whose employees are required to provide first aid, and the orders of these services for the cessation of resuscitation, or before the emergence of explicit signs of life in the affected (the emergence of independent respiration, the occurrence of cough, arbitrary movements).

In the case of long-term resuscitation measures and the emergence of physical fatigue, a participant in providing first aid, it is necessary to attract an assistant to the implementation of these events. Most of the modern domestic and foreign recommendations for conducting cardiopulmonary resuscitation provide for the change of its participants approximately every 2 minutes, or after 5-6 pressing and inhalation cycles.

Resuscitation activities may not be affected with obvious signs of non-viability (decomposition or injury incompatible with life), or in cases where the lack of signs of life is caused by the outcome of a long incurable incurable disease (for example, oncological).

How to give first aid to the victim

Make sure your safety

Before providing first aid, inspect the scene. If something threatens your safety, such as curtain wires or fire, do not come to the victim. Call the rescuers at 112 or correct the problem yourself, say, remove the broken glass.

If possible, the disposable gloves and glasses will protect you from contact with blood and saliva.

Check if the victim is conscious

Come and loudly give a person. If he does not answer, shake out of the shoulders. If there is no reaction, it means that a person is unconscious: go to the next step.

In the case when he at least somehow responded, leave it in the same position. Ask what happened and inspect from my head to the legs. If necessary, help help and call an ambulance.

Free the respiratory tract

Turn the victim to the back. Throw off his head back, for which hesitate the neck and lift the chin. This will help free the throat from the spawned language.

Open the affected mouth and inspect. If there is anything there, remove it. Any foreign object prevents breathing.

Check out breathing

Bend to the open mouth of the affected mouth. For 10 seconds, listen carefully listen to breathing, feel the skin of the air flow and watch the chest moving. During this time, a person should make at least two breaths. If he does not breathe, go to the next step.

If a person is rarely breathing (less than two times in 10 seconds), noisily or barely audibly - consider that there is no breathing and get ready to conduct resuscitation.

Do not check your breath with a mirror or a pyryshka. Such methods are unreliable and take a lot of time. Do not try to check the pulse: To do everything right, I need practice.

Call an ambulance

Call 103. In order not to spend time, ask someone to help you. Turn on a loud connection to simultaneously listen to the controller's prompts and conduct resuscitation.

Make 30 pages on the chest

This technique is suitable for adults and adolescents who look over 14 years old. About how to make resuscitation to small children, read below.

Put the victim on the back on the hard surface and put on your knees on the side of it. Free the chest from clothes. It is very important to correctly find a place for an indirect heart massage: the effectiveness of resuscitation depends on this.

Position the bottom of the palm is slightly lower than the center of the sternum (the bone to which the rib is attached). Top putting the second palm and connect your fingers into the castle. Straighten your elbows and keep your shoulders right above your hands.

Press to the sternole with all your weight, pushing it by 5-6 cm at a speed of 100-120 presses per minute (about twice a second). Before making the next press, do not break your hands and wait until the chest straightens.

Make two artificial inhales

Cardiovascular resuscitation
Film valve for artificial respiration

Artificial respiration can be dangerous if you hold it a stranger. If you do not know how to do it or are afraid to get infected, limit the indirect heart massage. For personal protection, you can use the film valve for cardiovascular resuscitation.

After 30 clicks again, tighten the head of the victim to free the respiratory tract. Hold your nose with your fingers, open the mouth and tightly reach the last one with your lips. Make a uniform inhale victim for 1 second. Watch the chest: it should rise. If there is no movement, again, tighten your head back and make a second breath. Not more than 10 seconds should go to all this.

Continue resuscitation

Alternate heart massage and artificial respiration in the ratio of 30 clicks and 2 inhales. You can stop resuscitation in three cases:

  1. I arrived an ambulance.
  2. The victim began to breathe or woke up.
  3. You are physically depleted.

If possible, find yourself an assistant and alternate with him to get tired less.

Turn the victim on the side

If a person is unconscious, but breathes, then he needs to flip on his side so that he will not suffocate the language or vomit.

How to conduct cardiovascular resuscitation to children

Check the signs of life in children you need the same as in adults. If the child is unconscious and does not breathe, call an ambulance and continue according to the following algorithm.

Make five artificial inhales. For children who are visible from 1 to 14 years old, act as well as adults, and infants need to simultaneously cover their mouth and nose, and mouth.

After that, once again check your breath. If it is not, begin to resuscitate in the ratio of 15 clicks (with a frequency of two per second) and two artificial inhales. Press one third of the thickness of the chest to the depth of one third. If the child is small, act with one hand if older is two.

Babies up to 1 year pressing are performed with fingers. To do this, graze the baby so that the thumbs are on top of the sternum. Find a moon-shaped process - this is a place where the lower ribs grow together with the sternum. Return from its edge to 1-1.5 cm up and place thumbs up over the sneaker. Also, clicking can be made by middle and index fingers at the same point.

Artificial respirationArtificial respiration (ID) is an emergency measure of emergency assistance in the event that a person's own breath is absent or disrupted to such an extent that represents a threat to life. The need to carry out artificial respiration may occur when assisting the resulting solar blow, drowned, affected by electric current, as well as with poisoning with some substances.

The purpose of the procedure is to ensure the process of gas exchange in the human body, in other words, to guarantee sufficient saturation of the blood of the injured oxygen and removing 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 self-breathing is restored.

Mechanism and methods of artificial respiration

Only due to the process of respiratory, the blood of a person is saturated with oxygen and carbon dioxide is derived from it. After the air falls into the lungs, it fills the pulmonary bubbles called alveoli. Alveola permeates an incredible set of small blood vessels. It is in the pulmonary bubbles that gas exchange is carried out - oxygen from the air enters blood, and carbon dioxide is given out of the blood.

In the event that the body's supply of oxygen is interrupted, the vital activity is threatened, since oxygen plays the "first violin" in all oxidative processes that occur in the body. That is why when stopping, the breath began to begin artificially ventilate the lungs should be instantly.

The air entering the human body in artificial respiration is fill in the lungs and annoys the nerve endings in them. As a result, nerve impulses come to the respiratory center of the brain, which are an incentive to generate response electrical pulses. The latter stimulate the reduction and relaxation of the muscles of the diaphragm, resulting in stimulation of the respiratory process.

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

No breathPlease note that the absence of breathing launches irreversible processes in the body after five to six minutes. Therefore, on time, artificial ventilation of the lungs can save a person life.

All methods of execution of the ID are divided into expiratory (mouth-in-mouth and mouth-in-nose), manual and hardware. Manual and expiratory methods compared to hardware are considered more work and less efficient. However, they possess one, very significant, advantage. You can carry them out without delay, almost any person can cope with this task, and most importantly, there is no need for any additional devices and devices that are not always at hand.

Indications and contraindications

The indication for the application of the ID is all cases where the volume of spontaneous ventilation of the lungs is too low to ensure normal gas exchange. This may occur with many as urgent and planned situations:

  1. With the constriction of the central regulation of respiration caused by a violation of cerebral circulation, brain tumor processes or its injury.
  2. With medication and other types of intoxication.
  3. In the case of damage to the nerve paths and neuromuscular synapses, which can trigger the injury of the cervical spine, viral infections, the toxic effect of some drugs, poisoning.
  4. For diseases and damage to the respiratory muscles and the chest wall.
  5. In cases of lesions of the lungs of both obstructive and restrictive nature.

The need to use artificial respiration is judged, based on the combination of clinical symptoms and external data. Changing the magnitude of pupils, hypoventilation, tachy and bradyistolia are states in which artificial ventilation of the lungs is necessary. In addition, artificial respiration is required in cases where the spontaneous ventilation of the lungs "turn off" with the help of a medical goal of minelaxants (for example, during an anesthesia during operational intervention or during intensive therapy of convulsive syndrome).

Light injuryAs for the cases when the ID is not recommended, then absolute contraindications do not exist. There are only prohibitions on the use of certain methods of artificial respiration in a particular case. For example, if the venous return of blood is hampered, the modes of artificial respiration are contraindicated, which provoke an even greater violation. When trauma of the lungs under the prohibition there are methods of lung ventilation, based on high pressure air and so on.

Preparation for artificial respiration

Before conducting expiratory artificial respiration, the patient should be examined. Similar resuscitation measures are contraindicated in injuries of the face, tuberculosis, polyomelite and trichloroethylene poisoning. In the first case, the reason is obvious, and in the last three conducting expiratory artificial respiration exposes the danger of who conducts resuscitation.

Before proceeding to perform expiratory artificial respiration, the victims quickly exempt from the squeezing throat and the chest of clothes. The collar is unbuttoned, the tie is unleashed, you can unbutton the trouser belt. The victim put on the back on the horizontal surface. The head will sweep the head as much as possible, the palm of one hand is put under the back, and the second palm put on the forehead until the chin will be on the same line with the neck. This condition is necessary for successful resuscitation, since with this position of the head, the mouth is disclosed, and the language departs from the entrance to the larynx, as a result of which the air begins to freely enter into the lungs. In order for the head to remain in this position, the rolled clothing is put under the blades.

After that, you need to examine the cavity of the affected mouth with your fingers, remove blood, mucus, dirt and any foreign items.

It is the hygienic aspect of the implementation of expiratory artificial respiration that is most delicate, since the rescuer will have to touch his lips of the damn skin. You can use the following reception: do a small hole in the middle of the nasal handker or gauze. Its diameter should be two or three centimeters. The fabric is superimposed by a hole on the mouth or the nose of the victim, depending on which method of artificial respiration will be used. Thus, air blowing will occur through a hole in the tissue.

Artificial Breathing from Mouth in Mouth

Artificial Breathing from Mouth in MouthTo carry out an artificial respiration by the method of from mouth to mouth, the one who will provide assistance must be on the side of the injured head (better on the left side). In a situation, if the patient lies on the floor, the rescuer falls on his knees. In the event that the jaws of the victim are scent, they are moving along with force.

After that, one hand is put on the forehead of the victim, and the other is placed under the back of the back, the patient's head as much as possible. Having done a deep breath, the rescuer delayed the exhale and, leaning over the victims, covers his mouth with her lips, creating a kind of "dome" over the oral opening of the patient. The nostrils of the victim are clamped with a large and index finger, located on his forehead. Ensuring tightness is one of the mandatory conditions for artificial respiration, since the air leak through the nose or mouth of the victim is able to reduce all efforts to not.

After sealing the rescuer rapidly, with power exhales, blowing air into the airways and lungs. The duration of the exhalation should be about a second, and its volume is at least a liter to ensure effective stimulation of the respiratory center. At the same time, the chest cell of who assisted should rise. In the event that the amplitude of its lift is small, this is evidence that the amount of air is incubated.

Exhausting, the rescuer is exhausted, freeing the mouth of the victim, but at the same time holding his head in the thumbnail. The patient's exhalation should last about two seconds. During this time, before making the next breath, the rescuer must make at least one ordinary breath "for itself."

Please note that if a large amount of air does not fall into the lungs, and in the patient's stomach, it will essentially difficult to salvation. Therefore, it should be periodically pressed to the subsequent (epigastric) area to free the stomach from the air.

Artificial Breathing In Nose

This method of artificial ventilation of the lungs is carried out if it is not possible to open the sick jaws or there is a lip injury or the oral area.

The rescuer puts one hand on the forefront, and the other is on his chin. At the same time, he simultaneously throws his head and presses his upper jaw to the bottom. The fingers of that hand, which supports the chin, the saving must press the lower lip so that the mouth of the victim was completely closed. Having made a deep breath, the rescuer covers his lips the victim's nose and with force blows the air through the nostrils, while watching the movement of the chest.

Rib cageAfter the artificial breath is completed, you need to release the nose and mouth of the patient. In some cases, the soft sky may prevent the air to go through the nostrils, therefore, when the mouth is closed, the exhalation may not be. With an exhalation, the head is mandatory held back back. The duration of artificial exhalation is about two seconds. During this time, the rescue itself should make a few exhaust-breathing "for themselves."

How long is artificial respiration

On the question of how long it is necessary to hold an ID, the answer is one. To ventilate the lungs in a similar mode, making breaks for three to four seconds maximum, follows the moment until you recover a full-fledged self-breathing, or while the doctor that appears will give other instructions.

It should be constantly monitored to ensure that the procedure is effective. The patient's chest should be swollen well, the skin of the face should gradually bring. It is also necessary to ensure that there are no foreign objects in the respiratory tract of the victim or the vomit.

Please note that because of the ID of the rescuer itself, weakness and dizziness may appear due to lack of carbon dioxide in the body. Therefore, ideally, air blowing should produce two people who can alternate every two or three minutes. In the event that there is no such possibility, every three minutes the number of breaths should be reduced to the one of who conducts resuscitation normalized the level of carbon dioxide in the body.

During artificial respiration, it follows every minute, whether the victim did not stop the victim. For this, two fingers are tied with a pulse on the neck in a triangle between the respiratory throat and the municipal muscle. Two fingers are put on the side surface of the sanding cartilage, after which they allow them to "slip" into the hollow between the municipal muscle and cartilage. It is here that the sleepy artery pulsation should be felt.

In the event that there is no ripple on the carotid artery, it is necessary to immediately start an indirect heart massage in combination with the ID. Doctors warn that if you skip the moment of stopping the heart and continue to make artificial ventilation of the lungs, you will not save the victim.

Features of the procedure in children

BabyWhen carrying out artificial ventilation, kids up to one year use equipment from the mouth to mouth and nose. If the child is older than the year, the method of mouth in the mouth is used.

Little patients also have a back. Before a year under the back, the kids are laying a folded blanket or slightly raise the upper part of the body, bringing a hand under the back. Head thrust out.

Help makes a shallow breath, hermetically covered the mouths of the mouth and the nose of the child (if the baby was not fulfilled the year) or only the mouth, then blows the air into the respiratory tract. The volume of the air should be the less than the younger patient. So, in the case of reanimation of a newborn, it is only 30-40 ml.

If there is a sufficient air volume in the respiratory tract, the chest movement appears. It is necessary to make sure after the breath that the chest is lowered. If you blow into the light baby too much air volume, it can cause a gap of the alvetol of pulmonary fabric, as a result of which the air will be released into the pleural cavity.

The frequency of blowings must correspond to the respiratory frequency, which has a property to decrease with age. So, in newborns and children up to four months, the frequency of breathing-exhale is forty-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, in the period from six to twelve years - up to twenty. Finally, a teenager between the ages of 12 and 15, the respiratory frequency is 20-18 breath-exhale per minute.

Manual methods of artificial respiration

There are also so-called manual methods of artificial respiration. They are based on changing the volume of the chest due to the application of external effort. Consider the main of them.

Sylvester method

This method is applied most widely. The victim is placed on the back. Under the bottom of the chest should be placed the roller so that the blades and the heads are located lower than the rib arcs. In the event that artificial respiration on this technique makes two people, they fall on their knees on both sides of the victim so to be located at the level of its chest. Each of them with one hand holds the hand of the victim in the middle of the shoulder, and the other is slightly above the level of the brush. Next, they begin to rhythmically raise the hands of the victim, pulling them on his head. As a result, the chest expands, which corresponds to inhale. After two or three seconds, the hands of the victim pressed to the chest, with her squeezing. This serves exhalation functions.

FractureAt the same time, the main thing is that the movements of the hands were as rhythmic as possible. Specialists recommend that artificial respiration as a "metronome" used their own rhythm of breaths and exhalations. In total, about sixteen movements should be done per minute.

The sielvester ID can also produce one person. He needs to kneel behind the head of the victim, intercept his hands above the brushes and perform the movement described above.

With hand fractures and ribs, this method is contraindicated.


In the event that the victims have damaged hands, the character of the reader can be used for artificial respiration. Also this technique is often used for the rehabilitation of people affected during their stay on the water. The victim is placed by a prick, turn the head on his side. The one who makes an artificial respiration becomes knees, and the body of the victim must be located between his legs. Hands must be put on the bottom of the chest so that the thumbs are laying along the spine, and the rest were lying on the ribs. When exhaling, it should be tilted forward, thus squeezing the chest, and during the breath to straighten, stopping pressure. Hands in elbows do not bend.

Please note that when the rib fractures, a similar method is contraindicated.

Labord method

The Labord method is optional to the methods of Sylvester and Schiefer. The language of the victim captures and produce rhythmic pulling, imitating respiratory movements. As a rule, this method is used in the case when breathing only stopped. The resistance of the language appeared is proof that human breathing is restored.

Method of Calliste

This simple and efficient method provides excellent ventilation of the lungs. The victim is argued, face down. A towel is put on the back in the field of blades, and its ends are spent ahead, which has been used under the mouse. The one who assists must take the towel in the ends and raise the torso of the victim for seven or ten centimeters from the ground. As a result, the chest expands, and the ribs rise. This corresponds to inhale. When the torso is lowered, it imitates exhalation. Instead of a towel, you can use any belt, scarf, etc.

Method of Howard

RibsThe victim has challenge. Under the back it is put on a roller. Hands are discharged and pull out. The head itself turn to the side, stretch and fix the language. The one who produces artificial respiration sits down on the femoral zone of the victim and has palms on the bottom of the chest. Speed ​​fingers should capture as many ribs as possible. When the chest is compressed, it corresponds to inhale when the pressure is stopped, it simulates exhalation. Per minute should be made from twelve to sixteen movements.

Fashion of Frank Iva

For this method requires stretcher. They are installed by the middle on the transverse stand, the height of which should be half the length of the stretcher. On the stretcher put the victim's injured, the face turn aside, the hands are placed along the body. A person is tied to the stretcher at the level of the buttocks or hips. When lowering the head end of the stretcher, inhale is inhabited when it goes up - exhalation. The maximum respiratory volume is achieved when the body of the victim is tilted at an angle of 50 degrees.

Method Nielsen

The victim placed face down. His hands bend in the elbows and cross, after which the palms down under the forehead. Saving on his knees is at the head of the victim. He puts his hands on the blades of the victim and, without bending them in the elbows, presses the palms. So it takes out. For a breath, saving takes the shoulders of the victim from the elbows and straightens, lifting and pulling the victim victim.

Hardware methods of artificial respiration

For the first time, the hardware methods of artificial respiration began to use even in the eighteenth century. Already then the first air ducts and masks appeared. In particular, the doctors offered to use fireplace bemes into light air, as well as devices created by their similarity.

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 intermittent vacuum and positive pressure or around the entire body, or only around the chest and the abdomen of the patient. Gradually, the respirators of this type were ousted by air blowing respirators, which differed in less solid dimensions and did not make it difficult to access the patient's body, allowing medical manipulations.

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

With an internal method of artificial ventilation, the device is connected through a mask or intubator to respiratory tract, and inhale is carried out by creating a positive pressure in the apparatus. The devices of this type are divided into portable, designed to work in "field" conditions, and stationary, the purpose of which is a long conduct of artificial respiration. The first is usually manual, and the second work automatically, the motor leads to their movement.

Complications of artificial respiration

Complications due to artificial respiration occur relatively rarely and in the event that the patient is on artificial ventilation of the lungs for a long time. Most often, unwanted consequences relate to the respiratory system. Thus, due to the incorrectly selected mode, respiratory acidosis and alkalosis may develop. In addition, long-term artificial respiration can cause the development of atelectasis, since the drainage function of the respiratory tract is disturbed. Microelectases in turn can be a prerequisite for the development of pneumonia. Preventive measures that will help to avoid such complications are careful respiratory hygiene.

If the patient is breathing with pure oxygen for a long time, it can provoke the occurrence of pneumonite. Oxygen concentration therefore should not exceed 40-50%.

In patients who have been diagnosed with abscessive pneumonia, alveol breaks may occur with artificial respiration.

  1. Burlakov R.I. Artificial ventilation of the lungs (principles, methods, equipment) / R.I. Burlakov, Yu.Sh. Galperin, V.M. Yurevich. - M.: Medicine, 1986. - 240 s.

Article author:

Velvikova Nina Vladislavovna

Specialty: infectious, gastroenterologist, pulmonologist .

Common experience: 35 years .

Education: 1975-1982, 1mmi, San Gig, Higher Qualification, Infectious Physics .

Academic degree: Higher Phone, Candidate of Medical Sciences.


  1. Infectious diseases.
  2. Parasitic diseases.
  3. Urgent states.
  4. HIV.

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Cardiopulmonary resuscitation allows you to save the life of a person. If no more than 5-6 minutes have passed since the cessation of cardiac activity, then the intensive care can be returned to life. Also due to timely actions in resuscitation, you can win a valuable time before the arrival of physicians.

Video provided "Kalashniki-Media"

How to determine if the heart stopped?

There are several signs characterizing such a state among them:

- stop breathing

- Pallor of skin

- No Pulse

- No heart knock

- No blood pressure.

What should I do first?

Before making an indirect heart massage and artificial respiration to a person, it is necessary to check whether a person is conscious. To do this, it is necessary to verify the victim if he did not respond, then it is necessary to check whether it breathes. For this you need:

"Go to the victim to the right and block his right hand to bed, and with your right hand to block the left hand of the victim. In this position, a person will not be able to resist if he suddenly finds.

- Try to carefully disperse the victim, look, whether it reacts on the shake of the shoulders and head. If there is no reaction, then the person is unconscious.

- Check your breath. To do this, carefully trap the head of the victim, so that the tip of the nose is raised. If in 10 seconds you do not observe any respiratory movements, then you need to call an ambulance and carry out resuscitation.

How to make cardiovascular resuscitation?

The base of one palm must be put on the middle of the chest of the victim, slightly above the sword-shaped process. After that, both hands should be taken either in the "castle", or one to another "cross-cross-time" and put pressure on them to the chest, performing the indirect heart massage - 30 clicks and two inhales "mouth in the mouth." Pressing frequency must be about 100 times per minute.

It is impossible to put pressure on the sternum, because at a pressure on the ribs there is a risk to break them. It is necessary to press with such a force so that the chest is shifted to the spine by 4-5 cm.

Resuscitation must be carried out until a person is silent or until the ambulance arrives.

See also:

First aid skills can be useful to each person. Therefore, it is important to know how to independently reanimate a person before the emergence of ambulance. The main method is cardiovascular resuscitation. The basic information is described below what it is, as and when you need to use these methods.

What is cardiopulmonary resuscitation (SLR)?

There are two types of surrenders - basic and specialized. The latter is carried out by doctors using special resuscitation equipment. But every person must have the skills of basic cardiopulmonary resuscitation. Artificial respiration and massage of the heart is carried out before the arrival of physicians, but it is important in parallel to call ambulance.


Starting resuscitation activities are necessary in the presence of such signs:

  • Pulse on carotid arteries is absent.
  • The patient does not breathe and is unconscious.
  • A person has a agonal or pre-arbital state.
  • Clinical death has come.

There is no need to massage a heart and artificial respiration, if a person breathes and his pulse is torn, even if he is unconscious. It is forbidden to carry out the CPR in the presence of obvious signs of biological death, if there are wounds incompatible with life. If the integrity of the lungs is violated, the first thing is rushed, and after that, artificial respiration is carried out with caution.

How to provide first help?

Heart massage is straight and indirect. The first option can be carried out only by a specialist, the chest is revealed when the heart is stopped and the mechanical impact is performed directly on the heart. Indirect heart massage, it is a resuscitation technique that can be done in any conditions in the presence of indications.

If the heart stop occurred suddenly, for example, as when she was shred, then you can apply the precordial blow before starting an indirect massage. Instruction:

  • Ensure the absence of a pulse;
  • Put two fingers on a moving process;
  • Heavily hit a fist over two fingers.

After that, you need to immediately check the pulse. In 50% of cases of this reception, it is already enough to launch a heart in a situation of clinical death.

Artificial respiration

When a person stopped breathing, he needs artificial respiration. Only so you can save his life. To restore the respiratory function, you need to free a person from clothes if she shifts his movement.

From the oral cavity it is necessary to remove everything that can interfere with breathing. The mucus, food particles and blood clots are cleaned with a handkerchief that need to wrap a finger.

Start inhale air into the lungs. This is done by the way "mouth in the mouth" or "mouth in the nose".

To do this, under the shoulders should be placed a pillow or a roller made of girlfriends. Throwing the head up, push the lower jaw forward. Then the inhaled air will fall into the respiratory tract, and not in the stomach.

Carrying out artificial respiration is located on the side of the patient. At the same time, hold the nostrils, and the other open the mouth. Need to pressed a little on the chin. It is recommended to cover your mouth with a bandage.

Make an intense breath and similar exhalation. Then stop, typing face. Expect until the victim is exhaled. Exhalation occurs automatically due to the elasticity of the lungs and sternum.

In case of artificial respiration, "mouth to the nose" is assumed to be somewhat different procedure. For this, it is necessary to hold the mouth of a person with a palm. You can also press one lip to another finger. During the minute it is necessary to make 12-14 deep intakes.

Artificial respiration is required long and persistently. It is necessary to provide first aid until the breath restores or before the emergency to arrive.

Closed heart massage

It is carried out by strong pressing hands on the lower third of the breast. At the same time, the entire mass of the body providing assistance is involved. For this, one hand must be put on the second.

Palms should be directed to the bottom. It will ensure the shift of the sternum in several centimeters.

The chest is compressed and squeezes the heart between the sternum and the spine.

It is important that the person who assist is to lay on a solid surface. Suppose you need to be left of the patient.


  • Locate your palms at an altitude of 2-3 cm above the sword-shaped process, right on the left "in the castle".
  • Make two or three blows by air victim through the mouth.
  • Produce compression compression, pressing so. To the palms deepened by 2-3 cm. Frequency - up to 80-100 times per minute.

Periodically, the pulse and breathing should be checked. If a person began to breathe independently, he had a heartbeat, he had to stop holding resuscitation activities and put it on the side. This is necessary so that in the event of a vomiting does not have to re-reanimate it if the vomits are blocking the respiratory tract.

Artificial Breath and Heart Massage Together

Heart massage can be made in parallel with artificial respiration. Events are carried out alternately. On the 5th instruments on the sternum during inhalation there are one blowing into the respiratory tract. At the same time, it is impossible to breathe in the same time to breathe and press the sternum - because of this there is a danger of a lung break.

The closed massage is often called indirect. Conducting actions in question assumes a huge physical and emotional tension. Therefore, it is better if the help will have several people. They will be able to periodically replace each other.


In that case, if there is no breathing and the pulse is not restored, resuscitation activities should continue until the moment of arrival ambulance. It is important to fix the time of stopping the heart of the patient and inform him of health workers when they arrive at the scene. It is also important to understand that providing first help a person should not expose himself danger.

It is important to remember that the salvation of a person's life depends not only on the timeliness of first aid. The correctness of the actions is often crucial.

With a sudden stopping of the heart and termination of breathing, the vital activity of the body is disturbed, the state of clinical death is developing. This terminal period is 3-5 minutes, but it is reversible with timely detection. Emergency assistance and the beginning of resuscitation measures allow you to restore breathing, blood circulation, heartbeat and oxygenation of the body. Compliance with the procedure for conducting cardiovascular intensive care (SLR) significantly increases the chances of salvation of each patient. In community-friendly conditions, when assisting, the speed of the start of actions after the onset of clinical death is crucial.

First aid is to verify consciousness, respiration, challenge emergency services, performing cardiovascular intensive care, consisting of indirect massages and artificial lung ventilation.

Sudden heart stop on the street: what to do before arriving soon?

Artificial respirationResuscitation measures are carried out after the state of clinical death, the main signs of which are: missing breathing and heartbeat, unconscious state, expansion of pupils, lack of reaction to external stimuli. To accurately determine the severity of the situation, it is necessary to identify such indicators of the victim:

  • Check the pulse on the carotid arteries of the neck under the jaw angle - with a decrease in pressure less than 60-50 mm Hg. Art. The pulse on the radial artery of the inner surface of the brush is not determined;
  • inspect the chest, check for independent respiratory movements;
  • approach the face of the victim to check the breath, definition of inhalation and exhalation (assessment of air movement);
  • Pay attention to the skin color - the blueness and sharp pallor appears when breathing;
  • Check consciousness - the lack of reaction to stimuli indicates a coma.

Cardiovascular resuscitation for new standards is carried out only in two cases. Bring out the completion of the complex of the CPR only after determining the pulse and respiration.

With a distinct definition of the pulse for 10-15 seconds and impaired atonuclear breathing with episodes of convulsive sighs, artificial respiration is required. For this, for a minute, it is necessary to make 10-12 inhales of "mouth in the mouth" or "mouth to the nose". Waiting for an ambulance, you need to measure the pulse every minute, with its absence, it is shown.

With the insolvency of independent respiration and the pulse, a complex of resuscitation activities is strictly according to the algorithm.

Checking consciousness is carried out according to this principle:

  1. Talk to the victim. Ask what happened how he feels.
  2. The procedure for conducting cardiovascular intensive careIf the answer does not follow, use pain stimuli. Spread for the top edge of the trapezoidal muscle or press on the base of the nose.
  3. If the reaction did not follow (speech, twitching, attempts to protect against hand) - there is no consciousness, you can move to the next step.

Breath Check:

  1. Turn the head back (holding it for the head and chin) and open your mouth. Inspect it for foreign bodies. If they are there - remove them.
  2. Bend to face and within 10 seconds. Check the breath. You must feel His cheek, hear and see the movements of the chest. Normally, it is enough to determine 2-3 inhales.
  3. If there is no breathing or felt only 1 inhale (which can be considered absence), you can assume the cessation of a vital function.

In this case, it is necessary to call an ambulance and start performing resuscitation activities when stopping heart and breathing.

Stages of cardiovascular resuscitation for new standards

It is extremely important to comply with the correct procedure for resuscitation. According to the latest medical protocols, to save the victim, the ABC algorithm must be adhered to:

  • A - ensure the permeability of the respiratory tract for oxygenation, eliminate the overlap of the lumen of the pharynx and the trachea;
  • B - perform breathing by the "mouth in the mouth" or "mouth to the nose";
  • C - Restore blood circulation by the method of indirect massage.

Technique and the order of the indirect heart massage and artificial ventilation of the lungs

  1. It is important to comply with security, before the beginning of the SLR, it is necessary to put a person for a rigid, stable and solid surface or half.
  2. After that, tilt the head of the side, to open the mouth and make sure that the lumen of the respiratory tract is not blocked. When obstruction is detected - to clean the respiratory tract with remedies (handkerchief or cloth).
  3. For effective artificial respiration, make a reception of Safara - to throw off the head back, push the jaw forward and upward, open the mouth with one movement.
  4. With signs of the spinal fracture in the neck area, only push the jaw.
  5. The resuscitation complex begins with 30 soda compression compression, which performs one person rhythmically without interruptions.
  6. To do this, it is necessary to put the right hand with a palm focusing on the bottom of the sternum in the center, on top of the right hand to apply the left and weave your fingers.
  7. What you need to do when you stop the heartTo perform a heart massage, the hands must be straight, not bent in the elbow joints.
  8. 100-120 pages per minute with rhythmic sternum compression by 5-6 cm deep into, until a complete expansion of the chest after compression.
  9. After 30 compression compression compression make 2 exhalations in the oral cavity or the victim's nose for 1 second.
  10. When carrying out breathing by the "mouth in the mouth" method, it is necessary to compress the nostrils with your fingers before making exhalation.
  11. During two exhalations, it is necessary to look at the chest: dissection and lifting indicate the correct execution.
  12. If the chest does not rise and does not fall, it is necessary to check whether the respiratory tract is necessary, it may take to repeat the reception of the Safara.
  13. With the election, it is necessary to check the pulse every 2 minutes. We reanimate without stopping up to 30-40 minutes.

Criteria for the effectiveness of events

Upon timely, aid increases the chance to save a person. For this, it is important to clearly follow the rules for conducting cardiovascular intensive care. The effective implementation of the complex of the SLR testifies:

  • The appearance of the pulse on carotid arteries is in order to make sure that the pulse is preserved, the heart massage can be stopped for 3-5 seconds;
  • Return of the reaction of pupils on the light stimulus - a narrowing indicates the enrichment of the oxygenated blood brain;
  • The emergence of independent respiration with a full-fledged sustainable breath and exhalation, without episodes of convulsive breaths, followed by termination (apnea);
  • disappearance of the sinusiness of the skin of the face, lips, brushes;

After restoring heartbeat and respiration, the resuscitation complex is stopped to perform, but the victim should be in the field of view of the resuscitation before the doctor's arrival

Frequent errors in helping

It should be remembered that the incorrectly rendered assistance is often harmful than its absence. The following erroneous recommendations and myths are often found on the Internet (the rule of four "not"):

  1. Do not check your breath with the help of a mirror or a flip - you spend time on his search, you can interfere with the moisture on the street, and when using a flock, the wind can prevent the reliability of the result. In such a situation, you mistakenly consider the dead person alive.
  2. Medical care when stopping a heartDo not check the pupil reflex - you need to be able to do it right and not with the help of an ordinary flashlight. If a person is alive, too bright light in individual diseases can damage the retina. Finally, there are neurological violations in which this reflex will not work in a person with preserved vital functions.
  3. Do not make a precondial blow. This requires an appropriate practice, besides, this method is not proven from the point of view of efficiency, and in some cases it can bring even greater harm.
  4. Do not make an IVL without protection (without a film-valve) unfamiliar people - the high risk of transmission of infection. If, during artificial ventilation, the chest does not rise, it is worth assumed that the air passes into the stomach, or the respiratory tract is blocked. In the first case, limit the NMS, in the second - clean your mouth or apply the reception of Gamelich.

Emergency care medical brigade: What an actions algorithm?

To provide emergency care with a sudden stopping of the heart for departure, a special cardiology team comes, whose task is to conduct extended resuscitation activities and immediate delivery of the patient to the hospital. It works on a protocol comprising such a sequence of actions:

  1. Checking the vital indicators and diagnosis. To do this, use a wider arsenal of equipment, including an electrocardiograph. It is necessary to exclude other causes of clinical death, such as bleeding or blockade.
  2. How to run a heart when it stopsRenewing the conductivity of the upper respiratory tract. For the maximum efficient supply of oxygen make them intubation.
  3. Resuscitation activities are carried out on the same algorithm, which is listed above, but for IVLs use breathing masks, a bag of an AMBU or an artificial ventilation unit.
  4. In the presence of flickering tachycardia or ventricular fibrillation on ECG raise the question of the use of defibrillation.
  5. Medical support is made by intravenous or intracardial administration of such drugs as "adrenaline" (1 ml of 0.1% in 19 ml of NaCl solution 0.9%) and "Curdaron" (with the presence of arrhythmias, 300 mg in / c).


The patient's life with a heart stop largely depends on the actions that surrounding. A timely and qualitatively provided domanticine care significantly increases the chances of survival and further restoration of the highest nervous activity.

The principles of the dog-binding resuscitation are very simple, almost every person can make them. Medical assistance is provided with the use of greater arsenal of funds and drugs.

Working out of the clock on the mannequin.

Cardiovascular brain resuscitation (SCL) - a complex of urgent events aimed at restoring the livelihoods of the body and deriving it from the state of clinical death.

Includes chest compression (indirect heart massage) to a depth of 5-6 cm at a speed of 100-120 pages per minute [one] . Condivation can also carry out artificial ventilation of lungs (artificial respiration). Current recommendations for adult victims make focus on the compression of the chest; For non-specialists, a simplified method is recommended, including only compression [2] . At the same time, if you do only to kids compression, it can lead to worst results [3] . The ratio of compressions and breaths should be 30 to 2 for adults.

Salmon itself, as a rule, does not lead to restoration of the heart. Its main goal is to restore the partial stream of oxygen-saturated blood to the brain and the heart to delay the leaning of fabrics. Defibrillation is required to restore normal heart rhythm.

Starting the elevation of the victim need as early as possible. At the same time, the presence of two of the three signs of clinical death is the absence of consciousness, breathing and pulse - sufficient readings for its start. The founder of cardiovascular resuscitation is considered the Austrian doctor Peter Safar, named by the triple reception of Safara.

  • Lack of consciousness
  • No breath
  • No blood circulation (more efficiently in such a situation, check the pulse on carotid arteries)

If a resuscator or a resuscator (conductive resuscitation person) has not defined the pulse on the carotid artery (or it does not know how to determine it), then it should be considered that the pulse is not, that is, the blood circulation stops. In accordance with the "Methodological recommendations for conducting cardiopulmonary resuscitation" of the European Council for Resuscitation 2010, the testimony for the beginning of the basic resuscitation activities serve only the absence of breathing and consciousness.

Contraindications to conducting [edit | Code ]

  • The presence of explicit signs of biological death.
  • Incompatible injury or injury.
  • Progression of reliably established incurable diseases. [four]
  • Damage to the pleura light, it is necessary to stick the cavity (plaster, press the hand, package, remedy)

A new set of measures to prevent the death of adult patients recommended by AHA includes the following elements:

  1. The speedy heart stop recognition and challenge the ambulance brigade
  2. Timely SLR with a focus on compression compression
  3. Timely defibrillation
  4. Effective intensive therapy
  5. Complex therapy after stopping the heart

According to the An Ana Recommendation on the ELD of 2011, the procedure for conducting cardiovascular intensive resuscitation with ABCDE on Cabed was changed. The order, stratitude and sequence of activities are very important.

Circulation , ensuring blood circulation.

Provided by a heart massage. Correctly conducted by the indirect heart massage (by the chest movement) provides the brain with the minimum necessary amount of oxygen, the pause for artificial respiration worsens the supply of the brain with oxygen, so it is necessary to breathe at least 30 clicks on the sternum, or not interrupted for a breath more than 10 seconds.

Airway. , respiratory tract.

  • Perform the diagnosis of the obstruction of the respiratory tract (generalized cyanosis, a decrease or absence of respiratory noise and the movements of the chest and the abdomen, the paradoxical movements of the chest, the participation of the auxiliary respiratory muscles, noisy breathing, bubble sounds, snoring, etc.) to carry out the triple reception of the Safara: to throw the head, Pull down the lower jaw and open the mouth.
  • Perform the correction of life-threatening disorders: the admission of respiratory tract, aspiration of the contents of the upper respiratory tract, oxygen therapy (target SPO2 94-98%, in patients with obstructive pulmonary diseases 88-92%).

Breathing. , that is, "breathing."

On the recommendation of the American Association of Heart Diseases (from 2010), unprepared eyewitnesses produces only indirect heart massage before the arrival of physicians

Respiratory resuscitist holds a breathing bag. The breath of "mouth in the mouth" is dangerous infection. The technique, see below.

Disability , neurological status.

  • Estimate the level of consciousness, pupils, meningeal symptoms, focal symptoms; blood glucose level; other metabolic disorders or the effects of drugs that can lead to the oppression of the level of consciousness;
  • Perform the correction of life-degrading disorders.

Exposure , appearance.

  • evaluate the condition of the skin and mucous membranes separated by drainage;
  • Perform the correction of life-degrading disorders.

Complex of resuscitation events [edit | Code ]

The components of the resuscitation complex are listed

Scheme of the indirect heart massage.

The only testimony for the precarceed strike is to stop the circulation that occurred in your presence in case less than 10 seconds passed and when there is no finished electric defibrillator. Continuation - the child's age of less than 8 years, body weight is less than 15 kg.

The victim is placed on a solid surface. The index finger and the middle finger must be put on the mamosaid process. Then, the edge is compressed in the fist of the palm of the palm on the sternum above the fingers, while the elbow of the strike should be directed along the injury body. If after that did not appear the pulse on the carotid artery, then it is advisable to move to an indirect heart massage.

Currently, a preconditional impact technique is considered not effective enough, but some experts insist on sufficient clinical efficacy for use in emergency resuscitation. [five]

Chest compression (indirect heart massage) [edit | Code ]

Indirect heart massage baby.

Assistance is carried out on a flat, rigid surface. Prior to compressions, the emphasis is carried out on the base of the palms. Hands in the elbow joints should not be bent. When compression, the line shoulder shoulder should be on the same line with the sternum and in parallel with it. Arrangement of hands perpendicular to breast. Hands with compression can be taken in "Castle" or one to another "cross-cross-time". During compression at the arrangement of the hands of the "Cross-Low", the fingers should be raised and not to touch the surface of the chest. The location of the hands with compressions is on the sternum, on the 2 transverse fingers above the end of the milder process. It is possible to stop compression only for the time required for the artificial ventilation of the lungs, and on the determination of the pulse at the carotid artery. Compression should be carried out at a depth of at least 5 cm (for adults) (recommendations of the Ana according to the election 2011).

The first compression should be a trial, to determine the elasticity and resistance of the chest. Subsequent compressions are made with the same force. Compression should be made with a frequency of at least 100 per minute, if possible, rhythmically. Compression is carried out in the front seat along the line connecting the breast with the spine.

When compression, it is impossible to tear your hands from the sternum. Compression is performed pendulum, smoothly, using the severity of the upper half of its body. Davit sharply, prescribe often (Ana's recommendations on the election 2011) Displacement of the base of the palms relative to the sternum is unacceptable. It is not allowed a violation of the relationship between compression and forced breathing:

- The ratio of breathing / compression should be 2:30, regardless of the number of people conducted by cardiovascular resuscitation.

For nonimes - when there is a point of compression, the arrangement of hands is possible in the center of the chest, between the nipples.

Newborn children indirect heart massage with one finger. Breast children - two fingers, older children - one palm. Pressing depth on 1/3 of the height of the chest.

Signs of efficiency:

  • Appearance of Pulse At the carotid artery
  • Promotion of skin
  • Reflex pupils for light

When restoring breathing and cardiac activity of the victim unknowingly necessarily laid on the side To eliminate his suffocation with its own spanging language or vomit masses. About the weavest of the language often testifies to breathing, resembling snoring, and sharply difficult to breathe.

Atemwege zu.jpg.Atemwege Frei.jpg.
Closed respiratory tract Open respiratory tract
Respiratory paths on the head cut. On the left before, on the right after throwing the head.

There are two ways: "From the mouth to the mouth" and in the extreme case "from the mouth to the nose". If you need to release the mouth and nose of the affected content of the content. Then the head of the victim thrust so that there is a stupid angle between the chin and neck. Next, they make a deep breath, pushing the nose of the victim, their lips are tightly wrapped the lips of the victim and produce exhale in the mouth. After that, it is necessary to remove your fingers from the nose. The interval between inhams should be 4-5 seconds.

The ratio of inhalations with an indirect 2: 30 heart massage (ERC Guidelines 2007-2008). It is advisable to use the so-called barriers To protect both the rescuer, and the rescued: from the nasal handkerchief to special films and masks that usually eat in the autoapplerette.

It is important to prevent the inflating the stomach, which is possible when the neck is overbidted. The criterion for the effectiveness of the IVL is an excursion of the chest (raising and lowering the chest).

It is usually performed on the operating table if during the operation found that the patient has stopped the heart.

The essence is as follows: the doctor quickly reveals the chest of the victim and begins to squeeze his heart with a rhythmic one or two hands, thereby causing blood through the vessels. As a rule, the method turns out to be more efficient than the indirect heart massage.

This method is widely used due to its high efficiency. Based on the use of a special device called a defibrillator, which briefly gives a high voltage current (about 4000-7000 volts).

Indication to the implementation of defibrillation is Stopping blood circulation on the type of ventricular fibrillation . Also, this method is used to relieve sucanementaricular and ventricular tachyarithmias. When asystolia (that is, when the heart stop) is ineffective.

The principle of operation of the defibrillator lies in the formation of energy as a result of the discharge of the capacitor, charged to pre-prior to a certain voltage. The power of electrical pulses is determined using the power units obtained by discharging. This energy is determined in Joules (J) - Watt Seconds.

Defibrillation causes a heart stop, after which the normal activity of the heart can recover.

In the past 10 years, the use of applying Automatic External (Outdoor) Defibrillators (AED, Andes) . These devices make it possible not only to determine the need for defibrillation and discharge power, but are usually also provided with voice instructions for the entire cycle of cardiovascular resuscitation. These defibrillators are installed in the most crowded and visited places, since the effectiveness of defibrillation drops sharply after 7 minutes after the emergence of the ineffectiveness of blood circulation (not to mention the fact that irreversible changes in the brain occur after 4 minutes) Standard technique of using Andes Such is: when a person is detected unconscious and disposable electrodes are superimposed on the skin of the breast (you can not even spend time checking the pulse and pupils). On average, after a quarter of minutes, the device (if there is indications of the discharge) proposes to press the button and determine or (if there is no testimony) to start indirect heart massage / artificial respiration and includes a timer. An analysis of the rhythm is carried out again after the discharge or after the expiration of the standard time released to the SLR. This cycle continues before the arrival of the Medical Brigade. When restoring the work of the heart, the defibrillator continues to work in observation mode.

Since 1999, the Internet covers the text entitled "How to survive a heart attack if you are alone" ("How to Survive A Heart Attack When Alone"). The main advice that is given in the text: when signs of a heart attack, it is necessary to cough hard, it can save life. The organization "Rochester General Hospital", cited in the original version of the text, denies its connection with it. [6] The American heart organization has released a special explanation that the cough cannot be used for effective self-help in the heart attack and, thus, does not relate to cardiovascular resuscitation. [7]

  1. Neumar RW, Shuster M., Callaway CW, Gent LM, Atkins DL, Bhanji F., Brooks SC, De Caen Ar, Donnino MW, Ferrer Jm, Kleinman Me, Kronick SL, Lavonas EJ, Link MS, Mancini Me, Morrison LJ , O'Connor Re, Samson Ra, Schexnayder SM, Singletary Em, Sinz Eh, Travers Ah, Wyckoff MH, Hazinski MF Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (eng.) // Circulation  (eng.) Russian : journal. - Lippincott Williams & Wilkins  (eng.) Russian , 2015. - NOVEMBER ( Vol. 132. , no. 18 Suppl 2. ). - P. S315-67 . - DOI: 10.1161 / CIR.00000000000252. - PMID 26472989.
  2. Leong B. S. Bystander CPR and Survival (Neopr.) // Singapore Medical Journal. - 2011. - August ( t. 52. , No. 8. ). - P. 573-575 . - PMID 21879214.
  3. ATKINS D. L., BERGER S., DUFF J. P., Gonzales J. C., Hunt E. A., Joyner B. L., Meaney P. A., Niles D. E., Samson R. A., Schexnayder S. M. Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (eng.) // Circulation  (eng.) Russian : journal. - Lippincott Williams & Wilkins  (eng.) Russian , 2015. - NOVEMBER ( Vol. 132. , no. 18 Suppl 2. ). - P. S519-25 . - DOI: 10.1161 / CIR.00000000000265. - PMID 26472999.
  4. Federal Law of 21.11.2011 N 323-FZ (ed. From 07/31/2020) "On the basics of the health of citizens in the Russian Federation". Article 66, paragraph 7.
  5. Precardial kick - a blow of salvation, or who and why insists on the opposite
  6. ROCHESTER GENERAL HEALTH SYSTEM - ROCHESTER NY  (Neopr.)  (inaccessible link) . Date of handling: April 6, 2013. Archived on November 20, 2005.
  7. Coogh cpr.  (Neopr.) . Date of handling: April 7, 2013.
  • Ed. B. R. Gelfand, A. I. Saltanova. Intensive therapy: National Guide. - Gootar Media, 2009. - T. 1st. - 955 p. - 2,000 copies. - ISBN 978-5-9704-0937-4.
  • Sumin S. A. Urgent states. - Medical Information Agency, 2006. - P. 652-675. - 800 s. - 4,000 copies. - ISBN 5-89481-337-8.
  • Rozhinsky M. M, Katovsky G. B. [ Provision of prefigure (inaccessible link) , Medicine, Moscow, 1981.
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Artificial Breathing and Heart Massage - Rules and TechnologyGood day, dear readers!

In today's times, looking at media reports, one can see one feature - natural cataclysms are increasingly and more often and more often, more and more car accidents, poisoning and other unable situations. It is these situations that are emergency situations, call for anyone to be in place where anyone requires help, knew what to do to save the lives of the victim. One of these resuscitation measures is artificial respiration, or as it is also called artificial ventilation of the lungs (IVL).

In this article, we will look at artificial respiration with you in combination with an indirect heart massage, since, when you stop the heart, it is these 2 components that are able to return the person to consciousness, and perhaps you will even save life.


Essence of artificial respiration

Doctors found that after stopping the heart, as well as breathing, a person loses consciousness and his clinical death comes. The duration of clinical death can last about 3-7 minutes. The amount of time rendered to the provision of resuscitation actions by the victim, after which, in case of failure, a person dies is about 30 minutes. Of course, there are exceptions, not without God's providence, when a person was returned to life and after 40 minutes of resuscitation actions, however, we will still focus on a small length of time. But this does not mean that if a person did not wake up after 6 minutes, you can leave it - if your faith allows you to try to the last, and let the Lord help you!

When stopping the heart, it should be noted, the blood movement stops, and at the same time the blood supply to all organs. Blood carries oxygen, nutrients, and when the nutrition of the organs ceases, literally after a short period of time, the organs begin to die, carbon dioxide stops out of the body, self-determination begins.

Artificial respiration and heart massage replace the natural work of the heart and the supply of the organism with oxygen.

How it works? When pressed on the chest, in the heart area, this organ begins to artificially compress and squeeze, thereby swaying blood. Remember, the heart works like a pump.

Artificial respiration in these actions is necessary for supplying oxygen to the easy, since blood flow without oxygen does not allow all organs and systems to obtain the necessary substances for their normal operation.

Thus, artificial respiration and a heart massage of each other cannot exist, on the exceptions of which we wrote a little higher.

This combination of actions is also called - cardiovary and pulmonary resuscitation.

Before considering the rules of resuscitation actions, let's learn the main causes of the heart stop and how to learn about it.

Heart Stop - Causes

Heart Stop - CausesThe main cause of heart stops are:

  • Fibrillation of myocardial ventricles;
  • Asistolia;
  • Blow electricity;
  • Overlapping breathing with third-party objects (air shortage) - water, vomit masses, food;
  • Stroke;
  • Strong supercooling of the body at which the temperature inside the body is lowered to 28 ° C and below;
  • Strong allergic reaction - anaphylactic shock (asphylaxia), hemorrhagic shock;
  • Reception of some substances and drugs - "Dimedrol", "Isoptin", "Obizant", barium or potassium salt, fluorine, chinin, calcium antagonists, cardiac glycosides, antidepressants, sleeping pills, adrenobloclars, phosphorodorganic compounds, and others;
  • Poisoning with such substances, such as drugs, gas (nitrogen, helium, carbon monoxide), alcohol, benzene, ethylene glycol, strikhin, hydrogen sulfide, cyanide potassium, silic acid, nitrites, various poisons against insects.

>>> Also read: Water rescue: First Aid Under

Heart stop - how does it work if it works?

To check whether the heart works, you need:

  • Check the availability of the pulse - attach two fingers to the neck under the cheekbones;
  • Check for breathing - put your hand on the chest and see if it raises, or attach the ear to the heart area and listen to the presence of shots from its work;
  • Attach the mirror to the oral cavity or the nose - if it is fucked, then a person breathes;
  • Lift the patient's eyelids and enclose a flashlight on the pupil - if pupils are extended and not reacting to the light, the heart stopped.

If a person does not breathe, begin to perform artificial respiration and indirect heart massage.

Cardiovascular Resuscitation

Cardiovascular ResuscitationBefore starting resuscitation actions, urgently call for ambulance. If there are other people nearby, start performing artificial ventilation of the lungs, and the other person will be ambulance.

Also, it will be great if you still have anyone else with you, with whom you can share assistance - one makes a heart massage, another artificial respiration.

>>> Also read: Indirect Heart Massage - Rules and Technology

Artificial Breathing and Indirect Heart Massage

1. Put the injured person on a solid surface.

2. Throw the head of a person back. Check if its tongue died in the throat, if so, pull it out. If there are vomiting masses or other foreign objects, free the mouth and throat from them with a piece of fabric, so that the victim does not choose. Under the neck, so that the head is trapped, you can put some roller, for example, from rolled clothes.

3. Determine the squeezing of the heart (compression) of the heart for the massage - is located at a distance of two folded fingers, above the end of the Meso-shaped process.

4. Take a strictly vertical stand and place the bottom of the palm to the place of pressure on the heart, straighten your hands.

Artificial Breathing and Indirect Heart Massage

5. Strictly vertically, make smooth presses on the chest, so that its pressing was in the range of 5-6 cm (no more, and no less), with a frequency of 101-112 pressed per minute. In children, to fight the chest need no more than 3-4 cm.

6. Every 30 clicks make artificial respiration - 2 inhale. Children have 2 inchs make after 15 clicks. If it makes artificial ventilation of the lungs "mouth to mouth" then overlap the victim's nose, otherwise the air will go through the nose, if you make a "mouth to the nose", then overlap the mouth.

7. If after the exhalation, the chest of the victim does not omit, it may indicate the blockage of its respiratory tract. To correct the situation, re-lift his chin up, thipping his head a little stronger, repeat the breath.

8. Implementation of artificial respiration is better through a piece of fabric, so as not to touch the lips of the victim. This is considered a measure of security, since inside the victim and on its mucous membranes may be infection.

In such a procedure, artificial support for the life of the body can be up to 30 minutes.

A positive result is:

  • The appearance of the pulse;
  • Respiratory appearance;
  • Reacting pupils on bright light.

Artificial Breathing and Indirect Heart Massage - Video

First aid

The ability to provide first aid is elementary, but very important skill. In an emergency, he can save someone's life. We present to your attention 10 basic first-aid skills. From this section, you will learn what to do with bleeding, fractures, poisoning, frostbite and other emergency cases. You will also learn about common mistakes that may end up the life of victims of serious danger.

First aid is a complex of urgent measures aimed at saving a person's life. Accident, a sharp attack of the disease, poisoning - in these and other emergencies is needed competent first aid.

According to the law, first aid is not a medical - it turns out to arrive the medical and delivery of the victim to the hospital. The first help can be provided by any person at a critical moment next to the victim. For some categories of citizens, first aid - official duty. We are talking about police officers, traffic police officers and MES, military personnel, firefighters.

First aid algorithm

In order not to be confused and competently provide first aid, it is important to comply with the following sequence of actions:

  1. Ensure that when you firstote the first aid, nothing threatens you and you do not expose yourself danger.
  2. Ensure the security of the victim and others (for example, to extract the victim from the burning car).
  3. Check for the victims of life (pulse, breathing, reaction of pupils for light) and consciousness. To check the breath, it is necessary to trample the head of the victim, lean towards his mouth and the nose and try to hear or feel breathing. To detect the pulse, it is necessary to attach a pillow to the finger to the carotid artery of the victim. To assess the consciousness, it is necessary (if possible) to take the victims of the shoulders, gently shake and ask any question.
  4. Call specialists: 112 - from a mobile phone, from the city - 03 (ambulance) or 01 (rescuers).
  5. Remote urgent first aid. Depending on the situation, this may be: - recovery of the airways; - cardiovascular resuscitation; - Stop bleeding and other events.
  6. Provide a victim physical and psychological comfort, wait for the arrival of specialists.

Artificial respiration

Artificial ventilation of lungs (IVL) is the introduction of air (or oxygen) into the respiratory pathways of the person in order to restore the natural ventilation of the lungs. Refers to elementary resuscitation measures.

Typical situations requiring IVL:

  • Automotive accident; incident on water; blow current and others.

There are various ways of IVL. The most effective in the provision of first aid by a non-specialist is the artificial respiration of the mouth in the mouth and mouth into the nose.

If during the inspection of the injured natural respiration is not found, it is necessary to immediately carry out artificial ventilation of the lungs.

Artificial respiratory technique mouth in mouth

  1. Provide the undergoing upper respiratory tract. Turn the head of the victim's side and remove the mucus from the oral cavity, blood, foreign objects. Check the nasal moves of the victim, cleanse them if necessary.
  2. Turn fighter the head of the victim, holding the neck with one hand.

    Do not change the position of the head of the victim during the injury of the spine!

  3. Put on the mouth of the victorious napkin, handkerchief, a piece of fabric or gauze to protect yourself from infections. Hold the nose victim with a big and index finger. Deeply inhale, tightly press the lips to the affected mouth. Make exhale in the lungs of the victim.

    The first 5-10 exhalations should be fast (for 20-30 seconds), then - 12-15 exhale per minute.

  4. Watch out for the movement of the chest of the victim. If the breast of the victim is inhaling the air rises, it means that you are doing everything right.

Indirect heart massage

If there is no pulse together with breathing, it is necessary to make an indirect heart massage.

Indirect (closed) Heart massage, or chest compression, is the compression of the muscles of the heart between the sternum and the spine to maintain the human circulation when the heart is stopped. Refers to elementary resuscitation measures.

Attention! It is impossible to carry out a closed heart massage in the presence of a pulse.

Indirect Heart Massage Technique

  1. Lay the victim on a flat solid surface. On the bed and other soft surfaces, it is impossible to compress the chest.
  2. Determine the location of the victim of the sword-shaped process. Movie-shaped process is the shortest and narrow part of the sternum, its ending.
  3. Measure 2-4 cm up from the sword-shaped process - this is a point of compression.
  4. Put the base of the palm to the point of compression. At the same time, the thumb should indicate either on the chin or on the stomach of the victim, depending on the location of the person carrying out the resuscitation. On top of one hand, put the second palm, fold your fingers into the castle. Pressing is carried out strictly base palms - your fingers should not come into contact with the sternum of the victim.
  5. Perform rhythmic peppers of the chest strongly, smoothly, strictly vertically, the severity of the upper half of your body. Frequency - 100-110 Pressing per minute. In this case, the chest should be fed at 3-4 cm.

Breast children indirect heart massage is made by index and middle fingers of one hand. Teenagers - palm of one hand.

If simultaneously with a closed heart massage, IVL is carried out, every two inhalation should be alternating with 30 pressure on the chest.

Harm: The indirect heart massage can break the ribs, therefore, broken bones can easily damage the lungs and heart.

How correct: The indirect heart massage is performed only after you have convinced that the pulse and breath of the victim are missing, and there is no doctor in proximity. During the time as long as one person does a heart massage, someone's second must cause ambulance aid. Massage is performed in the rhythm - 100 compressions in 1 minute. In the case of children, an indirect heart massage is performed with fingers in another rhythm. After the heart starts, proceed to perform artificial respiration. Alternative method: 30 compressions and 2 inhales, after which again repeat compression and 2 breaths.

In case of an accident, do not deliver the victim from the car and do not change it to the pose

Harm: Female outcome most often happens during injury or spinal fracture. Even the most not significant movement caused by helping the victim to lie is more convenient, can kill or make a person with disabilities.

How correct: Call an ambulance immediately after the injury, if there is a fear that the victim can be injured, neck or spine can be injured. At the same time, follow the breath of the patient before the arrival of the doctors.


Fracture - violation of the integrity of the bone. The fracture is accompanied by severe pain, sometimes fainting or shock, bleeding. Distinguish open and closed fractures. The first is accompanied by the injury of soft tissues, the bone fragments are sometimes noticeable in the wound.

First Aid Technique for Fracture

  1. Rate the gravity of the condition of the victim, determine the locomotive localization.
  2. If there is bleeding, stop it.
  3. Determine if the movement of the victim is possible before the arrival of specialists.

    Do not transfer the victim and do not change its position in the spinal injuries!

  4. Ensure the bones in the fracture area - spend immobilization. To do this, it is necessary to immobilize the joints above and below the fracture.
  5. Take the bus. As a tire, you can use flat sticks, boards, rules, rods, and so on. The tire is needed tight, but not tightly fix the bandages or the plaster.

With a closed fracture, immobilization is made on top of clothing. With an open fracture, you can not apply the bus to the places where the bone protrudes out.

Stop bleeding using a harness can lead to limb amputation

Harm: Passing the limbs - a consequence of the wrong or unnecessary imposition of the harness. Tissue necrosis occurs due to blood circulation violation in the limbs, because the harness does not stop bleeding, but completely blocks circulation.

How correct: Enter a dressing of pure cloth or sterile gauze on the wound and hold it. Before the arrival of the doctors will be enough. Only with strong bleeding, when the risk of death is above the risk of amputation, allowable to use the harness.

Technique imposing a hemostatic harness

  1. Enter the harness on clothes or soft lining just above the wound.
  2. Tighten the harness and check the ripple of the vessels: the bleeding should stop, and the skin below the harness is to pale.
  3. Write a bandage to the wound.
  4. Record the exact time when you are hiding.

Harness on the limbs can be added to a maximum of 1 hour. By its expiration, the harness must be loosen for 10-15 minutes. If necessary, you can tighten again, but not more than 20 minutes.

In the case of bleeding from the nose, it is forbidden to throw the head or go on the back

Harm: The pressure rises sharply if you throw the head on the nasal bleeding or lie on the back. Blood can get into lungs or cause vomiting.

How correct: Holding your head straight, you will speed up a pressure reduction. Attach something cold to the nose. Close the nostrils alternately for 15 minutes each, index and thumb. At this time breathe mouth. Repeat this technique, if bleeding does not stop. If bleeding continues, urgently cause ambulance care.

Use of drugs that cause vomiting

Harm: Preparations that provoke vomiting lead to a burning of the esophagus and contribute to the poisoning of the vomit masses when entering the lungs.

How correct: Call an ambulance care if you suspect poisoning. Describe the symptoms of poisoning and remember the manipulations and actions that the dispatcher will recommend. Do not evaluate yourself the severity of poisoning and do not look for advice on the Internet - inxication by vitamins or alcohol are very dangerous. Female outcome is possible in a short time, if you do not appeal to the doctor's help.


Syncin is a sudden loss of consciousness due to a temporary violation of cerebral blood flow. In other words, this is a brain signal that he lacks oxygen.

It is important to distinguish between the usual and epileptic faint. The first, as a rule, is preceded by nausea and dizziness.

A pre-corrupt state is characterized by the fact that a person rolls his eyes, covered in a cold later, he fits the pulse, the limbs are cold.

Typical sympathy situations:

  • Fean
  • excitement
  • Duchot and others

If a person fainted, give him a comfortable horizontal position and secure the influx of fresh air (unzipted clothing, loosen the belt, open the windows and doors). Splazinate on the face of victim to cold water, praise it on the cheeks. If you have a first-first aid kit, let's sniff a cotton swab, moistened with ammonia alcohol.

If consciousness does not return 3-5 minutes, immediately call an ambulance.

When the victim comes to himself, give him strong tea.

Do not insert into your mouth a man whose fit spoon. And do not remove him

Harm: A person in an enclosure can swallow or suffocate the subject that is inserted to protect the language in the mouth.

How correct: The attack leads to the formation or sharp shudder. The body itself cannot harm himself, and the attacks end themselves. It is better to call a doctor, and take care, that a person does not harm himself and could breathe freely. With the tongue nothing will happen. The man does not swallow him, and the bite of the tongue is not dangerous. Lay the sick side after an attack.


Burn is damage to the body tissues under the action of high temperatures or chemicals. Burns differ in degrees, as well as by damage type. The latter base is distinguished by burns:

  • thermal (flame, hot liquid, couples, split items)
  • Chemical (pitch, acids)
  • Electric
  • Radi (light and ionizing radiation)
  • Combined

In front of burns, it is necessary to eliminate the action of the affecting factor (fire, electric current, boiling water and so on).

Then, with thermal burns, the affected area should be released from clothing (neatly, not riding, and cutting around the wound sticking tissue around the wound) and for the purpose of disinfection and anesthesia, it is necessary to irrigate it with a waterproof solution (1/1) or vodka.

Do not use oil ointments and oily creams - fats and oils do not reduce pain, do not disinfect the burn and do not contribute to healing.

After the wound with cold water, impose a sterile bandage and attach cold. In addition, give the victim for warm salted water.

To accelerate the healing of light burns, use sprays with decanteral. If the burn covers the area more than one palm, be sure to consult a doctor.

Iodine processing, medical alcohol and washing of wounds of hydrogen peroxide sometimes pose a danger

Harm: The connecting tissue is destroyed by hydrogen peroxide, thereby wounds a lot longer. Alcohol, iodine and green burns intact cells and provoke pain or burn when contacting the wound.

How correct: Rinse the wound with clean water (can be boiled), then treat the wound by ointment with an antibiotic content. Do not overlap the bandage from the bandage or the plaster without the need. A tied wound heals a lot longer.

First Aid when drowning

  1. Remove the victim from the water.

    The sinking person grabs everything that comes at hand. Be careful: swim to him from behind, hold the hair or armpit, holding face over the surface of the water.

  2. Put the victim of the stomach on the knee, so that the head is down.
  3. Clean the oral cavity from foreign bodies (mucus, vomit, algae).
  4. Check for signs of life.
  5. In the absence of pulse and breathing, immediately proceed to the IVL and the indirect heart massage.
  6. After restoring breathing and cardiac activity, put the victim to the victim, cover it and ensure comfort before the arrival of the physicians.

Supercooling and frostbite

Supercooling (hypothermia) is a decrease in human body temperature below the norm necessary to maintain normal metabolism.

First aid for hypothermia

  1. Start (enclose) the victim in a warm room or wrapped with warm clothes.
  2. Do not rub the victim, give the body to gradually warm yourself.
  3. Give the victim warm drinking and food.

Do not use alcohol!

The supercooling is often accompanied by frostbite, that is, damage and leaning the body tissues under the influence of low temperatures. Particularly often found frostbite to the fingers and legs, nose and ears - body parts with reduced blood supply.

Causes of frostbite - High humidity, frost, wind, still position. Aggravates the condition of the victim, as a rule, intoxication.


  • Feeling cold
  • Tingling in the combined body part
  • Then - numbness and loss of sensitivity

First Help when frostbite

  1. Place the victim in warmth.
  2. Remove with it absorbing or wet clothing.
  3. Do not rub the victim by snow or cloth - so you are only injured by the skin.
  4. Take the frostbite body area.
  5. Give the victim hot sweet drink or hot food.


Poisoning is a disorder of the body's vital activity that has arisen because of the poison or toxin falling into it. Depending on the type of toxin, the poisoning distinguishes:

  • carnant gas
  • Yadochimikati
  • Alcohole
  • medicines
  • Food and others

On the nature of poisoning, the first aid measures are dependent. The most common food poisoning, accompanied by nausea, vomiting, diarrhea and stomach pains. In this case, it is recommended to take 3-5 grams of activated coal every 15 minutes for an hour, drink a lot of water, refrain from feeding and be sure to consult a doctor.

In addition, random or intentional Medicinal poisoning, as well as alcoholic intoxication .

In these cases, first aid consists of the following steps:

  1. Rinse the affected stomach. To do this, make it drinks several glasses of salted water (per 1 l - 10 g of salts and 5 g of soda). After 2-3 glasses, call the victim vomit. Repeat these actions until the vomits are "clean".

    The stomach washing is possible only if the victim is in consciousness.

  2. Dissolve in the glass of water 10-20 activated carbon tablets, let it drink this to the victim.
  3. Wait for specialists.

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