In the previous article, we introduced artificial respiration. Here, we talk about chest compressions that are complementary to artificial respiration. If you want to get through, go through the previous article and combine it with a piece of study.
Chest heart compression, Closed chest cardiac massage. Refers to the artificial application of external force to make the heart squeeze between the sternum and spine, so that the left and right ventricle pressure and pump out the blood; relax pressure, the ventricular diastolic, blood back to the heart. Clinical observations in recent years have proven that the power of the human circulation is not only the mechanism of the heart pump, but also mainly from changes in the increase or decrease in intrathoracic pressure. The thorax of cardiac arrest patients still has a certain degree of elasticity, and the junction of the sternum and ribs can be depressed due to pressure. Therefore, when the chest is pressed, the mechanism that causes blood to flow forward is due to a general increase in intrathoracic pressure so that intrathoracic pressure >carotid artery pressure> head arterial pressure> jugular venous pressure. It is this pressure difference that causes the blood to flow toward the carotid artery, to the head, and back to the jugular vein. The video requires pressing 100 times per minute per minute. In fact, the individual feels that the frequency of pressing should be higher than 100 beats/minute, and the effect is better at 120 times/minute. Of course, the authoritative guide still requires 100 times/minute to be correct. Tired and tired, haha).
Closer to home, first of all, in the implementation of chest compressions, to determine whether the patient has respiratory arrest (touch the carotid artery, both sides of the muscles in the neck and trachea), and to determine the cause of sudden cardiac arrest in patients, such as electric shock and other dangerous Sex must pay attention to its own safety in the treatment and transfer the patient to a safe place, but we must fight for the fastest time, because the effective cardiopulmonary resuscitation begins within 4 minutes of cardiac arrest, and the possibility of the patient being saved is very high. increase. For each 1 minute delay in CPR, the patient's survival rate decreased by 7% to 10%. Regarding the pre-treatment process, the same as the previous one (when a patient wears a movable denture when the airway is opened, he must remove him first), so it will not be repeated here.
Contraindications: Loss of chest wall opening, rib fractures, thoracic deformity or pericardial tamponade, where irreversible vital organs such as heart, lung, and brain are unrecoverable, resuscitation may not be necessary. Such as advanced cancer and so on.
Specific operations, follow these steps:
First, position. The patient is supine on a hard bed or flat surface. If it is over the ground or the bed is too soft, it should be transferred to a hard floor or a layer of hard plates to ensure that the press is effective, but do not delay the rescue time in order to find something hard.
Second, the operator's position. The rescuer should be close to the side of the patient's chest. To ensure that the force acts on the sternum vertically when the patient presses, the rescuer can use different postures such as a squat or footstool depending on the position of the patient;
Third, determine the location of the press. This is very important. Improper presses may invalidate the rescue. The correct place to press is the middle and lower 1/3 of the sternum. The specific positioning method is that the rescuer slides the middle finger and the middle finger along the middle of the costal arch to the middle of the rib arch intersections, ie, the substernal notch, and then places the index finger and middle finger across the substernal notch. The sternum above the index finger is located. The middle part is the pressing area. Place the thumb of the other hand on the sternum of the patient and remove the positioning hand. Place the palm roots on the back of the other hand so that the fingers lift off the chest wall. Raise your fingers with both hands. Rescuers have double elbow joints with straight shoulders, shoulders above the patient's sternum, shoulders holding down vertically and pressing down, pressing depths of 4 to 5 cm, compression frequency of 80 to 100 beats/min, and pressing and relaxing times approximately equal . For chest compressions on children, the compression site and the compression frequency are the same as those of adults, but the compression depth is 3 cm, and the movement should be smooth and the force should not be used excessively. If the subject of chest cardiac compression is an infant, its operation is somewhat different from adults and children. The compression site of the baby is on the sternum, where the line between the two nipples and the midline of the sternum is the next point. The rescuer presses with the middle finger and ring finger. The compression depth is 2 cm and the compression frequency is 100 beats/min. The force cannot be used excessively.
The correct and effective pressing technical requirements are:
1. The upper body of the rescuer leans forward. Both shoulders should be directly above the hands. The two arms should be straightened. The elbows should not be bent (remember that they cannot be bent, not just upper body strength). Using the weight of the upper body and the strength of the shoulder and arm muscles, press down vertically and do not lean to one side or sway (this will directly break the patient's ribs or sternum). Remember to keep your fingers from pressing only on the base of the palm of your hand while pressing. Press and relax the palm of your hand to keep your roots close to your chest.
2. The press should be steady, the force should be uniform, press regularly, and can not be interrupted;
3. After each press, relax completely to return the chest to its normal position so that the sternum is not stressed. When relaxing, take care not to leave the sternal anchoring point at the root of the palm of your hand. To determine whether the press is effective, if there are two rescuers, one person should be able to touch the carotid or femoral artery when one person presses.
Chest compression syndrome:
Rib fracture, pericardial blood or heart tamponade, pneumothorax, hemothorax, lung contusion, liver and spleen laceration and fat embolism. Follow correct methods of operation to avoid complications.
Precautions:
1. The duration of each artificial respiration exceeds 1 s, and the amount of tidal volume is such that the thoracic undulation can be observed.
2. Pressing must be done at the same time as artificial respiration. And establish a good intravenous fluid.
3. Pressing should not be too heavy or too fierce to avoid rib fractures. In severe cases, liver, stomach and other internal organs should be damaged; not too light, it will lead to poor results.
4. Do not leave the palm of your hand while relaxing.
5. Because of the need for rescue (if necessary intracardiac injection, ECG), stop pressing for less than 15 seconds.
6. Begin pressing before ventilation
7. Avoid delays or interruptions throughout the process.
(The above part is quoted from Baidu Encyclopedia, part cited from Baidu library)
Pressing main indicators: during the pressing process, efforts are made to reduce interruptions (except for some special operations, such as the establishment of artificial airways or defibrillation), and after 5 cycles of operation, judging the carotid pulse and breathing again, the judgment time does not exceed 10s, such as Has been recovered for further life support; if the carotid artery pulse and respiration are not restored, continue to perform the above operation after 5 cycles and judge again until advanced life support personnel and equipment arrive. 1 when the pressure can cause palpitation and aortic beat; systolic blood pressure 2>8.OkPa; 2 patient complexion, lips, nails and skin color turning red again; 3 expansion of the pupil re-reduce; 4 spontaneous breathing; 5 consciousness gradually recovered, can Eye movements, eyelash reflections and reflections on light, and even hand and foot twitches, increased muscle tone.
Do not forget to take artificial respiration while pressing on the chest, not to interrupt the cardiopulmonary resuscitation frequently for the purpose of observing the pulse and heart rate. The press rest time should not exceed 10 seconds in general so as not to disturb the successful resuscitation. In the past, the guideline called for open airway, artificial respiration, cardiac compression, ie, ABC, but the current guidelines require the order of cardiac compression, open airway, artificial respiration, or CAB. This sequence must be remembered. The ratio of compression and artificial respiration should be 30:2 according to the single-person resuscitation method. If you double press, you just press it, artificial respiration is responsible for artificial respiration. If you switch locations, it should not exceed 5 seconds.
Well, heart chest compressions are basically like this. Everyone has an impression of this and remembers a few points. In emergency situations, they will not be confused. In the next few articles, I will continue to introduce the first-aid measures after poisonous snake bites, the first-aid fixation of limb fractures, the handling of spine injuries, and the emergency dressing of hemorrhagic trauma. It is purely a personal knowledge of me. There are areas that are incorrect or imperfect. Please correct me.
Ribbed Manila Envelope
The ribbed manila envelope has the most significant feature that is distinct among other types of envelopes, namely ribbed lines. Ribbed lines are not produced while the envelopes are converted though, they exists when the paper was produced. The paper producing machine has the additional procedure of scoring the ribbed lines for this special type of paper. Not all the mills produce the same ribbed lines. Some of them have wider gaps, some may place the gaps between groups of gaps.