First Aid for Acute Respiratory Failure and Cardiac Arrest

Objective: to build students' knowledge of the basic techniques of first aid for respiratory disorders and the indications for artificial respiration; to master the basic knowledge needed to perform artificial respiration and chest compressions; to learn to provide first, pre-medical aid; and to cultivate in students a sense of responsibility and moral readiness for unexpected and extreme situations.

Equipment: the chart «First Aid for Respiratory Arrest», the film «First Aid for Respiratory Arrest. Respiratory Hygiene».

1.Causes and signs of respiratory disorders.

In life and clinical practice, situations arise in which, as a result of the course of a disease or exposure to extreme environmental factors, life-threatening conditions develop in the body. Such conditions are called emergencies. Only timely and competently provided first aid, followed by qualified medical care, can save the life of a patient or casualty.

Respiratory disorders.

Respiratory disorders can manifest as dyspnoea, suffocation, or respiratory arrest.

Respiratory arrest is a critical condition. The causes leading to apnoea are varied: foreign bodies, tumour involvement of the larynx, severe inflammatory diseases, neuromuscular diseases, overdose of sedatives and narcotics, drowning and hanging, electrical injury, and others.

Signs: after breathing stops – increasing cyanosis, a sharp drop in blood pressure, loss of consciousness, and loss of consciousness is often preceded by convulsions,

Cardiac activity soon stops. Clinical death occurs.

The signs of cardiac arrest are: cessation of breathing; loss of consciousness; dilation of the pupils; absence of pulse; occasional gasping breaths; pallor of the skin.

2.First aid:

• clear the airway of mucus and foreign bodies;
• eliminate tongue retraction;
• perform artificial lung ventilation and chest compressions.

Acute respiratory failure - a pathological condition in which the normal function of the external respiratory apparatus fails to provide the necessary gas exchange. Respiratory failure is divided into primary, associated with damage directly to the external respiratory apparatus; and secondary, which is based on diseases and injuries of other organs and systems.

The most common method of resuscitation is artificial respiration or chest compressions.

Artificial respiration for respiratory failure can be performed as follows: mouth to mouth; mouth to nose.

Providing first aid:

To confirm respiratory failure, it is necessary to check for rising/falling of the chest. To feel whether the casualty is breathing, one hand can be placed on the side of the chest near the lower rib, and the other on the epigastric region.

Medical care for an acute respiratory disorder consists of carrying out rehabilitative measures, namely performing artificial respiration and chest compressions. First aid for respiratory arrest must be carried out in a strict sequence.

The algorithm for pre-medical aid in respiratory failure is as follows:

1. Place a person with acute respiratory failure on a firm surface, loosen or unfasten any restrictive clothing. The casualty's airway must be kept clear.
2. If there is any content in the oral cavity or pharynx, clear it all out with a cloth.
3. If there is no pulse or respiratory movements, call an ambulance and begin performing artificial respiration and chest compressions.
4. A roll should be placed under the casualty's shoulders, with a recommended thickness of 15 – 20 cm. This will cause the casualty's head to tilt back and the mouth to open.
5. The head must not be tilted back excessively, as this may cause narrowing of the airway.
6. The jaw is pushed forward and the chin lifted upward to prevent the tongue from falling back.
7. If a head or spinal injury is suspected, artificial respiration and chest compressions should be performed without changing the position of the body.
8. A cloth, napkin, or handkerchief is placed over the casualty's mouth for reasons of personal hygiene.
9. After taking a deep breath, cover the casualty's mouth with your own as tightly as possible, and pinch the nostrils closed with your fingers. Perform 2 breaths; exhalation occurs spontaneously over 1 – 2 seconds. 12 – 15 respiratory movements should be performed per minute.
10. After the first breath, check the pulse. Then perform chest compressions, pressing sharply on the chest 5 times.
11. Check the pulse and breathing after a minute. If there is no breathing or heartbeat, continue performing artificial respiration and chest compressions.
12. When blowing air into the casualty's nose, their mouth should be closed with your hand.
13. Resuscitation must not be stopped until the ambulance arrives. Once circulation and breathing have been restored, resuscitation is stopped. The pulse should be checked every 1 – 2 minutes.
14. The casualty must not be left alone.
15. To restore breathing and circulation in a child, the rescuer's lips should cover both the infant's nose and mouth.
16. Chest compressions in a child are performed using just two fingers. To restore circulation in a school-age child, chest compressions are performed with one hand.
17. If resuscitation is being performed by 2 people, one should perform chest compressions to restore circulation while the other provides artificial respiration. The chest should be compressed 5 times (1 time/second), followed by a quick breath. About 12 such cycles should be performed per minute.

First aid for respiratory arrest and circulatory disturbance must be provided without delay. Pre-medical aid can save the casualty's life.

Performing artificial respiration by the "mouth-to-mouth" or "mouth-to-nose" method.

Artificial respiration should be performed if the casualty is not breathing or is breathing with difficulty (rarely, convulsively), or if breathing is gradually deteriorating regardless of the cause (electric shock, poisoning, drowning, etc.).

Artificial respiration should not be continued once spontaneous breathing has resumed.

When beginning artificial respiration, the person providing aid must:

• if possible, lay the casualty on their back;
• free the casualty from clothing that restricts breathing (remove a scarf, unfasten the collar, belt, etc.);
• clear the casualty's mouth of any foreign objects;
• if the mouth is tightly clenched, open it and push the lower jaw forward, so that the lower teeth are in front of the upper ones (as shown in the figure - not included).

If the mouth cannot be opened this way, a small board, a metal plate, the handle of a spoon, or similar object should be carefully inserted between the back molars (at the corner of the mouth) to pry the teeth apart;

• stand at the side of the casualty's head, slide one hand under the neck, and press on the forehead with the palm of the other hand, tilting the head back as far as possible;
• lean over the casualty's face, take a deep breath with an open mouth, seal your lips fully and tightly around the casualty's open mouth and exhale forcefully (while simultaneously closing the casualty's nose with your cheek or fingers). Air can be blown in through gauze, a handkerchief, a special "airway" device, etc.
• if there is no spontaneous breathing but a pulse is present, artificial respiration can be performed in a "sitting" or "vertical" position (against a support, on a mast, etc.);
• maintain a one-second interval between artificial breaths (the duration of each breath is 1.5 - 2 s);
• once the casualty's spontaneous breathing has been restored (visually determined by expansion of the chest), stop artificial respiration and place the casualty in a stable side position (the head, torso, and shoulders are turned simultaneously).

Chest compressions.

External chest compressions are performed when cardiac activity stops, characterised by:

• pallor or cyanosis of the skin;
• absence of a pulse on the carotid arteries;
• loss of consciousness;
• cessation or disturbance of breathing (gasping breaths).

The restoration of circulation must be carried out correctly so as not to harm the casualty. Emergency aid consists of performing compressive movements in cases of acute oxygen deficiency in the body.

1. To perform the compressions, the casualty is placed on a firm surface.
2. The point at which pressure should be applied is located.
3. Pressure on the heart is applied perpendicularly.
4. Compressions are applied to the chest (100 compressions per minute).
5. Position yourself at the casualty's side and (if aid is provided by one person) give two quick, forceful breaths using the "mouth-to-mouth" or "mouth-to-nose" method;
6. for every 2 deep breaths, perform 15 compressions on the sternum (when aid is provided by one person);
7. when two people take part in resuscitation, maintain a "breathing - compressions" ratio of 1:5 (i.e. after a deep breath, perform five compressions on the chest);
8. when resuscitation is performed by one person, interrupt chest compressions every 2 minutes for 2 - 3 s and check the pulse on the casualty's carotid artery;
9. if a pulse appears, stop external chest compressions and continue artificial respiration until spontaneous breathing resumes.

Carrying out these measures helps to compensate for acute oxygen deficiency in the brain. These actions give the casualty a chance of survival in the event of acute oxygen deficiency.

Emergency aid for respiratory and cardiac arrest has been provided correctly when the casualty shows:

• Pulsation of the carotid artery;
• Constriction of the pupils is noted;
• Spontaneous respiratory movements appear;
• A change in skin colour.

If these signs do not appear, it means the measures are being performed incorrectly. Resuscitation for respiratory and cardiac arrest, when performed correctly, helps restore the normal functioning of the respiratory organs and the heart.

If spontaneous contractions are not restored, specialists proceed with resuscitation. In the case of ventricular fibrillation, electrical defibrillation is required.

Knowledge check:

Answer the questions:

1. What is resuscitation?
2. How is the casualty's condition assessed?
3. Indications for performing resuscitation.
4. State the sequence of actions when performing resuscitation.
5. List the rules for performing chest compressions.
6. The procedure for resuscitation by one person, by two people.
7. State the sequence of first aid measures for poisoning via the respiratory tract.