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DIAGNOSIS OF CLINICAL DEATH

The main signs:

— absence of pulsation on carotid arteries;

— absence of respiration (by chest excursion);

— dilated pupils with no response to light (in 40-60 sec. after
discontinuation of blood circulation).

Additional signs •

— paleness or cyanosis of skin integument with transition to an earthy-
grey color;

— absence of independent movements and areflexia
Diagnosis of clinical death should be established for 8-10 sec, whereupon

it is necessary to proceed to carrying out resuscitation measures, the aim of which is in the restoration of blood circulation and respiration ensuring an activation of cerebral blood flow and maintenance of cerebral cortex function.

Resuscitation measures require a maximal concentration of the personnel rendering medical aid. This is just the case when one must hurry without haste and remember that only 5 minutes are left in reserve.

In order to facilitate a comprehension of the process of cardiopulmocerebral resuscitation (CPCR) it is tentatively subdivided into three stages (P. Safar, 1997):

1-st stage of resuscitation — immediate or an elementary maintenance of life (urgent oxygenation) (see an algorithm of basic support of life on page 85). The task at this stage is to maintain an oxygenation of the vitally important organs and systems and, first of all, the cerebral cortex. It is performed by persons found themselves, by chance, at the place of accident.

Methodically the aid is rendered with the use of three main stages: ensuring a patency of the upper respiratory tracts, APV and cardiac massage (the rule of A, B, C — air, breathing, circulation).

A. ENSURING A PATENCY OF THE UPPER RESPIRATORY TRACTS:

— to lay the victim on a hard horizontal surface;

— to throw the head back, in so doing one hand is placed under the victim's
neck and the other throws the head back, pressing on the forehead, Fig. 12
(cautiously, when a fracture of the spinal column in the cervical part is
suspected!!!);

— to bring the mandible forward, in so doing open the mouth, Fig. 13 (a triple Safar's technique);

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