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Fig. 23. Cardiovent

The patients with ciliary arrhythmia and other forms of arrhythmias often complicated by ventricular fibrillation should be taught a method of coughing autoresuscitation. A patient makes a deep inspiration, in this process the intrathoracic pressure becomes negative, the heart and vessels are being fdled with blood. Then the patient strains himself while the true glottis is closed, in so doing the intrathoracic pressure sharply increases, blood from the heart and

vessels is ejected into the aorta. After this the patient coughs in which
connection a thoracic pressure drops to zero, the heart and vessels are filled
again with blood. The patient repeats this cycle maintaining blood circulation,
and consequently his life up to the arrival of medical aid. In cardiologic
department a cough technique serves as a signal for a medical personnel to
carry out the resuscitation

In cardiac standstill on the operating table the patient may be required to carry out a closed-chest cardiac massage in the incovenient position. In prone position of the patient a massage is performed from the back as usual, but one presses on the backbone at the level of lower angles of shoulder-blades. In the patient's lateral position two men plant firmly against his back, the third carries out usual presses on the breastbone.

As far as an open-chest cardiac massage is concerned, its application is limited by hospital conditions. One has to resort to it in cardiac standstill in the course of thoracal operations and surgeries in the upper section of the abdominal cavity, multiple fractures of ribs, fractures of the breastbone and spinal column, in cardiac tamponade, TEPA if an embolectomy is planned, and in supercooling if a warming of the heart with warm solutions is intended. It is performed on the background of APV when a patient is intubated through an incision in theV intercostal space on the left. In abdominal operations a massage through a diaphragm is possible without its opening (subdiaphragmatically) or with its opening (transdiaphragmatically).

Every 2-3 min a presence of pulse is checked on carotid artery. ^' Signs of effectiveness of resuscitation measures are as follows: r 1) a presence of thorax excursion in inflation of air;

2) a pulsation on carotid and peripheral arteries in massage;

3) a change of colour of skin integument from cyanosis to rose;

4) a constriction of pupils.

In availability of these signs the resuscitation measures must be carried out to the final outcome.

As the reason to discontinue resuscitation measures may serve an absence of signs of effectiveness of resuscitation measures in the course of 30 minutes.

Along with carrying out resuscitation measures it is necessary to take measures for a call of specialized team of the first aid.

II stage of resuscitation — is a further maintenance of life (see algorithm of the II stage of CPCR on page 94). It starts from the moment of the first aid arrival and includes the following stages — D, E, F — drugs, electro­cardiography, fibrillation.

It is characterized by the fact that a specialist begins to participate in reanimation provided with a necessary emergency kit of medicaments, devices and equipment to diagnose a circulatory arrest, and treatment equipment (defibrillator, equipment for APV).

The aim of this stage is the restoration of independent blood circulation.

APV is continued, but it is already possible to use for these purposes some devices (Fig. 24): S-shaped tube (A), usual Gwedell's airway or nasopharyngeal airway, apparatuses for APV such as Ambou's bag (B), RDA-2 (C), there is also a possibility to intubate trachea and apply a mechanical ventilation with the use of oxygen and automatic unit — mining rescue device, DP-2, trigger respirators "Pneumocomp-l" and others. Trained personnel must perform a tracheal intubation as soon as possible.

Those who have no skills of tracheal intubation may, at the first stages of resuscitation, make use of combined Combitoue airway (Fig. 25) or esophageal obturator (Fig. 26) that are introduced as a gastric tube and have two lumina conducting the air into the trachea regardless of getting the airway tip into the esophagus or trachea. In certain situations APV can be performed through a laryngomask, though its main purpose is to maintain a patency of respiratory tracts in the time of anesthesia with the aim of avoiding a more complex

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