Reanimation (Resuscitation)
General
- Cardiopulmonary resuscitation is required in cases of cardiac and/or respiratory arrest
- Cardiac resuscitation is performed by cardiac massage, defibrillation (shock generator; treatment method against life-threatening cardiac arrhythmias) and administration of medication
- Therapy for respiratory arrest includes clearing the airway and artificial respiration to restore gas exchange in the lungs
- One can distinguish basic life support from advanced life support (by professional helpers)
Indications
- Cardiac arrest – mainly due to myocardial infarction (heart attack) and cardiac arrhythmias.
- Respiratory arrest
Procedure during resuscitation
- Check consciousness, call for help, attach AED (automated external defibrillator) if necessary.
- A – Clear the airway
- B – Ventilation
- C – Circulation (cardiac massage)
- D – Drugs (medication)
Check Awareness (Basic Life Support)
- Address person, shake
- If no response: call for help, back positioning
Clear airway (basic life support).
- Hyperextension of the neck
- Lifting the chin
- Professional rescuers use suction devices, airway devices such as Güdel tube (to keep the upper airway open)
External chest compressions (basic life support).
- Patient is lying on hard surface in supine position
- The pressure point is in the middle of the chest
- The pressure must be placed with the heels of the hands
- The chest should be pressed between 5 and 6 centimeters
- The pressure frequency should be between 100-120/ minute
- The chest must be completely unloaded after the compression; however, the hand is not lifted off
- The helper kneels sideways next to the patient; the upper body is vertically above the pressure point; the elbows are pushed through
- The helper should change after about 2 minutes
- Basically, lay resuscitation is started with 30 compressions, followed by 2 ventilations
Dangers of chest compressions
- Rib/rib series fractures – especially with incorrect pressure point → do not interrupt/abort resuscitation.
Ventilation (basic life support)
- Without aids – mouth-to-mouth/mouth-to-nose ventilation.
- With aids – professional helpers use to secure the airway endotracheal tubes (breathing tube, a hollow plastic probe), laryngeal masks (laryngeal mask, means of keeping the airway open), etc.
- Two ventilations should not last longer than 5 seconds
Dangers of ventilation
- Hyperventilation (deepened and/or accelerated breathing, i.e., lung ventilation increased above demand) may decrease the ejection fraction of the heart
- Hyperventilation increases the risk of regurgitation – backflow of gastric contents into the pharynx.
- The risk of infection during respiratory donation is extremely low
Advanced resuscitation (advanced life support).
- Defibrillation (treatment method/shock generator against the life-threatening cardiac arrhythmias) for ventricular fibrillation and pulseless ventricular tachycardia/ventricular tachycardia (asystole (without cardiac contraction) and pulseless electrical activity cannot be defibrillated)
- Intubation – insertion of an endotracheal tube to secure the airway.
- Application of medication
After successful resuscitation
- Patients after successful resuscitation are cooled (= mild therapeutic hypothermia) for 24 hours to protect the nervous system
