Artificial ventilation of light children of early age. The device of artificial ventilation of the lungs in children. Sequence of action
Equipment:Pelainka, glue, napkins. 1 pair of sterile gloves, sketch-shaped tray, rubber can, boiled water. Container for Waste Class "B", sterile gauze napkins.
Preparation for manipulation:
1. Explain your mother's course of procedure, and consent.
2. Conduct sanitary handling
Execution of manipulation:
1. To lay a child with a raised head end, turn the head on the side.
2. Close the neck and breast of the child with glued and pellets.
3. Submold to the mouth of the child a kick-shaped tray.
4. After stopping the vomiting with the help of a rubber sprinkler with boiled water to carry out the irrigation of the oral cavity, tilting the head of the child over the tray. Wipe the lips of the child with a napkin.
5. Give a drink 1-2 teaspoons of boiled water.
Completion of manipulation:
3. Wash out, dry hands.
19. Technique of IVL child various methods a. Bag of ambubs with mask
Equipment:Fabric roller, sterile gauze napkins, mask, interbu bag,
electrospots, container for class "B", sterile gloves.
Preparation for manipulation:
Performance of manipulation:
1. Take a baby's head back, put a roller in the shoulders, remove the lower jaw in front (relative to the child's position).
2. Attach a bag of AMBU to mask.
3. Tightly put a mask on the nose and mouth child.
4. To hold the mask on the face of the child with one hand: the nasal part of it to press the 1st finger, and the chin-2nd finger, 3.4 and 5 fingers pull the chin's chin up.
5. Free hand Combine the bag until the chest raising appears, then let go of the bag so that you exhale, and then take a breath again.
6. The IVL frequency should be at least 40 pins in 1 min. (in newborns) and 20 frills (in older children).
7. Continue IVL before the appearance self-breathing Or the arrival of the doctor.
Completion of manipulation:
1. Subject to the medical appointment of reusable processing in accordance with the industry standard and regulatory documents for disinfection and preservation cleaning.
2. To carry out disinfection of medical waste in accordance with Sanpin.2.1.3. 2630 -10 "Rules for collecting, storing and removing waste treatment - preventive institutions."
3. Wash out, dry hands.
B. Method breathing from "Mouth in Mouth"
Equipment:Fabric roller, sterile gauze napkins, electric cover, container for Waste class "B", sterile gloves.
Preparation for manipulation:
1. Conduct the sanitary processing of the hands. Wear gloves.
2. Put a child on a horizontal solid surface and free from clothes.
3. Inspect the upper respiratory tract, if necessary, remove vomit masses or mucus with the help of electric cover, a finger, a napkin.
Performance of manipulation:
1. Take the baby's head back, put under the shoulders roller,
to bring the lower jaw in front (relative to the situation of the child).
2. Put a napkin on the mouth and nose area.
3. For a breath and tightly press your mouth to mouth and the nose of the child.
4. Energetically exhale the contents of their lungs, without hiding the exhalation.
5. Make two deep breaths with an interval of 5 seconds and a duration of 1.5-2 seconds each.
6. Check the presence of breathing motions of the chest and air movement of the mouth and the nose of the child when exhale.
7. The IVL frequency should be at least 40 pins in 1 min. (in newborns) and 20 frills (in older children).
8. Continue IVL before the advent of independent respiration or the arrival of the doctor.
Completion of manipulation:
1. Subject to the medical appointment of reusable processing in accordance with the industry standard and regulatory documents for disinfection and preservation cleaning.
2. To carry out disinfection of medical waste in accordance with Sanpin.2.1.3.2630 - 10 "Rules for the collection, storage and disposal of waste of therapeutic - preventive institutions."
3. Wash out, dry hands.
The one who saved one life saved the whole world
Mishnah Sanhedrin.
Features cardiovascular Resuscitation in children of different agesRecommended by the European Council on Resuscitation, were published in November 2005 in three foreign journals: Resuscitation, Circulation and Pediatrics.
Sequence of resuscitation activities in children in general features It is similar to those in adults, but when conducting events to maintain life in children (ABC) special attention Points A and V. If the resuscitation of adults is based on the fact of the primacy of heart failure, then the child has a heart stop - this is the finale of the process of gradual fading physiological functions The body initiated is usually respiratory failure. The primary stop of the heart is very rare, ventricular fibrillation and tachycardia are its causes of less than 15% of cases. Many children have a relatively long phase of "Provision", which determines the need early diagnosis This phase.
Pediatric resuscitation is composed of two stages, which are presented in the form of algorithms (Fig. 1, 2).
Pentility restoration respiratory tract (DP) In patients with a loss of consciousness, aimed at reducing obstruction, which is frequent causes the spare on language. If the muscle tone lower jaw A sufficient, then the heading of the head will cause the movement of the lower jaw ahead and will open the respiratory tract (Fig. 3).
In the absence of sufficient tone, the heading of the head must be combined with the extension of the lower jaw (Fig. 4).
However, children breast-age There are features of the execution of these manipulations:
- do not excessively throw the baby's head;
- do not squeeze soft fabrics Chin, as it can cause the obstruction of the respiratory tract.
After the release of the respiratory tract, it is necessary to check how effectively the patient breathes: you need to look, listen, watch the movements of his chest and abdomen. Often the recovery of the airways and its maintenance is enough to ensure that the patient is in the subsequent breathing effectively.
Feature of artificial ventilation of the lungs in children early age Determined by the fact that little diameter The respiratory tract of the child provides a large resistance to the stream of inhaled air. To minimize the increase in pressure in the aerial paths and the prevention of abstratus of the stomach of breaths must be slow, and the frequency of respiratory cycles is determined by age (Table 1).
The sufficient volume of each breath is the volume providing adequate chest movements.
Make sure the breathing adequacy, the presence of cough, movements, pulse. If there are signs of circulation - continue respiratory support, if there is no circulation - to start an indirect heart massage.
In children up to a year, providing assistance, its mouth tightly and hermetically captures the nose and mouth of the child (Fig. 5)
in the elder children, the patient's nose presses the patient's nose over two fingers and covers its mouth (Fig. 6).
In children's practice, the heart stop is usually secondary to the obstruction of the respiratory tract, which is most often caused by a foreign body, an infection or an allergic process that leads to a respiratory tract. The differential diagnosis between the obstruction of the respiratory tract caused by foreign body and infection is very important. Against the background of infection to remove a foreign body is dangerous, as they can lead to an unnecessary delay in transportation and treatment of the patient. In patients without cyanosis, the cough should be stimulated with adequate ventilation, it is impractical to use artificial respiration.
The method of eliminating the obstruction of the respiratory tract caused by a foreign body depends on the age of the child. Purification with the finger of the upper respiratory tract blindly in children is not recommended to use, since at this moment you can push the foreign body deeper. If the foreign body can be seen, it can be deleted using Kelly clamp or a mesing tweezers. Pressing on the stomach is not recommended to apply in children up to a year, since it has a threat of damage to organs. abdominal cavity, especially liver. At this age, you can assist in this age while holding it on the hand in the position of the "rider" with a head lowered below the body (Fig. 7).
The baby's head is maintained by hand around the lower jaw and chest. On the back between the blades quickly apply four blows to the proximal part of the palm. Then the child is placed on the back so that the head of the victim was lower than the body throughout the reception and perform four paving on the chest. If the child is too big to put it on the forearm, it is placed on the hip so that the head is below the body. After cleaning the respiratory tract and the restoration of their free passability in the absence of spontaneous breathing, artificial ventilation of the lungs begin. In older children or adults in the obstruction of the respiratory tract, a foreign body recommend using Hamelich's reception - a series of subdiaphraggmal pressure (Fig. 8).
Emergency Createness is one of the options for maintaining the airways in patients who cannot be intubled by the trachea.
As soon as the respiratory tract is released and two trial respiratory movements are fulfilled, it is necessary to install whether the child has only a respiratory stop or at the same time a heart stop - determine the pulse on major arteries.
In children, up to the year, the pulse is estimated on the shoulder artery (Fig. 9)
T. K. A short and wide baby neck makes a difficult fast search for a carotid artery.
In older children, as in adults, the pulse is estimated at the carotid artery (Fig. 10).
Under resuscitation, the restoration of vital activity is understood with the full stop of the heart and breathing. The resumption of cardiac activity and respiration does not mean the final revival. More difficult further treatmentaiming full recovery all the functions of the body, mainly central nervous system.
Simple methods recovery of cardiac activity and respiration should own all doctors, medium medical staff and even some organized groups population. It is explained by the fact that cells of the cortex of the brain without oxygen die in conventional conditions After 3-5 minutes. Almost currently maintaining the vital activity of the brain cells when the heart and respiration is stopped, it is possible only with the help of artificially maintaining ventilation of lungs and cardiac activity. Therefore, the simplest methods of recovery of cardiac activity and respiration should begin the one who will be near the affected child. If in the next few minutes after stopping the heart and respiration there will be no artificial maintenance of ventilation and cardiac activity, then in the future any activities will be useless. Below will be the main methods of artificially maintaining ventilation and gas exchange, which are carried out in any conditions when stopping the breath and blood circulation. A pediatrician not only must master these methods, but also to train all the staff of the institution's reanimation basics and create a system of resuscitation activities.
Artificial ventilation of the lungs
Methods of artificial ventilation, based on blowing air, oxygen in the respiratory tract and light patients are most effective. The blowing can be carried out with mouth to mouth, mouth to the nose, with the help of a special respiratory bag, through the mask of the anestaneous apparatus and the endotracheal tube introduced into the trachea.
Before starting artificial ventilation, it is necessary to free the respiratory tract of the child from foreign languages, liquids, mucus. For this newborn or baby You can lift out the legs and remove the contents of the mouth. Little child Put on the thigh of a person providing assistance head down. The oral cavity among older children is released in the same way or fingers. Further actions Conductive artificial ventilation occur in a certain order:
1) the child is placed on the back, under his shoulders, it has a small roller and the head is swing abruptly, and the lower jaw holds; An animation makes a deep breath, and then quickly blows the baby in his mouth, while the nostrils of the child clamp;
2) when the child's head exhale is kept in a sharply dispersed position, the lower jaw is removed so that the upper and lower teeth come into contact; Exhaust continues twice the longer inhale (Fig. 5).
Fig. 5. Artificial breath mouth in the mouth. a - blowing air into the lungs through the mouth; B - Passive exhalation.
For one breath, the child needs to be blown into light volume, about 11/2 times higher than its respiratory volume. It produces 20-28 pins per minute.
When using the respiratory bag or anesthesia, the principles remain the same.
Rhythmic chest and diaphragm movements indicate that the air intake enters the lungs.
Artificial recovery and maintaining cardiac activity. With full cessation of cardiac activity no activities (intraarterial blood injection, medication tools), in addition to direct impact on the heart, the effect will not be given.
Heart stop is diagnosed in absence arterial pressure, pulse and cardiac tones, skin palls and sharp expansion of pupils. During the operation from vessels ceases bleeding.
In most cases restoration of cardiac activity begins with indirect heart massage (Fig. 6).
Fig. 6. Indirect heart massage (scheme). A - the heart is not compressed and filled with blood (diastole); B - the heart is compressed between the sternum and the spine, the blood pushes into the vessels (systole).
Principle of indirect massage It lies in the periodic squeezing of the heart between the sternum and the spine. At the time of compression, the blood pushes into the vessels, and at the moment when the heart is not compressed, it is filled with blood.
Indirect Heart Massage Technique
The child is placed necessarily on a solid base (table, bed with wooden shields, floor). Feet better raise. Then they produce energetic periodic pressing on the lower third of the sternum at a speed of 90-100 times per minute. When pressing the amplitude of the movement of the sternum should be 3-4 cm. Newborn, pressing the sternum is produced by one finger, baby - palm with raised fingers, and in children over 8-9 years old - two palms with raised fingers (Fig. 7, 8).
Fig. 7. Indirect heart massage in child of older
Fig. 8. Indirect heart massage in a newborn or infant child
During the indirect massage, it is useful until the appearance of independent heart abbreviations take the abdominal aorta, pressing the navel fist. This reduces the volume of circulating blood and improves the blood supply of the brain.
If within 11 / 2-2 minutes of indirect massage does not appear ripple on the carotid artery, you should move to direct heart massage. The chest is opened on the fourth or fifth left intercreicity from the middle-insucicular line to the sternum. Pericardium is often revealed. Heart ventricles are squeezed by one or two hands at a speed of up to 100 times per minute and a compression duration of 0.3 s. If the heart stops occurred during the operation on the abdominal cavity, then the heart massage can be produced through a diaphragm, pressing the heart to the chest.
Medical therapy and defibrillation
Medicase therapy is carried out only after the start of the heart and artificial ventilation massage.
1. In all cases of clinical death, it should be intravenously to introduce 10-60 ml of 4% sodium bicarbonate
2. In cases where the heart stop is caused by bleeding, it is necessary to introduce blood intravenously under pressure.
3. If cardiac activity after 1-2 minutes after the start of the massage is not restored, introduce intracardiac (in the left ventricle) or intravenously 0.1-0.2 mg (it is better to dissolve to 1 - 2 ml) 0.1% of the adrenaline solution.
4. Intravenously introduce 1-4 ml of 2% calcium chloride solution.
During heart fibrillation, defibrillation is carried out. The latter is one of of most dangerous complications Massage either comes independently from the same reason as the heart stop. Fibrigration is diagnosed on the same basis as the stop of the heart, but the Specific curve is visible on the ECG. With an open pleural cavity, chaotic twitching of individual muscle groups are observed. Most effective method Fibrillation treatment is electrical defibrillation with special defibrillators, which can be repeated several times. After the cessation of heart fibrillation should continue the heart massage.
Resuscitation efficiency
Determined by the appearance of the pulse on peripheral vessels, reducing pallor and cyanosis, narrowing the pupils and the appearance of corneal reflex, restoration of independent respiration and consciousness.
Conducting cardiovascular intensive care.
Above the methods of recovery and cardiac activity were presented above. When stopping the heart and breathing, artificial ventilation and heart massage are carried out simultaneously in the following order:
1) the rapid release of the respiratory tract;
2) 2-3 blowing air or oxygen into light patients;
3) 4-5 pressure on the sternum;
4) Subsequently - alternation of 1 inhale and 4-5 pressure.
At the moment of breath, it is impossible to apply to the sternum. If the resuscitation conducts one person, then for every 2 breaths, 15-18 presses are produced on the sternum. Every 2 min for a few seconds stop resuscitation activities to check their effectiveness. During resuscitation, experts or child are transferred to special institutionAnd during transportation is carried out in resuscitation.
The key to the success of resuscitation activities is the organization of systematic learning of everything medical personnel. Only this can provide timely for a few minutes. effective conduct resuscitation.
Isakov Yu. F. Children's Surgery, 1983.
Cardiopulmonary Resuscitation ChildrenCLOR in children under the age of 1 year
Sequencing:
1. Slightly shake or praise the baby if you suspect that he is unconscious
2. Put the baby on the back;
3. Call someone to the rescue;
4. Free the respiratory tract
Remember! When extensing the head of the baby, avoid its inflection!
5. Check if there is a breath, if not, start IVL: deeply inhale, cover your mouth and baby's mouth and make two slow shallow blows;
6. Check the pulse for 5 - 10 more. (in children under 1 year, the pulse is determined on the shoulder artery);
Remember! If you offer help at this time, ask for an ambulance.
7. In the absence of a pulse, place the 2nd and 3rd fingers on the sternum, one finger below the nipple line and start the indirect heart massage
Frequency at least 100 in 1 min;
Depth 2 - 3 cm;
The ratio of the jigs on the sternum and blows - 5: 1 (10 cycles per minute);
Remember! If there is a pulse, and the breathing is not determined; IVL is carried out with a frequency of 20 pins in min. (1 blowing every 3 seconds)!
8. After the indirect heart massage passes to the IVL; Make full 4 cycles
In children under 1, the respiratory disorder is most often caused by a foreign body in the respiratory tract.
As with an adult victim, the blockage of the respiratory tract can be partial or complete. With partial blockage of the respiratory tract, the baby is frightened, coughing, inhales with difficulty and noisy. With full blockage of respiratory tract - skin Covers Pale, lips become bluish, no cough.
The sequence of actions when reanimation of a baby with full blockage of respiratory tract:
1. Put the baby on your left forearm face down, so that the child's head "swallowed" with the life of the rescuer;
2. Make 4 cotton on the back of the affected palm base;
3. Put the baby to another forearm face up;
4. Make 4 pages on the chest, as with an indirect heart massage;
5. Perform 1 - 4 stages until the respiratory tract or kid will not lose consciousness;
Remember! An attempt to remove the foreign body blindly, as in adults, not allowed!
6. If the baby lost consciousness, make a cycle of 4 cotton on the back, 4 shoes on the sternum;
7. Inspect the affected mouth:
If the foreign body can be seen, remove it and make an IVL (2 pins);
If the foreign body is not removed, repeat the cotton on the back, shocks on the sternum, the mouth inspection and IVL as long as the baby's chest is not raised:
- After 2 successful blows, check the pulse on the shoulder artery.
Features of IVL in children
To restore respiration in children up to 1 year, IVL is carried out by "mouth to mouth and nose", in children over 1 year old - the way "mouth in the mouth". Both methods are held in the position of the child on the back. Children up to 1 year under the back are put a low roller (nr, folded blanket), or slightly lifted top The body was put under his back hand, the baby's head slightly thrust. Assist makes a shallow breath, hermetically covered mouth mouth and baby nose up to 1 year or only mouth in children older year, and blows into the airway air, the volume of which should be the less than less child. In newborns, the volume of inhaled air is 30-40 ml. With a sufficient volume of influenced air and air intake in the lungs (and not in the stomach), the pectoral movements appear. Having finished blowing, you need to make sure whether rib cage.
Blowing excessively large for the child of the air volume can lead to heavier consequences - To the rupture of the alveoli and the pulmonary fabric and the outlet of the air into the pleural cavity.
Remember!
The frequency of blowings should correspond to the age frequency of respiratory movements, which decreases with age.
On average, ChDD in 1 minute is:
In newborns and children up to 4 months - 40
In children 4-6 months - 35-40
In children of 7 months - 35-30
Children 2-4 years old - 30-25
In children 4-6 years old - about 25
In children 6-12 years old - 22-20
Children 12-15 years old - 20-18 years old.
Features of indirect heart massage in children
In children breast wall Elastic, so indirect heart massage perform with less effort and with greater efficiency.
The method of indirect heart massage in children depends on the age of the child. Children under 1 year enough to press 1-2 fingers on the sternum. For this, the help puts the child on his back head towards himself, covers it so that thumbs Hands were located on the front surface of the chest, and their ends - on the lower third of the sternum, the remaining fingers are put under the back.
Children older than 1 year to 7 years, the heart massage is produced, standing on the side, the base of one brush, and older children are both hands (as an adult).
During massage, the chest should be fed at 1-1.5 cm in newborns, by 2-2.5 cm in children 1-12 months, 3-4 cm in children older than the year.
The number of presses on the sternum for 1 minute must correspond to the average age frequency of the pulse, which is:
In newborns - 140
In children 6 months - 130-135
In children 1 year - 120-125
In children 2 years old - 110-115
In children 3 years old - 105-110
In children 4 years old - 100-105
In children 5 years old - 100
In children 6 years old - 90-95
In children of 7 years - 85-90
In children 8-9 years old - 80-85
In children 10-12 years old - 80
Children 13-15 years old - 75
Tutorial
UMP on the basics of nursing business, the editors of Ph.D. A.I.Shpirna, M., GOU VUNMTS, 2003, p. 683-684, 687-988.
S.A. Mukhina, I.I.Ternanovskaya, Atlas on the manipulation technique of nursing care, M., 1997, p.207-211.
Resuscitation to children.
In children, the cessation of blood circulation due to cardiac causes WHO is very rare. In newborns and infants, the reasons for the remain-new blood circulation can be: asphyxia, syndrome sudden death Newborn, pneumonia and bronchi-pains, drowning, sepsis, neuro-logical diseases. In children of the first years of life, the main cause of death is injuries (road, pedestrian, cycling), asphyxia (as a result of diseases or aspiration of foreign bodies), drowning, burns and firearms.
Definition of the pulse on carotid arteries in newborns is difficult due to short and round neck.. Therefore, checking the pulse in children under one year is recommended on the shoulder artery, and in children older than one year - at the carotid artery.
Patency of airways in children younger age It is achieved by a simple chin lifting or lower jaw extension. If the child's own breath in the first years of life is absent, then the most important resuscitation event is the IVL. For conducting IVL In children are guided regular rules. In children under 6 months. IVL is carried out by blowing air in the mouth and the nose at the same time. In children old 6 months. Breathing is carried out from mouth into the mouth, at the same time the nose of the child I and II fingers. Care should be taken with respect to the volume of the air and created by this pressure in the respiratory tract. The air is blown slowly for 1-1.5 s. The volume of each blowing should cause a calm rise of the chest. If the chest is not raised when zl, then this indicates the abstraction of the respiratory tract. SAMI frequent cause Obstruction - the incomplete opening of the respiratory tract due to the insufficiently correct position of the head of the reanimated child. It is necessary to carefully change the position of the head and then start it again.
The use of air ducts, intubation tubes, sane catheters in size, respectively, the child's age;
Age - the inner diameter (mm) of the intubation tube
newborn - 3.0
6 months - 3.5
18 months - 4.0
3 years - 4, .5
5 years - 5.0
6 years - 5.5
8 years old - 6.0
12 years - 6.5
16 years old - 7.0
The efficiency of the IVL is estimated on the excursion of the breast cell and the air flow during the exhalation. The tempo of IVL in newborns is approximately 40 per minute, in children older than 1 year - 20 per minute, at sub-spackers - 15 per minute.
The outer massage of the heart in infants is carried out by two Pal-Cami, and the compression point is located on 1 finger below the integrated line. The help supports the child's head in a position providing the respiratory tract. The depth of the sternum compression is from 1.5 to 2.5 cm, the frequency of pressure is 100 per minute (5 compressions for 3 s and faster). The ratio of the frequency of compression to the IVL tempo for the children of the first year of life should be 5: 1, regardless of the number of participants in resuscitation. After 10 cycles (5 compressions: 1 inhale) you need to try for 5 with a certain pouring pulse on the shoulder artery.
In children at the age of 1-8 years, pressed on the lower third of the sternum (on the thickness of the finger above the sword-shaped process) the base of the palm. The depth of the sternum compression is from 2.5 to 4 cm, the massage frequency is at least 100 per minute. Massage ratio: IVL - 5: 1 The condition of the child (pulse on the carotid artery) is re-evaluated after 1 min after the start of resuscitation, and then each 2-3 minutes.
In children over 8 years old, the Salry technique is the same as in adults.
Dosage of drugs in children under the election: adrenaline - 0.01 ml / kg; Atropine - 0.015 ml / kg, lidocaine - 0.05 ml of 2% r-ra / kg baby weight.
With the introduction of an 8.4% solution of sodium bicarbonate, it should be breed in half a sodium chloride isotonic solution.
Features of defibrillation in children. The dimensions of the electrodes for children are only aspect that they should not touch each other. The electrodes are located either in front, or one to the left of the sternum, and the second - on the back of the child. It is important to trace so that the electrically conductive gel is unloaded between the electrodes.
The magnitude of the first discharge for the treatment of ventricular fibrillation or ventricular tachycardia without a pulse is defined as 2 J / kg of the body weight of the child (regardless of the type of pulse). Subsequently, with ineffectiveness, the discharge value can be increased to 4 J / kg. Some literary sources recommended an increase in energy to 10 J / kg (naturally, not higher than the maximum value for adults), but the data for such recommendations is not enough.