Hospitals 

Compression in the chest - when to sound the alarm? Chest compression

Two theories have been proposed to explain the mechanisms of blood flow during chest compression. The earliest was the theory of the heart pump (Fig. 5.16A), according to which blood flow is caused by the compression of the heart between the sternum and the spine, as a result of which increased intrathoracic pressure pushes blood from the ventricles into the systemic and pulmonary channels.

In this case, a prerequisite is the normal functioning of the atrioventricular valves, which prevent the retrograde flow of blood into the atria. In the phase of artificial diastole, the resulting negative intrathoracic and intracardiac pressure provides venous return and filling of the ventricles of the heart. However, in 1980, 5. T. Neman, SR Baab, et al. discovered that cough, increasing intrathoracic pressure, briefly maintains adequate cerebral blood flow. The authors called this phenomenon cough autoresuscitation. A deep rhythmic intensified cough with a frequency of 30-60 per minute is able to maintain consciousness in trained patients (with cardiac catheterization) for the first 30-60 seconds after the onset of circulatory arrest, which is enough to connect and use a defibrillator.

Subsequently 5. Oisaz et al. (1983) showed that positive intrathoracic pressure is involved in the generation of systemic blood pressure. The authors measured the blood pressure by a direct method (in the radial artery) in a patient in a state of clinical death with refractory asystole during mechanical ventilation with an "Ambu" bag without chest compression. The pressure peaks on the curves were found to be due to rhythmic inflation of the lungs (Figure 5.17). During periods of cessation of mechanical ventilation, phase pressure



the depression disappeared, which indicated the ability of positive intrathoracic pressure to participate in the generation of systemic blood pressure.

These were the first works that allowed to substantiate the theory of the chest pump, according to which blood flow during chest compression is due to an increase in intrathoracic pressure, which creates an arteriovenous pressure gradient, and the pulmonary vessels act as a reservoir of blood. Atrioventricular valves remain open during compression, and the heart acts as a passive reservoir, not a pump. The theory of the thoracic pump was confirmed by the data of transesophageal echocardiography, according to which the valves remained open. On the contrary, in other studies using echocardiography, it was shown that at the time of compression systole, the atrioventricular valves remain closed, and open during the artificial diastole phase.

Thus, both mechanisms appear to be involved to some extent in generating circulation in CPR.

It should be noted that prolonged chest compression is accompanied by a progressive decrease in the mobility of the mitral valve, diastolic and systolic volumes of the left ventricle, as well as stroke volume, indicating a decrease in left ventricular compliance (compliance), up to the development of contracture of the heart muscle, that is, the phenomenon of the so-called "stone hearts ".

A fundamental problem in artificial circulation is the very low level (less than 30% of the norm) of cardiac output (CO) generated by chest compression. Correctly performed compression ensures the maintenance of systolic blood pressure at the level of 60-80 mHg, while diastolic blood pressure rarely exceeds 40 mHg and, as a consequence, causes a low level of cerebral (30-60% of normal) and coronary (5- 20% of the norm) of blood flow. During chest compression, the coronary perfusion pressure rises only gradually and therefore decreases rapidly with each successive pause required for mouth-to-mouth breathing. However, carrying out several additional compressions leads to the restoration of the initial level of cerebral and coronary perfusion. In this regard, significant changes have occurred in relation to the algorithm for performing chest compression. It was shown that the ratio of the number of compressions to the respiratory rate, equal to 30: 2, is more effective than 15: 2, providing the most optimal ratio between blood flow and oxygen delivery, and therefore the following changes were made in the EKC'2005 recommendations: the number of compressions and the number of artificial breaths for both one and two rescuers should be 30: 2 (Fig.5.18).

Chest compression technique. First of all, this is the correct laying of the patient on a flat, hard surface. After that, the point of compression is determined by palpating the xiphoid process and retreating two transverse fingers up, after which the hand is placed with the palmar surface on the border of the middle and lower third of the sternum (fingers parallel to the ribs), and another on it (Fig.5.19A). The position of the palms with a "lock" is possible (Fig. 5.19B). Compression is carried out with arms straightened in the elbow joints, using part of your body weight (Fig.5.19C).

Compression of the chest should be carried out at a frequency of 100 / min (about 2 compressions per second), to a depth of 4-5 cm, pausing for artificial respiration (it is unacceptable for non-intubated patients to blow air at the time of chest compression - there is a danger of air entering the stomach ).


The ratio of the number of compressions to the respiratory rate:

A) without airway protection for both one and two resuscitators should be 30: 2;

B) with airway protection (tracheal intubation, use of a laryngomask or combo tube), chest compression should be performed at a frequency of 100 / min, ventilation at a frequency of 10 / min (moreover, chest compression with simultaneous inflation of the lungs increases coronary perfusion pressure).

A sign of the correctness and effectiveness of chest compression is the presence of a pulse wave on the main and peripheral arteries.

To determine the possible restoration of spontaneous circulation, every 2 minutes, CPR is paused (for 5 seconds) to determine the pulse in the carotid arteries.

In children aged 10-12 years, chest compression is carried out with one hand, and the ratio of the number of compressions and breathing should be 15: 2. For newborns and infants - with the tips of two fingers at a frequency of 100-120 / min (see Fig.5.190).

The purpose of breast compression is to resume and maintain milk flow from the breast to the baby if the baby no longer swallows milk by itself during feeding (there is no sucking sequence: “mouth wide open - pause-closed mouth "). Thus, squeezing helps the baby to continue to receive milk. Compression of the breasts stimulates the milk flow reflex and often induces a natural flush.

This method can be useful when:

  • The child is not gaining weight well
  • The child has colic
  • Frequent and / or very long feedings
  • Sore nipples in the mother
  • Recurrent congestion and / or mastitis
  • It is necessary to help the child who quickly falls asleep under the breast to suck out more milk.

You don't need to squeeze your chest if everything is going well. When everything is in order, the mother just has to let the baby suck the first breast, and if the baby wants more, offer him the second. How do you know that the child has sucked everything? When he no longer swallows milk (“wide open mouth- pause-closed mouth "). Compression of the chest works especially well in first days, this allows the baby to receive more colostrum. Children don't need a lot of colostrum, but they need some of it... A good latching on and squeezing of the breasts will help them get it.

It may be helpful to know:

  1. Well attached to the chest it is easier for a child to get milk than an incorrect one. A poorly attached baby can only receive milk when the milk flow is very strong. Therefore, many mothers and their children do a great job, despite to improper attachment, because most mothers produce milk in excess.
  2. In the first three to six weeks of life, many babies fall asleep under the breast when milk flows slowly, not necessary because they have enough food. When they get older they may to become anxious and arching at the breast when milk flow slows down. Some babies arch at their breasts even when they are very young, sometimes already in the first days.
  3. Unfortunately, many babies do not breastfeed effectively. If the mother has a lot of milk, the baby often develops well when looking at weight gain, but the mother has to pay for it: sore nipples, "colic" in the baby, a baby who spends all the time at the breast, although effectively suckles only a small part of this time ...

Compression of the breast allows milk to flow when the baby begins to fall asleep under the breast, and as a result, the baby:

  1. gets more milk
  2. gets more fatty milk

Breast Compression - How It's Done:

  1. Support your baby with one hand
  2. Support your breasts with your other hand, with your thumb on one side of your breasts and your other fingers on the other, very far from the nipple.
  3. Watch if the baby is swallowing milk, although there is no need to closely monitor each sucking movement. The baby receives a noticeable amount of milk when he sucks in this rhythm: “mouth wide open - pause-closed mouth "- this is one sucking movement, a pause in this case not that that between sucks).
  4. When the child is already just lightly sucking on the breast or does not drink milk in the rhythm of "wide open mouth - pause-closed mouth ", squeeze your chest. Not to pain, and make sure that the shape of the breast near the baby's mouth does not change. By squeezing the breast, the baby will begin to suck again in a “wide open mouth” rhythm. pause- closed mouth ”and swallow milk.
  5. Keep your chest compressed until the baby stops swallowing milk, then relax your arm. Often the baby stops sucking at all when the compression has stopped, but he will start sucking as soon as the milk flows again. If the baby does not stop sucking after you release the squeeze, wait a little before squeezing again.
  6. The squeeze is removed so that your hand can rest and to allow the milk to flow to the baby. A baby who stops sucking after you relax your hand will start sucking again when he tastes milk.
  7. When the baby starts sucking again, he can swallow milk (“mouth wide open - pause-closed mouth "). If not, squeeze your chest again as described above.
  8. Continue to breastfeed your baby for the first time until he stops swallowing milk even with squeezing. You need to give the baby the opportunity to stay on this breast for a while after that, as your milk separation reflex may work again, and the baby will begin to swallow milk on its own. If the baby still no longer swallows milk, allow him to release the breast or take the breast out of his mouth yourself.
  9. If the baby wants more, attach it to the other breast and repeat the process.
  10. You can move the baby from one breast to another several times during feeding, of course, if your nipples do not hurt.
  11. Improve your baby's latching on to the breast.
  12. Squeeze the breast while the baby is sucking, but does not swallow milk.

In our experience in the clinic, this technique works best, but if you can find a way that is more effective for getting your baby to suck in a wide-open-mouth rhythm pause-Mouth Closed "Longer - use what works best for you and your baby. As long as the compression does not hurt your breast and while the baby swallows milk (“mouth wide open - pause- closed mouth ”), chest compression will work.

You don't have to do this all the time. Once your breastfeeding is fine, you can simply rely on nature.

Jack Newman, MD, FRCPC
Translation by V. Nesterova, with the permission of the author

    Correct laying of the patient on a flat solid surface. Determination of the point of compression - palpation of the xiphoid process and retreat two transverse fingers upwards, after which they position hand palmar surface on the border of the middle and lower third of the sternum, fingers parallel to the ribs, and on it the other (Fig. 13 A).

Variant arrangement of palms "lock" (Fig. 13 B)

    . Correct compression: arms straightened in the elbow joints, using part of the weight of your body (Fig. 13 C].

/

Rice. fourteen. The relationship between artificial respiration and the number of chest compressions

works with the use of echocardiography, it was shown that at the time of compression systole, atrioventricular valves remain closed, and open in the phase of artificial diastole. Thus, both mechanisms appear to be involved to some extent in generating circulation in CPR. with/

30 Pressing on the sternum

Compression of the chest. A fundamental problem in artificial circulation is the very low level (less than 30% of the norm) of cardiac output (CO) generated by chest compression. Correctly carried out compression ensures the maintenance of systolic blood pressure at the level of 60-80 HRM, while diastolic BP rarely exceeds 40 HRM and, as a consequence, causes a low level of cerebral (30-60% of normal) and coronary (5-20 % of the norm) of blood flow. When chest compression is performed, coronary perfusion pressure rises only gradually and therefore decreases rapidly with each successive pause required for mouth-to-mouth breathing. However, carrying out several additional compressions leads to the restoration of the initial level of cerebral and coronary perfusion. In this regard, significant changes have occurred in relation to the algorithm for performing chest compression. It has been shown that the ratio of the number of compressions to the respiratory rate, equal to 30: 2, is more effective than 15: 2, providing the most optimal ratio between blood flow and oxygen delivery:

The ratio of the number of compressions and the number of artificial breaths for both one and two rescuers should be 30: 2 (Fig. 14).

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2 Injections

Chest compression should be done with frequency of at least 100 compressions / min., to a depth of at least 5 cm in adults(since it should be noted that often resuscitators do not press on the chest deep enough, which reduces the efficiency of the blood circulation induced by compression, and therefore worsens the outcome of CPR), pausing for artificial respiration (it is unacceptable for non-intubated patients to blow air at the time of chest compression - danger of air entering the stomach).

Signs of the correctness and effectiveness of the chest compression is the presence of a pulse wave on the main and peripheral arteries

.

Rice. 15. Mechanical devices for chest compression

Direct heart massage remains a later alternative. Despite the fact that direct cardiac massage provides a higher level of coronary and cerebral perfusion pressure (50% and 63-94% of the norm, respectively) than chest compression, however, there is no data on its ability to improve the outcome of PCR, in addition, its use is associated with more frequent complications. Nevertheless, there are a number of direct indications for its implementation:

    The presence of an open chest in the operating room;

    Suspected intrathoracic bleeding;

    Suspected abdominal circulation disorder due to clamping of the descending thoracic aorta;

    Massive pulmonary embolism;

    Cessation of blood circulation against the background of hypothermia (allows direct warming of the heart);

    Failure of chest compression to generate a pulse in the carotid and femoral arteries due to the presence of deformation of the bones of the chest or spine;

    Suspicion of a prolonged period of unnoticed clinical death;

    Failure of correctly performed chest compression in combination with other measures of the stage of further life support to restore spontaneous normotension.

In order to facilitate long-term CJIP, mechanical devices for chest compression are widely used abroad, such as AutoPulse (Zoll) (Fig. 15 A) and Life-State (Michigan Instruments) (Fig. 15 B) etc.

B. Control and restoration of airway patency

The main problem that occurs in unconscious persons is the obstruction of the airways with the root of the tongue and the epiglottis in the laryngopharyngeal region due to muscle atony (Fig. 16 A). These phenomena occur in any position of the patient (even on the stomach), and when the head is tilted (chin to chest), airway obstruction occurs in almost 100% of cases. Therefore, after it is established that the victim is unconscious, it is necessary to ensure airway patency.

The "gold standard" for ensuring airway patency is "triple reception" according to P. Safar and tracheal intubation.

P. Safar was developed "Triple reception" on the respiratory tract, including: tilting the head back, opening the mouth and pushing the lower jaw forward(Fig. 16 C, D). Alternative methods of airway restoration are shown in Fig. 16 B and 16 D.

When carrying out manipulations on the airways, it is necessary to remember about possible damage to the spine in the cervical spine. Most likely to injure the cervical spine

can be observed in two groups of victims:

    In case of road traffic injuries(a person was hit by a car or was in a car during a collision);

    When falling from a height(including divers).

Such victims should not bend (bend the neck forward) and turn their head to the sides. In these cases, it is necessary to make a moderate extension of the head towards oneself, followed by holding the head, neck and chest in the same plane, excluding the overextension of the neck in the "triple reception", ensuring a minimum tilt of the head and simultaneous opening of the mouth and extension of the lower jaw forward

B. Throwing back the head


A. Obturation of the airways with the root of the tongue and epiglottis


D. "Triple reception" by P. Safar

Rice. 16. Methods for restoring airway patency

C. "Triple reception" by P. Safar

E. Reception in the respiratory tract with E. Reception in the respiratory tract with complete relaxation of the lower jaw, possible damage to the spine in

cervical spine

Rice. 17. Forced opening of the mouth using the crossed fingers method.


When providing first aid, the use of collars that fix the neck area is shown (Fig. 16 E].

Throwing the head back alone does not guarantee airway patency. So, in 1/3 of unconscious patients due to muscular atony, the nasal passages during exhalation are closed with a soft palate, which moves like a valve.

In addition, there may be a need to remove foreign matter contained in the oral cavity (blood clots, vomit, tooth fragments, etc.). Therefore, especially in persons with injuries, it is necessary to revise the oral cavity and, if necessary, clean it of foreign contents. To open the mouth, use one of the following techniques (Fig. 17).

1. Reception with the help of crossed fingers with a moderately relaxed lower jaw. The resuscitator stands at the head end or on the side of the patient's head (Fig. 17 A). The index finger is inserted into the corner of the victim's mouth and pressed on the upper teeth, then opposite

Rice. 18. Forced opening of the mouth. the index finger is placed the thumb on the lower teeth (Fig. 17 B) and forcibly open the mouth. In this way, a significant spreading force can be achieved, allowing the mouth to be opened and the oral cavity to be examined. If foreign bodies are present, they must be removed immediately. To do this, turn the head to the right without changing the position of the fingers of the left hand (Fig. 17 B). With the right index finger, the right corner of the mouth is pulled downward, which facilitates self-drainage of the oral cavity from liquid contents (Fig. 17 D]. One or two fingers, wrapped in a handkerchief or other cloth, cleanse the mouth and pharynx (Fig. 17 F). Solid foreign bodies removed using the index and middle fingers like tweezers or a hook-bent index finger.

    The finger-by-mouth technique is used in the case of tightly clenched jaws. The index finger of the left hand is inserted behind the molars and the mouth is opened while resting on the victim's head with the right hand placed on the forehead (Fig. 18 A).

    In the case of a completely relaxed lower jaw, the thumb of the left hand is inserted into the victim's mouth and the root of the tongue is raised with its tip. Other fingers grab the lower jaw in the chin area and push it forward (Fig. 18 B).

Restoring airway patency can also be achieved by using the Gwedel (Fig. 19) and Safar (5-shaped air duct) (Fig. 20) air ducts. The Safar air duct is used for mechanical ventilation by the "mouth to air duct" method.

These air ducts can be an adequate replacement for the two components of the "triple reception" - opening the mouth and extending the lower jaw, but even when using air ducts, a third component is required - tilting the head back.

Rice. 19. Technique of the introduction of the Gwedel air duct

    Select the required size of the duct - the distance from the duct shield to the earlobe;

    After the forced opening of the mouth, the air duct is introduced with a bulge downward, sliding along the hard palate to the level of the flap;

    After that, it is turned 180 ° so that its curvature coincides with the curvature of the back of the tongue.

Rice. 20. Technique of introducing the Safar air duct The most reliable method for sealing the airway is tracheal intubation.

It should be noted that tracheal intubation in patients with circulatory arrest is associated with a delay in chest compression lasting on average 110 seconds (from 113 to 146 seconds), and in 25% of cases, tracheal intubation lasted more than 3 minutes.

That's why attempt to intubate the trachea should be no more than 30 seconds, if during this time it is not possible to intubate the patient, it is necessary to immediately stop attempts at intubation and start performing mechanical ventilation with an AMBU bag (or a respirator) through a face mask with a reservoir bag and the obligatory supply of oxygen into the bag at a rate of 10-15 l / min (Fig. 21)

.Rice. 22. Technique for the introduction of a laryngeal mask


B. They continue to carry out the laryngomask downward, while simultaneously pressing with the index finger in the area of ​​the tube and mask connection, constantly maintaining pressure on the pharyngeal structures. The index finger remains in this position until the mask passes next to the tongue and falls into the pharynx;

    Using the index finger, resting on the junction of the tube and the mask, move the laryngomask further down, while performing light pronation with the brush. This allows you to quickly install it to the end. The resulting resistance means that the tip of the laryngomask is opposite the upper esophageal sphincter.

D. Holding the laryngomask tube with one hand, the index finger is removed from the pharynx. With the other hand, gently pressing on the laryngomask, check its installation.

D-E. The cuff is inflated and the laryngomask is fixed.

for lumen and

Esophageal

balloon


- Integral bite / block

Rice. 23.

A. Laryngomask repeats the shape of the larynx and obstructs the entrance to the esophagus; B. Laringomask 1-de1; B, G. Laryngomask for tracheal intubation

Rice. 25.

A. Air duct Combiuide; B. Pharyngeal cuff and distal airway; B. Esophageal cuff and fenestra in the proximal area; G. Laryngeal tube "Kipd-IT"

Rice. 24. Technique of introducing a double-lumen duct Combustion. Airway patency is guaranteed in any position of the airway tube - both in the esophagus and in the trachea.


Rice. 26. Stable position on the side of the victim who is unconscious

In addition to standard laryngomasks (Fig. 23 A), it is allowed to use laryngomasks 1-Se1, which has a repeating shape of the larynx, a non-deflating "cuff" made of thermoplastic elastomeric gel, the setting of which requires the most basic skills (Fig. 23 B]. And also laryngomasks, through which it is possible to carry out tracheal intubation with special endotracheal tubes included in the kit in case of complex intubation (Fig. 23 C, D).

b] the use of a double-lumen air duct Combustion, with this method of ensuring airway patency, it will be guaranteed at any location of the airway tube - both in the esophagus and in the trachea (Fig. 24 and 25 A, B, C). Either a laryngeal tube (Kma-LT) (Fig. 25 D).

Stable position on the side

If the victim is unconscious, but he has a pulse and adequate spontaneous breathing is maintained, it is necessary to give a stable position on his side, in order to prevent aspiration of gastric contents due to vomiting or regurgitation, and to take it in the airways (Fig. 26).

To do this, it is necessary to bend the victim's leg on the side on which the person providing assistance is located (Fig. 26B.1), put the victim's hand under the buttock on the same side (Fig. 26B.2). Then carefully turn the victim to the same side (Fig. 26B.Z), at the same time tilt the victim's head back and hold him face down. Place his upper arm under his cheek to maintain head position and avoid turning face down (Fig. 26B.4). In this case, the victim's hand, located behind his back, will not allow him to take a position lying on his back.

Algorithm for assisting with obstruction of the airway by a foreign body

If the airway is partially obstructed (maintaining normal skin coloration, the patient's ability to speak, and the effectiveness of the cough), immediate intervention is not indicated. In the event of a complete obstruction of the airways (with the inability of the patient to speak, ineffectiveness of cough, the presence of increasing difficulty in breathing, cyanosis), the following amount of assistance is recommended, depending on whether the patient is conscious or not:

a) In the mind- 5 pats with a palm in the interscapular region (Fig. 27 A) or 5 abdominal compressions - Heimlich's technique (Fig. 27 B). In the latter case, the rescuer stands behind the victim, squeezes one hand into a fist and applies (with the side where the thumb is) to the stomach along the midline between the navel and the xiphoid process. Firmly grasping the fist with the other hand, presses the fist into the stomach with a quick upward pressure. Reception of Heimlich is not carried out in pregnant and obese persons, replacing it with chest compression, the technique of which is similar to that of the Heimlich reception

.

Rice. 27. Technique for eliminating airway obstruction with a foreign substance in

conscious persons

b) Unconscious:

In our articles on breastfeeding, we repeatedly say that every couple - mother and child - is unique, each problem requires individual consideration. However, there are almost always some general recommendations that in any case will not harm and, perhaps, even help the mother figure out the situation on her own.

Breastfeeding

The first thing a young mother should master is correct attachment baby to the chest. It provides effective sucking, breast stimulation, helps to avoid pain during feeding and nipple injuries. But perhaps the most important thing for getting enough milk is the principle feeding on demand rather than scheduled. Moreover, if the baby sleeps for a long time during the first weeks of life and does not ask for a breast, he should be woken up and offered breast at least once every one and a half to two hours. Thus, 10-12 (or more) applications per day provide sufficient nutrition for the baby, maintain lactation and the health of the mother's breast. Frequent applications even before the arrival of milk, when there is only colostrum in the breast, ensures the laying of the required number of receptors for successful lactation, contributes to the emotional comfort of the mother, and helps to avoid or in a mild form cope with the phenomenon of postpartum depression. In favor of on-demand feeding, the joint stay of the mother and baby in the hospital works.

Even if for some reason there was a decline in milk production, frequent attachments are the key to good.

The technique also helps to get the baby more milk than he is able to suck out on his own. "breast compression"... This works well when the baby is very young and quickly gets tired of sucking; when the baby is often applied to the breast and sucks for a long time, but the mother still notices a slight increase in the baby's weight. This technique helps if the mother suffers from recurrent milk stasis. What does it look like? Mom takes the breast with her hand in the same way as she gives it, but farther from the nipple: the thumb on one side, the rest on the other. Squeezes the breast slightly, making sure that the baby does not lose the nipple and remains correctly attached. The technique can be used immediately (if it is initially difficult for the baby to suck milk on his own) or after the active pharynx runs out, and when the breast is compressed, the baby will take several more effective sips of milk.

Increased lactation

To increase lactation and the number of hot flashes in one feeding, you can repeatedly shift the baby from one breast to another, i.e. give both breasts at one feeding... How do you know what you can offer your baby a second breast? It is important to prevent an imbalance in front and back milk, so this is done only after the baby stops swallowing milk and just sucks for some time. This technique can be combined with the chest compression technique.

Calm and peace of mind of a mom are equally important for a successful one. It is worth taking care of your family. If the mother was scared, experienced a strong shock, pain, then special breathing exercises or just deep calm breathing, a warm bath (possibly with the baby), a pleasant activity, delicious food will help to calm down. Small physical activities (housework, walking, even just carrying a baby) - reduce the level of adrenaline. It is also necessary to offer the baby to breastfeed frequently.

Stimulation of lactation is promoted by everything that allows mom and baby feel each other skin: feeding naked as much as possible, sleeping together, carrying it in your arms, light massage and stroking with mother's hands, just laying out the baby on mother's bare belly and chest. Such contacts through psychological sensations trigger regulation at the hormonal level.

But already with established lactation, if possible, it is necessary to prevent a strong filling of the breast. In the milk accumulated in the breast, a special inhibitor protein appears - a substance that triggers a mechanism to reduce milk production.

False hypogalactia

We have already mentioned that sometimes there is a so-called false hypogalactia, i.e. a state when a mother thinks that she does not have enough milk, but in fact, the baby may well have enough milk. When does this happen? When a mother, ignoring reliable signs, begins to focus only on the following indicators and situations.

Mom makes "control feeds" - weighs the baby before and after feeding. She is nervous, worried about what figure she will see on the scales. The baby feels the stress of the mother, is distracted, sucks less effectively. During the day, babies can apply to their breasts for various reasons, including just calm down a little or "drink", while mom most often regards each attachment as "good nutrition" and is very upset when she sees only a few grams on the scales. If the weighing takes place in the clinic, it is even worse, because a strictly limited time is given for feeding, after which the baby, who has fallen asleep or has not yet been pumped at all, is put on the scales. And then there is the error of the scales, the expenditure of energy by the baby for sucking itself ...

Little or no milk is expressed at all. An imaginary sign, because it is impossible to reproduce the mechanism of sucking a baby with a milk sucker or hands. There is such a thing as breast capacity - the volume of milk that can accumulate in it. It is different for every woman. And even the left and right breasts of one woman can accumulate different amounts of milk. The capacity has nothing to do with the ability to produce milk, but it is this amount that, at best, the mother expresses, that is, even if it turned out to be expressed, the volume obtained is much less than that which the child is able to suck.

The baby does not calm down after feeding or is restless during feeding. Often mothers remember that they have "not enough milk" in the evening, when many children are especially restless. Babies can cry and worry for a variety of reasons. By the way, studies show that, as such, little children do not experience hunger until a certain point, and a truly hungry child will sleep rather than worry. In addition, sometimes anxiety is a sign of normal age-related behavior.

Reasons for concern

Some mothers refer to heredity: "Mom didn't feed, and I can't!" We have already mentioned that in the days of our mothers and grandmothers, feeding according to the regimen was widespread, often a woman was immediately recognized as "non-dairy", although, most likely, the failure of breastfeeding consisted in a separate stay in the hospital, rare feedings, the need to go to work early ... With the right actions, such "heredity" is happily avoided.

The breasts stopped filling between feedings. This simply speaks of the establishment of lactation: milk will now be produced in response to the baby's sucking, accumulation can only occur in case of long breaks between feedings.

Sometimes mothers think that small breasts are unable to produce milk. This is not true. Glandular tissue is responsible for milk production, which, even in a very small breast, can be very developed, have a large number of lobes and ducts. Adipose tissue is responsible for the size of the breast.

Mom believes that she eats little and / or does not diversify, so milk becomes scarce. To this is often added the confidence that the milk is "bad", its composition is defective. A varied, healthy diet for mom is undoubtedly very important. But it is more important for the health of the mother herself, her strength, her mood. The energy composition of milk (proteins, fats and carbohydrates) does not depend on the mother's nutrition, it is laid down genetically and in accordance with the needs of the child (for example, it is known that mothers of babies born prematurely, milk is richer in proteins). The vitamin and mineral composition of milk can be slightly influenced by the mother's diet, but at the same time the mother's body is such that even with a deficiency of some element in the mother, the composition of the milk will be complete.

Milk does not leak from the breast between feedings and / or from the second breast while sucking on the first. This does not mean at all about the absence of milk, but only about the fact that the ducts are "strong" enough not to let milk pass in the absence of sucking. The age of the child when the milk stops leaking is different for each (from a few days to several months). It happens that leakage is not observed from the very beginning (more often this happens with the second and subsequent children).

After feeding, the baby takes the offered bottle with the mixture, drinks all of it and then sleeps for a long time, usually the mother says: "So, he was hungry and only now he was full." Experts generally do not recommend conducting such a "test". The bottle satisfies the baby's natural urge to suck; already quickly evacuated from the stomach, the mixture gets there, but it is very difficult to digest, so the baby is asleep, because there is simply no strength left for anything else.

Mom reacts to the words of medical personnel, acquaintances, relatives that there is not enough milk, the child does not gorge himself. This imaginary sign should be noted separately, since he with enviable constancy brings confusion into the vulnerable souls of young nursing mothers, makes them afraid, sometimes it is completely unreasonable to introduce supplementary feeding to the baby and, in the worst case, even finish breastfeeding ahead of time.

Not everyone has competent information about breastfeeding, not everyone breastfed their babies themselves. The older generation is often guided by an imaginary sign of "milkiness inheritance" and tells a modern young mother that she will not be able to feed because her mother, grandmother, great-grandmother, aunt, grandmother's neighbor in the apartment did not feed ... They can undoubtedly be understood: there was simply no other example before my eyes! Sometimes the environment of a young mother draws her attention very closely to the size of her own breasts and claims that the breasts are not suitable for feeding. It is even worse when a mother who has just given birth has relatives in her own family who, instead of supporting, helping to establish breastfeeding, caring for a young mother, on the contrary, are downright advised not to suffer, but to give a mixture and are rather skeptical about help from lactation specialists. After all, they really want both mom and baby to be healthy, calm and happy! In order for the care of relatives to be combined with the establishment of natural feeding, experts recommend studying information about feeding and caring for a baby with the whole family, including the older generation.

But what are the medical personnel guided by when they talk about the amount of milk in the mother's breast? Probably all the same criteria, which, unfortunately, have long been considered the norm. The mixture is always the same (contains about 40 standard imperfect ingredients); it is supposed to be given strictly by the hour and a certain amount (often overestimated, that would be for sure, as they say). Before that, you need to take care of the cleanliness of the bottle and nipple (which are still approximately the same shape and size). So, having heard a medical judgment about the amount (absence) of milk in the breast, about the shape and size of the nipples, the mother just needs to remember that the breast is not a bottle with divisions, it cannot be filled to a certain mark and emptied, while looking at how much has flowed out. It is useful to immediately recall the imaginary signs of milk sufficiency: breast size, breast fullness, milk leakage, the amount of expressed. The breast "works" in response to the sucking of the baby, all babies and mothers are different. The composition of human milk is also unique, it contains more than 400 components, in addition, it is different for each mother and adapts to the needs of her baby.

Breastfeeding is a normal natural process. Nature intended that mothers produce, and babies sucked breast milk. It's just that a modern mother needs a little help and support (including informational) in order to breastfeed her baby correctly, for a long time and with pleasure. Remember that every mother is able to breastfeed her baby, and the situation of "not enough milk" in the vast majority of cases is solvable.

Malchenko Polina,
breastfeeding consultant, member of AKEV

Discussion

Thank you very much for the article! It should be given to all mothers in maternity hospitals to read to break deep-rooted misconceptions about breastfeeding. It is a pity when young mothers listen to the older generation with their unjustified advice about the feeding schedule and the need to introduce complementary foods.

06/30/2018 00:34:33, Natalia

To calculate the amount of milk required for babies under 2 months of age, use the following formula:

800 - 50 (8 - p), where

800 - daily milk allowance for a 2 month old baby;
n is the number of weeks of life;
50 - the amount of excess milk for each week missing up to two months;
8 is the number of weeks.
This is an approximate calculation, but you still have to rely on it. And so as not to think - the control of the eaten. Put the baby on the scales before and after feeding. Better in the morning, do not be afraid that you wake up, I hung mine up to six months periodically. Only the scales should be accurate, ideally especially for the little ones. I had trade, but showed exactly. I always knew when I had a crisis, then I immediately began to drink Apilak to improve lactation, apply it often, lay down to sleep next to me so that I would suck to the maximum at night. After three days everything was back to normal. I drank Apilak's course and until the next crisis, then started drinking again. But this is not necessary, in principle it was possible in advance, I later realized that about all the deadlines are the same.

Comment on the article "Not enough milk? It is worth understanding! Part 2"

How can a nursing mother survive the "stormy rush" of milk? Immediately after childbirth and during the first 2-3 days, colostrum is produced in the breast. It is released in small quantities, and my mother practically does not feel it. Then, by the end of 3, the beginning of 4 days after childbirth, the breast begins to increase in size, become more dense and tense. These changes indicate the beginning of the milk arrival process. Often they are accompanied by painful sensations, a slight increase in local temperature ...

Discussion

I had little milk after giving birth, as I had a cesarean section. Some tips from the article were needed when weaning a baby.

During the first pregnancy, she suffered for a very long time, expressed herself. And when my son was giving birth, I bought a breast pump, heaven and earth, it is much easier and very convenient!

Frequent milk consumption in old age increases the risk of hip fracture, Japanese scientists from a group of universities concluded. The reason for this is the harmful trans fats contained in this product, the researchers said. Milk has a reputation as one of the main sources of calcium - a substance necessary for bones and teeth. However, frequent consumption of this product leads to negative health effects. And at risk, first of all, people aged ...

the age of the baby, he must be at least 1.5 years old; state of lactation - have signs of involution of the mammary gland been shown for some time? To check this, the mother needs to part with her baby for a day, for example, leaving him with his grandmother or dad. If in a day there is no painful filling of the breast, it has not become dense and hot, then the woman is ready for weaning. If, after twelve hours, mommy is ready to run to the child so that he ...

Around the topic of proper nutrition, fierce controversy has been going on for several years. Nutritionists and journalists take turns blaming fats, carbohydrates, sugar, gluten for all mortal sins ... The list is endless. This topic becomes especially painful when it comes to baby food. We understand the most popular myths. Grandma's dinners Probably everyone remembers the times when weight gain in a child was considered an extremely good indicator. Our parents were sincerely happy ...

Discussion

I have nothing to do with chemistry, but from the media and from information about our favorite mixture to Humanu I know that if from native, then not from powder, but from cow, natural. Agree, it's one thing to make a powder from natural, and then "chemise" the mixture, and quite another thing, when without all kinds of pomace ...
I don’t know about allergies ... We didn’t.

we are not candidates of chemical sciences, but I will definitely say that native milk as a raw material for infant formula is always a sign of quality. For example, only some manufacturers of baby food can boast that their processing plants are located near farms, and that they make the same porridge mixtures not from powder, but from liquid fresh milk. This is more complicated, and the quality control system must be different. I have a friend, she transferred the baby to the formula right away - the milk disappeared on the 11th day after giving birth ... I used Remedia, but it is rare, Humana, - the pediatrician recommended it, since they are on native milk, not powdered, and the risk fluctuations in quality are minimal.
To tell the truth, it is not recommended to include in the diet of children from families of patients with insulin-dependent diabetes mellitus products containing native (unadapted) cow's milk protein. But this is for any GA food

4. if there is not enough milk - more often - more often - apply more often, yeah. but not more often than 2 hours later. if you don't ask more often, you can pump in between, but this also needs to be fought for at least a week for this matter. Not enough milk? It's worth understanding! Part 1.

Not enough milk? It's worth understanding! Part 2. Already from here the conclusion suggests itself - there is not enough milk - you need to express, a lot - you cannot express. Child with colic. Does the baby have colic?

Not enough milk? It's worth understanding! Part 2. Breastfeeding. Increased lactation and false hypogalactia. I fed my daughter from one breast, while expressing milk from the other (by this time I already had a breast pump, which ...

Discussion

white threads, milky? Then it just starts to flow more fatty milk, after the first, more watery. When it gets into a bottle, into previously expressed milk, it dissolves in it. And that's all :)
On business:
1. Tear off skin is normal. The skin on the nipple should change. Normal - if it doesn't hurt. Cracks are often from improper attachment. By the fact that you are now pumping and feeding from a bottle, you even more confuse the attachment in the direction of the wrong one, most likely. You'd better give it up. If it is completely impossible to breastfeed, use a syringe or spoon to pour. An electric breast pump, by the way, is not at all more gentle to the breast than a child. Vice versa. Therefore, well, it is very likely that the baby does not take the breast correctly.
2. Problems with the amount of milk can be associated with p..1. That is, to be the result of improper attachment. On the other hand, you may not have a problem, and doubts about the amount of milk have been sown by the "kind" words of doctors or relatives. Why did you decide that there is not enough milk? Give the numbers: with what weight the child was born, what was the lowest weight, what was the gain. How much do you feed (duration and frequency of feedings)? How much does a child pee and poop per day?
3. If milk starts to seem small, you should not start feeding without trying all the ways to increase the amount of milk. Why: The body produces as much milk as the baby eats. Therefore, you fed - the baby ate less from the breast - less milk came on the trail. day - you add more feeding - ... voila! at 5 months milk is "running out". It is not too late to rectify the situation - if you, of course, have a desire (and since you write here, then most likely you do :)).
Write the numbers for now, without them nothing is clear. And you definitely don't need a doctor :)

ALL norms are based on observations of artificial people. A child of 7 weeks can eat both 15 grams per feeding, and 215. There are a huge number of modification factors, on what it depends: the degree of vigor, colic, moon phase, time of day, the degree of maturity of mother's lactation, mood, mother's condition, ambient temperature , the time of the last sleep, the child's temperament and the manner of sucking, the peculiarity of the seizure, the period relative to the growth spurt, the situation with the intestines, etc. And it is almost impossible to predict them by calling the "average value". You can only assess the sufficiency of milk if a 7-week-old child has an increase in the last 2 weeks and the number of urinations per day.

And why did the child cry. Against the background of immature lactation, the mother often expresses the front milk, which is more saturated with lactose, without milk inflow. And if it is then given to a baby from a bottle, then, firstly, the feeling of satiety will quickly end, and secondly, the discrepancy with the natural composition, which would have been with normal feeding, can cause a storm in the intestines. The pancreas did not cope with the excess of carbohydrates, and the result was colic.

How to fix it? Do NOT breastfeed with expressed milk, if possible. And when you need to move away for a while, when expressing, induce a milk flow in yourself (nipple massage, pumping during feeding, auto-training), and not just mechanically freeing the breast from the milk that has accumulated over a certain period.

Probe all channels. This milk is stagnant. It will not dissolve by itself, it must be drained. The baby can dissolve, since they are weak in this. Not enough milk? It's worth understanding! Part 2.

Discussion

It must be softened and MUST be drained. One of the ways: with a warm compress (WARM camphor alcohol on gauze, tracing paper on top, polyethylene on top, put cotton wool on top and tie a woolen scarf.) For 2 hours, no more and no less. Then go straight to the bath, massage with a warm shower, or even a hot shower and express with DRY hands. If he cannot express, invite a midwife or take a breast pump. Massage hard stones in the chest. Probe all channels. This milk is stagnant. It will not dissolve by itself, it must be drained. The baby can dissolve, since they are weak in this. And there will be enough milk! It just increased. If camphor bothers, then there is such a remedy - OSMOgel. Make a compress with it.

As a last resort, keep in mind that Moscow has a very good center for all such dairy problems. I have no coordinates with me, but here I gave it in the spring, look at the search or call - it is in the planning center on Sevastopol. They can advise on the phone, can come to your home, great specialists.

Not enough milk? It's worth understanding! Part 1. Myths about breastfeeding. If I'm not mistaken, if a child is 2 - 3 months old, then he should eat 1/5 of his weight a day milk, then increase it slowly and now ...

Discussion

I have exactly the same story, everything is just like it was written about me ... but the child is a month later in a couple of days, I already give more mixture, it doesn't even suck everything out of the chest (there is so little there?) Probably too lazy to strain knowing what is what Today, my breasts almost did not give, I wanted to check how much milk I have, I pumped 15 g with a breast pump and the child eats 30-60 g of the mixture easily ... so I don’t know what to do, or in general to score on this breastfeeding, the child does not really want my milk anyway ?? or what ???

04/13/2016 07:59:33, Nastya D

Hello, please advise me too !! I fed until 3 months normally, I ate when I wanted, but the weight was 4700 .. The pediator said that there was a shortage and give the mixture! I kicked, but the baby had to cry ((although he is cheerful and vigorous! As a result, he may not even breastfeed right now, even at night, crying! ?? Tell me girls !!

04/07/2016 10:30:28, Alina Khusainova

Not enough milk? It's worth understanding! Part 1. Part II. ... they showed no signs of dehydration, etc. Any additional feeding or When breastfeeding, complementary foods should be introduced no earlier than 6 months of age.

Discussion

How many times a day do you feed? One or two breasts?

Did you eat something new or unusual?

Generally, when dehydrated (significant), the child does not look cheerful, he looks drowsy and lethargic. But given the enormous life potential of young children, a child's gaiety may not mean that there are no problems. But a sunken fontanel is really a sign of dehydration.
In general, diarrhea in children under one year old is a VERY SEVERE problem (unless it really is diarrhea, which in infants is determined not by the frequency of stool, but by the consistency), and this danger cannot be neglected (fortunately, diarrhea is very rare in exclusively breastfed children. phenomenon). If diarrhea occurs, you should definitely call a doctor, and before he arrives, give the child a rehydron solution (in extreme cases, rice broth) to prevent dehydration (1 teaspoon every 10-15 minutes), increase the frequency and duration of breastfeeding.

11/29/2001 10:29:40 AM, Lesha

2 am ... You woke up from a heaviness, cold or pressure in the chest. It's hard for you to breathe ...

What if you have signs of a heart attack? Maybe this is not a pain in the heart, but an elementary indigestion, how do you know?

When is chest compression dangerous?

More people die from coronary heart disease than from any other cause, and the only symptom that characterizes this condition is pain.

But the term "chest pain" is quite misleading.

Heart disorders do not always manifest with pain and do not always localized directly to the left. For this reason, I prefer the Latin term "angina pectoris", which means chest discomfort, usually in the middle.

We are not having a language lesson now; people die because they do not really feel the manifestations of ischemia and stay at home at a time when they develop a real myocardial infarction.

I want to tell you about the symptoms with which the sick go to the doctor.

When should you sound the alarm for pain syndrome?


So, is there any need to worry when a patient has symptoms of a heart spasm? There are 2 tips to help you decide if you should pay attention to unusual thoracic sensations: current signs of a heart attack and assessment risk factors for the development of myocardial ischemia in a particular patient.

Typical manifestations:

Constriction, squeezing, heaviness and coldness in the chest. The patient describes his sensations as a feeling of heaviness in the chest or a feeling of squeezing around the chest. Soreness is usually localized in the left half of the body above the costal arch. It is often impossible to identify a specific pain point.
Breathe heavily.
Profuse cold sweat, nausea and dread.
Numbness or soreness in the left arm, neck, or lower jaw.

Atypical signs:

The above typical symptoms and the simultaneous presence of several of them should definitely cause concern. But in many patients, the problems of the main pump of the body are manifested by other, atypical, symptoms that cause an incorrect assessment of the condition of the sick person, both by the doctor and by the sick:

  1. Soreness does not concern the left half of the thoracic region. Sometimes pain can occur on the right or center of the chest, in the upper abdomen, and even in the little toe!
  2. No pain. In some patients, pain syndrome may be absent. But at the same time, they complain of shortness of breath, shortness of breath, choking, compression in the chest and that it is difficult to breathe. Some studies have shown that approximately 1/3 of patients do not experience chest pain.
  3. Some patients present with tingling sensations in the area of ​​the heart or indigestion.
  4. I also once examined a sick person who complained of a coldness in his chest while inhaling.
  5. Weakness, tiredness. You can also read about.

How long does chest pain last during an ischemic attack?

In addition to unpleasant sensations, you need to pay attention to the duration of pain manifestations. The feeling of constriction during coronary spasm usually persists for several minutes and is not instantaneous.

Acute short-term pain in the thoracic region can rarely indicate something serious. Heart pain is usually bothersome at least 5 minutes and not more than 20-30 minutes.

Finally, if a heart attack begins at rest or after emotional stress and does not go away for a long time, this may indicate acute myocardial ischemia.

I do not want to say that the soreness that occurs during physical activity and goes away on its own should not be a cause for concern. This situation develops from a narrowing of the blood vessels that provide the heart with blood, and is called angina pectoris. It can lead to a heart attack if it lasts more than 5 minutes.

What are the risk factors for developing myocardial infarction?

It is imperative to take into account the factors predisposing to the onset of ischemic syndrome. There is a huge difference between a healthy 20-year-old girl and a 50-year-old man with diabetes and over 20 years of smoking history.

Factors that increase the risk of developing myocardial infarction include:

  • Age - men over 40 and women over 50.
  • Gender - Men have a higher risk of coronary syndrome than women, although this disease kills a huge number of women every year.
  • Heredity- if the closest relatives have coronary artery disease, then the likelihood of myocardial disease increases significantly. It is especially high if sick relatives are men over 50 or women over 60.
  • Smoking - people believe that smoking has a bad effect on the lungs, but the mortal danger is disproportionately higher for smokers. I strongly recommend that all patients over 40 years of age get rid of this dangerous habit that can lead to death. Instead of smoking, get into the habit of walking in the fresh air every day, exercising, fishing, or walking your dog. For a more complete picture, I advise you to pay attention to the ready-made presentation on smoking.
  • High blood pressure and diabetes mellitus also significantly increase the likelihood of coronary artery disease.
  • High cholesterol - impaired cholesterol metabolism due to improper diet, lifestyle or overweight and heredity increase mortality among patients.
  • Patients with atypical manifestations, but a high risk of coronary artery disease require more serious treatment than patients with classic symptoms, but a low risk of coronary disease. There are also other diseases of the cardiovascular system.

When is pain not associated with coronary problems?

  • Acute and short-term soreness that lasts a few seconds.
  • The tingling sensation that gets worse with deep breathing, movement, or pressure on a painful area is usually associated with muscle or bone problems in the chest, but not with the heart.
  • Pain that you can point with one finger can be caused by intercostal neuralgia, trauma, or other non-cardiac disease. Pain in the middle of the chest during inspiration is also often not associated with myocardial infarction.

What if you have signs of coronary syndrome?
I hope this article will help you to correctly assess the signs of a heart attack, if necessary. Remember a few must-have rules:
? If you are worried about incomprehensible chest discomfort, get examined!
? If you have a high risk of myocardial infarction and some of the signs of coronary artery disease - get examined!
? If you have a high risk of coronary spasm and classic symptoms of a heart attack - call your doctor or ambulance team immediately!
“It is always better to undergo additional testing for minor chest discomfort than to remain with a serious heart condition.