Features of resuscitation in children. Apparatus for artificial lung ventilation in children. Features of cardiopulmonary resuscitation in children

07.04.2019

Equipment: Diapers, oilcloth, napkins. 1 pair of sterile gloves, kidney tray, rubber can, boiled water. class B waste container, sterile gauze wipes.

Preparation for manipulation:

1. Explain the procedure to mom, get consent.

2. Sanitize your hands

Performing manipulation:

1. Lay the child with a raised head end, turn his head to the side.

2. Close the neck and chest of the child with oilcloth and a diaper.

3. Place the kidney tray in front of the child's mouth.

4. After stopping vomiting, use a rubber canister with boiled water to irrigate the oral cavity, tilting the child's head over the tray. Wipe baby's lips with a tissue.

5. Give 1-2 teaspoons of boiled water to drink.

End of manipulation:

3. Wash, dry your hands.

19. Technique of IVL for a child by various methods a. Ambu bag with mask

Equipment: Tissue roller, sterile gauze wipes, mask, Ambu bag,

electric pump, class B waste container, sterile gloves.

Preparation for manipulation:

Performing a manipulation:

1. Take the child's head back, put a roller under the shoulders, remove lower jaw in front (relative to the position of the child).

2. Attach the Ambu bag to the mask.

3. Put the mask firmly on the child's nose and mouth.

4. Hold the mask on the child's face with one hand: press the nose with the 1st finger, and the chin with the 2nd finger, 3,4 and 5 fingers pull the child's chin up.

5. free hand squeeze the bag until the chest rises, then release the bag to exhale, and then inhale again.

6. The frequency of ventilation should be at least 40 breaths per 1 minute. (in newborns) and 20 breaths (in older children).

7. Continue ventilation until spontaneous breathing or the visit of a doctor.

End of manipulation:

1. Process reusable medical devices in accordance with industry standard and regulations for disinfection and pre-sterilization cleaning.

2. Disinfect medical waste in accordance with San.PiN.2.1.3. 2630 -10 "Rules for the collection, storage and disposal of waste from medical and preventive institutions."

3. Wash, dry your hands.

B. Mouth-to-mouth breathing

Equipment: Tissue roller, sterile gauze wipes, electric suction, Class B waste container, sterile gloves.

Preparation for manipulation:

1. Sanitize hands. Put on gloves.

2. Put the child on a horizontal hard surface and free from clothing.

3. Examine the upper respiratory tract, if necessary, remove vomit or mucus using an electric suction, a finger, a napkin.

Performing a manipulation:

1. Take the child's head back, put a roller under the shoulders,

bring the lower jaw forward (relative to the position of the child).

2. Put a napkin on the area of the mouth and nose of the child.

3. Inhale and press your mouth tightly against the child's mouth and nose.

4. Forcefully exhale the contents of your lungs without forcing the exhalation.

5. Take two deep breaths with an interval of 5 seconds and a duration of 1.5-2 seconds each.

6. Check the presence of respiratory movements of the chest and the movement of air from the mouth and nose of the child during exhalation.

7. The frequency of ventilation should be at least 40 breaths per 1 minute. (in newborns) and 20 breaths (in older children).

8. Continue mechanical ventilation until spontaneous breathing appears or the doctor arrives.

End of manipulation:

1. Process reusable medical devices in accordance with industry standard and regulations for disinfection and pre-sterilization cleaning.

2. Disinfect medical waste in accordance with San.PiN.2.1.3.2630 - 10 "Rules for the collection, storage and disposal of waste from medical and preventive institutions."

3. Wash, dry your hands.

Technique artificial ventilation The lung is considered in this review as a combination of physiology, medicine, and engineering principles. Their association contributed to the development of mechanical ventilation, revealed the most urgent needs for improving this technology and the most promising ideas for the future development of this direction.

What is resuscitation

Resuscitation is a complex of actions, which includes measures to restore suddenly lost vital body functions. Their main goal is the use of methods for carrying out artificial lung ventilation in order to restore cardiac activity, respiration and vital activity of the body.

The terminal state of the body implies the presence pathological changes. They affect areas of all organs and systems:

brain and heart;
and metabolic systems.

Methods of carrying out require taking into account the peculiarity of the organism that the life of organs and tissues continues a little even after the heart and breathing have completely stopped. Timely resuscitation allows you to achieve effective bringing the victim to his senses.

Artificial ventilation, also called artificial respiration, is any means of assisting or stimulating respiration, a metabolic process associated with general exchange gases in the body through ventilation of the lungs, external and internal respiration. It may take the form of manually delivering air to a person who is not breathing or is not making sufficient effort to breathe. Or it could be mechanical ventilation using a device to move air from the lungs when the person is unable to breathe on their own, such as during surgery to general anesthesia or when the person is in a coma.

The objective of resuscitation is to achieve the following results:

the airways must be clear and free;
it is necessary to carry out IVL in a timely manner;
circulation needs to be restored.

Features of the IVL technique

Pulmonary ventilation is achieved by a manual device for blowing air into the lungs, either with the help of a rescuer who delivers it to the patient's organ by mouth-to-mouth resuscitation, or with a mechanical device designed for this procedure. Last method proved to be more effective than those involving manual manipulation of the patient's chest or arms, such as the Sylvester method.

Mouth-to-mouth resuscitation is also part of what makes it an important first aid skill. In some situations, this method is used as the most effective if there is no special equipment such as opiate overdoses. The performance of the method is currently limited in most protocols for healthcare professionals. junior medical workers it is recommended to perform mechanical ventilation in each case when the patient is not breathing properly.

Sequence of actions

The technique of artificial ventilation of the lungs is to carry out next steps:

The victim is laid on his back, his clothes are unbuttoned.
The head of the victim is thrown back. To do this, one hand is brought under the neck, the other gently raises the chin. It is important to throw back the head as much as possible and open the mouth of the victim.
If there is such a situation when it is impossible to open the mouth, one should try to put pressure on the area of the chin and make the mouth automatically open.
If the person is unconscious, push the lower jaw forward by inserting a finger into the mouth.
If you suspect that there is an injury in cervical region spine, it is important to gently tilt your head back and check if the airways are clogged.

Varieties of IVL techniques

Designed to bring a person to his senses the following ways performing artificial ventilation:

"mouth to mouth";
"mouth to nose";
"mouth-device-mouth" - with the introduction of an S-shaped tube.

The technique of artificial lung ventilation requires knowledge of some features.

When performing such operations, it is important to monitor whether the heart has stopped.

Signs of this condition may include:

The appearance of a sharp cyanosis or pallor on the skin.
Absence of pulse in the carotid arteries.
Lack of consciousness.

If the heart stops

In case of cardiac arrest, closed heart massage should be performed:

A person quickly fits on his back, it is important to choose a hard surface for this.
The resuscitator kneels on the side.
It is necessary to put the palm of the base on the area of \u200b\u200bthe sternum of the victim. At the same time, do not forget that you can not touch the xiphoid process. On top of one hand lies the other hand with the palm of your hand.
Massage is performed with the help of vigorous jerky movements, the depth of which should be four to five centimeters.
Each pressure should alternate with straightening.

Fulfillment implies following procedures during artificial ventilation of the lungs:

Tilt the head as much as possible to straighten the airways.
Pushing the lower jaw forward so that the tongue does not sink.
Easy mouth opening.

Features of the mouth-to-nose method

The technique of carrying out artificial ventilation of the lungs using the "mouth-to-nose" method implies the need to close the victim's mouth and push the lower jaw forward. It is also necessary to cover the area of \u200b\u200bthe nose with the help of lips and blow air into it.

It is necessary to blow simultaneously into the oral and nasal cavities with care in order to protect the lung tissue from possible rupture. This applies, first of all, to the peculiarities of carrying out mechanical ventilation (artificial ventilation of the lungs) for children.

Rules for performing chest compressions

Cardiac starting procedures should be performed in conjunction with ventilation artificial way. It is important to ensure the position of the patient on a hard floor or boards.

You will need to perform jerky movements with the use of gravity own body rescuer. The frequency of pushes should be 60 pressures in 60 seconds. After that, you need to perform ten to twelve pressures on the chest area.

The technique of carrying out artificial ventilation of the lungs will show greater efficiency if it is carried out by two rescuers. Resuscitation should continue until breathing and heartbeat are restored. It will also be necessary to stop actions in the event that the biological death of the patient has occurred, which can be determined by characteristics.

Important Notes When Performing CPR

Rules for holding mechanically:

ventilation can be done by using an apparatus called a ventilator;
insert the device into the patient's mouth and manually activate it, observing the required interval when introducing air into the lungs;
breathing may be assisted by a nurse, physician, physician assistant, respiratory therapist, paramedic, or other the right person, squeezing a bag valve mask or a set of bellows.

Mechanical ventilation is called invasive if it involves any instrument that penetrates the mouth (eg, endotracheal tube) or skin (eg, tracheostomy tube).

There are two main modes of mechanical ventilation in two departments:

forced-pressure ventilation, where air (or other gas mixture) enters the trachea;
negative pressure ventilation, where air is essentially sucked into the lungs.

Tracheal intubation is often used for short-term mechanical ventilation. The tube is inserted through the nose (nasotracheal intubation) or mouth (orthotracheal intubation) and advanced into the trachea. In most cases, products with inflatable cuffs are used for leakage and aspiration protection. Cuff tube intubation is believed to provide better protection from aspiration. Tracheal tubes inevitably cause pain and coughing. Therefore, unless the patient is unconscious or otherwise anesthetized, sedatives usually prescribed to ensure tube tolerance. Other disadvantages are damage to the mucous membrane of the nasopharynx.

History of the method

common method external mechanical manipulation, introduced in 1858, was the "Sylvester Method", invented by Dr. Henry Robert Sylvester. The patient lies on his back with his arms raised above his head to aid inhalation and then pressed against his chest.

The shortcomings of mechanical manipulation led doctors in the 1880s to develop improved methods of mechanical ventilation, including Dr. George Edward Fell's method and a second one consisting of a bellows and breathing valve to pass air through the tracheotomy. Collaboration with Dr. Joseph O "Dwyer led to the invention of the Fell-O" Dwyer apparatus: bellows and instruments for inserting and removing a tube that was advanced down the trachea of patients.

Summing up

Features of artificial lung ventilation in emergency is that it can be used not only by healthcare professionals (mouth-to-mouth method). Although for greater effectiveness, the tube must be inserted into the airway through the hole made surgically, which only paramedics or rescuers can do. This is similar to a tracheostomy, but the cricothyrotomy is reserved for emergency lung access. It is usually used only when the pharynx is completely blocked or if there is a massive maxillofacial injury that prevents the use of other aids.

Peculiarities of artificial ventilation of the lungs for children consist in the careful carrying out of procedures simultaneously in the oral and nasal cavities. Using a respirator and oxygen bag will help make the procedure easier.

When carrying out artificial ventilation of the lungs, it is necessary to control the work of the heart. Resuscitation procedures are stopped when the patient begins to breathe on his own, or he has signs of biological death.

Cordially- pulmonary resuscitation children

CPR in children under 1 year of age

Sequencing:

1. Shake or pat your baby lightly if you suspect he is unconscious

2. Lay the baby on his back;

3. Call someone for help;

4. Clear your airways

Remember! When unbending the baby's head, avoid bending it!

5. Check if there is breathing, if not, start mechanical ventilation: inhale deeply, cover the mouth and nose of the baby with your mouth and take two slow, shallow breaths;

6. Check for a pulse for 5 to 10 seconds. (in children under 1 year old, the pulse is determined on the brachial artery);

Remember! If you are offered help at this time, ask to call an ambulance.

7. If there is no pulse, place the 2nd and 3rd fingers on the sternum, one finger below the line of the nipples and start chest compressions.

Frequency not less than 100 in 1 min.;

Depth 2 - 3 cm;

The ratio of shocks to the sternum and blows - 5:1 (10 cycles per minute);

Remember! If there is a pulse, but breathing is not detected; IVL is carried out with a frequency of 20 breaths per minute. (1 breath every 3 seconds)!

8. After an indirect heart massage, they switch to mechanical ventilation; do 4 full cycles

In children under 1 year of age, respiratory failure is most often caused by a foreign body in the airways.

As in an adult victim, blockage respiratory tract may be partial or complete. With partial blockage of the airways, the baby is frightened, coughs, inhales with difficulty and noisily. With complete obstruction of the airways - skin turn pale, lips become cyanotic, no cough.

The sequence of actions for resuscitation of a baby with a complete blockage of the airways:

1. Place the baby on your left forearm, face down, so that the baby's head "hangs" off the rescuer's arm;

2. Make 4 claps on the back of the victim with the base of the palm;

3. Transfer the baby to the other forearm face up;

4. Make 4 chest compressions, as in chest compressions;

5. Follow steps 1-4 until the airway is clear or the baby is unconscious;

Remember! Attempting to remove a foreign body blindly, as in adults, is not acceptable!

6. If the baby is unconscious, do a cycle of 4 claps on the back, 4 pushes on the sternum;

7. Examine the victim's mouth:

If a foreign body is visible, remove it and give mechanical ventilation (2 breaths);

If the foreign body is not removed, repeat pats on the back, thrusts on the sternum, examination of the mouth and ventilation until the baby's chest rises:
- after 2 successful breaths, check the pulse on the brachial artery.

Features of IVL in children

To restore breathing in children under 1 year of age, mechanical ventilation is carried out "from mouth to mouth and nose", in children older than 1 year - by the method "from mouth to mouth". Both methods are carried out in the position of the child on the back. For children under 1 year old, a low roller is placed under their backs (for example, a folded blanket), or slightly lifted upper part the torso with a hand brought under the back, the child’s head is slightly thrown back. The caregiver takes a shallow breath, hermetically covers the mouth and nose of a child up to 1 year old or only the mouth in children older than a year, and blows air into the respiratory tract, the volume of which should be the smaller than less baby. In newborns, the volume of inhaled air is 30-40 ml. With a sufficient volume of air blown in and air entering the lungs (and not the stomach), chest movements appear. After completing the blow, you need to make sure that the chest is lowering.

Blowing too much air for the baby can lead to grave consequences- to the rupture of the alveoli and lung tissue and the release of air into the pleural cavity.

Remember!

The frequency of inspirations should correspond to the age-related frequency of respiratory movements, which decreases with age.

The average NPV in 1 minute is:

In newborns and children up to 4 months - 40

In children 4-6 months - 35-40

In children 7 months - 35-30

In children 2-4 years old - 30-25

In children 4-6 years old - about 25

In children 6-12 years old - 22-20

In children 12-15 years old - 20-18 years old.

Features of indirect heart massage in children

In children chest wall elastic, so indirect heart massage is performed with less effort and with greater efficiency.

The technique of indirect heart massage in children depends on the age of the child. For children under 1 year old, it is enough to press on the sternum with 1-2 fingers. To do this, the assisting person lays the child on his back with his head to himself, covers him so that thumbs hands were located on the front surface of the chest, and their ends - on the lower third of the sternum, the rest of the fingers are placed under the back.

For children older than 1 year to 7 years, heart massage is performed, standing on the side, with the base of one hand, and for older children - with both hands (as adults).

During the massage, the chest should sag 1-1.5 cm in newborns, 2-2.5 cm in children 1-12 months old, 3-4 cm in children older than a year.

The number of pressures on the sternum for 1 minute should correspond to the average age-related pulse rate, which is:

In newborns - 140

In children 6 months - 130-135

In children 1 year old - 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 7 years old - 85-90

In children 8-9 years old - 80-85

In children 10-12 years old - 80

In children 13-15 years old - 75

Educational literature

UMP on the Fundamentals of Nursing, edited by Ph.D. A.I. Shpirna, M., GOU VUNMTS, 2003, pp. 683-684, 687-988.

S.A. Mukhina, I.I. Tarnovskaya, Atlas on the manipulation technique of nursing care, M., 1997, pp. 207-211.

To restore breathing in children under 1 year of age, mechanical ventilation is carried out “from mouth to mouth and nose”, in children older than 1 year - by the method “from mouth to mouth”. Both methods are carried out in the position of the child on the back. For children under 1 year old, a low roller is placed under the back (for example, a folded blanket), or the upper part of the body is slightly raised with a hand brought under the back, the child’s head is slightly thrown back. The caregiver takes a shallow breath, hermetically covers the mouth and nose of a child under 1 year old or only the mouth in children older than a year old, and blows air into the respiratory tract, the volume of which should be the smaller, the smaller the child. In newborns, the volume of inhaled air is 30-40 ml. With a sufficient volume of air blown in and air entering the lungs (and not the stomach), chest movements appear. After completing the blow, you need to make sure that the chest is lowering.

Blowing an excessively large volume of air for a child can lead to serious consequences - to rupture of the alveoli and lung tissue and air to escape into the pleural cavity.

Remember!

The frequency of inspirations should correspond to the age-related frequency of respiratory movements, which decreases with age.

The average NPV in 1 minute is:

In newborns and children up to 4 months - 40

In children 4-6 months - 35-40

In children 7 months - 35-30

In children 2-4 years old - 30-25

In children 4-6 years old - about 25

In children 6-12 years old - 22-20

For children 12-15 years old - 20-18 years old.

Features of indirect heart massage in children

In children, the chest wall is elastic, so chest compressions are performed with less effort and with greater efficiency.

The technique of indirect heart massage in children depends on the age of the child. For children under 1 year old, it is enough to press on the sternum with 1-2 fingers. To do this, the assisting person lays the child on his back with his head to himself, covers him so that the thumbs are located on the front surface of the chest, and their ends are on the lower third of the sternum, the rest of the fingers are placed under the back.

For children older than 1 year to 7 years, heart massage is performed, standing on the side, with the base of one hand, and for older children - with both hands (as adults).

During the massage, the chest should sag 1-1.5 cm in newborns, 2-2.5 cm in children 1-12 months old, 3-4 cm in children older than a year.

The number of pressures on the sternum for 1 minute should correspond to the average age-related pulse rate, which is:

In newborns - 140

In children 6 months - 130-135

In children 1 year old - 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 7 years old - 85-90

In children 8-9 years old - 80-85

In children 10-12 years old - 80

In children 13-15 years old - 75

Resuscitation is understood as the restoration of vital activity with a complete stop of the heart and breathing. The resumption of cardiac activity and respiration does not mean the final recovery. More difficult further treatment aimed at full recovery all bodily functions, especially the central nervous system.

Simple methods restoration of cardiac activity and respiration should be mastered by all doctors, nursing staff and even some organized groups population. This is explained by the fact that the cells of the cerebral cortex without oxygen die in normal conditions after 3-5 min. Practically, at present, it is possible to maintain the vital activity of brain cells during cardiac and respiratory arrest only with the help of artificial maintenance of lung ventilation and cardiac activity. Therefore, the simplest methods of restoring cardiac activity and respiration should be started by the one who is the first to be near the injured child. If in the next few minutes after cardiac and respiratory arrest artificial maintenance of ventilation and cardiac activity is not provided, then in the future any measures will be useless. Below are the main methods of artificially maintaining ventilation and gas exchange, which are carried out under any conditions when breathing and blood circulation stop. The pediatrician should not only master these methods, but also train all the staff of the institution in the basics of resuscitation and create a system for resuscitation.

Artificial lung ventilation

The most effective methods of artificial ventilation, based on blowing air, oxygen into the respiratory tract and lungs of the patient. Insufflation can be carried out mouth to mouth, mouth to nose, using a special breathing bag, through the mask of the anesthesia machine and the endotracheal tube inserted into the trachea.

Before starting artificial ventilation, it is necessary to free the child's airways from foreign bodies, fluids, mucus. For this newborn or baby can be lifted by the legs and remove the contents from the mouth with your hand. small child laid on the thigh of the person providing assistance, head down. The oral cavity in older children is released in the same way or with fingers. Further actions conducting artificial ventilation occur in a certain order:

1) the child is laid on his back, a small roller is placed under his shoulders and the head is sharply unbent, and the lower jaw is held; the animator takes a deep breath, and then quickly blows the exhaled air into the child's mouth, while pinching the child's nostrils;

2) when exhaling, the child's head is held in a sharply unbent position, the lower jaw is pulled out so that the upper and lower teeth are in contact; exhalation lasts twice as long as inhalation (Fig. 5).

Rice. 5. Artificial respiration mouth to mouth. a - blowing air into the lungs through the mouth; b - passive exhalation.

In one breath, the child needs to blow into the lungs a volume approximately 11/2 times his tidal volume. Produced 20-28 injections per minute.

When using a breathing bag or anesthesia machine, the principles remain the same.

Rhythmic movements of the chest and diaphragm indicate that the blown air enters the lungs.

artificial restoration and maintenance of cardiac activity. With a complete cessation of cardiac activity, no measures (intra-arterial injection of blood, medications), in addition to a direct effect on the heart, they will not give an effect.

Cardiac arrest is diagnosed by the absence blood pressure, pulse and heart tones, pallor of the skin and a sharp dilation of the pupils. During the operation, bleeding from the vessels stops.

In most cases restoration of cardiac activity begins with an indirect heart massage(Fig. 6).

Rice. 6. Indirect cardiac massage (scheme). a - the heart is not compressed and is filled with blood (diastole); b - the heart is squeezed between the sternum and the spine, the blood is pushed into the vessels (systole).

The principle of indirect massage It consists in periodic squeezing of the heart between the sternum and the spine. At the moment of contraction, blood is pushed into the vessels, and at the moment when the heart is not compressed, it fills with blood.

Chest Compression Technique

The child must be placed on a solid base (table, bed with wooden shields, floor). It is better to raise your legs. Then vigorous periodic pressing is performed on the lower third of the sternum at a speed of 90-100 times per minute. When pressing, the amplitude of movement of the sternum should be 3-4 cm. In newborns, pressure on the sternum is performed with one finger, in infants- palm with raised fingers, and in children over 8-9 years old - two palms with raised fingers (Fig. 7, 8).

Rice. 7. Chest compressions in an older child

Rice. 8. An indirect heart massage in a newborn or infant

During the indirect massage, it is useful to clamp the abdominal aorta before the appearance of independent heart contractions, pressing the navel with a fist. This reduces the volume of circulating blood and improves the blood supply to the brain.

If within 11/2-2 minutes of indirect massage there is no pulsation on the carotid artery, you should proceed to a direct heart massage. chest open on the fourth or fifth left intercostal space from the mid-axillary line to the sternum. The pericardium is also more frequently exposed. The ventricles of the heart are also squeezed with one or two hands at a speed of up to 100 times per minute and a duration of compression of 0.3 s. If cardiac arrest occurs during surgery abdominal cavity, then the heart massage can be performed through the diaphragm, pressing the heart to the sternum.

Medical therapy and defibrillation

Drug therapy is carried out only after the start of a heart massage and artificial ventilation.

1. In all cases of clinical death, 10-60 ml of 4% sodium bicarbonate should be administered intravenously
2. In cases where cardiac arrest was caused by bleeding, it is necessary to inject blood intravenously under pressure.
3. If cardiac activity is not restored within 1-2 minutes after the start of the massage, inject intracardiac (into the left ventricle) or intravenously 0.1-0.2 mg (it is better to dilute to 1-2 ml) of 0.1% adrenaline solution.
4. Intravenously inject 1-4 ml of 2% calcium chloride solution.

With cardiac fibrillation, defibrillation is performed. The latter is one of the most dangerous complications massage or comes on its own from the same reasons as cardiac arrest. Fibrillation is diagnosed by the same signs as cardiac arrest, but a specific curve is visible on the ECG. When the pleural cavity is opened, chaotic twitches of individual muscle groups of the heart are noted. Most effective method Treatment of fibrillation is electrical defibrillation using special defibrillators, which can be repeated several times. After the cessation of cardiac fibrillation, heart massage should be continued.

Resuscitation efficiency

Determined by the appearance of a pulse peripheral vessels, reduction of pallor and cyanosis, narrowing of the pupils and the appearance of a corneal reflex, restoration of spontaneous breathing and consciousness.

Carrying out cardiopulmonary resuscitation.

Above, methods for restoring breathing and cardiac activity were given separately. In case of cardiac and respiratory arrest, artificial ventilation and heart massage are carried out simultaneously in the following order:

1) rapid release of the airways;
2) 2-3 injections of air or oxygen into the patient's lungs;
3) 4-5 pressures on the sternum;
4) subsequently - alternation of 1 breath and 4-5 pressures.

When inhaling, do not press on the sternum. If resuscitation is carried out by one person, then 15-18 pressures on the sternum are performed for every 2 breaths. Every 2 minutes, resuscitation is stopped for a few seconds to check their effectiveness. During resuscitation, specialists are called or the child is transferred to special institution and resuscitation during transportation.

The key to success in resuscitation is the organization of systematic training of all medical staff. Only this can ensure timely, effective resuscitation within a few minutes.

Isakov Yu. F. Children's surgery, 1983.