First-aid treatment for unconsciousness and respiratory arrest

Basic signs of life in the victim

The basic signs of life include consciousness, independent breathing and circulation. These are checked during the cardiopulmonary resuscitation algorithm.

Causes of respiratory and circulatory disturbances

Sudden death (respiratory and circulatory arrest) can be caused by diseases (myocardial infarction, heart rhythm disorders, etc.) or by external effects (trauma, electric shock, drowning, etc.). Regardless of the causes of loss of life signs, cardiopulmonary resuscitation is carried out in accordance with a specific algorithm recommended by the Russian National Resuscitation Council and the European Resuscitation Council.

The most common complication of cardiopulmonary resuscitation is fracture of the bones of the thorax (mainly ribs). It occurs most often when there is excessive force of hands on the victim’s sternum, improperly defined point of hand placement, increased bone fragility (for example, in elderly and elderly victims).

You can avoid or reduce the frequency of these errors and complications with regular and quality preparation.

Assess the safety for yourself, the victim(s) and others at the scene
At the scene, the first responder should assess the safety for himself or herself, the victim(s), and others. Then eliminate threatening factors or minimize the risk to self, victim(s), and others.

Check that the victim is conscious
The next step is to check that the victim is conscious. To check consciousness, gently shake the victim by the shoulders and ask loudly, “What’s wrong? Do you need help?”. An unconscious person will not be able to respond and answer these questions.

What to do if there are no signs of consciousness
If there are no signs of consciousness, you should determine if the victim is breathing. To do this, restore airway patency by placing one hand on the victim’s forehead and placing two fingers on the chin, tilting the head back and lifting the chin and lower jaw. If there is a suspicion of cervical spine injury, tilting should be done as gently and sparingly as possible.

How to find out if you are breathing
To check for breathing, lean your cheek and ear against the victim’s mouth and nose and for 10 seconds try to hear him breathing, feel the air being exhaled on your cheek and see the victim’s chest movements. In the absence of breathing, the victim’s chest will remain still, no breathing sounds will be heard, and the exhaled air from the mouth and nose will not be felt on the cheek. Lack of breathing determines the need to call an ambulance and perform cardiopulmonary resuscitation.

What to do if not breathing
If the victim is not breathing, the first responder should arrange to call an ambulance. To do this, call loudly for help, addressing a specific person near the scene of the accident and give them the appropriate instructions. Instructions should be given in a short, clear, informative way: “The person is not breathing. Call an ambulance. Let me know what you have called.”

What to do if it is impossible to involve a helper
If no helper is available, you should call the ambulance yourself (e.g., using the speakerphone function on your telephone). When making a call, be sure to give the dispatcher the following information: the location of the accident, what happened, the number of victims and what is wrong with them, what kind of help is being provided. Hang up the phone last, after the dispatcher answers.

Simultaneously with the ambulance call, apply pressure to the victim’s sternum with your hands
While calling the ambulance, it is necessary to start hand pressure on the victim’s sternum, who should be lying on the back on a hard and even surface. In this case, the palm base of one hand of the first aid worker is placed on the middle of the victim’s chest, the second hand is placed on top of the first, the hands are locked, the arms are straightened at the elbow joints, the shoulders of the first aid worker are placed over the victim so that the pressure is perpendicular to the sternum plane. Pressure by the hands on the victim’s sternum is applied with the weight of the torso of the first aid worker to a depth of 5-6 cm at a frequency of 100-120 per minute. After 30 hand presses on the victim’s sternum, it is necessary to perform mouth-to-mouth artificial respiration. To do this, open the airways of the victim (tilt the head, lift the chin), clasp his nose with two fingers, take two breaths of artificial respiration.

Breaths of artificial respiration are performed as follows:
You must take your normal breath, tightly wrap your lips around the victim’s mouth, and exhale evenly into his airway for 1 second, observing the movement of his chest. The reference point for sufficient volume of air being blown in and effective inhalation of artificial respiration is the beginning of the chest rise, determined by the first aid participant visually. After that, continuing to maintain the patency of the airways, it is necessary to let the victim make a passive exhalation, and then repeat the artificial respiration in the above-described manner. Two breaths of CPR should take no more than 10 seconds. No more than two CPR breaths should be attempted between hand pressures on the victim’s sternum. The use of a CPR device from the first aid kit or stowaway is recommended.

Performing mouth-to-nose CPR
If mouth-to-mouth resuscitation is not possible (because the lips of the victim are damaged, for example), mouth-to-nose resuscitation is used. This technique differs in that the first aid worker covers the victim’s mouth while tilting the head back and wraps his or her lips around the victim’s nose.

Continue CPR
Next, continue resuscitation efforts by alternating 30 chest compressions with 2 breaths of CPR.

Major errors in the performance of resuscitation measures include:
violation of the sequence of cardiopulmonary resuscitation measures; incorrect technique of performing hand pressure on the sternum of the victim (wrong positioning of the hands, insufficient or excessive depth of pressure, wrong frequency, lack of complete elevation of the chest after each pressure); incorrect technique of artificial respiration (insufficient or incorrect opening of airways, excessive or insufficient volume of blown air); incorrect ratio of hand pressures on the chest

When providing first aid, the simplest ways of checking for the presence or absence of signs of life are used:
Indications for stopping CPR

Resuscitation measures continue until the arrival of the ambulance or other special services whose staff are required to provide first aid, and the order of the staff of these services to stop resuscitation, or until the appearance of clear signs of life in the victim (the appearance of independent breathing, the appearance of cough, arbitrary movements).

In the case of long-term resuscitation measures and physical fatigue of the participant of first aid, it is necessary to involve an assistant in the implementation of these measures. Most modern domestic and foreign recommendations for cardiopulmonary resuscitation provide for the change of its participants approximately every 2 minutes, or after 5-6 cycles of pressures and breaths.

Resuscitation measures may not be carried out by victims with clear signs of non-vital signs (decomposition or trauma incompatible with life), or in cases where the lack of signs of life is caused by the outcome of a long-standing incurable disease (e.g., cancer).