Respiratory cessation is determined. Signs of respiratory arrest. Causes of respiratory arrest

Main reasons

What can cause this condition? What are the causes of respiratory arrest? So, doctors say that they occur most often in the following cases:

• In case of electric shock.
• In case of drowning.
• With a strong impact.
• During acute poisoning of the body.

In this case, it is important to remember that irreversible consequences in the body after stopping breathing occur within five to six minutes. So even before the rescue vehicle or ambulance arrives, the patient must be given first effective aid. After all, such simple manipulations can save a person’s life.

Signs of apnea

Apnea is a disease that is difficult to diagnose. Most of the signs of apnea coincide with the signs of other diseases, and the patient himself often even suspects that he has breathing problems during sleep.

Sure signs of apnea include:

• severe snoring that disturbs household members
• long periods of falling asleep and difficult waking up
• interrupted restless sleep with uneven breathing
• frequent urination at night
• pain in the throat and head that manifests itself during awakening
• fatigue, drowsiness, decreased performance
• awakenings from a feeling of suffocation, dreams in which any restriction of breathing occurs
• grinding teeth in sleep
• sleepwalking

IMPORTANT: If you notice the first signs of apnea, you should consult a doctor. Otherwise, the disease may progress, which over time can lead to a critical decrease in oxygen levels in the body, disturbances in the functioning of the nervous and cardiovascular systems, and the development of chronic bronchitis or bronchial asthma.

Indicators

Respiratory and cardiac arrest are characterized by the following signs by which the presence of this problem can be determined:

• Pupil dilation.
• No pulse. It must be remembered that you can “listen” not only to the carotid arteries, but also to the femoral arteries.
• Lack of breathing. You can check it by leaning your ear towards the patient’s nasopharynx. Or you can simply put a mirror to your nose. If it does not fog up, the person is not breathing.
• Condition of the skin. They become waxy pale or acquire a bluish tint.

Apnea in children

There are two main reasons for the development of apnea in children: hypertrophy of the tonsils and congenital disorders of the central nervous system. If children of any age can suffer from attacks of apnea due to enlarged adenoids or tonsils, then disruption of the functioning of the central nervous system can cause breath holding during sleep, mainly in infants.

IMPORTANT: Parents can notice the child’s breathing stops during night or daytime sleep. Childhood apnea is sometimes accompanied by reflex muscle contractions and changes in skin color. If an attack of apnea is detected in a child, adults should immediately wake him up and gently massage his chest. Before the baby falls asleep again, you need to make sure that the room is fresh enough and that the child is not wearing excess clothes. These factors play an important role in the formation of sleep structure.

Any case of childhood apnea should be a signal for immediate medical attention. Pediatricians usually suggest being examined in a hospital. Children suffering from severe forms of sleep apnea are prescribed medication or mask breathing during periods of sleep.

IMPORTANT: Parents who suspect their child has apnea can video record a few minutes of their baby's sleep. From this recording, a pediatrician or pediatric ENT specialist will be able to accurately determine whether the child has sleep apnea. If there is a real danger, the doctor may suggest solving the problem surgically.

Rescuer actions

There are special instructions for first aid. It is very important to follow it, because this is the only way to provide real effective help. The order of its execution should be as follows:

1. The person needs to be taken outside. Or ensure the flow of clean fresh air through windows and doors.
2. The victim should be laid on his back, with a cushion tucked under his neck. This is important, because the patient's head should be thrown back a little.
3. First aid for respiratory arrest is to clear the airways of excess fluid (vomit, water, mucus). In this case, you can use gauze pads.
4. Next, gauze should be placed on the victim’s mouth. This is a preparatory stage for artificial respiration. First, the lower jaw of a person must be moved forward a little.
5. Direct artificial respiration.
6. It is important to accurately note the time when breathing stops, as well as the beginning of revival.

However, first aid in case of respiratory arrest is to call the ambulance service. After all, only specialists can do everything necessary to bring a person back to life.

Method of performing artificial respiration

How to perform it correctly and what should be done if mouth-to-mouth artificial respiration is to be performed? So, for this there is a simple list of actions, the correct execution of which determines the result of the work done.

• Initially, you need to open your jaw. This can be done with your hand or with a stick. It is also important to remove the sunken tongue from the larynx. You will have to hold it with your fingers from the outside. This is a special precaution, because if this is not done, a person can block his own airways with his tongue. And all further manipulations will simply be ineffective.
• If there is a risk that the victim's spine may be damaged, his head should be in the primary position. Otherwise, the person must be lifted by the neck so that the head goes back a little and turns to the side. This is necessary so that the remaining water or vomit comes out and does not enter the body.
• It must be remembered that it is best to cover the victim’s mouth with a handkerchief. After all, during artificial respiration there is direct contact with the human mucous membrane. And this is unhygienic.
• Next, the rescuer stands on the side of the victim and kneels down. She covers his nose with her fingers. The one who provides assistance takes in a lot of air into the lungs and exhales it sharply into the mouth of the person being rescued. Thanks to the elasticity of the chest, its movements will be visible.
• The duration of inhalation takes a couple of seconds. The number of breaths per minute is approximately 12-15 times. It is important to ensure that the chest rises. Otherwise, all actions will be ineffective.
• It must be remembered that after each breath the victim must open his nose. The artificially pumped air must come out.
• If first aid is provided when breathing stops, you must remember that after inhalation it is necessary to perform a cardiac massage. This is important, because these two conditions (respiratory arrest and heart failure) are most often inseparable. To do this, press the chest with medium force five times in a row.
• You must also remember that it is necessary to empty the victim’s stomach of air. To do this, you need to lightly press on it periodically.
• If artificial respiration is performed using the mouth-to-nose method, air must be inhaled into the victim’s nose. In this case, his mouth should be tightly closed. All other actions are the same as described above.

If a child is injured

First aid instructions for children are slightly different. In this case, when inhaling air, not only the lips, but also the nose of the victim should be grasped at the same time. Heart massage is also somewhat different. In order not to break the bones of the baby’s chest, he needs to press with two fingers on the area where the lower ribs connect. It is also important to ensure that the baby's pulse is at least slightly rhythmic. It is good if it is 10-12 beats per 10 seconds.

If after the manipulations the victim’s breathing is still restored, this is not yet a reason to relax. In this case, before the ambulance arrives, you need to monitor the person’s pulse. It must be checked every two minutes. If a failure occurs, artificial respiration and cardiac massage must be repeated again.

You can do these movements for as long as needed. We must remember that such simple actions can save the life of the victim.

Drugs for intubation

Intubation without premedication is performed for apnea if the patient is not conscious or has a pulse. For other patients, it is important to carry out premedication, which makes the procedure easier and reduces the patient’s discomfort. If the patient’s condition allows, oxygenation with 100% 02 is preliminarily carried out for 3 to 5 minutes. This allows for four or five minutes of normal oxygenation during apnea.

Laryngoscopy activates the sympathetic system, which is accompanied by an increase in blood pressure and an increase in heart rate. To avoid such a reaction of the body, one or two minutes before sedation and myoplegia, 1.5 mg/kg lidocaine should be administered intravenously. During intubation, a vagal reaction (severe bradycardia) often occurs in adult patients and children. For this reason, 0.02 mg/kg atropine should be administered intravenously. The minimum dose of atropine for infants is 0.1 mg. The minimum dose for children and adult patients is 0.5 mg.

Some specialists use small doses of a muscle relaxant for premedication. Vecuronium is suitable at a dose of 0.01 mg/kg, administered intravenously for patients over 4 years of age. It allows you to prevent the appearance of muscle fasciculations caused by the administration of a full dose of succinylcholine. After the patient awakens, muscle pain and transient hyperkalemia may occur as a result of fasciculations.

Sedation and analgesia

Laryngoscopy and intubation, as already noted, are uncomfortable procedures for the patient. For this reason, immediately before the procedure, it is necessary to administer IV medications that have a sedative or sedative-analgesic short-term effect. After this, the physician's assistant should press on the cricoid cartilage (Sellick maneuver) and compress the esophagus to prevent regurgitation and aspiration.

0.3 mg/kg etomidate (Etomi-date) can be used. It is a non-barbiturate hypnotic and is preferred for use. Fentanyl at a dose of 5 mcg/kg is also acceptable. For children, the dose should be calculated as follows: 2-5 mcg/kg, this dose is higher than the analgesic one. Fentanyl is an opioid with sedative and analgesic effects and does not cause cardiovascular depression. If large doses of the drug are administered, there is a risk of chest rigidity.

1-2 mg/kg of ketamine is administered for an anesthetic effect (also has a cardiac stimulating effect). This drug, after waking up, can lead to inappropriate actions and hallucinations. 1-2 mg/kg of methohexital and 3-4 mg/kg of Thiopental have a good effect, but they lead to a decrease in blood pressure.

Myoplegia

Tracheal intubation is easier if the patient's skeletal muscles are relaxed. The effect of a drug called succinylcholine , which is administered intravenously at a dose of 1.5 mg per 1 kg of the human body. For infants, the dose of this drug is 2.0 mg/kg. Succinylcholine is a muscle relaxant with a depolarizing effect, which begins to act 0.5-1 minutes after administration. Its effect is only 3-5 minutes. It should not be used in patients with:

• muscle crushing (more than 1-2 days old)
• burns
• neuromuscular diseases
• spinal cord injuries
• penetrating eye injury (presumably)
• renal failure

Malignant hyperthermia is observed after administration of succinylcholine in one patient out of 15 thousand. This drug for children should be administered together with atropine to prevent severe bradycardia.

Non-depolarizing muscle relaxants begin to act more slowly, but their effect lasts 30 minutes or longer. These include Mivacurium 0.15 mg/kg, Atracurium 0.5 mg/kg, Vecuronium 0.1-0.2 mg/kg, Rocuronium 1.0 mg/kg. They must be administered within one minute.