I.Ya. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY

1. I.Ya. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY Lecture 2 Modern methods of provision of airway patency. Speaker:R.M. Lyakhovych

2. Provide patency of airways support, find out if there are signs of life …to confirm or oppose the circulatory arrest. • Patient’s response • Provide patency of airways support • Check respiration and pulse (not more than 10 sec)

3. Patency of airways support Suction units (aspirators)

4. Three stages of ABC-reanimation. Algorithm of its realization by one and two medical men. Testimony to defibrillation and technique of its execution. Cardiac shock of feature of clinical dynamics, first aid.

5. Patency of airways support Respiratory mask

6. Patency of airways support Laryngeal mask Laryngeal tube

7. First aid at the terminal states. • Concept about the terminal states, purpose and task the first medical aid, first-aid and medical rescue.

8. Patency of airways support laryngeal tubes laryngeal tubes

9. Patency of airways support Combitube

10. General principles, legal, organizational, medical and deontological features of giving the first aid in extraordinary situation. Algorithm of primary inspection of the patient in the place of event.

11. Patency of airways support Respiratory mask and Ambu bag

12. Patency of airways support A set for conicopuncture

13. BASIC CONCEPTS in REANIMATOLOGY • Reanimatologyis science about the revival of organism, which studies etiology, pathogenesis, diagnostics and treatment of the terminal states. • A reanimation (abroad widespread is a term of rescucitation) is a process of replacement and proceeding in the functions of organism by the leadthrough of the special reanimation measures.

14. Portable set of respiratory equipment Oxygen therapy Support of artificial ventilation of lungs

15. Training equipment for developing skills of patency of airways support

16. Clinical death -| it is the state which circulation of blood and spontaneous breathing absent in the conditions of, but there yet were irrecurent changes in the human brain, when it is yet possible to return a patient to life without a clinically meaningful neurological deficit.

17. The case of Fabrice Muamba versus the case of Hank GathersСлучай Фабриса Муамба против случая Хэнка Гатерса. Fabrice Muamba collapses at March, 2012 Soccer match in U.K. resuscitation for 78 minutes Фабрис Муамба, март 2012, реанимация длилась 78 минут

18. Success Fabrice Muamba with ICD leaving Hospital after successful over 1 hour on field resuscitationУспехФабрис Муамба покидает госпиталь после успешно, длившейся более 1 часа реанимации.

19. Versus the Tragic23 yo Hank Gathers collapses in 1990 basketball game and has brief seizure….not recognized as v fib arrest until too late Трагедия23 летний Хэнк потерял сознание в 1990г. Во время баскетбольного матча, приступ не был определен как остановка сердца, было поздно

20. Biological death is consisting of irreversible changes above all things of CNS, when to life turning a man is impossible. To the clinical signs of biological death take drying out and dimness of cornea, of a corpse spots and of a corpse.

21. Such concepts utillize in rescucitation, as a decortication (social death) is death of cortex (when somatic functions can recommence almost in full, but the function of cortex does not recommence) a that decerebration is death of cerebrum. • By the clinical signs of decortication ñ absence of свідо­мості and purchased reflexes. There is a timber-toe by the dead bark of the brain on condition of valuable supervision can live yet long time. To set the exact diagnosis of decortication heavily, as there are events, when after the protracted comma a man came to consciousness.

22. A decerebration arises up after more protracted total ischemia of brain (20 min and anymore), sometimes can develop on a background a decortication in the case of progress of іschemical-reperfusion defeats.

39. TYPES OF STOP OF the HEART Fibrillation of ventricles The most widespread type of uneffective circulation of blood in not hospital terms is all of to 2/3 cases.

40. During fibrillation of ventricles there is a desynchronization of reductions of myo-fibriles myocardium with the loss of pumping function of the heart. On EKG fibrillation of ventricles shows up alike on a wave the curve of differentamplitude in default of auricle and gastric complexes.

42. Unpulsive gastric tachycardia • The most widespread type of uneffective circulation of blood is in the conditions of permanent establishment.

43. Asystole • Practical absence of electric and mechanical activity of myocardium. On EKG appears as an almost straight line • The most frequent reason of asystole is ischemic heart (IKHS) trouble, it can develop on a background fibrilation of ventricles which are an unfavorable prognostic sign.

44. Electromechanic dissociation (EMD) and bradiarythmia with the uneffective mechanical activity of heart • At the transferred states electric activity of heart is stored, but it is not accompanied effective reductions of myocardium. On EKG discover typical and off type gastric complexes with a different rhythm. off type gastric complexes at electromechanical dissociation

45. Diagnostics of uneffective circulation of blood • The element of pneumocardial reanimation is very important. On timely diagnostics of stop of circulation of blood a prognosis depends often.

46. But more frequent all uneffective circulation of blood is diagnosed only after clinical signs. To them absence of pulse belongs, foremost, on central arteries (sleepy and thigh). The method of research of pulse is resulted the way of palpation. Research of pulse by means of palpation on a. carotis

47. To the early signs of unefficiency of circulation of blood paralytic mydriasis belongs also: at raising of overhead eyelid a pupil remains wide and irresponsive on light

48. Researchofpulsebypalpationandestimationofthestateofpupillaitispossibleto perform simultaneously. • Asalreadymarkedhigher, theobligatorysignsofuneffectivecirculationisabsenceofconsciousnessandrhythmicindependentbreathing.

49. PNEUMOCARDIAL REANIMATION • Complex of measures which are executed during the leadthrough of CPR, it is possible to divide on three basic groups: • base sustentation - after the English letters of ABC: • A (airway ореn) providing of communicating of respiratory tracts • B (breeth) artificial respiration • C (сirculation) a massage of heart

50. Must be conducted any man which is alongside; • subsequent methods of CPR, the purpose of which is proceeding in independent circulation of blood for a patient: electric defibrilation, medicinal therapy; • stabilizing of basic vitally important functions of organism sick, above all things it touches activity of cerebrum, heart and vessels, intensive therapy.