V. Reference basis of action

Method of leadthrough of artificial ventilation of lights.

A method is a «mouth in a mouth». Efficiency at this method is arrived at at the maximal filling up of chairman sick to back. Thus the root of language and epiglottis is displaced frontally and open free access of air in a larynx. Nurse, upright from one side, presses one-arm wrists on the brow of patient and fills up his chairman, and underlays the second under a neck. AVL rhythmic insufflation of air is underlaid from the respiratory tracts of nurse in the respiratory tracts of patient under positive pressure. During the leadthrough of AVL a mouth of patient must be constantly opened.

Method of leadthrough of indirect massage of heart.

For the successful leadthrough of indirect massage of heart sick it is necessary to place on a hard surface. If the stop of heart happened on a bed with a spring mattress, a patient needs to be put on a bed so that a pectoral department of spine was on a hard bend. For this purpose the overhead half of trunk is disposed on an edge by beds, a head here must hang down downward. A nurse is from one side from a patient and bares him thorax. The indirect massage of heart is conducted as follows. The left palm is laid on lower third of breastbone, and rights – on left. Both hands must be unbended, and a humeral belt is disposed above a thorax. A massage is carried out the energetic acute pressing on on a breastbone; thus a breastbone must be displaced on 3-4 see to the spine. Number of pressing on – 50-60 on a minute. A heart compresses between a breastbone and spine, and blood from ventricles is pushed in an aorta and pulmonary artery. At stopping of pressing on a breastbone rises and a heart is again filled with blood from cavas. Thus, there is artificial circulation of blood. It follows to conduct a massage to proceeding in the valuable independent operation of heart, to appearance of clear pulse and raising of pressure to 80-90 ìì. of рт. item The massage of heart must be necessarily accompanied artificial ventilation of lights.

VI. The system of teaching tasks is for verification of eventual level of knowledges.

Situatioonal tasks

1. From an operating-room the patient R. is translated in the chamber of intensive therapy, that carried under the combined anesthesia a gastrectomy, draining of abdominal region. In 15 minutes after interference the independent breathing was halted, cardiac activity is stored. Reanimatologist is shown out lower jaw, through a mouth entered of air-duct - the independent breathing absents.

What from complications did develop for this patient? How to give a help to the patient?

1.Answer: the reflex stop of breathing developed for a patient. It is needed to conduct artificial ventilation of lights «mouth in a mouth», or by the respiratory sack of Ambu.

2. A patient during 2 days got conservative therapy concerning traumatic shock of the III degree as a result of the closed break of bones of pelvis. A patient is shown out of shock. During X-ray examination in lungs found out plural shallow atelectasiss. Did this heavy complication develop as a result ?

2.Answer: this patient is with ‘shocked lung’..

3. Patient, 82 years old, had a stop of heart and breathing; in anamnesis – cardiac insufficiency lasted. On 5 minute of pneumocardial reanimation which began in time, proceeding in cardiac activity is not registered. Does it cost to continue reanimation measures? What prognosis, during a subsequent reanimation, in relation to proceeding in cardiac activity?

3.Answer': we must to prolong a pneumocardial reanimation farther. Fully picking up a thread cardiac activity is impossible.

4. A child has the sudden stopping of breathing, become blue skin, disappearance of pulse on main vessels and narrowing of pupils. What near-term measures need to be conducted.

4. Answer: it is needed quickly to conduct reanimation measures a child: artificial ventilation of lights, the massage of hear.

5. Woman of 64th with an unstable stenocardia during walking fallen down suddenly. A duty doctor at a review is establish a fainting fit, absence of pulsation on and. carotis and tones of heart, narrow pupils and liquid shallow breathing. What diagnosis? What first medical aid?

5.Answer: at sick displays of clinical death are absence of consciousness, pulsation, on carotids, the photoharmose of pupils absents. It is needed without delay to begin reanimation measures – indirect massage of heart, artificial ventilation of lights.

6. For the patient of 75-years old, which is in intensice therapy department concerning the heart attack of myocardium, there was fibrilation of ventricles. The immediate complex of reanimation measures is effective, picked up a thread sines rhythm. Objectively: AP 130/80, shortness of breath, – 24 in 1 minute, auscultation – from the right side of breathing not determined, during percusion is a box sound. Roentgenologic: two-bit of liquid. Specify the most reliable reason of complication which developed?

6.Answer: for a patient breaks of ribs and breastbone are with injuring of parietal pleura by wreckages as a result of leadthrough of reanimation measures.

7. A patient is in the state of clinical death. Artificial ventilation of lights is conducted by a method «from a mouth to the mouth» and indirect massage of heart. A doctor paid a regard to that air does not pass in the respiratory tracts of patient, and his chairman on a trunk are in one plane. Is there what reason of unefficiency of artificial respiration in this situation? Subsequent actions of doctor?

7.Answer: at the sick falling back of language. It is needed to show out a lower jaw downward and forward, to get a language, prolong to conduct reanimation measures.

8. The child 10 years old delivered ashore in 3 minutes after sinking. Objectively: a pulse on peripheral arteries is not determined, pupils are moderato extended, poorly react on light. Skin covers are pale with a cyanochroic tint. In the cavity of mouth sand, silt; breathing is sharply low-spirited. What urgent and primary measures at the grant of help to suffering?

8 .Answer: it is needed to release overhead respiratory tracts a patient from sand and to the silt, to eliminate the presence of water in respiratory tracts (to delete water if is). After it to conduct reanimation measures after to the generally accepted chart.

Distributing of marks which are appropriated students:

At mastering of theme 11 from rich in content the module # 3 for educational activity an estimation is proposed a student for traditional scale which converted to points as follows:

Estimation	Points
“5”(fine)	6 points
“4” (well)	4 points
“3”(satisfactorily)	2 points
“2” (unsatisfactorily)	0 points