↓↓

Resuscitarea medicală
în condiții bazale
You can live without water for a few days and without food for a few weeks. Without air, though,
you'll suffer brain damage within a few minutes and die after about ten minutes. Breathing, then,
would be a pretty good thing about which to become an expert.

CPR is not 100% successful, but it is the only alternative.

Basic life support (BLS) comprises the elements: initial assessment, then airway
maintenance, expired air ventilation (rescue breathing), and chest compression.
Basic life support implies that no equipment is employed; where a simple airway
or facemask for mouth to mouth ventilation is used, this is defined as "basic life
support with airway adjunct".
The purpose of BLS is to maintain adequate ventilation and circulation until
means can be obtained to reverse the underlying cause of the arrest. It is therefore
a "holding operation", although on occasions, particularly when the primary
pathology is respiratory failure, it may itself reverse the cause and allow full
recovery. Failure of the circulation for three to four minutes (less if the victim is
initially hypoxaemic) will lead to irreversible cerebral damage. Delay, even
within that time, will lessen the eventual chances of a successful outcome.
Emphasis must therefore be placed on rapid institution of basic life support by a
rescuer, who nonetheless should follow the recommended sequence of action.
 Early Ages - Flagellation Method
Early Ages - Heat Method

800 BC. Elijah's mouth to mouth. "...And he went up, and lay upon the child,
and put his mouth upon his mouth, and his eyes upon his eyes, and his hands
upon his hands; and he stretched himself upon the child; and the flesh of the
child waxed warm."1 This first recorded event has been the gate through which
all of us have traveled.
1530 - Bellows Method

1711 - Fumigation Method

1770 - Inversion Method 1803 - Russian Method

1773 - Barrel Method

1812 - Trotting Horse Method

1950 - Mouth-to-Mouth Resuscitation
1973 - CPR practice for the population
1992 - New reanimation method - the ACD method
1990's - New reanimation method - the VEST reanimation
1990'er - New reanimation method - the
abdominal resuscitation

1998 - Early defibrillation

1960 - 1999 Devices for CPR

2000 Optimised CPR Resuscitation -

Animax
1961
1991
1992
2000
2005
http://www.erc.edu/
1. Ensure safety of rescuer and victim
 Martor – “bunul samaritean”

Medic (oricare) Cine efectueaza

Paramedic RCR? “Nurse led
defibrillation”

Familia

“Hospital based medical emergency team”

 conştient
diagnostic
cu funcţii vitale prezervate
respiraţie = circulaţie
comatos
în stop cardiorespirator

asistenţa respiraţiei
Timpii morţi
manevre

asistenţa circulaţiei Perioade de

asistenţă
efectivă

Durată Eficienţă
 Sequence of actions for adult basic life support
For the purposes of these guidelines an adult is considered a person aged 8
years or over.
1. Ensure safety of rescuer and victim
 

2. Check the victim and see if he responds:

Gently shake his shoulders and ask loudly: "Are you all right?"

B. If he does not respond:

•Shout for help
• Unless you can assess him fully in the position you find
A. If he responds by answering or
him, turn the victim on to his back and then open the
moving:
airway:
• Leave him in the position in which
you find him (provided he is not in
further danger)
• Check his condition
• Get assistance if needed
• Reassess him regularly
 Sequence of actions for adult basic life support
For the purposes of these guidelines an adult is considered a person aged 8
years or over.
1. Ensure safety of rescuer and victim
 

2. Check the victim and see if he responds:

Gently shake his shoulders and ask loudly: "Are you all right?"

B. If he does not respond:

•Shout for help
• Unless you can assess him fully in the position you find
A. If he responds by answering or
him, turn the victim on to his back and then open the
moving:
airway:
• Place your hand on his forehead and gently tilt his
• Leave him in the position in which
head back keeping your thumb and index finger
you find him (provided he is not infree to close his nose if rescue breathing is
further danger) required
• Check his condition • Remove any visible obstruction from the victim’s
• Get assistance if needed
mouth, including disloged dentures, but leave well
• Reassess him regularly
fitting dentures in place
• With your fingertips under the point of the victim's
chin, lift the chin to open the airway
Keeping the airway open, look, listen and feel for breathing (more than an
occasional gasp or weak attempts at breathing):
• Look for chest movement
• Listen at the victim's mouth for breath sounds
• Feel for air on your cheek

A. If he is breathing normally:
•Turn him into the recovery position
Keeping the airway open, look, listen and feel for breathing (more than an
occasional gasp or weak attempts at breathing):
• Look for chest movement
• Listen at the victim's mouth for breath sounds
• Feel for air on your cheek

A. If he is breathing normally: B. If he is not breathing or is only making

•Turn him into the recovery position
occasional gasps or weak attempts at
breathing:
•Send someone for help or, if you are on your
own, leave the victim and go for help; return
and start rescue breathing as below

•Turn the victim onto his back if he is not

already in this position
•Send or go for help
•Check for continued breathing
Give 2 slow, effective rescue breaths, each of which makes the chest rise and fall:

cu excepţia victimelor de:

• intoxicaţii;
• înec;
• patologie traumatică;
• copii;

• Ensure head tilt and chin lift

• Pinch the soft part of his nose closed with the index finger and thumb of your hand
on his forehead
• Open his mouth a little, but maintain chin lift
• Take a deep breath to fill your lungs with oxygen, and place your lips around his
mouth, making sure that you have a good seal
• Blow steadily into his mouth whilst watching his chest; take about 2 seconds to
make his chest rise as in normal breathing
• Maintaining head tilt and chin lift, take your mouth away from the victim and
watch for his chest to fall as air comes out
• Take another breath and repeat the sequence as above to give 2 effective rescue
breaths in all
•If you have difficulty achieving an effective breath:
•Recheck the victim's mouth and remove any obstruction
•Recheck that there is adequate head tilt and chin lift
•Make up to 5 attempts in all to achieve 2 effective breaths
•Even if unsuccessful, move on to assessment of the circulation
4. Assess the victim for signs of a circulation:
•Look, listen and feel for normal breathing, coughing or movement by the victim
•Only if you have been trained to do so, check the carotid pulse
•Take no more than 10 seconds to do this

If you are confident that you have If there are no signs of a circulation, or
detected signs of a circulation: you are at all unsure, start chest
•Continue rescue breathing until the victim compressions:
starts breathing on his own With your hand that is nearest the victim's
•About every 10 breaths (or about every feet, locate the lower half of the sternum
minute) recheck for signs of a circulation; (breastbone):
take no more than 10 seconds each time •Using your index and middle fingers,
•If the victim starts to breathe normally on identify the lower rib edge nearest to you.
his own but remains unconscious, turn him Keeping your fingers together, slide them
into the recovery position. Be ready to turn upwards to the point where the ribs join the
him on to his back and re-start rescue sternum.
breathing if he stops breathing •With your middle finger on this point, place
your index finger on the sternum itself
•Slide the heel of your other hand down the
sternum until it reaches your index finger;
this should be the middle of the lower half of
the sternum
 Masajul cardiac extern

linia umerilor

unică zonă de 900

contact/compresiune
centrul toracelui
linia sternului

“Push hard” Depresie stern 5-6 cm.

“Push fast” Rata de 100/min este esentiala.

 Masajul cardiac extern

linia umerilor

unică zonă de 900

contact/compresiune
centrul toracelui
linia sternului

“Push hard” Depresie stern 5-6 cm.

“Push fast” Rata de 100/min este esentiala.

“Don’t stop” Pauzele scad perfuzia miocardica.

 Coronary Artery Perfusion Pressure
Improves With Longer Series of Chest
Compressions in Adult Victims
Coronary Artery Pressure at 5:1 ratio

Pressure at 15:2 ratio

 Masajul cardiac extern

linia umerilor

unică zonă de 900

contact/compresiune
centrul toracelui
linia sternului

“Push hard” Depresie stern 5-6 cm.

“Push fast” Rata de 100/min este esentiala.

“Don’t stop” Pauzele scad perfuzia miocardica.

Dupa 3 min de RCR performantele

“Change hands” se reduc semnificativ.
Hightower D et al. Decay in quality of closed-chest
compressions over time. Ann Emerg Med 1995; 26: 300-303.
European Resuscitation Council Guidelines for Resuscitation 2005
CC – compresie cardiaca
MMV – ventilatie gura-la-gura
 In Olanda, unde RCR se practica in secventa CAB (Chest
compresion, Airway, Breathing) rata de supravietuire este
comparabila cu cea din SUA.
Simoons ML et al. Eur Heart J 1990; 11(suppl): 92.
30 x 2x
 Relief of Foreign-Body Airway Obstruction
in Unresponsive Victim

 Previous guidelines included a complex set of skills

to relieve foreign-body airway obstruction (FBAO)
in an unresponsive victim
 The skills were difficult to teach, learn, and
remember
 Inclusion of complex skills in CPR courses reduced
retention of all skills
 The recommendations have been simplified
Lay Rescuer Relief of FBAO in Unresponsive Adult Victim

 Lay rescuer is much more likely to treat a victim

unresponsive from cardiac arrest than a victim
unresponsive from FBAO
› Sudden cardiac arrest – 250,000 deaths/yr
› FBAO – 3,200 deaths/yr
 Chest compressions may relieve FBAO
 If adult choking victim becomes unresponsive:
› Contact EMS
› Begin steps of CPR
› Look for (and remove) obstructing object
Airway obstruction

 conscious victim:
› back slapping
› abdominal thrusts
Manevra Hemlich
Airway obstruction

 unconscious victim:
› perform chest
compressions