Открытая медицинская библиотека

Статьи и лекции по медицине ✚ Библиотека студента-медика ✚ Болезни и способы их лечения.

Фармакология Fig. 24. The simplest devices for artificial pulmonary ventilation: a) Safar airway; b) Ambou's bag; c) RDA-2.
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Fig. 26. Esophageal obturator

A closed-chest cardiac massage is continued, ECG is being taken, and if a macrowave fibrillation is registered on ECG, — one should proceed to an immediate defibrillation. But the main thing that is possible at the specialized stage — it is an application of medicamentous agents.

That way of administration of medicaments should be selected which may be used in a maximum short time: intravenously with a preferred use of central veins (subclavian, femoral), endotracheally through an endotracheal tube or a puncture of cricothyroid ligament. An intracardiac injection, widely applied earlier, is not recommended.

They start with the preparations of "primary administration" that are introduced irrespective of the cause and form of circulatory arrest.

This is, first of all, adrenalin contributing to the restoration and increase of cardiac activity. Several variants of its dosage are discussed:

— standard as a bolus 1 mg every 3-5 min in solutions 1:1000 or 1:10000;

— average as a bolus 2-5 mg every 3-5 min.;

— incremental as a bolus 1—^3 —'5 mg in 3 minutes;

— high as a bolus 0.1 mg/kg every 3-5 min.

K. Grower and D. Cavallaro (1996) suggest if the effect of standard dose is absent to introduce it once again in 3-5 min., and then to increase the dose fast up to 3-5 and 10-15 mg, whereupon to change over to an infusion at the rate of 100-200 mg/min. The infusion may be started without a preliminary administration of high doses as a bolus. A survival rate increase as a result of high doses has not yet proved, though there is no harm from them in case of circulatory arrest.

Atropine may be considered as the other preparation of "primary administration" that is introduced either just after adrenalin injection or after appearance of independent cardiac contractions. It blocks a vagal action inhibiting sinoatrial and atrioventricular nodes. It is administered as a bolus 2-3 times in the course of resuscitation in the doses of 1 mg - 0.5 - 0.5 mg not exceeding a total dose of 2 mg.

A need to administer sodium bicarbonate is controversial, but if it is still decided to administer, then do it only after carrying out generally accepted measures (APV, a closed-chest cardiac massage, defibrillation, tracheal intubation), no earlier than 10 min from the onset of resuscitation, starting with 1 mmol/kg and repeating a half dose every 10 min., and better under the control of arterial blood gases. A way of administration is only intravenous, introduction into the trachea is dangerous because of the inhibition of ciliary epithelium activity. The application of sodium bicarbonate in the course of resuscitation may be accompanied by undesirable effects: a growth of intracellular acidosis because of the increase of carbon dioxide content, a shift of oxyhemoglobin dissociation curve to the left, catecholamine inactivation, decrease of the efficiency of defibrillation.