Asystole of the heart in adults and children
Causes of sudden death are many, and one of them is asystole. This condition directly life-threatening, occurs as a result of the cessation of the heart's electrical activity.
The chambers of the heart cease to contract, blood circulation stops, there comes a clinical death. Unless urgent resuscitation measures, the person dies within a few minutes. The situation is compounded by the fact that cardiac arrest often occurs outside the hospital walls. Only knowledge of the symptoms of asystole and the ability to provide emergency assistance will help to save the patient's life.
Cardiac arrest is rarely wanton, it is usually preceded by serious diseases, injuries, intoxication, accidents.
The most typical factors of asystole:
- Extensive myocardial infarction;
- Cardiogenic shock (sudden drop in blood pressure);
- Blockage of pulmonary artery by a blood clot;
- Cardiac tamponade (fluid in pericardium);
- Valvular heart disease (stenosis of major blood vascular, defect or absence of a septum between the ventricles, tetralogy of Fallot);
- Rupture of the aneurysm;
- Prolonged bouts of bronchial asthma;
- The last stage of cancer, as well as renal, hepatic, respiratory failure;
- Diabetes mellitus;
- Receiving cardiac glycosides, narcotic analgesics, barbiturates, calcium antagonists;
- Acute blood loss;
- Anaphylactic, hemorrhagic, painful shock;
- Blow in the abdominal wall ("spoon");
- Drowning, electrocution, lightning strike to person;
- Suffocation in case of accidental inhalation of small items;
- Pneumothorax for lung diseases;
- Carbon dioxide poisoning;
- Poisoning chemically active substances;
Unexpected cardiac arrest sometimes happen with various medical manipulations: the extraction of a tooth, bronchoscopy, coronary angiography, catheterization of heart cavities.
Dramatically increases the likelihood of asystole in people with heart disease, if they are abusing alcohol and tobacco (up to 30% of cases), overweight and high cholesterol. Risk factor are age older than 60 years, emotionally unstable, over-sensitivity, conflict.
Cardiac arrest in children
Some of these reasons related tomostly with congenital heart defects, characteristic for children. Besides them, there are also sudden infant death syndrome in infants (diesel engines).
The specified condition is also associated with the termination of the discharge function of the myocardium. Syndrome characteristic of children up to 5 months.
Circulatory arrest occurs during sleep. The main reason cardiologists are called physiological immaturity of the internal organs of the child.
- Multiple pregnancy;
- Fetal hypoxia;
- Asphyxia of the child at birth;
Infant death can contribute to parents ' Smoking, tight swaddling, sleep on a soft cushion in position on the abdomen.
The clinical picture of circulatory arrest
In some cases, threatening asystole of the heart makes itself felt obvious signs:
- Pale skin, blue nails, lips, nasolabial triangle;
- Acute-onset hypotension (drop in blood pressure below 60 mm Hg);
- The decrease in the number of heart rate of 30-40 beats/min.
But these symptoms, as well as premature beats and ventricular tachycardia, can be seen only with constant monitoring of the patient. According to statistics, only 30% of patients with heart failure are at this moment in a hospital or under the control of the family.
The remaining cases occur in the presence of strangers, far from medicine.
To prevent death, you must know the reliable signs of cardiac arrest:
- Loss of consciousness (occurs in 10-15 seconds after the termination of the ventricles);
- Rare noisy breathing (gasps);
- Persistent dilation of the pupils;
- The absence of a pulse.
The worst case scenario — when asystole of ventricles takes place during night sleep. The chances of saving a patient are slim to none as dramatically expressed no symptoms, and others may be up in the morning not to notice anything.
The sooner will come the urgent help, the more likely the salvation of man. Irreversible changes in the brain caused by oxygen starvation of cells, come quickly. Seeing that the man fell and is unconscious, others should take the following steps:
Loudly call out, to shake by the shoulders, Pat on the cheek. Maybe it's just faint.
If fallen doesn't recover, you have to determine if he had a pulse and breathing. Many begin to seek and ask passers-by the mirror to check breathing. And precious time is running out. Better to bring your ear to the chest or to the face of the fallen person andto listen.
It also checks the pulse on the carotid or femoral artery. It is not necessary to test peripheral vascular on wrists — where the beats may not be. The exact criterion of circulatory arrest — lack of pulse in the Central arteries. If not, call an ambulance and proceed to a simple complex of reanimation actions.
Algorithm ABC (CPR)
A — preparation of the respiratory tract to intensive care. The head of the patient, is laid on a solid plane, tilt up and back to get free access to the oral cavity. Wrapped finger with a napkin, clear the oropharynx of mucus, blood, vomit of the earth.
In — carrying out artificial respiration. If the first item is not showing signs of spontaneous breathing, the rescuer becomes over the victim to his knees and blows the air through the mouth. The nose of the patient it is necessary to pinch fingers. The effectiveness of artificial ventilation is determined by the raising and lowering of the chest. To avoid contact with the saliva and blood of the victim, air is blown through the handkerchief.
According to the latest regulations, if Reanimator believes that the method of restoring respiration "mouth to mouth" can be detrimental to health, it is entitled not to do so. Then, without wasting time, you should proceed to the third item.
— Compression of the chest. If the onset of unconsciousness was not more than 30 seconds, you can use the precordial impact. The man lying on the back, put a hand on the lower border of the ribs. Clenching his other hand into a fist, hit them in the lower third of the sternum. If the strike is not renewed heartbeat, begin the closed massage of heart muscle.
Pressing on the chest are made the bases of the palms, laid one on another. The aftershocks must be sharp and quick. The force of movement is calculated so as not to break the patient's ribs. Every 1-2 minutes, checking for a pulse and spontaneous breathing.
The affected leg can bend at the knees and placed above the head to increased passive flow of blood to the heart. Continue CPR until the medics.
Aid for asystole
On the way to the hospital, the following occurs:
- Intravenous atropine, adrenaline, dopamine. Injection directly into the heart muscle admitted the ineffectiveness of intravenous infusions;
- Artificial pulmonary ventilationmask. When failure — intubation (insertion of tube for connection of the ventilator);
- Blood transfusion, if there was massive blood loss;
- The use of a defibrillator (a device for influencing the patient with electrodes of large capacity to "run" a heart, to restore ventricular contraction);
- Transesophageal, transcutaneous cardioversion, if the ECG shows at least a minimum reduction.
If within half an hour not there are signs of positive dynamics (spontaneous breathing, heartbeat, pupil constriction in bright light), stop CPR and ascertain the onset of biological death.
If resuscitation is successful, the patient transferred to the intensive care unit.
According to the testimony surgical treatment:
- Puncture of the pericardium with accumulation in the cavity of blood or other fluid;
- Puncture of pleural cavity with pneumothorax.
Further, constant monitoring of the ECG, control of the composition of blood, maintenance of normal values of HELL. The patient's head draped with ice, the temperature in the external auditory canal did not exceed 34 degrees. In the subclavian vein entered the low-molecular solutions, glucose, Panangin, sodium bicarbonate.
The consequences of asystole
Survival after sudden death is low in different sources the numbers from 14% to 30%. Further, the patient's state of health depends on how much time he was in a state of clinical death.
This files most often have these complications:
- Memory impairment;
- Hearing loss;
- The loss of vision. In some cases, function of the affected part of the brain take on other plots, and the blindness goes;
- Periodic convulsions of the isolated character (any one limb, facial, and masticatory muscles);
- Auditory, tactile and visual hallucinations;
- Constant headaches;
- Postresuscitation disease — loss of consciousness, dysfunction of the systems of respiration, circulation, ischemia of the internal organs. In most patients, the basic functions are restored within 3 hours. About 20% of patients have coma. If deep loss of consciousness lasts more than 6 hours, hope to restore brain function dramatically decreases. The duration of coma more than two days often means the subsequent vegetative condition of the patient.
After three minutes of cardiac arrest and conducted a half-hour of resuscitation completely restored 50% of survivors. If the lack of circulation of blood lasted 5 minutes or more, the chances of further normal activity reduced tominimum.