Cardiopulmonary Resuscitation

By Dr.Bashir Ahmed Dar Chinkipora Sopore Kashmir India Associate Prof of Medicine [email protected]

Cardiopulmonary Resuscitation The rescue breaths combined with chest compressions is known as Cardiopulmonary Resuscitation (CPR). Cardiopulmonaray resuscitation which is part of prehospital care and basic life support, is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. CPR is commonly taught to the general public as these may be the only ones present in the crucial few minutes before emergency personnel are available. Each year, CPR helps save thousands of lives in the United States. More than five million Americans annually receive training in CPR through American Heart Association and American Red Cross courses. CPR must be performed within four to six minutes after cessation of breathing so as to prevent brain damage or death. CPR is not generally recommended for the chronically or terminally ill or frail elderly. For these people, it represents a traumatic and not a peaceful end of life. The medical term for a patient whose heart has stopped is cardiac arrest (also referred to as cardiorespiratory arrest), in which case CPR is used. If the patient still has a pulse, but is not breathing, this is called respiratory arrest and in such cases Rescue breathing is used.

What to do in an emergency Stay calm and remember, you can only do your best. First, use all your senses to assess the situation and make sure the area is free of hazards like live electricity

cables,gas,fumes, speedy traffic,falling masonry,firearm, particularly something that may have been responsible for the casualty you are about to care for, and ensure that there is no danger either to yourself or the casualty. (1)

Check the casualty for a response

Once you have assessed the situation, Then you should quickly check the casualty's responses by Gently shaking the casualty by the shoulders and ask loudly "Are you alright?“. If he responds and is breathing normally.

(2)

If the casuality responds by answering or showing movemet then put the casuality in the recovery position,and reassess responsiveness at intervals. Then send someone or go youself for help and call for an ambulance. (3) If he does not respond. When more than one rescuer is available, one should start resuscitation while another rescuer goes for help. A lone rescuer will have to decide whether to start resuscitation or to go for help. In these circumstances, perform resuscitation for about 1 minute before going for help.

when going for help he should.

Ask for an ambulance Describe the situation Give exact location Then return quickly to the casualty, not leaving the casuality alone more than three minutes. PROCEDURE WHEN CASUALTY IS UNRESPONSIVE. o

Turn the casuality onto his back.in a log roll manner.

o

Loosen any tight clothing around casualty's neck. and perform head tilt, chin lift manuare.

.

o ..

Place the palm of your hand across the victim's forehead and tilt the head backwards slightly

o .

With the other hand, slowly lift the chin forward and slightly up.,by placing two fingers under the point of the chin

o Move the chin up until the teeth are almost together, but the mouth is still. slightly open . o The head tilt and chin lift opens the airway by lifting the tongue and epiglottis,and stops the tongue from falling back and blocking the throat.

•

Then open the mouth..and look for any foreign object,froth,vomitus,etc if blocking the airway.

Remove any visible foreign material or vomitus from the mouth. Wipe liquids or semiliquids out of the mouth with fingers covered with a glove or piece of cloth. Extract solid material with a hooked index finger while keeping the tongue and jaw supported with the other hand. If the victim’s dentures are loose then remove the dentures. But it should be noted that well fit denture help in forming a tight seal around mouth during mouth to mouth breathing,and should not be removed.. then you should Keep the airway open, and look, listen and feel for normal breathing

To assess breathing,place your ear near the victim’s mouth and nose while maintaining an open airway. Then, while observing the victim’s chest, (1) look for the chest to rise and fall, (2) listen for breath sounds as air escapes during exhalation, and (3) feel the flow of air, on your cheek Look, listen, and feel for no more than 10 seconds,If the chest does not rise and fall and no air is exhaled, the victim is not breathing. In the first few minutes after cardiac arrest, a casualty may be barely breathing, or taking infrequent, noisy gasps. Do not confuse this with normal breathing.. If you have any doubt whether breathing is normal, act as if it is not normal. If the person is not breathing, give two rescue breaths. This is mouth-to-mouth breathing. With the head tilted and chin up, pinch the nose and you inhale deeply and give sufficient air to make the chest rise.you can actually see the chest to rise.When you remove your mouth from the victim's mouth and break the air seal, their chest fallsThis takes about two seconds. Allow the air to come out of the casualty’s mouth, then repeat. There should be a slight pause to ensure that the delivered breath is sufficient to cause the patient's chest to rise. After you've given the victim two rescue breaths, you then check whether or not they have a pulse.

Feel for the pulse at the side of the neck.

The easiest pulse to find is the carotid artery. There are two, one running down each side of the neck. Place two fingers on the centre of the throat and slide them to one side, finding the groove on the side of the neck. You should press gently and count out loud for ten seconds on one side of the neck only at a time. You will recognise a pulse as a throbbing sensation under your fingers (you can practice finding a major pulse on yourself or another person). Checking for circulation includes pulse and other signs of life e.g. movement and/or swallowing.

Feel for 10 seconds (again count if necessary).

If the casualty has a pulse: • •

Open the airway and keep it open . Pinch the nose closed.

Achieve an airtight seal with your mouth • • • •

Give continuous breaths at a rate of 10 times per minute. Look for the chest rising. Re-check the pulse every minute. As long as the casualty regains breathing of his own you are only required to perform ‘mouth to mouth’.breathing.

If the casualty does not have a pulse,and not breathing normally. A casualty who is not breathing and has no circulation, needs cardiopulmonary resuscitation known as CPR. This involves giving two rescue breaths, then chest compressions.

•

Start CPR as follows:

o The victim's clothing should be loosened to expose the chest. o o

o o

kneel by the side of the casualty position yourself vertically above the casualty's chest and, with your arms strai place the heel of one hand in the centre of the casualty's chest ,between the nipples.(new guide line 2006) place the heel of your other hand on top of the first hand interlock the fingers of your hands and ensure that pressure is not applied over the casualty's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone)

Press down on the sternum 4-5 cm

o o o

after each compression, release all the pressure on the chest without losing contact between your hands and the sternum repeat at a rate of about 100/min (a little less than 2 compressions per second) compression and release should take equal amounts of time

o

• • • • • •

•

• • •

• • • •

Rescuers should place their hands in the centre of the chest, rather than spend more time positioning their hands using other methods..

After 30 compressions open the airway again using head tilt and chin lift Pinch the soft part of the nose closed, using the index finger and thumb of your hand on the forehead. Allow the mouth to open, but maintain chin lift. Take a normal breath and place your lips around his mouth, making sure that you have a good seal. Blow steadily into the mouth while watching for the chest to rise, taking about 1 second as in normal breathing; this is an effective rescue breath. Maintaining head tilt and chin lift, take your mouth away from the casualty and watch for the chest to fall as air passes out

Take another normal breath and blow into the casualty's mouth once more, to achieve a total of two effective rescue breaths. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions. Continue with chest compressions and rescue breaths in a ratio of 30:2. Stop to recheck the casualty only if he starts breathing normally; otherwise do not interrupt resuscitation. If your initial rescue breath does not make the chest rise as in normal breathing, then before your next attempt: check the casualty's mouth and remove any obstruction recheck that there is adequate head tilt and chin lift do not attempt more than two breaths each time before returning to chest compressions Each rescue breath is given over 1 second rather than 2 seconds(new guide line 2006). Recheck pulse and breathing every minute., better is very less interruptions should be made, and continue till casuality shows movement or signs of breathing.

Most victims with respiratory or cardiac arrest have no signs of breathing. Occasionally, however, the victim will demonstrate abnormal and inadequate breathing. Some victims demonstrate apparent respiratory efforts with signs of upper airway obstruction. These victims may resume effective breathing when you open the airway. Some victims may have a patent airway but may make only weak, inadequate attempts to breathe. Reflex gasping respiratory efforts (agonal respirations) are another form of inadequate breathing that may be observed early in the course of primary cardiac arrest. Absent or inadequate respirations require rapid intervention with rescue breathing. If you are not confident that respirations are adequate, proceed immediately with rescue breathing. Lay rescuers are taught to provide rescue breathing if "normal" breathing is absent.

Does air exhaled from someone else's mouth really provide enough oxygen to save an unconscious person? Normally, the air you inhale contains about 20 percent oxygen by volume, and your lungs remove about 5 percent of the oxygen in each breath. The air you blow into a victim's mouth thus contains about 15 to 16 percent oxygen, which is more than enough to supply their needs. Mouth-to-nose ventilation has been recommended if a mouth-to-mouth seal is difficult to achieve, the victim's mouth is injured, the mouth cannot be opened or the victim is in water. Mouth-to-nose ventilation has been found to be practical and effective. if there are two rescuers, one should carry out chest compressions while the other delivers two breaths after every thirty compressions. There should be a slight pause to ensure that the delivered breath is sufficient to cause the patient's chest to rise.

Continue resuscitation until The victim shows signs of life. Qualified help arrives. You become exhausted.