CPR Cardiopulmonary resuscitation Introduction • The greater the number of people who know CPR, the better someone's chances of surviving. Heart attacks, drowning, or other problems may cause someone's heart to stop pumping blood. • This is called cardiac arrest. If you give a person CPR right away, he is more likely to survive. Most cardiac arrests happen at home with family members. You can help a loved one survive by doing CPR. You will learn CPR through this topic. You'll have a chance to practice many times while this lecture guides you. Give CPR 1. Resuscitation procedures are performed in the place, where the injured was found. Do not transfer the injured to another place. 2. Special attention should be given to the examination of the place so that a rescuer will not get injured him/herself (e.g. electric shock because of fallen conductor ). Before you assess the need for CPR, make sure the scene is safe. Look for anything nearby that might hurt you. You don't want to hurt yourself. POSITION the unconscious casualty so that he is lying on his back and on a firm surface WARNING! If the casualty is lying on his chest (prone position), cautiously roll the casualty as a unit so that his body does not twist (which may further complicate a back, neck, or spinal injury). 3. You need to assess the consciousness of the victim. • Check if the person responds. ''Tap him and shout, Are you OK?'' If he doesn't move, speak, blink, or otherwise react, then he is not responding. • It means he's unconscious. 4. If the person doesn't respond, check his breathing: a) Opening the Airway • In order for oxygen from the air to flow to and from the lungs, the upper airway must be unobstructed. • Upper airway obstructions often occur because 1) The casualty’s tongue falls back into his throat while he is unconscious. The tongue falls back and obstructs the airway, it is not swallowed by the casualty. 2) Foreign bodies become lodged in the throat. • The tongue is the single most common cause of an airway obstruction (Figure2-2). In most cases, simply using the head-tilt/chin-lift technique can clear the airway. This action pulls the tongue away from the air passage in the throat. NOTE • Perform finger sweep. If foreign material or vomitus is visible in the mouth, it should be removed, but do not spend an excessive amount of time doing so. Perform the head-tilt/chin-lift technique. Place one hand on the casualty’s forehead and apply firm, backward pressure with the palm to tilt the head back. Place the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the chin forward. The thumb should not be used to lift the chin. NOTE Avoid pressing on the soft part of the neck or under chin because the airway may be obstructed. B) Check the patient’s breathing (while maintaining an airway). After establishing an open airway, it is important to maintain that airway in an open position. Often the act of just opening and maintaining the air way will allow the casualty to breathe properly. Therefore, while maintaining an open airway the rescuer should check for breathing by observing the casualty’s chest and performing the following actions within 10 seconds: • (a) LOOK for the chest to rise and fall. • (b) LISTEN for air escaping during exhalation by • placing your ear near the casualty’s mouth. • (c) FEEL for the flow of air on your cheek. It is enough to have two main symptoms (the absence of consciousness and breathing) to diagnose clinical death . NOTE Action: Check Breathing • Look from head to belly to see if the person is breathing. Do this no more than 10. • If the person isn't breathing at all or if he is only "gasping", then he needs CPR. • A person who gasps usually looks like he is drawing air in very quickly. He may open his mouth and move the jaw, head, or neck. Grasps may appear forceful or weak, and some time may pass between gasps because they usually happen at a slow rate. The gasp may sound like a snort, snore, or groan. Gasping is not regular or normal breathing. • It is a sign of cardiac arrest in someone who doesn't respond! REMEMBER! NO RESPONSE NO BREATHING (UNCONSCIOUSNESS) + GIVE OR = ONLY GASPING NOTE If the casualty resumes breathing, monitor and maintain the open airway. He should be transported to the hospital, as soon as practical. CPR Chest Compressions 1. The victim must be placed is on a hard surface, because it is impossible to do an effective closed-chest heart massage on a spring bed. Move clothes out of the way. 2. Knee down close to the side of the casualty’s body. Shoulders of resuscitator are placed parallel to the sternum of the patient. 3. Put the heel of one hand on the lower third of breastbone. Put the heel of your other hand on top of the first hand. The center of pressure must correspond to projection of the ventricles on to the front wall of chest. This area is the lower third of the sternum. The middle of the sternum was recommended by the European Council on cardiopulmonary resuscitation (2010) as the pressure application point. 4. Straighten and lock your elbows with your shoulders directly above your hands without bending the elbows, rocking, or allowing the shoulders to sag. 5. Push straight down at 5 cm at a rate of 100 pushes a minute: • Force of Pressure on the sternum should be sufficient for complete emptying of the cavities of the ventricles from the blood • After each push, let the chest come back up to its normal position (without taking the hands from the chest)!! 6. Push on the chest 30 times. NOTE • Pushing is important, and doing it right is tiring. The more tired you are, the less effective your pushes are. If someone else knows CPR, take turns pushing. Switch about every 2 minutes, moving quickly to keep the pause in pushing as short as possible. Remind each other to push down at 5 cm, push at a rate of at least 100 pushes a minute, and let chest come back up to its normal position after each push. • When you push on the chest, you pump blood to the brain and heart. • People often don’t push hard enough because they’re afraid of hurting the victim. An injury is unlikely, but it is better than death. It’s better to push too hard than not hard enough. Occasionally, students worry they’ll make an injury worse if they give an injured person CPR. They won’t. If a person’s heart has stopped, he won’t survive. Your actions can only help. • The external heart massage provides only blood transport and does not provide gas exchange without ventilation (it may not remove hypoxia), so heart massage must be combined with artificial pulmonary ventilation. Give breaths 1. 2. After 30 pushes, open the airway with a head tilt-chin lift. Put one hand on the forehead and fingers of your other hand on the bony part of the victims chin. 3. A hand situated on a forehead of a victim provides tightness of the airway: close tightly a nose of a victim with a big and index fingers 4. Make a seal around victim's mouth with your mouth after a deep inhale. 5. Give 2 breaths. Time of inhale is 1 second, time of expiration is 2-4 seconds. 6. Watch for the chest to rise as you give each breath. 7. Next inhale can be done when thorax will be in the initial position. It is necessary to control the movement of the thorax Remember! • The ratio of compression to ventilation is 30:2 regardless of the number of people conducting cardiopulmonary resuscitation in adults and children over 8 years. • 30 pushes • 2 breaths Very important! • The air, inhaled by the resuscitator cannot fully enter the lungs of the victim during chest compressions. So you need to ensure that air injection follows the chest compressions, not does not take place during them. • In connection with the risk of infection of resuscitator during contact with the mucous membrane of the mouth and nose (for example, in case of poliomyelitis, rabies, tuberculosis, gas poisoning, AIDS), and also in order to increase the efficiency of artificial pulmonary ventilation a number of devices are used: Step Action 1 Make Sure the Scene is Safe 2 Check the person's consciousness • Tap and Shout • If person doesn't respond, then... 3 Yell for help other people: • See if there's someone who can help you. • Make sure the person is on a firm, flat surface. 4 Open the Airway by tilting the head and lifting the chin 5 Check the Breathing: • See if the person is not breathing or is only gasping. • No response (unconsciousness) + No breathing or gasping = GIVE CPR 6 Call the ambulance and ask bring AED register the time of starting Give CPR • Give set of 30 pushes and 2 breaths • Push hard and fast: - Move clothes out of the way - Put the heel of one hand on the lower third of the breastbone - Push straight down at 5 cm at a rate at 100 pushes a minute. - After each push, let the chest come back up to its normal position - Push on the chest 30 times Give breaths: - After 30 pushes, open the airway with a head tilt-chin lift. - Pinch the nose shut. Cover the person’s mouth with your mouth. - Give 2 breaths. Watch for the chest to rise as you give each breath. Remember! The rescuer should continue CPR until an AED arrives and is ready for use, EMS (emergency medical service) providers take over care of the victim, or the victim starts to move or until the appearance of signs of the life or signs of biological death. Choking in Adults • Choking is when food or another object gets stuck in the airway or throat. The object stops air from getting to the lungs. Some choking is mild and some is severe. If it's severe, act fast. Get the object out so the person can breathe. • Mild vs Severe Choking If someone • Can make sounds • Can cough loudly • The casualty can cough forcefully, though he may be wheezing between coughs If someone • • • • Cannot breath or Has a cough that has no sound or Cannot talk or make a sound or Makes the choking sign The block in the airway is Mild The block in the airway is Severe And you should • Stand by and let her cough • You should encourage the casualty to cough up the object obstructing his airway on his own • If you are worried about her breathing, call the ambulance And you should • Act quickly • Follow the steps to help a choking adult WARNING! Once an obstructed airway occurs, the brain will develop an oxygen deficiency resulting in unconsciousness. Death will follow rapidly if breathing is not promptly restored. How to Help a Choking Adult 1. Make the five sharp blows with the heel of your hand between patient's the shoulder blades. 2. If the injured person's breathing is not restored, perform the Heimlich maneuver. How to Help a Choking Adult When someone has severe choking, give thrusts slightly above the belly button. These thrusts are called the Heimlich maneuver. Each thrust pushes air from the lungs like a cough. This can help remove an object blocking the airway. Follow these steps to help a choking adult Heimlich maneuver Ste p Action 1 If you think someone is choking, ask, “Are you choking?” If he nods yes, tell him you are going to help. 2 Get behind him. Wrap your arms around him so that your hands are in front. 3 Make a fist with one hand. 4 Put the thumb side of your first slightly above the belly button and well below the breastbone. 5 Grasp your fist with your other hand and give quick upward thrusts into the belly. 6 Give thrusts until the object is forced out and he can breath, cough, or talk, or until he start to responding Help a Choking Large Person or Pregnant Woman • If someone is choking and is in the late stages of pregnancy or is very large, give thrusts on the chest instead of thrusts on the belly. • Follow the same steps except for where you place your arms and hands. Put your arms under the person's armpits and your hands on the lower half of the breastbone. Pull straight back to give the chest thrusts. How to help a Choking Adult Who Stops Responding (unconscious) Lower the choking adult to the ground, face up. Call the ambulance. Assess the needs for CPR Give CPR until the person speaks, moves, or breaths.
