Series 2 – CPR

CPR – Cardio Pulmonary Resuscitation, is the procedure of replacing the function of the heart and lungs when one or both have failed.
The aim of CPR is not necessarily to restart a heart that has stopped beating, but to maintain the blood pressure needed to perfuse the vital organs with oxygen – carrying blood.
CPR combined with defibrillation, provides the best chance of recovery. The most important bit is to do good compressions and have as little pause as possible so that the blood pressure does not drop too much.
Most of the reasons given for not resuscitating adults or children have been found to be not wanting to do any harm by pressing too hard or over-inflating lungs etc. A key thing to remember when doing CPR is that the casualty is technically dead… you cannot make them any more dead… and you will not save everyone despite your best efforts doing everything right.

Adult CPR: From puberty onwards

Remember in the last blog – the basics of DR ABC.
Check for danger, responsiveness, airway, breathing and CPR.

Circulation

Kneel at the side of the casualty and give chest compressions.
Place the heel of one hand in the centre of the chest, place your other hand on top and interlock your fingers
Keep your arms straight and position yourself vertically above the casualty’s chest
Press down on the breastbone to a depth of 5 -6cm, then release all the pressure without losing contact between your hands and the chest
Please do not worry if you crack a rib! A casualty would rather be alive with a sore chest than dead.

Do 30 chest compressions at a rate of 100 -200 per minute. The song “– “Staying Alive” – by the Bee Gees is a really good rate counter for this!!
Do not press too quickly, we want the chest to recoil between compressions to allow the heart to fill with blood. Remember CPR is about blood pressure. 1 and 2 and 3 and ….
NOTE: Ideally the casualty needs to be on a firm surface to perform chest compressions (not a bed)

Give Rescue Breaths

The greatest dilemma these days is about whether to do mouth to mouth ventilations or not. You do not need to do mouth to mouth if you are not willing and are worried about infections. I understand the unwillingness of blowing into the mouth of a stranger, who may have vomit, blood or dirt on their face.
Reluctance to do mouth to mouth often results in nothing being done at all and so research was done to test the effectiveness of compression only CPR in the absence of a face shield or breathing mask.
Compression only CPR was found to be effective in adults and better than nothing. In this case, just keep pumping up and down on the chest until help arrives. When you are too exhausted to carry on ask someone else to take over.
If you decide to do ventilations then the ratio is 30:2, compressions to ventilations.
Pinch the nose close, tilt the head back and blow steadily into the mouth, whilst watching the chest rise and fall.
Take another normal breath and blow in the casualty’s mouth once more to achieve a total of 2 rescue breaths. Do not interrupt compressions by more than 10 seconds to give 2 rescue breaths.
Continue with chest compressions until help arrives.

If a defibrillator (AED) arrives:

If you have a helper, ask them to continue CPR whilst you get the AED ready. They are simple to use.
Switch on the AED and follow voice prompts.
Attach the leads to the AED if necessary and attach the pads to the casualty’s bare chest (do this whilst the helper performs CPR)
Place the pads below the casualty’s right collarbone and the other pad around the left side over the lower ribs.

While the AED analyses the rhythm – Stop CPR and make sure o one touches the casualty.

If a shock is indicated, deliver shock.

Make sure that nobody is touching the casualty. The machine will tell you to deliver shock. Push the shock button as directed. Immediately start CPR at a ratio of 30:2 and continue as directed by the voice prompts.

Babies and Children CPR:

Many children to not receive resuscitation because potential rescuers fear causing them harm. It is better to perform adult style resuscitation on a child (who is unresponsive and not breathing) than to do nothing at all. Recall what we said about that before…

A few modifications to the adult sequence needs to applied. Do not tip the head back too far with young children or your risk occluding the airway due to anatomical differences.

  • Give 5 rescue breaths before starting chest compressions, then continue CPR 30:2
  • If you are on your own, give CPR for 1 minute before going for help
  • Compress the chest by at least one third of its depth (4 cm for a baby and 5cm for a child)
    • For a baby, use 2 fingers
    • For a child, use 1 or 2 hands as required.
  • If a child requires defibrillation, then place the pads on child front and back and continue to follow prompts as above with adults.

Resources

http://www.resus.org.uk/guidelines for the UK resuscitation council guidelines.

Again please do a first aid course and know how to save a life. What I have written here will go a long way, but does not replace the practical based course and CPR situation.

Next time…. Dealing with a chocking patient.

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