Cardiopulmonary resuscitation (CPR)
How to do cpr is an invaluable knowledge for everyone not minding their occupation, because it can save a life of a love one when help is not close. Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone’s breathing or heartbeat has stopped. It combines chest compression often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.
Note that CPR should not be done except it is confirmed that the patient is no longer breathing.
Indications and contraindications
CPR should be performed immediately on any person who has become unconscious and is found to be pulseless.
CPR should be started before the rhythm is identified and should be continued while the defibrillator is being applied and charged. Additionally, CPR should be resumed immediately after a defibrillatory shock until a pulsatile state is established.
The only absolute contraindication to CPR is a do-not-resuscitate (DNR) order or other advanced directive indicating a person’s desire to not be resuscitated in the event of cardiac arrest. A relative contraindication to performing CPR is if a clinician justifiably feels that the intervention would be medically futile.
How to do cpr
CPR comprises the following 3 steps, performed in order. It uses the acronym CAB
- Chest compressions to restore blood circulation
- Airway: Open airways
- Breathing: Artificial ventilation
How to carry out chest compression
- Place the heel of your hand on the breastbone at the centre of the person’s chest. Place your other hand on top of your first hand and interlock your fingers.
- Position yourself with your shoulders above your hands.
- Using your body weight (not just your arms), press straight down by 5-6cm (2-2.5 inches) on their chest.
- Keeping your hands on their chest, release the compression and allow the chest to return to its original position.
- Repeat these compressions at a rate of 100 to 120 times per minute until an ambulance arrives or you become exhausted.
- Chest compression is followed up with 2 rescue breath after the airways has been open.
How to open the airways
When a person becomes unconscious, they loose all muscle tone. The tongue being a muscle relaxes and may block the airway (trachea/windpipe) of the victim. The tongue is the most common cause of airway obstruction in an unconscious adult. To mitigate this and reopen the victims airway, we must perform a physical intervention to lift and move the tongue out of the way. The maneuver used to open a victims airway is called a head tilt/chin lift.
With the victim laying face up on a hard firm surface place one hand on the forehead of the victim while grasping the bony portion of the chin with the other. Tilt the head and lift the chin at the same time. This lifts the tongue and creates a pocket for oxygen to travel.
After opening the airways look for chest motion, listen for normal breath sounds, and feel for the person’s breath on your cheek and ear. Gasping is not considered to be normal breathing. If there is no sign of breathing, then move to artificial ventilation.
If the patient is not breathing, 2 ventilations are given via mouth to mouth, mouth-to-nose breathing if the mouth is seriously injured or can’t be opened. or a bag-valve-mask (BVM).
To perform the BVM or invasive airway technique, the provider does the following:
- Ensure a tight seal between the mask and the patient’s face
- Squeeze the bag with one hand for approximately 1 second, forcing at least 500 mL of air into the patient’s lungs
To perform the mouth-to-mouth technique, the provider does the following:
- Pinch the patient’s nostrils closed to assist with an airtight seal
- Put the mouth completely over the patient’s mouth
- After 30 chest compression, give 2 breaths (the 30:2 cycle of CPR)
- Give each breath for approximately 1 second with enough force to make the patient’s chest rise
- Failure to observe chest rise indicates an inadequate mouth seal or airway occlusion
- After giving the 2 breaths, resume the CPR cycle
How to do cpr for a child age 1-8 years and babies
The general CPR procedures is still applied here, except for some alterations.
How to do cpr for a child between 1-8 years
- Use two hands, or only one hand if the child is very small, to perform chest compressions.
- Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths.
- Breath more gently
How to do cpr for babies
- Imagine a horizontal line drawn between the baby’s nipples. Place two fingers of one hand just below this line, in the center of the chest.
- Gently compress the chest about 1.5 inches (about 4 centimeters).
- Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby’s mouth one time, taking one second for the breath. Watch to see if the baby’s chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
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