CPR (CARDIOPULMONARY RESUSCITATION)

 

CPR

(CARDIOPULMONARY RESUSCITATION)

NOTE: DO NOT PERFORM ANY MEDICAL PROCEDURE WITHOUT TRAINING OR CERTIFICATION]

Despite technological advances and new scientific discoveries, heart disease remains the number one cause of death globally, with 17.3 million deaths per year.

 

HEART

Before you learn how to perform CPR, it’s important to understand how the heart, lungs, brain and cells perform.

The heart consists of four chambers, the right and left atria (singular: atrium) and the right and left ventricles. The atria are located above the ventricles, as can be seen in the above diagram. The heart is a muscular organ supplied by the coronary arteries. It is located below your breastbone (sternum) and, in an adult, is approximately the size of your fist.

The heart pumps blood that has been deoxygenated after supplying the body’s tissues into the

lungs, and when that blood has been oxygenated again in the lungs, it exits the lungs to the left.

side of the heart, where it is pumped out into the body once again, to provide oxygen to all your vital organs.

Your body has about 5 liters of blood, which circulate through this system approximately 3 times per minute.

What is known as the cardiovascular system is composed of the heart, arteries, capillaries, and veins.

LUNGS

Your lungs are spongy, air-filled sacs, with one lung located on either side of the chest. The trachea, which is sometimes called the windpipe, conducts air down into the lungs through the

bronchi, which are smaller tubular branches. The bronchi then divide into smaller and smaller tubules called bronchioles. Air is exchanged in the alveoli, which are tiny sacs that allow oxygen and carbon dioxide to move between the lungs and the bloodstream via tiny capillaries.

Your lungs take in oxygen to supply your body’s organs and tissues. They release carbon dioxide, a waste product, into the atmosphere when you exhale.

Room air at regular atmospheric pressure contains 21% oxygen. Our bodies utilize approximately 4-6% of that oxygen and release about 16-17% back into the atmosphere, along with carbon dioxide, when we exhale. This 16-17% that we exhale can provide just enough oxygen to sustain someone in cardiac arrest, at least for a short time.

BRAIN

Your brain needs a constant supply of oxygen. Without oxygen, brain cells begin to die in 4 to 6 minutes.

On average, the brain weighs three pounds, and uses a whopping 20% of the body’s oxygen!

The medulla is located in the brain stem and controls automatic bodily functions, including consciousness and respiratory and cardiovascular function.

BODY CELLS

All of the body’s tissues are made up of cells.

All cells require oxygen to carry out their normal functions. They also require nutrients. Oxygen deprivation, or hypoxia, will cause cells to die within a few short minutes.

The body’s cells use oxygen and produce carbon dioxide as a waste product.   Carbon dioxide must be eliminated via the lungs through ventilation.

Red blood cells transport oxygen throughout the body.

CARDIOVASCULAR DISEASE

As mentioned previously, cardiovascular disease is the number one cause of death worldwide. While it is important to learn what to do when cardiovascular disease leads to a heart attack or stroke, it is equally as important, if not more so, to understand how to prevent cardiovascular disease from occurring in the first place.

There are numerous factors that can increase an individual’s risk of heart attack. Some of these factors can be controlled (modifiable risk factors), while others cannot (non-modifiable risk factors.

Modifiable risk factors, or factors that can be controlled to a certain degree by an individual, include:

a) cigarette smoking

b) hypertension

c)obesity

d) sedentary lifestyle (lack of exercise)

e) high cholesterol

f) high blood sugar (as in diabetes)

g) poor diet (diet high in sugar, fat)

h) stress

 

Non-modifiable risk factors, or risk factors that individuals cannot change, includes:

a) age

b) sex

c) genetics/hereditary factors (i.e. hereditary high cholesterol or hyperlipidemia)

d) race (i.e., certain groups may be at higher risk for hypertension, or high blood pressure)

Atherosclerosis, or hardening of the arteries, is a condition caused by the building up of plaque inside the body’s arteries, the large blood vessels that carry blood away from the heart to the body’s organs. Plaque is composed of fatty substances, cholesterol, fibrin (a clotting substance in the blood), calcium and cellular waste products. 

When plaque builds up, it can partially or totally block the flow of blood through an artery in the brain (which causes stroke), the heart (which causes a heart attack), the kidneys, the arms, the legs and other vital areas. Plaque may break off to block an artery, or a blood clot (thrombus) may form on the surface of the plaque- either of these two circumstances can lead to a heart attack or stroke.

                      HEART ATTAC

 A heart attack of ten presents with one or more symptoms:

a) Chest tightness, pressure, or discomfort

b) Nausea

c) Sweating

d) Shortness of breath

e) Fatigue

f) Weakness

g) Pain in the jaw or arm

h) Pale color of the skin

 

Women and people with diabetes often present with atypical symptoms, such as nausea and vomiting or back pain. About one-third of patients report no chest pain at all.

 

 

WHAT CAN WE DO?

a) Recognize the symptoms and signs of a heart attack.

b) Call for medical/professional help.

c) Don’t let the patient drive him or herself to the hospital

d) Keep the patient calm and seated in a position that is comfortable.

e) Offer 1 adult aspirin or 2 baby aspirin- aspirin should be chewed before swallowing to speed absorption (Note: do not give if the patient has already taken aspirin or if the patient has an allergy to aspirin)

f) Be prepared to start CPR if it becomes necessary

                                STROKE

    You should suspect a stroke if a patient presents with:

a) Severe headache with no known cause

b) Numbness or weakness of the face, arm or leg on one side of the body

c) Drooping eyelid or mouth on one side

d) Confusion or trouble understanding

e) Difficulty speaking /slurred speech

f) Loss of balance or coordination

g) Dizziness

h) Trouble with vision/blurred, double vision or loss of vision in one eye.

WHAT CAN WE DO?

a) Know the signs and symptoms of a stroke

b) Call for medical/professional help. Don't give the patient food or drink.

c) Keep the patient calm and quiet

d) Monitor the patient

e) Be prepared to begin CPR if it becomes necessary

A stroke is caused by one of two mechanisms: it can be caused by a ruptured blood vessel in the brain (called a hemorrhagic stroke) or by a blockage in one of the arteries that causes loss of blood flow and oxygen to a part of the brain (called an ischemic stroke). Ischemic strokes are more common. 

Remember that “Time is brain,” and act quickly. Stroke is the 3^rd leading cause of death in the world.

STARTING CPR

         HIGH QUALIYT CPR:

1) Compression rate of 100- 120 beats per minute on victims of all ages.

2) Compression depth of AT LEAST 5 cm maximum in adults 

3) Allow the chest to completely expand (recoil) after each compression (do not lean on the chest between compressions)

4) Not interrupting CPR

5) Avoiding excessive ventilations

6) Above all else, PUSH HARD ENOUGH AND FAST

a) Since many responders and even professionals are unable to feel or palpate a pulse quickly, the recommendation is to feel for a pulse for not more than 10 seconds. If you can’t feel a pulse or you’re not sure you can feel a pulse-start CPR.

b) It has been recognized that health care professionals should call for assistance when they come upon an unconscious victim, but they may also simultaneously assess breathing and check for a pulse before fully activating the emergency response system. This may encourage efficiency in assessment and response, rather than following a step- by-step response.

c) Rescuers should provide 2 breaths and then 30 compressions continuously.

NOTE: 

DO NOT PERFORM ANY MEDICAL PROCEDURE WITHOUT TRAINING OR CERTIFICATION]

CHEST COMPRESSIONS

Chest compressions are the most important component of CPR. Chest compressions are an attempt to mimic the normal activity of the heart. When a rescuer presses down on a victim’s chest, blood is forced out of the heart and into the arteries. When pressure on the chest is released, blood is allowed to return to the heart.

A small amount of oxygen will be present in the bloodstream for several minutes after the heart ceases to beat, just enough to keep the brain alive. Compressions can keep vital organs functioning until higher level care is available.

To perform compressions on an adult, place the heel of your non-dominant hand on the victim’s chest between the nipples. 

Then place your other hand on top of the first and interlace your fingers heel   of your hand should be pressing on the bottom two-thirds of the sternum, avoiding the xiphoid process (the small bony prominence at the very bottom of the sternum (breastbone).     

You should be as close to the victim’s side as possible, with your knees against the victim’s side (this will help prevent back injury). Lock your elbows and press down hard, depressing the sternum at least 2 inches (5 cm).

Your shoulders should be positioned directly over your hands in a straight line

Push hard and fast 100 to 120 times per

minute, counting out loud as you do so. It’s important that you allow the chest to recoil (return to its normal, relaxed position) in between compressions. If you do not allow the chest to recoil, the heart will not fill completely, which means that less blood (and therefore oxygen) will be pumped out of the heart to vital organs with the next compression.

Performing compressions is exhausting. Most people find that they become very tired after providing compressions for 2 or 3 minutes. When a person performing compressions becomes fatigued, there is a tendency to compress less firmly and more.

slowly, for this reason, it is recommended that rescuers trade off doing compressions every 2 minutes to prevent fatigue and optimize the quality of compressions. If you are alone, you will have to do the best you can- keep performing compressions until help arrives or you are physically so exhausted that you cannot continue.

                                          ONLY ONE RESCUER

 

 

If you are alone and come across an individual who is down, follow the steps below. If someone else is in the area to assist, use the ‘Two Rescuer’ sequence.

 

SAFETY:

If you come upon an individual who may need CPR, look around and make sure you and the victim are in a safe place. 

For example, if the victim is in water or on a road, try to move the victim to a safer area. If you are in a safe area, do not try to move the victim as he/she may have other injuries (i.e., to the head or neck) that you cannot see. Simply roll him over onto his back. 

Make sure the victim is on a firm surface, in case compressions are needed.

ASSESS THE VICTEM:

To quickly assess the victim, shake his shoulder and yell at him. 

Check for breathing. If he/she is not breathing, or is not breathing normally (i.e., only gasping), you must summon help. Note: Agonal breathing is breathing that is very slow, shallow and/or gasping.

Agonal breathing is a sign that the victim is dying. It is important not to mistake agonal breathing for normal breathing!

 

BEGIN CPR:

 

1.  Check for a pulse on the side of the neck. Feel for a pulse for at least 5 seconds but NO MORE THAN 10 seconds. To check for a carotid pulse, slide 2 or 3 fingers into the groove between the windpipe and the neck muscles at the side of the neck.

 

2.   If there is no pulse (or if you are unsure if there is a pulse), begin CPR starting with chest compressions. Provide 30 chest compressions, followed by two breaths.

 

3.  NOTE: If you are not comfortable giving rescue breathing and/or you do not have a mask available, do ‘Compression Only’ CPR.

 

a. Use the heel of one hand on the lower half of the breastbone in the middle of the chest.

place the other hand on top of the first hand.

c.  Straighten your arms and lock your elbows so that your body weight is over your hands.

d.  The most important part of CPR is to remember to push HARD and FAST. Each compression should be AT LEAST 5 cm deep, and the rate should be 100-120 compressions per minute.

e.   Be sure to let up on the pressure on the sternum after each compression (chest recoil) so the chest can re-expand, and blood can flow back into the heart. The purpose of CPR is to help the blood flow through the heart and into the rest of the vital organs; if you allow the chest to re-expand, more blood will flow into the heart and will be available to deliver to the rest of the body.

f.   Count out loud as you do compressions. When you have done 30 compressions, try to open the victim’s airway by doing a head tilt/chin lift. Note that if you are doing ‘Compressions Only’ CPR, you can skip this step.

i. With your non-dominant hand, push on the victim’s forehead to tilt the

head back.

ii. With your dominant hand, place your fingers under the bony part of the lower jaw and gently lift the jaw to bring the chin forward. Be sure you lift up on the bony part of the jaw and not the soft tissue under the jaw, so you don’t block the victim’s airway. Do not use your thumb to lift the jaw. Allow the victim’s mouth to remain slightly open.

iii. If you think the person’s neck may be injured, avoid the head tilt/chin lift. Use the jaw thrust maneuver if you have been trained to do so.

g.   If you have a barrier device to use between your mouth and the victim’s face, use it. Although the risk of infection from performing CPR is very, very low, it is expected that healthcare workers use a barrier device when providing CPR. This includes the use of face masks or bag-mask devices (see next section). Give each breath slowly – each breath should last one second. Make sure the chest rises with each breath. Repeat, giving a second breath.

h.   Start another cycle of chest compressions. Remember, push HARD and FAST. Alternate chest compressions (30) and giving breaths (2) until help arrives.

AIRWAY & BREATHING

 

 

Face masks provide a barrier between the rescuer and the victim. Some masks are equipped with a one-way valve that allows the rescuer’s breaths to enter the victim’s airway, but

prevents the victim’s expired air from entering the rescuer’s airway. These masks also prevent contact with vomitus and blood, which could pose an infection risk to the rescuer. It takes practice to learn how to use these masks effectively to provide ventilations.

USING A MASK:

a)  Position yourself at the victim’s side. If you are a lone (single) rescuer, positioning yourself at the victim’s side will allow you to provide both ventilations and compressions without having to move.

b)  Position the mask on the victim’s face. Masks are usually triangular in shape, and you will notice that the mask has a “pointy” end- this end goes over the bridge of the victim’s nose.

c) Seal the mask against the victim’s face. To do this, take the hand that is closest to the top of the victim’s head and place it along the edge of the mask. Some people find it easier to form a ‘C’ with their index finger and thumb and use these digits to grasp the mask around the base of the mouthpiece. With the thumb of your other hand, apply pressure along the bottom edge of the mask.

Then place the remaining fingers of your second hand along the bony edge of the jaw and lift the jaw upwards. Open the airway by performing a head-tilt chin-lift procedure. While you lift the jaw, ensure that you are sealing the mask all the way around the outside edge of the mask to obtain a good seal against the victim’s face.

d) Deliver air over 1 second, ensuring that the victim’s chest rises.

e) If the victim’s chest does not rise, reposition the mask and try to get a better seal.       Remember, you should be lifting the victim’s jaw into the mask, rather than                simply pushing the mask down onto the victim’s face.

f) Provide 2 ventilations over 1 second each with the mask after every 30                         compressions.

g) If the victim has a pulse but is not breathing, provide rescue breathing by                  providing 1 breath every 5 to 6 seconds (10-12 breaths/minute). Check for a pulse      every 2 minutes- if there is no pulse, start chest compressions along with                    ventilations at a rate of 30:2.

USING A BAG MASK:

A bag-mask device (bag-valve mask) consists of a mask attached to a reservoir bag. They are commonly used to provide positive-pressure ventilations during CPR. They can be attached to an oxygen source to provide 100% oxygenation during resuscitation.

As with the face mask, it takes practice to be able to use a bag-mask device. It can also be very difficult for one person to use a bag-mask device; therefore, it is recommended that use of a bag-mask device be used only when there are two rescuers available.

The steps to using a bag-mask device are as follows.

a) Position yourself at the top of the victim’s head- this allows room for the      second rescuer to provide compressions.

b) Place the mask of the bag-mask device on the victim’s face, using the bridge of the patient’s nose as a guide to correct positioning.

c) Use the E-C clamp technique to hold the mask in the correct position while you lift the jaw to obtain an open airway. To perform the E-C clamp technique, take the index finger and thumb of your non-dominant hand and form them into a ‘C’ around the top of the mask. Your other fingers of the same hand are used to lift the jaw (the ‘E’ part of the E-C clamp technique.

d) Squeeze the bag to deliver a breath- each breath should be delivered over 1 second. Watch for chest rise. If you do not observe chest rise, you do not have a tight seal. If this occurs, reposition the mask and try again. Be careful not to overinflate the lungs- each breath should result in visible and natural chest rise.

e)  Provide 2 ventilations after every 30 compressions. If the patient has a pulse but          is not breathing, provide one breath every 5-6 seconds (10-12 breaths/minute)             and check for a pulse every 2 minutes. If the victim loses their pulse, you will                need to begin chest compressions.

JAW THRUST MENOUVER:

If you suspect that a victim may have a neck or spinal cord injury (i.e., the victim has fallen, been in a motor vehicle accident or suffered another mechanism of injury that could result in injury to the neck or spinal cord), you should not use the head tilt-chin lift maneuver to open the victim’s airway.

This could further damage the neck or spinal cord. Instead, you should use the jaw thrust maneuver to open and maintain the victim’s airway.

To perform this maneuver:

a) Place your hands on either side of the victim’s head. Rest your elbows on the               surface that the victim is laying on.

 b) Put the fingers of both your hands under the angle of the victim’s lower jaw and        lift so that the jaw slides forward

c) Use your thumb to push the lower lip away from you if the victim’s lips close

Recovery position

An unconscious victim who is breathing and has a pulse should be assisted into the recovery position to protect the airway.

This position keeps the airway open, prevents aspiration of fluids into the lungs and allows fluid (such as saliva or blood that could occlude the airway) to drain from the mouth.

1. Extend the victim’s arm that is closest to you above the victim’s head.

2. Place the victim’s leg that is farthest away from you over his other leg.

3. Place the victim’s arm that is farthest from you across his chest.

4. Supporting the head and neck, roll the victim towards you.

5. Position his or her top leg so the knee props up the victim’s body.  

6. Place the victim’s hand or arm under his/ her chin to aid in keeping the airway       open