OsteoBlog: First Aid Series 2 - CPR
CPR - Cardio Pulmonary Resuscitation, is the technique of replacing the function of the heart and lungs when one or both have failed.
Someone who is not breathing effectively and has no pulse is regarded as being in cardiac arrest and they need timely, good quality CPR amongst other things, in order to have a hope of recovery.
Please read my last blog about the basics of first aid and patient assessment before reading this!
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 and certain drugs, 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. Get on the chest and stay on the chest!
People get caught up in trying to remember ratios of breaths to compressions for different age groups, what to do when, and how to do it. So, lets keep it simple.....
PLEASE GO AND DO A FIRST AID COURSE....BUT READ THIS TOO COS IT MAY HELP!!!
Chain of survival!!!
You, as the rescuer make up at least half of the chain of survival. See how important you are? The skills you have are paramount for survival so always have a go, doing something (even slightly wrong) is better than doing nothing in a cardiac arrest situation.
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.
Lets not sugar coat things here........the patient is technically dead......you cannot make them any more dead........and you will not save everyone despite your very best efforts doing everything right. Trust me, I have been involved in hundreds of resuscitations and have not won them all. You cannot help everyone but you will be a hero for trying.
Adult CPR: From puberty onwards...
Remember from the last blog - the basics of DR ABC. Early, fast recognition of cardiac arrest is essential to survival outcomes.
Check for danger, check responsiveness levels, open airway and check for EFFECTIVE breathing. If there is no breathing, or the breaths are very noisy and irregular and the patient is blue, then assume there is no pulse, do not waste time trying to feel for a pulse.
Get help, dial 999, and begin CPR.
Get them onto a flat hard surface, do not do CPR on a bouncy bed.
Kneel by the patient, open the airway by tilting the head back.
Place the palm of your hand over the lower half of the sternum and other hand on top. Keep fingers raised off the chest so all the force goes through the palm heel. Lock out your elbows and press down about 5cm in depth at a rate of 100-120/min.
The song "Staying Alive" by the BeeGees or "Nelly the Elephant", 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 refill with blood. Remember CPR is about blood pressure. 1 and 2 and 3 and....
Please do not worry about cracking a rib by pushing too hard. This is inevitable, very off putting and sounds horrid, but the patient would rather be alive with a sore chest then dead!
The greatest dilemma these days is about whether to do mouth to mouth ventilations or not. I do not tell anyone to do mouth to mouth if they are not willing and are worried about infection. There are no recorded occurrences of infection transmission of HIV, Hep B/C or anything else during the CPR process, but I understand the unwillingness of blowing into the mouth of a complete 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 adjunct.
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, you are too exhausted to carry on or the patient starts to recover (cough, splutter, moaning, moving).
If you decide to do ventilations then the ratio is 30:2, compressions to ventilations. The breaths should be given quickly over a second each into a sealed mouth whilst pinching the nose and tilting the head back. Watch for chest rise and fall. If you are not sure you are doing it effectively or they have an airway obstruction preventing air entry, continue with compressions.
Well done, you just learned how to keep someones brain alive and give them the best chance of survival.
Child CPR: From one year to puberty.....
Bystanders are less likely to resuscitate this age group for fear of doing harm - recall what we said about that before......
Kids are more likely to have drowned or have had some sort of airway incident prior to the cardiac arrest and so ventilations are the priority to begin with.
Establish cardiac arrest quickly using the same method as adults.
Do not tip the head back too far with young children or you risk occluding the airway due to anatomical differences.
Give 5 rescue breaths over one second each breath, sealing your mouth round theirs. If the child is very small then you can cover their mouth and nose with your mouth to create a good seal.
Get help ASAP by calling 999 or sending someone to do this.
You should again put your hand over the lower half of the sternum (you'll probably only need the one hand) or between the nipples, and press down about a 3rd of the depth of the chest to compress. You will keep the ratio at 30:2 to avoid confusion, and the rate is the same at 100-120/min.
Do not be tempted to go faster just because the child is smaller than an adult, the heart still needs time to refill between compressions.
For babies and young children you can use two fingers to compress or encircle the chest wall and use your thumbs.
See the picture here for the encircling method of compressions......>
Again, continue CPR until help arrives, you are exhausted or the patient starts to recover.
The science bit.....
The 30:2 ratio for CPR comes from research (published in Critical Care Medicine journal, 2000) into the prospective drop in blood pressure between compressions if the ventilations take too long. If 30 compressions are done, then the blood pressure rises to above the optimum brain perfusion level. When you come off the chest to give ventilations, the pressure drops to around optimum level before rising back up again.
So the blood pressure is maintained despite a pause for breaths. This is why we stress that the less time off the chest the better. Do not sacrifice good compressions for poor ventilations!
Child cardiac arrests tend to have respiratory causes and so ventilations are prioritised.
Adult cardiac arrests tend to have cardiac causes so the oxygen levels in the blood are higher when they go into cardiac arrest - so compressions are a priority.
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 a practical based course and CPR tuition.
If you have any comments or questions then please contact me and I would be happy to help.
Next time.......Dealing with a choking patient.
Thank you for reading.