CARDIO-PULMONARYRESUSCITATION(CPR)

Adult

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Module 4 ADULT CARDIO-PULMONARY RESUSCITATION (CPR)

4.1 DEFINITION

Cardio-PulmonaryResuscitation(CPR)includesaseriesofassessmentsandinterventionsthatsupportcardiacandpulmonaryfunctions.Whencardiacarrestoccurs,theheartstopsbeatingandcirculationceases.Unlessthecirculationisre-startedquickly,organdeathwillbegintooccur.Themostsensitiveorganisthebrainandifitscirculationtothebrainisnotre-startedwithin4to6minutes,permanentandirreversibledamagecanoccur.ItisthereforeimportanttostartCPRasquicklyaspossible.

Aircontainsapproximately21%oxygenatsealevel.Duringitspassagethroughthebody,onlyabout5%oftheoxygenisutilisedandhenceexhaledaircontainsapproximately16%oxygen.WhenmouthtomouthventilationisdoneduringCPR,thereisjustsufficientoxygenintheexhaledairtokeepthevictimalive.Chestcompressionsqueezestheheartbetweenthebreastboneandthespineandtherebyhelpstocirculatethebloodanddeliverthisoxygentothevitalorgans,especiallythebrain,heartandkidneys.

IfCPRisperformedpromptlyandcorrectly,1) heartfunctionmayberestored,and2) circulationmaybemaintaineduntilinstitutionofotherlifesupportmeasures.

Thenextsectiontakesyoustep-by-stepthroughtheproceduresneededtoperformCPRorcardio-pulmonaryresuscitation–thebasicskillneededtosavelifeintheeventofcardiacarrest.

4.2 STEPS FOR ADULT ONE-MAN CPR

STEP 1 ChECK FOR DANGER

• Lookoutforunsafeenvironmenteg,electricalcurrent,fire,possibleexplosion,constructionworksorpoisonousgas.

• Ensurethatthesceneissafeforyoutohelp.

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STEP 2 ASSESS UNRESPONSIvENESS

Quicklyassessanddeterminewhetherthevictimisresponsive.Therescuershouldtaporgentlyshakethevictimonhis/hershouldersandaskloudly:“Hello!Hello!AreyouOK?”

Avoidviolentshakingofthevictimasthismightresultininjury.Also,avoidunnecessarymovementsoftheneckintheeventofinjurytotheheadandneck.

Ifthevictimdoesnotrespond,he/sheislikelytobeunconscious.Unconsciousnessmaybedueto:• Anairwaythatisobstructed(blocked)byfood,secretionsoratonguethathasfallen

backwards.• Breathingthathasstopped.• Aheartthathasstoppedbeating,usuallybecauseofaheartattack.

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STEP 3 ShOUT FOR hELP & ACTIvATE EMERGENCY MEDICAL SERvICES (EMS)

Ifthevictimdoesnotrespond,callloudlyforhelpandimmediatelydial995foranemergencyambulance.

TherescuershouldactivatetheEmergencyMedicalServices(EMS)assoonashehasdeterminedthatanadultvictimisunconsciousandrequiresemergencycare.

Ifthereisanotherpersonaround,askhim/hertodothecalling.WhencallingtheEMS,state:• Locationofvictim.• Thetelephonenumberyouarecallingfrom.• Whathappened(e.g.thatsomeoneishavingaheartattack/isunconscious).• Numberofvictims.• Hanguponlyafterinstructedtodosobythedispatcher.

Inaddition,thereisanincreasingnumberofAEDs(automatedexternaldefibrillators)thatarecurrentlybeingdeployedinpublicareas.Thesecanalsobelifesaving.ThuscallforanAED.Sayloudly“Help!CallAmbulance995,GetAED”. BC

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Airwayblocked

Tonguefallsback

Withheadtilt-chinlift,theairwayisclear

STEP 4 POSITION ThE vICTIM

ForCPRtobeeffective,thevictimmustlieonafirm,flatsurface.Ifthevictimislyingfacedown,oronhis/herside,youwillneedtorollthevictimoverontohis/herback.

Dotakecarethatthehead,neckandbodyaresupportedandturnedsimultaneouslyduringre-positioning.

STEP 5 OPEN ThE AIRWAY

PerformaHead tilt-chin lift Manoeuvretoopentheairway.Intheunresponsivevictim,muscletoneisimpairedresultinginthetonguefallingbackandobstructingtheairway.Asthetongueisattachedtothelowerjaw,movingthelowerjawforwardwillliftthetongueawayfromthebackofthethroatandopentheairway.

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• Placeonehandonthevictim’sforeheadandapplyfirmbackwardpressurewithyourpalmtotilttheheadback.

• Placethefingersofyourotherhandunderthebonypartofthelowerjawtoliftthejawforward.

STEP 6 ChECK FOR NORMAL BREAThING

Placeyourearandcheekoverthevictim’smouthandnoseandassessforbreathing(upto10seconds):

–Lookfortheriseandfallofthechest.

–Listenforairescapingduringexhalation.

–Feelfortheflowofairfromthevictim’smouthandnosemovingpastyourcheeks.

*GaspingisNOTconsideredasnormalbreathing.

Caution• Donotpressdeeplyintothesofttissuesunderthechinbecausethismightobstructtheairway.

• Performagentlechinliftifheadorneckinjuryissuspected.

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STEP 7 ASSESS FOR PULSE (FOR hEALThCARE PROvIDERS ONLY)

• Maintainheadtilt,locatetheAdam’sappleorcentreofthethroatofthevictimwiththeindexandmiddlefingers.

• Slideyourfingersdownintothegrooveatthesideofthenecknearyou(Thisisthelocationofthecarotidpulse).

• Applygentlepressureandfeelforthecarotidpulseupto10seconds.• Ifthevictimhasnopulseorifunsureofthepresenceofnormalbreathingorpulse

within10seconds,startchestcompressions.

* Forlaypersons,itisnotnecessarytocheckforpulse.Ifvictimhasnobreathing,startchestcompressions.

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XiphiSternum

STEP 8 LOCATE hAND POSITION FOR ChEST COMPRESSION

Chestcompressiontechniqueconsistsofserial,rhythmicapplicationsofpressureoverthelowerhalfofthesternum(breastbone).Tolocatethecorrecthandpositionforchestcompression:

• Maintainheadtilt,runyourmiddlefingerfromthelowermarginofthevictim’sribcagetillyoureachtheXiphiSternum.

• Placeyourindexfingernexttothemiddlefinger.

• Placetheheelofonehandnexttotheindexfinger.

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• Removetheindexandmiddlefingers.• Placetheheeloftheotherhandontop

ofthehandonthesternum.

• Interlacethefingersofbothhandsandliftthefingersoffthechestwall.

• Straightenbothelbowsandlocktheminposition.

• Positionyourshoulderdirectlyoverthevictim’schest.

STEP 9A PERFORM ChEST COMPRESSION

• Useyourbodyweighttocompressthevictim’schestbyatleast5cm.• Countyourcompressions: 1and2and3and4and5and 1and2and3and4and10and 1and2and3and4and15 1and2and3and4and20 1and2and3and4and25 1and2and3and4and30.

• Performchestcompressionsatarateofatleast100perminute.Allowcompleterecoilofthechestwallaftereachcompression.

• Theratioofcompressionandventilationis30compressions:2breaths.

• healthcare Providers–Checkpulseafter5cyclesof30compressions:2ventilations.Ifnopulseorunsurepresenceofpulse,resumeCPR.

• Laypersons –ContinueperformingCPRuntilhelparrivesorvictimstartsmoving.

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DONT’s

DO’s

STEP 9B MOUTh-TO-MOUTh BREAThING

Toperformmouth-to-mouth-breathing:• Maintainheadtilt-chinlift.• Pinchthenosewithyour

thumbandindexfingertopreventairfromescapingthroughthevictim’snose.

• Sealyourmouthoverthevictim’smouthandgive2shortbreathsinquicksuccessiononeaftertheother.

• Releasethenostrilstoallowexhalationaftereachbreath.

• Eachrescuebreathshouldmakethechestrise.

• Thedurationforeachbreathis1second.• Ventilationvolumeisbetween400to600ml.Note : Toogreatavolumeofairislikelytocauseairtoenterthestomachandresultingastricdistension.

GUIDELINES FOR PROPER COMPRESSION

• Maintainyourhandsonthesternum(breastbone)duringeachupstroke.

• Releasethepressureonthechestaftereachcompressiontoallowbloodtoflowintothechestandheart.

• Useyourbodyweighttoperformthechestcompression.• Keepthefingersoffthechestwall.• Compressatrateofatleast100perminute.

• Donotliftthehandsfromthesternum(breastbone),otherwisecorrecthandpositionmaybelost.

• Donotbounceorjerkduringcompressionsasthesemovementsmaycauseinjuries.

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ChECK DANGER

UNRESPONSIvE?Tapshoulderfirmly

Askloudly

ShOUT “hELP! CALL AMBULANCE 995,

GET AED” Activate EMS

OPEN AIRWAYHeadtilt,chinlift

NOT BREAThING NORMALLY?Look,Listen,Feel

Upto10sec

30 ChEST COMPRESSIONSCentreofchest/lowerhalfofsternum

Depthatleast5cmRateatleast100permin

Allowcompletechestrecoil

OPEN AIRWAYHeadtilt,chinlift

2 BREAThS1secperbreath,tidalvolume400-600mltillchestjustrises

CONTINUE UNTIL PATIENT WAKES UPAED ARRIvES AND ANALYSING

hEART RhYThM EMERGENCY TEAM TAKES OvER CPR

ChECK CAROTID PULSEForhealthcareprovidersonly

Definepulseandnormalbreathingwithin10sec

No

No

No

hEALThCARE PROvIDERS –

Checkpulseafter5cyclesof

30compressions:2ventilations.IfNopulseorunsureofpresenceofpulse,

resumeCPR

IF UNABLE / UNWILLING TO DO MOUTh-TO-MOUTh FOR ANY REASONDO CONTINUOUS ChEST COMPRESSIONS AT LEAST 100 / MINUTE

Adult 1-man CPRD

R

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B

C

FlowchartcourtesyofNRC

STEP 10 RE-ASSESSMENT (FOR hEALThCARE PROvIDES ONLY)

• Assessthevictimforpulseandbreathingafterevery5cyclesofCPR30:2.• Ifpulseisabsent(ifunsureofpulseandvictimhasnobreathing,assumecardiac

arrest),continueCPR30:2.• Ifboththepulseandbreathingarepresent,positionthevictimintherecovery

position.• Continuetomonitorthevictim’spulseandbreathingeveryfewminutesasthesecan

stopsuddenly.

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