Basics of Cardiopulmonary Resuscitation (CPR)

Basics of Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is an emergency procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest. Here’s a detailed guide on the basics of CPR:

Assess the Situation

  • Safety First: Ensure the scene is safe for both the rescuer and the victim. Move the victim only if there is no imminent danger (e.g., fire, collapsing building).
  • Check Responsiveness: Tap the victim and shout, “Are you OK?” to check if they are responsive.

Call for Help

  • Activate Emergency Services: If the person is unresponsive, call emergency services immediately. If others are present, instruct someone specific to call 911 or the local emergency number and to get an Automated External Defibrillator (AED) if available.

Open the Airway

  • Head-Tilt/Chin-Lift: Place one hand on the victim’s forehead and gently tilt the head back. With the other hand, lift the chin forward to open the airway. This maneuver prevents the tongue from blocking the airway.

Check for Breathing

  • Look, Listen, and Feel: Place your ear near the victim’s mouth and nose, and look for chest movement. Listen for breath sounds and feel for air on your cheek. Check for no more than 10 seconds.
  • If the victim is not breathing or is only gasping, begin CPR immediately.

Chest Compressions

  • Hand Placement: Place the heel of one hand on the center of the chest, on the lower half of the sternum. Place the other hand on top and interlock the fingers.
  • Body Position: Position yourself with your shoulders directly over your hands, keeping your arms straight.
  • Compression Depth and Rate: Push hard and fast, at least 2 inches deep for adults and children, and about 1.5 inches for infants. The compression rate should be 100-120 compressions per minute.
  • Allow Full Recoil: Allow the chest to return to its normal position after each compression. This ensures the heart refills with blood between compressions.

Rescue Breaths

  • Mouth-to-Mouth: After 30 compressions, give 2 rescue breaths. Pinch the victim’s nose shut, cover their mouth with yours, and blow to make the chest rise. Each breath should last about 1 second.
  • Bag-Valve-Mask (if trained): Use a bag-valve-mask (BVM) device to give breaths if available and if you are trained to use it.

Continue CPR

  • Compression-Breath Ratio: Continue cycles of 30 chest compressions and 2 rescue breaths.
  • Minimize Interruptions: Keep interruptions to compressions to less than 10 seconds.

Use an AED

  • Turn on the AED: Follow the voice prompts. Attach the adhesive pads to the victim’s bare chest as indicated (one pad on the upper right side of the chest, the other on the lower left side).
  • Analyze and Shock: Ensure no one is touching the victim. Allow the AED to analyze the heart rhythm. If a shock is advised, ensure everyone is clear of the victim and deliver the shock. Immediately resume CPR starting with chest compressions after the shock.

Special Considerations

  • Infants and Children:
    • For infants, use two fingers for compressions, and the compression depth should be about 1.5 inches.
    • For children, use one hand if the rescuer is larger or two hands if the rescuer is smaller and capable of delivering compressions without causing harm.
    • The compression rate remains the same: 100-120 compressions per minute.
  • Drowning Victims: Begin with rescue breaths before compressions.
  • Pregnant Women: Perform compressions slightly higher on the sternum and consider lateral uterine displacement if another rescuer is present.

Continue Until Help Arrives

Continue CPR until:

  • The person shows signs of life (e.g., breathing, movement).
  • An AED is available and ready to use.
  • Trained medical personnel take over.
  • You are too exhausted to continue.

Key Points to Remember

  • High-Quality Compressions: Effective chest compressions are crucial. Push hard and fast, allowing full recoil.
  • Minimal Interruptions: Limit pauses in compressions to less than 10 seconds.
  • Correct Depth and Rate: Ensure compressions are at the proper depth and rate for the victim’s age group.
  • Immediate AED Use: Use an AED as soon as it is available. Follow the device’s prompts precisely.

DRSABCD

DRSABCD is a mnemonic used in first aid to guide responders through the initial steps of assisting someone in a medical emergency. Each letter stands for a specific action:

 

D: Danger

  • Assess for Danger: Ensure the area is safe for yourself, the victim, and any bystanders. Look for any potential hazards such as fire, traffic, or electrical wires.

R: Response

  • Check for Response: Gently tap the victim and ask loudly, “Are you okay?” Look for any signs of consciousness or response.

S: Send for Help

  • Call Emergency Services: If there is no response, or the victim is seriously injured, call emergency services immediately. If others are present, instruct someone specific to make the call and bring back an Automated External Defibrillator (AED) if available.

A: Airway

  • Open the Airway: If the victim is unresponsive, open their airway using the head-tilt, chin-lift maneuver. Place one hand on their forehead and gently tilt their head back, then lift their chin with your other hand.

B: Breathing

  • Check for Breathing: Look, listen, and feel for normal breathing. Place your ear near the victim’s mouth and nose, look for chest movement, listen for breath sounds, and feel for air on your cheek. Check for no more than 10 seconds.

C: CPR (Cardiopulmonary Resuscitation)

  • Start CPR: If the victim is not breathing normally, start CPR. Perform 30 chest compressions at a rate of 100-120 per minute, followed by 2 rescue breaths. Continue cycles of 30 compressions and 2 breaths.

D: Defibrillation

  • Use an AED: As soon as an AED is available, turn it on and follow the voice prompts. Attach the adhesive pads to the victim’s bare chest as indicated. If a shock is advised, ensure no one is touching the victim and deliver the shock. Continue CPR immediately after the shock until medical professionals take over or the victim starts to show signs of life.

Summary of DRSABCD:

  1. Danger: Ensure the area is safe.
  2. Response: Check for a response.
  3. Send for Help: Call emergency services.
  4. Airway: Open the airway.
  5. Breathing: Check for normal breathing.
  6. CPR: Perform CPR if the victim is not breathing.
  7. Defibrillation: Use an AED as soon as possible.

There are specific criteria and situations where starting CPR may not be appropriate. Here are the main criteria for not starting CPR:

 

Signs of Irreversible Death

  • Rigor Mortis: Stiffening of the body after death.
  • Lividity: Pooling of blood in the lowest parts of the body, causing purplish discoloration of the skin.
  • Decomposition: Visible signs of body decay.
  • Severe Injuries Incompatible with Life: Catastrophic injuries, such as decapitation or massive cranial destruction.

Do Not Attempt Resuscitation (DNAR) Orders

  • Valid DNAR Orders: Presence of a legally binding DNAR (Do Not Attempt Resuscitation) order or similar advance directive that explicitly states CPR should not be performed.

Danger to Rescuer

  • Unsafe Environment: If the environment is unsafe and performing CPR would put the rescuer in serious danger (e.g., fire, toxic gas, electrical hazard), CPR should not be started until the situation is made safe.

Obvious Clinical Signs of Death

  • Absence of Vital Signs with Prolonged Down Time: If the patient has no signs of life (no pulse, no breathing) and it is clear they have been deceased for an extended period.
  • Medical Professional’s Decision: A trained medical professional on scene determines that the patient is beyond recovery and declares death based on clinical judgment.

End-Stage Terminal Illness

  • Known Terminal Illness: If the patient has a terminal condition and it is known that they are in the end stages of their illness, particularly if there is a documented decision not to resuscitate.

No Evidence of Expected Recovery

  • Medical Judgment: In some cases, medical personnel may decide not to start CPR if it is determined that the patient has no chance of recovery and that CPR would only prolong the dying process.

Summary:

  • Signs of irreversible death: Rigor mortis, lividity, decomposition, catastrophic injuries.
  • Legal directives: Presence of a DNAR or similar advance directive.
  • Safety: Unsafe environment for the rescuer.
  • Clinical signs: Absence of vital signs with prolonged downtime, determined by a medical professional.
  • Terminal illness: Known end-stage terminal illness with a decision not to resuscitate.
  • Medical judgment: No chance of recovery, as determined by medical personnel.

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