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IMPORTANT!: Cardiopulmonary resuscitation (CPR) is a procedure used to maintain blood circulation throughout the body until the Emergency Medical Services (EMS) can respond to the emergency. You must never perform CPR unless you have completed an approved course, taught by an approved instructor. The American Heart Association and the American Red Cross both offer such courses in communities across the country. The information on this page is not intended to take the place of an approved course. Everybody should take a course in CPR and become proficient in first responder care. This is especially important if you have or take care of children, the elderly, or someone with cardiac or breathing problems. Contact your local AHA, ARC, or local hospital about classes in CPR and become certified today!"
COMPONENTS OF CPR
The skill of cardiopulmonary resuscitation consists of three parts:
- A (airway) skills.
- B (breathing) skills.
- C (circulation) skills.
Before beginning CPR, you need to know how to determine if the airway is open and to correct a blocked airway by using the head-tilt/chin-lift or jaw-thrust technique. You need to know how to determine if the patient is breathing by using the look, listen, and feel technique. You need to know how to correct the absence of breathing by performing rescue breathing.
To perform CPR, you must combine the airway and breathing skills with the circulation skills. You do this by checking for a pulse. If there is no pulse, you must correct the patient's circulation by performing external chest compressions. The airway and breathing components push oxygen into the patient's lungs. The external chest compressions move the oxygenated blood through the body. External chest compressions are done by depressing the patient's sternum (breastbone). This causes a change in the pressure of the patient's chest and causes enough blood to flow to sustain life for a short period of time.
CPR by itself cannot sustain life indefinitely. It should be started as soon as possible to give the patient the best chance of survival. It is only by performing all three parts of the CPR sequence that you can keep the patient alive until more advanced medical care can be administered. In many cases, the patient will need defibrillation and medication in order to recover from cardiac arrest.
THE CARDIAC CHAIN OF SURVIVAL
In most cases of cardiac arrest, CPR by itself will not be enough to save lives. It is the first link in the American Heart Association's "chain of survival", which includes the following links:1. Early access to the emergency medical services (EMS) system.
2. Early CPR.
3. Early defibrillation.
4. Early advanced care by paramedics and hospital personnel.
As a first responder, you have the ability to help the patient by providing early CPR and by making sure that the EMS system has been activated. Some first responders may also be trained in the use of automated defibrillators. By keeping these links of the chain strong, you will help to keep the patient alive and early advanced care can be administered by paramedics and hospital personnel.
Just as an actual chain is only as strong as its weakest link, so too this CPR chain of survival is only as good as its weakest link. Your actions in performing early CPR are vital to giving cardiac arrest patients their best chance for survival.
WHEN TO START & STOP CPR
CPR should be started on all non-breathing, pulseless patients, unless they are obviously dead. Few reliable criteria exist by which death can be determined immediately. The following criteria are reliable and indicate that CPR should not be started.1. Decapitation: Decapitation occurs when the head is separated from the rest of the body. When this occurs, there is obviously no chance of saving the patient.
2. Rigor mortis: This is the temporary stiffening of muscles that occurs several hours after death. The presence of this stiffening indicates the patient is dead and cannot be resuscitated.
3. Evidence of tissue decomposition: Tissue decomposition or actual flesh decay occurs only after a patient has been dead for more than a day.
4. Dependent lividity: Dependent lividity is the red or purple color that occurs on the parts of the patient's body that are closest to the ground. It is caused by the person's blood seeping into the tissues on the dependent, or lower, part of the person's body. Dependent lividity occurs after a person has been dead for several hours.
If any of the preceding signs is present in a pulseless, non-breathing person, you should not begin CPR. If non of these signs is present, you should begin CPR. It is far better to start CPR on a person who is later declared dead by a health care provider than to withhold CPR from a patient whose life might have been saved.
Remember: Unless you are sure that a person is obviously dead, activate the EMS system and then begin CPR.
IF YOU WORK IN A HEALTH CARE FACILITY:
In a health care facility, you must know whether CPR is to be initiated. A patient who is very elderly or who has a terminal illness may not wish to be resuscitated if cardiac arrest occurs. In these cases the physician must write an order "do not resuscitate" (DNR) or "no code". This order is placed within the patient's file and should be reviewed by patient care employees prior to a cardiac arrest incident. If there is no DNR order, full life support measures are given for cardiac arrest.
WHEN TO STOP CPR
You should discontinue CPR only when:1. Effective spontaneous circulation and ventilation have been restored.
2. Resuscitation efforts have been transferred to another trained person who continues CPR.
3. A physician assumes responsibility for the patient.
4. The patient is transferred to properly trained EMS personnel.
5. Reliable criteria for death (as previously listed) are recognized.
6. You are too exhausted to continue resuscitation, environmental hazards endanger your safety, or continued resuscitation should place the lives of others at risk.
ADULT CPR, ONE RESCUER
Standard precautions should be followed if all possible. This means gloves should be worn and a barrier device should be used. If the victim is bleeding, a gown and mask may also be necessary. These items should be readily available in a health care facility. In the field, or at home, these items may or may not be available. However, CPR should be initiated and maintained regardless of standard precautions if it means that a life could be saved.
Careful assessment is required before CPR is administered.
1. Gently shake the person and ask him, "Are you okay?" Call the victim's name if you know it.
2. Call out for help. If someone responds to your call, send her to call the EMS system. If no one responds to your call, call the EMS system yourself and return to the victim as soon as possible.
3. Turn the victim on his back as a unit, supporting the head and back. For CPR to be effective, the victim must be lying on his back on a hard surface.
4. Open the airway, using a head-tilt, chin-lift technique. (If the person has experienced injuries that may include spine and/or neck trauma, use the jaw-thrust technique instead of the head-tilt, chin-lift technique to prevent further trauma to the neck and/or spine.)
5. Maintain the open airway with the head-tilt, chin-lift technique and place your ear near the victim's mouth. At the same time, observe the victim's chest. You are looking, listening, and feeling for any signs that the victim may be breathing. You should look, listen, and feel for 3 to 5 seconds. If victim is breathing, maintain open airway, monitor breathing, call EMS if not done earlier.
6. If there are no signs of breathing, seal the victim's nose with your thumb and forefinger and seal the victim's mouth using your mouth or a barrier device.
7. Ventilate 2 times, taking in 1-1/2 to 2 seconds for each ventilation. Allow the chest to deflate between ventilations. Watch the chest rise to determine if enough air is getting through.
8. After the ventilation, assess for the presence of a heartbeat. Maintain the open airway, using the head-tilt technique, with one hand. With the other hand, feel the victim's carotid pulse on the near side of the victim. Take 5 to 10 seconds to determine whether there is a pulse. If there is a pulse, but no respirations, continue with ventilations at a rate of 1 every 5 seconds (12 per minute). Continue to check periodically for a pulse.
9. If there is no pulse, begin chest compressions at the ratio of 15 compressions to 2 ventilations. Kneel by the victim's shoulders and determine proper hand placement. Your shoulders should be over the victim's sternum. Using correct hand placement and technique, compress the victim's chest 1-1/2 to 2 inches. While doing compressions, you must:
- Place your bottom hand over the victim's sternal notch.
- Place your other hand on top of your bottom hand - only the heel of your bottom hand should be touching the victim's chest.
- Keep your elbows straight, with your shoulders directly over the victim's sternum.
Compress 1-1/2 to 2 inches each time.
- Maintain hand contact with the victim's chest.
- Allow the chest to relax during the upstroke.
- Use a compression rate of 80 to 100 compressions per minute.
- Count out loud during compressions: one and, two and, three and,...
10. Do 15 compressions to 2 ventilations per cycle.
11. Do four cycles:
- 15 compressions and 2 ventilations for each cycle.
- Take 1-1/2 to 2 seconds for each ventilation.
- Observe chest rise to check for effectiveness of ventilations.
- Use a compression rate of 80 to 100 compressions per minute.
12. At the end of four cycles, feel for the carotid pulse for 5 seconds. If there is no pulse, ventilate 2 times.
13. Continue to repeat the cycle of 15 compressions to 2 ventilations. Feel for the carotid pulse every few minutes.
14. If a second rescuer arrives (See Adult CPR, Two-Person),
- The second rescuer identifies himself, saying, "I know CPR - Can I help?"
- The second rescuer does carotid pulse check for 5 seconds.
- The second rescuer does 2 ventilations and continues with one-person CPR as directed in this procedure and the approved training.
- The first rescuer observes the victim's chest during ventilation and does carotid pulse checks during compressions to evaluate the effectiveness of both techniques.
15. If the victim resumes breathing but is unconscious, and if there is no evidence of trauma, place the victim in recovery position on his side.
16. If the heart is beating but there is no breathing, continue ventilations at the rate of 1 every 5 seconds or 12 times per minute.
17. If there is no heartbeat and no breathing, continue with chest compressions and ventilations at the ratio of 15 compressions to 2 ventilations.
ADULT CPR, ONE PERSON RESCUER
ADULT CPR, TWO PERSON
CHILD CPR, ONE PERSON (Patient Age: 1 year to 8 years old)
INFANT CPR, ONE PERSON (Patient Age: Less than 1 year old)
CPR COMPLICATIONS & LEGALITIES
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