In this article, you will learn what is CPR, what are the manifestations and its technique.
What is CPR?
Cardiopulmonary resuscitation(CPR) is a combination of techniques that includes, chest compressions to maintain blood circulation to the heart, brain and other vital organs and deliver oxygen to prevent brain damage, and artificial ventilation(mouth to mouth breathing) to maintain oxygenation.
CPR should be performed when the individual is unconscious or unresponsive, pulseless and not respiring.
The cardiopulmonary arrest has different causes in adults and infants. In adults it can be caused by the following:
- Ventricular fibrillation, It’s an abnormal heart rhythm in which ventricles do not pump blood to the body and electrical impulses are so rapid that there is insufficient blood flow to heart chambers and the body.
- Drug reaction or overdose
- Acute myocarditis
- The electrical shock that can lead to fibrillation
- Severe shock
- Heart valve disease such as mitral or aortic regurgitation
- Pulseless ventricular tachycardia
- Pulseless bradycardia
- Respiratory illness
In newborns, Cardiac arrest is due to :
- sudden infant death syndrome (SIDS)
- Respiratory distress syndrome(RDS)
- airway obstruction
- neurologic disease
- congenital heart disease such as stenosis or regurgitation, teratology of fallout etc.
Indications of CPR you must Know!
Not everyone knows when to perform CPR. There are some basic indications that tell a person when there is a need to start CPR. I have mentioned some common indications below:
When a person is suddenly collapsed or is found lying down, first you have to see if the person is conscious or not. For this purpose, check whether the individual is responsive to sudden tapping or other reflexes or not.
Responsiveness is ascertained in adults and children by tapping shoulder and infants by simply tapping the bottom of the feet. Approach the individual and lean at his/her side and tap the shoulder or bottom of the feet and ask he/she is fine or not.
If the person does not respond in any way like he doesn’t move, blink, cry or show any other reflex then the person is unresponsive/unconscious. In such cases, call for help and check the pulse and breathing immediately.
More than half of the people gasp during the cardiopulmonary arrest which is described as gurgling, moaning, snorting and snoring. It can be misinterpreted as breathing but it can be life-threatening for the individual. This abnormal breathing or gasp is a sign of cardiac arrest.
Gasping occurs in the first few minutes of arrest and the individual takes in air forcefully to oxygenate the lungs. The mouth may be open during gasping and head moves during gasping. it is an emergency condition and CPR must be started immediately otherwise there would be less chances of survival because the brain has no oxygen perfusion during this state.
No pulse is a sign of cardiopulmonary arrest and blood is not being pumped from the heart to the different parts of the body.
In adults and children, check carotid pulse which is present on either side of the front of the neck below the angle of the jaw.
In infants, the brachial pulse is checked which is located on the medial side of the cubital fossa medial to the tendon of biceps brachii. It should not take more than 5 seconds because the less time you spend on checking if the person needs CPR or not will be time-saving for the patient and there will be more chances of survival. Start CPR within 10 seconds after assessing the condition of the individual.
Techniques of CPR
There are poor survival rates and neurologic outcomes for patients with cardiac arrest. Early and proper resuscitation involving cardiopulmonary resuscitation, defibrillation and post-cardiac arrest care can increase the chances of survival. Cardiac arrest survival rates have been increased by targeted education and treatment of cardiac arrest directed at emergency medical services professionals and by public awareness and education.
CPR consists of 3 steps in its full, standard form:
- chest compressions
For lay rescuers, compressions only(COCPR) is advised.
Positioning for CPR is as follows:
- The patient should be lying supine on his/her back and there should be a flat and hard surface underneath so that effective compression of the sternum can take place.
- CPR on a soft mattress and soft surfaces is inefficient.
- The person performing CPR should be higher above the patient so that he can put his body weight adequately while compressing the chest of the patient.
Initiation of CPR
- Give 30 chest compressions
- Perform the head-tilt chin-lift maneuver to open the airway and ascertain if the patient is breathing
- Look in the patient’s mouth for a foreign body obstructing the airway before beginning ventilations.
- Put the heel of one hand on the patient’s sternum and the other hand on top of the first, fingers intertwined.
- Extend the elbows and the person performing CPR leans directly over the patient.
- Press downward, compressing the chest at least 2 inches. (The compression depth for adults should be at least 2 inches)
- Now release the chest and allow it to recoil completely
- The compression rate should be at least 100/min.
- After 30 compressions, 2 breaths are given; however, an intubated patient should receive continuous compressions while ventilations are given 8-10 times per minute.
- This process is repeated until a pulse returns.
- If the patient is not respiring, 2 ventilations are provided via the provider’s mouth or a bag-valve-mask. If feasible, a face shield or pocket mask should be applied.
To achieve the bag-valve-mask (BVM)or invasive airway technique, the method is following
Secure a tight seal between the mask and the patient’s face.
Press the bag with one hand for approximately 1 second, forcing at least 500 mL of air into the patient’s
Press the patient’s nostrils closed to assist with a tight seal.
Put the mouth completely over the patient’s mouth.
After 30 chest compression, give 2 breaths (the 30:2 cycle of CPR)
Give each breath for approximately 1 second with ample force to make the patient’s chest lift
After providing the 2 breaths, continue the CPR cycle.