First aid for cardiopulmonary arrest

Cardiopulmonary emergencies

CARDIAC EMERGENCY (CPR)

First aid for cardiopulmonary arrest

Establish unresponsiveness

      When you first discover the victim, look at him closely. Shake him gently by the shoulders and shout ' Are you okay?'. This 'shaking and shouting' will establish whether or not he is unconscious.

            Observe A.B.C. of resuscitation - A = Airway,

B = Breathing, C = Circulation.

Open the airway

Open the victim' s airway. The most common cause of airway obstruction in an unconscious person is the tongue, which has relaxed and fallen into the airway.

Because the tongue is attached to the lower jaw, moving the lower jaw forward will lift the tongue away from the back of the throat, opening the airway

You can use three methods to open the airway: the preferred head-tilt/chin-lift, the head-tilt/neck-lift, or the jaw thrust without head-tilt.

To use the head-tilt/chin-lift method, place your hands that is closest to the victim' s head on his forehead and tilt his head slightly. Place the fingertips of your other hand under his lower jaw on the bony part near the chin. Gently lift the chin up, taking care not to close his mouth.

To use the head-tilt/neck-lift method, place the palm of your hand that is closest to the victim' s head on his forehead and your other hand under his neck.

Place the hand lifting his neck close to the back of his head to minimize cervical-spine extension.

Then gently press back on his forehead while lifting up and supporting his neck.

Use the jaw-thrust without head-tilt method if you suspect the victim has a neck or spine injury. Kneel at the victim' s head, facing his feet.

Place your thumbs on his mandible near the corners of his mouth, pointing your thumbs toward his feet. Then position the tips of your index fingers at the angles of his jaw. Push your thumbs down while you lift upward with the tips of your index fingers. This action should open the victim' s airway.

Once you have opened the victim' s airway see if this action alone has restored his breathing. Put your ear over his mouth and nose while you look forward his chest and abdomen.

Listen for any air movement and look to see if his chest or abdomen is moving up and down. Feel with your chest for any flow of air. If the victim has started to breathe, maintain his airway until help arrives.

Restore breathing

            If the victim hasn' t started to breathe, close his nostrils with the thumb and index finger of your hand on his forehead.

            Open your mouth wide and place it over the victim' s mouth, sealing it tightly so that no air can escape.

            When you use the jaw-thrust method to open the airway, you must tuck your cheek under his nostrils.

Deliver four quick breaths

o Don' t allow the victim to exhale between these breaths.

o These four breaths maintain positive pressure in the airway. Even if the victim has stopped breathing for only for a short time, some of his lungs' alveoli may have collapsed. Positive pressure helps reinflate them.

When you see the victim' s chest rise, then fall (after your fourth breath), you will know that air is entering and escaping his lungs. If the victim wears dentures, keeping them in place will usually make ventilation easier. But if they are slipping, remove them.

Restore Circulation

            Now locate the victim' s carotid pulse. To do so, keep your hand on his forehead to maintain the head-tilt position. Use your other hand to find the carotid artery on the side closest to you, in the groove beside the larynx. Use your index and middle fingers to gently palpate the artery for 5 to 10 seconds.

            If you find a pulse, don' t give cardiac compressions but do ventilate the patient at a rate of one breath every seconds (12 breaths a minute).

            Continue to check his pulse after every 12 breaths. If you find no pulse, prepare to begin cardiac compression. Position yourself close to the victim' s side, with your knees apart. This position gives you a broad base of support.

Use the fingers of your hand that' s closest to the victim' s feet to lower margin of his rib cage and trace the margin to the notch where the ribs meet the sternum.

            Next, place your middle finger on the notch.

            Place your index finger of the same hand next to your middle finger. Then place the heel of your other hand next to your index finger on the long axis of the sternum, as shown.

            This is the correct position for cardiac compression. If your hands are placed incorrectly, you may lacerate the victim' s liver or fracture a rib.

            Place the hand you used to locate the notch over the heel of your other hand. Interlock or extend your fingers to keep them off the victim' s ribs and to maintain vertical pressure through the heel of the hand touching the sternum.

            Align your shoulders over your hands, keeping your elbows straight. Keeping your fingers off the ribs and your shoulders aligned ensures that you will compress downward, not laterally. Lateral compressions won' t deliver sufficient pressure.

            Using the weight of your upper body, compress downward about 1.1/2 to 2 inches (3 to 5 cm), concentrating the pressure through the heels of your hands.

            Don' t deliver bouncing compressions because they are less effective and could injure the victim. Then relax the pressure completely to let the victim' s heart fill with blood.

            Don' t remove your hands from his chest when you relax, or you will lose your hand position.

            If you are the only rescuer, time your compressions at a rate of 80 a minute. Count, 'One and two and three and four and five and …' up to the count of fifteen.

            Then deliver two quick breaths without allowing the victim to exhale between them. (Actually, you will be delivering 60 compressions a minute, with the delay to

ventilate the victim).

   Perform CPR for 1 minute, check the victim' s pulse, then quickly telephone for help if none has arrived. Return quickly and resume CPR. If there is no phone available, continue CPR.

            If a second rescuer arrives, ask her to call or go for help if you have not been able to do so. Then she can help you resuscitate the victim. (Of course, she must be trained in CPR if she is going to assist you).

            Have the second rescuer get on the opposite side of the victim' s airway, across from you. As she opens the victim' s airway and tries to locate the carotid pulse, you continue giving compressions.

            If your compressions are strong enough, she should feel a pulse. When the second rescuer signal that she has found the pulse you are generating, stop your compressions for 5 seconds so she can see if the victim' s heart is beating on its own.

            If she can' t feel a spontaneous pulse, she should deliver one breathe. You can then resume compressions (approximately 60 per minute), while the second rescuer delivers a full breath on the upstroke of every fifth compression.

            To assure that you work as a team, count out loud: 'One thousand one, one thousand two, one thousand three, one thousand four, one thousand five, one thousand…' and so on. Have the second rescuer check for the victim' s pulse every few minutes.

            When you feel tired, tell the second rescuer you want to switch positions. To alert her, say: 'Switch, one thousand, two, one thousand, five, one thousand'. When you finish this count, the second rescuer should be delivering a full breath as you a move toward the victim' s head.

            When you get to his head, open his airway and assess his carotid pulse for 5 seconds. The second rescuer should get into position for cardiac compression.

            If you can' t feel a pulse, deliver one breath and tell the second rescuer to start the compressions. If you do find a pulse but the victim is not breathing, tell the second rescuer not to give any compression.

            Continue giving the victim mouth-mouth ventilation and check his pulse every few minutes, in case his heart stops again.

Cardiopulmonary resuscitation for small children and infants is similar to that for adults.

            Generally, a child younger than a year is considered an infant, and one between 1 and 8 years old is considered a small child.

            Use adult CPR techniques for children older than 8 years. In an emergency, of course, you are not going to delay CPR until you determine the child' s age. Instead, consider his body size relation to the size of your hand.

For example, if he looks too small to use both hands for cardiac compression, use the heel of one hand. If he is too small for that, use two or three fingers.

CPR for small children

1.     Use the head-tilt/neck-lift (as shown) or head-tilt/chin-lift method to open the airway. You may need to use two or three fingers instead of your whole hand to lift the child' s neck if it is very small.

2.     If you use the head-tilt/chin-lift method, be careful not to close the child' s mouth when you lift his chin. Also, be sure your fingers are not pressing on the soft tissue under his chin, which may cause edema and subsequent airway obstruction.

3.     If the child' s face is large enough, maintain a tight seal by pinching his nostrils (as shown) and placing your mouth over his. If he has a small face, place your mouth over his mouth and nose. When ventilating, give only enough air to make the child' s chest rise.

4.     Try to palpate the child' s carotid pulse. If you find a pulse, do not give cardiac compression but do ventilate the child at a rate of one breath every

5.     4 seconds. If you can' t locate a pulse, find the proper location for compression. Use the same technique you would for an adult.

                         Then compress about 1 to 1.1/2 inches (2.5 to 3.8 cm), using the heel of one hand (as shown).

            Give 80 compressions a minute, with a breath after every fifth compression. Your count should be: 'One and two and three and four and five and one…' and so on.

            This rate and ratio are the same if you have a second rescuer helping you, but the second rescuer should ventilate on the upstroke of the fifth compression.

CPR for infants

1) When you tilt an infant' s head, you will lift up his back as well. So before opening an infant' s airway, place a rolled towel of your hand closest to his feet beneath his back to support it.

            Then gently tilt his head back. You don' t need to neck.

            Cover both his mouth and node with your mouth. To ventilate, give only small breaths - just enough to make his chest rise.

            If you are having trouble ventilating the infant, his stomach may be distended, limiting chest expansion.

            Don' t relieve gastric distension unless absolutely necessary, because the infant may aspirate stomach contents.

            But if his abdomen is so tense you can' t ventilate, turn him onto his right side and gently press on his epigastric region.

            Gastric distension is caused by delivering too much air, so give only enough air to make the infant' s chest rise.

            Because an infant' s neck is short and chubby, palpate his brachial rather than carotid pulse. The brachial pulse is located on the inside of the upper arm, midway between the shoulder and the elbow.

            Don' t palpate his apical pulse - what you think is a pulse may be just precordial activity.

            To locate your hand position for cardiac compression, draw an imaginary line between the infant's nipples. (An infant' s heart is located higher in the chest than a small child' s or adult' s).

            Place two or three fingers in the middle of this line. Deliver about 100 compressions a minute, giving a breath after every five compression.

            Count to yourself: 'One, two, three, four, five' (even though you are alone). Because an infant is so small, one

rescuer along can try to resuscitate him.

Unconsciousness

Any interference with the normal functioning of the brain and the nerves brings about loss of consciousness. Level of Consciousness

                        Partial ( Stupor)

                        Complete ( coma)

Causes of unconsiousness

                        Brain injuries

                        Convulsions

                        Heat strokes

                        Diabetes

                        Heart attack

                        Epilepsy

                        Hemorrhage

                        Poisons - eg. Carbon mono-oxide poisoning

Management

            See that there is a supply of fresh air and the air passages are free.

            Take the casualty away form harmful gases

            Watch for symptoms of shock

            Remove false teeth

            Loosen tight clothing up to neck, chest and waist.

            If the breathing has stopped or about to stop, turn the casualty into the required position and start artificial respiration.

            If breathing is noisy, turn casualty to 3 quarter turn position and support in this position with pillows.

            If breathing is not noisy, let the casualty lie on his back, raise the shoulder slightly with the pillow and turn the head to one side

            Watch continuously for any changes in the condition

            Do not leave the casualty until the medical comes

            Do not give any form of drinks in this condition

            On return to consciousness, give little water.