Cardio Pulmonary Resuscitation (CPR) – Adult

Individuals, who find themselves thrust into a situation where casualties are having a suspected Cardiac Arrest, need to be able to react immediately. It is important that the lay-person should quickly recognise the signs and symptoms of a cardiac arrest and have had the training to perform Cardio Pulmonary Resuscitation (CPR).

My previous article on ‘Airway Management’ explains how to recognise and confirm when patients are in a state of dying; following Danger Response Airway Breathing (DRAB) you can quickly determine whether the casualty are unresponsive and if they are NOT breathing normally; for the lay-person these are the signs and symptoms of cardiac arrest.

It’s human nature to start CPR immediately but before starting chest compressions it is imperative that the emergency services have been informed and a defibrillator requested. If there is no one else to make this 999 call then the first aider must abandon the casualty and make this call themselves.

Once you know the Emergency Services are enroute and a defibrillator requested Cardio Pulmonary Resuscitation (CPR) can commence. You need to locate the centre of the breast bone (Sternum) and place the heel of your ‘lead’ hand upon it and lock your elbow; quickly place the heel of the second hand above the other and again lock the elbow. Using a rocking motion you need to depress the chest 5cm-6cm; 30-times, at a pace of 100-120 compressions per minute; allow the chest to rise on each compression but keep contact with chest at all times – don’t bounce.

Tip: Position your knees close into the side of the casualty so you can position yourself directly above the casualty’s chest. The rocking motion keeps the effort to a minimum; pushing increases the effort and tires the rescuer quickly.

On the completion of 30-compressions it is preferred, but optional to administer two rescue breaths to the casualty. At the correct depth and pace it takes approximately 10-compressions to build enough blood pressure to give partial respiration to the brain; eventually the blood oxygen levels need to be replenished and the administration of two-rescue breaths after 30-compressions helps to keep this consistent. If for any reason you feel unable to perform rescue breaths through lack of ability or distaste then continuous chest compressions should be performed.

Rescue breaths are successful when the casualty’s head is placed back into the head-tilt-chin-lift position, and the soft part of the patients’ nose is pinched shut before the rescuer makes a seal around the patients open mouth. A breath lasting no longer than a couple of seconds should then be eased into the patient; out of the corner of your eye try to spot a subtle movement in the chest as this is all that is needed. Nevertheless, you should only make two attempts to achieve two rescue breaths; if either fails you must return to chest compressions immediately you have made the two attempts.

Tip: Try not to blow into the mouth of the casualty as if you were blowing out a candle; best practice is to blow as if you’re making a ‘sigh’. This helps to sustain a seal around the patients’ mouth.

Tip: Do lift the chin of the casualty while pinching the nose with your other hand as this ensures removing the tongue from the airway and clears the airway.

Once rescue breaths have been completed you immediately return to 30-chest compressions and continue at a rate of 30:2. The only times you will stop doing CPR is when you are too exhausted to continue, someone with equal or more ability are able to take over, it becomes too dangerous to continue or in the unlikely event that the casualty starts to show signs of life.

It has to be understood that CPR alone is highly unlikely to be successful in returning the casualty to life. In best practice CPR will partially oxygenate the brain and prolong permanent brain cell damage and death; it places the casualty in ‘hold’ until definitive care arrives. CPR success is down to the ability of the rescuer to perform continuous chest compressions with minimal interruption for rescue breaths. The rescuers hands need to be correctly placed, the compressions need to be at the correct pace and need to attain the correct depth on the patient’s chest.

Definitive care usually arrives in the form of the medical professional; the aim of the ambulance service is to attend these incidents quickly; within 8-minutes in Urban areas; 20-mins in Rural areas. It is known that the best chance of survival is the attendance, as early as possible, of a defibrillator. All ambulances carry Defibrillators and it will be used if the cardiac rhythm of the heart requires it. These days, Automatic External Defibrillators (AED’s) are in many public places and definitive care may arrive before the ambulance service in the form of a lay-person trained to use an AED and perform good quality CPR.

Tony Clough

FIRST AID TRAINING Ltd

Web: www.tcfirstaidtraining.co.uk

Email: mail@tcfirstaidtraining.co.uk

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