CPR

Cardio Pulmonary Resuscitation

This page is not intended to replace the instruction that is offered by certified CPR instructors. It is only meant as a guide. It would be like learning to drive a car by only reading a book! If you have small children, it can not be stressed strongly enough that the you and other members of you household take a CPR course.

Again I would like to stress that you should only perform CPR  if you are properly trained. CPR is something that everybody should learn, and the sooner the better. CPR can save a child or adults life.

Cardiopulmonary resuscitation is a means of restoring circulation to the body when the heart has ceased pumping on its own due to myocardial infraction (heart attack), massive hemorrhage (excessive blood loss), or other physiological reasons. It maintains the oxygen content of the blood and manually distributes it to the cells of the body where it is needed, especially the brain. Brain cells cannot endure more than about four minutes without oxygen or extreme and irreversible brain damage ensues. The following steps for cardiopulmonary resuscitation are not meant to be an absolute guide for performing this lifesaving procedure, but rather as a reminder for those who have forgotten their skills, or an introduction for those who are interested in taking an instructional class in the future.

CPR instructions and procedure for one-rescuer cardiopulmonary resuscitation on an adult victim.

In order to perform CPR and obtain maximum efficiency per compression, the victim must be placed flat on his/her back on a hard surface. This may require that the patient be moved from a soft surface, such as a bed, to the floor. Unresponsiveness must be ascertained by shouting and shaking the patient at the shoulders. Loudly ask, “Are you okay?” If unresponsiveness continues, call the  local emergency service. If other people are in the vicinity, order one particular person to do this so that you may begin CPR immediately. Select one person so that he/she is personally responsible for activating the emergency medical system, and inform them of the status of the patient so they can pass the information on to the operator.

Performing CPR is easy as 1 2 3 if you follow these simple basic steps. Your first step is to open an air passage. Tilt the head and lift up on the chin to remove the tongue from the back of the throat. Once you’ve called for help, go back to the victim and begin your ABC's. A is airway. B is breathing. And C is circulation.

A is airway. Open the airway using the head tilt, chin lift. Pushing down on the head and lifting up on the chin removes the tongue from the back of the throat. The tongue is the most common airway obstruction in an unconscious person. If the person is going to breathe on his own, it should happen as soon as you clear the airway. If you do not hear, see or feel any breathing, you must give two breaths. Look, listen and feel for even a faint indication that your victim is drawing breath. If not, remember that everyone gets two breaths initially.

B is breathing. Everyone gets two breaths initially. We assess the response by looking to see if the chest rises and falls, putting our face close to the victim’s so that we can hear and feel him breathing. If you do not hear or feel any breathing, give the victim two breaths. Pinch the person’s nose and put your lips over the other person's lips and blow until you see the chest rise. If you have a protective device, use it. Watch out of the corner of your eye to be sure you blow just enough to see the chest rise. Find the carotid artery to the side of the Adam’s Apple area and feel for five or 10 seconds. If there is no pulse, begin chest compressions.

Once both breaths go in, it is time to move to C - circulation. Check the pulse at the carotid artery in the neck, which is easily found by locating the Adam's Apple and sliding your fingers just to the side.

Feel around in this area. If there is no thumping under your fingers in a three-second time span, begin chest compressions. Start by finding the proper placement for your hands. Locate the base of the sternum, the spot where all the ribs come together in the center of the chest.

Place two fingers on that point. Put the heel of the other hand beside those two fingers. Interlace your fingers, lock your elbows and compress the victim’s chest, using your body weight, to the necessary depth of 1 1/2 to 2 inches deep. Or remember this, two hands, two inches.

Count aloud as you compress 15 times and follow by giving the victim two breaths. That's Cycle Number 1. Repeat for a total of four cycles – about one minute in elapsed time.

Then check again for a pulse in the neck and watch for signs that the person is breathing. This procedure should continue uninterrupted until advanced life support arrives. A brief summary of the procedure of CPR is the ABC’s: Airway, Breathing, and Circulation. When these are assessed and treated sequentially and CPR is properly performed, the life-sustaining effects of CPR can be attained. After reading this article you should be very aware of how to perform Adult CPR.

 Step-by-step procedure of adult cpr with two rescuers.

The heart may stop pumping on its own for a number of reasons, including myocardial infraction (heart attack), massive hemorrhage (excessive blood loss), insufficient oxygen due to suffocation or drowning, or other physiological reasons. The systematic, coordinating pumping of the atria and ventricles of the heart maintain the oxygen content of the blood and manually distributes it to the cells of the body where it is needed, especially the brain. Brain cells die after about four minutes without oxygen, and extreme, irreversible brain damage ensues. The following steps for cardiopulmonary resuscitation are not meant to be an absolute guide for performing this lifesaving procedure, but rather as a reminder for those who have forgotten their skills, or an introduction for those who are interested in taking an instructional class in the future. A person is not legally insured to perform CPR unless he has passed a written and skills exam and been certified by an organization such as the American Red Cross. It is highly encouraged that everyone receive this basic training, even children.

Do not perform CPR unless you are professionally rained and certified.

In order to attain maximum efficiency per compression, the victim must be positioned flat on his/her back on a hard surface. This may require that the patient be moved from a soft surface, such as a bed, to the floor or even a table if necessary. Unresponsiveness must be ascertained by shouting and shaking the patient at the shoulders. Loudly ask, “Are you okay?” If unresponsiveness continues, call 911 or local emergency medical system. If other people are in the vicinity, order one particular person to do this so that you may begin CPR immediately. Select one person so that he/she is personally responsible for activating the emergency medical system, and inform them of the status of the patient so they can pass the information on to the operator. If two people are present who know CPR, it is preferable that they both stay to perform the procedure together while an untrained individual places the 911 call. If this is not possible, then one of the trained individuals should go to a phone immediately and return as soon as possible to assist.

One of the two rescuers should kneel at the head/shoulders of the victim, and the other rescuer should kneel on the opposite side of the patient, if possible. This is to ensure that both people have adequate room to maneuver. The second rescuer should be positioned at the mid-chest of the patient. The rescuer at the head is in charge of maintaining the airway and administering rescue breaths while the other rescuer performs chest compressions. The exact procedure is as follows:

The first step of CPR is always ensuring adequate airway in the patient. The position of the head is termed “head-tilt/chin-lift,” and is achieved by pressing down on the forehead with the heel of one hand and pushing up on the chin with the fingers of the other hand. This positions the airway so that there is minimal obstruction from tissue surrounding the trachea and the airway is open.

The second step is restoring breathing to the patient. With the first step completed, the first rescuer (at the patient’s head) should position his/her cheek directly above the victim’s nose and mouth so that any breath coming in or out of the patient’s nose or mouth will be felt warm on your cheek, and any breathing noises can be heard. Your eyes should be directed toward the victim’s chest to watch for rising and falling which indicate respiration. Your hand can also be placed lightly on the chest to feel for rising and falling of the chest as well. Perform this look, listen and feel method for 5-10

seconds. If the patient is breathing but unconscious, DO NOT perform CPR, just wait for the ambulance. If the patient is not breathing, pinch his/her nose closed and give 2 full, slow breaths into the victim’s mouth using a microshield, if possible. It is up to the discretion of the rescuer whether to perform CPR if a microshield is unavailable. It is important that the breaths not be too shallow because the blood will not be adequately oxygenated. Furthermore, you should wait for the chest to rise and fall before delivering the second full breath. If the breath does not go in, reposition the head using head-tilt/chin-lift method and try again. If the breath still does not go in, then the airway is obstructed and the Heimlich maneuver should be performed using abdominal thrusts. If the breaths do go in, proceed to the next step.

Communication between the rescuers is of utmost importance. The rescuer at the head is “in charge” and signals to the second rescuer when the airway has been assessed and the breaths were successfully delivered. At that signal, the second rescuer proceeds with circulation as follows:

The last step in CPR is circulation, which is evaluated by checking the carotid pulse at the side of the trachea in the neck. The second rescuer should feel for 5-10 seconds. If there IS a pulse, the first rescuer should just continue rescue breathing at a rate of 1 breath every 5 seconds (12 breaths per minute) and DO NOT perform compressions. If there is no pulse, chest compressions should be begun by the second rescuer placing the heel of one hand over the lower part of the sternum, approximately 2 fingers’ width above the very tip of the sternum. Place the other hand directly above the first hand with palms down, and interlock fingers. Depress the sternum 1.5 to 2 inches per compression. The mechanism of this compression actually compresses the heart between the sternum bone and the vertebrae, causing it to manually expel blood and naturally refill, distributing blood throughout the body without actually contracting the cardiac muscle. The rate of compression in two-rescuer CPR is 5 compressions to every 1 breath (80-100 compressions per minute). Every minute, the presence of a pulse should be re-evaluated at the carotid artery.

If one rescuer gets tired or fatigued, they should call a switch of position. Communication plays a key role during the entire procedure, and the second rescuer should count out loud with every compression, pausing after the fifth one for the first rescuer to deliver a rescue breath. If a switch is necessary, the second rescuer calls out loud “Switch, two, three, four, five...” and the first rescuer delivers a final breath before they alternate positions and begin the next cycle by re-assessing breathing and pulse.

This procedure should continue uninterrupted until advanced life support arrives. A brief summary of the procedure of CPR is the ABC’s: Airway, Breathing, and Circulation. When these are assessed and treated sequentially and CPR is properly performed, the life-sustaining effects of CPR can be of inestimable importance.