CPR

Steps of CPR

1. 911
2. Airway
3. Breathing
4. Circulation
5. Defibrillation

911

• BSI, scene safe.
• The patient is lying on the floor.
• Assess for a response
  • "hey sir/madam are you alright?" (vocal stimulus).
  • Sternal rub (painful stimulus).
• If no response, call 911
  • if you're alone, call 911 and grab an AED.
  • if there're others, get others to call 911 and grab an AED.

Airway

• Open the airway using either head-tilt chin-lift or jaw thrust.

Breathing

• Check for breathing (take 5-10 seconds).
  • Look for chest rise
  • Listen for breathing sounds
  • Feel for air movement through the nose and also for chest rise.
• If no breathing (or inadequate breathing), give 2 breaths.
  • Take 1 second to deliver each breath.
  • Watch for chest rise and avoid gastric inflation.
• Ventilation techniques
  • Mouth-to-mouth: the most effective seal formed. Requires you to pinch the patient's nose and give breaths through the mouth.
  • Mouth-to-mask: you deliver breaths through a mask that covers both the mouth and the nose. Requires you to hold the mask firmly down to maintain a good seal.
  • Bag-valve mask: you sqeeze on a bag to ventilate through a mask that covers both the mouth and the nose. Requires you to hold the mask firmly down to maintain a good seal.

Circulation

• Check the carotid pulse (5-10 seconds).
• If there is a pulse, give 1 breath every 5-6 seconds and recheck pulse every 2 minutes.
• If no pulse, perform 5 cycles of 30:2 compressions:ventilations.
  • Make sure the patient is lying on a hard surface.
  • Position on the patient's side.
  • Remove all clothing covering the chest.
  • Perform compressions by pushing on the chest between the nipples with both hands (the heel of one hand pushes on the patient's chest and the heel of the other hand is placed over the first one).
  • Arms straight so that you are using the weight of your body to push straight down.
  • Push hard and deep so that blood gets pumped (1½ to 2 inches of compression).
  • Allow for complete chest recoil before pushing again.
  • 100 compressions per minute.

Defibrillation

• Attach electrodes.
• Clear: ask people in the immediate surrounding to keep away.
• Assess for shockable rhythm.
• If shockable, clear again and shock, then immediately resume CPR for 5 cycles. Reassess breathing and pulse afterwards.
• If shock not advised, then immediately resume CPR for 5 cycles and analyze rhythm again.

CPR notes

• For infants and children
  • You may deliver compressions if heart rate is less than 60 bpm with signs of hypoperfusion.
  • Compression to ventilation ratio for children should optimally be 15:2, if possible (such as if there are 2 rescuers).
  • Ventilation for children should occur at a rate of 1 breath per 3-5 seconds.
  • For infants, use thumbs to perform compressions (two thumb-encircling hands technique).
• If cardiac arrest is witnessed or occurred within 5 minutes, apply AED immediately.
• Minimize interruptions to chest compressions to less than 10 seconds.
• If there're 2 EMTs, one can perform continuous chest compressions while the other ventilates at the appropriate rate (5-6 bpm for adults and 3-5 bpm for infants and children).
• Rescuers should switch turns every 5 cycles of compressions to keep compressions strong and avoid fatigue.
• The shockable rhythm is V-Fib, or ventricular fibrillation.
• CPR stands for Cardio-Pulmonary Resucitation