Cardiopulmonary Resuscitation (CPR)

objectives By the end of this lecture, the students would be able to: List the sequence of CPR. Explain the procedures for performing CPR. Demonstrate CPR. Know when to terminate CPR.

CPR is a life-saving technique. Time is critical in starting CPR. CPR is indicated whenever heart and/or breathing stop (cardiac and/or respiratory arrest). CPR can keep a person alive until more advanced procedures (such as defibrillation - an electric shock to the chest) can treat the cardiac arrest.

CPR steps are called CAB (Chest Compression, Airway, and then Breathing). Providing artificial circulation via chest compressions. Opening and maintaining the airway. Providing artificial ventilation through artificial breathing.

CPR provides circulation of blood to the brain and air to the lungs in order to prevent damage to the brain. If breathing stops → brain damage occurs within few minutes usually 4 minutes, and brain death could occur within 8-10 minutes.

Steps before starting CPR Within 5 to 10 seconds, check for (1) responsiveness and for (2) no breathing [or only gasping]. Check responsiveness by gently tapping on shoulders and asking loudly “Are you OK?” or “Do you hear me?” Note: In infants (i.e., less than 1 year of age) victims, you should tap on the heel of the foot.

In CPR, victims are divided into 3 categories: Adults (involves all adults and children who reached the puberty.) Puberty is defined as chest or underarm hair on males, or any breast development on females. Children (victims from the age of 1 to puberty.) Infants (involves victims with less than 1 year of age.)

What to do if the victim is unresponsive and not breathing or not breathing normally (only gasping)?

If the victim is unresponsive and not breathing or not breathing normally (only gasping), and he/she is an Adult: activate the EMS system (997) and get a nearby Automated External Defibrillator (AED).

If the victim is unresponsive and not breathing or not breathing normally (only gasping), and he/she is a Child or an Infant: If you did not witness the arrest and you are alone (single rescuer), you should perform 5 cycles (about 2 minutes) of CPR before leaving to activate the EMS and to bring an AED. If the arrest is sudden and witnessed, leave the victim, activate the EMS and get the AED and then return to the victim. However, if someone else is present, you may ask him/her to activate the EMS and to bring an AED.

CPR Sequence (C-A-B)

Chest Compression step (Also called Circulation step) Check for the presence of pulse: For adults, carotid artery pulse may be used. For children, carotid artery pulse OR femoral artery pulse may be used. For infants, brachial artery pulse may be used.

If there is no pulse, then this victim needs cardiopulmonary resuscitation (CPR). In infants, if the pulse is less then 60 beats/minute, this victim also needs cardiopulmonary resuscitation (CPR). Careful! If you are not trained to perform CPR, then find someone who is trained.

Carotid Artery Checking

Femoral Artery Checking

Brachial Artery Checking

Hands Placements for Compressions: For Adults Put the heel of one hand on the center of bared chest over the lower half of the breastbone, then put the heel of the other hand over the top of the first. Your shoulder should be right over your hands and your elbows should be straight/extended. Key Messages: You should deliver compressions in a smooth fashion at a rate of at least 100 compressions per minute. At the end of each compression, allow the chest to recoil completely.

Hands Placements for Compressions: For Children Similar to the Adults; but you have the option to use 1 or 2 hands. Remember: You should deliver compressions in a smooth fashion at a rate of at least 100 compressions per minute. At the end of each compression, allow the chest to recoil completely.

Hands Placements for Compressions: For Infants 1-rescure CPR Use 2 fingers of one hand. Place the middle and index fingers on the breastbone just below the nipple line. 2-rescuer CPR The compressor will place both thumbs side-by-side in the center of the chest on the lower half of the breastbone [nearby the nipple line]. This technique is also called: 2-thumb encircling hands technique.

Hands Placement in Adults

Key Considerations Checking the pulse should occur within a minimum 5 seconds and a maximum 10 seconds. Each set of 30 compressions should be done in approximately 18 seconds. A ventilator (the rescuer who provides ventilations): can check for a pulse during compressions to make sure they are effective by feeling a pulse every compression. should observe for correct delivery of compressions by the compressor.

Airway step Put the victim on his back on a firm surface. Kneel close to the victim neck or shoulders. To open the airway, tilt the forehead backward and the chin upward (called head-tilt/chin-lift maneuver) طريقة حني رأس المصاب إلى الخلف و رفع الفك إلى أعلى .

Careful! In victims with suspected head, neck or back injuries, use a method called: jaw-thrust maneuver طريقة رفع الفك السفلي.

Breathing step Close the nostril and give 2 breaths (mouth to mouth) and observe the chest rises. Give each breath over one second to allow chest recoil.

After two (2) minutes of “compression:ventilation CPR cycles”, If the victim has no pulse, give chest compressions and resume CPR. Check for a pulse every approximately 2 minutes.

After two (2) minutes of “compression:ventilation CPR cycles”, If the pulse is present BUT breathing is absent, continue artificial breathing only (called rescue breathing). In adults: Give 1 breath every 5‐6 seconds for about 10‐12 breaths/minute. Each breath should be delivered over 1 second, making the chest rise. Re-check the pulse every two minutes.

After two (2) minutes of “compression:ventilation CPR cycles”, If the pulse is present BUT breathing is absent, continue artificial breathing only (called rescue breathing). In infants and children: Give 1 breath every 3‐5 seconds for about 12‐20 breaths/minute. Each breath should be delivered over 1 second, making the chest rise. Re-check the pulse every two minutes.

After two (2) minutes of “compression:ventilation CPR cycles”, If the pulse and breathing returned to normal, place the victim in recovery position. وضعية الانعاش (وضعية الأمان الجانبي)

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Using an AED

Using an AED Put an AED on victim as soon as it arrives and turn it on. When an AED is analyzing the victim's data, no one should touch the victim.

When can I stop CPR? The victim revives. Trained help arrives. You are too exhausted to continue. The victim is pronounced dead. The cardiac arrest continues for 30 minutes (controversial).

Why CPR may fail? Delay in starting. Improper procedures (example, forget to pinch nose). Delay in defibrillation. Improper techniques. Terminal disease or unmanageable disease (massive heart attack).

More Information The first rescuer reaches the victim should ensure safety at the scene quickly. Hands-only CPR should be encouraged where untrained caregivers are involved. Performing CPR compressions on the xiphoid process can cause internal organ damage. Always, switch roles (compressor to ventilator, and vice-versa) when an AED starts analyzing the rhythm.

In 2-rescure adult CPR, switch roles (compressor to ventilator, and vice-versa) every 5 cycles or 2 minutes, taking less than 5 seconds, to prevent fatigue. In 2-rescure child or infant CPR, switch roles (compressor to ventilator, and vice-versa) every 10 cycles or 2 minutes, taking less than 5 seconds, to prevent fatigue. Note: During this 2-rescuer CPR, you are doing the CPR cycles at 15:2 not 30:2.