Cardiopulmonary Resuscitation

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Cardiopulmonary Resuscitation

Definition
Purpose
Description
Precautions
Normal results
Prevention

Definition

Cardiopulmonary resuscitation, commonly called CPR, combines rescue breathing (one person breathing into another person) and chest compression in a lifesaving procedure performed when a person has stopped breathing or a person’s heart has stopped beating.

Purpose

When performed quickly enough, CPR can save lives in such emergencies as loss of consciousness, heart attacks or heart “arrests,” electric shock, drowning, excessive bleeding, drug overdose, and other conditions in which there is no breathing or no pulse. The purpose of CPR is to bring oxygen to the victim’s lungs and to keep blood circulating so oxygen gets to every part of the body. When a person is deprived of oxygen, permanent brain damage can begin in as little as four minutes and death can follow only minutes later.

Description

There are three physical symptoms that indicate a need for CPR to be performed immediately and for emergency medical support to be called: unconsciousness, not breathing, and no pulse detected.

Unconsciousness

Unconsciousness is when the victim seems to be asleep but has lost all awareness and is not able to respond to questions, touch, or gentle shaking. A sleeping person will usually respond to a loud noise, shouting, or gentle shaking. An unconscious person will not respond to noise or shaking. When unconscious, a person can not cough or clear the throat, which may allow the windpipe to become blocked, causing suffocation and death. People with a major illness or injury or who have had recent surgery are at risk for losing consciousness. If a person has fainted, which is brief unconsciousness, the cause may be dehydration (lack of body fluids), low blood pressure, or low blood sugar. This is a temporary condition. If the victim is known to have diabetes, a bit of fruit juice may revive the person once they have regained consciousness.

Just before a person loses consciousness, symptoms may include:

lack of response to voice or touch
disorientation or stupor
light-headedness
headache
sleepiness

Not breathing

Not breathing, which is also called apnea, is the lack of spontaneous breathing. It requires immediate medical attention. The victim may become limp and lifeless, have a seizure, or turn blue. Prolonged apnea is called respiratory arrest. In children, this can lead quickly to cardiac arrest in which the heart stops beating. In adults, cardiac arrest usually happens first and

KEY TERMS

Apnea— A period of no breathing, sometimes sudden, sometimes prolonged.

Arrest— A sudden stopping of the function of a body organ, such as no breathing (respiratory arrest) or no beating of the heart (cardiac arrest).

Cardiopulmonary— Involving both heart and lungs.

Circulation— The passage of blood and delivery of oxygen through the veins and arteries of the body.

Respiratory— Referring to breathing in and breathing out, and the function of the lungs.

Resuscitation— Reviving an unconscious person or restoring breathing.

Shock— A sudden reducing of function in major body systems such as circulation and respiration.

then respiratory arrest. In adults, the common causes of apnea are obstructive sleep apnea (something blocks the airway during sleep), choking, drug overdose, near-drowning, head injury, heart irregularities (arrhythmia, fibrillation) or cardiac arrest, nervous system disorders, or metabolic disorders. In children the causes may be different, such as prematurity, bronchial disturbances or pneumonia, airway blockage or choking on a foreign object, holding the breath, seizures, meningitis, regurgitating food, or asthma attacks.

No pulse detected

If the rescuer is unable to detect a pulse or has difficulty feeling a pulse, it can be an indication of the use of improper technique by the rescuer, or it may be due to shock or cardiac arrest in the victim. If a sudden, severe decrease occurs in pulse quality (such as pulse weakness) or pulse rate (how many beats in a minute) when other symptoms are also present, life-threatening shock is suspected. The rescuer may need to explain to a doctor or medical professional where on the victim’s body the pulse was measured, whether or not the pulse is weak or absent, and what other symptoms are present.

Medical help and CPR are needed immediately if any of these symptoms are found. Time is critical. A local emergency number should be called immediately. If more than one person is available to help, one person can call 911 or a local emergency medical service, while the other person begins CPR. If needed, the emergency dispatcher (the person who picks up emergency 911 calls) can give step-by-step CPR instructions over the telephone. Local medical personnel, staff at hospitals and fire departments, and members of the American Heart Association teach CPR courses. If a critically ill patient or postoperative patient is being cared for at home, it is a good idea for a family member to take a CPR course to be better prepared to help in the event of an emergency.

The steps usually followed in adult CPR by a layperson are as follows:

If the victim appears to be unconscious with either no breathing or no pulse, the person should be shaken or tapped gently to check for any movement. The victim should be spoken to loudly, asking if he or she is OK. If there is no response, the rescuer should leave to call 911 immediately, send someone to call for help, or call from a cell phone. If the rescuer is alone, they should call 911 before beginning CPR. If an automated external defibrillator (AED) is found close by, the rescuer should bring the AED back with them to the victim’s side.
The victim should be placed on his or her back on a level surface such as the ground or the floor. The rescuer should kneel next to the victim and tilt the victim’s head back. The rescuer should then put their ear to the victim’s open mouth and look for chest movement, listen for air flowing through the mouth or nose, and feel for air on his or her cheek. If there is no breathing, they should pinch the victim’s nose, make a seal over the victim’s mouth with theirs, and give the victim a breath big enough to make the chest rise. The rescuer should use a CPR mask if there is one available. The rescuer should let the chest fall, then repeat the rescue breath once more. If the chest does not rise, the victim’s head should be repositioned to help ensure the tongue is kept away from the windpipe, then the rescuer should try again to give a breath.
If the victim is found to be breathing and has perhaps fainted, he or she can be placed in the recovery position until medical assistance arrives. This is done by straightening the victim’s legs and pulling the closest arm out away from the body with the elbow at a right angle (or three o’clock position), and the other arm across the chest. The far leg should be pulled up over the victim’s body with the hip and knee bent. This allows the victim’s body to be rolled onto its side. The head should be tilted back slightly to keep the windpipe open. The head should not be propped up.
If the victim is not breathing, the rescuer should begin chest compressions. Chest compressions are needed to restore circulation (the victim has no pulse). The rescuer should push down one and a half to two inches on the chest, placing the heel of one hand in the middle of the chest, putting the other hand on top of the first, and interlacing the fingers. When performing compressions, the rescuer should keep the elbows straight, center his or her shoulders over the victim, develop an up-and-down rhythm, and keep their hands firmly on the victim’s chest. Compressions should be done on the center of the chest midway between the nipples. Compressions should be hard and fast, at a rate of 100 times per minute. The rescuer should perform 30 compressions at this rate, then give 2 breaths and the again, 30 compressions (this ratio is the same whether it is performed by one or by two people at the scene). The rescuer should allow the chest to completely recoil before the next compression. The sequence of 30 compressions and two breaths should continue to be repeated until professional medical help arrives. Note: If an AED is immediately available, deliver one shock if advised by the device, then begin CPR. If an AED is not available initially, but later becomes available and the person is still unresponsive, stop doing CPR and quickly follow the directions for using the AED.

Precautions

There are certain important precautions for rescuers to remember in order to protect the victim and get the best result from CPR. These include:

Do not leave the victim alone.
Do not give the victim anything to eat or drink.
Avoid moving the victim’s head or neck if spinal injury is a possibility. The person should be left as found if breathing freely. To check for breathing when spinal injury is suspected, the rescuer should only listen for breath by the victim’s mouth and watch the chest for movement.
Do not slap the victim’s face, or throw water on the face to try and revive the person.
Do not place a pillow under the victim’s head.

The description above is not a substitute for CPR training and is not intended to be followed as a procedure.

Normal results

Successful CPR will restore breathing and circulation in the victim. Medical attention is required immediately even if successful CPR has been performed and the victim is breathing freely.

Prevention

Loss of consciousness is an emergency that is potentially life threatening. To avoid loss of consciousness and protect themselves from emergency situations, people at risk can follow these general guidelines:

People with such conditions as diabetes or epilepsy should wear a medical alert tag or bracelet.
People with diabetes should avoid situations that will lower their blood sugar level.
People who feel weak, become dizzy or light-headed, or have ever fainted, should avoid standing in one place too long without moving.
People who feel faint can lie down or sit with their heads lowered between their knees.
Risk factors that contribute to heart disease should be reduced or eliminated. People can reduce risks if they stop smoking, lower blood pressure and cholesterol, lose excess weight, and reduce stress.
Illegal recreational drugs should be avoided.
Seeing a doctor regularly and being aware of any disease conditions or risk factors can help prevent or complicate illness, as can seeking and following the doctor’s advice about diet and exercise.
Using seat belts and driving carefully can help avoid accidental injury.
People with poor eyesight or those who have difficulty walking because of disability, injury, or recovery from illness, can use a cane or other assistive device to help them avoid falls and injury.