Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful

in many emergencies, such as a heart attack or near drowning, in which
someone's breathing or heartbeat has stopped
The American Heart Association recommends starting CPR with hard and
fast chest compressions
This hands-only CPR recommendation applies to both untrained
bystanders and first responders
CPR can keep oxygen-rich blood flowing to the brain and other organs until
emergency medical treatment can restore a typical heart rhythm. When the
heart stops, the body no longer gets oxygen-rich blood. The lack of oxygen-
rich blood can cause brain damage in only a few minutes
Algorithm of CPR
I. Diagnosis
1. Is the person conscious or unconscious?
If the person appears unconscious, tap or shake his or her shoulder and
ask loudly, "Are you OK?“
2. If there is no response, perform A (airway): open the person's airway
using the head-tilt, chin-lift maneuver. Put your palm on the person's
forehead and gently tilt the head back. Then with the other hand, gently lift
the chin forward to open the airway

3. Check the patient’s breathing within 10 seconds by:

Look for the chest to rise and fall.
Listen for air escaping during exhalation by placing your ear near the
casualty’s mouth.
Feel for the flow of air on your cheek

4. If there is no consciousness and breathing:

- Call the ambulance
- Ask someone to bring the AED
- Start doing the CPR immediately (perform the steps of C-A-B)
C-A-B Steps
1. C – Chest Compression
Depth of compression – 5 cm
Rate of compression – of 100 to 120/min
Numbers of compression – 30 times
2. A – Airway
Open the person's airway using the head-tilt, chin-lift maneuver
3. B – breathing
(2 breaths) - mouth-to-mouth breathing or mouth-to-nose breathing
1. C – Chest 2. A – Airway 3. B – Breathing
Compression
 Chest Compressions
Compressions means you'll use your hands to push down hard and fast in
a specific way on the person's chest. Compressions are the most
important step in CPR.
Follow these steps for performing CPR compressions:
● Put the person on his or her back on a firm surface
● Kneel next to the person's neck and shoulders
● Place the lower palm (heel) of your hand over the center of the
person's chest, between the nipples
● Place your other hand on top of the first hand. Keep your elbows
straight and position your shoulders directly above your hands
● Push straight down on (compress) the chest at least 2 inches (5
centimeters) but no more than 2.4 inches (6 centimeters). Use your
entire body weight (not just your arms) when doing compressions
● Push hard at a rate of 100 to 120 compressions a minute. The
American Heart Association suggests performing compressions to
the beat of the song "Stayin' Alive"
● Allow the chest to spring back (recoil) after each push!
 Airway
● When you've performed 30 chest compressions, open the person's
airway using the head-tilt, chin-lift maneuver
● Put your palm on the person's forehead and gently tilt the head back.
Then with the other hand, gently lift the chin forward to open the
airway

Breathing

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose

breathing if the mouth is seriously injured or can't be opened. Current
recommendations suggest performing rescue breathing using a bag-
mask device with a high-efficiency particulate air (HEPA) filter
1. After opening the airway (using the head-tilt, chin-lift maneuver),
pinch the nostrils shut for mouth-to-mouth breathing and cover the
person's mouth with yours, making a seal
 2. Prepare to give two rescue breaths. Give the first rescue breath —
lasting one second — and watch to see if the chest rises
3. If the chest rises, give a second breath
4. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and
then give a second breath. Thirty chest compressions followed by
two rescue breaths is considered one cycle

How to Use an AED

“Early defibrillation improves outcome from cardiac arrest.”

When the AED arrives, follow these steps to use the AED:
1. Turn on the AED and follow audio instructions
2. Remove all clothing surrounding the patient’s chest (including bra)
3. Apply the included electrode pads to the person’s bare skin. Make
sure the person’s chest is dry
4. Allow the AED to analyze the person’s heart rhythm. Make sure no
one, including you, is touching the victim. Touching the victim can
interrupt the AED’s analysis
5. Deliver a shock (if needed): If the AED determines that the patient is
in cardiac arrest and that a shock is needed, the way it delivers the
shock depends on whether the AED is a semi-automatic model or a
fully-automatic model
6. Perform CPR and re-analyze. AEDs are programmed with the
American Heart Association’s guidelines. The current AHA’s
protocols call for two-minutes of CPR in between AED heart rhythm
analysis periods. Follow the AED instructions about when to resume
CPR and when to deliver additional shocks
7. Continue listening to the AED until EMS arrives and takes over the
rescue
 Cardiopulmonary Resuscitation (CPR) In Children
I. Diagnosis
1. Ensure the area is safe (heck for hazards, such as electrical
equipment or traffic)
2. Check child's responsiveness (Gently stimulate child and ask loudly:
"Are you alright?)
3. If child does not respond
- Call for help
- Carefully turn the child on their back
If the child is under 1 year old:
- Ensure the head is in a neutral position, with the head and neck in line.
At the same time, with your fingertips under the point of the child's
chin, lift the chin. Do not push on the soft tissues under the chin as
this may block the airway
 If the child is over 1 year old:
- Open your child's airway by tilting the head and lifting the chin

4. Check their breathing (Keeping the airway open, look, listen and feel
for normal breathing by putting your face close to your child's face
and looking along their chest)
* Look for chest movements
* Listen at the child's nose and mouth for breathing sounds.
* Feel for air movement on your cheek.
Look, listen and feel for no more than 10 seconds before deciding
that they're not breathing. Gasping breaths should not be considered
to be normal breathing
5. If the child is not breathing:
- Carefully remove any obvious obstruction in the mouth
- Give 5 initial rescue breaths (mouth-to-mouth resuscitation)
- While doing this, note any gag or cough response – this is a sign of
life
Rescue breaths for a baby under 1 year:
- Ensure the head is in a neutral position and lift the chin
- Take a breath, then cover your baby's mouth and nose with your
mouth, making sure it's sealed. If you cannot cover both the mouth
and nose at the same time, just seal either with your mouth. If you
choose the nose, close the lips to stop air escaping
- Blow a breath steadily into the baby's mouth and nose over 1 second.
It should be sufficient to make the chest visibly rise
- Keeping their head tilted and chin lifted, take your mouth away and
watch for the chest to fall as air comes out
- Take another breath and repeat this sequence 4 more times

Rescue breaths for a child over 1 year

- Tilt the head and lift the chin
- Close the soft part of their nose using the index finger and thumb of
 the hand that's on their forehead
- Open their mouth a little, but keep the chin pointing upwards
- Take a breath, then place your lips around their mouth, making sure
it's sealed
- Blow a breath steadily into their mouth over about 1 second, watching
for the chest to rise
- Keeping their head tilted and chin lifted, take your mouth away and
watch for the chest to fall as air comes out
- Take another breath and repeat this sequence 4 more times. Check
that your child's chest rises and falls in the same way as if they were
breathing normally
6. Assess the circulation (signs of life)
- Look for signs of life. These include any movement, coughing, or
normal breathing – not abnormal gasps or infrequent, irregular
breaths

Signs of life present

If there are definite signs of life:
- Continue rescue breathing until your child begins to breathe normally
for themselves
- Turn the child on their side into the recovery position and send for
help
- Continue to check for normal breathing and provide further rescue
breaths if necessary
No signs of life present
If there are no signs of life:
- Start chest compressions immediately
- Combine chest compressions with rescue breaths, providing 2 breaths
after every 30 compressions
7. Chest compressions: General Guidance
• To avoid compressing the stomach, find the point where the lowest
ribs join in the middle, and then 1 finger's width above that. Compress
the breastbone.
• Push down 4cm (for a baby or infant) or 5cm (a child), which is
approximately one-third of the chest diameter.
• Release the pressure, then rapidly repeat at a rate of about 100-120
compressions a minute.
• After 30 compressions, tilt the head, lift the chin, and give 2 effective
breaths.
• Continue compressions and breaths in a ratio of 2 breaths for every
30 compressions.
• Although the rate of compressions will be 100-120 a minute, the
actual number delivered will be fewer because of the pauses to give
breaths.
• The best method for compression varies slightly between infants and
children.
Chest compression in babies less than 1 year
• Do the compressions on the breastbone with the tips of 2 fingers, not
the whole hand or with both hands.
• The quality (depth) of chest compressions is very important. If the
depth of 4cm cannot be achieved with the tips of 2 fingers, use the
heel of 1 hand.

Chest compression in children over 1 year

 • Place the heel of 1 hand over the lower third of the breastbone
• Lift the fingers to ensure pressure is not applied over the ribs
• Position yourself vertically above the chest and, with your arm
straight, compress the breastbone so you push it down 5cm, which is
approximately one-third of the chest diameter. The quality (depth) of
chest compressions is very important

• If you had no response to your call for help and you're alone, continue
resuscitation for about 1 minute before trying to get help – for
example, by calling 112
8. Continue resuscitation until
• Your child shows signs of life – normal breathing, coughing,
movement of arms or legs.
• Qualified help arrives.

Choking First Aid

Infant, Up to Age 1 Year
Choking happens when an object gets stuck in the throat or airway. This
can block the flow of air and cut off oxygen to the brain. Baby will have a
weak cough and trouble breathing or noisy breathing.
Young babies may choke if they swallow breastmilk or formula too quickly
or if they have too much mucus.
Signs of a blocked airway
These are signs of choking:
● Violent coughing
● A high-pitched sound when breathing in
● Your baby can’t cough, breathe, or cry
● Face turns pale and bluish

At the first sign of choking

If the baby is conscious, having troublebreathing, and can’t cry or make
sounds, start first aid for choking right away. This will clear the airway.
Follow these guidelines:
1. Don't put your finger into the baby’s mouth to remove the object. Your
finger could push the object farther into the baby’s throat.
2. Have someone call 911 if you're not alone.
3. Sit down. Then lay the baby stomach-down along your forearm.
Support the baby’s face (head) and neck in your hand. If you need to,
support your arm with the baby along your thigh. Make sure the
baby’s head is slightly lower than the rest of his or her body. This will
help dislodge the object more easily from the throat.
4. Use the heel of your free hand to give 5 quick thumps (back blows)
between the baby’s shoulder blades.
5. If the object is still lodged, turn the baby face up on your forearm.
Support the head. Place 2 or 3 fingers in the middle of the baby’s
breastbone. Push down about 1/2 to 1 inch. Do this 5 times fast.
 6. Check the baby’s mouth to see if the object is dislodged. If
not, repeat steps 3 and 4 until the baby’s airway is clear and the baby
is breathing normally.
If the baby is not breathing, becomes unconscious, or is unresponsive,
follow these guidelines if you are not alone:

1. Have someone call 911 right away.

2. Lay the baby on a firm, flat surface, such as a table, the floor, or the ground.
3. Start infant CPR (cardiopulmonary resuscitation)

Choking in Adult

Mild choking: encourage them to cough

If the airway is only partly blocked, the person will usually be able to speak,
cry, cough or breathe.
They'll usually be able to clear the blockage themselves.
To help with mild choking in an adult:
● encourage them to keep coughing to try to clear the blockage
● ask them to try to spit out the object if it's in their mouth
● don't put your fingers in their mouth to help them as they may bite
you accidentally
If coughing doesn't work, start back blows.
Severe choking: back blows and abdominal thrusts
Where choking is severe, the person won't be able to speak, cry, cough or
breathe. Without help, they'll eventually become unconscious.
To carry out a back blow on an adult:
● Stand behind them and slightly to one side. Support their chest with 1
hand. Lean them forward so the object blocking their airway will
come out of their mouth, rather than moving further down.
● Give up to 5 sharp blows between their shoulder blades with the heel
of your hand. The heel is between the palm of your hand and your
wrist.

● Check if the blockage has cleared.

● If not, give up to 5 abdominal thrusts.
Abdominal thrusts
Don't give abdominal thrusts to babies under 1 year old or pregnant
women.
To carry out an abdominal thrust:
● Stand behind the person who's choking.
 ● Place your arms around their waist and bend them forward.
● Clench 1 fist and place it right above their belly button.
● Put the other hand on top of your fist and pull sharply inwards and
upwards.
● Repeat this movement up to 5 times.

If the person's airway is still blocked after trying back blows and abdominal
thrusts, get help immediately:
● Call 999 and ask for an ambulance. Tell the 999 operator the person
is choking.
● Continue with the cycles of 5 back blows and 5 abdominal thrusts
until help arrives.

If they lose consciousness and aren't breathing, you should begin

cardiopulmonary resuscitation (CPR) with chest compressions.
Complications
Get urgent medical help if:
● they have a persistent cough after choking
 ● they feel something is still stuck in their throat
Abdominal thrusts can cause serious injuries. A health professional such
as your GP or a doctor in A&E should always examine someone after they
have received abdominal thrusts.