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CARDIOPULMONARY RESUSCITATION (CPR)

INDICATION
  • cardiopulmonary arrest/ Clinical death (Breathlessness, Pulselessness).
CRUCIAL TIME
  • CPR is instituted within 4-6 minutes after the arrest, to prevent brain death.
TWO TYPES OF CPR
  • Basic Life Support (BLS) - Involves the use of the hands, mouth and the sincere desire to give the person a second chance for life.
  • Advanced Cardiac Life Support (ACLS) - Involves BLS and the use of equipment, emergency drugs and fluids to monitor the client and stabilize his condition.

CPR involves the ABCD of Life Support
A- open airway
B- restore breathing
C- restore circulation
D- provide definitive treatment (ACLS)

TECHNIQUES OF BASIC LIFE SUPPORT

Step I. Assess level of Consciousness
  • Shake the victim's shoulders and ask "Are you okay?"
  • If no response, place the client in supine position on a firm surface.
Step II. Open the Airway
  • The tongue is the most common cause of airway obstruction in the unconscious person.
  • Use the head tilt-chin lift and the jaw thrust methods for opening and maintaining airway.
  • Jaw thrust is recommended for clients with suspected neck injury.
  • Take 3 to 5 seconds to look, listen and feel for spontaneous breathing.
Step III. initiate artificial ventilation
  • Mouth-to-mouth ventilation
  • Mouth-to-nose ventilation
  • Mouth-to-stoma ventilation
  • Mouth-to-barrier ventilation
*NOTE: Give 2 initial breaths lasting for 1 1/2 to 2 seconds. If no rise and fall of the chest is observed, consider airway obstruction.

Step IV. Assess Circulation
  • Check carotid pulse (adult) for 5 to 10 seconds, brachial pulse for infant and child.
  • No pulse, cardiac compressions are initiated.
Step V. Initiate External Cardiac Compressions/ External Cardiac Massage
  • Place the heel of the hand on the area of 2 fingerbreadths from the xyphoid process (adult); midsternum for infant.
  • Depress the sternum with heels of both hands, one on top of the other 1 1/2 to 2 inches (adult); heel of the hand 1 to 1 1/2 inches (child); 2 fingers 1/2 to 1 inch (infant).
  • If 2 man rescue: 80-100 cardiac compressions per minute, with ratio of 5:1 (compression to ventilation).
  • If 1 man rescue: 80-100 cardiac compressions per minute, with ratio of 15:2 (compression to ventilation)
  • Reassess the client after 4 cycles; if pulse is absent, continue CPR.
  • Recheck pulse every 3 to 4 minutes thereafter.
*Most common complication of CPR is fracture of the ribs. Most common punctured internal organ during CPR is the liver.

When to stop CPR?
  • When the client is revived.
  • When the EMS has been activated.
  • When the rescuer is exhausted.
  • When the client is dead.