| Friday, March 9, 2007 |
| CPR |
Definition of Cardio Pulmonary Resuscitation
Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. CPR involves a combination of mouth-to-mouth rescue breathing and chest compression that keeps oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.
When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing.
Cardiac Arrest Symptoms and Causes
Cardiac arrest is the sudden loss of cardiac function, when the heart abruptly stops beating. A person whose heart has stopped will lose consciousness and stop normal breathing, and their pulse and blood pressure will be absent. Unless resuscitative efforts are begun immediately, cardiac arrest leads to death within a few minutes. This is often referred to by doctors as “sudden death” or “sudden cardiac death (SCD).”
Ventricular fibrillation is the most common cause of cardiac arrest. Ventricular fibrillation occurs when the normal, regular, electrical activation of heart muscle contraction is replaced by chaotic electrical activity that causes the heart to stop beating and pumping blood to the brain and other parts of the body. Permanent brain damage and death can occur unless the flow of blood to the brain is restored within five minutes. Heart attack is the most common cause of ventricular fibrillation. Less common causes of cardiac arrest include respiratory arrest (loss of breathing function), choking, trauma, electrocution, and drowning.
Early cardiopulmonary resuscitation (CPR) and defibrillation (electrical impulses delivered to the chest to restore normal heart rhythm) are the only way to reverse a cardiac arrest. These lifesaving measures must be instituted within a few minutes after cardiac arrest in order to have any chance of success. For every minute that passes without defibrillation, a person’s chances of survival decrease by seven to ten per cent. In areas where emergency medical services are able to provide defibrillation within five to seven minutes, the survival rate for cardiac arrest has been reported to be as high as 49%. It is rare for a resuscitation to be successful if more than ten minutes have elapsed following a cardiac arrest.
Cardiac arrest is obviously a serious medical emergency. The mortality (death rate) from cardiac arrest can be decreased by providing immediate CPR and prompt defibrillation. Many public places are now equipped with automated external defibrillators (AEDs) that allow lay persons to provide emergency defibrillation in case of cardiac arrest.
CPR FOR ADULT
There are 5 steps that we used to call DR ABC
A. DANGER
Before starting to help other we must check whether there is danger arround ,for example fire, knife , leaking gas, if it is there we must anticipate so it won't harm not only the victim but also for us as rescuer. We want help other but wont hurt us.
B. RESPONSE
Is the person conscious or unconscious?
If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"
If the lone healthcare provider witnesses the sudden collapse of a victim of any age, after verifying that the victim is unresponsive the provider should first phone 777 and get an AED if available, then begin CPR and use the AED as appropriate. Sudden collapse is more likely to be caused by an arrhythmia that may require shock delivery.
If the lone healthcare provider is rescuing an unresponsive victim with a likely asphyxial cause of arrest (eg, drowning), the rescuer should provide 5 cycles (about 2 minutes) of CPR (30 compressions and 2 ventilations) before leaving the victim to phone the emergency response number.
C. AIRWAY: Clear the airway
1. Put the person on his or her back on a firm surface.
2. Kneel next to the person's neck and shoulders.
3. Open the person's airway using the head tilt-chin lift. Put your palm on the person's forehead and gently push down. Then with the other hand, gently lift the chin forward to open the airway. Or jaw thrust maneuver (grasping the posterior (back) aspects of mandible (lower jaw) with the fingers of both hands (with the thumbs at the chin) and lifting up) if there is suspicion about cervical fracture.
4. Check for normal breathing, taking no more than 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Do not consider gasping to be normal breathing. If the person isn't breathing normally or you aren't sure, begin mouth-to-mouth breathing.
D. BREATHING: Breathe for the person
Rescue breathing can be mouth-to-mouth breathing or mouth-to-
nose breathing if the mouth is seriously injured or can't be opened.
1. With the airway open (using the head tilt-chin lift) jaw trust if there is neck injury, 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. If it does rise, give the second breath. If the chest doesn't rise, repeat the head tilt-chin lift and then give the second breath.
3. Begin chest compressions — go to "CIRCULATION" below.
E. CIRCULATION: Restore blood circulation
1. Place the heel of one 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.
2. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 1 1/2 to 2 inches. Push hard and push fast — give two compressions per second, or about 100 compressions per minute.
3. After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn’t rise, repeat the head tilt-chin lift and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions.
4. If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, open the kit and follow the prompts. If an AED isn't available, go to Number 5 below.
5. Continue CPR until there are signs of movement or until emergency medical personnel take over.
Check the presence of carotid pulse by putting two finger on the carotid vein site, if none then start CPR by compressing the heart.
The rescuer should compress in the center of the chest at the nipple line.
The rescuer should compress the chest approximately 1 to 2 inches, using the heel of both hands.
Lay rescuers should use a 30:2 compression-ventilation ratio for all (infant, child, and adult) victims. Healthcare providers should use a 30:2 compression-ventilation ratio for all 1-rescuer and all adult CPR and should use a 15:2 compression-ventilation ratio for infant and child 2-rescuer CPR.
( this is the latest one, as we know before 1 rescuer is 2 breath 15 compression, 2 rescuer 2 breath 5 compression).
CPR for Children (Ages 1-8)
To perform CPR on a child:
The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:
Healthcare providers (and all rescuers who complete the healthcare provider course, such as lifeguards) performing 2-rescuer CPR should use a 15:2 compression-ventilation ratio, and a 30:2 compression-ventilation ratio for one rescuer.
Rescuers should compress over the lower half of the sternum, at the nipple line (as for adults).
Lay rescuers should use 1 or 2 hands, as needed, to compress the child’s chest to one third to one half the depth of the chest.
Breathe more gently.
Continue until the victim moves, help arrives, exhaustion occurs, rigor mortise sets in.
CPR for Infant
Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don't know why the infant isn't breathing, perform CPR.
To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don't shake the child.
If there's no response, follow the ABC procedures below and time the call for help as follows:
• If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 777 or your local emergency number.
• If another person is available, have that person call for help immediately while you attend to the baby.
AIRWAY: Clear the airway
1. Place the baby on his or her back on firm, flat surface, such as a table. The floor or ground also will do.
2. Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
3. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.
If the infant isn't breathing, begin mouth-to-mouth breathing immediately.
BREATHING: Breathe for the infant
1. Cover the baby's mouth and nose with your mouth.
2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head tilt-chin lift and then give the second breath.
3. If the chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant.
4. Begin chest compressions — go to "CIRCULATION" below.
CIRCULATION: Restore blood circulation
1. Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.
2. Gently compress the chest to about one-third to one-half the depth of the chest.
3. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 times a minute.
4. Give two breaths after every 30 chest compressions.
5. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.
6. Continue CPR until you see signs of life or until a professional relieves you.
WHEN WE CAN STOP CPR
1. Breathing or pulse restarts.
2. Medical assistance arrives.
3. Exhausion occurs.
4. Rigor mortise sets in.
ditulis oleh Arya Wirawan, Staff Nurse Clinic KHALDIYA, Kuwait |
posted by Eko Priyanto @ 5:15 PM   |
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