Cardiopulmonary Resuscitation

Basic CPR competency is a foudational skill in both basic and advanced life support training and ample data supports the need to improve ongoing maintenance of competency. Many out-of-hospital cardiac arrest victims do not receive CPR before the arrival of professional rescuers. Video-based instruction effectively trains students more quickly than traditional classroom based courses and evidence suggests ongoing refresher training benefits skill retention. Real time feedback devices improve CPR quality in both training and actual resuscitation.


INTRODUCTION
CPR is a technique involving heart and lungs that is used when breathing stops. Administering CPR can restore breathing and restart the heart if heart failure accompanies the loss of breathing. This valuable technique should be learned by all caregivers and parents in case an emergency arises where professional help is not immediately available. Emergencies happen all too often, and early intervention can save a life. This lesson will cover how to secure the scene of an accident to protect the victim and the first responders.
It is a sequence of techniques used to sustain life in the absence of spontaneous breathing and heart beat Together chest compressions and rescue breath are called cardiopulmonary resuscitation The aim of CPR is to maintain victim's breathing and circulation until emergency aid arrives. -3 steps before the initiation of resuscitation for management of a collapsed patient 1. ensure your own safety 2. check the level of responsiveness by gently shaking the patients and shouting: "are you alright?" 3. shout for help.
Then check for carotid pulsation. Apnea (cessation of respiration) is conformed by:-1. Look: to see chest wall movement. seesaw (paradoxical) movement of the chest wall indicates airway obstruction. 2. listen: to breath sounds from the mouth. 3. feel: air flow for at least 10 seconds.
Refers to the period of time immediately following trauma during which approximately 50% death occurs. The causes of death is usually preventable provided that adequate resuscitation, diagnosis and surgical intervention are provided. (eg. Tension penumothorax , cardiac temponade).

LIFE SUPPORT INCLUDES C-A-B
C= Circulation. A= Airway. B= Breathing C = Circulation (A)CHEST COMPRESSION -(Cardiac massage ) The human brain cannot survive more then 3 minutes with lack of circulation. So chest compression must be started immediately for any patients with absent central pulsation.

Techniques of chest compression:
1. patients must be placed on a hard surface (wooden board). 2. The palm of one hand is placed in the concavity of the lower half of the sternum 2 fingers above the xiphoid process. (Avoid xiphisternal junction -fracture & injury ) The other hand is placed over the hand on the sternum. Shoulder should be positioned directly over the hands with the elbows looked staright and arms extended. Sternum must be depressed 4-5 cm in adults. and 2-4 cm in children, 1-2 cm in infants.
Must be performed at a rate of 100 -120/min. During CPR the ratio of chest compressions to ventilation should be as follows.
Single rescuer = 30:2 In the presence of 2 rescuer chest compression must not be interrupted for ventilation.

CHEST OF COMPRSSION IN INFANTS (0-12 MONTHS)
Check for Responsiveness -1. Check for responsiveness Shake or tap the child gently. See if the child moves or makes a noise. Shout, "Are you okay? " 2. If there is no response, shout for help. Send someone to call 911 and retrieve an automated external defibrillator (AED) if one is available. Do not leave the child alone to call 911 and retrieve an AED until you have performed CPR for about 2 minutes 3. Carefully place the child on his or her back. If there is a chance the child has a spinal injury, two people should move the child to prevent the head and neck from twisting consider in defibrillation station safety first -teamwork vital wording / exact language used is less important than communicating principles to ensure safety. Not a script. Chest compressions while defibrillator charging first time rhythm checked is when compressions are ceased.

precaution:
Make sure the paddles have conducting gel on them: 1-the electricity will not be properly transmitted to the chest wall without it. 2-even with the gel these paddles will often a seconddegree skin burn . make sure you have cleared the bed:make sure that no one is in contact with the bed otherwise this person may be electrocuted and develop VT or VF. Hold the paddles down firmly. Chest compressions must be continued for 2minutes after DC shock before reassessment of cardiac rhytham.
Complication of defibrillation: skin burn injury to myocardium and elevation of cardiac enzymes .electrocution of person in contact with bed.
A-AIRWAY AIRWAY-loss of consciousness often results in airway obstruction due to loss of tone in the muscles of the airway and falling back of the tongue.
(A)-Basic techniques for airway patency:-1. Head tilt, chin lift:one hand is placed on the forehead and other on the chin the head is tilted upwords to cause anterior of displacemets of tongue.

jaw thrust:-
3. Heimlich manoeuvre:if the pt is conscious or the foreign body cannot be removed by a finger sweep.it is done while the pt is standing up or tying down . this is a subdiaphragmatic abdominal thrust that elevates the diaphragm expelling a blast of air from the lungs displaces the foregion body. In infants his can be done by a series of blowsb on he back and chest thrusts.