How is cardiopulmonary resuscitation performed?

Cardiopulmonary resuscitation (CPR) is a set of activities carried out at the stage of emergency care in order to restore vital body functions.It is necessary to start CPR as early as possible, because it will give an opportunity to revive a person without incurable consequences.

Clinical death is the main indication for CPR. If two of the three signs of clinical death (lack of breathing, pulse or consciousness) are identified, CPR should be started immediately.

According to wikipedia.org.

The technique for performing CPR depends on the competence of the person providing first aid in medical matters. For non-medics, one version of resuscitation is recommended, for medicine-savvy people, another is professional. It also matters who gets CPR: a newborn, a younger / older child, or an adult.

Video: Base CPR

Description of cardiopulmonary resuscitation

The standard form of cardiopulmonary resuscitation (CPR) consists of 3 stages of emergency care:

1. Compression of the chest.
2. Cleansing / opening the airways.
3. Artificial lung ventilation (ALV).

Presented actions must be performed in the indicated order in accordance with the guidelines of the American Heart Association (AHA) 2010.

CPR was founded by Peter Safar, an American doctor who developed a triple technique used in resuscitation.

Medical professionals must perform all three components of CPR. Nemedics can use 30 chest compressions. At the same time, it is important to perform a maneuver of tilting of the head in order to open the air duct and determine whether the victim breathes.

Before the start of artificial ventilation of the lungs, the obstruction of the airways must be avoided. To do this, you need to look into the patient's mouth in order to eliminate it in the presence of a foreign body. Otherwise, airway obstruction leads to inefficient ventilation / oxygenation and may lead to a deterioration of the condition.

In a hospital setting or in the presence of a medical assistant or other medical professional, as well as in an outpatient setting, according to the Advanced Cardiac Life Support (ACLS) recommendations, a more active approach to cardiac arrest treatment, including intervention with narcotic analgesics, electrocardiographic (ECG) monitoring, defibrillation and invasive respiratory tract procedures.

Attempting to perform CPR is better than doing nothing at all, even if there is no certainty that the assistance actions are correct. This particularly applies to the abhorrence of many people to conduct mouth-to-mouth mechanical ventilation. If there is no desire at all to perform mechanical ventilation, performing chest compression alone is still better than doing nothing.

Resuscitation

• Chest compression

The palm of one hand is placed on the patient's chest, and the other hand is placed on top of the first, while the fingers intertwine. Elbows wide apart. The rescuer leans directly above the victim (see Image below). Palms pressed downward, squeezing the chest, at least 5 cm.

It should be noted that the palms are located in the center of the sternum, and the arms are extended. Compression of the chest is performed at a rate of at least 100 presses per minute. In this case, it is necessary to press vigorously and strongly, although at the same time care should be taken not to rely on the patient between compressions. This will prevent damage to the chest and deterioration of blood circulation.

After 30 presses, 2 breaths are taken (see the “Mechanical ventilation” section). It should be noted that in the presence of the intubated trachea, the patient must be continuously compressed, and ventilation - 8-10 times per minute. This whole process is repeated until the pulse begins to be determined or the patient is placed under the care of the ambulance brigade.

CPR is performed correctly if the rescuer has fatigue. If possible, one rescuer can replace another approximately every 2-3 minutes.

Compression without ventilation is performed at a speed of 100 / min to a depth of 38-51 mm (up to 4 cm) without pauses. Such a chest compression continues until the arrival of medical specialists or until another rescuer can continue to press.

Features of the compression in children:

• The newborn is pressed on the chest with one finger.
• Infants spend compression with two fingers.
• Older children perform pressure with one hand.

When the chest is compressed properly, the skin becomes pink and a pulse appears on the carotid artery.

• Mechanical ventilation

It can be performed in two ways: “mouth to mouth” and “mouth to nose”.

IVL mouth to mouth

The mouth-to-mouth method is as follows:

• The patient's nostrils are closed to ensure a reliable flow of air into the airways.
• The rescuer tightly puts his mouth to the victim's mouth.
• A strong inhalation is done in approximately 1 second, and the chest of the patient should rise.
• If the chest does not rise, this indicates inadequate sealing of the mouth or occlusion of the respiratory tract.
• 2 such exhalations should be done one after the other after 30 compressions (CPR ratio 30: 2). When ventilation is done, the compression pressure is repeated.
• If aversion is expressed to this variant of IVL, a barrier device in the form of a handkerchief or a special face mask can be used.

Mechanical mouth to nose

It is carried out similarly to the above method with the only change that the rescuer's mouth is tightly applied to the victim's nose, while his mouth is clamped.

In both cases, bloating of the stomach should be avoided. This may occur with a very strong tilting of the head.

Defibrillation

With the help of a special device-defibrillator, a high voltage current (up to 7000 volts) is supplied for a very short time.The effectiveness of this method is quite high, the only standard defibrillators should be used only by medical personnel.Also, this variant of the normalization of the heart rhythm is not effective at complete cardiac arrest.

Automatic external defibrillators are advanced models of previous devices that are suitable for use by paramedics.The devices are equipped with voice accompaniment, the need for defibrillation and current strength are also automatically determined.

Algorithm action using an automatic defibrillator:

• After identifying a person who has lost consciousness, an ambulance is called.
• The breast is released from clothes, after which electrodes are applied (as a rule, disposable).
• 15 seconds later, the device either instructs you to press a button to perform defibrillation, or advises you to start making CPR, for which the timer starts.
• Evaluation of heart activity is performed after defibrillation or some time after the start of CPR.
• If the work of the heart is restored, the device continues to monitor cardiac activity.

Thus, the main thing is not to delay the performance of CPR, since already 4 minutes after the cardiac arrest, brain cells begin to die off, and this, even after the launch of cardiac activity, threatens with serious complications.

Key points

• Cardiopulmonary resuscitation includes three main actions: chest compression, airway clearance, and mechanical ventilation.
• In determining an unconscious person, it is better to perform at least just compression of the chest than to do nothing at all.
• Usually 2 breaths are taken for every 30 presses.
• It is necessary to perform CPR as quickly as possible, because after four minutes the brain cells begin to die off.

Video: Instructions for cardiopulmonary resuscitation