Cardio pulmonary resuscitation
Cardio (heart) pulmonary (lung) resuscitation refers to restarting the functioning of heart and / or lung, if it stops or malfunctions, due to heart attack, trauma, shock, disease or any other cause. The objective of CPR is to restore breathing and circulation and involves rescue breathing and chest compressions.
Try to shout for help or make a quick phone call as soon as possible, to get trained medical help.
CPR can be described as simply as ABC: Airway – Breathing –Circulation.
- Remove any object that is obstructing air flow from the mouth. This could be foreign bodies (in cases of drowning, etc) or the rolled back tongue.
- Carefully lift the jaw and tilt the head backward to open the airway. The airway normally makes a 90º turn at the mouth. Straitening the neck makes the airway almost a straight line, facilitating breathing or the putting in of an airway if available. However, in case of an accident in which it is suspected that the neck bones may have broken, this must not be done, as it may permanently damage the spinal nerves passing through the broken spinal junction.
- Check for breathing. In case there is no obvious chest movement for breathing, holding a piece of glass in front of the nose may reveal vapor marks of exhaled air. Listening with the ear placed gently over the front of the neck may enable one to hear the sound of breathing even when quite faint.
- If there is no breathing, and the airway has been cleaned open, start mouth to mouth ventilation or chest compression ventilation.
- Mouth to Mouth respiration: Clean the mouth area of the patient of any secretions and debris. Take a deep breath and hold it. Pinch the nose of the patient to block the nasal passage and then place your mouth over that of the patient, to make an airtight seal. Exhale slowly and steadily into the patients mouth and observe for lifting of the chest of the patient. Remove your mouth and release the nose to allow the patient to exhale. Repeat about 10 to 15 times per minute.
- Check pulse. The pulse is the wave of blood flow felt over the arteries as they carry blood away from the heart after each heart beat. It is best felt on an artery lying over a bony prominence. The best places to feel them are in the neck, elbow or wrist, in that order.
- Be sure to feel for the pulse with your finger tips and not the thumb; the artery of the thumb lies in front of the thumb, and you may be feeling your own pulse! In contrast, the arteries of the fingers are at either side, and hence will not cause this false sensation.
- Place two fingers on the victims Adam’s Apple and slide your fingers between the Adam’s Apple and the muscle on the side of the neck to feel for the pulse of the Carotid (neck) artery as it travels over the neck spinal bones.
- Stretch out the elbow and feel for a pulse wave over the front and inner side of the elbow joint as the artery travels over the bony elbow joint surface.
- Feel down from the thumb towards its base at the front and outer side of the wrist joint. There is a longitudinal groove in the wrist bones in front and just below the base of the thumb. The arterial pulse can be felt in this groove. Count the number of pulse waves per minute (or, like a doctor, count for 15 seconds and multiply by 4)
- If a pulse cannot be felt in any of the positions, it may be absent, too feeble or masked by fat in an obese person. Listen with the ear pressed against the chest on the left side, about 3 to 4 inches below the mid section of the left collar bone for heart sounds of any. If heard, try once again to locate the pulse in time with the sounds heard. If still no pulse is felt, then external heart massage may need to be done.
- Position the victim flat on his back on a firm surface. Unfasten the victim’s clothes, if necessary, to gain access to the victim’s chest.
- Kneel astride the victim, roughly over the lower abdomen. Use your index and middle finger, and find one of the victim’s lowest ribs and then slide your fingers up to the point where the lower edge of the rib cage meets in the middle. Place the heel of one hand two finger width above this point. Place the heel of the other hand over the heel of the first hand and interlock your fingers. Leaning well over the victim, arms straight, elbows locked straight, press down vertically on the breast bone, using the weight of your body, depressing it approximately 4 – 5 cm and then rock backwards releasing the pressure without removing your hands. Using your weight for the pressure will save your stamina for a prolonged resuscitation effort, that may prove life saving in the end. There is a distinct possibility of some ribs cracking; try to avoid doing so; still, an alive person with a few broken ribs that will soon join, is much better than a dead person.
- Cardiac massage is best done on a low hard surface bed or on the floor. Do not try it on a spring bed or a soft mattress since you will be wasting your energy on compressing the bed and not the chest of the patient.
- It is advisable to give about 10 to 15 heart compressions followed by 2 breaths. If a helper is available, take turns to give four chest compressions followed by one breath, till medical help arrives; each cycle should take about 8 to 10 seconds.