CPR, a Lifesaving Skill for First Aid

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Unfortunately, 95% of those who suffer cardiac arrest, die before reaching the hospital. This is why it is important for everyone to learn CPR (Cardiopulmonary resuscitation).

After studying this section, if you feel you are not completely ready, do not worry and do whatever you have learned. Based on your level of proficiency, choose one of the following options:

• If you cannot do all the CPR steps correctly

Perform chest-compression-only CPR, which means giving chest compressions at the rate of 100 to 120 per minute. Research has shown that chest-compression-only CPR (without rescue breaths) is highly effective.

• If you think you can do all the CPR steps

In order to do complete CPR, you should repeat the cycle of 30 chest compressions and then two rescue breathing. We will explain those steps in more detail in the following section.

Before giving any help to the victim, first look at the accident scene for any potential danger that might threaten you and the victim. If you find such a danger, try to remove it without moving the victim. If it is not possible, move the victim to a safe place.

Check the victim’s consciousness before performing CPR

When you find someone who seems to need CPR, first make sure he is unconscious. To check the victim’s consciousness, tap the victim and ask: “Are you OK?”. If you have not received any response, call the emergency medical services. Then check the victim’s breathing and if he does not breathe, begin CPR as soon as possible. If you find someone drowning in water or an unconscious child under two years old, you should first perform CPR for two minutes, then call the ambulance.

If you have an AED device, ask other people to bring it, but you should not stop CPR until AED is available and ready to use.

Before CPR check for breathing, not the pulse!

Checking for the pulse can be time-consuming for ordinary people. So, when you face an unconscious victim, you should not waste your time finding the pulse, but instead, you should check the victim’s breathing. To do so, put your ear near the victim’s mouth and nose and at the same time look at his chest to detect breathing movements. If you find signs of breathing or if the person starts coughing do not perform CPR.

What to do when someone is choking?

When an unconscious person is not able to breathe, there is a possibility that an object obstructs her airway. So, in the first step, you should open the victim’s mouth and search for any foreign object. If you can see the object, try to remove it by your finger. However, if the object is too deep or if you cannot see any object, do not push your finger into the victim’s mouth, since it can thrust the object further into the airway.

In this case, you should start CPR, because chest compression can remove the object from the airway. So, after each cycle of CPR open the victim’s mouth and look again to see if you can find any foreign object.

How to do CPR?

In this section, we will explain how to perform CPR in more detail. Before performing CPR, you should lie the casualty on his back in a hard place like room floor and not somewhere like a bed. Then you should begin the CPR cycle by chest compression.

Essential steps in hands-only CPR

If you decided to perform chest compression-only CPR without rescue breathing, place your hand at the center of the victim’s chest between his nipples. Then, place your other hand on top of the first hand and interlock your fingers. In order to maximize the pressure on the chest and prevent any damage, you should apply pressure by the heel of your hands, not by your fingers.

For chest compressions in children, you can use only one hand and in infants three fingers. Then, you can put your free hand on the victim’s forehead and push it a little backward to keep the airway open.

Position your shoulders vertically over your hands. Without bending your elbows, push down the chest 2 to 2.5 inches (5 to 6 centimeters) using your body weight. The depth of chest compressions for children over the age of one year should be 2 inches (5 centimeters) and for infants 1.5 inches (4 centimeters).

Without moving your hands, release all the pressure on the victim’s chest to return to the normal position. Perform chest compressions at a rate of 100 to 120 times per minute until emergency medical service (EMS) arrives or you become exhausted or the person starts breathing again.

How to perform CPR with rescue breathing?

To do standard CPR with rescue breathing, perform chest compression with the above-mentioned method. After 30 chest compressions, give two rescue breaths and repeat this cycle. Delivering two breaths should not take more than 10 seconds.

If you have CPR mask and gloves available, you should always use them to perform rescue breathing.

When you lie down an unconscious victim on his back to perform rescue breathing, tongue usually falls back into the airway and blocks it. So, before you do rescue breathing, you need to remove this blockage by one of the following ways:

Head-tilt/chin-lift technique for opening the airway

Place your hand on the patient’s forehead and tilt his head backward by applying pressure. At the same time, place fingers of your other hand under the chin and raise it, while you are moving the head backward.

When use the jaw-thrust maneuver to open the airway?

If you think the patient might have the spinal injury, in order to remove airway obstruction, you should use the jaw-thrust method.

To perform this technique, you should kneel above the victim’s head and push the patient’s jaw upward using your index and middle fingers. At the same time, you should open the patient’s mouth slightly with the tips of your thumbs. Avoid any bending or twisting of the victim’s neck or body while performing this technique.

1. Mouth to mouth resuscitation

The best way to enter the air into the victim’s lungs is mouth to mouth rescue breathing. After opening the victim’s airway by head-tilt/chin-lift or jaw-thrust techniques, pinch the victim’s nose with your hand and with your other hand open his mouth. Insert your mouth on the victim’s mouth and exhale into it gently for about one second. In order to make sure your exhalation enters the victim’s lungs, look at his chest to see if it raises with your exhalation. Finally, release the victim’s nose, detach your mouth and allow the air to come out of his lungs.

If there is an obstruction that prevents your breath from entering the patient’s lungs, perform head-tilt/chin-lift or jaw-thrust techniques and repeat rescue breathing again. If this was not successful, continue chest compressions.

2. Mouth to nose resuscitation

If you cannot blow into the victim’s mouth (for example, if the victim’s mouth is too large, if there is a serious damage in the victim’s mouth, if the victim has no teeth, or if you cannot open the victim’s mouth), you can perform mouth to nose rescue breathing, instead.

ATTENTION: It is possible that vomiting occurs when you are blowing into the victim’s mouth or nose. In this case, you should turn him into the recovery position, open his mouth and clean it.

How does a defibrillator work?

AED (Automated External Defibrillator) is a device which is necessary for every place like house or office. Using AED, you can treat a patient who suffers from cardiac arrest, easily and effectively. Moreover, almost everyone can learn how to use this electronic device simply.

After attaching AED pads to the victim, it begins to analyze the heart rhythms. Then, it will inform you through audio or visual commands if a shock is necessary or not. Please pay attention that you shouldn’t use AED in a place which contains explosive materials, or if the victim lies on a metal or wet surface. The use of AED is NOT recommended for children under one year of age.

How to use an AED for cardiac arrest treatment?

• When you turn on the AED, the device will give you a series of commands by which you can easily perform CPR or deliver a shock if necessary.

• After turning on the AED, remove all the clothes from the patient’s chest and dry it.

• Now, you should remove the backing papers from AED pads and attach them to the patient’s chest.

• Place one pad above the right nipple, and the second pad to the side of the left nipple so that the heart is between the two pads.

• For children, use pediatric pads and make sure the pads do not touch each other. If the two AED pads risk touching each other, place one pad in the front center of the chest and the other in the middle of the child’s back.

• At this time, AED begins analyzing the heart’s electrical activity. Ensure that nobody is touching the victim during analysis (stand clear).

• If the AED indicates that a shock is not required, start CPR. If the AED recommends that the victim needs to be shocked, press the “shock” button. Make sure no one touches the victim while the AED is delivering a shock.

• After delivering the shock, resume CPR for two minutes. At this time, AED analyzes the heart rhythm again and instructs you if a further shock is required or you should continue CPR.

• Continue these steps until emergency medical service (EMS) arrives or you become exhausted or the person starts breathing again.

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