CTSARA    CTSARA First Aid Facts

CPR Training CPR IN THREE SIMPLE STEPS
1. CALL Check the victim for unresponsiveness. If there is no response, Call 911 and return to the victim. In most locations the emergency dispatcher can assist you with CPR instructions. Define: Unresponsiveness During cardiac arrest, the heart stops pumping blood, the blood pressure falls to zero and the pulse disappears. Within 10 seconds of cardiac arrest the person loses consciousness and becomes unresponsive. If you shake or shout at the victim, there will be no response. Sometimes a person in cardiac arrest may make grunting, gasping or snoring type breathing sounds for a couple of minutes. Do not be confused by this abnormal type of breathing. If a person is unresponsive (doesn't respond to shouts or shakes) and not breathing (or breathing abnormally) then call 911 and begin CPR.
2. BLOW Tilt the head back and listen for breathing.  If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths.  Each breath should take 2 seconds. Define: Abnormal Breathing Remember a person in cardiac arrest may have abnormal breathing for a couple of minutes. This abnormal breathing is called "agonal respiration" and is the result of the brain's breathing center sending out signals even though circulation has ceased. The key point is that the abnormal breathing may sound like grunting, gasping or snoring. It disappears in 2-3 minutes. If you see this type of breathing DO NOT delay CPR. The person desperately needs air and only you can provide it.
3. PUMP If the victim is still not breathing normally, coughing or moving, begin chest compressions. Push down on the chest 11/2 to 2 inches 15 times right between the nipples.  Pump at the rate of 100/minute, faster than once per second. Pushing on the Chest In general the chest should be pushed down 11/2-2 inches. Sometimes you may hear a cracking sound. Do not be alarmed. The sound is caused by cartilage or ribs cracking. Even if this occurs the damage is not serious. The risk of delaying CPR or not doing CPR is far greater than the risk of a broken rib.
CONTINUE WITH 2 BREATHS AND 15 PUMPS UNTIL HELP ARRIVES NOTE: This ratio is the same for one-person & two-person CPR.  In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing. Complications of CPR Vomiting is the most frequently encountered complication of CPR. If the victim starts to vomit, turn the head to the side and try to sweep out or wipe off the vomit. Continue with CPR. The spread of infection from the victim to the rescuer is exceedingly rare. Most cardiac arrests occur in people's homes - relatives or friends will be the ones needing to do CPR. Even CPR performed on strangers has an exceedingly rare risk of infection. There is NO documentation of HIV or AIDS ever being transmitted via CPR. Checking The Pulse The pulse check is no longer taught or expected of laypersons.   Instead, if you see no signs of life (defined as breathing normally, coughing or moving) you should begin to pump on the chest.  Please note that the pulse check is still expected of health case providers.

Expired Air Resuscitation

On normal inspiration, a person breathes in approximately 21% oxygen. The body uses between 4 — 4.5% of this amount for its normal functions. Therefore, on expiration a person breathes out approximately 16% oxygen. To breathe into another person as a means of supplementing their oxygen supply is not only feasible, but in cases of a non-breathing casualty, essential. Immediate supplementary breathing is necessary, as the brain suffers irreversible tissue damage if deprived of oxygen for longer than about three minutes. Rapid and effective resuscitation saves lives!

EXPIRED AIR RESUSCITATION (EAR) is the method by which a rescuer breathes for a casualty who is in respiratory arrest. The common term is 'mouth-to-mouth resuscitation'. It is a most effective method for sustaining life, as a rescuer breathes out sufficient oxygen to supply a casualty with the necessary requirement. There are five methods for delivering EAR:

MOUTH-TO-MOUTH where the rescuer seals the casualty's mouth with his or her mouth and breathes into the airway through the mouth.

MOUTH-TO-NOSE is used where the casualty has sustained facial injuries that preclude using the mouth. The rescuer closes the casualty's mouth, seals the nose with his or her mouth, breathes gently, then releases the casualty's jaw to allow exhalation.

MOUTH-TO-NOSE-AND-MOUTH is the preferred method when resuscitating a child, as the rescuer's mouth can cover and seal the child's nose and mouth.

MOUTH-TO-STOMA is used for resuscitating a casualty fitted with a stoma from a pipe-like device fitted into the throat with an opening in the neck. These devices are often encountered because the casualty is in a high-risk group, usually because of previous respiratory and/or cardiac problems. The rescuer breathes through the stoma directly into the airway — a most effective method.

MOUTH-TO-MASK is the most desirable method to be employed by the rescuer as a means of avoiding possible cross-infection. Masks come in various configurations, but their use is similar — the mask is fitted firmly over the casualty's nose and mouth, and the rescuer delivers breaths through the valve or aperture, thus avoiding direct contact with the casualty's mouth.

EAR is necessary for casualties in complete respiratory arrest. Certain conditions cause the loss of respiratory effort, and the first aid provider should be aware of the potential for resuscitation. Choking, heroin overdose, near drowning, certain bites and stings, as well as respiratory conditions such as asthma and emphysema can cause respiratory arrest necessitating rapid and effective EAR to sustain life.

Breaths need to be effective, which is evidenced by the rise and fall of the chest with each breath from the rescuer.  Make up to five attempts to achieve the initial two effective breaths.

When considering which resuscitation technique to use, the age of the casualty must be taken into account.  The classifications are:

• Infant - Newborn to 1 year
• Young Child - 1 to 8 years
• Older Child - 9 to 14 years
• Adult - 15 years and older

Additional consideration must be given to the physical size of the child.  Often a young child may be as well developed as an older child.

INDICATIONS FOR EAR:

• unconscious collapse
• cyanosis (blue)
• absent respirations, or breathing rate less than 4—5 per minute

PROCEDURE FOR EAR:

• check for DANGER
• call help
• roll casualty away from you
• check airway
• open airway
• look, listen and feel for breathing
• if breathing effectively, remain in stable side position
• if not breathing, roll onto back
• ensure airway is open (head tilt or jaw lift)
• give two effective breaths - jaw support (pistol grip).  Make up to five attempts to achieve two effective breaths
• assess the rise and fall of the chest (if suspected obstruction — reassess airway)
• check pulse
• IF PULSE PRESENT, commence EAR for adults and older children by giving one effective breath every 4 seconds (15 breaths per minute)
• for younger children and infants, give one effective breath every three (3) seconds (20 breaths per minute)
• reassess pulse about every one minute
• constantly reassess airway, be alert for vomits

 

Breaths must be effective.  An effective breath is one where there is visible rise and fall of the chest during EAR.  Five attempts may be used to deliver the two effective breaths.

Full breaths are used for an adult and older child. When breathing into a young child ensure that you modify the force of the breaths. If delivered too forcefully, the air will be directed into the stomach, which may cause the child to vomit.

The method to be employed for infants is 'frog breathing' or 'puffing', where the rescuer fills his or her mouth with air and 'puffs' it into the infant's mouth. There will be adequate pressure and volume to satisfy the lung's requirements, but not enough to impact on the stomach.

EAR is continued until the casualty begins breathing spontaneously, until the rescuer is relieved by medical aid, or until the casualty deteriorates into full cardiac arrest at which point the rescuer delivers cardio-pulmonary resuscitation (CPR).