Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation or CPR is an emergency life-support procedure. It includes artificial respiration and manual cardiac massage. Both these procedures are applied to prevent irreversible brain damage or death in the case of cardiac arrest. They should be performed only by someone trained in the technique after making sure that the victim's heart has stopped or respiration has ceased.

The first step is to check if a victim's pulse has stopped and then to check the pulse rate in the neck or groin. If no pulse can be felt the rescuer can assume that the victim's heart has stopped and start CPR at once if he is properly trained. If untrained in CPR one should seek emergency medical help as soon as possible. Those who are performing the CPR may shout out to someone nearby to call for medical help.

The first step in CPR is to give artificial respiration. Artificial respiration is a lifesaving method used to restore breathing to a person whose breathing has stopped. If breathing has stopped, the victim will soon become unconscious. There will be no chest movement, and the skin will be pale or a slightly bluish colour. When breathing stops there is no oxygenation of the blood and irreversible brain damage or death may occur in as little as three to six minutes. Therefore it is important to start artificial respiration as soon as possible and continue until medical help arrives. If breathing restarts and becomes regular, the victim should be observed continuously until medical help arrives.

The most common and efficient method of artificial respiration is mouth-to-mouth resuscitation.

Mouth-to-Mouth Resuscitation

1. Assess the responsiveness of the patient by gently shaking the victim and shouting "Are you OK"? This precaution will prevent us from injuring during resuscitation someone who is not truly unconscious.

2. Ask someone nearby to call for Medical Help.

3. Move the victim away from any dangerous location, that is, locations close to harmful gases, fire, etc. Place the victim face up on a firm surface, such as the floor or the ground.

4. Open the Airway. One very important step in the resuscitation process is to immediately open the airway. Quite often the tongue may block the passage of air into the air passages. To open the airway, one hand must be placed on the victim's forehead and firm, backward pressure with the palm is applied to tilt the head back. If there is a suspicion of neck injury, the head should not be moved unless it is absolutely necessary to open the airway. Place the fingers of the other hand just under the chin and lift to bring the chin forward. If there is material like vomitus or any foreign body that appears to block the air passages it must be removed.

5. Ascertain whether the patient is breathing: With the airway open, look at the chest for signs of breathing. Put your ear next to the nose and mouth and listen for breathing. Feel for the flow of air. If there is no breathing, begin artificial respiration.

6. Mouth-to-Mouth Resuscitation: Place one hand on the victim's forehead to pinch the victim's nose closed. Ensure that your breathing is regular. Take a deep breath and place your mouth tightly over the victim's mouth. If you wish you may place a thin handkerchief between your mouth and the victim's mouth. However, do not use a very thick cloth, as it may be difficult to blow through it. Blow until the victim's chest rises. Listen for air being passively exhaled. Repeat with breaths at the rate of 12 times per minute. Children should receive smaller breaths repeated at the rate of 20 times per minute.

The aim of external cardiac massage is to cause the heart to pump blood to the other parts of the body. It should be started simultaneously with artificial respiration in a victim whose heart has stopped beating (as made out by an absent pulse in the neck or groin). The rescuer should place the heel of the palm of one hand parallel to and over the lower part of the victim's sternum (breastbone), 1 to 1.5 inches from its tip. The rescuer puts the other hand on top of the first and brings the shoulders directly over the sternum. The rescuer's fingers should not touch the victim's chest.

Keeping the arms straight, the rescuer pushes down forcefully on the sternum. This action, called external cardiac compression, results in blood flow from the heart to other parts of the body. The rescuer alternately applies and releases the pressure at a rate of about 60 compressions per minute. Each time after 15 compressions, the rescuer gives the victim artificial respiration (three or four breaths). The ratio of 15 cardiac compressions to 3 or 4 breaths is commonly followed.

If the victim is a small child, then the rescuer must use only one hand for the cardiac compression. For infants, the pressure is exerted using the index and middle fingers at the middle of the sternum. In all cases, the compressions must be accompanied by artificial respiration. Treatment should continue until medical help arrives.

CPR is best performed by two trained persons. One should administer external cardiac compression, and the other should provide artificial respiration. The rescuers should position themselves on opposite sides of the victim so they can switch roles easily if either becomes fatigued.