CPR stands for Cardio Pulmonary Resuscitation.
This For a complete guideline on protective equipments as well as
involves the giving if life giving breaths and a series of
external chest compression to person who has no breathing
and no pulse.
Often, CPR is associated with medical emergencies such as
heart attack, drowning, choking
. It should be noted however that CPR is applicable to any
situation wherein the victim or patient has no breathing and no
signs of life.
CPR training involves the use of mannequin or CPR dummies
where the student can apply breaths and compressions to the
chest. The courses are often offered by accredited instructors
from different institute and are usually updated from time to
time.This guideline is based on Pro CPR setting and some
aspects of the guideline are not done by Lay Person
responders.
CPR saves life! 911 episode, a true story
The Chain of Survival
The chain if survival involves a series of procedures that a first
aider or responder should do to increase the chances of the
victim's survival. The four links of the chain are as follows:
Early Access - immediately call for an ambulance or the EMS
to insure that equipments such as the AED and lifesaving
medications will be brought to the scene.
Early CPR - providing life saving breaths and external chest
compression helps prevent brain damage.
Early Defibrillation - it has been noted that for every minute
that defibrillation is not given there is a 10% decrease on the
patients survival. So and so that and Automated External
Defibrillator has been introduced to the public.
Early Advance Care - providing advance cardiac life support
procedures as well as cardiac medications to the victim
Disease Prevention
Bear in mind that providing CPR may expose you to certain
diseases. It is important that you should have sufficient
protection against bloodborne and airborne diseases.
first aid guides on common medical emergencies visit my first
aid and lifesaving hub.
When to start CPR
When person stops breathing and the heart stops pumping,
brain damage will occur in about 4 minutes. Thus, CPR should
be started immediately when the following conditions are
observe on the victim:
- The victim is unconscious
- The victim has no breathing
- The victim has no signs of life (no pulse)
Assessment should be done in a systematic manner to insure
that CPR can be given in the most reasonable time to increase
the chances of survival.
For people with medical background, checking of pulse is
necesarry. The pulse can be checked on the carotid area.
However, for layperson, checking for signs of life such as
coughing, movement, eye opening is enough.
When not to do CPR
Although we have mentioned that CPR is done when the
above situation exists, there are also situations that CPR
should not be applied anymore. Herewith are the following:
Rigor Mortis - this is a condition where the body is stiff
already. This condition occurs when the person died and
several hours has elapsed already.
Livor Mortis - commonly known as lividity. When the heart
stops pumping due to cardiac arrest, the blood does not
circulate anymore and blood is pulled by gravity. This
condition can be observed by looking at the body of the
victim. Half of the patients body which is near the ground will
be somewhat bluish, this indicates that blood has been pulled
by gravity to the ground. The upper half will be pale.
Crushed head or skull - if the victims head or skull is
crushed by 50% or more, CPR is not necessarily applied.
Decapitated head or body - if the head has been has been
separated or the body is cut in half, clearly the victim is
beyond recovery
Decomposition - when the body is decomposing already, this
is a sign of certain death and CPR is no longer necessary.
DNR - this are actually legal orders from a physician. This
means, Do Not Resuscitate. In some cases, the patient has
requested for a do not resuscitate order. Basically this is a
lawful and binding order.

SWAT Medic Gerry Caballes

Determine Unresponsiveness
The author demonstrating CPR to employees of Taj Resort,
Mali, Republic of Maldives After checking the scene for safety and scene is safe, you may
proceed to check the victim for responsiveness. You may do
What are the steps in CPR this by tapping the victim's shoulder or chin. Ask if the victim
is alright. If there is no response, then it would be best to call
CPR involves the giving of breaths and chest compression for emergency medical services if you have not called for
when the person has ceased breathing and when the heart assistance yet.
stops pumping. Exhaled air still contains enough oxygen that
can sustain life to a person on respiratory arrest. External chest
compression will enable the heart to pump and circulate blood
which carries the oxygen to the body tissues and organs which
are essential for survival. Giving breath alone to a cardiac
arrest victim does not deliver oxygen to the brain.

In doing CPR proper assessment and should be conducted and

certain step should be followed to make it effective. Bear in
mind that it should be done early as stated under the chain of
survival metaphor for a greater chance of success.

Check the scene for safety

Before doing anything, make sure that the scene is safe. It is

very important to survey the scene for any hazards that could head tilt chin lift
be dangerous to you or the victim. Assuming that the scene is
unsafe, make it safe if it can be done without harming
yourself. If not, then call for assistance. Only when the scene
is safe that you can start your assessment and aide.

Hazards may include fire, possible explosion, electrocution, jaw thrust

falling, and many other things. You may perform emergency
transportation such as dragging the victim or rolling the victim
to safer place if the scene safety cannot be guaranteed.
Open the airway
There are two methods of opening the airway. The head tilt
chin lift method and the jaw thrust maneuver.

If no cervical injury is suspected, you may use the head tilt

chin lift maneuver. One hand is placed on the forehead while
the two fingers of the other hand is placed on the chin. By
tilting the head backward, this will open the airway. Most
often, more than two fingers are place on the chin, this will
often cause a chocking effect on the neck. Make sure that you
only place two fingers on the chin as you open the airway.
If cervical injury is suspected, use the jaw thrust maneuver.
This is done by lifting the lower jaw upwards without moving
the neck to insure that no additional injury will occur.
Bear in mind that most cases of obstruction during CPR is the
tongue. So it is imperative that either of the methods should be
applied to insure the opening of the airway and allowing the
air that you blow to enter the lungs.
CLICK HERE TO FOR A DETAILED INSTRUCTION ON
HOW TO OPEN THE AIRWAY
Check for breathing
The next step is to check the breathing. If you can recall the
ABC's after opening the airway, you now proceed to B for
Breathing.
You can check the breathing by placing your ears near the
patients mouth and nose and listen or feel for air coming out.
Look also for the rise and fall of the chest, this will indicate
that the patient is breathing.
Check the breathing for 5 but no more than 10 seconds.
(In most cases the common thing to remember here is LLF.
Look Listen and Feel. That is to look for the rise and fall and
listen and feel for air.)
Give two initial breaths
If the patient is not breathing, simply give two blows. This can
be done by sealing the patient's mouth with your mouth and
blowing air into the mouth. This is commonly called mouth to
mouth resuscitation. At least two blows should be given at 1
second each. Remember that the head should be tilted upon
blowing or the airway opening should be maintained while
giving your blow. Otherwise, effective ventilation is not
achieved.
Pinch the nose as you blow on the mouth. This will insure that
the air will go directly to the lungs instead of going out to the
knows. Release the knows as you release the mouth after each
blow.
For infants, seal the mouth and nose with your mouth as you
blow. There is no need to pinch the nose. Do not put to much
pressure as you blow on an infant. Only use the air from your
mouth.
Providing rescue breaths can be done in the following:
Mouth to Barrier - this is with the use of mout to barrier
devices such as pocket mask, face shield. This devices are
very useful and are very effective in providing the rescuer
personal protection.
Mouth to mouth - providing blows towards the mouth of the
victim
Mouth to nose - in some cases where mouth to mouth cannot
be given effectively, mouth to mouth is the other alternative.
Mouth to Stoma - this is the blowing of air towards the
patient's stoma.
brachial pulse checking
Check for pulse
After providing two blows, you may now proceed to check the
pulse. For adult and children check the pulse on the carotid
artery. You simply place your finger on carotid artery and feel
for a pulse. ( for people with no medical background, simply
check for signs of life that is - movement, coughihg, eye
opening, breathing). If the pulse is not felt and the vicitm has
no signs of life begin CPR.
For infants check the pulse on the brachial artery. Your fingers
cannot be accomodated in the neck of an infant thus it is
imperatvie that you check on the brachial artery instead of the
carotid.
Pulse check is only necesarry for healthcare providers. For
those who have no medical background (layperson) checking
of pulse is not mandatory. (Most often brain damage occurs
for failure to provide cpr immediately and most layperson are
not familiar on how to check the pulse properly taking to
much time to check and often deliver late cpr.
FOR LAYRESPONDERS, PULSE CHECK IS NO LONGER
NECESARRY. RATHER, CHECK FOR SIGNS OF LIFE
INSTEAD.
For Children, you may use one or both hands during
compression. Compress the chest 1/3 to 1/2 the depth of chest.
For infants compress using 2 fingers. Compress the chest 1/3
to 1/2 the depth of chest.
Provide Cycles of CPR and Rescue Breaths
Perform 5 cycle of 30 compressions and 2 ventilations. This
should be accomplished in two minutes time. The compression
as mentioned should be given at a rate of 100 compressions
per minute and blows should be given at 1 second each blow.
Regardless if the victim is an adult, child or infant, the ratio
for compression and ventilation is 30:2 for single rescuer CPR

When To Stop CPR

The CPR provider can stop CPR in any of the following

conditions

Help arrives - EMS personnel, first aider who can take over

Exhausted - you may stop CPR to rest but never leave the
victim until help arrives since this may constitute
adult and child chest compression
abandonment

Life Appears - when patient is revive or pulse and breathing

have returned

Pronounce dead - when a Medical Doctor

infant chest compression

Give external chest compression

arrives at the scene and pronounce the victim dead.
If the pulse is absent, then perform chest compression. This is
accomplished by placing both hands on the chest and
compressing the chest. This will actually make the heart
contract and eventually pump blood to the body most
especially to the brain.

What is important is proper placement of the hand and proper

positioning of the body to insure good and effective
compression without getting tired right away.

Place the middle finger of one hand in line with the nipple line
of the victim. Bring the heel of your hand to the patients
sternum until the heel of the hand is directly on top of the
sternum while keeping the middle finger aligned with the
nipple. Place the other hand on top of the other hand. The
fingers can be interlocked or not. What is important is that
only the heel of your hand should making the compression
with the assistance of your upper body. This can be
accomplished by moving your upper body forward until your
shoulders are parallel with your hands.

Give 30 compressions, at a rare of 100 compressions per

minute. The depthness of compression should be at least 1
1/2" to 2 inches for adults.