Cardiopulmonary Resuscitation or ABC of Life Support A recent WHO statement that the lives of over 50% of patients following acute myocardial infarction could have been saved if instantaneous application of resuscitation speaks volumes of its importance. Therefore, it is a must- know not only for clinicians but also for each and every individual. Iris a simple manual technique which can be performed in any cardiopulmonary emergency. Indications for CPR Orthopaedic polytrauma ~ Drowning Electric shock Drug intoxication Suffocation ~ Early Identification Unconsciousness Severe hypoxia of brain leads to unconsciousness. It rapidly spreads to the myocardium resulting into spontaneous heart failure. Therefore, quick restoration of airways (A), breath- ing (B) and circulation (C) (or ABC of life support) is the immediate priority to save life.Identify the System Failure thumbs and open the victim ji luunb and open the victims mouth by using ea — whether it is a cespieatory hilure or a circulatory failure, oF both, + ake full-dleep breath. Respitatory faihire ean he identified by (ecling for the * Quickly seal the victin’s open mouth with your mouth breath at the nostrils and normal up and down movement and forcefully blow air into the victim's mouth. cof the ribeag circulatory failure can be identified * Now remove mouth, allowing the victim to breath by the absence of carotid/radial pulse. ou ponies listening carefully and feeling for the exhaled air. Basic Principles of CPR + The slow up and down chest movement isan indi- cator of effective ventilation, 1. To restore average normal rate of breathing of 8-12 ven- tilations/min (oF one ventilation for every 5s), done by direct blowing of air into the victim's mouth, 2. To restore circulation, manual rhythmic chest or myo- [No atemp’ s lv be mace lo tra vcl"y vain ry (0 the cardial compressions ate given at the average normal cervical spine or facia! Iractures to supine head tiling postien, heart rate of 60 beats/min (or one compression every Patients wih fascial inuries. need removal of biocd stan, minute). debris anc puling tongue forward before inating ventiation Methodology of CPR - Circulation (Fig. 1.10): Airway clearance: Roll the victimuan the back (supine) on + Keeping the victim in supine position, loosen a hard-flat surface. clothes and bare the chest. + Clear che airways that may be obstructed due to the ae- + Identify the centremost notch on the ribcage cumulation of saliva and other exudates. where the ribs join (xiphisternal junction). * Open the airways to the maximum by giving well-sup- * Determine a centtal point on the sternum at about three-finger distance above the tip of the xiphoid. ported head tilt position, which occasionally may restore yont * Place the heel of one hand at that point. spontancous respiration, Breathing (Fig. 1.9): + Place the other hand exactly above the hand placed. + Maintaining head in a backward tilted position, earlier, so that che hand and fingers are at right block both the noserils with index finger and angles to the long axis of the sternum. “ ® sre98 — peewee, RRO «+ Mainiain victn's head ited downwards 10 open up the airway. yoann in reeet iy une your head ond cruisin ol th Dlg ents by he * Sn baja alive vn adc zy chien Wh i “+ Koaping waich on the rise ark! fall of fe chest; éhyihmic chest movement conferns, (Block the vicherfe nosis. cotton of cospiration. + Bea boven auth completly by your om OU ceacaaeer ntti: en average, 12 vntaion et miul ot vebRaton + Foca Bow no tb ci open mewn (A ror of rion vention | « Soal the vtin’s mouth completely by yout own mouth. wore ratty, out oa varttaon canbe erloye Naa ou et orth ere losing een Ixia mouth + Ws esinacaly mare sccapable. « Fig. 1.9 (A and 8) Puimonary resuscitation,‘STEPS shawna veers head ted. + Knee! cose © De victm s shoulder directly over the chest. + Locate ne xohoc process. e) ‘CONFIRMATION * Confirn ne restoration of creulaton by palpating the cart pulse, + Locate De xD7 stemaljuncton ala point 1.5 inches from tne tp (about 3-fnger eam ancve De xDNOS tp) + Paze heel cl one nand over the midstemal region, ‘+ Keeong eons extended, using the body weight, give quick compressions tb eeoreas te sterum donmwarts for about 1.5-2 inches and release mecately Iherecty restores ercuaton to the myocardium and brain, + Repeat ermeda'sy in Gack succession (an average rate of 60 cororessons per mrvie) * Fig. 1.10 (A a + Now position your shoulders exactly above the hands, keeping elbows straight and using the weight of the upper body, conduct smooth but definitive seties of chest compressions at the rate c. 1 compression/sec). “Aecacli compre wards with a sudden jerk. There will be an clastic recoil of the rib cage as soon as the force of com- pression is released instantaneously. Give a slight pause before the next compression, Continue the gle of compression till the restoration of circula- tion is evident. + Each compression results in the ejection of blood from the ventticks (ventricular systole), + Momentary pause following each compression re- sults in filling of the blood into ventricles (ven- tricular diastole), “Ensure the restoration of circulation by palpating the carotid pulse following cach compression cycle. Failure of both the systems In the event of fallure of both the systems, ideally ewo rescuers should be available to maintain smooth continuity, However, only a single person lhas wo manage the fsilure ‘of both the syscems by switching on alternately from one sytem to the other. In such an event, the average normal “chest compressions of 60 beats/min and an average normal ) Ckcuiatory resuscitation. compressions co lung inflation has to be completed every. 1 see by quick switch-overs. CYT This process of resuscitation once begun should be contin: ued til the restoration of the system failure, sometimes even Up to the moment the patient reaches the hospital emer- gency ward. Tests for the successful application of life supports: 1, The adequacy of cerebral circulation + Tese by pupillary reaction 2, Adequacy of respiration + Return of the slow up anc down movement of the chest (rib cage) 3. Adequacy af circulation + Return of the central carotid pulse, its volume and rhythm + CPR in infants and children + Avoid exaggerated head-til + Forartficial ventilation, rescuers mouth should be covering both the nose and the open mouth + Smaller breathes need 10 be delivered at a faster rate of one every 3 see + For cardiac arrest, give external cardiac massage+ For external cardiac compressions, use the heel of only one hand or the index and the middle fingers ‘= The sternal depressions are smaller: 0.75-1 inch for infants and 1=1.5 inches for children + The rate of chest compression should be faster about 100 beats/min Precordial Thump (Fig. 1.11) Precordial thump is performed when a cardiac arrest oc- cuss without hypoxia. Only one quick and strong hard blow is delivered over the midsternal area by the ulnar aspect of hand with the forearm supinated. If there is no restoration of heart beats, the conventional method of the cycle of chest compressions is initiated instandly, Normal and functional ranges of movements at various joints are oie in Table 1.17. intros areata ag io ton the midsternal aoa. a wanted arc are wits prascnd p it blow is given over tho mister Ssloenan sonra nrg ‘1 1Canere i no Invent ngtanty,