CPR

CPR - Cardiopulmonary resuscitation is an emergency procedure for people in cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed both in hospitals and in pre-hospital settings.

CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to ventilate the lungs and pass oxygen in to the blood, called artificial respiration. Some protocols now downplay the importance of the artificial respirations, and focus on the chest compressions only (CCR).

Despite its name, CPR is unlikely to restart the heart; its main purpose is to maintain a flow of oxygenated blood to the brain and the heart, which are both the most essential organs to life and the most vulnerable to damage from lack of oxygen (hypoxia). Effective CPR helps by delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage. Advanced life support, including intravenous drugs and defibrillation (the administration of an electric shock to the heart) is usually needed to restore a viable or "perfusing" heart rhythm-one which will support life. This only works for patients in certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than the 'flat line' asystolic patient, although CPR can help induce a shockable rhythm in an asystolic patient.

Indications

Blood circulation and oxygenation are absolute requirements in transporting oxygen to the tissues. The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. If blood flow ceases for one to two hours, the cells of the body die unless they get an adequately gradual blood flow, (provided by cooling and gradual warming, rarely, in nature (such as in a cold stream of water) or by an advanced medical team). Because of that CPR is generally only effective if performed within seven minutes of the stoppage of blood flow. The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures as sometimes seen in near-drownings prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain death, and allows the heart to remain responsive to defibrillation attempts.

If the patient still has a pulse, but is not breathing, this is called respiratory arrest and artificial respiration is more appropriate. However, since people often have difficulty detecting a pulse, CPR may be used in both cases, especially when taught as first aid.

source: wikipedia.org

Circulation

Once oxygen can be delivered to the lungs by a clear airway and efficient breathing, there needs to be a circulation to deliver it to the rest of the body.

Non-breathing patients

Circulation is the original meaning of the 'C' as laid down by Jude, Knickerbocker & Safar, and was intended to suggest assessing the presence or absence of circulation, usually by taking a carotid pulse, before taking any further treatment steps.

In modern protocols for lay persons, this step is omitted as it has been proven that lay rescuers may have difficulty in accurately determining the presence or absence of a pulse, and that, in any case, there is less risk of harm by performing chest compressions on a beating heart than failing to perform them when the heart is not beating. For this reason, lay rescuers proceed directly to cardiopulmonary resuscitation, starting with chest compressions, which is effectively artificial circulation. In order to simplify the teaching of this to some groups, especially at a basic first aid level, the C for 'Circulation' is changed for meaning 'CPR' or 'Compressions'.

It should be remembered, however, that health care professionals will often still include a pulse check in their ABC check, and may involve additional steps such as an immediate ECG when cardiac arrest is suspected, in order to assess heart rhythm.

Breathing patients

In patients who are breathing, there is the opportunity to undertake further diagnosis and, depending on the skill level of the attending rescuer, a number of assessment options are available, including:

• Observation of colour and temperature of hands and fingers where cold, blue, pink, pale, or mottled extremities can be indicative of poor circulation
• Capillary refill is an assessment of the effective working of the capillaries, and involves applying cutaneous pressure to an area of skin to force blood from the area, and counting the time until return of blood. This can be performed peripherally, usually on a fingernail bed, or centrally, usually on the sternum or forehead
• Pulse checks, both centrally and peripherally, assessing rate (normally 60-80 beats per minute in a resting adult), regularity, strength, and equality between different pulses
• Blood pressure measurements can be taken to assess for signs of shock
• Auscultation of the heart can be undertaken by medical professionals
• Observation for secondary signs of circulatory failure such as oedema or frothing from the mouth (indicative of congestive heart failure)
• ECG monitoring will allow the healthcare professional to help diagnose underlying heart conditions, including myocardial infarctions
  

source: wikipedia.org

Breathing

Unconscious patients

In the unconscious patient, after the airway is opened the next area to assess is the patient's breathing, primarily to find if the patient is making normal respiratory efforts. Normal breathing rates are between 12 and 30 breaths per minute, and if a patient is breathing below the minimum rate, then in current ILCOR basic life support protocols, CPR should be considered, although professional rescuers may have their own protocols to follow, such as artificial respiration.Rescuers are often warned against mistaking agonal breathing, which is a series of noisy gasps occurring in around 40% of cardiac arrest victims, for normal breathing.

If a patient is breathing, then the rescuer will continue with the treatment indicated for an unconscious but breathing patient, which may include interventions such as the recovery position and summoning an ambulance.
Conscious patients

In a conscious patient, or where a pulse and breathing are clearly present, the care provider will initially be looking to diagnose immediately life-threatening conditions such as severe asthma, pulmonary oedema or haemothorax.

source: wikipedia.org

Airway

Unconscious patient

In the unconscious patient, the priority is airway management, to avoid a preventable cause of hypoxia. Common problems with the airway of patient with a seriously reduced level of consciousness involve blockage of the pharynx by the tongue, a foreign body, or vomit.

At a basic level, opening of the airway is achieved through manual movement of the head using various techniques, with the most widely taught and used being the "head tilt — chin lift", although other methods such as the "modified jaw thrust" can be used, especially where spinal injury is suspected, although in some countries, its use is not recommended for lay rescuers for safety reasons.

Higher level practitioners such as emergency medical service personnel may use more advanced techniques, from oropharyngeal airways to intubation, as deemed necessary.














Conscious patient

In the conscious patient, other signs of airway obstruction that may be considered by the rescuer include paradoxical chest movements, use of accessory muscles for breathing, tracheal deviation, noisy air entry or exit, and cyanosis.

source:wikipedia.org

ABC - Airway, Breathing, Circulation.

ABC in first aid it stands for Airway, Breathing and Circulation.
At all levels of care, the ABC protocol exists to remind the person delivering treatment of the importance of airway, breathing, and circulation to the maintenance of a patient's life. These three issues are paramount in any treatment, in that the loss (or loss of control of) any one of these items will rapidly lead to the patient's death.

The basic application of the ABC principle is in first aid, and is used in cases of unconscious patients to start treatment and assess the need for, and then potentially deliver, cardiopulmonary resuscitation.
In this simple usage, the rescuer is required to open the airway (using a technique such as "head tilt - chin lift"), then check for normal breathing. These two steps should provide the initial assessment of whether the patient will require CPR or not.
In the event that the patient is not breathing normally, the current international guidelines indicate that chest compressions should be started.

source:wikipedia.org

First aid

First aid is the provision of initial care for an illness or injury. It is usually performed by a non-expert person to a sick or injured casualty until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.

While first aid can also be performed on animals, the term generally refers to care of human patients.

source:wikipedia.org