Resuscitation (CPR)

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 Definition

Resuscitation is the combination of the technique used for sustaining lives of those patients whose spontaneous breathing and heart beat is stopped.this is also termed as cardiac pulmonary resuscitation CPR.

Principles

1.   - with three minutes the flow of oxygenated blood is to be restored to the brain by means of artificial respiration and chest compression to prevent irreversible brain damage.

2.      -  transportation of the casualty to the hospital as quickly as possible to receive other treatments i.e  defribrillation ,drugs etc

                  ABC of resuscitation


A - airway
B - breathing
C - circulation
  

  Airway 

 Open the airway: 

1. Clear the secration,dentures, debris and other foreign bodies out of his mouth and throat .

2 . Place the casualty on his back.

3 .use head tilt and chin lift method  place two fingers under the casualty's chin,lift the jaw at the sametime,place the other hand on the casualty's forhead and tilt the head background.


Note:

In case of head or neck injuries tilt the head carefully just enough to open the airway.


Breathing. 

Look listen and feel for 30 second before deciding that the breathing is absent, and if there is no breathing restored, check for cyanosis.

Restore the breathing by: 

1 mouth to mouth ventilation.
2 mouth to nose ventilation.

Mouth to mouth ventilation

1 -place the casualty on his back tilting his head back.

2 - clean saliva and secreations from the mouth by using clean handkerchief or clean cloth.

3-  remove the dentures, if any.

4-  place a piece of clean cloth or handkerchief over the casualty's lips.

5-. Open your mouth wide and take a deep breath.

6-. Place your lips around the casualty's mouth making a good seal and blow the inhaled air into his mouth by pinching his nose with your index finger and thumb until the chest expands (take 2second for full inflation).

7 - remove the lip and allow the chest to fall.

8 - repeat the inflation for 16-18 times pr minute until natural breathing is restored .

9 - check casualty's pulse rete to make sure that the heart is breathing. If the heart is not beating normally, then external chest compression has to be performed immediately.

         Mouth to nose ventilation

Mouth to nose breathing may be applied on the above mentioned principal when it is not possible to open casualty's mouth due to injury.

                   

Signs of effective ventilation

 1 increasing heart beat. 
2 spontaneous respiration.
3 skin colour improvement


      Circulation

If there is no pulse felt , following mouth to mouth ventilation then immediate chest compression has to be initiated along with mouth to mouth ventilation to ensure blood circulation to the brain.

 Chest compression

1 position  the casualty flat on his back on any flat and hard substance.

2 give a heard and direct blow with the closed fist below the left nipple which may stimulate the heart and it starts beathing.

If the heart start beating 

 

         Continue thumping the heart 60  time s a minute and continue giving artificial respiration 15 times per minute simultaneously ie at the ratio of 4,:1 .

If  the heart does not start beating then  cardiac massage has to be applied which is as under:  

1 stand at the suitable side of the casualty.

2 place the heel of the left hand on the lower end if the sternum 1/2 inches above the xiphisternum.

3 places the heel of the right hand on the top of the left hand and interlock the fingers                 

4 place the heel of the right hand on the top of the hand and interlock the fingers.

5 press 1 1 1/2 inches inside with pressure applied from the shoulder joint keeping the elbow straight.total 60 of such pressure should be applied in a minut .

6 continue artificial respiration 15 per minute simultaneously with of 4:1. 

7 check for carotid pulse and observe for disappearance of cyanosis.

8 continue the procedure toll the casualty reaches the nearest medical facilities. 


Note : 

1 if there are two first aiders, ones can give artificial rer and the other can give cardiac compression . 

2 for children up to 10 years, 80-90 cardiac compression per minute with one hand are sufficient and the children below 2year,100 cardiac compression with ones hand is be applied.


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