Cardiopulmonary resuscitation, commonly known as CPR, is a lifesaving technique crucial in emergencies such as a heart attack or near drowning, where someone’s breathing or heartbeat has stopped. It’s a procedure that combines rescue breathing, which provides oxygen to the person’s lungs, and chest compressions, which keep the person’s blood circulating. Immediate CPR can double or even triple a cardiac arrest victim’s chance of survival.

Performing CPR on an adult involves assessing the situation, ensuring the person’s safety, and delivering chest compressions at the correct rate and depth. If one has received proper training and is confident, they may also administer rescue breaths in conjunction with compressions. Otherwise, hands-only CPR is recommended, focusing solely on chest compressions until professional help arrives.

Knowing how to execute CPR effectively is essential since it can significantly impact the outcome for an individual in cardiac distress. Training and refreshers on the technique are recommended, so one can act confidently and swiftly should the need arise. It’s about preserving life and giving victims the best possible chance until emergency services can take over.

Recognising a Cardiac Arrest

Identifying a cardiac arrest in an adult promptly can make a critical difference. It’s vital that one can assess the victim and call for emergency services without delay if a cardiac arrest is suspected.

Assessing the Adult Victim

When an adult is suspected to be in cardiac arrest, it is necessary to assess their responsiveness. If one finds an individual unresponsive, they should check for normal breathing. Agonal breathing, which may be an occasional gasp or shallow breath, should not be mistaken for normal breathing. An absence of or abnormal breathing pattern in an adult who is unresponsive can indicate a cardiac arrest.

Calling Emergency Services

Immediately after confirming that the adult is unresponsive and not breathing normally, it’s critical to call for emergency assistance. In the UK, this means dialling 999; in the US, one would dial 911. It is essential to provide clear and concise information to the emergency operator, including the exact location and the apparent condition of the adult victim. Always stay on the line until instructed to hang up, as the operator may provide important guidance on administering CPR before the paramedics arrive.

Basic Life Support Steps

Basic Life Support (BLS) is a critical process in emergencies where someone’s breathing or heart has stopped. The steps involve ensuring safety, assessing responsiveness, managing the airway, checking for breathing, and providing chest compressions and rescue breaths if necessary.

Safety and Response

One must first ensure the area is safe for themselves and the injured person. They must then check for responsiveness by gently shaking the person’s shoulders and asking loudly, “Are you alright?”

Airway Management

If there is no response, they should proceed to open the person’s airway by tilting the head back and lifting the chin. It is vital to ensure the airway is clear of any obstructions.

Breathing Check

The next step is to check for normal breathing, looking for chest movements, listening for breath sounds, and feeling for breath on their cheek, which should be conducted for no more than 10 seconds.

Chest Compressions

If the person is not breathing normally, chest compressions should be initiated immediately. Compressions should be firm and deep, at a depth of 5 to 6 cm, with a rate of 100 to 120 compressions per minute.

Rescue Breaths

After every 30 chest compressions, rescue breaths should be given. To perform a rescue breath, tilt the person’s head, lift their chin, pinch the nose shut, and give two full breaths into the person’s mouth.

Using an Automated External Defibrillator (AED)

When a cardiac arrest occurs, the use of an Automated External Defibrillator (AED) can be critical in increasing the chances of survival. In the UK, it is recognised by Resuscitation Council UK that the involvement of bystanders in applying AEDs alongside CPR makes a notable difference to outcomes.

AED Setup

To use an AED, one initially needs to power on the device. After checking that the area is safe, they must expose the patient’s chest to ensure proper pad placement. The AED kit typically includes a pair of pads and an instruction manual, though many modern AEDs provide vocal instructions as well.

  • Switch on the AED: Locate and press the power button.
  • Prepare the Patient: Remove any clothing from the chest and wipe it dry.
  • Attach AED Pads: Follow the diagrams on the AED pads to place them correctly on the patient’s bare chest.

AED Application

Once the AED is set up, the individual must apply the pads correctly to allow the device to analyse the patient’s heart rhythm. Correct placement is crucial; one pad is placed to the right of the chest, below the collarbone, and the other to the left side, below the armpit.

  • Position of Pads:
    • Right Pad: Below the right collarbone.
    • Left Pad: Lower left side of the chest.

Applying the AED pads to a bare chest allows for a more accurate reading and ensures that the pads stick properly.

Following AED Prompts

After the pads are correctly applied, the defibrillator will analyse the heart’s rhythm. It is vital that everyone stands clear of the patient while the AED analyses and, if necessary, delivers a shock. The AED will provide vocal instructions on if and when to administer CPR.

  • Clear the Area: Ensure everyone is away from the patient during analysis.
  • Follow Instructions: The AED will guide the user through voice prompts.
  • CPR Intervention: If instructed, perform CPR and follow the timed prompts of the AED.

The above steps highlight the basics of using a defibrillator in a situation where an individual suffers from cardiac arrest. Familiarising oneself with these steps can prepare a person to act promptly and effectively, which is critical for increasing the patient’s survival odds.

CPR Technique and Quality

High-quality CPR technique is essential for increasing the patient’s chance of survival. Precise hand placement, adequate compression depth and rate, and minimal interruptions are vital components of effective CPR.

Hand Placement

The rescuer should place the heel of one hand in the centre of the chest, right between the nipples and then lay the other hand on top, interlocking the fingers. They must ensure that pressure is applied straight down on the sternum, avoiding pressing on the ribcage or stomach.

Compression Depth and Rate

  • Depth: Compressions should be at least 5 centimetres but not exceeding 6 centimetres deep.
  • Rate: Aiming for a rate of 100 to 120 compressions per minute is crucial for maintaining blood circulation.

One’s training and regular practice help maintain the necessary muscle memory and efficiency for achieving these requirements.

Minimising Interruptions

To ensure the maximal benefit of chest compressions:

  • Limit interruptions to less than 10 seconds.
  • Quickly swap between performing compressions and providing rescue breaths, if trained to do so.

It is important that everyone involved in CPR provision refreshes their training regularly to maintain skill proficiency and understand the latest CPR steps, thereby reducing the potential for interruptions during an emergency response.

Special Circumstances

When administering cardiopulmonary resuscitation (CPR), certain scenarios require adaptation from the standard protocol. Understanding these specific circumstances is crucial in providing effective aid.

CPR in Public Places

In public places, the presence of bystanders can significantly influence the administration of CPR. Bystanders trained in basic life support can initiate CPR before medical professionals arrive. It is advised for individuals to use hands-only CPR if they are not fully confident in performing rescue breaths. Emergency services should be alerted as soon as possible, and one should check for accessible equipment like automated external defibrillators (AEDs), which are often located in public venues.

CPR with Multiple Rescuers

If there are multiple rescuers, they should coordinate to provide advanced life support (ALS) if they are trained to do so. Taking turns in performing chest compressions can help prevent fatigue and maintain the quality of compressions. They should follow the Resuscitation Council UK guidelines to ensure synchronicity in their efforts and maximise the patient’s chance of survival. It is critical that rescuers communicate effectively, swapping roles every two minutes to ensure consistency and efficiency.

Aftercare Following Resuscitation

Following successful resuscitation, it is crucial to place the individual in a stable position and monitor their condition continuously until emergency services arrive. Ensuring airway patency and responding to any changes in their status are key priorities.

Recovery Position

If the individual is breathing but remains unconscious after resuscitation, they should be placed in the recovery position. This involves:

  • Laying the individual on their side, ensuring they are supported so they do not roll onto their face or back.
  • Extending the arm they are lying on and placing the other arm at a right angle, creating a stable structure.
  • Bending the knee that’s on top upwards to prevent rolling.
  • Checking that the airway remains clear and is not obstructed by the tongue or vomit.

Continued Care

Until the ambulance arrives, continued care involves:

  • Regularly monitoring breathing and responsiveness. If the individual stops breathing at any point, cardiopulmonary resuscitation (CPR) may need to be recommenced.
  • Assessing circulation, airway, and breathing (the ‘CAB’ of first aid) at frequent intervals.
  • Keeping the individual warm and comfortable, using blankets or coats if necessary.
  • Not providing any food or drink, as this can present a choking risk to someone who is only partially conscious.
  • Reassuring the individual if they regain consciousness, explaining what has happened and that help is on the way.

Legal and Ethical Considerations

When addressing the legal and ethical considerations of cardiopulmonary resuscitation (CPR), one must consider the aspects of consent and the presence of Do Not Attempt CPR (DNACPR) orders. These facets are guided by overarching principles set by entities such as the Resuscitation Council UK and the National Institute for Health and Care Excellence (NICE).

Consent to CPR

In the UK, consent is a critical component of performing CPR on an adult. Healthcare professionals are tasked with ensuring that consent, where possible, is obtained before commencing resuscitation. This aligns with guidelines from the Resuscitation Council UK, which stress the importance of considering the patient’s autonomy and wishes. In emergency situations where a person is unable to give consent due to incapacitation, it is assumed that they would want to be resuscitated unless there is evidence to the contrary.

Do Not Attempt CPR (DNACPR) Orders

A DNACPR order is a medical decision that CPR should not be carried out, as it would not be in the best interests of the patient. It is a determination made after careful consideration of the patient’s health status, taking into account their wishes, beliefs, and values. The Resuscitation Council UK collaborates with healthcare professionals to provide clear ethical guidelines that should be considered when creating DNACPR orders. Such orders are also made following the NICE guidelines, ensuring that they are based on the most current evidence and best practice standards.

CPR for Different Demographics

When performing CPR, it’s crucial to understand that procedures and techniques vary depending on the age of the patient. Specific adaptations are necessary for children, infants, and special cases such as pregnant individuals.

Differences in CPR for Children and Infants

Children and infants require modified CPR techniques due to their smaller body size and different physiological needs. For children between the ages of 1 and puberty, one should use the heel of one hand for chest compressions, pressing down approximately 5 cm, with a compression rate of 100 to 120 per minute. Compared to adults, where two hands might be necessary to achieve the recommended depth of 5-6 cm. With infants under 1 year old, two fingers should be used, targeting a compression depth of about 4 cm.

CPR Adaptations for Pregnant Victims

Pregnant individuals may need particular adjustments while performing CPR to increase the chances of survival for both the mother and the unborn child. It involves manually displacing the uterus to the left, which can improve blood flow during CPR. Chest compressions should still be administered at the standard rate of 100 to 120 compressions per minute, pressing down by 5 to 6 cm. However, during the advanced stages of pregnancy, a team approach is advised to handle additional complications.

Training and Certification

Proper training and certification in cardiopulmonary resuscitation (CPR) are crucial for effectively performing this life-saving procedure. They equip an individual with the skills required to administer CPR in emergency situations.

CPR Training Courses

CPR training courses provide the theoretical knowledge and practical skills needed to perform CPR on adults, with specific courses also available for paediatric first aid. We offer a CPR Certificate Training Course that prepares participants for workplace emergencies, covering adult resuscitation techniques comprehensively. These courses often culminate in a certification that indicates the individual is trained in CPR and Basic Life Support (BLS), in line with the most current guidelines.

Maintaining CPR Skills

It is paramount that individuals maintain their CPR skills post-certification to ensure proficiency. To aid in this, organisations such as the Resuscitation Council UK offer a range of courses designed for healthcare professionals and trainers to keep their resuscitation practice updated. Regular refresher courses are recommended, as they help trained individuals remember the correct procedures and adapt to any new techniques that may have been introduced.

Improving Survival Rates

Effective measures in community awareness and immediate response can significantly enhance the chances of survival for individuals experiencing a cardiac arrest. These efforts are crucial in the critical minutes before emergency services arrive.

Community Awareness

The likelihood of surviving a cardiac arrest significantly increases with widespread public knowledge on how to perform CPR and use automated external defibrillators (AEDs). Initiatives to improve rates of bystander CPR and AED use have shown positive impacts on survival rates. Training and awareness campaigns, such as those led by the Resuscitation Council UK, aim to equip individuals with the necessary skills to respond effectively in the event of a cardiac emergency.

Importance of Immediate Response

When a heart attack leads to a cardiac arrest, every second is critical. Immediate initiation of CPR by a bystander can double or even quadruple the chance of survival. Ensuring prompt defibrillation, ideally within 3–5 minutes of collapse, can yield survival rates of up to 50–70%. However, with each passing minute, the probability of survival to hospital discharge diminishes by 10%. According to the British Heart Foundation, less than 10% of people in the UK survive an out-of-hospital cardiac arrest, highlighting the imperative need for immediate action.

Resources for CPR Knowledge

The availability of insightful resuscitation training resources and accessible online educational material is crucial for those seeking to learn or refresh their knowledge of CPR (cardiopulmonary resuscitation) techniques.

Local Resuscitation Courses

At Skills Training Group, we offer a range of first aid courses, both online or face to face.

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