First Aid/CPR

< First Aid

Contents
• 1 Warning
• 2 CPR for adults
o 2.1 Assessing the situation
o 2.2 Approaching the patient
o 2.3 Calling for help
o 2.4 Commencing CPR
 2.4.1 A for Airway
 2.4.2 B for Breathing
 2.4.3 C for Circulation
 2.4.4 D for Defibrillation
• 3 CPR for children age twelve months to eight years
• 4 CPR for infants
• 5 Notes
• 6 See also

• 7 External Links

[edit] Warning
Even when performed correctly, CPR can injure the person it is performed on. This is a
normal occurrence, and one should realize that it is more important to keep a person's
body tissues perfused with oxygen than to refrain from performing CPR out of fear of
causing rib fractures or other minor damage. CPR is also never guaranteed to save
someone's life. CPR should only be performed on a person in cardiac arrest (no signs of
circulation) or on a CPR mannequin. Those wishing to learn and perform CPR should
take CPR training from a qualified instructor. Reading the Wikipedia is not a substitute
for first aid training. Moreover, since the Wikipedia may be altered by anyone at any
time, some parts of the article may be inaccurate.

[edit] CPR for adults

CPR is best performed by someone who has received training, but generally it would be
unwise to wait for such a person to arrive before commencing CPR. Adult CPR is also
appropriate for children over 8 years old. Child CPR (below) is indicated for children
smaller than an average 8-year-old.

[edit] Assessing the situation

The first step in a CPR scenario is to ensure that there is no ongoing danger to any person
involved before the patient is approached. The cause of a first accident may cause a
second one. These may include:

• Poisonous gas or live electric wires

• Ongoing traffic
• Explosives or flammable materials [this would make defibrillation dangerous]

[edit] Approaching the patient

Approaching the patient: the rescuer comes in front of the patient, introduces herself, and
asks the patient to squeeze her hand, in case she would be too weak to speak

The person attempting CPR approaches the patient visibly and announces his/her role and
offers help. Direct questions ("Can you hear me?", "What happened?", "Where are you
hurt?") or instructions ("Open your eyes!") are favoured. It is often recommended that
one announces to the patient that he/she will be touched ("I am going to touch your
shoulder, all right?"); the rescuer can take the hand of the patient and ask him to squeeze
his hand, in case the patient is conscious but too weak to speak, or incapable.

If the patient responds and there are no safety issues, CPR is unnecessary, and more time
is available to summon help as needed.

If there is no response, meaning the patient is unconcious, a single rescuer will generally
need to call for help before commencing CPR.

[edit] Calling for help

Anyone may call for help and report an unconscious patient. The primary rescuer may
need to do this him/herself if no others are available. Rescue services will generally
require the following information:

1. Name of the person calling

2. Place and originating telephone number/radio bandwidth
3. Presence of an unconscious patient and other important safety issues (e.g. obvious
large volume of blood loss, head injury, burns)

[edit] Commencing CPR

[edit] A for Airway

Quick inspection of the mouth may reveal a blocked airway. If possible, the patient
should be placed on his/her back on a firm surface. The next step is to get a further view
of the mouth and throat and to make as much space for breathing as possible:

• In the possibility of a neck injury, lifting the chin or jaw may be enough to
stabilise the airway;
• In other cases, tilting the head back will lift the tongue away from the back of the
mouth, opening the airway.

[edit] B for Breathing

Proper check of the patient's respiration : the helper listens to the breath, tries to feel the
air flowing on her cheek, the chest going up and down, and see the movements of the
chest.

After opening the victim's airway, breathing effort is checked. Placing one's cheek in
front of the victim's mouth (about 3-5 cm away), while looking at the patients chest,
should allow one to detect any of the following signs:

1. feeling the airflow on the cheek

2. hearing the airflow
3. seeing the chest rise and fall

This is done for no less than 5 to no more than 10 seconds. If there is no breathing,
artificial respiration is commenced. Both the abdomen and the chest should rise and fall
together.

If the victim is breathing, he/she is placed on the side (in the recovery position) and
covered, unless suspected cervical spine injury.. More time is now available to call for
help. The absence of breathing effort is a further reason to summon emergency medical
services (or to update them that the patient is not breathing) and to start mouth-to-mouth
breathing. If there is a public access defibrillator nearby, a bystander may be able to fetch
it.
mouth-to-mouth rescue breathing. The head of the patient is tilted backward. The rescuer
closes the patient's nose with one hand, while lifting the chin with her other hand to keep
the mouth open.

Rescue breathing is the act of mechanically forcing air into a patient's respiratory system;
it is only indicated in respiratory arrest, and not in a weakly breathing patient. Ideally, one
should never blow into an unknown body for fear of projections of bodily fluids (blood,
vomit, etc); thus, a CPR mask or what is called a face shield would be better to protect
the rescuer.

Initially, two rescue breaths are given. In rare cases these can help a nearly breathing
patient recover spontaneous respiration.

• Tilt back the head of the patient to extend his airway. In most unconscious
patients, the jaw will fall open.
• Use two fingers to lift the chin. This will lift the casualty's tongue and stop it
blocking the airway.

In some cases (like some cases of epilepsy), the muscles of the patients are so
contracted that it is impossible to open the mouth. Note that the patient will not
"swallow" their tongue, contrary to urban legend. If breathing into the mouth is
impossible because of a clenched jaw, seal the lips closed and instead breath into
the nostrils.

• Close the nose of the patient with your free hand

• take a deep breath, put your mouth on the mouth of the patient in an airtight
manner, and blow into the mouth of the patient slowly and gently for no more
than 1 seconds. Do not try to inflate the lungs like a balloon, breaths should be
gentle to prevent air from entering the stomach.

When you have given two rescue breaths, check for signs of circulation (check the
carotid pulse if that is what you have been taught to do), while keeping an eye on his
respiration. Chances are that

• the patient might have recovered spontaneous respiration thanks to your rescue
breaths
• the patient might be in a state of cardio-respiratory arrest
If the patient has recovered spontaneous respiration, put him in the recovery position
unless suspected cervical spine injury, cover him, and monitor his respiration on a regular
basis until a mobile medical unit arrives.

If the patient is in a state of cardio-respiratory arrest CPR.

If you are on your own, and the casualty's condition is obviously the result of injury,
drowning, or choking, perform CPR for two minutes (5 cycles of chest compressions and
breaths at a ratio of 30:2), and then go and get help. For any other adult casualty, go and
get help yourself immediately if you find that breathing is absent. When you return to the
patient begin this procedure again, starting with opening the airway.

If breaths do not reach the lungs (victims' chest does not rise), probable causes are:

• The victim's tongue is still obstructing the airway. You need to repeat the chin lift
and head tilt. This is by far the most common explanation.
• Air is escaping elsewhere. You need to make sure you are sealing around the
mouth and pinching the nose fully.
• There is a foreign body obstructing the airway. In this situation, reposition their
head and look in the mouth for obstructions. Try to give one more breath. If the
chest is not rising, look for and remove any foreign object in the mouth, repeat the
chin lift and head tilt and try again. If it does go in, give one more breath.
• If breaths are still ineffective, (if trained, check pulse as taught), immediately go
to chest compressions. These alone may force whatever item obstructing the
airway out so you can safely remove it.
• If the breaths do go in and if there is a pulse but no breathing, continue rescue
breathing at a rate of 1 every 5-6 seconds (10-12/min).

If you did not tilt the head because of possible neck injury but the breaths are still not
entering the lungs, tilt the head anyway. The victim will die without air in their lungs.

[edit] C for Circulation

In December 2000, ILCOR (The International Liason Committee on Resusitation)

recomended against teaching Lay Persons to check for a pulse, but rather to check for
other signs of circulation such as coughing, twitching, or shallow breathing. In November
2005, this recomendation was further revised to teach Lay Persons to begin chest
compressions on all unresponsive non-breathing patients without checking for signs of
circulation.
Checking the carotid pulse

If students are trained to take the casualty's pulse, it is performed as follows.

To check for a pulse place your fingers on the victim's Adam's Apple and slide them to
the side until you find a groove in the neck above the carotid artery. Check for pulse for
no more than ten seconds. In infants the pulse is taken in the brachial artery on the inside
of the upper arm. Pulses can also be found in the wrists and the ankles, although, in an
emergency situation, they are less likely to be present than a carotid pulse.

The American Heart Association notes that agonal respirations should not be confused
with normal breathing. Agonal respirations are sometimes seen in cardiac arrest victims
and is a physiological reflex to the lack of oxygen. They are characterized by infrequent
gasping breaths. If agonal respirations are present, they should be ignored and CPR
promptly started if no signs of circulation are detected.

If there is no circulation:
Positioning the hand before giving the CPR. The hand must be placed two fingers away
from where the ribs meet together (the xyphoid process).

Send a bystander to call for help using the emergency telephone number. Use your hand
and point at the nearest well abled bystander and tell him or her using an authoritative
voice:

You, call *insert emergency telephone number here*, get an AED and return

Even if alert has already be given, this will help the medical unit better prepare their
intervention.

Begin chest compressions:

• Place the victim on their back on a firm surface. (a soft surface will render the
compression completely useless).
• Kneel next to the victim's chest.
• Remove, open or cut the patient's excess clothes. CPR must be performed close to
the patient’s chest (although doing CPR through a t-shirt or similar thin clothing
is acceptable).
• Place your hands one on top of the other with your fingers interlaced "in the
center of the chest, between the nipples".
• It is especially important to avoid making compressions at the exact point where
the ribs meet; in order to avoid breaking the Xyphoid Process which could cause
tremendous damage to the lungs or other internal organs.
• Shift your weight forward on your knees until your shoulders are directly over
your hands.
• Keeping your elbows locked straight, repeatedly bear down and then come up,
bear down and come up. You must depress the chest of an average adult about 2
inches (4-5cm) with each compression. It is important to release completely after
each chest compression.
• Compress the chest "hard and fast" 100 times every minute. To get the right speed
and rhythm, count out loud as you do the compressions, saying "1, 2, 3, 4, 5, 6,
7, ... 28, 29, 30". Try to compress and release for equal periods of time.
• After each 30 compressions*, give the victim 2 rescue breaths (see B for
Breathing)
• Return to the victim's chest and put your hands in the correct position again.
• Repeat this cycle of 30 and 2* for a total of 5 cycles, which is 2 minutes, than
check the airway, breathing, and circulation; then repeat the process over again.
Correct position for CPR. The arms are fully extended and the thrusts are given from the
hips.

Continue until:

• breathing returns
• qualified help arrives and you are asked to stop (if a defibrillator arrives, its
operation will have priority on the CPR).
• you are too exhausted to continue.

Common mistakes in performing chest compressions include rocking back and forth and
bending the elbows. It is also important to note that, particularly in elderly patients,
crepitations will often occur. Crepitations are the shattering of bones in the rib cage and
sternum. They can be both heard and felt. Do not discontinue CPR due to crepitations,
although check your hand position if bone breakage appears to be excessive.

[edit] D for Defibrillation

Typical view of the defibrillator operator. The leader is at the head of the patient,
administrating oxygen. Note how the head of the patient in secured between the leader's
knees. The defibrilation patches are on.
For cardiac arrest following a heart arrhythmia (which can occur after a heart attack,
electrocution, electroltye imbalance), defibrillation is the most effective treatment. CPR
is not usually effective on its own, but since defibrillation is rarely available within four
to five minutes of cardiac arrest, bystander CPR remains essential in preventing oxygen
deprevation damage to the heart and brain. New research indicates that when a person has
been in prolonged cardiac arrest and a defibrillator arrives, two to three minutes of CPR
before attempting defibrillation improves the victim's prospects (Weisfeldt 2004).

Automated external defibrillators are placed in busy public places such as malls and
office buildings or in hard-to-reach locations such as ships and aircraft. They are
therefore referred to as public access defibrillators. In most countries, police units also
carry them. You might thus be able to perform precise defibrillation before the arrival of
the medical units.

The probability of a successful defibrillation starts at 90% immediately after the cardiac
arrest, and decreases by ten percent every minute. After ten minutes of CPR without
defibrillation, chances of survival are low. Without CPR, chances of survival drop
dramatically after only two minutes. You should perform CPR to the best of your ability
until a trained medical professional (for example, a paramedic) is available to assess the
casualty's condition.

Basic usage of an AED defibrillator is shown as followed. Do not use this information
unless you are qualified by a trained instructor to do so.

If you find a victim on the ground, preform 2 full minutes of CPR, starting with checking
responsiveness, then call for help and get an AED, unless someone else, other than the
victim, is there with you, have them retrieve one. If you see a victim go down, if
available, use an AED first. If the AED is not available, continue CPR until one arrives.
When an AED arrives, you must:

1. Move the victim to a dry, safe location and dry chest area if wet.
2. Unzip or open the AED unit.
3. Remove shirts, jackets, and on women, remove bras.
4. Remove (rip out) any metal objects in the chest area, such as piercings and
necklaces.
5. Remove medicine patches and wipe the area dry.
6. Turn on the unit and follow its instructions.
7. Apply pads to the chest as according to the pictorial directions on the pads.
8. Plug the pads into the unit.

Once you plug the pads in, it will analyze the victims heart rhythm. Make sure no one is
touching the victim during this time. There will be two possible outcomes and solutions,
both are shown below:

1. It will tell you that no shock is advised.

2. it will tell you that a shock is advised.
For the first outcome, leave the pads on and continue CPR starting with chest
compressions, unless the device has not been updated. If it has not, follow what the
device says, no matter what you were taught. For the second outcome, it will start
charging. At this point, no persons should be touching any part of the victim. If you touch
the victim when it is analyzing the victim, it may mistake your heart rhythm for the
patients. Once it is done charging, it will tell you to push the shock button. Again make
sure you, and everyone else is clear of the victim. If you touch the victim when the unit
discharges, you will be shocked. This will not only injure or kill you, it would deliver less
energy to the victim, thus rendering the shocks ineffective. After the shock is delivered, it
will reanalyze the victim. It will produce the two possible outcomes stated above. If no
shock was advised, leave the pads on and continue CPR starting with chest compressions
for 2 minutes, or until further help arrives.

For children (1-8), it is exactly the same, with the exception of the pads. Child size pads
will be smaller. If there are no child size pads, use the adult ones, placing one on the
chest and one on the back. DO NOT USE CHILD PADS ON ADULTS!
Use of an AED on infants is not recommended.

If the victim has an internal defibrillator or pacemaker, place the pads about an inch
below it. If the victims chest is hairy, there may be a shaving kit included, if not press the
pads down firmly. If the AED tell you to check the pads, rip the pads off, which will
basically shave the area, and apply new ones. If there is only one set of adult pads, but
you have child pads as well, use the child pads to shave the area first, then apply the adult
pads in the same spot.

[edit] CPR for children age twelve months to eight years

The method of CPR for children is similar to that used for adults. However there are
some differences, as children have less lung capacity and a somewhat faster respiration
rate. Also, compressions should be considerably less forceful than those used on adults.

A conscious child struggling to breathe will often find the best position to keep a partially
obstructed airway open and should be allowed to maintain that position until medical
help is available. If the young victim is unresponsive, position the child or infant on the
back on a firm, flat surface and begin CPR.

• For Airways: place your hand on the child's forehead and gently tilt the head
slightly backward to open the airway. Augment the head tilt by placing 1 or 2
fingers from the other hand under the chin and gently lifting upward. Note that
when opening the airway, a child's head should not be tilted as far back as you
would an adults.
• For Breath: Give two effective rescue breaths, in the same manner as you would
for an adult. However, remember that an infant will need much less air than a
larger child or an adult would. A proper amount of air will move the chest up and
down between breaths. A slow, deliberate delivery will reduce the likelihood of
forcing air into the stomach, causing distension. Rescue breathing is the single
 most important maneuver in rescuing a non-breathing child or infant. If repeated
rescue breathing attempts do not result in airflow into the lungs, evidenced by
chest movement, a foreign body obstruction should be suspected.
• For Circulation, as discussed in the section on adult CPR, either check for
circulation by checking a pulse or alternatively by checking for obvious signs of
life, according to your training. In children over one year old, the pulse can be felt
at the side of the neck. To check the pulse: while maintaining the head tilt with
one hand, find the windpipe at the level of the Adam's apple with two fingers of
the other hand. Slide the fingers into the groove closest to you, between the
windpipe and neck muscles, as for adults.

If the child is over 1 year of age, compression is applied to the breastbone by the heel of
one hand, located in the midline, 2 fingers'-breadth above the tip of the breastbone (just
below the imaginary line between the two nipples). With one hand, the chest is
compressed to about one third of the depth of the chest (the exact distance depends on the
size of the child) at a rate at about 100 compressions per minute, as for an adult.
Compression and relaxation time should be equal and the rhythm smooth and even. The
fingers must be kept off the chest.

While the 5:1 ratio has been used in the U.S. for decades "because oxygen is more
important for children", the new 2005 American Heart Association guidelines
recommend the same compression ratio as adults, which is 30:2, unless there are two
rescuers and you are a healthcare provider, in which case the ratio drops to 15:2.

[edit] CPR for infants

CPR demonstrated on a infant dummy

Infants under twelve months of age use most of the same guidelines as children, with the
exception of a few things said below.

Tilting the head and lifting the chin will not work in infants, as they have little or no
neck. The infant should be cradled in the dominant arm, with the head resting in the
rescuer's palm. As in children, the compression/respiration ratio should be 30:2, unless
there are two rescuers and you are a healthcare provider in which case, the ratio
drops to 15:2.
Respirations are easiest if performed with the mouth covering the entire nose and mouth,
and should be given in short puffs of air and not full exhalations. Chest compressions
should be delivered at a rate of at least one hundred per minute using two fingers on the
sternum at the nipple line, with a compression depth of 1/3 to 1/2 an inch depending on
the size of the child.

[edit] Notes
Continue CPR until help arrives or your life is placed in danger by continuing to perform
CPR.

See also wilderness first aid for situations where it may be impossible to continue CPR
and guidelines for how to proceed in such a situation.

Also note that it may be inappropriate to perform CPR in a disaster or triage situation
with mass casualties.