Save a Life by CPR

Cardiopulmonary Resuscitation or CPR is a sequence of steps done to revive a person who has suffered a cardiac arrest.

Cardiac arrest happens when the heart that beats normally at 60 to 100 beats per minute, suddenly stops beating. A victim who has suffered a cardiac arrest is identified as follows - he/she is unresponsive, is not breathing and does not have a pulse.

CPR done in the correct sequence helps identify the victim in cardiac arrest as quickly as possible and helps initiate CPR.

Starting CPR does not require any fancy equipment or medication. It can be done in any setting - in the hospital or out of hospital.

The following are the steps of CPR. This sequence is also known as the Basic Life Support(BLS) Primary Survey.

Steps of CPR

1. Check Response

As soon as you encounter a victim who does not appear to be conscious get close to his side, firmly tap the front of the shoulders and in a loud clear voice ask if he/she is all right.

2. Call for Help

If there is no response by the victim, you have to call the emergency helpline in your country (911 in the USA, 999 in the UK and 112 in the European Union). If there is a bystander nearby you could ask that person to call the emergency number and get an automated external defibrillator (AED).

3. Open the Airway

After calling for help get back to the victim's side and kneel close to the right shoulder. Place your left hand across the victim's forehead. Use the index and middle finger of your right hand to put under the victim's chin and tilt the head back. This manoeuvre is called the head tilt-chin lift.

4. Assess whether victim is breathing or not

Kneeling by the victim's right side bend forward and tilt your head to the right so that you're looking at the victim's chest to see if there are chest movements. At the same time listen and feel for breaths from the victim's mouth and nose. Your assessment should not take more than 10 seconds. This manoeuvre may be remembered by the mnemonic look-listen-feel.

5. Give two breaths to the victim

If the victim is not breathing, take a normal breath, pinch the victim's nose with the thumb and index finger of your left hand and blow into the victim's mouth by sealing your lips around his/her mouth. You should blow just hard enough to see that the chest of the victim rises. Allow the victim's chest to come back down and then give a second breath to the victim.

6. Assess whether victim has a pulse

Still kneeling next to the victim put two fingers of your right hand on the right side of the front of the neck of the victim just to the right of the Adam's apple. Feel this area for 10 seconds for the presence of a pulse.

7. Start chest compressions

If you do not feel a pulse on the victim's neck, you should proceed to giving chest compressions.

Remove any clothing that the victim may be wearing on the chest. Ensure that the victim is lying on a hard flat surface. Kneel on the right side of the victim and place your right hand over the centre of the victim's chest on the breastbone. The heel of the hand should be along the midline just below a line joining the victim's nipples. Now support your right hand with the other hand and lean over the victim with your wrists, elbows and shoulders all in a straight line. Start compressing on the victim's chest at a rate of 100 compressions per minute. The chest should go down (depth of compression) by 4 to 5 cm or 1.5 to 2 inches for compressions to be effective.

8. Give five cycles of 30 compressions and 2 breaths

Once you start chest compressions you should proceed to give 30 compressions and then give 2 more breaths to the victim. You should do five such cycles and then stop to check the pulse of the victim again.

If the victim still does not have a pulse proceed to give five more cycles of CPR. Continue CPR until help arrives.

The steps of CPR are essentially the same in children except for the following differences.

1. Children need a lesser volume of air
While giving artificial breaths to a child you need to give a lesser volume of air. It is enough if you give a breath that is sufficient to produce visible chest rise.

2. Depth of compressions
During CPR, the force used during chest compressions should be adequate to push the chest down by 1/3rd to 1/2 the depth of the chest. Using only one hand (usually your dominant hand) may be enough to produce the force required to deliver adequate chest compressions. If you cannot depress the chest by 1/3rd to 1/2 the depth of the chest using one hand, you should use both hands to give chest compressions.

Though the principles of CPR on an infant are the same as in the adult, there are a few key differences that are to be kept in mind while resuscitating an infant.

1. Check for response by flicking or tapping the sole of the feet of the infant

While doing CPR on an infant you check response by flicking or tapping the sole of the feet. If the baby is responsive it will cry or move the limbs.

2.. Check the brachial pulse instead of the carotid pulse

An infant's neck is very small which does not allow the carotid pulse to be felt properly. You would have to feel the brachial pulse instead. Using two fingers feel the brachial pulse on the inside of the arm against the arm bone just above the bend of the elbow.

3. Technique of chest compressions

Since the infant is too small for you to use your hand to give chest compressions as in the adult, the following technique should be used. Draw a line connecting the two nipples. Place two fingers of your right hand - typically your index and middle fingers - just below the line, on the breastbone along the middle. Depress at a rate of 100 compressions per minute and at a depth 1/3rd to 1/2 of the depth of the infant's chest.

If two rescuers are present, the rescuer doing chest compressions should move towards the foot end of the baby. She should place both her thumbs just under the line joining the two nipples in the midline on the breastbone while the rest of her hands encircle the baby's chest.

4. Ratio of chest compressions.

The ratio of chest compressions to breaths in the presence of two rescuers is 15:2. With one rescuer the ratio is 30:2 as in the adult.

Studies and observations have concluded that many people withhold themselves from doing CPR when it is required because they do not want to give mouth to mouth breaths to the victim. In such cases, you can still save the life of the victim by doing only chest compressions.

In hands-only CPR, if you find that the victim is not breathing and do not want to give breaths to the victim, immediately start doing chest compressions at the recommended rate. Doing hands-only CPR is better than no CPR and maybe lifesaving if started immediately.

What will you do if you find an unconscious person who does not respond to your call?
Call 911 or your emergency response system and get an AED.

What is the correct ratio of chest compressions to breaths in an adult victim?
30:2

Once you have started chest compressions how many cycles of compressions and breaths should you continue?
5

What is the correct ratio of chest compressions to breaths in a child victim?
30:2 if there is only 1 rescuer; 15:2 if there are 2 rescuers.

How often would you assess the victim during CPR?
Every 2 minutes.