Cardio pulmonary resuscitation

ardiac resuscitation or basic life support (or BLS for short) is an essential skill that not only healthcare workers, but everyone must be taught to save lives in an emergency situation. It can be learned in various ways, for instance, through online courses, in-person classes or YouTube videos. The main objective of the BLS is to maintain blood and oxygen supply to vital organs, like the brain and heart, when one’s heart or breathing have stopped. Basic life support training allows one to identify and manage critical emergencies, such as cardiac arrest or an obstructed airway. The two important components of basic life support are cardiopulmonary (heart-lung) resuscitation (CPR) and automatic external defibrillator (AED).

The first step is to check the scene to ensure the rescuers safety. For example, on a motorway, one must shift the patient to a safe area before starting CPR and not start the procedure in the middle of the road. Performing CPR in open spaces, rather than cramped spaces, makes it easier for the rescuer to manage. Ensuring that the victim’s neck is stable, place them on a hard, flat surface. Once laid, the victim should be assessed for alertness to the rescuer’s voice. If they respond, it’s best to leave them in the position they are in until help arrives. If there is no response, then the pulse and breathing should be assessed before beginning cardiopulmonary resuscitation. At the same time, dial emergency numbers on your mobile phone. However, if you are in the parking lot of a hospital or waiting area of a clinic, you must get someone to bring both an ambu-bag (a self-inflating bag) and an automatic external defibrillator that are close by.

CPR consists of two main steps: chest compressions and rescue breaths. Before starting, check simultaneously for breathing and pulse for no more than 10 seconds. Check the neck artery (carotid pulse), and if there is no pulse, start chest compressions at once. If there is a pulse, but there is gasping or choking, then rescue breathing must be started immediately. If there are no signs of life (i.e., no pulse and no breathing), then do both chest compressions (thirty times) and rescue breathing (twice). A second person should be at hand to critique the compressions and encourage the person doing compressions to perform a steady rate. CPR is continued until you get an automatic electrical defibrillator (AED) or an ambulance arrives to provide medical treatment.

Remember, for a patient with no pulse, the most critical BLS skill is good quality chest compressions. For chest compressions, the palm of your hand should be placed above the xiphoid process on the breastbone. Previously, the mid-nipple line was the indicator for CPR, but since obesity is on the rise, the new indicator is the area just above the xiphoid process on the breastbone. The ideal way is to place the heel of one hand on the breastbone, then place the heel of your other hand on top of the first hand, at the same time ensuring elbows are straight, position your body directly over your hands, compress the chest.

High–quality chest compression has a compression rate of 100-120/min, and compression depth of at least 50 mm (2 inches) in adults and at least a third of the anterior-posterior dimension of the chest in infants and children. It must be noted here that there should be full chest recoil between compressions, and interruptions between compressions should be less than 10 seconds. The person doing chest compressions should be switched every two minutes or five cycles of CPR, in order to minimise error in compressions due to exhaustion. The process of CPR presses the heart against the vertebral column to create suction which keeps the heart circulating oxygenated blood to the brain and other vital organs of the body.

CPR consists of two main steps: chest compressions and rescue breaths. Before starting, check simultaneously for breathing and pulse for no more than 10 seconds. Check the neck artery (carotid pulse), and if there is no pulse, start chest compressions at once.

Breathing assessment has three aspects:

1. Look to see if the victim’s chest is rising and falling.

2. Listen over their mouth and nose for breathing sounds.

3. Feel their breath against your cheek

For airway and breathing, a head tilt-chin lift or jaw-thrust (if there is a neck injury) is needed. For the head-tilt chin lift, one hand should be placed on the person’s forehead and by gently lifting the head back, use two fingers to lift the tip of the chin. For jaw-thrust, lift the jaw angle forward and upwards without moving the head. The aim of these two types of manoeuvers is to move the tongue away from the back of the throat so that it does not obstruct the airway. There is one breath every 5-6 seconds for respiratory arrest. It is important to note that there is a visible rise and fall of the chest with each rescue breath. Since the Covid-19 pandemic, a pocket CPR mask is preferred to direct mouth-to-mouth breathing. Another option is a bag valve mask, sometimes known by the proprietary name, Ambu-bag. It is a hand-held device commonly used in 2-rescuer CPR to provide positive-pressure ventilation to patients with inadequate breathing. Rescue breaths aim to help keep the lungs inflated and to provide oxygen to the victim.

AED is the second important component of basic life support but, unfortunately is generally unavailable in Pakistan. However, basic facts about the AED should be commonly known, as both the American Heart Association and the Resus Council, United Kingdom, stipulate that no resuscitation is complete without the AED. Once the AED is brought to the area of the accident, it should be turned on, so that it informs what to do. Then, remove the patient’s shirt to attach the AED pads. In the meantime, ensure that any moisture on the skin of the chest, including sweat and water droplets of a person rescued from drowning, is cleared. Also, the rescuer should remove medication patches on the skin with gloves. The AED pads indicate the area where they have to be placed. The chest compressions should be stopped, and the rescuer by saying “Stand Clear,” must ensure that everyone stays away from the victim. Push the analyse button and allow the AED to analyse the patient’s rhythm. If a shock is recommended, the rescuer should ensure that no one is touching the person again, repeating “Stand Clear.” Once clear, the shock button should be pressed, on the instruction of AED. Immediately begin CPR in both cases, whether shock is advised or not by the AED; perform two minutes of CPR and follow the AED prompts once again.

Understanding BLS courses and practicing the techniques are perhaps some of the most challenging tasks confronting first aid. It is also necessary to stay updated with the latest guidelines. Adequate knowledge of first aid and basic life support should be considered an essential aspect of the school and college education curriculum. Recent studies show a significant lack of knowledge regarding the typical signs and risk factors associated with serious medical conditions among medical students and laypersons. There is an urgent need to establish learning objectives in order to encourage students to complete BLS courses during their education.

Basic first-aid courses can be run regularly by ambulance services in various parts of the country. Moreover, traders’ associations can be approached for keeping Ambubag and AED in their shops to help if a buyer has a cardiac arrest. Authorities and police in public places should also be educated about first aid to act in case of collapsed victims rapidly. Ambubag and AED are available at reasonable prices online for easy access to the public.


The writer is a family physician

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