CPR for Adults

Ma.Teresa J. Mayuga Emergency Department Head Nurse

A. Chest Compressions
Importance:
One important part of CPR is chest compressions, which keep blood flowing to the heart, brain, and other vital organs.

CHEST COMPRESSION TECHNIQUE

1. Position yourself at the victims side 2. Make sure the victim is lying on his back on a firm, flat surface. If the victim is lying face down, carefully roll him onto his back.

3. Move or remove all clothing covering the victims chest. You need to be able to see the skin.

4. Put the heel of one hand on the center of the victims bare chest between the nipples. 5. Put the heel of your other hand on top of the first hand.

6. Straighten your arm and position your shoulders directly over your hand. 7. Push hard and fast. Press down 1 to 2 inches with each compression. For each compression, make sure you push straight down to the victims breastbone

8. At the end of each compression, make sure you allow the chest to recoil or reexpand completely. Full chest recoil allows more blood to refill the heart between chest compression. Incomplete chest recoil will reduce the blood flow created by chest compression.

9. Deliver compression in a smooth fashion at a rate of 100 compression per minute.

10. Place patient in a recovery position once breathing and pulse are present.

Chest Compression Technique

Chest Compression Technique

Step

Action
Position yourself at the victims side. Make sure the victim is lying on his back on a firm, flat surface. If the victim is lying facedown, carefully roll him onto his back. Move or remove all clothing covering the victims chest. You need to be able to see the skin. Put the heel of one hand on the center of the victims bare chest between the nipples. Put the heel of your other hand on top of the first hand. Straighten your arms and position your shoulders directly over your hands. Push hard and fast. Press down 1 to 2 inches with each compression. For each chest compression, make sure you push straight down on the victims breastbone. At the end of each compression, make sure you allow the chest to recoil or re-expand completely. Full chest re-coil allows more blood to refill the heart between chest compressions. Incomplete chest recoil will reduce the blood flow created by chest compressions. Deliver compressions in a smooth fashion at a rate of 100 compressions per minute.

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Foundation Facts

If you have difficulty pushing the breastbone deep enough during compressions, put one hand on the breastbone to push on the chest. Grasp the wrist of that hand with your other hand to support the hand as it pushes the chest. This technique may be helpful for rescuers whose hands and wrists are arthritic.

Compression Rate
Scientific evidence has not identified a single ideal compression rate. Most studies support a compression rate of about 100 compressions per minute if compressions are deep enough and interruptions to compressions are minimized.

B. Opening Airway

Head Tilt-Chin-Lift
Step

Action Place one hand on the victims forehead and push with your palm to tilt the head back.

Place the fingers of the other hand under the bony part of the lower jaw near the chin.
Lift the jaw to bring the chin forward.

Head Tilt-Chin-Lift

The head tilt-chin-lift relieves airway obstruction in the unresponsive victim. A, Obstruction by the tongue. When a victim is unresponsive, the tongue can block the upper airway. B, The head tilt-chin-lift maneuver lifts the tongue, relieving airway obstruction.

CAUTION: Things to avoid With Head Tilt-Chin Lift

Do not press deeply into the soft tissue under the chin because this might obstruct the airway. Do not use the thumb to lift the chin. Do not close the victims mouth completely (unless mouth-to-nose breathing is the technique of choice for the victim).

Jaw Thrust Maneuver

Jaw Thrust Maneuver

Step
1

Action
Place one hand on each side of the victims head, resting your elbows on the surface on which the victim is lying. Place your fingers under the angles of the victims lower jaw and lift with both hands, displacing the jaw forward.

If the lips close, retract the lower lip with your thumb.

CPR Rescue Protocol

The following steps are for lay rescuers responding to a call for help during situations other than witnessed arrest (i.e you did not see the victim collapse.
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Establish scene safety. Make sure that you wont end up a victim as well. Establish yourself to the bystander as capable of performing CPR and seek permission to help. Check for unresponsiveness. If unresponsive, get someone to activate local EMS or call for medical assistance

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Open Victims Airway. Perform the head tilt- chin lift maneuver or jaw trust maneuver. If you think a neck injury is involved. Check for signs of breathing, deliver 2 initial rescue breaths Check for signs of circulation. If none, start CPR. Deliver 30 chest compression and 2 ventilations per cycle. Check for signs of circulation after every 5 cycles

9. If victim recovers with normal breathing, place in recovery position 10. If signs of circulation return but the victims breathing is inadequate, perform rescue breathing

For witnessed arrest

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Check unresponsiveness. Never leave the victim alone unless you have to get help and no one is around If there are two rescuers, one can take care of the ABCs and ventilating the victim on one side while the other does the chest compression from the opposite side. Switching should be done every 5 cycles Control the crowd.

GOLDEN RULES IN GIVING EMERGENCY CARE

1.

What to DO: Do obtain consent when possible. Do think the worst. Its best to administer first aid for the gravest possibility. Do remember to identify yourself to the victim. Do provide comfort and emotional support. Do respect the victims modesty and physical privacy. Do be as calm and as direct as possible. Do care for the most serious injuries first. Do assist the victim with his or her prescription medication. Do keep onlookers away from the injured person. Do handle the victim to a minimum. Do loosen tight clothing.

2. What Not to DO:

Do not let the victim see his/ her own injury. Do not leave the victim alone except to get help. Do not assume that the victims obvious injuries are the only ones. Do not make any unrealistic promises. Do not trust the judgment of a confused victim and require them to make decision.