Practice

5 CPR

Basic CPR, semiautomatic defibrillation and basic airway management

Overview

Sudden cardiac arrest is the leading
cause of death in Europe, affecting
approximately 700,000 people each
year. Many of the victims of sudden
cardiac arrest can survive if the
witnesses act immediately
The actions that bind the victim of
sudden cardiac arrest to survival are
called “Chain of survival”.

All rescuers, trained or not, should provide chest compressions to
victims of cardiac arrest. It remains essential to place special
emphasis on applying high quality chest compressions.
The objective should be to compress to a depth of at least 5 cm and
at a frequency of at least 100 compressions / min, allow complete
retraction of the thorax, and minimize interruptions of chest
compressions.



Trained resuscitators should also provide ventilations with a compressions-ventilations (CV) ratio of 30:
2.
Guided by telephone, CPR-with-only-compressions-thoracic is encouraged for untrained resuscitators.

The only way to effectively treat sudden cardiac arrest or sudden cardiac death caused by Ventricular
Fibrillation is through an electrical shock administered by a defibrillator. The defibrillator pushes an
electrical current through the heart, applying it through electrodes located in the victim's chest.

When practicing a basic CPR:

• The breathing has stopped completely.
• After taking the pulse, there are no signs of circulation and it does not respond to physical
stimuli.
• You are the most capable person to perform cardiopulmonary resuscitation


The ten steps of CPR

1. Ensure safety: Make sure there is no danger in approaching the victim.


2. CHECK IF THE VICTIM IS AWARE
Shake your shoulders gently
Ask him out loud: "Are you okay?




3. REQUEST AID; It gives the alarm voice, it does not respond, it does not
open eyes, it does not move ...



4. OPEN THE AIRWAY
Place the victim face up.
Place one hand on your forehead and throws head back
Raise the chin using the tip of the fingers of the other hand.



5. CHECK IF YOU BREATHE WITH NORMALITY
SEE-FEEL-HEAR
YOU ONLY HAVE 10 SECONDS
SEE; if there is movement in the thorax.
HEAR; near mouth respiratory sounds
FEEL; air in the cheek
IF DOUBTS ACT AS IF BREATHING DO NOT GO NORMAL


6. CALL 112 (911) (999)
• You are facing a cardio-respiratory arrest
• The victim is unconscious
• If breathing is not normal or absent

YOU ARE ALONE?
• FIRST. Call 112 and If necessary, leave the victim momentarily to make the call.
• SECOND. Starts thoracic compressions

WITH SOMEONE?
• START CPR while another person Call 112
• Get a defibrillator, if you're in a public place where he finds it.

In the call to 112 indicate your name, place of the incident, that there is a victim in cardio-respiratory
arrest and that you initiate CPR maneuvers

7. START THE THORACIC COMPRESSIONS.
• Kneel beside the victim.
• Place the heel of the hand in the pressure area.
• Place the heel of the other hand over and interlace the fingers.
• Place the arms straight.
• Compress the chest at 100 compressions per minute with a depth of
about 5 cms.


8. Ventilation is currently not recommended except for highly trained
personnel with specialized material.
Change the resuscitator every 1-2 minutes



9. DEXA Defibrillation if possible




DEXA

Most have three simple buttons or steps.
• Switched on.
• Heart rhythm analysis
• Discharge or electric shock

Patching that can only be done in one position


Use of the semiautomatic defibrillator

Make sure the patient is not wet, before turning on the DEXA.
If it is, you should dry it.
If there is water in the nearby area, you have to take the person to a dry
place.





Turn on the DEXA
When turned on, it will give you instructions on how to act in the
situation.
It is likely to tell you to connect the patch cables to the AED.
Usually, you will have to connect them to the part above the
blinking light on the top of the device.
When the patches are connected, the machine will give you more
instructions.



Prepare the chest area.
You must remove certain objects from the victim, to use the DEA patches.
Open or cut your shirt.
If the patient has a lot of hair on his chest, you will have to shave him.
You will also have to check if there are signs that indicate the presence of a
device implanted in the patient, such as a pacemaker.
Remove any jewel or metal accessory that you observe.
Metal conducts electricity.
Most AEDs have a razor or scissors to remove hair from the person's chest.
If you check the chest, you can see the presence of a pacemaker or some
other implanted device.
Also, you can see if you have a medical alert bracelet.
If the victim is a woman, you will have to remove her bra, if it has a wire. Like
jewelry, it can conduct electricity.


Place the patches.
In general, the DEA electrodes consist of adhesive patches.
The AED will instruct you to place the electrodes or patches. You must make sure
to place them correctly.
You must place one of the patches under the clavicle on the upper right side of the
victim's bare chest. The other should be placed under the pectorals or chest, on
the left side, at the base of the heart, a little to the side.
Make sure there is no fabric or other object between the patches and the skin. Any obstruction will
cause the AED to function inappropriately.
If you do not place the patches properly, the DEA could repeatedly provide the message "check
electrodes (check electrodes)".
If the person has an implanted device or a piercing, you should place the patches at 2.5 cm (1 inch) from
them.


Have the DEA perform an analysis.
After you have placed the patches appropriately, you must have
everyone clear the area in which the victim is located.
Once everyone has moved away, press the analyze button of the DEA,
so that it begins to analyze the heart rate of the victim.
Then the DEA will tell you if an electric shock is needed or if you should
continue to perform CPR.


Apply an electric shock to the victim, if needed.
If the AED indicates that you must apply a shock to the victim, you
should make sure again that no one is near it.
Then you will have to press the download button (shock) of the DEA.
This will send an electric shock through the electrodes, with the
purpose of reviving the heart.
The DEA will only apply one download at a time. The body of the
person will move because of the force of the discharge, but this will
not last long.


Continue to perform CPR.
You will have to continue performing the CPR after having applied the shock to the victim.
You must do it for 2 more minutes, then let the AED re-check the presence of a heart rhythm.
Keep doing it until the emergency team arrives.
Also, you will have to stop if the victim can breathe on his own or if he regains consciousness.


Obstruction of the airway by foreign body (OVACE)

Warning symptoms: The universal sign of choking is to bring your hands to your
neck.
Other signs may be difficulty speaking and the bluish color of the skin or mouth
salivation.

What to do:
Call 112, preferably someone who is not solving the problem.
If the victim can cough, encourage him to cough.
If the victim can not cough or has no strength for it, but remains conscious, start abdominal
compressions.

To do this (conscious victim):
Ask the victim if he is drowning and tell him he is going to help.
Heimlich Maneuver: Stand behind and embrace the victim in the back with both arms.
In this position and standing, place a closed hand with the fist with your thumb on the
abdomen, just above the navel and below the end of the sternum and the other
covering the first.
Tilt the victim forward to facilitate the exit of the object causing the obstruction.
Press at that point, in the inward and upward direction.

In pregnant, obese or under one year abdominal compressions are replaced by chest compressions.
The place of compression will be in the center of the chest, which is the lower half of the central bone of
the victim's breast or sternum.

In children under one year old, place the baby face down, with the head lower than the rest of the
body, on one of his arms resting on his legs.
Alternate five strong strokes between the scapulae with five chest compressions, with two fingers, in
the center of the chest. Observe after each stroke, if the object comes out. Be especially careful when
holding the baby.

If the victim lost consciousness:
Alert 112 or ask someone to do so and request a DESA, as soon as possible.
Lie on the floor face up, stand on your side knees and start chest compressions in the same way as if a
cardiorespiratory stop.
Continue with them until the arrival of emergency medical services, until it runs out and can not
continue or until the victim has signs of life, that is, breathe, cough or move.
When the emergency medical services arrive, explain what has happened, the measures taken and all
the information you have about the victim.

What NOT to do:
Administer first aid to a person in the choking phase if the person is coughing and is able to speak,
because with only the cough, can evacuate the object spontaneously.
Conduct abdominal compressions under one year, could cause greater damage.
Perform the compressions out of the indicated place, as it could cause damage to the ribs or intestine.
Try to extract the foreign body with blind fingers from the inside of the mouth.



Maintenance of the airway in unconscious people


Breath assessment:

What to do:
If unconscious, place one hand on the forehead of the victim, gently pulling back the head and the other
hand on the chin, opening the mouth. Approach your face to the face of the victim, looking at the chest,
listening and feeling on his cheek how he exhales the air and watching how the chest rises. Do not use
more than 10 seconds in this operation.
In case the patient does not breathe or his breathing is ineffective (gasping, scarce chest movement),
start cardiopulmonary resuscitation maneuvers.
If the victim is conscious, assess the rhythm of breathing (continuous or with prolonged stops), depth
and speed.


What NOT to do:
Lean on the patient's chest to assess breathing.
Close the airway while assessing breathing.

What to do:
Keep calm. Check the situation.
Place the victim in a proper position to assess vital signs.
Loosen all clothing that may prevent you from breathing (ties, belts, pants, etc.).
If the victim breathes, place him in a lateral safety position, making sure, every so often, that he is still
breathing.
If the cause was traumatic, lay the victim face up while keeping the airway open, holding the head.
If you do not breathe or your breathing is ineffective (gasping, poor thoracic movement), be prepared to
start resuscitation maneuvers.

Other tips

• Ask the witnesses what the victim was doing before the event, when it happened, and if she
has a serious illness (diabetes).
• Call 112 and explain the situation of the victim, as well as all the background information and
what he was doing before losing consciousness.
• Cover the victim to prevent him from taking cold, if necessary.
• Never leave the victim alone.
• If you have any visible wound, treat it.
• If the victim regains consciousness, try to find out what happened to him.
• Upon the arrival of the emergency medical services, inform them of what has happened, of all
the changes that have taken place, collected background and the maneuvers carried out.


What NOT to do:
Feed or drink the victim, as it could choke.
Mobilize the victim if the cause was traumatic

Tracheal oral cannula (Guedel cannula, Mayo tube)

Objectives of the cannula:
Establish a free communication between the mouth and the base of the tongue.
Avoid that the tongue obstructs the airway and that the teeth close with force.
Keep the airway open without needing to hyperextend the neck or dislocate the
jaw.
Remove the obstacle of the tongue by resting it on the floor of the mouth.


Indications of placement.
The oropharyngeal cannula (Guedel cannula or Mayo tube) is placed to preserve air permeability in the
following circumstances:
• Unconscious patient who breathes spontaneously and who presents an air obstruction due to
an alteration of the gag reflex and / or a posterior displacement of the tongue.
• Patient who presents a seizure.
• Air permeability has not been achieved through other types of maneuvers, such as
hyperextension of the neck, chin elevation or mandibular subluxation.

Other indications of placement.
Patient ventilated manually with Ambú®; The oropharyngeal cannula elevates the soft tissues of the
posterior pharynx, which facilitates ventilation and minimizes gastric insufflation.
Patient intubated orally that bites or tightens the endotracheal tube, since the oropharyngeal cannula is
used as an anti-crush device


Description of the Oropharyngeal Cannula (Guedel)
The oropharyngeal airway or Guedel cannula is a curved plastic tube, with a flange reinforced at the oral
end, flattened to ensure that it fits perfectly between the tongue and the hard palate.
Suitable sizes are available for small and large adults.

There are several sizes with lengths ranging from 6 to 10 cm.
Suggested cannula sizes:
• Large adult = 100 mm = Guedel nº5.
• Median adult = 90 mm = Guedel nº4.
• Small adult = 80 mm = Guedel nº 3.
• Children and R. Born =
No.000, 00, 0, 1 and 2.
Each size has an associated color

An estimate of the required size is obtained by selecting a cannula
with a length corresponding to the vertical distance between the
patient's incisors and the angle of the jaw.




The measurement is determined by placing the cannula in the same position in
which it was placed. This is very important.



Try insertion only in unconscious patients: if glossopharyngeal and laryngeal reflexes are present,
vomiting or laryngeal spasm may occur.

Technique of insertion of the oropharyngeal cannula:

Open the patient's mouth and make sure there is no foreign
material that can be pushed into the larynx (if there is any, use
aspiration to remove it).Remove dentures.
Perform hyperextension of the neck if possible. Keep the neck in
hyperextension if possible during the entire insertion of the
cannula.

Insert the cannula into the oral cavity in an inverted position until the junction between the hard and
soft palate and then rotate it 180º.
The rotation should be done gently when reaching the soft palate so as not to damage the mucosa and
introduce it completely.

Advance the cannula until it is placed in the pharynx. This technique of rotation minimizes the
probability of pushing the tongue back and down.
If the patient has nausea or struggle, remove the cannula.

The correct placement is indicated by an improvement in the permeability of the airway and by the
positioning of the reinforced section, flattened, between the patient's teeth.

After insertion, maintain the chin-front maneuver or mandibular traction and check the permeability of
the airway using the see-hear-feel technique. Aspiration through an oropharyngeal airway is usually
possible using a thin-gauge flexible aspiration probe.