Introduction
Cardiopulmonary resuscitation is a first aid tool that - if undertaken promptly and correctly - can save several lives .
In detail, cardiopulmonary resuscitation consists of a series of maneuvers aimed at maintaining blood circulation and transporting oxygen to the various organs and tissues in an individual, when the heart is no longer able to contract or is unable to convey blood through blood vessels. Clearly, performing cardiopulmonary resuscitation does not absolutely guarantee that the patient will live, but increases the chance of survival and the likelihood that - in the event of recovery - it does not report brain damage.
Cardiopulmonary resuscitation belongs to the set of maneuvers of the so-called support of basic vital functions, better known by the acronym BLS, deriving from the English Basic Life Support .
Please note
The information reported here is for illustrative purposes only and is not intended to replace in any way the teachings and information provided by doctors and other health professionals during the execution of the BLS and BLS-D courses ( Basic Life Support and Defibrillation - Cardiopulmonary Resuscitation Base). and early defibrillation) for both health and non-health workers.
To be able to put cardiopulmonary resuscitation into practice correctly, in fact, it is necessary to acquire certain theoretical and practical skills that only professionals in the sector are able to transmit.
What is that
What is Cardiopulmonary Resuscitation?
Cardiopulmonary resuscitation is an instrument of fundamental importance in the field of first aid provided to a person who loses consciousness . More in detail, this is a technique that involves performing two particular maneuvers: chest compressions ( external cardiac massage or MCE ) and mouth-to-mouth, or even better, mouth-mask ventilations . The procedure for performing cardiopulmonary resuscitation will be investigated in the following chapters.
Did you know that ...
The BLS and BLS-D courses for non-healthcare workers are also organized on the Italian territory, in order to educate "ordinary" citizens about the simpler cardiopulmonary resuscitation maneuvers that, however, can be fundamental to save the life of a person in need .
More detailed information on this is available on the official website of the IRC ( Italian Resuscitation Council ).
What is it for
What is the purpose of Cardiopulmonary Resuscitation and why it is important to perform it
Cardiopulmonary resuscitation serves to "mimic" the work normally performed by the heart, lungs and airways in order to guarantee the blood circulation and the transport of oxygen to organs and tissues, even when the individual has stopped breathing and his heart no longer contracts or fails to circulate blood within blood vessels (as happens, for example, in the event of sudden cardiac death - or cardiac arrest - or in the case of a heart attack).
Through the practice of cardiopulmonary resuscitation, it should be possible to preserve the body's cells from damage and death resulting from the lack of oxygen supply but, above all, it increases the chances not only of survival of the individual but also of recovery without damage to brain level. In fact, when the oxygen no longer reaches the brain, within a few minutes, the cells that make it up enter into suffering and then die if no action is taken in a timely manner.
Did you know that ...
In the presence of cardiac arrest, the individual's chances of survival decrease by 10% every minute if cardiopulmonary resuscitation is not practiced .
Clearly, when a person loses consciousness, there can be no absolute certainty that it is a cardiac arrest; however, if the individual is unconscious, does not breathe or breathes badly, the guidelines of the ERC ( European Resuscitation Council ) and the IRC ( Italian Resuscitation Council ) still recommend performing cardiopulmonary resuscitation. Of course, one should NEVER forget to alert health workers by calling 118 .
In any case, it is good to specify that for non-health operators, even if they have obtained the BLS or BLS-D certificates, there is no obligation to intervene with cardiopulmonary resuscitation .
Adult CPR
How to perform Cardiopulmonary Resuscitation in the Adult?
Cardiopulmonary resuscitation in adults involves two specific maneuvers: cardiac massage (chest compressions) and artificial ventilation (mouth-to-mouth breathing or mouth-mask breathing - always recommended).
These maneuvers must be performed at specific intervals of time and following a precise pattern . More in detail, it is necessary to alternate 30 chest compressions with 2 artificial ventilations ( ratio 30: 2 ).
Before describing in more detail how these maneuvers should be performed, it is very important to point out that cardiopulmonary resuscitation can only be performed if the individual is NOT conscious, does NOT breathe or otherwise does not breathe normally .
Before Cardiopulmonary Resuscitation
When an individual falls to the ground apparently unconscious, before beginning cardiopulmonary resuscitation, it is necessary to determine his state of consciousness and evaluate his breathing .
The procedure for making such determinations and evaluations will be summarized in the following points:
- Make sure you are in a safe environment (identify the presence of fumes, gases, fires, electric cables, etc.).
- Evaluate the person's conscience by gently shaking her shoulders and calling her .
- If the person does not respond and is unconscious, lay him on a rigid surface (for example on the ground) in a supine position .
- Open the individual's airway by placing a hand on his forehead and gently pushing to extend the head backwards ; at the same time, place the forefinger and middle finger of the free hand under the chin and lift it upwards, without exerting too much pressure.
- While opening the airways, check for foreign bodies (if present and visible, you could try to extract them very carefully) and evaluate the person's breathing .
- The evaluation of the breath is carried out by approaching one side of one's face - holding out the cheek and ear - to the face of the individual being rescued and following the GAS scheme:
- Watch out if the chest rises and falls (if so, it means that the person is breathing);
- To listen if there are breathing noises;
- S on his cheek if air comes out of his mouth.
In order not to lose precious time, the assessment of respiration should take place quickly, at most in 10 seconds . To do this, count to 10 while watching, listening and feeling can be useful.
- If the victim breathes normally but is not conscious, put him in a lateral safety position and contact 118 immediately, providing the operator with all the necessary information (the person is unconscious, breathing, etc.).
- If the victim does not breathe normally or if he does not breathe properly, first of all it is necessary to call or have someone call 118 and ask - if you have the necessary skills to use it - to have a defibrillator (external semi-automatic defibrillator or DAE) carried. ). Then immediately begin cardiopulmonary resuscitation .
Please note
In the presence of doubts about the normal breathing of the individual, the guidelines of the IRC ( Italian Resuscitation Council ) say they act as if the breath were absent, therefore, proceed with the SPC.
- If you are alone and the defibrillator is not at hand, DO NOT interrupt cardiopulmonary resuscitation to look for it, but continue until help arrives.
Phases of Cardiopulmonary Resuscitation
Below, we will summarize by points the different actions that must be taken to perform cardiopulmonary resuscitation which, remember, must be implemented only if the individual is unconscious and does not breathe, or in any case has a non-normal breathing.
- Position yourself to the side of the person and uncover the chest if there are very bulky clothes or clothing (for example, coats, jackets, overalls, etc.).
- Begin the external cardiac massage by performing 30 chest compressions as follows:
- Place the dominant hand on the chest of the unconscious individual; place the other hand over the dominant hand and braid the fingers as shown in the photo.
- Compress the chest - keeping the arms tight and "moving up and down" the back - with a depth of 4-5 centimeters (not exceeding 6 centimeters) and taking care to return completely to the initial position to make the chest expand again between one compression and another, but without removing your hands from the chest of the rescued person.
- Cardiac massage must be performed with a frequency of 100-120 compressions per minute (corresponding to about two compressions per second ).
Did you know that ...
Counting chest compressions aloud can help relieve the tension that builds up in an emergency situation.
- After performing 30 chest compressions, perform 2 ventilations as follows:
- Open the individual's airway by placing a hand on his forehead and gently pushing to extend the head backwards; at the same time, place the forefinger and middle finger of the free hand under the chin and lift it upwards, without exerting too much pressure.
- Place your mouth on the mask ( mouth-mask breathing ) or - in the absence of protective means - directly on the person's mouth ( mouth-mouth breathing ), close the individual's nostrils with two fingers and blow slowly for about 1 second, checking with the corner of the eye the chest rises .
Please note
When the individual who needs help is not known, or if it is not known enough, mouth-to-mouth breathing is always not recommended . Generally, in fact, this type of ventilation is done only on relatives - without infectious diseases - and on children.
- Detach from the mouth or mask, catch your breath and perform the second breath.
- If you are unable to perform the ventilations correctly, do not waste any more time and resume with cardiac massage . The latter, in fact, must not be interrupted for more than 10 seconds to perform the ventilation.
Please note
If the rescuer does not want to, cannot or does not feel able to ventilate, the IRC guidelines recommend continuing with cardiac massage without stopping .
- After performing the two breaths, resume with the external cardiac massage by performing another 30 chest compressions and repeat the compressions-ventilations cycle until help arrives or, if necessary, if you know their use and have the necessary skills ( course BLS-D) - until the arrival of an external semi-automatic defibrillator (AED).
Please note
In case of obvious trauma (for example, falling from a ladder or scaffolding, if the individual is hit, etc.) - especially if at the head and neck - the person should not be touched, it should be left in the position where was found and cardiopulmonary resuscitation should not be performed by non-healthcare personnel. Of course, it is necessary to call 118 immediately .
Pediatric CPR
Cardiopulmonary Resuscitation in the Pediatric Age
Because children have different characteristics from adults, the IRC guidelines recommend performing slightly different maneuvers than those above. More specifically, the child's physical structure is smaller and thinner than that of an adult person, therefore, cardiopulmonary resuscitation maneuvers must be adapted in order to be equally effective but without causing damage .
Before Pediatric Cardiopulmonary Resuscitation
The operations to be performed before undertaking any pediatric cardiopulmonary resuscitation are the same as described for adults:
- Assessment of the safety of the environment in which one operates;
- Assessment of consciousness (in this case, however, the child should not be shaken, but should be called and pinched slightly on the arms - painful stimulus);
- Airway opening (more gently than the adult; in the infant, keep the head in a neutral position );
- Control of the presence of foreign bodies and evaluation of respiration following the GAS scheme ;
- If necessary, start of pediatric CPR .
Please note
If the rescuer is alone, he must shout loudly to seek help and have 118 called, without leaving the child .
If no one arrives, the rescuer can leave to call 118 only after one minute of cardiopulmonary resuscitation .
On the contrary, 118 must be alerted immediately, therefore before the start of the pediatric SPC, in the event of:
- Child with known heart conditions .
- Apparently healthy child who falls to the ground and does not respond to stimulation .
Phases of Pediatric Cardiopulmonary Resuscitation
Pediatric cardiopulmonary resuscitation takes place in a slightly different manner from that performed in adults. In fact, if after the initial assessments we reach the conclusion that the child is not conscious and does not breathe, 5 breaths must be carried out immediately .
The method of execution varies according to the age of the child:
- Infant (0 to 12 months of age): keep the head in neutral position, place your mouth on the mouth and nose of the infant and slowly blow air for 1 second, checking with the corner of the eye that the chest is raised as in a normal breath. Remove your mouth and check that your chest is completely lowered. Inhale and repeat the maneuver four more times, for a total of 5 breaths .
If you are unable to surround both the nose and the suckling's mouth with your mouth, you can only blow into the nose - pushing with the two fingers that support the chin to close the mouth - or you can only blow into the mouth, closing the nose with two fingers.
- Children over one year of age : proceed with mouth-to-mouth or mouth-mask breathing as described for adult individuals.
After performing the 5 breaths, it is necessary to check if the child gives vital signs following the MO-TO-RE scheme :
- Service ;
- TO sse;
- KING spiro.
Presence of signs of life after 5 breaths
If the baby / infant shows signs of life, continue with the ventilations ; indicatively, with a frequency of 12-20 per minute .
Absence of signs of life after 5 breaths
If there are no signs of life, start chest compressions as shown below.
Suckling:
- If the rescuer is alone, use the two-finger technique . Holding the head in a neutral position with one hand, place two fingers of the free hand on the lower half of the sternum and compress the chest about 4 centimeters, then release completely.
- If you are in two rescuers, instead, you can put the two-handed technique into practice. Position yourself at the feet of the infant, place your thumbs side by side on the lower third of the sternum and, surrounding the child's chest with your hands, perform the compressions as described above.
Children over one year of age:
- Hold the baby's head in a neutral position with one hand and place the palm of the free hand on the lower half of the sternum keeping the fingers raised and aligning the shoulder and elbow.
- Compress the chest with a depth of 5 centimeters maintaining a frequency of 100-120 compressions per minute, taking care to release it completely after each compression. In this regard, it should be pointed out that the frequency must not exceed 120 compressions per minute.
After the first 5 breaths, in the absence of vital signs, the compression / ventilation ratio is 15: 2 (perform 15 chest compressions and 2 ventilations, mouth-mouth or mouth-nose, depending on the age of the child).
- In the case of large children and / or in the case where the rescuer is particularly thin and unable to perform compressions with a single arm, it is possible to proceed as if the external cardiac massage were to be performed in the adult . Then, we continue alternating 30 chest compressions with 2 ventilations .
Please note
If you are not able to perform the ventilations, the external cardiac massage must still be performed. However, unlike adults, in infants and young children, ventilations are more important than chest compressions.
Also in this case, pediatric cardiopulmonary resuscitation must proceed until the eventual arrival of an external semi-automatic defibrillator (if you have the skills to use it), or until the arrival of 118 .
It should be remembered again that the information contained herein is for illustrative purposes only and does not replace the notions transmitted during specific courses of BLS and BLS-D for non-health operators held by doctors and professionals in the sector.
