Cardio Pulmonary Resuscitation - Assignment Example

Cardio Pulmonary Resuscitation Since its introduction to American physicians in 1960, CPR has remained a staple of emergency medicine. More people continue to be trained in CPR administration not only in America but other countries in order to save lives. In the recent times, the American Heart Association introduced the ‘hands-only CPR’ whereby rescue forgo rescue breaths. Despite the advancements made, the effectiveness of the CPR is still low in the country. To address the challenge there are calls to introduce CPR training in schools and increase access to automated external defibrillators. This paper examines the key CPR concepts using information obtained from different secondary sources. What is Cardio-pulmonary resuscitation? Cardio pulmonary resuscitation is an emergency procedure that is performed to restore spontaneous blood circulation and breathing in the victims. The practice encompasses core components such as airway control, artificial respiration and cardiac massage. According to Mistovich and Karren (2010) Vesalius is credited with the earliest account of artificial respiration and airway control. Later on, Tossach conducted the first documented resuscitation on an injured coal miner. These early pioneers popularized the concept of mouth-to-mouth resuscitation but it was later disregarded due to hygienic reasons. Later on in 1800s, Leroy d’Etiolles introduced the idea of manipulating the body to induce ventilation. In 1958, Safar, Escarraga and Elam published an article which saw the re-introduction of the mouth-to-mouth resuscitation (Safar, 1989). Their findings were supported by the National Research Council of the National Academy of Sciences. The 1800s saw the introduction of the cardiac massage. Early in the 20th century, George Washington Crile wrote an article to popularize the combination of the thoracic compression, artificial respiration and parenteral epine-phrine infusion. The CPR process is used to re-start a patient’s heart after it ahs stopped breathing. According to Huether and McCance (2004) heart failure may be caused by many factors including unhealthy lifestyle, heart-related illnesses, accidents and chronic diseases. According to the available literature is effective in patients suffering form heart attack, severe kidney failure, cancer, severe heart failure and serious infection. However, CPR is associated with various side effects. For instance, pushing down the broken bones may cause further injury to the victims and secondly, CPR can puncture the lungs and impair mental functioning. Why do we have to do CPR? The CPR process is very important to the victim and is composed of several functions. The first function is neutralizing any dangers from the surroundings. The rescuer should ensure any hazards are removed and the victims are well taken care of. The second component is checking the status of the victim by asking questions and if the victim does not respond the rescuer should send for help. The third component is unblocking the airway and checking for breathing. After checking for breathing, the rescuer is then supposed to start the compressions. According to Mistovich and Karren (2010) the rescuer should first administer 30 compressions at a rate of 2 compressions per second. All along, the rescuer should make sure the victims are lying on their backs and the head and the chin is lifted. The CPR should be repeated in a cycle of compressions and 2 rescue breaths. If the victim fails to respond to the CPR, an automated external defibrillator should be used. According to Mistovich and Karren (2010) chest compressions during CPR generate small but critical amount of blood flow to the heart and brain. Mistovich and Karren (2010) further suggest that the quality of the chest compressions determines the success of the resuscitation. The physiology of chest compressions can be understood using the external; cardiac massage and thoracic pump models. According to Huether and McCance (2004), external cardiac massage compresses the cardiac structures hence forcing the blood to circulate. On the other hand, the thoracic pump model suggests that chest compressions increase the global intra-thoracic pressure. During the CPR process the brain is susceptible to the decreased blood flow and could suffer from irreversible damage within five minutes of absent perfusion. Chest compressions ensure blood circulates to the brains and other susceptible organs such as the myocardium. The appropriate way to do compressions Given the importance of the chest compressions, it is important that the rescuer administers them in the right manner. Chest compressions are supposed to be forceful and should be administered on the lower half of the sternum. The victim should be placed in a supine position while the rescuer kneels beside the victim’s chest. For compressive force to be effective, the patients should be placed in a firm surface. In addition, interruptions of chest compressions should be avoided and the rescuer should take maximum care not to dislodge lines and tubes. The rescuer should place the dominant hand on the center of the victim’s chest. The place of his or her hands should be positioned in the midline and aligned with the long axis of the sternum. The non-dominant hand should be placed over the dominant one, with the fingers elevated of the patient’s ribs. This arrangement ensures the rescuer is able to apply enough compressive force and to minimize damage of the ribs. The rescuer should avoid applying force over the xiphisternum and the upper abdomen. While applying pressure on the victim’s chest, the rescuer should keep his arms straight and extended. The rescuer’s shoulders should be positioned vertically above the victim’s chest to ensure maximize the effectiveness o f the compressive forces. In the article titled, technique for chest compressions in adult CPR, Rajab, Conrad, Cohn and Schmitto (2011) suggests that chest compressions should be delivered at a rate of at least 100 per minute and any interruptions should be avoided. In the same article, Rajab, Conrad, Cohn and Schmitto (2011) argue that compression depth should be maintained at 5 cm and the rescuer should allow the victim’s chest to recoil completely. In addition, the rescuer should avoid removing his or her hands from the victim’s chest, in order to maintain the right compression depth. The rescuer should observe a duty cycle of 50% and the compressor should be rotated every two minutes. Chest compression is terminated after the patient recovers or if the patient is unresponsive to the treatment. The BLS Survey The American Heart Association recommends training of persons to equip them with the necessary skills to save lives. Receiving the CPR training gives the rescuers the ability to perform basic activities such as restoring the blood circulation, clearing the airway, and conducting rescue breathing. One the major components of the BLS survey is checking the responsiveness of the patient by tapping or shouting. The rescuer is also supposed to determine whether the patient is breathing or not. To determine whether the patient is breathing or not, the rescuer should listen for breath sounds. Alternatively, the rescuer should use the cheeks to feel the flow of air from the patient’s breaths. The next key component of the BLS survey is activating the emergency response system and obtaining an automatic external defibrillator. According to the acceptable principles, the rescuer is required to activate the ERS and begin the CPR after establishing that the patient is unresolved and is unable to breathe. Another key step is checking for the carotid pulses. If the patient is unresponsive or if he or she is not breathing well, the rescuer should take up-to 10 second checking for a pulse. In the absence of a pulse, chest compressions should be administered immediately. As suggested by the 2010s, AHA guidelines for CPR and ECC, the rescuer should adhere to the C-A-B sequence. The last component of the BLS survey is defibrillation. A defibrillator or AED is used to check for a shockable rhythm and is normally used in the absence of a pulse. Pocket masks As earlier indicated, mouth-to-mouth resuscitation is the cornerstone of the CPR. However, there is reluctance by the medical professionals to use this type of resuscitation. One of the common reasons given by nurses and the physicians is the fear of contracting diseases and infections. Their observations are supported by a study conducted by Handley (2002) which shows that HIV transmission can occur due to trauma, oral lesions and contact with blood. It is of this reason, that the medical practitioners are advised to carry pocket masks. Pocket masks are considered to be effective in delivering rescue breaths to the patient during cardiac or respiratory arrest. The pocket masks have a pre-inflated cuff to provide an effective seal around the mouth and the nose. The one-way valve reduce contamination while the in-line filter, filters the air. A pocket mask also has an oxygen inlet port to deliver high-flow oxygen to the patient. The pocket mask is placed on the patient’s face with the base of the mask resting between the casualty’s chin and the lower lip. The masks are re-usable but the filters and the valve should be discarded after use. According to Handley (2002) the masks are preferred as they create a comfortable distance between the patient and the rescuer. The device also allows the rescuer to observe the chest movements and monitor the patient. However, while pocket masks are preferred by the medical practitioners, a study conducted by Adelborg et al (2011) indicates that mouth-to-mouth ventilation is superior to mouth-to-pocket masks. In this study, Adelborg et al (2011) used a sample of 60 life guards to perform three sessions of single rescuer CPR. According to Adelborg et al (2011) significantly more ventilation were delivered by the mouth-to-mouth ventilations compared to the mouth-to-pocket masks. The study tend sot suggests that, unless it is absolutely necessary, the rescuers should always resort to mouth-to-mouth ventilation. Using the bag mask This device provides positive pressure ventilation to the patients, and made up of a bag and valve combinations. Bag masks have proved to be effective in airway management and providing patients with enough airbag masks come in different sizes and are the responsibility of the rescuers to choose the most appropriate one. Bag masks are either attached to the oxygen tank or draw room air. The device is operated by one whereby the rescuer hold holds the BVM with one hand, while the other hand compresses the bag delivering the oxygen. The two-person bag ventilation mask has been shown to be more effective than a singly-operated bag mask in delivering greater tidal volumes and introducing less air leak. When using a bag mask one is required to position himself or herself above the victim’s hard. The rescuer then places the mask on the victim’s head and holds it in position using the E-C device. Once the mask is in place, the rescuer is ten required to press the bag and watch for the chest rise. One rescuer CPR and 2 rescuers CPR There are two basic ways of performing CPR: 1-person CPR and the 2-person CPR. Of the two techniques, the 2-Person CPR is the best, as the victim is able to receive enough air volume and is less tiring. One of the rescuers administers the chest compressions while the other performs the rescue breaths. Alternatively, the tow rescuers can trade off about every two minutes. Adult CPR and Child CPR and Infant CPR In all the patients, the chest compression rate and the sequence is the same. In addition, during the CPR chest wall recoil should be allowed between compressions and interruption should be limited to less than 10 seconds. The way CPR is administered varies according to the age. The CPR procedure varies among the adults, children and the infants and these differences are captured in the table below. CPR COMPONENT ADULTS CHIDLREN INFANTS Activating EMS and getting an AED Call for help and if alone phone EMS immediately Call for help but if alone phone EMS after giving 5 cycles of CPR Call for help but if alone phone EMS after giving 5 cycles of CPR COMPRESSION DEPTH 5CM 5CM 4CM COMPRESSION-VENTILATION RATIO 30:2 1 or 2 rescuers 30:2 1 or 2 rescuers 30:2 Single rescuer 15:2 2 rescuers Compression location Centre of chest Centre of chest Just below nipple line on breast bone Compression method 2hands : heel of 1 hand , other hand on top 2hands : heel of 1 hand , other hand on top 2 fingers: middle and ring While the above captures the differences in CPR entities there are a number of CPR components that are common among the adults, children and the infants. One such component is the type of the response. It is the role of the rescuer to ensure that the environment is safe enough and to establish if the victim is responsive or not. To check for breathing and open the airway, the rescuer is required to tilt the chin and should not take more than five minutes to check for the visual cues such as chest rise. Compression rate in adults, children and the infants should be maintained at 100 compressions per minute while the compression ventilation ration should be held at 30:2. However, for the drowning patients, CPR sequence should start with 2 initiation breaths before chest compressions. Rescue breathing Although some of the instructors may not emphasize on rescue breathing, it is considered important in resuscitating the patients. Two breaths are administered for every 30 chest compressions. To breathe air into the patient, the rescuer pinches his or her nose and the closes on the victim’s mouth. The rescuer breathes slowly into the victim leading to the rising of the chest. However, a study conducted by Rea et al (2010) insists that there is no need of rescue breathing if the rescuers are not competent enough. These findings are captured in a randomized trial where 981 of the participants received chest compression only while 960 received chest compression plus rescue breathing. In the end Rea et al (2010) concluded that administering chest compressions alone especially in cancer patients increases the overall survival rate. Choking for an infant Choking is very common in small children and is caused by swallowing of huge chunks of food. Some of the other objects that small children choke on include: buttons, carrots and toys. Symptoms of choking in children include high pitched breathing, coughing, color changes and lack of breathing. Choking in infants is treated using back slaps and chest thrusts. To administer the back slaps the baby is supported using one hand, facing upside down. The baby is placed on the laps and the back slaps are then administered using the heel of hand. On the other hand, chest thrusts are administered with the baby facing up. The chest thrusts are applied using two fingers just below the nipple line. Choking for an adult Choking in adults occurs when foods and other solids partially or completely block the airway. According to the available statistics, choking is a leading case of home injury death in the United States and adults are at an increased risk of choking due to dental problems and age-related illness. Other causes of choking include eating too fast, talking with food in the mouth, wearing dentures and eating foods with wrong texture. Symptoms of choking include: inability to talk, coughing, fainting and clutching. In adults and children choking is treated using back blows and abdominal thrusts. Blows and thrusts are administered until the obstruction is dislodged. To apply the blows, the victim is made to bend until he or she is near parallel to the ground. The victim is supported with one arm and then the back blows are administered between the shoulder blades. Conclusion CPR is an important component of emergency response and leads to significant survival rates of the patients. Despite its success some of the procedures are still archaic and infringe on the rights of the rescuers. For this reason, there is need to address some of the concerns raised by the medical practitioners and conduct extensive research in order to simplify the entire process. References Adelborg, K., Dalqas, C., Grove, E., Jorqensen, C., Al-Mashhadi, R. & Lofqren, B. (2011). Mouth-to-mouth ventilation is superior to mouth-to-pocket mask and bag-valve mask ventilation during lifeguard CPR: a randomized study. Resuscitation, 82(5), 618-622 Handley, A. J. (2002). Teaching hand placement for chest compression--a simpler technique. Resuscitation, 53(1), 29-36 Huether, S., & McCance, K. L. (2004). Understanding pathophysiology. St Louis: Mosby Mistovich, J. J., & Karren, K. J. (2010). Pre-hospital emergency care. New Jersey: Pearson education Rajab, T., Pozner, C., Conrad, C., Cohn, L. & Schmitto, J. (2011). Technique for chest compressions in adult CPR. World Journal of Emergency Surgery, 6, 41 Safar, P. (1989). Initiation of closed-chest cardiopulmonary resuscitation basic life support. A personal history. Resuscitation, 18, 7–20. Read More