CPR: Mouth-to-Mouth Resuscitation - Dissertation Example

Mouth-to-Mouth Resuscitation CPR dates back to the 1700s. Research shows that the Paris Academy of Sciences officially proposed mouth-to-mouth resuscitation for people who experienced drowning in 1741. More than a century later in 1891, German doctor Friedrich Maass conducted arguably the first officially documented chest compression procedure on humans (Jones, 2014). In 1960, Drs William Bennet Kouwenhoven, James Jude and Peter Safar, a group of pioneering resuscitation researchers, combined chest compressions with mouth-to-mouth techniques to produce cardiopulmonary resuscitation, what we now commonly known as CPR. In the 1960s, through the formal support of the technique and the commissioning of a program to teach doctors about close-chest CPR, the American Heart Association (AHA) became the leader in public CPR training. Currently, through its more than 3500 legal Training Centers and almost 300,000 Instructors, the association trains close to 13 million people every year on CPR, advanced life support and first aid (Jones, 2014). Over the years, CPR has morphed from a procedure carried out almost exclusively by healthcare professionals and doctors to a basic lifesaving skill that is easy enough for everyone to master. However, studies show that a number of factors prevent spectators from practicing CPR (Walker, 2013). These include fears that they will do it incorrectly, acquire an infection or face legal action as a result of their attempt to apply CPR. Proposals listed in the 2010 AHA Guidelines for CPR & ECC (Emergency Cardiovascular Care) keep simplifying the procedure for first responders so that more people will and can act in case of emergencies (Walker, 2014). However, equipping everybody with CPR and first aid skills, from healthcare professionals to rescuers has also undergone a number of changes. According to Sumisu (2013), scientific research has enabled the AHA to develop not only specialized indoctrination for healthcare professionals, but also lead the way in new techniques such as Hands-Only for spectators, so that more victims have a greater chance of surviving. The AHA first approved Hands-Only CPR in 2008. Hands-Only is a 2-step procedure of dialling 911 and pushing fast and hard in the middle of the chest until paramedics arrive (Keefe, 2013). Via the association’s Hands-Only Ad Council lobby and other leading initiatives, it is spreading the message that everyone can and should master the simple procedures that can save lives. In 2005, in partnership with Laerdal Medical, its Alliance collaborator, the AHA commissioned the CPR Anytime individual learning program. The program was designed to increase CPR awareness among the general public. Infant CPR Anytime and CPR Anytime kits have all that the public may need to master basic CPR skills in just about 20 minutes. According to Leonard (2014), people can learn the techniques in group settings as or the comfort of their homes, and then avail the kit to friends and close family members to pass them on to others. To facilitate the delivery of indoctrination to busy healthcare workers and professionals who are required to respond to emergencies in their facilities, the AHA designed OnlineAHA.org in 2007, which currently provides different course in CPR and first aid, rhythm recognition, simple and advanced life support, stroke education, etc. According to Leonard (2014), in the four years since its launch, the website has allowed more than 1.3 million people to complete training. In addition, the AHA has developed instruments for the general public that offer real-time lifesaving data. For example, the AHA has developed its first app, Pocket First Aid & CPR Smartphone app. In 2010, this app helped an American filmmaker, Dan Wooley, who had been trapped for close to three days under rubble from the devastating Haiti earthquake, to survive the ordeal (Walker, 2014). Using the information on the app, which has a lot of information featuring demonstrations on CPR and first aid techniques and almost 50 detailed videos, he managed to treat his injuries. CPR Steps The technique is most successful when applied as fast as possible. It should only be performed when someone does not show signs of life or when they are unresponsive; not breathing normally (some people will take irregular gasping breaths during heart attack; one should nor wait until the victim is not breathing at all) or not breathing completely; or unconscious (Jones, 2014). It is not vital to look for a pulse when a victim is discovered with no signs of life. It can be challenging to look for someone’s pulse sometimes, and a lot of time can be wasted in the process. According to Jones (2014), if CPR is required, it must be initiated without any delays. The simple steps for carrying out CPR are applicable for infants, children and adults. They derive from guidelines revised in 2010 by the AHA and that are easy to follow and recall. The information should only be used as a guide and not as an alternative to undergoing formal CPR training (Walker, 2013). The common steps are: D – Dangers; R – Response; S – Seek help; A – Open the airway; B – Normal breathing; C – Initiate CPR; D – Attach defibrillator (AED). Source: (Leonard, 2014) Dangers When checking for dangers, the rescuer should consider why the victim seems to be in the condition he is in – is there the presence of gas or has he been electrocuted? Could they be intoxicated or under the influence of alcohol or drugs and, therefore, a potential hazard to the rescuer? Rescuers should approach victims with caution and avoid any potentially dangerous situations (Sumisu, 2013). If the victim is in a dangerous area (e.g. a road), it is good to move him as quietly as possible to protect both the rescuer and the victim’s safety. Response Check for a response. Is the person conscious? Shake them gently and shout at him as if attempting to arouse them (Sumisu, 2013). If there is no reaction, call for help. Send for Help Call 000 or whatever emergency number used in that country and request for an ambulance. Open Airway Examine the airway. It is advisable to roll the victim on their back gently if it is necessary. Tilt their head back gently, open their mouth and take a look inside. If the foreign and fluid matter is present, roll the victim gently onto his side (Sumisu, 2013). Tilt his head back, open his mouth and remove any visible foreign matter (false teeth, chewing gum, vomit, food) as fast as possible. It is essential not to take much time in this step because the priority is performing CPR (Sumisu, 2013). Chest compressions can help remove foreign material from the upper airway. Normal Breathing Examine the victim for signs of breathing. Observe, feel and listen for any signs of breathing. If the victim is breathing normally, gently roll him onto his side (Sumisu, 2013). In case they are not breathing or not breathing as expected, move to step 6 (Sumisu, 2013). Someone in cardiac arrest can make occasional snoring or grunting attempts at breathing; this is not normal breathing. If the rescuer is unsure of whether the victim is breathing normally, it is time to initiate CPR as illustrated in the next step. Initiate CPR Chest Compressions The rescuer should place the heel of his hand on the bottom half of the victim’s breastbone. After this, the other hand should be placed on top of the first hand, and then the rescuer should either interlock the fingers or grasp his wrist. The compression depth should always be a third of the victim’s chest depth (Keefe, 2013). The ratio should be either thirty compressions to 2 breaths – mouth-to-mouth based on step 7 – while aiming for a hundred compressions and not more than 8 breaths per minute (Sumisu, 2013). Alternatively, if the rescuer is hesitant to perform mouth-to-mouth, he should carry out nonstop chest compressions at a frequency of about a hundred per minute. Some experts argue that thinking about the song Staying Alive by the Bee Gees while conducting compressions on the beat is helpful in maintaining the right rhythm in some situations, victims will have broken ribs due to chest compressions (Jones, 2013). This is still preferable to the notion of not being able to receive CPR. If a scenario like this occurs, the rescuer should pause and realign the hands before continuing (Jones, 2014). Cardiac compressions are exhausting, and the exhaustion will affect the quality of the procedure. If any other responders are available and ready to help then they should rotate every 2 minutes; even if they do not feel exhausted yet (Walker, 2014). Creating compressions is the utmost priority. If a responder finds the procedure too time consuming, unpleasant, or cannot harmonize the breathing then effective compressions will still be helpful. It is vital to prevent all resuscitation attempts because of the mouth-to-mouth aspect Mouth-to-Mouth If breathing is not normal, the rescuer should ensure that they are positioned on their back on a flat, firm surface (Leonard, 2014). After this, they tilt the victim’s head back and then lift their chin to open the airway. The next step is to block the nostrils using the thumb and finger. Place the mouth over the victim’s mouth and then blow into it. Give the victim two full breaths – also known as rescue breathing. According to Keefe (2013), the responder should ensure that there is no air leaking and that the victim’s chest is rising and falling as expected. In case the chest is not rising and falling, the responder should confirm that the head is tilted back, and the nostrils are pinched tightly, blocking the victim’s mouth with theirs. If there is still no change, examine the airway to confirm that there is no obstruction. If it is impossible to get air into the victim’s lungs, revert to cardiac compressions (Sumisu, 2013). Compressions can help remove any objects in case of airway obstruction. Keep performing CPR by repeating the routine of 30 compressions followed by two breaths until professionals arrive. As in step 6, cardiac compressions are exhausting and will influence the quality of the process (Jones, 2014). If any other responders are available and ready to help then they should rotate every 2 minutes; even if they do not feel exhausted yet. As soon as Automated External Defibrillator (AED) becomes available, attach it The rescuer should only use an adult AED on any victim who is above 8 years, not responding and not breathing normally (Walker, 2013). In children below 8 years, paediatric pads or AED are ideal. These devices vary and, therefore, guidelines should be followed in each scenario. The responder must sustain CPR until the AED is activated, and the pads are attached. According to Leonard (2014), the pads should be placed following the diagrammatic illustrations on the pads. Skin-to-pad contact is vital for successful defibrillation. Any excessive chest hair or moisture, as well as any medication pads, should be removed in the quickest way possible. It is essential to follow the instructions on the AED; the victim should not be touched during shock delivery or analysis (Jones, 2014). CPR for Infants and Young Children CPR procedure for children aged 8 years or younger is similar to the one in older children or adults, with only a slight difference in the technique (Sumisu, 2013). For Children between 1 and 8 Years For compressions, the responder should use one hand’s heel, compressing to a third of chest depth (Leonard, 2014). The rest of the steps are similar to the normal procedure in older children and adults. For Infants (up to a year old) Position the infant on their back. The chin should not be lifted, and the head should not be tilted back. This is important because infants’ heads are still larger compared to their bodies. After this, mouth-to-mouth resuscitation should be performed by blocking the infant’s nostrils and mouth with the mouth (Sumisu, 2013). Small amounts of breath should be used. Perform cardiac compression using only two fingers of one hand, to around a third of chest depth. The rest of the steps are similar to the normal procedure in older children and adults. If the victim recovers in the process of CPR, review his condition if there are indications of life return (normal breathing, response, movement, or coughing). If the victim is breathing independently CPR should be stopped, and they should be placed on their side while their head is tilted back (Jones, 2014). If the victim is not breathing, full CPR should be sustained until professional help arrives. According to Jones (2014), the responder should be ready to reinitiate CPR if the victim stops responding or breathing, or becomes unconscious once more. Remain on their side until professional help arrives; you can talk to them reassuringly in the meantime. It is essential not to stop CPR or cardiac compressions prematurely to examine the victim for indications of life. If the responder is in unsure, he should sustain full CPR until medical help arrives (Walker, 2013). Frequent pulse checks are not advisable because they can stop cardiac compressions and prolong resuscitation. Stopping CPR The procedure is generally stopped under only three conditions. Firstly, the victim ought to have recovered and should be breathing independently (Jones, 2014). Secondly, professional should have arrived and taken charge of the situation. Thirdly, the person conducting CPR should be compelled to avoid physical fatigue. Help can be sought by dialling the emergency numbers set in different countries (Keefe, 2013). Important Points Always call for medical help during an emergency (Jones, 2014). CPR is a lifesaving procedure that everybody should master. Chest compressions are the utmost priority in CPR. If the responder is not comfortable performing mouth-to-mouth, cardiac compressions alone can also be lifesaving. Issues Studies conducted in 2009 revealed that despite continued efforts to improve CPR, the quality of cardiac compressions still needs improvement (Keefe, 2013). The studies also showed that there are huge disparities in recovery from out-of-hospital heart attack in emergency medical services (EMS). Finally, the studies showed that most victims of sudden out-of-hospital heart attacks are not given in CPR by bystanders (Leonard, 2014). There is increased emphasis on performing CPR in teams because procedures in healthcare facilities and EMS involve teams of responders, with responders performing multiple actions at the same time. For instance, one responder can trigger the emergency response system while another initiates chest compressions. A third rescuer can either offer ventilations or find the bag-mask used in rescue breathing while a fourth finds and fixes the defibrillator. According to Walker (2013), the ethical issues associated with CPR are complex, and they occur in various settings – in and out of the hospital – among different rescuers. They also involve commencement and halting of basic and advanced life support. All healthcare facilities should consider the legal, ethical and cultural aspects connected with care provision for persons needing CPR (Leonard, 2014). Although healthcare providers have a role to play in the decision-making steps during CPR, they should rely on the local legal and policy requirements, the victim or his family’s preferences, and science. CPR quality must remain high, and more efforts are required to improve the process, especially considering that very few bystanders provide CPR to victims of heart attack (Keefe, 2013). Victims also need effective and efficient post-cardiac arrest treatment and care by methodical teams composed of members who work well together. Education and regular refresher training is, potentially, the key to enhancing CPR performance. All stakeholders must recommit themselves to enhancing the quality of all post-cardiac arrest care and the rate of bystander CPR. According to Sumisu (2013), the general public must embrace CPR and start viewing it as a lifesaving procedure that would save their lives, as well as others’. In today’s increasingly busy and dangerous world, CPR knowledge should be as basic as knowing how to drive or using a computer. References Jones, S. (2014). ACLS, CPR, and PALS clinical pocket guide. Philadelphia: F.A. Davis Company. Keefe, R. (2013). Handbook for public health social work. New York: Springer Pub. Leonard, P. (2014). Quick & easy medical terminology (7th Ed.). St. Louis, Mo.: Elsevier. Sumisu, T. (2013). CPR: Conditional positive regard. Peterborough: FastPrint Pub. Walker, L. (2014). CPR and first aid - lay responder training. S.l.: Kendall Hunt. Read More