CPR – Guide

Lately we have seen the sad demise of many prominent personalities. I was emotionally disheartened to know about the deaths of Paul Walker of ‘Fast and Furious’ caliber and cricketer Phillip Hughes. Both these met their end through freakish accidents. Sometimes I wonder if man can intervene an individual’s death to bring him back and help those who’ve begun to mourn. At present this can only be true in my imaginations. If there is something that can prevent the death of an individual, it is early and correct cardiopulmonary resuscitation (CPR).

Before we begin to understand what cardiopulmonary resuscitation is, I wish to ask my readers “When do we call an individual’s death?” Is it when someone doesn’t respond to any external stimulus, or an unconscious person? The right answer provided in medical literature is this; death is declared when functions of the vital organs, namely the heart, lungs and brain, cease. Therefore, the next time you see an individual unconscious with no breathing and pulse, he/she isn’t dead yet. You can intervene and save the individual if the intervention is timely and accurate.

‘Acting quickly and fast’ is the most important criteria that will decide the outcome of resuscitation. The steps involved are as follows:

1. Position the individual: Resuscitation is easier and more effective when the individual is resting flat on the back, so first place the individual gently on the back on a flat resting surface or ground.

2. Start pumping chest: Chest compression is currently the most important step of CPR. You start by placing the heel of your palm on the area where the bottom of the sternum (breast bone) meets the lower ribs. Place second palm over the first hand. Make sure fingers are off the chest. You may interlock fingers to make sure fingers are off the chest.
Position your shoulders directly above the hands. Elbows should be fully extended. Compress the chest 2 inches deep if the individual is an adult. In case of a small child, compression should be 1.5 inches deep.
Relax completely to make sure chest rises to normal size before next compression.
Chest compression should be rapid and fast with a rate of 100 compressions per minute at least.
In case of a new born or very small child, one could use only two fingers (the index finger and the middle finger) to perform the compression. If you are able to hold the chest between thumb and other fingers, you could use your thumb to perform chest compressions.
Compressing one’s back is an alternative but is less effective, meaning, if the person is lying on their stomach and you are unable to move the person to his back. The area of compression would be between the shoulder blades, exactly opposite the area defined above.
Pregnant ladies should be preferably resuscitated with the lady positioned on the back.

3. Ventilation: Ventilating an individual with your own breath should not be done at the expense of chest compression unless the individual has suffered from drowning, sedative over dosage or if the individual is a new born infant.
Start by pushing the chin up gradually to clear the airway, unless the individual has suffered from a neck injury, as in a fall from a height. In that case, tilt the head to the side.
Deliver two exhaled breaths through sealed mouth and pinched nose. Effective breaths will make chest rise during this process.
As per current guidelines, ventilation if necessary should be done between every 30 chest compresses. The rate can be increased to every 15 compresses in children and every 3 compresses in newborns.
Ventilating an individual with mouth to mouth breathing is not important if you have no one else to assist you. Continued chest compressions should be done until someone comes for assistance.

4. Ask someone to call for emergency medical assistance while making sure the above mentioned steps are followed diligently. As CPR effort can be tiring, bring in more people to help from the gathering (if any).

Chest compression (C), Airway (A) and Breathing (B), the ‘CAB’ of CPR can save one’s life. Therefore, do not hesitate to perform it or help someone in performing it if the need arises.