Friday, September 06, 2013

Updated CPR Procedure from Nurse Educator Nurina

My CPR post has generated a bit of interest and it has my friend, Nurina Van Oostrum, a staff nurse with a private hospital chipping in to educate everyone. Nurina is a mother of three and she does triathlon as well. Her official position in the Hospital is Nurse Educator, Where part of her job is Basic Life Support and Advanced Life Support instructor.

Today's blog entry is courtesy of Nurina and while the method I share could be a little outdated, the intention is the same - to act should an emergency occur and immediately make the decision that could save someone's life. This is her sharing
Performing CPR : Updated - Nurina Von Oostrum
CPR is needed when someone suffers a cardiac arrest (the heart stops beating). There are a number of reasons why sudden cardiac arrest might happen. The most common reason are heart attacks: a heart attack can result in the heart to start quivering instead of pumping blood around. Other reasons are severe electrolyte imbalances, heat stroke, drugs, poisoning, a range of heart conditions, a blood clot blocking the lung vessels, or for instance a direct blow to the chest etc

Heart attacks are caused by blocked arteries. Risk factors are age, gender (male have a higher risk), family history of heart disease as well as life style; lack of exercise, high stress, smoking, high cholesterol foods increases the risks. Another little known risk factor is chronic infections which play a role in the build-up of plaque blocking the arteries; good oral hygiene can help prevent heart attacks!

When someone suffers a cardiac arrest the heart stops pumping blood around the body. Cells in the body –especially those in the brain- can only survive for a limited time without the oxygen transported by the blood. After 4 – 6 minutes brain damage will start to occur!

What to do if someone suffers a cardiac arrest?

First of all –take a deep breath and stay calm. Panicking is not gonna help and might influence you to make silly decisions.

Follow the steps of DR CAB

D = danger
Ensure there is no danger to the rescuer. Touching someone who’s holding a life electricity wire is going to create another victim. If the situation is hazardous you might have to abort the rescue attempt and save yourself.
Turn the victim unto his back if needed

R1 = Response
Check whether the victim is really unresponsive. Tap on his/her shoulder and shout “are you okay?” Observe the body for any signs of life, movement of limbs.
If the victim is not unconscious do not proceed with CPR

R2 = Respiration (breathing)
Scan the chest for normal breathing. Watch this video for agonal gasps (a reflex which should not be confused with breathing): 

If no breathing is detected within 10 seconds proceed to: C = Circulation
If there is breathing stay with the victim till help arrives, do not proceed with CPR.

R3 = Rescue
Alert the emergency services at 999 (there is no longer a difference between landlines and mobiles, all call 999).
BTW making a prank call to 999 is a criminal offence and can land you in jail! The 999 number receives over 41,000 calls daily of which the majority are pranks -grrr

C = Circulation
Start chest compressions by pushing on the breastbone (in the middle of the chest). Place the heel of one hand on the breastbone, place the other hand on top and interlock fingers. Hold your arms at a 90 degree angle to the chest with straight elbows. Push down at least 2 inch (5cm) –use your weight to press down –this is where correct position is important as CPR is hard work. Push at a rate of at least 100 per minute (you can use the rhythm of the song ‘staying alive’ to get the correct rate-provided you’re old enough to remember that song). If you’ve never learned how to do CPR the 999 telephone operator can guide you. Compression depth should be constant. Compress 30 times

A = Airway
In unconscious victims the airway can be blocked by the tongue which falls back in the throat. Open the airway by performing a head-tilt-chin-lift: hold one hand on the forehead, the fingers of the other hand on the chin and tilt the head backwards. This will ensure the back of the tongue is lifted upwards and no longer blocks the airway.

B = Breathing
Breathe for the victim by pinching his nose, covering his mouth with your mouth and blowing in your expired air until you see his chest rise up. Blow twice
Note; there is a –small- risk of getting infected by diseases such as hepatitis or HIV when performing mouth to mouth breathing (especially when there is blood in the victim’s mouth and you have a wound in your mouth). You can prevent this by using a pocket mask (sold by some pharmacies and most dive-shops) or mouth barrier (sold as key-chains).
If you don’t want to give mouth to mouth breathing continue to give chest compressions only.
Give 5 cycles of 30 chest compressions and 2 breaths before you evaluate for signs of life.

D = defibrillation
Defibrillation will shock the heart, causing the irregular rhythm to revert to a normal heart beat. The sooner this is done the better the chances of success!

Nowadays we have AED= Automated External Defibrillator. These devices are designed to be used by anyone with basic CPR knowledge. They are very simple to use and give clear voice instructions on what to do. While they are not so common yet in Malaysia, in Singapore you can find them everywhere (bus and train stations, every floor of shopping malls etc). In Malaysia you can find them on airports, on airplanes, newer shopping malls and ambulances.
Listen to instructions from professional rescue providers once they arrive.

Not every victim of sudden cardiac arrest will survive when given CPR. 
Prevention is the best!
Without CPR every victim of sudden cardiac arrest will die within minutes.

Go and learn CPR so you’re prepared to help when needed. In a good quality CPR course you will learn how to do:
·         Give chest compressions for adults, children and infants
·         Give mouth to mouth breathing
·         Use a pocket mask
·         Operate an AED
·         Relieve choking

Emergencies don’t wait for you to be prepared


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