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 CPR theory and learning

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zhi yong Y

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PostSubject: CPR theory and learning   Sat Jan 17, 2009 11:53 am

WHAT AND WHY CPR?

What is C.P.R? C.P.R stands for Cardio Pulmonary Resuscitation. If we separate the content of this title (C.P.R) we can understand the whole idea. Then we have to understand why it is so important. Finally we must understand how to practice it when someone is in need.

1. “C” in C.P.R stands for Cardio, which means Heart.
2. “P” stands for Pulmonary, which means Lungs.
3. “R” stands for Resuscitation, which means to revive from a not normal condition.

As we all know that on human being in this world could live without oxygen. Absorption of Oxygen to the whole body is through Lungs while distribution is done by Heart. This clearly shows us how important these two organs are in ensuring a human to be alive. Cardio Pulmonary Resuscitation means when someone goes into a condition where his Heart and Lungs stop functioning, a combination of mouth-to-mouth rescue breathing and chest compression would be done in order to keep some oxygenated blood flowing to the brain and vital organ to revive him from death to alive. A human can only be dead when his or her heart or lungs stop functioning. This also brings us to two different types of death.

1. “Clinical Death” – this is classified as near death (Reversible Condition). Sudden cessation of Heart or Lungs function due to condition such as Heart Attack (Myocardial Infraction), Drowning, Suffocation, Severe Allergy Reaction and many more. This means the human’s cells are still alive (especially brain cells) where active resuscitation could bring back the victim to alive.

2. “Biological Death” – Total human cells had been dead (especially brain cells) due to lack of oxygen supply for a period of time. This death is final. (Irreversible Condition).

During first few minutes of “Clinical Death” if we promptly initiated C.P.R this could give a chance from a human entering into a “Biological Death” condition. 4 minutes after the cessation of Heart and Lungs function takes place, the brain cell’s starts to die due to lack of oxygen. When reach the 10 minutes mark, the brain could go into an irreversible condition, where death is final.

ANATOMY OF AIRWAY

Lungs are situated in the thoracic cavity above the diaphragm. Lungs can be described as 2 air sacs fixed to a pipeline called Airway. Airway consists of nose, mouth, throat (pharynx), Epiglottis, larynx, trachea and lastly bronchi, which embedded to both lungs. Lungs are surrounded by tiny blood vessel called “Capillaries”. These capillaries linked to large blood vessels originated from the Heart where they carry deoxygenated blood (blood lack of oxygen).

The process of “Breathing” and “Gas Exchange” happens in lungs and this is how it works.
1. First the initiation of breathing starts at a place called “Respiratory Centre” in brain.
2. This part of brain sends impulses (messages) to the “Intercostals Muscles and Diaphragm Muscles” via the spinal cord.
3. This impulse contracts these muscles.
4. When these Intercostals Muscles contract, the chest is pulled forward.
5. At the same time when the Diaphragm Muscles contracts, the Diaphragm pulled down.
6. This 2 condition (no.5 & 6) will make the lungs to react like a vacuum that sucks air through the Airway to the Lungs. (Inhalation – Active Process)
7. The air drawn into the Lungs goes through a process called “Gas Exchange”.
8. Gas Exchange simply means Oxygen from air enters into the blood capillary (surrounding the lungs) while Carbon Dioxide from blood capillary (surrounding the lungs) expires into the lungs.
9. Approximately 5% of oxygen from atmosphere (20.9% - 21% at sea level) is absorbed into body (blood capillary surrounding the lungs). Approximately 16% of oxygen is exhaled each time.
10. Once gas exchange occurs, due to positive pressure the air in lungs would be pushed out through Airway from Lungs. (Exhalation – Passive Process)

The Airway works only as a “Pipeline or Passage Way” and nothing else, but it is a very important as the air can only go thru the Airway to reach the lungs for the vital Gas Exchange to happen. As for the Lungs, it works only as an pair of “Air Sacs” and nothing else, but nevertheless it is the only area where Gas Exchange can take place that ensure our status of life.

Lungs are one of the organs where it is solely control by the Brain. This is why when your brain had ceased function (e.g.: COMA) the Heart may still function (Pacemaker) and the human can be alive but the Lungs needs a machine called Ventilator to help in breathing.

A normal healthy adult breaths 14 – 18 times / min but during excretion (exercise, work, walking, stress, anxiety and more) the breathing rate increases.

If the Breathing stops (Respiratory Arrest), the supply of oxygen to blood capillary would stop where it leads to cell destruction and death. The only way to replace the Breathing function is to do mouth-to-mouth “RESCUE BREATHING”, one of the duties in C.P.R.

ANATOMY AND PHYSIOLOGY OF HEART.

Heart is a organ that is surrounded by muscle. The Heart is about the size of your clenched fist, where it is placed at the centre of your chest region. The Heart is placed in between your breastbone (Sternum) and Spine (Thoracic Vertebras) front and back plus in between two lungs at the side.

The Heart works as a “pump” and this is how it works.
1. First, the Heart receives “Deoxygenated” (low oxygen content) blood from all over the body at right side of the Heart.
2. Then the Heart pumps this “Deoxygenated” blood to lungs via its right side blood vessel.
3. In the Lungs, absorption of Oxygen (5%) and release of Carbon Dioxide would take place. (Gas Exchange)
4. Bloods becomes “Oxygenated” (rich in oxygen content).
5. This “Oxygenated” blood travels back to the left side of Heart thru blood vessel.
6. Finally the left side of Heart pumps the “Oxygenated” blood to all parts of body for metabolic process.

The Heart works only as a “pump” and nothing else, but nevertheless it is one of the two most important organs that ensure our status of life.

Heart is one organ where solely it is not control by the Brain. This is possible due to a special part in the heart called the “Pacemaker”. Pacemaker can be described as an electrical station, which generates electrical impulses (messages) to the Heart muscles cells for contraction (this makes the heart pump). This is why even if your brain had ceased function (e.g.: COMA) the Heart can still function and the human can be alive.

In a normal and healthy adult the Heart pumps approximately 60 – 80 times/min. During excretion (exercise, work, walking, stress, anxiety and more) the Heart pumping rate increases. In some athletes or sportsman we could also come across lower heart beat or pump, this is possible due to large heart size.

If the Heart stops pumping (Cardiac Arrest), the supply of oxygenated blood would stop and if this persist for more than 10 minutes it can lead to death. The only way to replace the heart’s function is to do “CHEST COMPRESSION”, one of the duties in C.P.R.

C.P.R AS EASY AS ABC.

C.P.R could be done as simple as ABC, this is also known as basic rescue skills. The ABC’s of C.P.R stands for Airway, Breathing and Circulation.

A - AIRWAY
 Ensure your own safety, make sure the place is safe for you to attempt the rescue activity.

 Next, determine Unresponsiveness (no movement or response to stimulation) by tapping gently on shoulder and shout, “Are you alright?”

 Why need to assess? This is because that person could be sleeping, resting, still conscious just closed eyes due to pain or other condition where he don’t need help.

 EMS (Emergency Medical Services): once the unconsciousness is established call for Ambulance, shout for help to attract passer-by. When someone comes for help, and tell him or her to call for an ambulance. Why? Most of adult unconscious victim could have heart related diseases where this needs professional help from Hospital or Ambulance Services. (In CPR you would have understood ABC, but there is a D which stands for Defibrillator and Drugs. The defibrillator is needed in cases where Ventricular Fibrillation or a wiggling heart is common in a Heart Attack victim and this is only available via Ambulance Services at the rescue scene.)


 Open Airway: now immediately open the Airway by using Head-Tilt / Chin-Lift. It is common that an unconscious victim would present with a blocked Airway. Head-Tilt / Chin-Lift would be able to Open the Airway. Why? In an unconscious victim, muscle will loose its control. If the victim who is lying on his back (supine position), his or her tongue and epiglottis may fall back due to gravity pull and this could close the airway. This is possible as the tongue is controlled by muscle and the epiglottis is attached at the end of the tongue.

B - BREATHING

 Determine Breathlessness by look for chest movement, listen and feel for breathing (check for 5-10 sec). If there is no breathing, follow the next step.

 Treat victims with occasional gasp as if he or she is not breathing. This occasional gasps should not be misjudged as normal breathing.

LOOK, LISTEN & FEEL


 Attempt 2 X Rescue Breathing (mouth-to-mouth) with each breath lasting for 1 second. Take a normal breath (not deep) before giving each Rescue Breaths. Each Rescue Breaths should make the chest rise. Avoid rapid and forceful breaths.

 To provide a mouth-to-mouth rescue breaths open the victim’s airway, pinch the victim’s nose, create an air tight seat between your mouth and the victim’s mouth and blow the air through the victim’s mouth.
 If the chest dose not rises when attempt first rescue breath, reposition the head and open airway again. Then try attempt Rescue breathing again. The Reposition Head is done to determine if the Airway is opened promptly or not the 1st time. If the 2nd attempt still fails this shows that, the victim has a Foreign Body Airway Obstruction (FBAO).

 No matter the air enters to the lungs or not after 2 attempts you need to continue with the next step.

C - CIRCULATION

 No assessment on pulse or signs of circulation is needed, immediately attempt should be carried out to provide 30 X Chest Compression and 2 X Rescue Breathing for 5 Cycle in 2 minutes (for both 1or 2 rescuers)

CHEST COMPRESSION
 Chest compression needs to reach 100 compression every minute. With each compression’s depth is 1 ˝ - 2 inches. (Adult - <8yrs).

 To provide a good Chest Compression you need to “push hard and fast” and with a constant flow of in and out. Don’t place jerking or crushing movement on the chest.


 Minimise interruption between Chest Compression and Rescue Breathing. Avoid all sluggish movement and have a firm and fast movement from Chest Compression and Rescue Breathing.

 After 5 Cycles of CPR (30 : 2 of 5 cycles) check for breathing, if no breathing present then continue CPR for another 5 cycle. Until breathing presents.

 When breathing is present, place the unconscious on Recovery Position. Why? Recovery position helps victim in maintaining an open airway at all time, which prevents salivary, vomits and tongue from falling back that could obstruct the airway.
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