Latest CPR guidelines

You are at your son's weekly rugby practice. Suddenly, one of his team mates collapses. He doesn't respond at all and it appears that he might not even be breathing. No-one else is around and it is up to you to act quickly.

One thing you can do that doesn't require fancy equipment or a medical qualification, is CPR (cardiopulmonary resuscitation). Except in the case of choking, CPR will not address the underlying causes of the problem, which could be heart attack, cardiac arrest or stroke, but will buy you time until help arrives.

CPR combines mouth-to-mouth breathing and chest compressions to help someone who has stopped breathing, has no pulse and is unconscious. The purpose is to keep oxygenated blood circulating to the brain and other vital organs until help arrives. If the brain is starved of oxygen for more than four minutes, permanent brain damage can result. Therefore, immediate action is required and every second counts.

Even if you are unsure whether you are doing CPR correctly, it is better to perform CPR imperfectly, than not at all.

New guidelines

The American Heart Association (AHA) released the new International CPR and ECC Guidelines in 2000. The most important change is that it is no longer necessary to determine whether someone has a pulse before starting CPR.

The guidelines were changed because research indicated that at least 35 percent of lay rescuers are wrong about whether or not a victim has a pulse. Finding one's own pulse can already be difficult. Finding an unconscious person's pulse in an emergency, is even harder.

The new guidelines recommend that a lay person instead looks for normal breathing, movement, response to stimulation and other signs of circulation when deciding whether to begin chest compressions. Other changes to the guidelines include standardising the ratio of chest compressions to breaths during adult CPR.

What to do in an emergency

Step 1: Is he responding to shake and sound?
Ask with a loud voice: Are you OK? If there is no response, tap or gently shake the shoulder. (If you suspect a head or neck injury, do not shake the shoulder.) In the case of a baby, tap the feet. If there is no response, go to step 2.

Step 2: Check the ABC's

A: is the airway open?
Open the airway by tilting the head back - keep one hand on his forehead and two fingers of the other hand under the chin to lift the jaw. (If you suspect a head or neck injury, avoid tilting the head. Carefully lift the jaw only.) In the case of an infant (under one year), tilt the head back by lifting the chin. Do not tilt the head too far back.

Check if there is an obvious obstruction. If it is clearly visible, remove it.

B: is he breathing?
Kneel next to him with your head close to his head. Look to see if his chest rises and falls. Listen for any normal breathing sounds and feel for any air moving in or his mouth or nose. Do this for up to 10 seconds.

Sometimes a person in cardiac arrest may make grunting, gasping or snoring-type sounds for a few minutes. This abnormal breathing is false reflex breathing. If you hear this type of breathing without any other signs of life, do not delay CPR. The person desperately needs air and only you can provide it.

If there is breathing, place the person in the recovery position, unless you suspect a head or spinal injury.

C: is there circulation?
Check for breathing, coughing and any movement in response to mouth-to-mouth breathing. Do this for up to 10 seconds. If there are no such signs, start with chest compressions.

If the person is not responding and not breathing, follow these steps:

For adults and children over 8:

1. Call
Call for help.

2. Blow
  • Roll the victim on his or her back. (If you suspect a head or neck injury, gently roll the head, neck and shoulders together as a unit until the person is on his or her back).
  • Pinch the nose shut while you continue to lift the chin forward to keep the airway open.
  • Cover the victim's mouth with yours to create an airtight seal, and blow steadily while you watch to see if the chest rises. Each breath should take 2 seconds. Between breaths, lift your head and see if the chest falls.
  • If the chest rises and falls, it is an effective breathing. If it does not, adjust the head and try again. Remove any obvious obstructions from the mouth. Make up to 5 attempts if necessary.
  • As soon as you've given 2 effective breaths, stop and check for signs of circulation.

If signs of circulation are present, continue giving 10 breaths per minute until help arrives. Check for circulation every minute. Place in recovery position if breathing returns.

If you cannot achieve effective breaths or there are no signs of circulation, start chest compressions.

3. Pump (only if no signs of circulation)
Kneel beside the person. Place the heel of one hand right between the nipples and on the breastbone. Place the heel of your other hand on top of the first hand. Lean over the victim with your arms straight and elbows locked, with your shoulders directly above your hands. Press down vertically on the victim's breastbone 4-5 cm. It will help to count: "one-and-two-and-three-and-four…", giving one push each time you say a number. When saying "and", release the pressure but do not move your hands. Give 15 pumps at almost 2 compressions per second (rate of 100 per minute). Then give 2 slow breaths.

4. Repeat 15 pumps and 2 breaths 4 times and then check for circulation. If there are still no signs of life, continue with CPR until help arrives or the person takes a spontaneous breath or makes a movement.

For children between ages 1-8:
CPR for children is similar to the procedure for adults. There are, however, three differences:

1. If you are alone with the child, give one full minute of CPR before calling for help.
2. Give 20 breaths per minute, instead of 10.
3. Use the heel of one hand only for chest compressions, and press down 2,5-4 cm only.
4. Give 1 full breath followed by 5 chest compressions.

For infants (up to age 1)
If you are alone with the infant, give one full minute of CPR before calling for help.

1. Blow
  • Cover the infant's mouth and nose with your mouth to create an airtight seal. Give 2 small gentle blows. Each breath should be 1-2 seconds long. You should see the infant's chest rise with each breath.
  • Then stop and check for circulation. If signs of circulation are present, continue giving 20 breaths per minute until help arrives. Check for circulation each minute.

2. Pump (only if no signs of circulation)
If you cannot achieve effective breaths or there are no signs of circulation, start chest compressions.

Position your 3rd and 4th fingers in the centre of the chest, just below the level of the nipples. Press down only 1-2.5 cm. Give 5 gentle chest compressions at a rate faster than one per second. Repeat with 1 breath and 5 compressions. You should give 100 compressions per minute.

4. Call for help after one minute if you are alone.

Important notes:

  • If there is someone to help you: one person should do chest compressions, while the other does mouth-to-mouth breathing. Stop with chest compressions while breathing is given.
  • The only way to tell whether CPR is effective, is to see if the chest raises with ventilation and if the chest compression results in a pulse.
  • If you suspect that the victim has a spinal injury, only lift the chin. Do not tilt the head back.
  • When pushing on the chest, you may hear a cracking sound due to cartilage or ribs cracking. Even if this occurs, the damage is not serious. The risk of delaying CPR or not doing so, is far greater than the risk of a broken rib.
  • The victim may vomit. If this occurs, turn the head to the side and try to sweep out or wipe off the vomit. Continue with CPR.
  • The spread of infection from the victim to the rescuer is very rare. There is no documentation of HIV ever being transmitted via CPR.

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