CPR and First Aid [2]
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Wikipedia-Article "CPR"
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For other meanings of CPR, see CPR (disambiguation)
Cardiopulmonary resuscitation (CPR), is an emergency first aid protocol for an unconscious person on whom both breathing and pulse cannot be detected.
The medical term for a patient whose heart has stopped is cardiac arrest (also referred to as cardiorespiratory arrest), in which case CPR is used. If the patient still has a pulse, but is not breathing, this is called respiratory arrest and Rescue breathing is used. In many first aid certifications, the CPR protocol is also used for an unconscious and choking patient.
The mot common treatable cause of cardiac arrest outside of a hospital is a heart attack leading to a heart rhythm disturbance. Cardiac arrest may be caused by a number of events, including drowning, drug overdoses, poisoning, electrocution and many other conditions.
Many countries have official guidelines on how CPR should be provided, and these naturally override the general description of CPR in this article.
In 2005 new CPR guidelines were published, with input from the American Heart Association, the Canadian Heart and Stroke Foundation and European Resuscitation Council, with the primary goal of simplifying CPR for laypersons and healthcare providers alike.
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Importance
Heart action and respiratory effort are absolute requirements in transporting oxygen to the tissues. The main organ to suffer from oxygen starvation is the brain, which may sustain damage after four minutes and irreversible damage after about seven minutes. The heart also rapidly loses the ability to maintain a normal rhythm. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain death, and allows the heart to remain responsive to defibrillation attempts.
CPR is commonly taught to ordinary people who may be the only ones present in the crucial few minutes before emergency personnel are available.
Effectiveness
CPR is almost never effective if started more than 15 minutes after collapse because permanent brain damage has probably already occurred. A notable exception is cardiac arrest occurring with exposure to very cold temperatures. A patient cannot be pronounced dead before he has been brought back to a normal temperature by appropriate means: Hypothermia seems to protect the victim somewhat. There are cases where CPR, defibrillation, and advanced warming techniques have revived hypothermia victims after over 30 minutes or longer.
In respiratory arrest, when the victim still has a heartbeat, such as in drowning, choking, or drug overdose with opioids or sedatives, Rescue breathing, a protocol different than CPR, should be used.
About 10% of those on which CPR has been performed will recover entirely, while most will not survive or develop serious complications. However, if CPR is begun within several minutes of cardiac arrest and defibrillation arrives shortly thereafter, a patients chances of recovery rise to near 80%.
History
CPR was developed by Drs. James Elam and Peter Safar in the 1950s [1]. Safar wrote the book ABC of resuscitation in 1957. In the US, it was first promoted as a technique for the public to learn in the 1970s. Early marketing efforts oversold the effectiveness of CPR in rescuing heart attack and other victims. The standards for CPR in the United States are established by the American Heart Association. Rewritten every several years, most recently in 2005, these standards stress the importance of immediate defibrillation as well as performing effective chest compressions during resuscitation.
In the United Kingdom, the guidelines for CPR are written by the Resuscitation Council (UK). The most recent guidelines were published in November 2005. See external link below.
CPR Training
CPR is a practical skill and needs to be regularly practiced (on a resuscitation mannequin) to ensure full competency.
CPR training is available through many commercial, volunteer and governmental organizations worldwide.
CPR training is not confined to just the medical professionals. Almost anyone is able to perform CPR: early CPR is essential in preventing brain damage during a cardiac arrest until a defibrillator or other medical help arrives.
Myths and popular culture
Sometimes CPR should not be performed, particularly if other persons are injured and need immediate help. CPR takes a lot of effort, and may keep care providers from helping others. See triage.
CPR is often portrayed in movies and television as being highly effective in rususcitating a person who is not breathing and has no circulation. A 1996 study by the New England Journal of Medicine showed that CPR success rates in television shows was 75%. The reality is that CPR administered outside hospitals has a 2-15% success rate on its own, and is most importantly used to sustain oxygen supply to the brain until specialized medical equipment and personnel can reach the scene (see defibrillator).
Some people discern a superficial similarity to CPR in a passage from the Books of Kings (II 4:34), wherein the Hebrew prophet Elisha warms a dead boy's body and "places his mouth over his".
Several medical studies have indicated that CPR is inaccurately portrayed in the media: it is commonly described on television and movies as the definitive treatment of cardiac arrest and leads the general public to believe that CPR alone can have an extraordinary resuscitation save rate.
The truth remains that while CPR is an integral part of the resuscitation process, it cannot be used to replace other resuscitative adjuncts such as defibrillation, airway management and intravenous drug therapy. While CPR prevents brain damage by circulating oxygen throughout the body, it rarely restarts the heart, nor can it be done forever. Therefore, it is very unlikely for someone to resuscitate another person with CPR only, unless in very special circumstances. Usually if someone "regains" signs of circulation after only bystander CPR was performed, it is usually because the victim was not actually in true cardiac arrest.
Many rescuers who have performed CPR — healthcare provider and layperson alike — have indicated their surprise about what it is really like to perform CPR. Some note that they were unprepared for cartilage separation (considered to be normal in some cases) during chest compression, and believed that they were performing CPR incorrectly (when they were not). Others note that they were shocked when patients vomited, a stark contrast to the clean environment CPR was taught to them in classes (although in modern American Red Cross classes pupils are warned about the possiblilty of vomiting and the importance of using barriers, such as gloves, against bodily fluids - especially blood). In some cases, rescuers blamed themselves when patients were not resuscitated, believing it was their fault for doing "CPR incorrectly" or "not doing CPR well enough".
It is considered important to educate the general public and healthcare professionals that CPR is never guaranteed to save someone's life. Even if CPR is performed perfectly, the person in cardiac arrest may still not be resuscitated. The American Heart Association notes that "some hearts are too sick to be saved" and reflects the reality that CPR is not a cure-all but merely an important part of the resuscitation process. Rescuers who perform CPR should ideally never be blamed for a patient's death because of "inadequate CPR": it is not CPR's goal to "save" someone, but only to maintain the circulation of oxygenated blood to the brain until more advanced medical help arrives to provide advanced cardiac life support.
References
- Weisfeldt ML. Public access defibrillation: good or great? BMJ USA 2004;328:E271-E272. Fulltext. PMID 14988214.
- Resuscitation Guidelines 2005. Resuscitation Council (UK), 2005. ISBN 1903812100. Online version.
See also
External links
- American Heart Asscoiation: Find a CPR course near you
- UK Resuscitation Council 2005 guidelines in plain English
- European Resuscitation Council European 2005 guidelines]
- American Heart Association 2005 guidelines - gives scientific detail.
- Overview of changes from 2000 to 2005 guidlines
- Learn CPR - Basic description of CPR procedure, incorporating 2005 update
- How to do CPR on an adult : outdated instructions from eHow.com
- How to do CPR on a child (outdated)
- CPR for an infant : clear and concise instructions. (outdated)
- Open Directory: CPR and First Aid Training
- Open Directory: CPR websites
Wikipedia-Article "First Aid [2]"
First aid is the immediate and temporary aid provided to a sick or injured person until medical treatment can be provided. It generally consists of series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform with minimal equipment.
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History
The Knights Hospitaller were probably the first to specialize in battlefield care for the wounded. St. John Ambulance was formed in 1877 to teach first aid (a term devised by the order) in large railway centres and mining districts. The order and its training began to spread throughout the British Empire and Europe. As well, in 1859, Henry Dunant helped organize villagers in Switzerland to help victims of the nearby Battle of Solferino. Four years later, four different nations met in Geneva and formed the organization which has grown into the Red Cross. Developments in first aid and many other medical techniques have been fueled in large by wars: the American Civil War prompted Clara Barton to organize the American Red Cross. Today, there are several groups that promote first aid, such as the military and the Scouting movement. New techniques and equipment have helped make today's first aid simple and effective.
Training
It is best to obtain training in first aid before a medical emergency occurs. One needs hands-on training by experts to perform first aid safely, and recommendations change, so that training should be repeated every two years or so. Training in first aid is often available through community organizations such as the Red Cross and St. John Ambulance. In many countries in the Commonwealth of Nations, St. John Ambulance provides first aid training and in some countries operates Ambulance services. In the United States, the American Heart Association and American CPR Training also offer first aid training.
In the United Kingdom, there are two main types of first aid courses offered. An "Emergency Aid for Appointed Persons" course typically lasts 1 day, and covers the basics, focusing on critical interventions for conditions such as cardiac arrest and severe bleeding, and is usually not formally assessed. A "First Aid at Work" course is a 4 day course (2 days for a requalification) which covers the full spectrum of first aid, and is formally assessed. Other courses offered by training organisations such as St John Ambulance include Baby & Child Courses; and courses geared towards more advanced life support, such as defibrillation and administration of medical gases (oxygen & entenox).
Basic First Aid
This is intended as a quick guide only. Effective CPR and first aid require hands-on training that is best accomplished by attending a class in person. (See list above for organizations).
This section summarizes one common formula for performing first aid.
- Survey the scene What's going on? Is it safe for me to approach?
- Do a primary patient survey Airway, Breathing, Circulation
- Call for emergency services
- Do a secondary patient survey, and provide appropriate emergency first aid
Survey the scene
Survey the scene and approach the victim. Determine whether the scene is safe. Look for dangers, such as downed powerlines, traffic, unstable structures or swift-moving water. Determine what may have happened, how many victims are involved, and if any bystanders can help.
If several persons appear to be injured, perform triage.
Survey the patient
Perform an initial assessment. Get consent from a conscious victim (parent/guardian if the victim is a minor) before providing care. If the victim is unconscious, consent is implied. Use infection control precautions and check for signs and symptoms of any life-threatening conditions and care for them. To perform an initial assessment:
- Check the victim for consciousness and obtain consent if the victim is conscious;
- Check the ABCs (airway, breathing and circulation); and
- Check for severe bleeding.
One should provide brief care for the conditions. If the patient lacks air or circulation, their brain will suffer damage after approximately four minutes. To care for breathing and circulation means first clearing the airway, and briefly attempting to restart their breathing or circulation with rescue breathing or CPR. This step is crucial, because an unconscious person's airway can be blocked by a normal, comfortable-looking head position (i.e., on their back with a pillowed head). Often, simply tilting the head back will open the airway and restart their breathing. Likewise, many people recovering from a blocked airway vomit, and if they are unconscious, they can drown in the vomit. The standard prevention for both these issues is to turn a breathing, unconscious patient on their side, turning their head and spine in the same movement to prevent spinal injury, pillowing their head on one of their arms.
Do not move victims unless it is necessary to remove them from danger, or to make treatment possible (such as onto a hard surface for CPR).
Calling for emergency medical services must take priority over extended care such as long term rescue breathing or extended CPR, since these techniques are intended to gain time for emergency services to arrive as part of the chain of survival. However, if bystanders are available, both can be pursued at the same time.
Call for emergency services
The next step is to activate emergency medical services by calling for help using a local emergency telephone number, such as 911 in Canada or the United States, 999 in the UK, 112 in most of continential Europe, 000 in Australia and 111 in New Zealand. Operators will generally require the caller's name and location and some information on person that is being called about (level of consciousness, injuries, name if known, chronic medical illnessess if known).
If you ask bystanders to call an ambulance for you, make sure they report back to you once released by the emergency operator to confirm that the call has been made. See Call for help.
Also note that in some circumstances, such as in remote areas or on the battlefield, outside help may be unavailable. The skill of wilderness first aid covers other measures including evacuation, but is no substitute for a medical professional if one can be located.
Do a secondary survey and begin extended care
The secondary survey is to gather information about conditions or injuries that may not be life threatening, but may become so if not cared for.
A properly trained and certified first aider performs three stages in the secondary survey:
- Interview
- Vitals
- Head-to-toe examination
Perform a secondary survey only if you are sure that the victim has no life threatening (ABC) conditions.
It is also essential that stages be performed in order, especially with the interview first, in case the patient loses consciousness.
1) Interview the victim
- Signs and Symptoms - Visible indications of injury and patient reported sensations (e.g. pain)
- Allergies - especially those relevant to injury (i.e. allergy to latex, pencillin, etc.)
- Medications - what current or recent medications the patient is taking
- Past Medical History - any related history, or medical conditions that could complicate treatment (e.g. heart condition)
- Last meal - last food and/or drink
- Events - confirm how injuries most likely occurred
(Note - interview should include bystanders as well to supplement info from the patient)
2) Vitals
(Most certifications at the first-aid level include only the following 4 vitals)
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- LOC - Level of Consciousness description (e.g. - alert, aware, disoriented, confused, unresponsive
- Breathing Rate - Number of breaths per minute. Calculate by counting breaths for 10 seconds and multiplying by six, or 15 seconds and multiplying by four.
- Pulse Rate - Number of heartbeats per minute. Calculate by counting pulse for 10 seconds and multiplying by six, or 15 seconds and multiplying by four. Pulse for an unconscious person is taken on the neck (carotid pulse) and on the wrist (radial pulse) for a conscious person.
- Skin Condition - Pale vs. normal, cool/cold vs. hot, clammy/sweaty vs. dry
3) Head-to-toe examination
- Perform a head-to-toe examination (for a child, toe-to-head)
- Look for medical alert bracelets or medallions.
- Compare one side of the patient against the other
- Look for pain, or deformity
Wilderness (or mass emergency) First Aid
Wilderness first aid is the provision of first aid (q.v.) under conditions where the arrival of emergency responders or the evacuation of an injured person may be delayed due to constraints of terrain, weather, and available persons or equipment. It may be necessary to care for an injured person for several hours or days.
In the United States, Wilderness First Aid (WFA) is the name of a certification in Wilderness Medicine that covers wilderness first aid; depending on the laws applicable where it is practiced, it may impose specific responsibilities and confer specific immunities on duly-diligent practitioners. For instance, the practicing of certain rules of WFA, by someone certified in the usual "street" First Aid discipline but not in WFA (or a higher Wilderness Medicine qualification), could result in civil liability or perhaps even criminal prosecution.
A classic problem is whether to leave an injured person or stay if only one person is ambulatory. Barring special circumstances, the injured one should be stabilized, placed in shelter, and marked in a way visible from the air (usually a single, long line of cut brush or trampled snow). Then the injured one should be left alone, while the other goes for help.
If there are three or more, the healthy group should be split into halves by speed, with the fastest going for help, and the others remaining to make the preparations. (In a party of four, it would be a rare hiker who would be better sent for help alone, rather than sent in a sub-party of two.)
Ensuring the rescuers can find the injured person is crucial. If a personal locator beacon is available, it should be triggered and placed with the injured person. If enough help is available, air-visible markings may be worthwhile. Where surveyor's tape is available within the party (and assuming clear trails are available), it should be used by the sub-party going for help, to back up memory and notes with tape-flagging of the toward-the-injury-location choices of trail at intersections. (When an injury location is off clear trails, by distances that make it impractical to keep blazes of tape within sight of each other, forks in watercourses should be treated as substitutes for trail intersections.)
See medical emergency for a list of medical emergencies and specific guidance directed towards first-aiders, Outdoor Emergency Care technicians and EMTs, often including evacuation criteria.
Training in wilderness first aid is available. Any group of persons traveling in wilderness should have at least one person trained in wilderness first aid and carry a first aid kit designed for the area they are traveling in.
Nursing care is not part of normal first aid but is part of wilderness first aid.
Conditions that often require first aid
Also see medical emergency
- Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the brain or lungs.
- Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.
- Bone fracture a break in a bone initially treated by stabilizing the fracture with a splint.
- Burns, which can result in damage to tissues and loss of body fluids through the burn site.
- Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the patient's trachea is not cleared, for example by the Heimlich maneuver.
- Childbirth.
- Cramps in muscles due to lactic acid buildup caused either by inadequate oxygenation of muscle or lack of water or salt.
- Diving disorders resulting from too much pressure.
- Gastrointestinal bleeding.
- Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
- Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
- Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
- Hemorrhage, or heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to the wound site and elevating the limb if possible.
- Hyperglycemia, or diabetic coma.
- Hypoglycemia, or insulin shock
- Hypothermia, or exposure, occurs when a person's core body temperature falls below 33.7°C (92.6°F). First aid for a mildly hypothermic patient includes rewarming, but rewarming a severely hypothermic person could result in a fatal arrhythmia, an irregular heart rhythm.
- Insect and animal bites and stings.
- Muscle strain.
- Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
- Sprain, a temporary dislocation of a joint that immediately reduces automatically but may result in ligament damage.
- Stroke a temporary loss of blood supply to the brain.
- Sucking chest wound, a life threatening hole in the chest which can cause the chest cavity to fill with air and prevent the lung from filling, treated by covering with an occlusive dressing to let air out but not in.
- Toothache, which can result in severe pain and loss of the tooth but is rarely life threatening.
- Wounds and bleeding, including laceration, incision and abrasion, and avulsion, which present risk of infection and should be irrigated with sterile normal saline and may require antibiotic medication.
Providing first aid
Techniques and procedures of first aid
- Artificial respiration
- Cardiopulmonary resuscitation (CPR)
- Occlusive dressing
- Oxygen first aid
- Triage
- Tourniquet
- Sub-abdominal thrusts
External links
- First Aid advice from St. John Ambulance, including downloadable audio files of spoken tips.
- Emergency Institute
- HealthWorld Online - Emergency & First Aid
- First aid tips and tutorials
- Wilderness manuals: First aid - U.S. Army manual.
- VBgov.com - First Aid Tips
Interesting Note: