Cardiopulmonary resuscitation is a field first aid method used for patients with sudden cessation of breathing and heartbeat and loss of consciousness. Its purpose is to provide minimum cerebral blood supply to the patient through mouth-to-mouth blowing and chest cardiac compressions. Respiratory and cardiac arrest, medically called sudden death, is mostly seen in patients with coronary heart disease, drowning, electric shock, lightning strike, severe trauma, hemorrhage, etc. It occurs mostly in public places, homes and workplaces, and is mostly too late to be sent to hospitals for resuscitation. Correct and effective CPR can be started within 4 minutes of onset and can save countless sudden death patients, therefore, it is of great social significance to let more people master on-site CPR.
When a patient suddenly collapses, first of all, the patient should be shaken while shouting, to determine whether unconscious, with or without breathing heartbeat, no response, CPR should be started immediately, the steps are as follows.
1, the patient’s preparation.
Lay the patient down on a flat surface or hard board, when the patient has trauma (such as fractures, etc.), be careful to move, so as not to aggravate the injury. Keep the patient’s airway open, available tilt – chin lift (or jaw or neck) method, so that the patient’s oral cavity, pharyngeal axis in a straight line, to prevent the tongue root, epiglottis obstruction of the airway opening, the method is the operator generally stand or kneel on the right side of the patient, the left hand placed on the patient’s forehead force back pressure, the right hand fingers on the lower edge of the patient’s mandible, the chin up and forward lift .
2.Mouth-to-mouth blowing.
Mouth-to-mouth blowing is an effective method of providing air to the patient. The method is: the resuscitator will place the right hand on the patient’s chin to press down on the chin, propping up the patient’s mouth, and the thumb and index finger of the left hand pinch the patient’s nostrils to prevent the air exhaled from escaping. Rescuers with their own lips wrapped around the outside of the patient’s mouth to form an airtight seal, and then with medium force, with a speed of 1 – 1.5 seconds to blow into the patient’s mouth about 800 ml of air, after blowing, the rescuer that raised his head to the side, a deep inhalation, to be the next blow, so repeatedly at a frequency of 12 times per minute, until the patient has spontaneous breathing.
3.Extra-thoracic cardiac compressions.
The purpose is to form a pressure difference between the inside and outside of the chest cavity through extra-quadrant cardiac compressions to maintain the power of blood circulation. The method is that when the rescuer is on the right side of the patient, the root of the palm of his left hand is placed on the lower part of the patient’s chest sternum, and then the palm of the right hand is pressed on the back of the left hand (the tips of the index and middle fingers are available for infants, and the root of the palm of one hand is available for children), the fingers of both hands are cocked without touching the patient’s qu wall, the arms are straightened, the elbow joints are not bent, and pressure is formed by pressing downward with both shoulders, pressing the sternum down about 3.5 – 4.5 cm (1.5 – 2.5 cm for infants, 2.5 cm for children). 2.5–4.5 cm for infants and 2.5–4 cm for children), pressing and relaxing for equal periods of time, but without leaving the patient’s qu bone area with the palms of the hands, repeatedly, 80–100 times per minute.
4.Cautions for performing CPR
1, mouth-to-mouth blowing and chest cardiac compressions should be performed simultaneously (single or double at the same time), the ratio of compressions to blowing is: single resuscitation 15:2, double resuscitation 15:2.
(1) That is, blowing twice (single) or once (double), chest cardiac compressions 15 times (single) or 5 times (double), too much blowing and compressions too little, will affect the success or failure of resuscitation.
(2) The site of chest compressions should not be too low, so as not to damage the liver, spleen, stomach and other internal organs. The force of compressions should be appropriate, too violent and too large, will fracture the sternum, bringing pneumothorax hemothorax. Pressing the pressure is too light, the pressure formed in the chest cavity is too small, insufficient to promote blood circulation.
(3) mouth-to-mouth blowing should not be too large (should not exceed 1200 ml), blowing into the time should not be too long, so as not to occur acute gastric dilatation. The blowing process should be observed to see if the patient’s airway is open and if the chest is blown up.
(4) Success and termination of resuscitation. After performing cardiopulmonary resuscitation, the patient’s pupils change from large to small, the response to You is restored, brain tissue function begins to recover (such as the patient struggles, muscle tone increases, there are swallowing movements, etc.), can breathe on their own, the heartbeat is restored, cyanosis subsides, etc., cardiopulmonary resuscitation can be considered successful. If after about 30 minutes of CPR resuscitation, the above resuscitation performance does not occur, it is predicted that the resuscitation has failed. If there is a pulse, the systolic pressure remains above 60 mmHz, and the pupils are in a contracted state, CPR resuscitation should be continued. If the patient is profoundly unconscious, lacks spontaneous respiration, and the pupils are dilated and fixed, this indicates brain death. After CPR lasts for one hour, no recovery of cardiac electrical activity indicates cardiac death. CPR resuscitation may be abandoned when the patient develops cadaveric spots.
Precordial pounding
The precordial pounding is a quick single blow to the middle or lower middle third of the sternum from the small fissure. It is used in the immediate event of cardiac arrest, ventricular fibrillation or ventricular tachycardia, and in the immediate event of cardiac arrest before pacemaker installation in patients with atrioventricular block. Usually only one thump is performed, and if there is no response, chest compressions should be performed immediately.
Pounding in the precordial region is not a resuscitation technique and is generally not used for onsite resuscitation. Although pounding can be used for a potentially responsive heart, it can cause a cardiac effect and provoke the arrested heart to resume beating. However, it is not a substitute for effective chest compressions because pounding is not only ineffective for prolonged ventricular fibrillation, hypoxic cardiac arrest, and electrocardiographic mechanical separation, but can also convert ventricular tachycardia into ventricular fibrillation and can cause ventricular fibrillation in patients with blood loss or asphyxia, so precordial pounding should only be used when there are clear indications. The use of precordial pounding is contraindicated in infants and children under all circumstances. The purpose of this section is to prevent the use of precordial pounding by laypersons who are unable to grasp the indications for its use.
Prioritization of first aid
On-site first aid (or pre-hospital first aid) refers to the emergency treatment and care of injuries caused by diseases, accidental trauma and disasters before the arrival of medical personnel, so as to create favorable conditions for the transfer of patients, alleviate their pain and prevent further deterioration of injuries and conditions. People inevitably encounter some accidents in life, sudden emergencies or trauma, whether the correct and timely treatment is directly related to the patient’s safety and prognosis, especially for some critical injuries and patients, time is life, correct and timely treatment can greatly reduce the mortality and disability rate. Therefore, it is of great significance to let more people master the knowledge of on-site first aid, and when they encounter these situations, they can carry out self-help and mutual rescue to protect people’s life safety.
When carrying out on-site rescue, the rescuers should carry forward the humanitarian spirit of saving lives and helping the injured, and should be notified quickly. Medical emergency units to rescue at the same time, calm, flexible and rapid on-site rescue work, encounter a large number of wounded, to organize the masses for self-help and mutual aid. In first aid, we must adhere to the principle of first rescue, first heavy and then light, first urgent and then slow, to hemorrhage, confusion, abnormal breathing or respiratory arrest, weak pulse or cardiac arrest of critically injured patients, to save lives first and then treat injuries. For patients with multiple injuries, we should generally maintain a clear airway, stop hemorrhage, deal with shock and internal organ damage, then deal with fractures, and finally deal with wounds.
The priority should be clearly distinguished and timely resuscitation should be carried out. Commonly used vital indications are.
(1) consciousness: the casualty does not respond to external stimuli such as questioning, tapping and pushing, indicating that the casualty is unconscious or lost, and the condition is critical.
(2) respiration: normal people breathe 16 – 18 times per minute, when dying breathing becomes faster, shallower, irregular. Before death, breathing becomes slower, irregular, and even stops.
(3) Blood circulation: normal human heartbeat per minute is 60 – 80 times for men and 70 – 90 times for women. In severe trauma (such as hemorrhage), the heartbeat is fast and weak, the pulse is thin and rapid, and in death, the heartbeat stops.
(4) Pupils: the pupils of both eyes are equal in size and round when normal, and rapidly shrink when exposed to light. In critically injured patients, the pupils of both eyes are not equal in size and round, or shrink or dilate or are oblique, and do not respond to light stimulation. Respiratory arrest, cardiac arrest, and fixed dilatation of bilateral pupils are the three main features of death. The appearance of cadaveric spots is irreversible death.
To determine the degree of trauma, generally speaking, minor injury means that the human body has only minor injuries such as abrasion of local tissues or subcutaneous hematoma. Serious injury refers to the body has a fracture, internal organ damage, large or special area burns (burns), serious crush injuries and other single or multiple simultaneous injuries. Critical injury refers to the injured patient has a hemorrhage (including internal bleeding) or severe traumatic brain injury caused by coma, shock, respiratory and cardiac arrest, etc.. On-site resuscitation to accurately determine the severity of trauma, adhere to the heavy first, then light, first urgent then slow.