I. Judging consciousness
Tap or shake the patient’s shoulder with your hand and call out, “What’s wrong with you!” If the patient does not respond then the patient has lost consciousness; look at the time (accurate to the minute).
Second, call for help
Activate EMSS, immediately ring the alarm and ask medical personnel to come to the rescue; at the scene, wave your hand while shouting to the crowd: “Somebody, help!”
Third, place the patient in the resuscitation position
To facilitate resuscitation, make the patient lie on his back on a hard surface, loosen the patient’s clothespin, belt (female patients loosen underwear), remove oral and nasal secretions, remove the movable dentures, go to the pillow and lie down.
IV. Immediately perform chest cardiac compressions 30 times to establish artificial circulation
Compression site: the middle and lower 1/3 of the sternum.
Compression frequency: 100 times/min or more for adults.
Depth of compression: 125px.
Compression to relaxation ratio: 1:1.
The resuscitator kneels (stands) on the shoulder side of the patient, legs apart, the index finger and middle finger of one hand move along the patient’s rib arch to the middle, find the sternal subcut at the junction of the rib arch on both sides as a positioning mark, then place the middle finger across the sternal subcut above the sternum, press the root of the palm of the other hand against the top of the index finger, then overlap the root of the palm of the positioned hand on the former hand, cross the fingers up, straighten both arms, use the upper body weight and shoulder and Arm strength vertically downward rhythmic, even pressure, pressing depth of 125px, after the pressure relaxes the hand and does not leave the chest to maintain the correct position of pressure, at this time the thorax to return to the original state, the pressure in the chest cavity and venous blood flow back to the heart, so that the heart cavity is filled with blood; then downward pressure, repeatedly, to maintain blood circulation.
Positioning for children: 1 horizontal finger below the vertical intersection of the line of both breasts and the sternum.
Infants: downward pressure with the palm of one hand.
Infants: ring method, overlapping downward pressure with both thumbs; or downward pressure with one hand with index and middle fingers together.
Depth of downward pressure: at least 2.5-3.5 cm for infants and 1.5-2.5 cm for babies.
Compression frequency: at least 100 times per minute.
V. Open the airway
Remove foreign bodies and dentures in the mouth, keep the airway open, use the forehead pressure and chin lift method (to avoid the tongue root falling back and blocking the airway): one hand palm root placed on the forehead, downward and backward force, so that the head back, the other hand index finger, middle finger placed at the angle of the jaw, upward and forward force pull up the jaw, so that the angle of the jaw and earlobe line perpendicular to the ground.
Judging breathing (one listen, two look, three feel)
Under the premise of keeping the airway open.
Listen: the sound of airflow through the airway.
Look: the presence or absence of heaving of the chest.
Feel: the presence or absence of gas discharge from the airway. Check time not more than 10 seconds.
Six, mouth-to-mouth artificial respiration 2 times
Place the forehead hand thumb, index finger pinch the patient’s nostrils (nasal root), the other thumb to separate the patient’s lips, deep inhalation after opening the mouth to wrap the patient’s mouth and blow hard, the time should reach more than 1 second, each blowing volume of about 500-600ml, until the patient’s chest lifted. Release the hand that pinches the nose, let the gas exhale, and reset the thorax.
VII. Judgment of circulation
To feel the carotid artery pulsation, use the right index and middle fingers to feel the right carotid artery (judged for 5-10 seconds) along the jaw and next to the thyroid cartilage for 2 cm (or next to the laryngeal node for 50 px), and place a cardiac compression plate if there is no pulsation. In infants, check the brachial artery (medial side of the upper arm, midpoint of the elbow and shoulder).
Eight, do five consecutive cycles (each cycle compression to blow ratio of 30:2) or compressions after about two minutes, check the effect of CPR
Effective indicators of CPR.
1.Circulation: Aortic pulsation can be touched.
2, respiration: resumption of spontaneous breathing, the appearance of spontaneous breathing does not mean that artificial respiration can be stopped, if spontaneous breathing is weak, still should insist on mouth-to-mouth breathing or other respiratory support (ventilator or breathing balloon).
3, blood pressure: upper limb brachial artery systolic pressure > 60mmhg.
4.Mental: resuscitation is effective, coma becomes shallow, eye movement, eyelash reflex and light reflex are seen, even the arms and legs start to twitch and muscle tone increases.
5, facial color (mouth and lips): effective resuscitation can be seen in the face with cyanosis turned into ruddy or nail bed, skin ruddy; if the patient’s face becomes gray, it means that the resuscitation is not effective.
6, pupils: when resuscitation is effective, the pupils are visible from large to small. If the pupil changes from small to large, fixed and cloudy cornea, it means that the resuscitation is not effective.
IX. Vasoactive drugs
1, epinephrine: as the most commonly used vasopressor during CPR, epinephrine has a strong alpha-adrenergic effect, which can produce beneficial hemodynamic effects during CPR. Epinephrine significantly elevates central arterial pressure, leading to significant increases in coronary and cerebral perfusion pressure, and also improves resuscitation success. The current recommendation is to apply epinephrine 1 mg every 3-5 minutes in adult patients in cardiac arrest. intra-tracheal or intra-osseous administration of epinephrine is also effective if the patient has no intravenous access.
2. Pressin: It is recommended as an alternative vasopressor during CPR and also has a strong vasoconstrictive effect. 40 U of pressin can be used to replace the first or second dose of epinephrine.
Atropine, a drug that eliminates vagal effects, has no known adverse effects in patients with cardiac arrest and can be used to treat severe bradycardia and cardiac arrest. The intravenous dose is 1 mg per minute and the total dose is 3 mg.
X. Anti-arrhythmic drugs
Amiodarone is currently considered as the first choice. Patients with ventricular fibrillation or pulseless ventricular tachycardia who cannot be treated with sequential CPR → shock → CPR → vasoconstrictors can be treated with 150-300 mg of amiodarone administered intravenously. Patients in cardiac arrest may also be treated with intravenous lidocaine (initial dose of 1-1.5 mg/kg).
Eleven, brain resuscitation
Enabling the patient to restore normal brain function and other functions is the basic goal of cardiopulmonary cerebral resuscitation. A normal or mildly increased mean arterial pressure should be maintained in unconscious patients, and increased intracranial pressure should be reduced to ensure the best cerebral perfusion pressure. Because hyperthermia and agitation can increase oxygen demand, lowering core body temperature during the metabolic phase of cardiac arrest protects the myocardium and reduces myocardial reperfusion injury. Hypothermia also has a protective effect on the brain, possibly by lowering intracranial pressure and preventing ischemic brain injury. Hypothermia should be considered for patients in cardiac arrest who receive resuscitation, especially those who receive longer-term resuscitation. Hypothermia may also be considered for those in cardiac arrest due to other cardiac rhythms.
Consideration should be given to lowering the body temperature in comatose patients after successful resuscitation and should be initiated as soon as the hypothermia protocol is ready, ensuring careful monitoring of core body temperature and hemodynamics during the recommended 24-hour cooling period, preventing chills, and maintaining adequate perfusion pressure.
After successful resuscitation the head should be elevated 30 degrees and maintained in a central position to facilitate venous return. Since endotracheal suctioning can increase intracranial pressure, it needs to be carefully observed when performed, while 100% oxygen preoxygenation should be given before suctioning in order to prevent hypoxemia from occurring. In conclusion, attention to the details of post-resuscitation brain oxygenation and perfusion can greatly reduce the occurrence of secondary neurological injury and maximize the chances of overall neurological recovery.
XII. Further life support
During the further life support (ALS) phase, it is recommended that the frequency of uninterrupted chest compressions be at least 100 compressions per minute. The rescuer responsible for ventilation should provide a ventilation rate of 8-10 breaths/minute, but should not hyperventilate and needs to be rotated frequently (every 2-3 minutes) to avoid overexertion that would reduce the quality of CPR.
The rate of external chest compressions should be 100 compressions/minute, as a lower compression rate reduces the forward flow of blood. Since it takes a long time to re-establish adequate aortic and coronary perfusion pressure after each compression interruption, interruptions in compressions should be avoided as much as possible. For example, pulses should be checked for no more than 10 seconds. During the first few minutes of CPR, uninterrupted chest compressions alone are an alternative to conventional CPR, with the advantage of engaging nonmedical personnel who are reluctant to do mouth-to-mouth ventilation.
Chest compressions for 1.5-3 minutes prior to defibrillation help to pump blood into the heart, thereby increasing the likelihood of restoring voluntary circulation with defibrillation. Chest compressions for 1-2 minutes immediately after defibrillation help to prevent hypotension and cardiac arrest, which are common after defibrillation shocks
After restoration of autonomic circulation, the patient may remain in a coma for a considerable period of time, requiring transfer to the ICU for further treatment. At this time, the patient’s spontaneous breathing may be absent, requiring ventilator-assisted breathing. Hemodynamics may also be in an unstable state with abnormal heart rate, rhythm, body circulation blood pressure and organ perfusion. Hypoxemia and hypotension can accelerate brain damage and care should be taken to avoid their occurrence. The underlying status of each organ system must be clarified, and monitoring and appropriate treatment should be given. Mechanical ventilation, oxygen supply and cardiac monitoring must be given continuously during the transfer of the patient to the intensive care unit.
Precautions.
1. accurate compression sites, even force, hands must not leave the chest wall when relaxing, and compressions must be continuous, with no more than 5 seconds of pause if any.
2, to prevent complications, such as rib fractures, hemopneumothorax, etc.
3, mastering the effective indications of cardiopulmonary resuscitation.
5, when compressions are performed, the operator stands (kneels) on the shoulder side of the patient, with both knees the same width as the shoulder, to facilitate operation and save effort.
6, whether single or double CPR (except neonatal) compression to ventilation ratio is 30:2, neonatal single CPR compression to ventilation ratio of 30:2, double 15:2.