CPR, also known as heart massage or artificial respiration, is a first aid method used to bring the person back to life in cases such as sudden cardiac arrest or suffocation. CPR is the abbreviation for "cardiopulmonary resuscitation". "Cardio" refers to the heart, "pulmonary" lungs, and resuscitation refers to external supportive interventions on a person whose breathing or blood circulation has stopped. Application has vital importance. Life-threatening situations can happen to anyone at any time. In such cases, CPR is powerful enough to save many patients' lives when done in no time. If it is intervened in a timely and correct manner, the probability of saving the patient increases considerably. The part of these interventions without using any drugs or devices is called "basic life support". Everyone should know these techniques in case of dangerous situations. Although it is highly regarded in our country, it is a matter that should be learned by family members who look after patients at home in order to intervene in emergency situations. There are some differences in practice for babies, children and adults.
CPR is the whole of the methods applied in emergency cases such as sudden stop of heart and breathing. If CPR is started within 4 minutes at the latest in cases such as cardiac arrest or inability to breathe, 7% of the patients can return to life without any problems. Brain damage usually does not occur within the first 4 minutes. If CPR is started during this time, the chance of saving the patient without permanent damage is high. Brain damage begins in 4-6 minutes. Permanent damage may occur in the brain within 6-10 minutes. After 10 minutes, irreversible fatal damage may occur. For this reason, CPR should be started as soon as possible to avoid oxygen deprivation of body tissues, especially the brain, when someone becomes ill.
Majority of deaths due to cardiac arrest are due to not reaching the hospital on time. CPR on the person whose heart is stopped saves time. Patients' chances of returning to life are greatly increased, especially with deliberate CPR. We know the importance of first aid from the events we have experienced, seen and heard. Therefore, learning the details of CPR applications can be life-saving in any emergency.
CPR can be explained as the method of blowing air from the mouth of the patient (artificial respiration) and applying manual pressure to the area where the heart is located (heart massage). Air is supplied to the lungs by blowing air from the mouth of the person. By applying pressure to the rib cage, the heart is able to pump blood to the body. In this way, blood flow can continue to organs and tissues, primarily the brain. Trained people can use "chest compression + breathing", while untrained people can only use "chest compression".
When Is CPR Performed?
Cardiac arrest is the cessation of blood circulation in the body as the heart stops. It usually occurs as a result of heart rhythm irregularities. 75% of cardiac arrest cases occur at home. Especially when people who are alone at home encounter such a situation, it can have very fatal consequences. Mortality rate is high in people who have had cardiac arrest alone.
If someone close to us becomes ill, first of all, it is necessary to be calm and to control the vital functions of the sick person. Should think logically and should act without panic. In such events, even seconds are very important. The time taken to think logically for 3-5 seconds is much less than 3-5 minutes in panic and can save lives. The problem experienced by the patient at that moment should be monitored and tried to be understood. The sick patient will probably be conscious at first and will be able to communicate with his movements. He will still be able to hear those around him and react to what is being said. The distress experienced by the person can be detected before the consciousness disappears. This process is very important.
What are the Symptoms of Cardiac Arrest?
Before or after "cardiac arrest," some or all of the following symptoms may occur:
- Heart palpitations
- Dizziness and lightheadedness just before fainting
- Chest pain
- Nausea and vomiting
- Loss of consciousness
- Inability to take a pulse, blood pressure dropping to zero
- Abnormal breathing
- Arrest of breathing
Some of the problems mentioned above can also be noticed by the patient. However, the time until fainting will be very short. The patient may not have time to take any measures for himself.
If you see signs of cardiac arrest in someone near you, you should stay calm and call the 112 emergency department immediately. You must inform the authorities of the open address and follow the instructions to be given. What you need to do next is to prepare for first aid applications. If there is more than one person next to the patient, one should seek help from the environment and the other should start CPR in order not to waste time.
Important note: If you are at home and the only person with the patient leave the outside door open Remember. There may be people who come to help you. This way, you don't have to interrupt CPR to open the door.
If there are doctors, nurses or healthcare professionals around, you should seek help from them. If not, you should continue CPR uninterruptedly for the patient to survive until the ambulance and medical teams arrive. If first aid is not given to the person whose heart and breathing stops, the brain will start to be irreversibly damaged for 10 minutes without oxygen. Even if the patient returns to life, permanent damage may occur in his body. Therefore, CPR should be started as soon as possible and it should be continued without stopping until the medical teams arrive.
How to Understand Respiratory Congestion?
In a situation where the respiratory tract is partially obstructed, the person can breathe, cough, speak or make a sound. In the case of complete obstruction, he cannot breathe, cannot speak, suffers and reflexively brings his hands to his neck. The level of the blockage can be understood from the patient's movements.
If the respiratory tract is blocked, the substances that cause obstruction should be cleared from the mouth and throat first. During this procedure, the patient should be moved as little as possible in case of a spine fracture and should not be turned left or right. In recent years your circulation It has been determined that it has priority over respiration. Even if breathing stops, the oxygen gas in the blood can continue vital functions for a while. For this reason, if the cleaning cannot be completed quickly, heart massage should be started so that blood can flow to the brain. If artificial respiration is to be done, it should be kept in mind that the respiratory tract must be clean and open. If the respiratory tract is not completely cleared, congestion may recur during artificial respiration.
How is CPR Performed in Adults?
First of all, by asking simple questions to the patient, it is checked whether he / she answers or not. Consciousness is controlled by tapping the patient's shoulder against the possibility of shock. Eye tracking is provided by hands. As a result of these, if there is no response from the patient and there are signs of cardiac arrest, CPR is started immediately.
If there are several people around, the person performing CPR can assign others to call for help. If the savior is alone first 112 emergency service must search. When talking to the emergency room, the patient should not leave the patient and the instructions of the emergency service officer should be followed.
The person applying first aid should make sure that his own safety first, then the safety of the environment and the patient.
The patient should be placed on his back on a flat and firm surface with as little movement as possible.
Due to the event, the patient may have neck or spine trauma. For this reason, it must be intervened very carefully. Even the neck section should be fixed as much as possible.
There are several techniques to control the obstruction of the airway. If neck trauma is suspected, lower jaw thrust maneuver is applied. If there is no suspicion of trauma, the head of the patient is pushed back by holding the forehead with one hand and the chin with the other. To that too head tilt chin lift maneuver is called. With these methods, the airway will be opened, it will become more easily controllable whether the patient is breathing or not and whether the respiratory tract is blocked by an object. If the root of the tongue of the patient has fallen backwards, it is likely to block the airway. The obstruction should be cleared by manually sliding the patient's tongue sideways. If a different object obstructs the airway, the inside of the patient's mouth should be cleaned manually. These procedures can be done more easily by turning the patient on its side. It should be kept in mind that the patient should be moved as little as possible in case of neck and spine trauma. After the occlusion is cleared, CPR can be started by moving to the side of the patient. If there is a second assistant, he / she should provide the airway opening maneuver and stand ready at the patient's head end.
If the rescuer is a paramedic, they should check the heart rate for at least 10 seconds. It is recommended that someone who is not a healthcare professional does not have a pulse check. Because when the adrenaline level in the body rises while in panic, the person can hear their own pulse and this may cause erroneous practices. Even performing chest compressions alone delays the patient's brain death as it pumps blood into the body and saves time until help arrives.
If the person is not breathing and has no heartbeat, their nose is closed and orally for two seconds. "First rescue breath" blown. Hygiene can be achieved by placing an air-permeable cloth on the mouth. The patient's chest should move upwards with the breath given through the mouth. If the rib cage does not move, it should continue to breathe. If the patient's chest does not move despite the strong breath being blown, there may be a blockage in the respiratory tract. This blockage needs to be cleared. After cleaning, the rescuer should take deep breaths and continue blowing until the patient's rib cage rises. Air should be blown into the patient's lungs with a capacity of at least "1 liter per minute". This volume can be achieved by inflating both cheeks like blowing a balloon.
Important note: All the air we blow out is not carbon dioxide gas. In the breath we give a person, there is enough oxygen to meet his needs.
Cardiac massage can be started after the patient has given 2 breaths and sees that the chest is moving. The upper and lower points of the section known as the sternum (bellybone or breastbone) are visually identified. It is divided into two equal parts imaginatively. It places the part where the palm meets the wrist in the middle of the detected lower part. The other hand is placed on the hand placed on the patient's chest, and the fingers of the lower hand are raised so that they do not touch the rib cage. The reason for this is to prevent the pressure to be applied from damaging the ribs and to ensure that the power is directly transmitted to the sternum. Cardiac massage is started with support from the shoulder and waist at a right angle, keeping the hand position intact and the arms straight. The suppression time should equal the release time. The pressure applied in the relaxation phase should be completely reduced, allowing the chest to return to its normal position. While doing this, the hands should not be lifted so that they are completely separated from the patient's skin.
Important note: It is unlikely that heart massage will harm a patient whose heart is working.
The rescuer should position his torso parallel to the patient's torso. Handles to effectively transmit power at a right angle to the body should be kept. Otherwise, the rescuer will get tired quickly by exerting too much effort. With body weight, with support from the shoulders and waist, the patient's chest is pressed and released so that the chest is at least 5 cm down. The print should not be more than 6 cm. In this way, 100 prints are applied at a speed of 120-30 prints per minute, approximately faster than once per second. 30 prints should take about 18 seconds. When counting CPR, the rhythm can be adjusted by saying "and" between single-digit numbers (for example: 1 and 2 and 3 and 4 and 5 and 6 and 7 and ...). Since double-digit numbers take longer to pronounce, it is necessary to add the word "and" between them. are absent (for example:… 24, 25, 26, 27, 28, 29, 30). Afterwards, the patient's airway is opened with appropriate maneuver and 2 breaths are given again. CPR is continued in the form of 2 breaths and 30 heart massage until the patient breathes spontaneously or until the medical teams arrive. 2 breaths and 30 heart massage rounds are called "1 cycle". Vital signs in the patient should be checked rapidly at the completion of every 5 cycles.
If the rescuer is the only one, he must act very quickly during CPR and artificial respiration passages. If there are two people next to the patient, one of them can continue to blow air into the lungs (artificial respiration) while one of them performs heart massage. Artificial respiration rate in adults should be around 15-20 per minute. Since CPR is a very tiring procedure Every 2 minutes It can be replaced with the other person.
People who do not have artificial respiration training or who are unable to perform artificial respiration for any reason can only continue heart massage until help arrives. The oxygen present in the blood will be sufficient for a while for vital functions.
The respiratory tract, breath and circulation order, defined as the ABC of CPR, has been improved in recent years. CAB It has been changed. In order of importance, the respiratory tract, breathing, circulatory system has become the circulation, respiratory tract and breathing. The most important part here is to maintain the blood circulation. Others are opening the respiratory tract (respiratory tract) and artificial respiration (breathing), respectively. Such a change has been deemed appropriate as a result of evaluations made by experts worldwide.
C = Circulation = Circulation
A = Airway = Airway
B = Breathing = Breathing
If respiration and heartbeat have returned, the patient should be turned to his side and given a recovery position and his vital functions should be checked regularly. It should also be kept in mind that patients with suspected trauma should not move.
How is CPR Performed in Children and Babies?
The life-saving method that can be applied to adults, children and even babies is called CPR. Disorders such as sudden breathing or cardiac arrest can be seen in adults, as well as in children and infants. Many babies and children patients' lives can be saved when CPR is applied without wasting any time in emergency situations. The techniques of the application are slightly different in adults, children and babies.
There are differences between CPR techniques applied to infants and children and those applied to adults. If the respondents are children or babies, the application should be made more sensitive. Mistakes made during the intervention can have negative consequences. Therefore, correct techniques must be applied.
Sudden cardiac arrest in infants and children compared to adults rarer is seen. Respiration and blood circulation in children usually deteriorate in a process, after which cardiac and respiratory arrest develops. It is rare for this to happen suddenly. It can be understood beforehand that children will need urgent assistance and precautions can be taken. In order not to make a wrong intervention, the life-saving techniques that should be applied for both adults, children and babies should be learned in detail.
There are some differences in basic life support for children, including those under the age of 8 and over. The most important of these is: Since breathing problems are generally at the forefront in children under 8 years of age, five cycles of CPR (about two minutes) should be performed first and after 112 emergency service must be searched. If the child is older than 8 years old, since heart problems are usually at the forefront and electroshock may be required, first 112 emergency service should be searched and then CPR application should be started. Even a few seconds time difference is very important here. It is necessary to analyze the patient accurately and quickly and make a decision immediately.
The most common cause of airway obstruction in an unconscious baby is tilting the head forward and the tongue falling back. If there is no suspicion of trauma, a towel or clothing is placed under the baby's shoulders and the head is tilted back. Thus, the closed respiratory tract is easily opened. If trauma is suspected, the baby's neck should be stabilized. If there is a spine injury, the patient should be moved without jerking and maintaining the current body position. It should not be forgotten that babies under the age of one must be judged by their movements and appearance, as they cannot communicate verbally even if they are conscious.
In an emergency, the patient's pulse should be checked first and if it is detected that it is not beating, heart massage should be started immediately. Heart massage is performed with one hand in children up to the age of 8, and using 2 or 3 fingers in babies. Since the body tissues of babies are very sensitive, cardiac massage should be done without excessive pressure. For CPR, the baby's chest center (the middle of the line under the two nipples) is determined. The breastbone (sternum) is pressed down to 4 cm (1/3 of the chest height when viewed from the side). The speed of the massage should be 100 times a minute (approximately two presses per second). If the number of rescuers is high, every 15 rescuers should be rescued, and if the rescuer is the only one, 30 artificial respiration should be given after every 2 heart massage. These procedures should be continued until the health teams arrive. If the only rescuer in basic life support applied to babies is the only rescuer, it should be remembered that the 112 emergency service should be called after five cycles (approximately two minutes) of CPR.
Heart massage should be performed 1 times per minute in children aged 8-100 years. This corresponds to approximately two heart massages per second. Every five cycles, that is, approximately every two minutes, the child is reassessed. The rate of heart massage / artificial respiration in children aged 1-8 is "30/2". After every 30 heart massage, 2 respiration is done. It should not be forgotten that if the only rescuer is the only rescuer in basic life support applied to children between the ages of 1-8, as in babies, the 112 emergency service should be called after five cycles (approximately two minutes) of CPR.
While performing artificial respiration to babies, the rescuer's mouth is positioned to cover both the nose and mouth of the patient. In children and adults out of infancy, the patient's nose is closed manually and only breathing is done through the mouth.
The CPR techniques applied to children older than eight years are slightly different from those used for infants and young children. Cardiac massage can be harder as body tissues develop. In some cases, it may be necessary to use both hands during chest compression.
In babies and children, if the airway is completely obstructed by a foreign object (food, toy pieces, etc.), several symptoms can be seen. If the airway is completely blocked, the child cannot breathe, make a sound or cough. If the airway is partially obstructed, sudden respiratory distress occurs, weak and silent coughing and wheezing may be heard. In cases of obstruction, the respiratory tract must be opened first.
Alternately to open the obstructed airway in babies "Back kick" (5 times between scapulae, one stroke every second) and "Diaphragm pressure" (5 times to the upper part of the diaphragm). This cycle should continue until the foreign body comes out or the baby is unconscious. If the baby is unconscious, CPR should be started immediately.
Several different methods can be applied to open the obstructed respiratory tract in children. If he is unconscious, the child's mouth is opened with the head tilt chin lift maneuver. If a foreign body is seen in the mouth, it is removed. It is necessary not to unconsciously insert a finger into the child's mouth to look for a foreign object. After cleaning the mouth, CPR is started immediately.
Is CPR Risky?
There is no fatal risk of performing CPR. On the contrary, thousands of people come back to life in this way. Pressure applied to the chest during CPR can damage tissues or break the ribs. However, it is more important for the patient to survive. With the right techniques, it is possible to save lives with minimal or no harm to the patient.
Infection transmission is also very rare. There is no record of transmission of diseases such as AIDS. Nevertheless, as much as possible against the risk of transmission of diseases adherence to hygiene rules must.
CPR is the most important part of first aid and is life saving. It is not dangerous when applied correctly. Missing or faulty applications are dangerous. Therefore, correct techniques should be learned and applied by paying attention to the differences in adult, pediatric and infant patients.