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Cardiopulmonary Resuscitation (CPR): A Complete Case Study

Cardiopulmonary resuscitation, or more commonly known as, CPR, is an emergency process of resuscitation. It is an emergency medical process that combines artificial ventilation and chest compressions, to maintain the blood flow and its circulation, and ample of oxygenation in the times of a cardiac arrest.

CPR is only done until further medical measures are taken to stimulate the normal blood flow and proper breathing in the person. Although the chances of having a positive reaction and neurological responses from someone who just suffered a cardiac arrest is very rare, yet, CPR stands to be one of the most common processes of emergency revival.

Proper CPR and affirmative responses from the actions can revive the person in time to pave way for better medical support. All this may be topped off with post-cardiac arrest medical operations, so that cent percent recovery can be confirmed.

Usefulness of CPR  

The efficiency of the CPR method is unparalleled to any other emergency procedure of revival during any form of cardiac attacks. This process, cardiopulmonary resuscitation, leads the way to a steady base for further cardiopulmonary operations.

It helps to preserve the affected body for progressive life support and defibrillator. It is to be used immediately by a person who has become pulseless or knocked out. The type of cardiac electrical activity can be assessed through a quick “swift”.

This can well ahead give a detailed account of cardiac arrest type, as well as point out further medical treatments. Loss of operative cardiac activity is usually aggravated by non-perfusing arrhythmia, which is also known as malignant arrhythmia.

The most mutual non-perfusing arrhythmia that can be generally seen are:

  • Pulseless bradycardia
  • Pulseless ventricular tachycardia (VT)
  • Asystole
  • Ventricular fibrillation (VF)
  • Pulseless electrical activity (PEA)

The procedure of CPR should be started much before the rhythm has been identified. And, it should continue unflinchingly, until the person has been properly resuscitated, or during the defibrillator is being charged and set up.

Also, CPR should be resumed at once, in a blink of an eye, just right after the defibrillator shock has been applied, should continue till the person regains its pulse fully and functionally.

Complications involving the Process of CPR

While CPR is resuscitation procedure of the last resort, the inherent process of the way CPR is performed brings in a lot of complications along with it. Certain medical complications that can follow the implantation of CPR on one’s body can be sternal fractures, rib fractures, bleeding in the anterior mediastinum, hemopericardium, heart contusion, upper airway complications, fat emboli, harm to the abdominal viscera − gashes of the liver and spleen, pulmonary complications − pneumothorax, hemothorax, lung contusions.

Women, statistically seen, generally, possess a greater risk of sternal fractures than men. The danger of rib fractures just heightens and gets more prominent with age.

Restrictions involving the Process of CPR

The only utter contradictory restriction to CPR is a do-not-resuscitate (DNR) order or other advanced instruction demonstrating a person’s conclusive wish to not be given artificial respiration to in the occurrence of a cardiac arrest, or cardiac faults.

A relative contraindication to performing CPR may arise if a clinician justifiably feels that the intervention would be medically futile, although this is clearly a complex issue that is an active area of research.

There have also been issued further recommendations on the implementation of CPR. They include:

  • Not performing resuscitation should be heavily considered in cases involving the patients where they have injuries which are penetrating in nature, or victims blunt trauma who will obviously not survive through the implementation of the procedure.
  • Regular revival or process of resuscitation should be promptly begun in suffering patients who have not foregone any experience of a traumatic injury.
  • Victims of lightning bolt strikes or drowning with major cases of hypothermia should be ready, without any overthinking, should be resuscitated.
  • Child patients who have shown signs of recovery before any traumatic or heavy implementation of CPR should be at once taken immediately to the emergency room; proper CPR, under expert medical care in the hands of professionals should be performed, the obstructed airway should be cleared, and venous or intraosseous lines should be placed on-route properly.
  • In the cases in which the injury or the accident was not witnessed, it may be directly supposed that a lengthier period of hypoxia might have already happened and restricting the process of CPR to thirty minutes or less may be readily deliberated.
  • When the state of affairs or effectiveness of the hurtful events put the executors of procedure are in uncertainty, resuscitation can be commenced and sustained the patient arrives at the hospital.
  • Dismissing the process of resuscitation performed on children should be contained within the state rules.

Procedures for CPR

The process of CPR can be done in two distinct procedures:

  • Through the delivery of chest compressions,
  • By mouth-to-mouth ventilations.

CPR, in its most elementary form, can be executed anywhere by anyone. There is no absolute need for specialized equipment for the implementation of CPR. Some universal precautionary measures including gloves, masks, gowns, etc., should definitely be taken if accessible.

cpr

However, the nature of this process is such that the majority of its execution takes place in an outdoor, or in an out-of-hospital setting where such precautionary measures are not accessible, especially in times of emergency situations when this is performed, one does not have the time to take such cautions instead of trying to revive the person in front of them. Added to that, no transmission of disease can possibly happen through the process of CPR.

In its usual form, CPR consists of the three flowing techniques:

  • Chest Compressions
  • Airway
  • Breathing

For rescuers who are laid down, COCPR, or Compression-only Cardiopulmonary resuscitation is advised.

The ideal positioning for CPR is as follows:

  • The person executing the compressions should be positioned in a way where they are high enough above the patient to attain adequate control so that he or she can use body weight to sufficiently compress the chest.
  • The delivery of CPR on a mattress or on any other soft material surface is usually less effective and adequate.
  • The process of CPR is the most effortlessly and successfully performed by having the patient lay down supine on a moderately hard surface, which permits operative compression of the sternum.

For an adult who is unconscious, the procedure of CPR is commenced as follows:

  • Provide at least thirty chest compressions on the person.
  • Carry out the head-tilt chin-lift movement to expose the airway and govern if the patient is breathing.
  • Before starting ventilation, inspect the patient’s mouth for any unrequired foreign form blocking the airway.

Chest Compressions.

The provider should do the following:

  • Put forward the heel of one hand on the patient’s sternum and the other hand on top of the first, fingers interlaced and tightened.
  • Extend the elbows, and the person implementing inclines directly over the patient (the person unconscious).
  • Press down strongly, compressing the chest at least 2 inches.
  • Release the chest quickly and allow it to retreat completely, without fail.
  • The depth of the compressions performed for adults should be at the least, a minimum of 2 inches (instead of up to 2 inches, as mentioned above).
  • The rate by which the compressions should be performed needs to be at least hundred per minute.
  • The key and the most important phrase for chest compression is, “Push hard and fast.”
  • Inexperienced eyewitnesses should perform chest compression-only CPR (COCPR) to avoid causing any CPR related complications further.
  • After the completion of thirty compressions, two breathe-ins are most important to be given; however, a patient who is intubated should take delivery of incessant, interrupting firm compressions, while ventilations are given eight to ten times per minute.
  • This complete course of procedure is to be performed in recurrence until a pulse comes back or the patient is reassigned to absolute medical care, in the hands of experts.
  • To avert fatigue or injury of the person who is executing all of this, new providers should intercede in an interval of every two to three minutes (in the least). Providers should take turns in or swap out, as the situation permits, giving the initial chest compressor a respite while the next rescuer continues CPR on the patient.
  • During the time period of pregnancy when a woman is laid down on her back, the positioning may take place in such a way that the uterus may compress the inferior vena cava and thus cut down the venous return. It is therefore suggested (through experts everywhere) that the uterus is pushed to the left side of the woman; if this action is not as in effect as perceived then two options remain, to either roll the woman 30 degree or medical care professionals should consider crisis-averting resuscitative hysterotomy.
  • Mostly state protocols everywhere, in general, support the presence of family right there in the implementation of CPR. This takes account of the occurrence of CPR for children.

Ventilation

The provider should take note of the following instructions.

If the patient has stopped breathing altogether, two ventilations are given via the provider’s mouth or a bag-valve-mask (BVM). If obtainable, a device which can be readily used as a barrier device (pocket mask or face shield) should be instantly used.

To carry out the BVM or invasive airway technique, the executor does the following:

  • Make certain of the placing of a tight seal between the mask and the patient’s face.
  • The provider must then squeeze the bag with one hand for the time period of approximately one second, coercing at least 500 mL of air into the patient’s lungs for resuscitation to take place.

Mouth of mouth

To perform the mouth-to-mouth technique, the provider does the following:

  • Begin by pinching the patient’s nostrils close to help with an airtight seal.
  • The rescuer then has to put his or her mouth completely over the patient’s mouth to begin the process of giving mouth to mouths.
  • After the completion of thirty chest compressions, provide with two breaths (the 30:2 cycle of CPR).
  • Provide each breath to the patient for an approximate time duration of one second with enough power to create a rise in the patient’s chest.
  • The failure to observe any prominent chest rise points out a short mouth seal or airway clog up.
  • Subsequently giving the two power breaths through mouth seals, the rescuer must immediately carry on the CPR cycle.

Additional devices for CPR  

While there is an availability of several connecting devices, there is no comparison found to defibrillation, as of 2010, which have unfailingly been established to be superior to regular CPR for out-of-hospital cardiac trauma.

Timing devices 

The timing devices can have a metronome (an object which is usually carried by many ambulance teams) in order to provide full assistance to the provider in acquiring the correct rate of breathing. Some pieces can also give timing reminders for carrying out compressions, ventilating and changing operators.

Manual assist devices

Mechanical chest compression devices are not presently endorsed for extensive use. No high-quality studies have taken place to examine if taking the use of mechanical assist devices for chest compression protects more lives equated with using the regular traditional method of hand compression technique.

These items can there to be positioned on top of the chest, with the CPR provider’s hands going over the device, they can be audio, or video,  photographic displays of what is to be done further.

Mobile apps

To provide guidance to training and incident management, mobile apps have been made available in the biggest app markets. An assessment of the availability of around 61 apps has shown that a major number do not obey international guiding principles for basic life support, and many of those apps are not designed in a comprehensible way.

As a result, the Red Cross had to update and endorse its emergency alertness application, which takes the usage of pictures, text, and videos to assist the user.

The Resuscitation Council of UK has an app, titled Lifesaver, which demonstrates how to perform CPR.

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