CPR - When and how to perform CPR
 
The body, especially the brain, requires oxygen to keep the cells alive. The air that you breath out still contains about 16% oxygen, so it can save life if it's blown into the patient's lungs. This is called mouth-to-mouth or artificial ventilation. If circulation is absent, i.e. there are no life signs or pulse, artificial ventilation must be combined with chest compressions (cardiopulmonary resuscitation or CPR) otherwise the oxygen will not reach the body's vital organs.

Artificial ventilation carries little or no risk of the transfer of infection. However, for your peace of mind you may want to use a face shield. There are some of these in the green bag and, if you'd like to have one of these to keep in your wallet or handbag contact Jeremy or Dem who can order it for you. As an example of the cost, Jeremy can get  the face shields at a cost of £1.30 each plus £1.93 p&p plus vat.

NB If you don't have a face shield with you, you should never hesitate to give a patient artificial ventilation.
Before approaching any patient always follow the DRABC procedure. Having confirmed that it's not dangerous to approach and examine the patient, check his response (AVPU). If there's no response, open his airway by placing 2 fingers under his chin and the other on his forehead and gently tilt the head well back (see fig 1). If the airway is obstructed attempt to clear the obstruction. Check for breathing for 10 seconds.

If he's not breathing but life signs are evident start artificial ventilation:

 The patient should be placed, lying on his back, on a level surface. If it's likely you'll deploy the AED it must also be dry.
  1. Make sure that the airway is still open (fig 1)
  2. Close his nose by pinching it with your thumb and forefinger
  3. Take a full breath and place your lips around his mouth, ensuring you make a good seal
  4. Blow into the patient's mouth until you see his chest rise (fig 2). Take about 2 seconds for a full inflation
  5. Remove your lips and allow the chest to fall fully, which takes about 4 seconds
  6. Repeat steps 4 & 5 ONE more time
  7. Assess for signs of circulation (life signs). Take no longer than 10 seconds
  8. If there are signs of circulation continue artificial ventilation at the rate of 10 per minute until the patient starts breathing or help arrives
   Fig 1Fig 2.
If there are no signs of circulation commence CPR
1. Cardiac arrest is diagnosed if a casualty is unresponsive (no life signs) and not breathing normally.
2. Place one of your hands in the centre of the casualty's chest and the other on top of it, interlocking your fingers.
  •      Use a ratio of compressions to rescue breaths of 30:2 for all casualties - adults and children.
  • Each rescue breath is given over 1 second (rather than the 2 seconds advised hitherto).
5. Give 30 compressions immediately.
6. Follow this by 2 rescue breaths (Unless there are OBVIOUS signs of circulation)
7. Give 30 compressions followed by 2 rescue breaths
8. Continue compressions and ventilation at 30:2 ratio
In a first responder situation, where both partners are present, you should insert an oralpharyngeal airway prior to starting artificial ventilation then one partner should continue to carry out CPR while the other partner sets up and switches on the AED. As soon as the AED is ready, CPR should stop and the prompts from the AED should be followed. See How to Defibrillate.
For a child (aged 1-7 years): Position the heel of one hand only 2 fingers' width above the tip of the sternum. Press with less force than you would for an adult, compressing the sternum 1 to 1½ inches (about ⅓ of the depth of the chest). Give 5 chest compressions. Then give 1 rescue breath. Repeat the 5 compressions/1 breath cycle 12 times (about 1 minute) then check again for signs of circulation, such as normal breathing, coughing, or movement in response to rescue breaths. If there are still no signs of circulation, continue to give chest compressions and rescue breaths until help arrives or until signs of circulation are present and breathing is restored.
For a baby (under 1 year old): Place 2 fingers on the baby's sternum, about 1 finger-width below an imaginary line connecting the nipples. Press with gentle force, compressing the sternum about ½ to 1 inch (about ⅓ of the depth of the chest). Give 5 chest compressions. Then give 1 rescue breath covering the baby's mouth and nose. Repeat the cycle of 5 compressions and 1 breath 12 times (about 1 minute) then check again for signs of circulation. If there are still no signs of circulation, continue to give chest compressions and rescue breaths until help arrives or until signs of circulation are present and breathing is restored.

CPR Ready Reference
  Adults Children Infants
If the patient is not breathing but has signs of circulation, such as movement in response to rescue breaths: Give 2 breaths every 15 seconds. Give 1 breath every 3 seconds. Give 1 breath every 3 seconds.
If the patient is not breathing and does not have signs of circulation: Trace the ribs into the notch; place 2 fingers on the sternum. Same as for an adult. 1 finger-width below nipple line.
Do chest compressions with: 2 hands stacked; heel of 1 hand on sternum Heel of 1 hand on sternum 2 or 3 fingers on sternum
Rate of compressions per minute: 100 100 100
Compression depth: 1½ to 2 inches 1 to 1½ inches ½ to 1 inch
Ratio of compressions to breaths: 15:2 5:1 5:1

 
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