PERFORMING CARDIOPULMONARY RESUSCITATION ONE AND TWO PERSON

Critical Aspects Establish whether the patient is unresponsive. (Shake the patient and shout, Are you OK?) Activate the emergency response system immediately if the patient is an adult. If you are alone and the patient is an infant or child, perform CPR for 1 minute, and then activate the emergency response system. Carefully place the patient on a hard surface. Logroll the patient if you suspect a cervical spine injury. If the patient is in a hospital bed, place a CPR board under the patients back. Properly position yourself. A Airway. Open the patients airway. Use either the head tilt chin lift maneuver or the jaw thrust maneuver. B Breathing. Check for breathing. (Place your ear over the patients mouth and nose. Look, listen, and feel for breathing for no longer than 10 seconds.) If the patient is breathing, continue to hold the airway open. If the patient is not breathing, administer two (2) slow breaths. C Circulation. Check for signs of circulation. Use the carotid pulse in adults and children, and the brachial or femoral pulse in infants. Assess for pulse for 5 to 10 seconds. Also check for other signs of circulation, such as movement. If signs of circulation are absent , correctly position your hands and begin chest compressions. Continue CPR for four cycles, then reassess pulse. Stop CPR if the patient responds, regains an adequate pulse, and begins to breath; if you are too exhausted to continue; or if signs of death are obvious.

EQUIPMENT: Resuscitation bag with mask, mouth shield, or face mask with one way valve. Oxygen source, if available Chest compression board or hard surface DELEGATION: Assistive personnel trained in basic life support can perform cardiopulmonary resuscitation (CPR). ASSESSMENT: Assess the following: A. Airway. Assess the patients level of consciousness. R: Assessing the patients level of consciousness prevents administering CPR to a patient who is sleeping or has depressed level of consciousness. B. Breathing. Assesses for airway patency and breathing. C. Circulation. Injury can result if CPR is administered on a patient who doesnt require it. Determine (preferably in advance of an emergency) whether the patient has an advance directive stating that he does or does not wish to have CPR performed. Monitor the effectiveness of chest compressions and ventilations. R: Ineffective chest compressions and ventilations can have detrimental effects on the patient. Assess the patients cardiac and respiratory status after cardiac rhythm and respirations are restored. The patients condition is typically unstable after an arrest; therefore, careful, frequent assessment of the cardiac and respiratory systems is necessary to quickly detect deterioration in patients status.

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PROCEDURE: Establish whether the patient is unresponsive by shaking him and shouting Are you OK? R: Unresponsiveness must be determined to avoid performing CPR on a patient who might be sleeping or have a decreased level of consciousness. Activate the emergency response system immediately if the patient is an adult. If you are alone and the patient is an infant or child, perform CPR for 1 minute, and then activate the emergency response system. R: Activating the emergency response system immediately ensures that advanced life support equipment such as a defibrillator, airway management equipment, and IV medication are on the way for use. Carefully place the patient on a hard surface. Logroll the patient if you suspect a cervical spine injury. If the patient is in a hospital bed, place a CPR board under the patients back. R: A hard surface is necessary to provide chest compression adequately. Logrolling the patient maintains stability of the cervical spine should a cervical spine injury be present. Properly position yourself. Variation: One person CPR a. Position yourself on the floor, with your knees parallel to the patients sternum. R: This position requires the least amount of body movement when you switch from compressions to ventilation. Variation: Two Person CPR b. Position yourself on the floor, with your knees parallel to the patients sternum. The second person should position himself on the opposite side of the patient, with his knees parallel to the patients sternum. If the patient is in a hospital bed, stand with your body parallel to the patients sternum. R: Positioning one person on each side of the patient allows one person to deliver chest compressions while the other person ventilates the patient. Open the patients airway. Variation: Head- Tilt Chin - Lift Maneuver a. Place one hand on the patients forehead, and apply firm pressure, tilting the patients head back. R: Tilting the patients head back helps open the airway. b. Place the fingertips of your other hand under the patients chin, and lift his chin. Keep the patients mouth partially open. R: This maneuver pulls the base of the tongue away from the back of the throat maintaining an open airway. Varaiation: Jaw Thrust Maneuver c. Kneel at the patients head, with your elbows on the floor. Place your thumbs on his lower jaw near the corners of the mouth. R: Placing thumbs on the lower jaw near the corners of the mouth prepares you to lift the lower jaw to opulls the open the airway. d. Place your fingers around the lower jaw, and lift the lower jaw with your fingertips. R: This maneuver pulls the base of the tongue away from the back of the throat, maintaining an open airway while protecting the cervical spine. While keeping the airway open, check for breathing by placing your ear over the patients mouth and nose. Look, listen, and feel for breathing for no longer than 10 seconds. R: Assesses the patients ability to move air into and out of the lungs. Cardiac arrest can occur independently of respiratory arrest, at least initially. If the patient is breathing or resumes effective breathing, continue to hold the airway open. Alternatively, if the patient is not breathing, administer two (2) slow breaths. R: You should initiate two slow breaths immediately if the patient isnt breathing to provide the patient with much needed oxygen. Variation: Adult (Adolescent and Older)

a. Pinch the patients nose with your thumb and fingers. Place your mouth, the mouth shield, or the face mask over the patients mouth. R: Prevents air from escaping through the nares when you deliver a breath. b. Deliver two breaths into the patients mouth, allowing 1 second per breath. Move your mouth or mask to allow the patient to exhale between breaths. Deliver subsequent breaths at a rate of 10 to 12 breaths per minute. R: allowing 1 second per breath allows the adults lungs to expand appropriately and ensures adequate oxygen delivery. Variation: Child (1 to Adolescent) a. Pinch the childs nose with your thumb and fingers. Place your mouth, mouth shield, or the face mask over the childs mouth. R: Prevents air from escaping through the nares when you deliver a breath. b. Delivering two breaths over 1 second per breath allows the childs lungs to expand appropriately and ensures adequate oxygen delivery. Variation: Infant (Less than 1 year of age) a. Place your mouth over the infants mouth and nose, forming a seal. R: A seal keeps air from escaping through the nares when you deliver a breath. b. Deliver two breaths (very gentle puffs) into the infants nose and mouth, allowing 1 second per breath. Allow the infant to exhale between breaths. Deliver subsequent breaths at a rate of 12 20 breaths/ minute. R: delivering two breaths over 1 second per breath allows the infants lungs to expand appropriately and ensures adequate oxygen delivery. 8. Check for signs of circulation, using the carotid pulse in adults and children and the brachial or femoral pulse in infants. Assess for a pulse for 5 to 10 seconds. Also check for other signs of circulation, such as movement. R: lets you know whether chest compressions are indicated. Chest compressions are indicated when the pulse is absent in the adult or is less than 60 beats per minute in the infant. Check the pulse for 5 to 10 seconds, because the pulse may be present but difficult to detect if it is slow, irregular, weak, or rapid. 9. If signs of circulation are absent, correctly position your hands, and begin chest compressions. If a second person is present, the second person should assess the pulse while the first person performs compressions. R: Correct hand placement prevents patient injury. Allowing the second person to check for pulse helps assesses the effectiveness of CPR. a. Adult: 1. Place the heel of one hand over the lower half of the sternum, and place your other hand on top of the first hand, locking them in position. 2. Compress 1 to 2 inches at a rate of 100 compressions per minute. R: The chest must be compressed 1 to 2 inches to ensure adequate circulation and prevent patient injury. b. Child: 1. Place the heel of one hand over the lower half of the sternum. 2. Compress 1/3 to the depth of the chest at a rate of 100 compressions per minute. R: The chest must be adequately compressed to ensure adequate circulation and to prevent injury. c. Infant: 1. Place two finger breadth below the intermammary line. R: Because the chest is small, fingers are used to prevent compressing too forcefully, as could occur if you used the hand. 2. Compress 1/3 to the depth of the chest at a rate of at least 100 compressions per minute, 120 compressions per minute in the newborn. R: The chest must be adequately compressed to ensure adequate circulation and to prevent injury.

10. Continue ventilating the patient. Variation: Adult The second rescuer should administer the ventilations, making sure to deliver the breath as the rescuer administering compressions pauses between compressions. Note: The ratio for compressions to ventilations is 15:2 for two persons and 30: 2 for one person CPR in adult. The person performing chest compressions must pause momentarily to allow the second person to deliver ventilations. R: Pausing to deliver ventilations ensures adequate delivery of ventilations. This technique delivers 10 to 12 breaths per minute and approximately 100 compressions per minute. Variation: Child and Infant Administer two breaths for every 30 compressions with a single rescuer and 2 breaths per 15 compressions with two rescuers. R: This technique delivers about 20 breaths per minute and 100 compressions per minute. 11. Continue CPR for four cycles, and then reassess pulse. R: Reassessing pulse prevents administering CPR inadvertently to the patient who doesnt require it. 12. Stop CPR if the patient responds, regains an adequate pulse, and begins to breath; if you are too exhausted to continue; or if signs of death are obvious. R: CPR should be continued only as needed. Part of administering CPR responsibly is knowing when to stop the procedure when the patients condition becomes hopeless. EVALUATION After the airway is opened, monitor for the return of spontaneous respirations. Evaluate the effectiveness of ventilations and chest compressions. PATIENT TEACHING Instruct the family and caregivers where they can receive CPR training and certification if the patient is at risk for experiencing cardiopulmonary arrest. Explain the importance of keeping emergency phone numbers readily available in the event of an emergency. HOME CARE Activate the emergency response team by dialing 911 in the community setting or by dialing an other designated emergency number if the 911 service is not available. Make sure the patient is on a firm surface before administering CPR. DOCUMENTATION Document the date and time the arrest occurred. Document whether the patient experienced cardiac or respiratory arrest or both. Record the events surrounding the arrest, such as the location of the patient when the arrest occurred, precipitating factors, who discovered the patient, and whether the arrest was witnessed. Document who initiated CPR. Record the name of the physician notified. Record the length of time in which the patient received CPR. Document any complications and the patients response to CPR. Record all information on the designated code record if the arrest occurred within the hospital setting, including medications given and procedures performed.