1.

Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases
in the body by pulmonary ventilation, external respiration, and internal respiration. [1] Assistance takes many forms, but generally
entails providing air for a person who is not breathing or is not making sufficient respiratory effort on their own [2] (although it must be
used on a patient with a beating heart or as part of cardiopulmonary resuscitation to achieve the internal respiration).
Pulmonary anton ventilation (and hence external parts of respiration) is achieved through manual insufflation of the lungs either by
the rescuer blowing into the patient's lungs, or by using a mechanical device to do so. This method of insufflation has been proved
more effective than methods which involve mechanical manipulation of the patient's chest or arms, such as the Silvester method. [3] It
is also known as Expired Air Resuscitation (EAR), Expired Air Ventilation (EAV), mouth-to-mouth resuscitation, rescue breathing or
colloquially the kiss of life.
Artificial respiration is a part of most protocols for performing cardiopulmonary resuscitation (CPR)[4][5] making it an essential skill for
first aid. In some situations, artificial respiration is also performed separately, for instance in near-drowning and opiate overdoses. The
performance of artificial respiration in its own is now limited in most protocols to health professionals, whereas lay first aiders are
advised to undertake full CPR in any case where the patient is not breathing sufficiently.
Mechanical ventilation involves the use of a mechanical ventilator to move air in and out of the lungs when an individual is unable to
breathe on his or her own, for example during surgery with general anesthesia or when an individual is in a coma.
Artificial respiration means applying some method to supply a person with air, or essentially breathing for him. There are natural
methods for doing this, such as blowing air into a persons mouth when performing cardiopulmonary resuscitation (CPR), and there
are also hand operated or mechanical ways to provide these needed breaths if a person is not breathing on his own or is not
breathing adequately.
When the body does not get enough oxygen because it is not breathing on its own or not breathing enough, the brain cells begin to
deteriorate rapidly. They rely on a constant supply of oxygen in order to stay alive. This is why artificial respiration is so vital under
many circumstances. In order to hopefully preserve brain cells and prevent tissue death, a continued supply of oxygen is required.
Mechanical respiration can be used to maintain life in people who are essentially brain dead. This method may be used when a
person has technically died but is a designated organ donor. Keeping organs fully functioning is necessary to provide the best chance
that they will be successfully transplanted. In these cases, the person truly is not alive and meets many other standards that define
death, but it can be challenging for that persons survivors to consider them as "gone" because a machine is providing them with
breath.
The most basic level of artificial respiration is mouth-to-mouth resuscitation. In the field, and when EMT or medical workers are
moving patients, they may also use a hand squeeze pump to supply needed air. More extensive methods of providing air include
placing tubes in the nose or the mouth, called intubation.
Intubation can provides air by machine, and it can use air with a higher oxygen content as needed or simply use room air. This also
helps prevent things like vomiting into the lungs during or after surgery. Intubation is standard in many surgeries even if people dont
need breathing support; the tube allows quick access in case breathing slows down so much that support is required. People can
continue to breathe on their own through the tube.
The most invasive way in which artificial respiration is provided is through a hole in the trachea. Sometimes, a medical condition may
make it impossible to place a tube from the mouth into the trachea, and medical workers may need more direct access to it. Cutting
a small hole in the base of throat provides this access and may be needed occasionally.
People who have respiration assistance dont necessarily lack the ability to breathe. They may not be able to breathe enough, and
many forms of anesthesia repress or suppress breathing so much that people wont take as many breaths as they need while
drugged. Premature infants born with insufficient lung function and capacity may require extra support from mechanized respiration
too, so they get the vital oxygen and gas exchange they require to promote growth and brain health. Sometimes, mechanical
respiration may be a complicated issue in these smallest of patients and can cause damage and side effects, though the benefits
often outweigh risks.
Many people who are intubated during surgery are extubated before they even wake up, but some people may continue to need
respiration support for a while. Basically, machines that provide respiration can be programmed to take the additional breaths a
patient is failing to take. Once the patient begins to take these breaths on their own, he is weaned off artificial means of respiration.
3.Bleeding
Major bleeding may be a life-threatening condition requiring immediate attention. Bleeding may be external or internal. Bleeding may
be from an ARTERY, a major blood vessel which carries oxygen-rich blood from the heart throughout the body. It may be from a VEIN,
which carries blood back to the heart to be oxygenated or bleeding may be from a CAPILLARY, the smallest of our body's blood

vessels.
ARTERIAL bleeding is characterized by spurts with each beat of the heart, is bright red in color (although blood darkens when it meets
the air) and is usually severe and hard to control. ARTERIAL bleeding requires immediate attention!
VENUS bleeding is characterized by a steady flow and the blood is dark, almost maroon in shade. Venus bleeding is easier to control
than Arterial bleeding.
CAPILLARY bleeding is usually slow, oozing in nature and this type of bleeding usually has a higher risk of infection than other types
of bleeding.
FIRST AID FOR BLEEDING IS INTENDED TO:

STOP THE BLEEDING

PREVENT INFECTION

PREVENT SHOCK

How to control bleeding

Apply DIRECT PRESSURE on the wound. use a dressing, if available. if a dressing is not available, use a rag, towel, piece of
clothing or your hand alone.
IMPORTANT:
ONCE PRESSURE IS APPLIED, KEEP IT IN PLACE. IF DRESSINGS BECOME SOAKED WITH BLOOD, APPLY NEW DRESSINGS OVER
THE OLD DRESSINGS. THE LESS A BLEEDING WOUND IS DISTURBED, THE EASIER IT WILL BE TO STOP THE BLEEDING!

If bleeding continues, and you do not suspect a fracture, ELEVATE the wound above the level of the heart and continue to
apply direct pressure.

If the bleeding still cannot be controlled, the next step is to apply PRESSURE AT A PRESSURE POINT. For wounds of the arms
or hands, pressure points are located on the inside of the wrist ( radial artery-where a pulse is checked) or on the inside of
the upper arm (brachial artery). For wounds of the legs, the pressure point is at the crease in the groin (femoral artery).
Steps 1 and 2 should be continued with use of the pressure points.

The final step to control bleeding is to apply a PRESSURE BANDAGE over the wound. Note the distinction between a dressing
and a bandage. A dressing may be a gauze square applied directly to a wound, while a bandage, such as roll gauze, is used
to hold a dressing in place. Pressure should be used in applying the bandage. After the bandage is in place, it is important to
check the pulse to make sure circulation is not interrupted. When faced with the need to control major bleeding, it is not
important that the dressings you will use are sterile! use whatever you have at hand and work fast!

A SLOW PULSE RATE, OR BLUISH FINGERTIPS OR TOES,

SIGNAL A BANDAGE MAY BE IMPEDING CIRCULATION.

Signs and symptoms of INTERNAL BLEEDING are:

bruised,swollen, tender or rigid abdomen

bruises on chest or signs of fractured ribs

blood in vomit

wounds that have penetrated the chest or abdomen

bleeding from the rectum or vagina

abnormal pulse and difficulty breathing

cool, moist skin

First aid in the field for internal bleeding is limited. If the injury appears to be a simple bruise, apply cold packs to slow bleeding,
relieve pain and reduce swelling. If you suspect more severe internal bleeding, carefully monitor the patient and be prepared to
administer CPR if required (and you are trained to do so). You should also reassure the victim, control external bleeding, care for
shock (covered in next section), loosen tight-fitting clothing and place victim on side so fluids can drain from the mouth.
Basic First Aid for Bleeding
If a person loses too much blood he or she can go into shock. The best way to help someone who is bleeding is to apply pressure to
the wound using a clean cloth and your hand. If possible, you should try to elevate the bleeding area above the person's heart. Do
not remove the cloth once the wound has been controlled. You should never apply a tourniquet to someone unless it involves a
severed limb.
Secondary survey also known as secondary assessment is the process of discovering what has actually happened to the casualty and
what injuries they have.
Secondary assessment is undergone after the primary assessments have been completed: (DR ABC- danger, response, airways,
breathing and circulation) once it is clear that the casualty is breathing and whether they are conscious or not the secondary
assessment can be underway.
from the head to the toes each part of the body is examined for bleeding, lumps and bumps, broken bones and deformities. As well as
finding out about the physical injuries you should also look out for any medical alert bracelets which may state whether that person
has an illness such as epilepsy; which in turn could be the reason for their collapse for example.
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7. Open wounds can be classified according to the object that caused the wound. The types of open wound are:

Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, razor, or glass splinter.

Lacerations, irregular tear-like wounds caused by some blunt trauma. Lacerations and incisions may appear linear (regular)
or stellate (irregular). The term laceration is commonly misused in reference to incisions.

Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are
often caused by a sliding fall onto a rough surface.

Puncture wounds, caused by an object puncturing the skin, such as a nail or needle.

Penetration wounds, caused by an object such as a knife entering and coming out from the skin.

Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at
the site of entry and one at the site of exit, generally referred to as a "through-and-through."

Open wounds can be classified according to the object that caused the wound. The types of open wound are:

Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter.

Lacerations, irregular tear-like wounds caused by some blunt trauma. The term laceration is commonly misused in reference
to incisions.

Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are
often caused by a sliding fall onto a rough surface.

Puncture wounds, caused by an object puncturing the skin, such as a nail or needle.

Penetration wounds, caused by an object such as a knife entering the body.

Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at
the site of entry and one at the site of exit, such is generally known as a through-and-through.

9. Apnea, or respiratory arrest, occurs when the brain's drive to breathe is interrupted or the airways are blocked. Without
intervention, respiratory arrest will be followed by cardiac arrest, and as such should be considered a medical emergency. According
to the Merck Manual, when a patient stops breathing for more than five minutes, irreversible damage is done to the organs,
particularly the brain. In addition, 8 to 30 percent of adults have some brain impairment after resuscitation.

Head Injury
According to the website Brain Injuries, 12, 000 to 15,000 people in the United States suffer severe brain injuries each year. Many die
from these injuries, and approximately 10,000 are left paralyzed by the trauma. Traffic accidents, falls and physical assault can cause
major head trauma. Males aged 15 to 35 are more likely to have a head injury than females in the same age group. Serious head
injuries can cause bleeding of the ventricles of the brain or swelling of brain tissue. Excessive pressure from swelling can cause brain
stem herniation and respiratory arrest. When people suffer mild concussions, they often lose consciousness and respiratory function
ceases, albeit briefly.
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Asthma
Asthma is an inflammatory disease of the airways. An asthma attack creates swelling and inflammation of the bronchial tubes that
lead to the lungs. When the airways are inflamed and swollen, they become constricted, causing the patient to struggle for air. It is
like breathing through a straw--the patient cannot get enough air into the lungs. According to a 2005 article published in the "Indian
Journal of Critical Care," 100 to 150 million people worldwide suffer with asthma, and asthma is responsible for 180,000 deaths each
year. Patients suffering a sudden asthma attack that rapidly progresses to airway obstruction usually come to the emergency room
with hypercapnia, the inability to rid body of carbon dioxide, and hypoxia, the inability to get oxygen to the body. Without immediate
intervention, respiratory arrest will follow.
Drug Overdose
According to the National Institute on Drug Abuse, 47 million Americans used a prescription drug non-medically in 2003. Pain
relievers, tranquilizers, stimulants and sedatives are the drugs of choice for abusers. Opioids such as oxycontin, hydrocodone and
oxycodone are known respiratory depressants. Adolescent abusers frequently mix these medications with alcohol, which increases
the effects and can cause respiratory arrest.
When someone stops breathing it is called apnea. Apnea may be temporary or prolonged. Respiratory arrest is prolonged apnea. In
children, cardiac arrest is often the caused by respiratory arrest, however in adults, respiratory arrest is often caused by cardiac
arrest. Respiratory arrest is life-threatening and must be treated immediately, even when the heart is still beating. Vital organs may
be damaged in less than five minutes. Aside from cardiac arrest, there are several possible causes for respiratory arrest.
1.

Airway Obstruction
o

Airway obstruction (choking) can be the result of mucus, vomit, blood, spasm or swelling of the vocal chords,
trauma, foreign body, aspiration, pneumonia, drowning, pulmonary hemorrhage, pulmonary edema, bronchospasm
or tumor. In addition, individuals that have congenital development disorders frequently have an abnormal airway
that may become obstructed with little difficulty.

Drugs
o

Drug overdose can result in respiratory arrest due to the impairment of the central nervous system. Opiates, such
as heroin, morphine and codeine, block the neurotransmitters in the brain to slow breathing. An overdose can result
in complete respiratory arrest. Other drugs that may result in overdose and respiratory arrest include narcotics,
barbiturates, anesthetics and alcohol.

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Injury/Disease
o

Infection of the central nervous system, brain stem hemorrhage, spinal cord injury or intracranial hypertension
(cerebrospinal fluid pressure is too high) can cause respiratory arrest. Neuomuscular diseases, such as myasthenia

gravis, botulism, poliomyelitis, Guillain-Barre' syndrome and metabolic disturbances can all cause respiratory
muscle weakness, which can lead to respiratory arrest.
Other Causes
o

Other causes of respiratory arrest in children may include seizures, premature birth, holding their breath and
gastroesophageal reflux (heartburn). Other causes in adults may include cyanide poisoning, carbon monoxide
poisoning, irregular heartbeat, stroke and neuromuscular blocking drugs (muscle relaxants).

Considerations
o

You should get emergency medical treatment for anyone who is having a seizure, becomes limp, remains drowsy
and unresponsive, loses consciousness or begins to turn blue. If the individual has stopped breathing and you know
CPR you should begin to perform it. In some public locations you may find an Automated External Defibrillator, a
device that can treat cardiac arrhythmias (irregular heartbeat), which can be life-threatening. Follow the
instructions to use it until help arrives.

List of 31 causes of Complete respiratory arrest

This section shows a full list of all the diseases and conditions listed as a possible cause of Complete respiratory arrest in our
database from various sources.

Anaesthesia

Asthma

Botulism

Brain hemmorhage

Brain injury

Brain stem infarct

Brain tumours

Bronchiectasis

Carbon monoxide poisoning

CNS infection

Congenital developmental
disorders

COPD

Cyanide poisoning

Diaphragmatic paralysis

Drowning

Duchenne muscular
dystrophy

Gullian Barre syndrome

Head injury

Hydrocephalus

Lung carcinoma

Metabolic disturbances

Metastases to the brain

Myasthenia gravis

Obstruction

Opiate overdose

Pneumoconiosis

Pneumonia

Poliomyelitis

Pulmonary edema

Respiratory failure

Spinal cord injury

6. Secondary survey also known as secondary assessment is the process of discovering what has actually happened to the
casualty and what injuries they have.
Secondary assessment is undergone after the primary assessments have been completed: (DR ABC- danger, response,
airways, breathing and circulation) once it is clear that the casualty is breathing and whether they are conscious or not the
secondary assessment can be underway.
from the head to the toes each part of the body is examined for bleeding, lumps and bumps, broken bones and deformities.
As well as finding out about the physical injuries you should also look out for any medical alert bracelets which may state
whether that person has an illness such as epilepsy; which in turn could be the reason for their collapse for example.

You, as a person giving first aid, have now completed your primary survey, quickly going through your ABCs, airway,
breathing and circulation. You have addressed the immediate lifesaving problems. Now is the time that you move on to your
secondary survey. As with any first aid situation keep in mind, your own safety is important. Make sure the scene is safe and
make sure you wear proper gear to protect yourself from blood or any other bodily fluids.

In a secondary survey, you will do a head to toe examination of the victim, looking for any signs or symptoms of injury or
possible underlying medical conditions. In this quick survey, you will gather as much information as you can about what led
up to the event. You will also, if possible, find out from the victim or bystanders if the patient has any underlying medical
conditions which could have caused the episode. This information, passed on to the professional rescuer upon their arrival is
important. It will help the responder make a more advanced diagnosis of the patient's present condition and also guide their
treatment of the victim.

Begin your survey of the victim with the head. Look for any cuts, abrasions, swelling or discoloration. Look for bleeding from
the mouth, nose and ears. Also, look for any clear fluid coming out of these areas especially the ears. This could be a sign of
spinal injury. Check for discoloration behind the ears. This discoloration, or Battle's sign, could be an indication of a severe
head injury.

Next move your survey down to the neck area. Quickly scan for any bruising, swelling, discoloration, cuts or abrasions. Look
for anything that seems amiss such as a shifting of the windpipe, known as tracheal deviation. The neck is also a good place
to look for any medical alert tags. These are sometimes worn by people to help rescuers identify underlying medical
conditions. Now is also a good time to obtain a pulse. Use your first two fingers and find the carotid pulse. Count the beats
for thirty seconds and multiply by two. This will give you the heart rate.

The next area to look at is the chest area. Once again, you will look for any bruising, discoloration, cuts bruises or any
penetrating wounds. Look for any abnormal rise and fall of the chest as the victim breaths. Make not of any pain or
tenderness the patient might have.

The next area to move on to is the abdomen. Look for any injuries paying close attention to pain, tenderness, discoloration,
rigidity, guarding of painful areas, or the presence of any pulsating masses.

Now look at the arms. You will look for any signs of fracture, deformity, shortening or unusual rotation. Check for pulses here
usually at the wrist. If you cannot find a pulse, make note of this and let the emergency responders know. This is another
area where you will find medical alert tags.

Survey the leg area as you did with the arms. Look for any fractures, deformity or shortening. You can also check the top of
the foot for the pedal pulse.

If you don't suspect trauma or any spinal injury, you can gently roll the victim on their side and quickly do a survey of their
back.

While doing your secondary survey, gather as much information as possible. Note level of the patient's consciousness. Is the
patient alert and oriented to time and place? Are they confused or even unconscious? Can they tell you what happened or
what started the event? If possible, ask the patient about any medical problems they might have any medications they
might be on or any allergies they might have. As before, make a note of any answers and pass them along to the
responders.

A secondary survey by a person rendering first aid can be valuable to the outcome of the patient. If you are already trained
in first aid you should be able to conduct a good secondary survey, gathering information that will greatly help the
professionals. If you need first aid training, contact your local American Red Cross, fire department or community
organization. They can help you become a valuable link in the chain of survival.

8. In 1990, the American Heart Association developed the Chain of Survival. This protocol addresses the fact that most SCA
episodes occur outside of a hospital, with death occurring within minutes of onset. For the Chain to be effective, quick
execution of each and every link is critical. With each minute that passes, the likelihood of survival decreases 7-10%.

Time After the

Onset of Attack

Survival Chances

With every minute

Chances are reduced by 7-10%

Within 4-6 minutes

Brain damage and permanent death start to occur

After 10 minutes

Few attempts at resuscitation succeed

To provide the best opportunity for survival, each of these four links must be put into motion within the first few minutes of
SCA onset:

Early Access to Emergency Care must be provided by calling 911.

Early CPR should be started and maintained until emergency medical services (EMS) arrive.

Early Defibrillation is the only one that can re-start the heart function of a person with ventricular fibrillation (VF). If an
automated external defibrillator (AED) is available, a trained operator should administer defibrillation as quickly as possible
until EMS personnel arrive.

Early Advanced Care, the final link, can then be administered as needed by EMS personnel.

When each link in the chain works successfully, the chance of surviving SCA increases greatly.

Type of Care for SCA Victims after Collapse

Chance
of
Survival

No care after collapse

0%

No CPR and delayed defibrillation (after 10 minutes)

0-2%

CPR from a non-medical person (such as a bystander or family member) begun within 2 minutes, but
delayed defibrillation

2-8%

CPR and defibrillation within 8 minutes

20%

CPR and defibrillation within 4 minutes; paramedic help within 8 minutes

43%

Since more than 70% of SCA cases occur at home, and another 10% to 15% occur at work 2 , trained EMS personnel are
unlikely to be at the scene at onset. Therefore, trained lay responders with quick access to defibrillation units can be a vital
asset when SCA strikes. In certain environments, where the Chain is strong and when defibrillation occurs within the first few
minutes of cardiac arrest, survival rates can approach 80% to 100%. 3

People who survive sudden cardiac arrest have an excellent prognosis: 83% survive for at least one year, and 57% survive
for five years or longer. In fact, when analyzed by age group, survival rates for SCA survivors are comparable to survival
rates of people who have never had an event. Clearly, early intervention can offer years of productivity and fulfillment to
victims of SCA.

The first link in the Chain of Survival is the Early Access.

Imagine you are at the airport waiting for a plane, dinning at your favorite restaurant, or sitting in your office. Suddenly, the
person sitting next to you slumps over. You decide to take action and check on the person, but he or she won't respond to
you. What should you do?

Call 9-1-1 or your local emergency number. This is the first link in the Chain of Survival. It is called "Early Access" because
seeking emergency help as quickly as possible is key to SCA survival. Every minute counts.

Could you recognize the symptoms of SCA?

Unresponsiveness

Loss of consciousness

Lack of pulse

Cessation of breathing

SCA is not the same as a heart attack. However, a victim of either condition requires an immediate 911 call.

Your Part in the 911 Call

Stay on the phone and answer the questions asked by the emergency medical services (EMS) dispatcher. Give short, precise
answers. According to the American Heart Association, these questions may include:

"What is your emergency?"

Give as much information as you can such as, "The man sitting next to me had sudden chest pain, then collapsed." Or "She's
lost consciousness and doesn't seem to be breathing."

"What's happening now?"

"My friend is giving CPR. We have an automated external defibrillator (AED)." Or, "We're trying to find a medically trained
person to assist us."

"Where is the victim located?"

"We are at the Evergreen Company, here at 1234 Fifth Avenue NE, in the back hall."

"What number are you calling from?"

"The number is 888-555-1313 and my name is Jo."

During the call, the EMS dispatcher enters vital information into a computer, so Emergency Services knows where to go and
what to expect. You may be told to remain on the phone until helps arrives, and to meet them, and direct them to the scene.
Some dispatchers can provide medical care instructions to help you initiate CPR and defibrillation until medical help arrives.

A prompt 911 call sets the Chain of Survival in motion, giving the next two links, CPR and early defibrillation, the greatest
opportunity for success.

Checklist for Early Access Preparedness

1.

Can you identify the symptoms of SCA?

2.

Are you prepared to recognize an emergency situation and call emergency services?

3.

Do you know your local emergency services phone number? Is it 9-1-1, or something different? Do other members of your
community know this number?

4.

Does your community have enchanced 9-1-1 coverage?

5.

Do you know how long it takes for Emergency Medical personnel to respond to an emergency in your community? If it's
longer than a few minutes, find out how you could improve response time.

6.

Do obstacles prevent Emergency Medical personnel from reach any given location? Such obstacles could include high-rise
buildings, gated communities, remote locales, or high security areas.

Cardiopulmonary resuscitation (CPR) is the second link in the Chain of Survival. This step can buy life-saving time between
the first link (Early Access to Emergency Care) and the third link (Early Defibrillation).

Early CPR is an important link in the Chain of Survival. During cardiac arrest, the heart quivers and twitches, and cannot
pump blood effectively through the body. CPR keeps blood flowing to the heart, brain and throughout the body, sustaining
life until a defibrillator, or other advanced medical care, arrives.

CPR requires two basic activites

Chest compressions

Rescue breathing - either mouth-to-mouth or mouth-to-mask breaths

An SCA victim's chance of survival doubles if CPR occurs before medical services arrives. In some communities,
9-1-1 medical dispatchers are trained to provide CPR instructions over the phone. But not everywhere. That is why it is vital
that the citizens in your community know CPR and can act fast in an emergency.

Lay people can initiate CPR in more than half the SCA cases in which someone has witnessed the incident. And since 10-15%
of SCA cases occur at work and 75-80% of cases occur at home, the person who does CPR often knows the vicitim. Survival
often depends upon the bystander who take action and performs CPR, and keeps it going until medical services arrives.4

Once an SCA victim collapses and a bystander calls 911, the next step in the Chain is to perform CPR if you are trained, or to
find someone who is.

It's important, therefore, to increase the number of trained CPR people and the number of training programs in your schools
and community.

The American Heart Association offers a simple four-hour course called Heartsaver AED Anytime to teach CPR and AED use.
It is appropriate for both lay people and professional first responders, such as police officers and fire-fighters.

According to the American Heart Association, CPR helps ensure that the defibrillator's shock will stop Ventricular Fibrillation
(VF), restoring a normal heart rhythm. But it must be followed within minutes by the third link in the chain, Early
Defibrillation.

Although CPR can sustain life for a short time, it must be followed within minutes by the third link, early defibrillation. Only
when combined with early defibrillation and early advanced care can CPR significantly increase an SCA victim's chance for
long-term survival.

Click here for the new CPR Guidelines from the American Heart Association.

Checklist for Early CPR Preparedness

1.

Are you trained in CPR? If not, sign up for a class in your area and encourage a friend or family member to join you.

2.

Are people in your workplace trained? If not, see if your company would sponsor a training program through an organization
such as the American Heart Association, the American Red Cross, or the National Safety Council.

3.

Is CPR offered in local schools? If not, help start a program to ensure that all students learn CPR before graduating from high
school.

4.

If you are trained, has your certification expired? If so, it's time to take a refresher course.

5.

Are the emergency dispatchers in your area trained to give medical care instructions over the phone? If not, see how this
situation could be changed.

This step is often called the critical link in the Chain of Survival, because treatment with an automated external
defibrillator(AED) can restore a normal beat to a heart quivering from SCA by delivering a measured electrical shock.

Timing is important. According to the American Heart Associtation, reducing the time interval between CPR to delivery of a
shock by even a few seconds can increase a person's possibility of survival. For every minute that passes without
defibrillation, the chances for survival drop by 7-10%. After 10 minutes, survival is unlikely.

Unfortunately, many communities don't offer widespread access to AEDs. And, although many ambulances are equipped,
emergency medical services can sometime arrive too late. Traffic, secured buldings, high-rises, and remote areas can all
contribute to a delay.

Lives are saved when communities ensure that their emergency response personnel (such as police officers and fire-fighters)
and citizens are trained in CPR and AED useage. When Communties place AEDs inside police cars, fire trucks, municipal and
public buildings, schools, and recreational areas, defibrillation can occur withouth delay and lives are saved. According to the
American Heart Association, 40,000 additional lives could be saved in the United States each year with widespread access to
defibrillation.

CPR alone cannot fully resuscitate a person in SCA. Most SCA victims are in ventricular fibrillation (VF), an electrical
malfunction of the heart that causes the heart to twitch irregularly. Defibrillation, the delivery of an electrical shock to the
heart muscle, can restore normal heart function if it occurs within minutes of SCA onset.

After using AEDs to restore a normal heart rhythm, the next step in the Chain of Survival is Early Advance Care.

When CPR and defibrillation are provided within eight minutes of an episode, a person's chance of survival increases to 20%.
1
When these steps are provided within four minutes and a paramedic arrives within eight minutes, the likelihood of survival
increases to over 40%. 1

Defibrillation, the Key to Survival

According to the American Heart Association (AHA), in cities where defibrillation is provided within 5-7 minutes, the survival
rate from SCA is as high as 49%. 1 The AHA also cites that after automated external defibrillators (AEDs) were placed at
Chicago's O'Hare and Midway Airports, 9 out of 14 SCA victims (64%) were revived with an AED and had no permanent
neurological damage.

However, the availability of AEDs in locations such as airports, airplanes, offices, community centers, and other public places
is an evolving trend. The process began almost forty years ago, when the time-sensitivity of SCA and the importance of prehospital care first captured the attention of Dr. J.Frank Pantridge.

To learn more about increasing the availability of AEDs in your community, see the Defibrillation Program section.

Early Defibrillation Checklist

1.

How long would it take an AED to reach you in an emergency? Learn whether this "call-to-shock" time is 5 minutes or less at
least 90 percent of the time. If the "call-to-shock" times takes longer than five minutes, see what your community can do
imporve the AED accessibility.

2.

Do your state laws allow all first responders, such as polic officers, fire-fighters, and trained lay people to use AEDs?
Determine the legal liabilities in your state.

3.

Are the first response emergency vehicles (e.g., fire trucks, police cars) equipped with AEDs? Are these personnel trained to
deliver the first shock within 60 seconds of their arrival? If not, find out how to start a Public Access Defibrillation Program in
your community.

The fourth link in the Chain of Survival is Early Advanced Care. Paramedics and other highly trained EMS personnel provide
this care, which can include CPR, defibrillation, administration of cardiac drugs, and the insertion of endotracheal breathing
tubes. This type of advanced care can help the heart in VF respond to defibrillation and maintain a normal rhythm after
successful defibrillation.

The trained EMS personnel monitor the patient closely on the way to the hospital, where more definitive diagnostic
evaluation can occur.

Learn how to strengthen the links in the Chain of Survival in your community.

5.If the Person Is Conscious but Not Able to Breathe or Talk:

1. Give Back Blows

Give up to 5 blows between the shoulder blades with the heel of your hand.

2. If Person Is Still Choking, Do Thrusts

If the person is not pregnant or obese, do abdominal thrusts:

Stand behind the person and wrap your arms around the waist.

Place your clenched fist just above the persons navel. Grab your fist with your other hand.

Quickly pull inward and upward.

Continue cycles of 5 back blows and 5 abdominal thrusts until the object is coughed up or the person starts to breathe or
cough.

Take the object out of his mouth only if you can see it. Never do a finger sweep unless you can see the object in the person's
mouth.

If the person is obese or pregnant, do high abdominal thrusts:

Stand behind the person, wrap your arms them, and position your hands at the base of the breast bone.

Quickly pull inward and upward.

Repeat until the object is dislodged.

3. Give CPR, if Necessary

If the obstruction comes out, but the person is not breathing or if the person becomes unconscious:

For a child, start CPR for children.

For an adult, start CPR for adults.

4.Follow Up

When emergency medical personnel arrive, they will take over and may do CPR or take the person to the hospital, if needed.

Choking occurs when a foreign object such as a mouthful of food, a marble or false teeth partly or completely blocks a
persons airway. Choking may be a life-threatening medical emergency because the brain can only survive a few minutes
without oxygen. Another name for choking is foreign body airway obstruction.
First aid can save the life of a choking person if applied correctly and immediately. Procedures are different for adults and
children. Always call triple zero (000) in an emergency.
The suggestions in this fact sheet are not a substitute for first aid training. Everyone should learn first aid skills. See the
Where to get help section of this fact sheet for organisations that offer first aid courses.

Symptoms of choking partly blocked airway

A person with a partly blocked airway can still breathe, speak or cough. Symptoms include:

Panicked and distressed behaviour

Inability to talk in complete sentences or at full volume

Frantic coughing

Unusual breathing sounds, such as wheezing or whistling

Clutching at the throat

Watery eyes

Red face.

Symptoms of choking completely blocked airway

A person with a completely blocked airway cannot breathe, speak or cough at all. Symptoms include:

Panicked and distressed behaviour, including vigorous attempts to breathe

Clutching at the throat

Watery eyes

Red face at first, turning pale and then blue due to lack of oxygen (cyanosis)

Unconsciousness and collapse.

Note that in a young child, their struggle to breathe may not last long and the stopping of frantic activity may be indicative
of a serious or life-threatening situation, rather than a sign that they have dislodged the obstruction. Look for other signs and
symptoms such as the childs responses, a pale face, or cold and clammy skin. These are signs that the child is in shock.

First aid for choking if the person is conscious

To begin with, reassure the person. Encourage them to breathe and cough. If coughing does not remove the blockage or if
the person choking is a baby, then:

Call triple zero (000).

Bend the person well forward and give five back blows with the heel of your hand between their shoulderblades check if
obstruction is relieved after each blow.

If unsuccessful, give five chest thrusts by placing one hand in the middle of their back for support and the heel of the other
hand on the lower part of their breastbone check if obstruction is relieved after each thrust.

The technique for adults and children is different from that required for babies:

Adult or child ask the person to lean over with their hands on their knees or sit in a chair leaning forward. The amount of
force used on a child is less than that on an adult.

Baby place the baby on your lap or forearm, with their head lower than their body, but ensure that you have them in a firm
hold. The amount of force is less than that used on a child.

First aid for choking if the person is unconscious

If the person becomes unconscious:

Call triple zero (000).

Remove any visible obstruction from the mouth.

Commence cardiopulmonary resuscitation (CPR).

Cardiopulmonary resuscitation (CPR)

First aid CPR procedure includes:

Place the person on their back on a hard surface such as the floor (place a baby on a table).

Tilt the person's head gently back, pinch the nostrils closed, cover their mouth with yours to create a seal and blow firmly.
(Do not tilt a babys head back. Instead, cover their nostrils and mouth. Blow in puffs.)

Place the heel of one hand on the lower half of the persons breastbone. Place the other hand on top of the first hand and
interlock your fingers. Keep your fingers up so that only the heel of your hand is on the persons chest.

Press down firmly and smoothly (compressing to one third of chest depth) 30 times. Then administer two breaths. Repeat at
the rhythm of five cycles in two minutes.

Continue CPR and only stop when the ambulance officers take over or the person recovers.

Performing first aid on yourself

If you are choking:
Try to stay calm. Attract someones attention for help.
Attempt forceful coughing. Lean as far forward as you can. Hold onto something that is firmly anchored, if possible. Breathe
out and then take a deep breath in and cough. This may eject the foreign object.
Dont let anyone slap you on the back while you are upright. Gravity may cause the object to slip further down your trachea
(windpipe).
Where to get help
In an emergency, call triple zero (000)
Emergency department of the nearest hospital
Your doctor
For first aid training, contact:
St John Ambulance Australia (Victoria) Tel. 1300 360 455
Australian Red Cross Tel. 1300 367 428
Things to remember
Always call triple zero (000) for an ambulance in an emergency.
Dont slap a choking person on the back while they are upright gravity may cause the object to slip further down the
trachea (windpipe).
First aid for choking adults includes back blows and chest thrusts while the person is leaning forward.
10. respiratory arrest is caused by the lungs malfunctioning while cardiac arrest stems from the heart malfunctioning. One
can lead to the other though since blood is pumped from one system to the next in order for them to keep functioning
properly.

A respiratory arrest is the cessation of normal respiration due to failure of the lungs to contract effectively.

A respiratory arrest is different from (but may be caused by) a cardiac arrest, where the heart muscles fail to contract
properly

Respiratory arrest prevents delivery of oxygen to the body. Lack of oxygen to the brain causes loss of consciousness. Brain
injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if left untreated
for more than five minutes. For the best chance of survival and recovery, immediate and decisive treatment is imperative.

Respiratory arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. The treatment
for respiratory arrest is artificial ventilation.

Cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the end of normal circulation of the blood due to
failure of the heart to contract effectively.[1] Medical personnel may refer to an unexpected cardiac arrest as a sudden cardiac
arrest (SCA).

A cardiac arrest is different from (but may be caused by) a heart attack, where blood flow to the muscle of the heart is
impaired.[2]

Arrested blood circulation prevents delivery of oxygen to the body. Lack of oxygen to the brain causes loss of consciousness,
which then results in abnormal or absent breathing. Brain injury is likely if cardiac arrest goes untreated for more than five
minutes.[3][4][5] For the best chance of survival and neurological recovery, immediate and decisive treatment is imperative. [6]

Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. Unexpected cardiac
arrest sometimes leads to death almost immediately; this is called sudden cardiac death (SCD).[1] The treatment for cardiac
arrest is cardiopulmonary resuscitation (CPR) to provide circulatory support, followed by defibrillation if a shockable rhythm
is present.