Cardiopulmonary resuscitation (CPR) is a combination of rescue breathing (mouth-to-mouth) and chest compressions. If an individual is not breathing or blood is not being adequately circulated, performing CPR can restore circulation of oxygen-rich blood to the brain and other vital organs. Because the LACK OF OXYGENATED BLOOD causes brain damage in only a few minutes, CPR should be performed immediately once the indications are present. There are multiple reasons which may require a responder to administer CPR. It may be due to smoke inhalation, electrocution, near drowning, drug overdose, blunt trauma, or an obstructive airway, just to name a few, whatever the cause the signs that CPR is indicated remains the same.
Knowing what to look for through the eyes of the trained and READY responder, trained but RUSTY responder, or UNTRAINED responder is of utmost importance.
Rule of thumb, before assessing any individual make sure the scene is safe. Look for anything nearby that may cause further harm to the injured person, or that may harm you. Keep in mind that you can not help if you get injured too.
A busy parking lot or street, a room with chemical spills or poisonous fumes, or an area where there are down power lines are unsafe and need to be deemed safe before approaching. As you render care be aware of any change or changes that make it unsafe for you or the person you are helping.
Determining the Responsiveness
Whether an individual has suddenly collapsed or is found lying down, the quality or state of being must be determined. In other words is this individual UNRESPONSIVE?
An unresponsive individual is unconscious. This state is similar to sleep usually as the result of a serious injury or a lack of oxygen (Lack of blood flow to the brain).
Responsiveness is assessed in the adult and child by tapping the shoulders.
Responsiveness is assessed in the infant by tapping the bottom of the feet.
- Approach the individual, lean over or kneel at his or her side.
- Tap his or her shoulders and ask if he or she is OK. Tap the feet of an infant.
If the individual does not move, speak, blink, cry, or otherwise react when you tap him or her, this individual is unresponsive.
- Shout for help so that if others are near by they can help you.
- Check for breathing
Checking for Breathing
If an individual is NOT BREATHING he or she is unable to take air into the lungs by way of the nose or mouth.
NOT BREATHING NORMALLY or agonal gasp is a sign of sudden cardiac arrest. These gasps may be seen in the first few minutes after the arrest. A person who gasps usually looks like he or she is quickly drawing in air which may appear forceful or weak. There may be intermittent moments between gasping due to it’s slow rate. The mouth may be open and the jaw, head, or neck may move with gasps and sound like a snort, snore, or groan. Although agonal gasps are not normal this particular individual is more viable BUT CPR MUST be started immediately otherwise the possibility for brain perfusion will be lost.
It is of high importance that we are able to identify what agonal gasps look like because they are often mistaken for LIVE respirations by bystanders and this sometimes delays the INITIATION of CPR.
The unclear description of agonal gasps given to the 911 dispatchers also causes confusion and delays the CPR instructions given over the phone.
During the time of the arrest many individuals have what appears to be seizures, which is associated with the ventricular fibrillation or
V-Fib. Agonal gasping have been noted at these times as well but may be seen without this seizure appearing activity. This appearance has also delayed the initiation of CPR due to bystanders not knowing that this is a sure sign CPR should be started immediately.
- Lean over or kneel at his or her side.
- Scan the chest from head to waist repeatedly for at least 5 seconds but no more than 10 seconds, while looking for the chest to rise and fall.
If the individual is NOT breathing or NOT breathing NORMALLY (agonal gasp) he or she needs CPR.
- Be sure he or she is lying on his or her back on a firm, flat surface.
- Expose the chest
- BEGIN CPR starting with chest compressions.
Checking for Pulse
NO PULSE is the absence of the beating resulting from a regular rhythmic pumping of the blood through your veins and arteries.
Pulse site for an adult and a child are the carotid pulse. Located on either side of the front of the neck just below the angle of the jaw.
Pulse site for an infant is the brachial pulse. Located by feeling the bicep tendons in the area of the antecubital fossa.
- Lean over or kneel at his or her side
- Feel for the carotid or brachial pulse for at least 5 seconds but no more than 10 seconds. If you do not feel a pulse or is UNSURE you have felt a pulse CPR is needed.
- Expose the chest
- Begin CPR starting with chest compressions.
The action in which you perform is based on your skills as a trained and ready responder, trained but rusty responder, or an untrained responder. No matter where you fall in your training the indications that CPR should be performed on an individual is being unresponsive, not breathing or not breathing normally (agonal gasp), and having no pulse!