3.7 Adult Basic Life Support- CPR 

When patient is found unconscious or suspected to have cardiac arrest follow strictly the following guideline: 

3.7.1 Determine un- responsiveness: 

The 1st step is identifying the patient‘s condition or responsiveness by touching and shouting. If patient is not responding to your communication the next step is suspect patient may have cardiac arrest and 

3.7.2 Call for help

you need more people for different reason. Such as Someone who can call the EMS, who can assist you on initiating the care- CPR 

3.7.3 Contact EMS if available

EMS is an organization responsible for the pre hospital emergency patient care. They are trained for care of emergency patient at the scene during transportation 

3.7.4 Position the victim and assess the patient for sign of life and act according the following sequence 

A-air way- to assess the airway fast and proper: 

• Stabilize the neck – if there is suspect of trauma C-spine care with inline positioning and stabilizing is mandatory 
• To open the air way push backward on the forehead and lift the chin if the possibility of cervical spine injury is less 

• or use only jaw thrust in patients with suspicion of cervical spine injury 
  

• Keep the head tilted 
• Place your ear just above the casualty's nose and mouth 
• Look for chest movement 
• Listen for sounds of breathing 
• Fell for breath on your cheek 
• If there is no breathing despite open/patent airway go for B 

B-Breathing 

• Assume cardiac arrest if patient is unresponsive and apneaic or has an abnormal (agonal) breathing pattern. 
• Give 30 chest compressions immediately before any rescue breaths are attempted. 
• Breath in to the causality twice, using mouth to mouth maneuver if you don‘t have at hand bag valve mask/Amubag. Each breath should take about 1 sec, and use enough air to make the chest rise. 

If you have the devise ambubag give 2 rescues breathes and avoid over inflation of the lungs

If the chest doesn‘t rise when you blow air 

a. Reopen the airway by tilting the head and lifting the jaw, see and remove any foreign bodies or secretions 

b. Pinch the nose again 

c. Make a better seal around the mouth 

d. Try blowing again 

C -circulation 

• Carotid artery palpation has been found inaccurate in both untrained and health care workers and has been omitted. An absence of spontaneous breathing including agonal breaths is now taken as a sign of cardiac arrest. 
• Stastart chest compression: 
• Depress and release the chest rhythmically, 
• Press the heels of the hands straight dawn on the center of the chest. 
• The pressure and release phases should take the same time, 
• Give compressions at a rate of 100 per min., 
• Count compressions out loud, 
• Give 30 compressions to 2 breaths weather with one rescuer or TWO 
• Depress the chest 3.8-5cm depth 

After every 5 cycle/2min. check for spontaneous breathing and circulation for 5 sec

D- Defibrillation 

• The most frequent cause of cardiac arrest is said to be cardiac fibrillation. 
• Start defibrillation as soon as possible if available 
• Treat VF/ or pulseless VT with a single shock followed by resumption of CPR. 
• Reassess rhythm after 2 minute (5 cycles of 30:2 CPR) and give another shock if indicated. 
• Remember after every defibrillation immediately continues cardiac compression. 
• The initial shock for all biphasic defibrillators is 150J with subsequent shocks at 200J. The initial and subsequent shocks for monophasic defibrillators are 360J. 
• If there is difficulty differentiating between a rhythm of fine VF and asystole, the treatment should be as for asystole and no shock given. Defibrillation in these cases causes myocardial injury and chest compression is the preferred. Chest compressions are the most important part of CPR 
• During the initial phase of cardiac arrest when the pulmonary vessels and heart likely contain sufficient oxygenated blood to meet markedly reduced demands, the importance of compressions supersedes ventilations 
• CCR vs CPR (flow is more important than content) Particularly early in cardiac arrest (the first 4-6 minutes) Interruptions in compressions, no matter how brief, result in unacceptable declines in coronary perfusion pressures and worse outcomes . 
• Rescuers must ensure that chest compressions are provided continuously during CPR. 
• When a single rescuer is providing CPR-chest compressions should be performed continuously, without stopping to provide ventilations. (not yet part of the AHA guidelines ) .