Life-Threatening Emergencies (Rescue Breathing/CPR/Choking)

Published on 14/03/2015 by admin

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Last modified 14/03/2015

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Life-Threatening Emergencies (Rescue Breathing/CPR/Choking)

Basic Resuscitation

The approach to basic resuscitation has recently undergone important modifications. The most recent American Heart Association/American College of Cardiology consensus guidelines advocate a circulation, airway, and breathing (CAB) approach to basic life support. This strategy involves immediate initiation of chest compressions for unconscious patients without spontaneous or normal cardiorespiratory function. The logic for this paradigm shift is that there is likely ample oxygen present in the lungs and arterial system for several minutes following cardiac arrest to avoid ischemia if blood can reach the target organs. Thus immediate circulation of blood via chest compressions is recommended to facilitate optimal oxygenation of the brain and other key organs sooner than the conventional airway-first approach.

Adult

The currently recommended sequence of adult basic life support performed by a health care provider can be summarized as follows:

1. Check the patient for unresponsiveness. If the person is not responsive and not breathing or not breathing normally, call for help and return to the patient.

2. C: If the patient is still not breathing normally, coughing, or moving, check for a carotid pulse for no longer than 10 seconds. If no pulse is detected in 10 seconds, begin chest compressions. Push down in the center of the chest a distance of 5 cm (2 inches) 30 times. Pump hard and fast at the rate of at least 100 pumps per minute, faster than once per second (Figs. 25-1 and 25-2).

FIGURE 25-1 Hand position for chest compressions in CPR.

FIGURE 25-2 Chest compressions: adult.

3. A: Tilt the head back, and lift the chin.

4. B: Pinch nose and cover the mouth with yours, and blow until you see the chest rise. Give two breaths. Each breath should take 1 second. An improvised CPR barrier may be crafted from a glove (Fig. 25-3).

FIGURE 25-3 An improvised CPR barrier is created using a latex or nitrile glove. Make a slit in the middle finger of the glove.

5. Continue with 30 pumps and two breaths until help arrives, then the rescuers should switch roles every five cycles, continuing at a ratio of 30 : 2 to minimize fatigue. A brief resuscitation pause to assess for the presence of spontaneous pulses should be performed every 2 minutes.

Defibrillation

After 2 minutes of CPR, when accessible, an automated external defibrillator should be applied to evaluate for the presence of a cardiac rhythm that may respond to electrical therapy. This is rarely an option in the wilderness environment. An acceptable, although infrequently successful, method of terminating a malignant tachyarrhythmia is the precordial thump. To perform a precordial thump, the patient’s chest should be cleared of clothing to facilitate accurate assessment of anatomy. Next, one or two firm blows should be delivered to the middle to lower one-third of the sternum with a closed fist from a height of 20 to 25 cm (8 to 10 inches) above the chest. A central artery should again be palpated for a pulse. If unsuccessful after one attempt, the precordial thump approach should be abandoned and further life support initiated.

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