Cardiopulmonary resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a procedure to support breathing and circulation on a person who has stopped breathing (respiratory arrest) and/orwhose heart has stopped (cardiac arrest). It should be performed if a personis unconscious and not breathing in order to maintain oxygen and blood flow to the heart, brain, and other vital organs.

Respiratory and cardiac arrest can be caused by allergic reactions, an ineffective heartbeat, asphyxiation, breathing passages that are blocked, choking,drowning, drug reactions or overdoses, electric shock, exposure to cold, severe shock, or trauma.

CPR has been practiced for over 40 years, and is an important part of the emergency cardiac care system designed to save lives. Each year, thousands of deaths are prevented by prompt notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat normally), and advancedcardiac life support measures.

More than five million Americans receive training in CPR through American Heart Association and American Red Cross courses annually. CPR can be performedby trained bystanders or healthcare professionals on infants, children, and adults. It should always be performed by the person on the scene who is most experienced in CPR. When performed by a bystander, CPR is designed to supportand maintain breathing and circulation until emergency medical personnel arrive and take over. When performed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures.

To prevent brain damage or death, CPR must be performed within 4-6 minutes ofwhen breathing stopped. It is a two-part procedure that involves rescue breathing and external chest compressions. To provide oxygen to the person's lungs, the rescuer administers mouth-to-mouth breaths, then helps circulate the blood through the heart to vital organs by external chest compressions.

If a person suddenly becomes unconscious, the rescuer should call out for help, and then determine if the person is responsive by shaking him or her gently on the shoulder and asking, loudly, if they are okay. If the person doesn'tanswer, the rescuer or another bystander should call the emergency medical system (911). The rescuer should kneel near the person's shoulders and check to see whether the person is breathing by looking at the chest and abdomen, and listening and feeling for breath from the person's lips. If no signs of breathing are present after three to five seconds, CPR should be started.

The rescuer opens the person's airway by placing the head face up, with the forehead tilted back and the chin lifted. The rescuer checks again for breathing (three to five seconds), then begins rescue breathing (mouth-to-mouth artificial respiration). He pinches the person's nostrils shut while holding the chin in the other hand. The rescuer places his mouth against the person's mouth with the lips making a tight seal, then gently exhales for about one to one and a half seconds. The rescuer breaks away for an instant to take abreath and then repeats. The person's head is repositioned after each mouth-to-mouth breath.

After two breaths, the rescuer checks the person's pulse by moving the hand that was under the person's chin to the artery in the neck (carotid artery). If the person has a heartbeat, the rescuer continues rescue breathing until help arrives or the person begins breathing on his or her own. If the person isbreathing, the rescuer turns the person onto his or her side.

If there is no heartbeat, the rescuer performs chest compressions. The rescuer kneels next to the person, placing the heel of one hand in the spot on thelower chest where the two halves of the rib cage come together (the breastbone). The rescuer puts his other hand on top of the one on the chest and interlocks the fingers. He straightens his arms, leans forward to position the shoulders directly above the hands and presses down, using only the palms, so that the person's breastbone sinks in about 1[frac12]-2 in. The rescuer releaseswithout removing the hands, then repeats for 15 times in 10-15 seconds.

The rescuer tilts the person's head and returns to rescue breathing for one or two quick breaths. He then alternates breathing and heart presses for one minute, and checks for a pulse or breathing. If the rescuer finds signs of a heartbeat and breathing, CPR is stopped. If the person is breathing but has nopulse the heart press is continued; if the person has a pulse but is not breathing, rescue breathing is continued.

When performing CPR on an infant or child under the age of eight, some slightmodifications should be made to the CPR procedure. The rescuer must make a seal around the infant/child's mouth (and nose with infants) and give gentle breaths. The rescuer delivers 20 rescue breaths per minute, taking 1[frac12]-2seconds for each breath. Chest compressions are given with only one hand fora child and with two or three fingers for an infant. The breastbone is depressed only 1-1[frac12] in for a child and [frac12]-1 in for an infant and therescuer gives at least 100 chest compressions per minute. After administeringCPR for one minute, the rescuer should call out for help again if none has arrived, and continue the CPR procedure.

Emergency medical care is always necessary after successful CPR. Once the person's breathing and heartbeat have been restored, the rescuer should make himor her comfortable and stay there until emergency medical personnel arrive.The resucer can continue to reassure the person that help is coming and talkpositively until the professionals arrive and take over.

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