First Aid A-Z

Resuscitation and CPR:

Description:

Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with mouth-to-mouth ventilation or chest compression only. It is an effort to manually preserve intact heart and brain function in a person who is in cardiac arrest until further measures are taken to restore spontaneous blood circulation and breathing.

 

Sign & Symptoms:

It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations. Treatment: In accordance with International Liaison Committee on Resuscitation guidelines (ILCOR) CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. The rescuer may also provide ventilation by either mouth-to-mouth resuscitation or using a face mask that, if used correctly, pushes air into the patient’s lungs.

 

Current recommendations place emphasis on high-quality chest compressions over ventilation; a simplified CPR method involving chest compressions only is recommended for untrained rescuers or anyone unwilling to perform mouth-to-mouth ventilation. Mouth-to-mouth and chest compressions is the ‘gold standard’ treatment.

 

In children only doing compressions may result in worse outcomes.

 

More information on defibrillation

CPR’s main purpose is to restore partial flow of oxygenated blood to the heart and brain. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed in order to restore a viable or beating heart rhythm.

 

Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead.

 

Simple overview of CPR

CPR is indicated for any person unresponsive, not breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest. Resuscitation Council (UK) 2015 guidelines recommend that laypersons should not check for a pulse.

 

Effectiveness

CPR serves as the foundation of resuscitation, preserving the body for defibrillation and advanced life support. CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.

 

Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden (VF) cardiac arrest dramatically improves survival.

 

Compression Ratio

Compression to ventilation ratio of 30:2 is recommended. With children if untrained 30:2. Recommended minimum compression depth in adults (5-6cm), and children is at least 5 cm (2 inches) and in infants it is 4 centimetres (1.6 in). In adults, rescuers should use two hands for the chest compressions, while in children they should use one, and with infants two fingers (index and middle fingers). (The depth is extremely important).

 

Compression only

Compression-only (hands-only resuscitation) CPR is a technique that involves chest compressions without mouth-to-mouth ventilation. It is recommended as the method of choice for the untrained rescuer or those who are not proficient because it is easier to perform and instructions are easier to give over a phone by the ambulance service dispatcher.

 

It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR.

 

Pregnancy

During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left.

 

Chance of receiving CPR

Effectiveness of CPR is variable, and the studies suggest only around half of bystander CPR is performed correctly. A recent study has shown that members of the public having received CPR training in the past lack the skills and confidence needed to save lives. Experts believe annual training is needed to improve the willingness to respond to cardiac arrest.

 

Type of Arrest Chance / Survival:

  • Out-of-Hospital Cardiac Arrest Overall / 10%
  • Unwitnessed Out-of-Hospital Cardiac Arrest / 4%
  • Witnessed Out-of-Hospital Cardiac Arrest / 15%
  • Witnessed and "Shockable" with Bystander CPR / 37%
  • Bystander Compression-only Resuscitation / 13%

 

Resuscitation Council (UK) 2015

Recommends the following:

  • All school children should be taught CPR and how to use a defibrillator.
  • All Adults who are able should be taught CPR.

 

There is a clear correlation between age and the chance of CPR being commenced. Younger people are far more likely to have CPR attempted on them before the arrival of emergency medical services. It was also found that bystanders more commonly administer CPR when in public than when at the patient's home, although health care professionals are responsible for more than half of out-of-hospital resuscitation attempts.

 

There is also a clear correlation between cause of arrest and the likelihood of a bystander initiating CPR. Laypersons are most likely to give CPR to younger cardiac arrest victims in a public place.

 

Chance of receiving CPR in time

CPR is likely to be effective only if commenced within 6 minutes after the blood flow stops because permanent brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become dormant in as little as 4–6 minutes in an oxygen deprived environment.

 

 

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Choking

Description:

When a person inhales food or objects causing a blockage of the airway.

 

Signs & Symptoms:

  • Distressed expression
  • Reddening face, lips becoming blue tinged
  • Not able to breath
  • Grasping or pointing at throat
  • Unable to speak or cough
  • Unconsciousness is rapid

 

Treatment (adults and children above 1 year):

  1. Encourage the casualty to cough (they may not be able to).
  2. Lean the casualty forward, or put children over your knee so that the head is lower - allow gravity to help you.
  3. Deliver 5 back blows; hit between the shoulder blades with the heel of the hand up to 5 times. If the obstruction has not cleared carry on with step 5:
  4. Administer 5 abdominal thrusts; stand behind the casualty and put your arms around their middle (a reverse hug). Make a fist with one hand then place it between the belly button and the ribs. Cup the fist with the other hand and pull sharply inwards and upwards to try and expel air out of the lungs. Check between thrusts to see if the obstruction has cleared.
  5. Repeat steps 3 and 4 while the casualty is conscious until the obstruction clears.
  6. If the casualty becomes unconscious, commence CPR and dial 999/112.

WARNING: After abdominal thrusts, the casualty MUST go to hospital as an injury can be caused by this technique.

 

Babies (under 1 years):

  • Follow steps 2 and 3 above not using the heal of the hand.
  • DO NOT give abdominal thrusts. Exchange these for chest thrusts; turn the baby over onto its back with the head lower than the chest. Place two fingers in the middle of the chest and give up to 5 sharp thrusts. Check after 5 sharp thrusts to see if the obstruction has cleared. Repeat these steps and call 999/112
  • If the baby becomes unconscious start CPR.

 

CAUTION:

It is important that chest thrusts and abdominal thrusts are not practiced on people as they can cause trauma.

 

You might also be interested in our Resuscitation and CPR course under the specialist first aid courses section of our website.

 

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Drowning:

Description:

Drowning is death by asphyxia due to suffocation caused by water entering the lungs and preventing the absorption of oxygen, leading to cerebral hypoxia.

 

People drowning fall into three categories:

 

1. Passive Drowning

People who suddenly sink due to a change in their circumstances such a loss of consciousness or sudden onset of a medical condition such as cardiac, alcohol, stroke, epilepsy or hypothermia.

 

2. Active Drowning

People such as non-swimmers and the exhausted.

 

3. Secondary Drowning

Inhaled fluid (usually only a small quantity) can act as an irritant in the lungs. This process of events could be delayed for up to several hours, so a person who may have been rescued, resuscitated and recovered might relapse with severe breathing difficulties.

 

Evidence has identified that a person who drowns does not necessarily inhale large amounts of water into the lungs. In fact 90% of deaths from drowning are the result of relatively small amount of water. Inebriates or those under the influence of drugs have died in puddles.

 

If water enters the airways of a conscious victim they will try to cough it up or swallow it but some also enters the airways involuntarily. This causes laryngospasm preventing any water from entering the lungs. Unfortunately this can also inhibit air entering the lungs too and the victim can become unconscious. The laryngospasm then relaxes and water can enter the lungs causing WET DROWNING. In about 10% the seal caused by laryngospasm remains but then cardiac arrest occurs and this is called DRY DROWNING.

 

All patients should be taken to hospital.

 

Signs & Symptoms:

  • Patient is unconscious (U) on the AVPU score.
  • Not breathing normally.
  • No signs of life.

 

Treatment:

  • Do not put yourself at risk. Remember 'Reach or Throw – Don't GO'.
  • Where possible keep the patient horizontal during rescue.
  • Check Airway and breathing. if in doubt start CPR.
  • Dial 999 even if the person recovers.

 

CAUTION:

  • Never enter the water unless you are trained to do so.
  • Try to reach them with a rope of branch or throw them an object that can float or buoyancy aid.
  • Remember 'Reach or Throw – do not GO'.

 

 

We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.

 

You might also be interested in our blog. One of our more popular articles is about quality or quantity when it comes to first aid training.

 

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Head Injury (serious head injury)

Description:

 

Damage to the brain, scalp or the skull. External bleeding may be present.

 

Injuries to the head can lead to unconsciousness, which can dangerously compromise the airway. When an injury is sustained to the head there may also have been damage caused to the neck. In addition, permanent damage to the brain can also result from a head injury.

 

Types of head injury and possible causes:

 

Concussion. Where the brain is shaken and hits against the inside of the skull. This can be caused by a fall or a blow to the head. Concussion may also cause unconsciousness for a short period, but can be followed by an improvement in response and full recovery.

 

Compression. Swelling or bleeding in the skull puts pressure on the brain. This can occur from injury, a ruptured blood vessel, a tumour or infection (meningitis). There may be a history of a recent head injury with apparent recovery but then a deterioration in the patient’s level of consciousness (AVPU) can occur.

 

Fractured skull. Damage to the skull may cause bleeding within the skull causing compression. The broken bone may damage the brain or ‘brain shaking’ may have occurred causing concussion.

 

Signs & Symptoms:

Compression

  • Level of response (AVPU) worsens as the condition develops.
  • Intense headache.
  • Flushed, dry skin.
  • Deep, noisy, slow breathing.
  • Slow, strong pulse.
  • One or both pupils may dilate as pressure increases.
  • Condition worsens and fits may occur.

 

Concussion

  • Short term memory loss, confusion, irritability.
  • Mild, general headache.
  • Pale, clammy skin.
  • Shallow/normal breathing.
  • Rapid, weak pulse.
  • Normal pupils, reacting to light.
  • Possible nausea or vomiting.

 

Fractured skull

  • Bleeding, swelling or bruising to the head.
  • A soft area or depression of the scalp.
  • Bruising around one or both eyes.
  • Bruising or swelling behind the ear.
  • Bleeding or fluid coming from the nose or an ear.
  • Deformity or lack of symmetry to the head.
  • Blood in the white of the eye.

 

Treatment:

  • Be aware – a casualty suffering a serious head injury could also have a neck injury.
  • Apply appropriate pressure to any wound to stop bleeding, cover the site to protect from infection.
  • With any casualty who is unconscious, has a reduced conscious level (AVPU), their conscious level deteriorates or you suspect a fractured skull ring 999/112.
  • Maintain airway and breathing; use the recovery position if you needed to protect the airway. Keep the head and body inline.
  • If the casualty is conscious help them lie down. Keep the head, neck and body inline in case of neck injury.
  • Look and treat any other injuries.

 

CAUTION:

DO NOT allow a concussed sports player to 'play on' until they have been checked by a doctor.

 

 

We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.

 

You might also be interested in our blog about pitch-side first aid.

 

You can also sign-up to our newsletter here or at the bottom of our homepage.

 

First Response. Training for life. Training to save a life.

Meningitis:

Description:

Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the MENINGES. The inflammation may be caused by infection by virus, bacteria or other micro-organisms and less commonly by certain drugs.

 

1. VIRAL MENINGITIS

Usually a mild disease but can make people feel very unwell. Although most people make a full recovery some can be left with debilitating effects such as deafness, epilepsy and cognitive defects.

 

2. BACTERIAL MENINGITIS

Life-threatening and needs urgent medical attention.

 

3. NEONATAL MENINGITIS

Occurs in babies under 1 month old.

 

Meningitis can be life threatening because of the inflammation's proximity to the brain and spinal cord so should be classified as a medical emergency.

 

Signs & Symptoms:

  • High temperature or fever.
  • Violent vomiting.
  • Loss of appetite.
  • Severe headache.
  • Neck stiffness.
  • Joint or muscle pains.
  • Drowsiness & Confused.
  • Disorientated.
  • Dislike of bright light (Photophobia).
  • Dislike of loud noises (Phonophbia).
  • Seizures.
  • Skin rash: Small purple/red "pin prick" rash. Does not fade when the side of a glass is pressed against it.

 

Sometimes, especially with small children only non specific symptoms may present such as irritability and drowsiness. If a rash is present it may indicate a particular cause e.g. meningococcal bacteria. This rash is characterized as a small purple "pin prick" which does not fade when the side of a glass is pressed against it.

 

A rash does not fade under pressure is a sign of meningococcal septicaemia which is a medical emergency. However if someone is ill and getting worse do not wait for the rash as it can appear later or not at all.

 

Babies:

  • Drowsiness, restless and high pitched crying.
  • Reluctance to feed.
  • Slight tenderness and swelling of the soft parts of the skull.

 

Treatment:

  • Call your GP. If any delay Dial 999.
  • If you think the child/baby may have meningitis, seek medical advice immediately Dial 999.

 

Diagnosis is usually made by performing a lumbar puncture, which involves inserting a needle into the spinal canal to extract a sample of cerebrospinal fluid that envelopes the spine and brain. Depending on the type of meningitis treatment would involve antibiotics or anti viral or in some instances corticosteroids.

 

CAUTION

  • DO NOT delay seeking medical advice or help.

 

We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.

 

You might also be interested in our blog about 'quality rather than quantity' when it comes to first aiders.

 

You can also sign-up to our newsletter here or at the bottom of our homepage.

 

First Response. Training for life. Training to save a life.

 

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