CARDIOPULMONARY RESUSCITATION (CPR)

and
FOREIGN-BODY AIRWAY OBSTRUCTION
Kierstine O Garcia, RN
FO1 BFP
EMS STAFF


CHAIN OF SURVIVAL

CARDIOPULMONARY RESUSCITATION

FOREIGN-BODY AIRWAY OBSTRUCTION

CPR
CARDIOPULMONARY RESUSCITATION
1. Chain of Survival
Cardiopulmonary resuscitation (CPR) can save the lives of victims in cardiac arrest. Two
thirds of heart attack victims (due to heart disease) die outside the hospital, most within two
hours of the onset of symptoms. Though CPR itself is not enough to save the life of a victim of
heart attack, it is a vital link in the chain of survival.


The chain of survival has hour links, and the patients chances for surviving are the greatest
when all the links come together.
1. Early access
2. Early CPR
3. Early defibrillation
4. Early advanced life support
The need for these interventions should not be limited to victims of heart disease .Many
victims of drowning, trauma, electrocution, suffocation, airway obstruction, allergic reaction,
etc., may be saved by prompt intervention.

2. Heart Attack Risk Factors
Risk factors that cannot be changed (non-modifiable)
Heredity
Age
Gender
Risk factor that can be changed (modifiable)
Smoking
Hypertension
Exercise
High cholesterol
Contributing factors
Obesity
Diabetes
Stress

3. Breathing
Adequate breathing is characterized by:
Chest and abdomen rise and fall with each breath
Air can be heard and felt exiting the mouth and or nose
Inadequate breathing is characterized by:
Inadequate rise and fall of the chest
Noisy breathing:bubbles,rales,stridor,whistling,etc.,
Absent breathing is characterized by:
No chest or abdominal movement
Air cannot be heard or felt exiting the mouth or nose

4. Cyanosis
A bluish discoloration of the skin and the mucous membranes caused by a lack of oxygen in
the blood and tissues.
This condition can be the result of the patient breathing in an environment poor in oxygen,
suffering from illness or respiratory injury, or airway obstruction.
Cyanosis can be more easily noticed on the lips, ears and nostrils or nailbeds. In patients with
dark pigmentation, it is necessary to inspect the nostrils, palm, and nailbeds, and the mouth and
tongue.
5. Clinical and Biological Death
Clinical Death: Occurs when a patient is in respiratory arrest (not breathing)or in cardiac
arrest(heart not beating).The patient has a period of 4 to 6 minutes to be resuscitated without
brain damage. Clinical death can be reversed.
Biological Death: The moment the brain cells begin to die. Biological death cannot be reversed.

6. Signs of Certain Death
Lividity: pooling of blood from the lower areas of the body
Purple to bluish color
Rigormortis: Stiffening of body and limbs, occurs usually 4-10 hours after death.
Decomposition: the breakdown of substance into simpler chemical forms.
Other: Mortal wounds such as decapitation, severe crashing injuries

Technique for Opening the Airway

Head-Tilt Chin-Lift



Jaw Thrust


When opening the airway, use the correct method:
Medical case: (any part of the body is affected none in particular)
Head-Tilt Chin-Lift
Trauma case: (specified like head or neck injury)
Jaw Thrust
Head-Tilt Chin-Lift
This is the method of choice for opening the airway.
Do not use this method if you suspect head, neck or spinal injury.
1. Position the patient lying face up (supine position).
2. Kneel by the patients shoulder toward the head.
3. Place hand on the forehead and place the fingertips of your other hand under the bony
part of the patients jaw.
4. Lift on the chin, support the jaw, and at the same time, tilt the head back as far as
possible.
For infants and children: Place in the sniffing positiondo not over-extend.
Important Precautions:
Always keep the patients mouth slightly openuse your thumb to hold down the
patients lower lip.
Never dig into the soft tissue under the patients chin.
Once the airway is open, check breathing.Look, listen and feel. If patient is not breathing,
artificial ventilation should be started. If unable to ventilate, assume the airway is obstructed.
J aw Thrust
The jaw thrust is the only maneuver recommended on an unconscious patient with suspected
head, neck, or spinal injury.
1. Position the patient lying face up.
2. Kneel above the patients head. Place your elbows next to the patients head on the surface
where the patient is lying. Place both hands on either side of the patients head.
3. Grasp the angle of the patients jaw on both sides. For an infant or child use two or three
fingers.
4. Use a lifting motion to move the jaw forward (up) with both hands.
5. Keep the patients mouth slightly open by using your thumbs if needed.
Artificial Ventilation (Rescue Breathing)
Once the patient has an open airway, you can provide artificial ventilation for a patient
breathing inadequately or not at all.
How is it possible to maintain a patient alive with exhaled air? Natural air contains
approximately 21% oxygen and the body only utilises about 5%.Therefore,exhaled air contains
16%oxygen.This exhaled air can resuscitate a person who is not breathing, until a high-
concentration oxygen source is available.
Techniques for Artificial Ventilation
Mouth to mouth and nose

Mouth to mouth

Mouth to mouth

Mouth to stoma


Cardiopulmonary Resuscitation Management
1. Survey the scene, introduce and ask permission
2. Check for responsiveness
a. Tapping of shoulders (2x)
b. Calling of names
3. Shout for help or activate EMS if patient is unresponsive
4. If available get Automated External Defibrillator
5. Perform 30 chest compression for about 15-18 seconds
a. Proper position should be at the midsternum area of the chest
b. Always observe the proper depth of the compression not to deep
c. Allow the chest to return to its normal position
d. Position shoulders over hand with elbows lock and arm straight
e. Keep hand in contact with the chest all the times
6. Opening the airway (head-tilt, Chin-lift maneuver)
a. Proper position is observe
b. Hand on the forehead
c. Fingers on the chin
7. After every 30 chest compressions give two 1 second breath (1,1001,1,1002)
8. While giving ventilation observe:
a. Nose maintained pinch
b. Full slow breaths (1sec)x 2
c. Cover the whole mouth
9. Repeat cycles of chest compressions and 2 ventilations for 5 seconds (approximately 2
minutes)
10. Check the carotid pulse for 10 seconds every 2 minutes (equivalent to 5 cycles of CPR)
11. If pulse is positive and breathing is negative give artificial respirations:
a. Give one full breath every 5 seconds for 24 cycles (blow, 1,1002,1003,1001 up to 24
cycles)
12. While giving artificial ventilation:
a. Nose maintained pinch
b. Full slow breaths (1sec)x 2
c. Cover the whole mouth
13. Recheck the carotid pulse for 10 seconds
14. Place the patient in recovery position if pulse and breathing are both present.

CPR for Infant
1. Survey the scene, introduce and ask permission
2. Check for the infants responsiveness
a. Gently tap the bottom of the infants feet
b. Shout hey baby are you OK?
If there is no response
3. Ask someone to call EMS
4. Perform 30 chest compressions at about 15-18 seconds
a. Position two fingers on the compression area (one finger width below the
imaginary nipple line)
b. Depth of compression at 1/3 to
c. Allow the chest to return to its normal position
d. Maintain open airway with one hand while compressing the chest with two
fingers of the other hand.
e. Keep fingers at contact with the chest at all times.
5. Open the airway (head-tilt, chin-lift maneuver)
a. Proper head-tilt should be observe (neutral or slightly extended position)
b. Hand should be at the infants forehead
c. Fingers should be place at the infants chin
6. Give two puffs after each 30 compressions
7. While giving ventilation:
a. Slow breath 1 second x 2
b. Mouth seal over the infants mouth and nose
8. Repeat cycles of chest compressions and 2 ventilations for 5 cycles (approximately
for 2 minutes)
9. Check the brachial for 10 seconds every 2 minutes (equivalent to 5 cycles of CPR)
10. If pulse is positive and breathing is negative give artificial respiration:
Give 1 breath every 3 seconds for 40 cycles (blow, 1, 1001 up to 40 cycles)
11. While giving ventilation:
a. Slow breath 1 second x 2
b. Mouth seal over the infants mouth and nose
12. Recheck the brachial pulse for 10 seconds
13. Place the infant in recovery position if the pulse and breathing is present.

Recognizing Foreign Body Airway Obstruction (FBAO)

Foreign-Body Airway Obstruction
Foreign-body airway obstruction should be considered in any victimespecially
a younger victim who suddenly stops breathing, becomes cyanotic, or loses
consciousness for no apparent reason.
Two types of FBAO:
Partial:
An object caught in the throat that does not totally block breathing. A patient with
partial obstruction may have adequate or poor air exchange. With adequate air
exchange, the patient may cough forcefully, though there may be wheezing
between coughs. Do not interfere with patients attempt to clear the airway. With
poor air exchange ,the patient will exhibit a weak, ineffective cough, high pitched
noise while inhaling, increased respiratory difficulty and possible cyanosis. Treat
this situation as a complete airway obstruction.
Complete
The patient is unable to speak, breath, or cough. May clutch the neck with thumb and
finger. Air movement will be absent.
Heimlich maneuver
The Heimlich maneuver (sub diaphragmatic abdominal thrusts) is
recommended for relieving foreign-body airway obstruction. By elevating the
diaphragm, the Heimlich maneuver can force air from the lungs to create an
artificial cough intended to expel a foreign body obstructing the airway. Each
individual thrust should be administered with the intent of relieving the
obstruction. It may be necessary to repeat the thrust several times to clear the
airway. Five thrusts per sequence is recommended.
When you perform this maneuver, you should guard against damage to internal
organs, such as rupture or laceration of abdominal or thoracic viscera. To minimize this
possibility, your hands should never be placed on the xiphoid process of the sternum or on the
lower margins of the rib cage. They should be below this area but above the navel and in the
midline. Regurgitation may occur as a result of abdominal thrusts. Be prepared to position
the patient so aspiration does not occur.

HEIMLICH MANEUVER WITH VICTIM STANDING OR SITTING.
To perform the Heimlich maneuver with victim standing or sitting, stand behind the
victim, wrap your arms around the victims waist, and proceed as follows:
Step 1Make a fist with one hand.
Step 2Place the thumb side of the fist against the victims abdomen, in the midline slightly
above the navel and well below the tip of the xiphoid process.
Step 3Grasp the fist with the other hand and press the fist into the victims abdomen with a
quick upward thrust.

Step 4Repeat the thrusts and continue until the object is expelled from the airway or
the patient becomes unconscious.

Each new thrust should be a separate and distinct movement

HEIMLICH MANEUVER WITH VICTIM LYING DOWN.
To perform the Heimlich maneuver with victim lying down, proceed as follows:
Step 1Place the victim in the supine position (face up).
Step 2Kneel astride the victims thighs and place heel of one hand against the victims
abdomen, in the midline slightly above the navel and well below the tip of the xiphoid.
Step 3Place the second hand directly on top of the first.
Step 4Press into the abdomen with a quick upward thrust.


Responsive Adult/Child
1. Introduce, ask for consent and determine complete or partial airway obstruction
2. Get in position, stand behind the patient and place one leg between the patients leg
3. Reach around and locate the navel
4. With the other hand, make a fist and place it against the abdomen, thumb side in, just
above the navel
5. Grasp your fist with the first hand and give up to five abdominal thrust/Heimlich
Maneuver in quick inward and upward direction
6. Observe, the patient will cough or speak if the object is removed or dislodged
7. If still obstructed repeat the thrust until the airway is clear or the patient becomes
unconscious.
Unresponsive Adult/Child
1. Place the patient into supine position
2. Activate EMS
3. Open the airway using the appropriate technique (head-tilt, chin-lift)
4. Assess breathing for ten (10) seconds
5. Attempt to provide one full slow breath
6. If unable to provide adequate chest rise/air bounces back, reposition the head
7. Give again one full slow breath
8. If air still bounces back, give thirty (30) chest compressions
9. Check airway, if obstruction is visible perform finger sweep. If obstruction is not visible
go back to step number 5
10. If object was removed and patient still unconscious:
a. Give two (2) confirmatory blows
b. Check breathing for ten (10) seconds
c. If breathing is adequate, put the patient into recovery position
11. If object was removed and patient becomes conscious, put him/her into recovery position
(side lying).
FBAO in I nfant
1. Survey the scene, introduce and ask permission
2. Pick up the infant and determine if partial or complete obstruction:
a. No strong cry
b. Weak, ineffective cough
c. Difficulty of breathing
3. Support the infants head as you place him down on your forearm. Use your thigh to
support your forearm. Keep the infants head lower than the body.
4. Rapidly deliver 5 back blows just between the shoulder blades. If this fails to expel the
object proceed to the next step.
5. While supporting the infant between your forearms, turn him over onto his back. Perform
5 chest thrust (at about 15-18 seconds).
a. Position two fingers on the compression area (one finger width below the imaginary
nipple line)
b. Depth of compression at 1/3 to
c. Allow the chest to return to its normal position
d. Maintain open airway with one hand while compressing the chest with two fingers of
the other hand.
e. Keep fingers at contact with the chest at all times.
6. Continue with this sequence of back slaps and chest thrust until the object is expelled or
the infant loses consciousness
Unresponsive I nfant

1. Position the infant lying face up, the open the airway by placing the infants head in
neutral or sniffings position
2. Activate EMS if you are not alone (ask someone to call for help)
3. Check breathing for 10 seconds. Open the airway (head-tilt, chin-lift maneuver)
a. Proper head-tilt should be observe (neutral or slightly extended position)
b. Hand should be at the infants forehead
c. Fingers should be place at the infants chin
4. If there are no signs of breathing attempt to ventilate.
a. Slow breath 1 second x 2
b. Mouth seal over the infants mouth and nose
5. If air bounce back reposition the head and ventilate again.
6. If still bounces back proceed to the next procedure
7. Perform 30 chest compressions
8. Open the airway and look for the object. If the object is not visible repeat step 4
9. If the object is visible, do finger sweep. If object is removed proceed
10. Provide two (2) confirmatory blows
11. Check breathing for 10 seconds
12. Place infants into recovery position if infants coughed or becomes responsive.