Source: Close, A. "Emergency Care", 2001.
Circulation has stopped (cardiac arrest) if:
- The patient is unconscious, not breathing and pulseless
- The skin is very pale or blue (cyanosed)
- The body looks limp and there is no movement
If there is no circulation start Cardio-Pulmonary Resuscitation (CPR).
The carotid pulse is located in the neck. Place the first and second fingers of one hand on the patient's larynx "Adam's Apple". Slide the fingers gently to either side of the larynx into the notch between the patient's larynx and the large muscle at the side of the throat. Check for presence of the pulse for at least 10 seconds.
The radial pulse is located on the inside of the wrist, near the base of the thumb (do not use your thumb to check the pusle - it has a slight pulse that can be mistaken for the patient's).
In infants, the pulse best felt is the brachial pulse on the inside of the upper arm.
Assess rate per minute, normal is 60-18 beats per minute (rest), asess rhythm stability, and assess pulse strength (weak, normal or strong).
External Cardiac Compressions
If the heart is not pumping, its function needs to be replaced by the First Aider. This methodis known as External Cardiac Compression (ECC). The technique compresses the heart between the sternum and the spine as well as causing pressure changes within the chest cavity causing blood to flow through the circulatory system.
Locate Compression Position: Find the sternum (breastbone), and place heel of hand on the lower half of the sternum (closer to feet).
Technique - ECC - Adults:
- Grasp the wrist of the lower hand or link the fingers, one hand on top of the other
- Position your knees, slightly apart beside the patient to give good balance
- Straighten your arms and ensure shoulders are directly above hands
- Perform the first compression carefully to assess hardness or softness of the chest
- Compress the sternum 4 to 5 cm or 1/3 of the chests depth
- Do not lift your hands off the chest between compressions
- Continue compressions using your body weight and arms together by bending at the hops to efficiently perform the required rate and depth for that patient.
Technique - ECC - Infants/Children
- Locate the lower end and center line of the sternum, place two fingers and compress sternum 2 to 3 cm.
A person requires Cardio-Pulmonary Resuscitation (CPR) when they have suffered a cardiac arrest. This is when they are unconscious, not breathing and have no pulse. Some common causes of cardiac arrest are heart attack, electrocution, drug overdose, lack of oxygen, and severe bleeding. In order to provide resuscitation of a patient in cardiac arrest, EAR and ECC are combined to form CPR.
CPR = Expired Air Resuscitation + External Cardiac Compression
*CPR is only approximately 30% as effective as the patient's normal breathing and heartbeat, even when it is performed perfectly.
The Standards for performing CPR is 15:2 (15 chest compressions to 2 breaths). This should be repeated 4 times every minute, ending with 60 compressions and 8 breaths (a minimum for survival).
How To Perform CPR
The First Aider performs both the EAR and ECC after delivering the first 5 breaths:
- Start ECC with 15 compressions (within 10 seconds)
- Provide 2 breaths (within 5 seconds)
- Deliver four cycles of 15:2, then check the ABC's, and repeat again, checking then after 2 minutes of CPR.
*Children: 5:1 (within 3 seconds), 20 times a minute.
*Pregnancy: remove weight of the baby off the abdominal aorta by "Placing sufficient padding under the right buttock to give an obvious pelvic tilt to the left".
When to Stop CPR
CPR may be discontinued when:
- The patient recovers, OR
- Medical or ambulance assistance arrives, OR
- The patient is pronounced dead by a doctor, OR
- The area where the patient is becomes unsafe, OR
- You are physically or emotionally unable to continue.
Note - Remember attempts to resuscitate a person are not always successful. The important thing is to have a go, and give the patient a chance at survival. Therefore, you should not blame yourself if your resuscitation attempt is unsuccessful.