CPR and the Heimlich Maneuver

OBJECTIVES:

At the end of the class you will be able to:

1. Do 1 man and 2 man CPR for the adult, child and infant.
2. Perform the A, B, C s of CPR.
3. Help a choking conscious and unconscious adult, child, and infant.
4. Save your own life with the self Heimlich Maneuver.

What is CPR?

CPR is cardiopulmonary resuscitation. CPR has 2 parts. They are:

1. mouth-to-mouth breaths (rescue breathing) and
2. pressing on the chest (compressions).

The first part of CPR gives the person the oxygen they need in order to live when they can no longer breathe on their own. The second part gives the person's body the blood flow it needs to live when the heart has stopped and it is no longer pumping the blood to the person's body and organs, including the brain. A person needs oxygen rich blood to travel throughout the body in order for the body to stay alive. CPR does this for a time when the person's heart and lungs are no longer doing it.

It is most important to keep oxygen going to the brain and the heart. The heart and the brain can recover if CPR is done quickly and it is done in the right way. The brain will die and the person will die within a couple of minutes after the heart stops if CPR is not given.

CPR can be done on adults, children, infants and even pets. It saves thousands of lives every year.

Why We Must Know CPR

The most common cause of death for adults is when the heart stops beating. This happens most often to people that have heart disease as many have. Heart disease is very common with older people. CNAs and other people who work in hospitals, homes and nursing homes often take care of people who are old and who have heart disease. We must, therefore, know about CPR and how to do it in order to save a person's life when the person chooses to have CPR done if, and when, their heart stops.

The chances of a person living after CPR is done is two times that of a person who does not get the CPR when their heart stops. A person's heart can stop in a hospital, in his or her own home, in a nursing home and where we live. For example, it can happen during a football game, in a store and on the street.

Should Everyone Get CPR When Their Heart Stops?

No. Not all people should get CPR when their heart stops. Some people and their decision maker may have said that they do not want to have CPR done if their heart stops. These people do not get CPR. You must know who should and who should not get CPR long before their heart stops. We must follow their wishes to have or not have CPR.

Reading this class about CPR will give you a review of CPR but you should take a live class and/or practice CPR with an expert in order to make sure that you can do it and you can do it well. A hand on practice is very important.

CPR Steps for the Adult (8 years old and older)

CPR must be done on a hard, firm surface while the person is lying on their back. A board must be used if the person is in a bed. The floor can be used if the person has fallen.

Any easy way to remember the CPR steps is to remember that CPR is as easy as A - B - C

A - stands for AIRWAY
B - stands for BREATHING or BLOWS
C - stands for CHEST COMPRESSIONS for CIRCULATION

BEFORE you start CPR, you must make sure that the person is just not sleeping. CPR is only started when the person is not conscious and their heart and lungs are NOT working on their own. It is NOT done when a person is sleeping or in a coma.

Do these things in order to find out if the person is sleeping or not.

• Are the person's eyes moving or blinking?
• Are the arms or legs moving?
• Do you hear any sounds, like breathing?
• Try to wake the person up. Call them loudly by their name and gently shake them.
• If they do not wake up, call for help. Call 911 or yell out "HELP. HELP" if you are in a place where there are other people, like in a hospital or a store.

A- AIRWAY

Tilt the head back and find out if the person is still breathing.

Do NOT do CPR if the person is breathing.

Do these things in order to find out if the person is breathing or not.

• Look at the person's chest. Put your ear close to the person's face and put your hand on the person's chest.
• Is the person's chest going up and down?
• Can you feel any breath on your cheek?
• Can you hear any air moving from the nose or mouth?
• Can you feel the chest go up and down with your hand?
• Look, listen and feel for about 5 to 10 seconds.

The person is breathing if you can:

• see the person's chest going up and down, or
• feel breath on your cheek, or
• feel the person's chest move up and down, or
• hear air moving in and out of the person's nose or mouth. breathing.

Do NOT do CPR if the person is breathing. If the person is NOT breathing, do the next step.

B - BREATHING

Tilt the head back, hold the chin up with the other hand and BLOW.

Tilt the person's head back, pinch their nose closed, cover the person's mouth with your mouth and blow 2 good breaths at least one second long into the person's mouth. Your air will push air into the person's lungs.

You know if your breaths are going into the person's lungs if you see the person's chest go up and down. If the chest is NOT going up and down:

• re-position the head and chin and/or
• blow harder.

If the chest is still not going up and down, the person probably has a blocked airway so you must perform the procedure below for the choking person.

Use a special CPR mask to protect yourself from an infection.

C - CHEST COMPRESSIONS FOR CIRCULATION

If there is no pulse, begin chest compressions. Chest compressions are NOT done if the person has a pulse.

Do these things in order to find out if the person has a pulse or not.

• Feel for a pulse on the side of the person's neck (carotid pulse).
• Feel for this pulse for about 5 to 10 seconds.

If there is a pulse and the person is NOT breathing, keep giving the person one deep breath every 5 seconds, but re-check for a pulse every 2 minutes. The heart will not beat for long on its own when the person is not breathing because the oxygen is not flowing to it.

If the pulse is not present, you must begin chest compressions so the blood circulates through the person's body, especially their brain and heart.

Here are the steps:

• Put the heel of one hand on lower part of person's breastbone (sternum).
• Put your other hand on top of your first hand. Press down on the sternum for 1½ to 2 inches for an adult at a rate of 80 to 100 compressions per minute. This is MORE than one per second. Count 1 and 2 and 3 and 4 etc.
• Give 2 deep breaths after every 30 chest compressions.

Do NOT stop until you are instructed to stop by the doctor, nurse or other healthcare provider that is in charge of the person and their care.

CPR for Children (1 to 8 years old)

If you are giving CPR to a child, do the same CPR steps as an adult with 3 changes. These changes are:

1. Give CPR for a full 2 minutes BEFORE calling 911 if nobody else is around to call for help.
2. Use only 1 hand for chest compressions, not 2.
3. Press down on the chest only 1/3 of the depth that you would for an adult. Press down only ½ to 0.7 inches for the child.

CPR for Infants Less than 1 Year Old

If you are giving CPR to an infant, do the same CPR steps as an adult with 7 changes. These changes are:

1. Tap the infant. Do NOT shake the baby.
2. Do not tilt the head too far back.
3. Cover the infant's nose and mouth with your mouth. Do NOT pinch the nose.
4. Give gentle breaths, not blows.
5. Press down just below the baby's nipples.
6. Use 2 or 3 fingers, instead of your hand, to press down on the chest.
7. Press down only 1/3 the depth of the baby's chest.

To get a free CPR pocket guide that you can print out and carry with you, go to: http://depts.washington.edu/learncpr/pocket.html

Doing CPR When 2 People are Working Together

CPR can, and should, be done with 2 people if a second person is trained in CPR.

The procedures for 2 man CPR are the same as when 1 person is doing CPR EXCEPT the breaths increase to 2 breaths every 15 compressions for children and infants, EXCEPT newborns. Newborns and adults still get 2 breaths every 30 compressions with 2 man CPR.

All age groups get 2 breaths every 30 compressions with one man CPR for all age groups.

Here is a summary of breaths and compressions.

Caring for the Conscious Person Who Is Choking

Do NOTHING for a choking adult or child who is able to speak or cough. Just stay with them, call for help and try to calm them down. You also do not do anything if the infant is crying or coughing.

Do these things only if the conscious, choking person is NOT speaking or coughing.

Adult and Child (1 to 8 Years Old)

For the conscious, choking adult and child you must continuously do the Heimlich Maneuver until the person becomes unconscious OR they begin to breathe on their own.

The steps are:

1. Stand behind the person and put your arms around the person's waist.
2. Make a fist with on hand and put the thumb side on the person's belly just under the ribs and above the belly button (naval).
3. Put the other hand over the closed fist.
4. Thrust or push your hand and fist in a strong, fast, upward push against the person's belly. Continue the thrusts until the object comes out.

Do NOT stop until the person becomes unconscious or starts to breathe, cough and/or speak on their own. Perform the steps for an unconscious, choking person (see below) if the person becomes unconscious. Get medical help if the person becomes able to breathe on their own. They still need help.

Infant (Less than 1 Year Old)

For the conscious and unconscious, choking infant you must continuously do the Heimlich Maneuver until the infant begins to breathe on their own.

The steps are:

1. Give 5 back blows.
2. Give 5 chest thrusts (Put your index and middle fingers of both hands below the ribs and just above the naval and give quick, upward thrusts).
3. Repeat 1 and 2 until the object comes out or they begin to cry, or breathe on their own.

Do NOT stop until the baby becomes unconscious or starts to breathe, cry or cough on their own.

Caring for the Unconscious Adult and Child Who Is Choking

Do these steps when the choking person is unconscious and when your CPR breaths are NOT making the person's chest rise and fall.

1. Put the person on a firm surface, like on a board or on the floor.
2. Kneel on the floor with your knees near the person's hips.
3. Place one hand on top of the other and place these 2 hands below the ribs and above the naval.
4. Do quick, hard, upward thrusts using your body and hands.

Remove an object, or food, if you see it in the mouth.

Do NOT stop until the person starts to breathe, cough and/or speak on their own.

What to Do If You Choke

When you choke, you can save your own life with the same procedure.

Here are the steps:

1. Make a fist and put the thumb side of your fist against your belly, below the ribs and above the navel, in the same way you would do for others.
2. Grab your fist with your other hand and press into your upper abdomen with a quick upward, thrust in the same way you would do for others.
3. Repeat until you get rid of the object.

OR

1. Lean over a table or chair edge so that your upper belly, below the ribs and above the naval, is on the edge of the table or chair.
2. Quickly and firmly thrust upward against the chair or table until the object comes out.

Summary

CPR and the Heimlich Maneuver save lives. As a healthcare worker, you must be skilled in these tasks. Study these skills and practice these skills in a frequent manner.

References

American Heart Association (12/13/2005). "Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. Volume 112. Issue 24 Supplement. circ.ahajournals.org/content/ vol112/24_suppl/#AMERICAN_HEART_ASSOCIATION_GUIDELINES _FORCARDIOPULMONARY_RESUSCITATIONAND _EMERGENCY_CARDIOVASCULAR_CARE

University of Washington (2005). "Learn CPR: You Can Do It." http://depts.washington.edu/learncpr/

Copyright © 2006 Alene Burke