Unit 7

Cardiopulmonary
Resuscitation

Unit Summary

by Abd Alrahman Basim

Section 1:
Patient Assessment

Section 2:
Website

Channel

The Heart

Section 3:
The Purpose of CPR

Section 4:
The Initial Steps Before Providing CPR

Section 5:
Administering CPR

Section 6:
CPR for Children and Infants

Term 2

Health Science 2021-2022

Basic Health Assessment
Assessment: a test or analysis.

A basic health assessment is a physical examination of a person. The results of a basic health assessment will tell
you about the health status of that person. They are carried out by medical professionals such as a nurse or a
doctor.

The assessment is not limited to a certain number of tests or checks, and it will vary depending on the person
and the situation.

The Vital Signs

Vital: absolutely necessary, essential for life.

Vital signs measure the body’s most basic functions. Four vital signs which are often checked by medical
professionals are:

• Body Temperature
• Pulse Rate
• Respiration Rate
• Blood Pressure

How to Carry Out Basic Health Assessments of the Vital Signs

Assessing vital signs is a key part of first aid. Taking a series of measurements will provide information about
how the sick or injured person’s body is functioning.

They can also show if a patient is getting better or worse when the measurements are taken over time. Knowing
the normal rates means that you know if the person who you are dealing with is at risk of further injury or death.

Body Temperature:

• A person’s body temperature can be taken from many parts of the body including the mouth, ear canals,
on the skin, or under the arm.

• Digital thermometers are most commonly used.

• For a healthy adult, the normal body temperature is between 36.5°C and 37.2°C.

• The environment can influence a person's body temperature, especially if they are in a very cold or very
hot place.

Pulse Rate:

• As the heart beats, forcing blood through the arteries, you can feel beats pressing on the arteries that
are located close to the surface of the skin.

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 • For most people, it is easiest to take the pulse rate at the wrist, but you can also find a pulse on the
side of the neck and on the inside of the elbow.

• To check a person’s pulse, simply use the first and second fingertips. Press firmly
but gently on the arteries until you feel a pulse and count the pulse for 60 seconds.

• A normal pulse for a healthy adult at rest is 60-100 beats per minute.

• A person's pulse rate can be influenced by medical conditions. It is important to take this into
consideration when measuring pulse.

Generally, a lower resting heart rate suggests that the heart is working more efficiently, and the person has good
cardiovascular fitness. For example, an athlete resting heart rate may be closer to 40 beats per minute.

Respiration Rate:

• This is the number of breaths a person takes per minute.

• Measuring the respiration rate is done when a person is at rest, by counting the number of breaths they
take for one minute. Every time the chest rises is considered one breath.

• For a healthy adult, the normal respiration rate at rest is 12-20 breaths per minute.

Blood Pressure:

• This is the force of blood pushing against artery walls.

• Two numbers are recorded when measuring blood pressure.

• The higher number is known as systolic pressure. This is the pressure inside the artery when the heart
contracts and pumps blood around the body.

• The lower number is known as diastolic pressure. This is the pressure inside the artery when the heart
is at rest and filling with blood.

• A normal blood pressure reading for a healthy adult is a systolic pressure of 120 and a diastolic pressure
of 80. This is written as 120/80 mmHg (millimetres of mercury).

• A person whose blood pressure reading is greater than 140/90 mmHg is known to have hypertension
(high blood pressure).
• lower blood cholesterol, which will reduce the risk of developing cardiovascular disease.

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Anatomy of the Heart
The heart is divided into four sections, the right atrium and
left atrium, and the right ventricle and left ventricle.

The left side of the heart receives oxygen-rich blood from the
lungs and carries this oxygen around the body.

The right side of the heart receives oxygen-poor blood after

it has been delivered to the organs in the body.

The oxygen-poor blood contains carbon dioxide which returns

to the lungs where it gets exhaled.

Why might the Heart Stop Beating?

Reason 1: Heart Failure
It happens when the heart muscles weaken, which causes the ventricles to
enlarge (become bigger), which makes it unable to pump enough blood
around the body.

Blood carries oxygen, nutrients, and energy to organs in the body. If there is
not enough blood being taken to these organs, it is considered heart failure.

Reason 2: Cardiac Arrest

Cardiac arrest is when the heart suddenly stops beating. This is usually due to problems with the electrical
systems in the heart.

This can quickly result in death if the correct steps are not taken after a person goes into cardiac arrest.

Cardiac arrest may be reversed if cardiopulmonary resuscitation (CPR) is performed, and an automated
external defibrillator (AED) is used to shock the heart and bring back the heart rhythm within minutes.

The signs of cardiac arrest include:

- Unresponsive/sudden loss of consciousness

- No breathing
- No pulse

There may be other symptoms before a cardiac arrest happens. These include:

- Chest pain - Dizziness

- Shortness of breath - Palpitations
- Weakness - Nausea

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There are many possible causes of cardiac arrest. The most common cause of cardiac arrest is a heart attack.

Other causes of cardiac arrest include:

- Ventricular fibrillation – this is when the heart is not beating at a normal rhythm
- Ventricular tachycardia – this is when the heart is beating too fast
- Coronary heart disease
- Respiratory arrest – breathing stops due to lung failure
- Hypothermia – dangerously low body temperature
- Dramatic drop in blood pressure
- Drowning

Reason 3: Heart attack

A heart attack occurs when the blood flow that brings oxygen to the
heart is severely reduced or stopped.

This happens because coronary arteries that supply the heart with
blood can slowly become thicker and harder from a build-up of fat,
cholesterol, and other substances, called plaque.

This slow process is known as atherosclerosis. If the plaque breaks open and a blood clot forms that blocks the
blood flow, a heart attack occurs.

Cardiac arrest is an “ELECTRICAL” problem.

A heart attack is a “CIRCULATION” problem.

Symptoms of a heart attack:

• Chest pain - a person may feel tightness in the centre of the chest, it can spread to other areas, such as
the arms, jaw, neck, back and stomach
• Shortness of breath
• Coughing
• Wheezing
• Nausea
• Feeling light-headed or dizzy
• Sweating
• Weakness
• Palpitations (noticeable heartbeats)

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What is CPR?
CPR stands for cardiopulmonary resuscitation.

CPR is a lifesaving technique that is used on someone who is in cardiac arrest. It helps to pump blood around
the person’s body when their heart cannot do it on its own.

By knowing CPR, you could save a life. In order to give CPR you must have a qualification which says you are fully
trained in CPR and you are able to complete the necessary skills to provide it in a real-life situation.

It is important to refresh these skills regularly by renewing your qualification.

It is quite easy to become qualified in CPR. You can attend a training course over one or two days where you will
learn and practise all the necessary skills and complete a test to make sure you understand all the steps.

Chain of Survival
The chain of survival describes the actions that need to be taken to treat adults who have gone into cardiac
arrest outside of a hospital setting. There are six steps:

1. Immediately recognise the emergency and call the local emergency number (998).
2. Perform high-quality CPR immediately.
3. Complete rapid defibrillation as soon as it is available.
4. Provide basic and advanced emergency medical services.
5. Provide advanced life support and post-cardiac arrest care.
6. Provide rehabilitation treatment and support during the recovery period.

The first three steps of the chain can involve you if you are at the scene of an emergency and someone has gone
into cardiac arrest. The last three steps would normally be completed in a hospital.

A strong chain of survival can improve the chances of survival for people who have suffered a cardiac arrest. It
can also make the recovery process much quicker.

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Initial steps to follow at the scene of an emergency
If you see an adult who may have gone into cardiac arrest, take the following steps to assess the emergency and
get help:

Step 1: Make Sure the Scene is Safe

Do this before anything else. Do not put yourself in danger by helping someone else. Look for possible hazards
that could cause you harm. You cannot help if you also become hurt.

Step 2: Check for a Response

Lean over the casualty or kneel by their side. Tap the casualty on the shoulder and ask if they are OK.

If the person moves, speaks, blinks, or otherwise reacts when you tap them, then the person is responsive. Ask
the person if they need help.

If the person does not move, speak, blink, or otherwise react when you tap them, then the person is
unresponsive. Shout for help so that others nearby can help you.

Step 3: Shout for Help

The sooner you realise there is a problem, the better. When more people are helping, you can give better care
to the person who is in cardiac arrest.

Step 4: Call 998 and Get an AED

If someone comes to help, get them to call for an ambulance and get an AED. Ask them to put the phone on
speaker mode so that you can hear the instructions given from the ambulance dispatcher. If no one is around to
help, call 998 yourself and put it on speaker mode.

They will normally ask you questions about the emergency. Speak clearly so they can help you as much as
possible. Stay on the phone until they tell you to hang up.

Step 5: Check for Normal Breathing

If the person is unresponsive, check for normal breathing. Look for movement of the chest area for at least 5
seconds, but no more than 10 seconds. If the person is breathing, their chest will rise and fall. If they are not
breathing, or if they are gasping, they will need CPR.

If the casualty is unresponsive but breathing normally, then:

• CPR is not needed.

• Put the casualty in the recovery position.
• Stay with the casualty until medical care arrives.

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If the casualty is unresponsive and not breathing normally,, then:

• CPR is needed.
• Make sure the person is lying on a firm, flat surface.
• Start giving CPR.

What to Do if You are not Sure

If you think someone needs CPR but you are not sure, give them CPR. You may save that person’s life. High-
quality CPR is not likely to cause harm if the person is not in cardiac arrest.

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CPR has two main skills:

• Providing compressions
• Giving breaths

Providing Compressions
Compression: the act of pushing hard and fast on the chest.

When you give chest compressions, you pump blood to the brain and around the body. To do this successfully,
it is important to remember the following points:

• Give compressions that are deep enough.

• Give compressions that are fast enough.
• Let the chest come back up to its normal position after giving each compression.
• Do not stop giving compressions for more than ten seconds, even when stopping to give breaths.

It is better to push too hard than not hard enough. It is more dangerous for blood to not pump around the body
than any damage caused by giving compressions.

Here is how to provide compressions for an adult during CPR:

1. Make sure the person is lying on their back, on a firm, flat surface.

2. Make sure clothes are not in the way of giving compressions.

3. Place the heel of one hand on the centre of their chest; over the lower part of the breastbone.
Put your other hand on top of your first hand.

4. Push directly down at least 5 cm.

5. Keep repeating this at a rate of 100-120 compressions per minute. Make sure you count the
compressions to ensure you are doing enough.

6. Make sure that the chest fully rises to its normal position between each compression.

7. Avoid stopping compressions for more than 10 seconds, even when you are giving breaths.

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Giving Breaths
After each set of 30 compressions, you need to give 2 breaths. You should
use a barrier device, such as a pocket mask or face shield if possible.

When you give breaths, the person’s chest must rise. This is how you
know you have given an effective breath.

Step 1: Open the Airway

You must open the airway of the patient before giving breaths. This is to make sure that there is a clear passage
for air to get into the lungs and that the tongue is not in the way. Follow these steps to open the airway:

1. Put one hand on the forehead and the fingers of your other
hand on the solid part of the chin. Do not press the soft part
of the chin as this can block the airway.

2. Gently tilt the head back and lift the chin up.

Step 2: Giving Breaths Using a Pocket Mask

Pocket masks are made of plastic and fit over the person’s mouth and nose. They will protect you (the rescuer)
from blood, vomit, or disease. There are different kinds and sizes of pocket masks for adults, children, and
infants.

1. When you are using a pocket mask, put it over the casualty’s mouth and nose. If there is a pointed end,
put the narrow end of the mask on the bridge of the nose and widest part of the mask over the mouth.

2. Open the airway while pressing the mask on the casualty’s face. Make sure the mask is sealed between
the person’s face and the mask.

3. Give two breaths by blowing into the mask. Watch for the chest to rise as you give each breath.

4. Make sure you do not take more than ten seconds when giving the two breaths, as compressions should
not be stopped for any longer than ten seconds.

Step 2: Giving Breaths Without a Pocket Mask

It is best to use a barrier device, but if it is not available you should follow the steps below:

1. While holding the airway open, pinch the nose closed with your thumb and first finger.

2. Take a normal breath and cover the person’s mouth with your mouth.

3. Give two breaths by blowing into their mouth for approximately one second for each breath.

4. Watch for the chest to rise as you give each breath.

5. Make sure you do not take more than ten seconds while giving the two breaths. Compressions should
not be stopped for any longer than ten seconds.

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Step 3: Put Both Steps Together
Follow the steps for compressions. After thirty compressions give two breaths. Make sure you do not stop
compressions for more than ten seconds.

You should continue CPR until a medical professional arrives to take over, or the casualty starts breathing on
their own again.

Remember When providing CPR, give sets of 30 compressions and 2 breaths.

Two Rescuer Compressions

As you get tired, your compressions will become less effective. If there is someone else available to help you
who is also trained in CPR, take turns in giving compressions.

Change the person who is doing compressions every 2 minutes. Make sure you switch as quickly as possible.

Automated External Defibrillator (AED)

An automated external defibrillator (AED) is a portable, electronic device which delivers an electric shock
through the chest to the heart.

Using an AED as well as performing high-quality CPR within 3-5 minutes of cardiac arrest increases a casualty’s
chance of survival from 6% to 74%. If there is an AED available, it should be used when giving CPR.

AEDs are completely safe and are very easy to use. Once you turn it on, it will prompt you with what you need
to do. The machine analyses if the person needs a shock and will automatically give one if needed.

Using an AED:
• Turn on the AED
To do this, you will need to either press the ‘on’ button or lift the lid. When you do this, you will hear
prompts which will tell you everything you need to do.

• Attach the Pads

The AED may have both adult and child pads. Make sure you use the
adult pads on anyone older than 8 years old. Peel the back off the pads
and attach them to the person’s bare chest in the positions shown.

• Clear the Casualty

The AED will analyse the heart rhythm. If a shock is required, it will tell
you. Make sure everyone stays away from the person and nobody
touches them at this time. Then press the 'shock' button.

• Resume CPR
After administering a shock, immediately resume CPR by giving compressions. The AED will continue to
give you prompts. Continue to give CPR and use the AED until a medical professional arrives to take
over, or the casualty becomes responsive.

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Special Situations
• If the casualty is lying in water, then quickly move them to a dry area.

• If the casualty is lying in a small puddle, then you can use the AED as the person doesn’t need to be
totally dry.

• If the casualty has water or sweat on their chest, then quickly wipe the chest dry before attaching the
pads.

• If the casualty has an implanted defibrillator or pacemaker, then make sure you do not put the AED pad
directly on the implanted device.

• If the casualty has a medicine patch where the pad needs to be placed, then with gloves on, remove
the patch, wipe the area clean and attach the pads as normal.

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The Difference Between Adult and Child CPR
When it comes to giving breaths, here are some things you should think about:

• Their mouth and nose are much smaller, meaning their airway can get blocked by smaller objects.
• The tongue takes up more space in the mouth.
• Their trachea is smaller.
• The chest muscles are not fully developed.
• Chest cavity and lung volumes are smaller.

CPR for a Child

Giving CPR to a child between the ages of one to eight years old is almost the same as for an adult:

1. Use two hands, or only one hand if the child is very small, to perform chest compressions.
Press straight down on the chest (about 5 cm).

2. Breathe more gently. Remember they have smaller lungs than an adult.

3. Use the same compression-breath rate that is used for adults: 30 compressions followed by
two breaths at a rate of 100 to 120 compressions per minute.

4. If an AED is available, use it and follow the instructions. Use paediatric (child) pads for children
aged between one and eight (if available). If paediatric pads aren’t available, use adult pads.
Give one shock, then resume CPR (starting with chest compressions) for two more minutes
before administering a second shock.

CPR for a Baby

Most cardiac arrests in babies occur from lack of oxygen. This can be from drowning or choking. If you know the
baby has an airway obstruction, perform first aid for choking. If you don’t know why the baby isn’t breathing,
perform CPR.

Tap the baby’s foot and watch for a response or any movement. DO NOT shake the baby.

Taking no more than 10 seconds, put your ear near the baby's mouth and check for breathing. Look for chest
motion, listen for breath sounds, and feel for breath on your cheek and ear.

If a baby is unresponsive and not breathing, then you need to provide CPR.

If there is no response and they are not breathing, follow these steps:

Compressions:
1. Place the baby on its back on a firm, flat surface, such as a table or the ground.

2. Imagine a horizontal line drawn between the baby’s nipples. Place two fingers of one hand just below
this line in the centre of the chest.

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 3. Gently compress the chest (about 4 cm).

4. Use the same compression-breath rate as is used for adults: thirty compressions followed by
two breaths at a rate of 100 to 120 compressions per minute.

5. Keep repeating this at a rate of 100-120 compressions per minute. Make sure you count the
compressions to ensure you are doing enough.

Open the Airway:

After thirty compressions, gently tilt the head back by lifting the chin with one
hand. Tilt the forehead back with the other hand. Avoid pressing the soft part
of the neck or under the chin because this might block the airway. Also, do not
push the head back too far. This might close the airway as well.

Breathing:

• If possible, use a pocket mask or a barrier device. Babies have much smaller faces than adults, so is
important to ensure that the mask is sealed around the nose and mouth.

• Give two rescue breaths. Deliver a gentle puff of air (instead of deep breaths from your lungs) and
slowly breathe into the baby’s mouth one time.

• Watch to see if the baby’s chest rises. If it does, give a second rescue breath. If the chest does not rise,
re-open the airway and then give the second breath.

• Perform CPR for about two minutes before calling for help, unless someone else can make the call while
you attend to the baby.

• Continue CPR until you see signs of response, or until a medical professional arrives.

Do not use an AED on children younger than one year of age.

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Resources
• G11 – Term 2 – Unit 7: Cardiopulmonary Resuscitation

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