Cardiopulmonary Resuscitation (CPR) is a life-saving technique used when someone’s breathing or heartbeat has stopped. It maintains blood flow and oxygen to the brain and other vital organs until professional medical help arrives. Understanding the correct application of CPR is crucial, as it is intended for specific circumstances.
The Purpose of Cardiopulmonary Resuscitation
CPR involves chest compressions, often combined with artificial ventilation, to preserve brain function and maintain circulation. Its goal is to manually circulate oxygenated blood to the brain and heart when the heart has stopped beating effectively (cardiac arrest). This helps delay tissue death, extending the opportunity for successful resuscitation without permanent brain damage. CPR is recommended for individuals who are unresponsive, not breathing normally or only gasping, and who do not have a pulse.
Potential Consequences of Unnecessary Chest Compressions
Performing chest compressions on someone with a pulse can cause physical injuries and worsen their medical condition. Compressions are forceful, requiring significant pressure to circulate blood, which can cause harm when applied to a beating heart.
Common injuries from unnecessary compressions include rib and sternum fractures. Studies indicate rib fractures occur in approximately 30-40% of adult CPR cases, and sternal fractures in 14-30%. These fractures can be painful and lead to prolonged recovery.
Beyond skeletal injuries, unnecessary chest compressions can cause internal organ damage, including bruising to the heart or, rarely, lacerations to the liver or spleen. Liver injuries are the most common intra-abdominal complications (0.6% to 3% incidence), primarily affecting the left lobe due to its proximity to the sternum. There is also a risk of lung injuries, such as contusions, and aspiration pneumonia if vomiting occurs. Such injuries can complicate recovery and delay appropriate medical assessment and treatment.
Assessing for a Pulse and Other Signs of Life
When encountering an unresponsive person, a quick and accurate assessment is important to determine if CPR is necessary. First, check for responsiveness by tapping the person’s shoulder and asking loudly, “Are you okay?” If there is no response, immediately call for emergency services.
Simultaneously, assess for normal breathing and a pulse. Look for chest rise and fall to determine if the person is breathing normally, noting that gasping or abnormal breathing is not considered normal. To check for a pulse in an adult, place two or three fingers on the carotid artery, located in the groove on the side of the neck, between the windpipe and the neck muscles. This pulse check should take a minimum of 5 seconds but no longer than 10 seconds. If no pulse is detected or if you are unsure, begin chest compressions immediately. Prompt action is crucial, as delaying CPR can significantly reduce the chances of survival.
Appropriate Actions for an Unresponsive Person with a Pulse
If an individual is unresponsive but has a pulse and is breathing, even if abnormally, the appropriate course of action differs from performing CPR. Immediately contact emergency services, such as 911 or your local equivalent. Provide as much detail as possible about the person’s condition and location.
While waiting for medical help to arrive, continuously monitor their breathing and pulse. If the person is unresponsive but breathing normally, placing them in the recovery position can help maintain an open airway and prevent choking on fluids or vomit.
To place someone in the recovery position:
Kneel beside the person and straighten their legs.
Extend the arm nearest to you at a right angle, with the palm facing up.
Bring the other arm across their chest, placing the back of their hand against the cheek closest to you, and hold it there.
Bend the far leg at the knee, ensuring the foot is flat on the floor.
Gently roll the person towards you onto their side by pulling on the bent knee, supporting their head and neck.
Tilt their head slightly back to keep the airway open, with their mouth pointing downward to allow drainage.
Do not attempt to move them into the recovery position if a spinal injury is suspected.