Definition, Purpose, and History of CPR

CPR, or cardiopulmonary resuscitation, is a medical technique used to save the lives of adults, children, and babies who have suffered respiratory failure. While the first attempts at resuscitation can be traced to Ancient Greece, experts tend to date the history of CPR to the mid-18th century, when the first attempts at artificial respiration were made. Modern CPR was first developed in the 1960s and has since become a widely recognised and essential medical procedure for saving lives in emergency situations. It involves a combination of chest compressions and rescue breathing to manually pump oxygenated blood to the brain and other vital organs until medical help arrives. The purpose of CPR is to maintain the flow of oxygenated blood to the body's tissues and organs, which can help prevent brain damage and other life-threatening complications that can occur when the heart and lungs stop functioning properly.

Identifying a Child or Baby in Respiratory Arrest

Identifying that a child or baby is having breathing difficulties and taking quick action is very important. The brain needs oxygen to live, and if deprived, it will not be able to function properly. The first step is to look for any signs of consciousness, such as responsiveness, and see if you can wake them up. If the child does not respond, check for breathing by placing your ear close to their mouth and listening for breathing. Also, check to see if you can feel them breathing; put your hand underneath their nose; and at the same time, look down the chest and stomach to see if you can see it rising up and down. Do this for ten seconds. After 10 seconds, If there is no sign of breathing, call for help and begin rescue breaths and chest compressions immediately. Other signs that children may not have enough oxygen are blue or pale skin and dilated pupils. If you are with a child who has darker skin tones and are unsure about colour change, check inside the lip beds or in the eye lids to see if they are blue or gray, which would indicate a lack of oxygen. If you are ever unsure whether a child is breathing normally, it is best to assume that they are not and begin CPR right away. It is important to remember that time is of the essence when it comes to treatment, and quick action can make all the difference in saving a life.

Preparation for CPR

Preparation for CPR is essential to ensuring that you can administer this life-saving technique effectively. The first step is to ensure that it is safe and that you have removed any nearby dangers or hazards. You will also need to ensure that emergency services have been called. In the UK, you can call 999; in America, you can call 911; and in other countries within Europe, you can dial 112. Put your phone on a loudspeaker, and the call handler will talk you through the whole process and give you support. Anyone can do CPR; however, it is recommended that you learn or get taught formal CPR training, which is widely available through organisations such as the American Red Cross and the American Heart Association. Additionally, it is important to have the necessary equipment on hand, such as a CPR mask or face shield, to protect yourself from any potential infections. In emergency situations, it is also important to have access to an automated external defibrillator (AED), which can help to restore the heart's normal rhythm. Shout for help, and send someone to go and get the nearest defibrillator. While you start the CPR, Finally, it is crucial to remain calm and focused when administering CPR, as this can help increase the person's chances of survival. By taking these steps to prepare for CPR, you can be better equipped to respond quickly and effectively in emergency situations.

CPR for infants and children

CPR for infants and children is slightly different from the adult CPR technique, as their smaller bodies require different methods of chest compressions and rescue breathing. All infants and children should have five initial rescue breaths, then follow a ratio of 30 compressions and two rescue breaths and repeat. In infants or children under one year of age, the rescuer should use two fingers to perform chest compressions in the centre of the chest, pressing about a third of the way into the chest. For children between one and eight years of age, the rescuer should use the heel of one hand again, a third of the way into the chest, to perform chest compressions. Rescue breathing techniques for infants and children are similar to those used for adults, but the rescuer should cover the infant's mouth and nose with their own mouth for rescue breaths and provide air from your cheeks rather than your lungs (think of the air needed to blow out a candle) when providing breaths for infants. It is important to note that when performing CPR on infants and children, it is crucial to call for medical help as soon as possible. If you are by yourself with the child, it is recommended that you do a minute of CPR first before calling for help, as it is very important to deliver some oxygen into their body as their smaller bodies are more vulnerable and can deteriorate quickly. By becoming familiar with the specific techniques for performing CPR on infants and children, you can increase their chances of survival in emergency situations.

Rescue Breathing Technique

Rescue breathing, also known as mouth-to-mouth resuscitation, is a technique used in CPR to provide oxygen to a child or adult who is not breathing and in respiratory distress. It is very important that oxygen is delivered straight away to a child or baby, so five rescue breaths will need to be delivered straight away. To do this, you will need to first ensure that the child's airway is open by tilting their head back and lifting their chin. Pinch their nose shut and create a tight seal over their mouth with your own. Take a deep breath and blow into their mouth for about one second, watching for their chest to rise. Release your seal and allow their chest to fall before repeating the process. By providing rescue breathing, you can help deliver oxygen to the child's brain and vital organs, increase their chances of survival, and reduce the likelihood of brain damage.

Performing chest compressions

Performing chest compressions is a critical component of CPR and involves pressing down on the centre of the chest in order for oxygenated blood to be pumped to the brain and to keep blood moving through the heart muscle and other vital organs. The first step is to make sure the child is on the floor, or if an infant is on a hard, flat surface, kneel next to their chest. Position your hands in the centre of their chest, with one hand on top of the other, and interlock your fingers. With your arms straight and your shoulders directly over your hands, begin compressions by pressing down on the chest with the heel of your hand and pressing down about two inches. Compress the chest at a rate of 100 to 120 compressions per minute, or two compressions per second, and give 30 compressions. It is important to allow the chest to recoil fully between compressions to allow blood to flow back into the heart. After 30 compressions, give two rescue breaths, then give another 30 compressions, followed by two more rescue breaths, and repeat chest compressions and breaths until help arrives or the person shows signs of consciousness or breathing. By performing chest compressions correctly, you can help to maintain the flow of oxygenated blood to the person's vital organs and increase their chances of survival.

When not to perform CPR

We should always do CPR, as without it, the child will die. However, it is important to seek medical guidance and follow the appropriate protocols for the person's specific situation if we are not sure what to do. There are some situations where it may not be appropriate or necessary to perform CPR. If the child is already showing signs of irreversible death, such as rigour mortis or dependent lividity, CPR will not be effective. However, we should always try, as there is always a chance and we will need a medical professional to make the decision to stop life-saving treatment.

Drowning and Near Drowning

Drowning and near-drowning occur when a child's airway is submerged in water and they are unable to breathe. Drowning is a leading cause of death worldwide, and it can occur in any body of water, including swimming pools, lakes, rivers, ponds, oceans, and even baths at home. Children only need to be submerged in a few centimetres of water to drown, and they should never be left alone near or in water. Near-drowning refers to a child who has survived the initial submersion in water but may still be experiencing respiratory distress or other complications. In both cases, it is important to act quickly to prevent brain damage or death. The first step in treating a drowning or near-drowning victim is to remove them from the water and assess their breathing and circulation. If the child is not responding and not breathing properly, CPR should be initiated immediately, starting with five rescue breaths and followed by chest compressions and rescue breaths at a ratio of thirty compressions followed by two rescue breaths. Even if the child is breathing, it is important to seek medical attention to ensure that there are no underlying injuries or complications. They may still be at risk of secondary drowning. By understanding the signs and symptoms of drowning and near-drowning and knowing how to respond quickly and effectively, you can help save lives and prevent long-term damage.

Suffocation and choking

Suffocation and choking are two related but distinct medical emergencies that can cause serious harm or death if not addressed promptly. Suffocation occurs when a child's airway is blocked, preventing them from breathing. Choking, on the other hand, occurs when a person's airway is partially blocked, restricting their ability to breathe. Common causes of choking include food, small objects, or excessive mucus or saliva. In both cases, it is important to act quickly to clear the airway and restore normal breathing. If a child is choking, encourage them first to try and cough or attempt to clear the obstruction themselves. If they are unable to do so, if this does not work, then put the child over your knee and then give up to five back blows with the palm of your hand in the middle of the child's shoulder blades in an upward direction. If this does not work, call for an ambulance straight away, and then perform an abdominal thrust by standing behind them, wrapping your arms around their waist, making a fist with one hand, placing it just above their belly button and underneath their rib cage, and applying upward pressure to the abdomen like the letter J.

Bleeding and serious injuries

Bleeding and serious injuries can significantly impact the effectiveness of CPR and may require modifications to the standard CPR techniques. For example, if a child has suffered a spinal cord injury, it may be necessary to stabilise the neck and spine before initiating CPR. In cases of severe bleeding, it may be necessary to control bleeding by applying direct pressure to the wound using a clean, sterile dressing before starting CPR. Similarly, if a child has suffered a significant chest injury, it may be necessary to modify the depth and pressure of chest compressions to avoid causing further harm. It is important to assess the extent of any injuries and adjust the approach to CPR accordingly, while still prioritising the restoration of circulation and oxygenation. If you are unsure how to proceed, it is important to seek medical guidance and follow established protocols for managing trauma and injuries in emergency situations. By understanding the potential impact of trauma and injuries on CPR and knowing how to adapt your approach, you can help provide effective care in emergency situations.

Overdose and poisoning

Overdose and poisoning are medical emergencies that can require immediate CPR in some cases. Small children learn and explore by picking up items with their hands and putting them in their mouths to identify what is real, and this can occasionally cause accidental emergencies. Typically, poisons are either corrosive or non-corrosive. If the poison is corrosive, it will burn, so you must immediately take action to cool the poison and remember to take all the necessary precautions and keep yourself safe from the risk of contamination. In situations where a child has inhaled medication or tablets or has been exposed to toxic substances, their breathing and circulation may be compromised, leading to respiratory arrest or cardiac arrest. If a child is unresponsive and not breathing or has irregular breathing, CPR should be initiated immediately, starting with rescue breaths followed by chest compressions. However, it is important to ensure that the appropriate precautions are taken when dealing with potentially toxic substances, such as wearing face shields and protective gloves, avoiding direct contact with the substance, and making sure there is no further risk of contamination. If you suspect that a child has been exposed to a toxic substance, seek medical attention immediately and follow the appropriate protocols for managing these types of emergencies. By understanding the potential risks of overdose and poisoning and knowing how to initiate CPR while taking appropriate precautions, you can help provide effective care in these emergency situations.

The Importance of CPR Training, Certifications, and Skills

CPR is a life-saving skill that can make a critical difference in the outcome of an emergency situation. The importance of CPR training, certification, and skills cannot be overstated. By learning how to properly perform CPR, individuals can increase the chances of survival for someone experiencing a cardiac arrest or other medical emergency. CPR training provides the knowledge and skills necessary to assess the situation, perform CPR, and use an AED if available. Additionally, being certified in CPR demonstrates a level of competence and expertise that can increase confidence in your ability to respond in an emergency. Regular training and updates on CPR techniques and guidelines are also important to ensure that skills remain current and effective. Whether you are a healthcare professional, a first responder, or a member of the general public, CPR training is an essential investment in your ability to save lives. By prioritising CPR training, certification, and skills, you can make a meaningful difference in emergency situations and help to save lives.

Coping with the stress of CPR

Performing CPR can be a stressful and emotionally challenging experience, even for experienced healthcare professionals. The physical demands of chest compressions and the urgency of the situation can lead to feelings of anxiety, fear, and frustration. It is important to remember that it is normal to experience these emotions and that there are strategies to help cope with the stress of performing CPR. One strategy is to focus on the task at hand, following the steps of CPR as you have been trained to do. This can help to maintain focus and reduce feelings of overwhelm. Additionally, it can be helpful to take breaks when possible, delegate tasks to others if available, and seek support from colleagues or supervisors. After a CPR event, it can be beneficial to debrief and process the experience with colleagues or a mental health professional to help manage any lingering feelings of stress or trauma. By recognising and addressing the potential stressors of performing CPR, individuals can better manage their emotional reactions and maintain their effectiveness in emergency situations.

Caring for Yourself After Performing CPR

Caring for yourself after performing CPR is just as important as caring for the child in need. The physical and emotional demands of performing CPR can take a toll on the body and mind, and it is important to prioritise self-care in the aftermath of an emergency situation. One key strategy is to rest and allow yourself time to recover, both physically and emotionally. This may involve taking time off work or engaging in activities that promote relaxation and stress reduction, such as exercise or mindfulness meditation. Additionally, it can be helpful to debrief with colleagues or a mental health professional to process any lingering emotions or trauma related to the experience. Finally, it is important to seek medical attention if any injuries or health concerns arise as a result of performing CPR. By prioritising self-care and seeking support when needed, individuals can better manage the aftermath of performing CPR and maintain their physical and emotional well-being.

Support and Resources for CPR Providers

Support and resources are available to individuals who provide CPR, both during and after an emergency situation. One resource is CPR training and certification programmes, which provide the knowledge and skills necessary to perform CPR effectively. In addition to training programmes, there are many resources available to support individuals who have provided CPR, such as support groups, counselling services, and debriefing sessions with colleagues or mental health professionals. Many organisations also have employee assistance programmes that offer support and resources to employees who have experienced a traumatic event, including those related to CPR. It is important to seek out these resources and take advantage of the support available, as this can help individuals manage the emotional and physical demands of providing CPR and promote overall well-being. By recognising the importance of support and resources for CPR providers, organisations and individuals can better prioritise the well-being of those who perform this critical life-saving skill.

Episode 4.1: Administering CPR to a Child

This very important part of Unii's Paediatric First Aid Journey covers CPR.