Shake the patient and try to rouse him by calling. Call out for help and next turn the patient, then keep him in supine position and now proceed with ABC of cardio-pulmonary resuscitation.


First open the airway. The head-tilt-chin-lift manoeuvre is superior to jaw-thrust and neck-lift manoeuvre. Tilt the head backwards by applying firm pressure on forehead while the fingers of other hand are placed under the mandible near the chin. In presence of neck injury modified jaw thrust technique may be used. During this manoeuvre soft tissue under the chin should not be compressed, Now look for chest movement and by placing the ear over the mouth and nose of the patient and looking towards his chest and abdomen simultaneously whether the patient had started breathing or not. If no breathing has commenced, remove any obstruction in oropharynx (artificial denture, foreign body, mucus) by the finger and reassess again. If the patient is conscious ask him to cough. If these are not successful, apply firm blows to the back alternating with finger sweeps. Heimlich manoeuvre, instead of back-blow is recommended by AHA and ARCS.BASIC CARDIOPULMONARY RESUSCITATION…


If the patient is still not breathing gently pinch the nostrils to close them by the index finger and thumb kept over the forehead. Now after taking a deep breath place your mouth over patient’s mouth with an air tight seal. Two slow full breaths in succession are to be given within five seconds allowing a pause after each breath. This will prevent gastric distention. Look to the chest and see whether it rises and falls as you breathe in and out of the patient. Some prefer to give four quick breaths but there is a danger of gastric distention. Now palpate the carotid artery for about five seconds to avoid missing the pulse in presence of bradycardia. In presence of neck injury palpate femoral artery for pulse. Now if no pulse is felt over a major artery like carotid or femoral, proceed quickly to establish circulation with chest compression. If pulse appears, patient should be ventilated with exhaled air 12-16 times per minute. If there is no pulse call for help and proceed to the next step.BASIC CARDIOPULMONARY RESUSCITATION.


Locate the crux of xiphoid with one hand and follow the inferior end of xiphoid. The heel of one hand should be placed on midsternal region with the bottom of hand 1-2 fingers width above the xiphoid. Chest compression should be done vertically downwards and straight with heel of one hand upon another or interlocked hands with shoulders directly over the sternum. The basic compression rate is 80-100 per minute with the depth of compression 1 2 -2 inches. Compression duration should be at least 50% of total duration of cycle. Before ventilating twice 15 compressions should be done and 3-5 seconds should be taken for two ventilations and a pause should be given between two ventilations. Count during each compression like one, two, three, etc. until 15 compressions are delivered when you should have pause for two chest inflations. After first minute of CPR observe for pulse once again and continue it after every 2-3 minutes. The process is to be continued and there should be no stoppage for more than 5 seconds anywhere except only for intubation or for defibrillation. Open chest massage should be considered only when the operator cannot offer adequate basic CPR….BASIC CARDIOPULMONARY RESUSCITATION

One person CPR

At the rate of 50/min perform 15 chest compressions and then moving towards the head opening the airway deliver two successive breaths in 5 seconds. Again move to the chest and give 15 chest compressions and again deliver two ventilations.

Two person CPR

It is to be noted that artificial circulation should always be combined with artificial ventilation. Thus for one victim two rescuers are required. One will perform chest compression at the rate of 60/min and the other will continue airway ventilation onevery 5th compression. In spite of proper CPR technique there may be several complications like fracture of sternum or rib, pneumothorax, haemothorax, costochondral separation, contusion of lung, laceration of liver and fat embolism.


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