Every good certified nursing assistant should be proficient at cardiopulmonary resuscitation (CPR). To become skilled and certified at CPR you will need to practice on dummies with an instructor, but this will give you the basics so that you will already have some understanding of what you are doing when you take the class.
Serious disorders of the heart or breathing apparatus can cause living people’s hearts or breathing to stop, and brain damage or death can occur in a few minutes if a rescuer is not available to act quickly. When the heart has stopped beating we say that the patient is in cardiac arrest. Oxygen cannot get to the brain and heart muscle and tissue is rapidly lost. When the patient stops breathing he or she is in respiratory arrest. Again, oxygen cannot reach the brain or heart muscle and neither tissue will live long without oxygen. As the rescuer, you will need to provide oxygen to the brain and heart as soon and as well as possible.
History: In ancient times people would “breath the breath of life” into people who were not breathing, and in more modern times near-drowning victims would be rolled over a barrel or have their arms pulled up and pushed back down onto their chests. When electrical shocks were invented for use in resuscitation it was discovered pressing paddles to the chest got good results. It was assumed that pressing onto the chest compressed the heart, making it pump artificially. CPR was born, with rescuers breathing into the patient’s mouth and compressing his or chest.
What Happens During CPR: During the 1970’s researchers at Harbor General Hospital and UCLA Medical Center found that the heart acts as an open a conduit during CPR. During CPR we increase and decrease the pressures in the lungs. Changing the pressures in the lungs serves to pump blood through the lungs, where it picks up oxygen, and on into the heart and the rest of the body.
The first thing to do upon finding a patient who is not breathing is to tap and shout. When people sleep they occasionally stop breathing for a short time and restart on their own. No one wants his or her sleep disturbed by a well-meaning would-be rescuer pounding on his or her chest, so tap the patient’s shoulder while shouting his or her name. If there is no response or if the patient is gasping for air, it is time to go into action.
If you are in a hospital or nursing home there will be a way to call for help. During orientation you will be told whether to pick up the telephone and call the operator, press the nurse call button or use some other device, such as a button on the wall.
If you are at home or on the street call 911 or ask someone to call for you. If a group of people is standing around and no one moves to call when you ask, pick out some one and say, “Lady in the red jacket, call 911.” Personalizing your request is more likely to get a response.
Begin CPR with chest compressions. The patient should be on a firm surface, so if you are in a hospital or nursing home put a CPR board under his or her upper back. If you are away from work, put the patient onto the floor or other hard surface. Put the heel of one hand onto the patient’s chest, in center between the nipples. Place the other hand over the bottom hand, interlacing your fingers to keep them off the chest. This will help to prevent breaking a rib. If you are on the floor, kneel and bend at the hip, keeping your elbows straight, to compress the chest 100 times per minute. If the patient is on a bed or other high surface, stand and bend from the hips. If you are a student who has not yet been trained in CPR, continue compressions until help arrives.
If you are certified in CPR, give 30 chest compressions and 2 rescue breaths, making sure that the chest rises with each breath. Tilt the head back, pinch the nostrils, form a seal over the patient’s mouth and exhale. In a hospital there is likely to be a guard to place between your mouth and the patient’s, or you can use a ambu-bag is one is present. If the patient’s chest does not rise, check the mouth for loose dentures, food, or other objects that might be blocking the airway and remove them. Continue 30 compressions per 2 breaths until relief arrives, a physician tells you to stop or you are too exhausted to continue.
If you suspect a neck injury, do not tilt the head back, so that you will not cause a spinal cord injury. Instead, thrust the jaw forward, hooking your thumbs under the angle of the jaw on each side. If this proves too time-consuming or you are unsure of how to proceed, go back to performing chest compressions at a rate of 100 per minute.
Fractured ribs are something we are all taught to avoid, but, realistically, they happen even when CPR is performed properly. As mentioned before, be sure to press on the breastbone, or sternum, rather than the ribs, and keep your fingers up off the ribs. If you do feel a rib crack, continue CPR as best you can.
Training is important to get it right. This has given you the basics, but careful instruction, study and practice will make you qualified and ready to save lives. Go to it.