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Cardiopulmonary Resuscitation (CPR)
  1. What is cardiopulmonary resuscitation?
    Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful when someone's breathing or heartbeat has stopped.

    Cardiopulmonary resuscitation is a combination of rescue breathing and chest compressions.
    Rescue breathing provides oxygen to a person's lungs.
    Chest compressions keep the person's blood circulating.
    Permanent brain damage or death can occur within minutes if a person's blood flow stops.

  2. When should you start on-the-spot cardiopulmonary resuscitation?
    Was the patient alive a few minutes before?
    Is there a few minutes history of injury?
    Is there no pulse, breath movement, or heart sounds?
    Are there no signs of rigor mortis?
    Are extremities of victim warm like a living human being?
    If yes, start cardiopulmonary resuscitation.


    CPR is required someone's breathing or heartbeat has stopped, as in cases of electric shock, drowning, or heart attack. CPR is a lifesaving procedure in this situation.



  3. How do you start cardiopulmonary resuscitation in adults who suddenly fall unconscious?
    Start by asking, "How are you?" You can translate this into the local language.
    If there is no reply, tap or shake the person's shoulder and loudly ask, “Are you okay?”
    If there is no reply, place the person on the ground.
    Check to see if the person can hear, see, and talk.
    Verify if there is a pulse and breathing.
    If there is no pulse and no breathing for 10 seconds, begin chest compressions.
    Give 30 chest compressions before giving two rescue breaths.
    Call for emergency or more help. Give them the location.

  4. What is the most important part of CPR?
    Rescue breathing, airway management, chest compressions

  5. When should you ensure that a scene is safe?
    When you first see the potential victim

  6. How should you ensure safety when administering CPR?
    Check for safety hazards, chemical spills, gas fumes, or anything dangerous. Wear disposable gloves. Use a one-way mouth guard.

  7. Does a person with agonal breathing sounds, like gurgling or gasping, need CPR?
    Yes, immediately.

  8. What is the maximum amount of time you should check for a pulse?
    10 seconds

  9. What should the depth of compressions be when administering CPR in adults?
    At least 2 inches (5 cm) but not greater than 2.4 inches (6 cm)

  10. Where should you place your hands when doing compressions on an adult victim while administering CPR?
    On the lower half of the breastbone

  11. What should the rate of chest compressions be while administering CPR?
    100-120 compressions per minute

  12. What is the first step to take when operating an AED, if available?
    Turn on the AED.

  13. What is the best way to open the airway of an unresponsive victim?
    Tilt the victim’s head and lift the chin.

  14. What should you do immediately after the AED delivers a shock?
    Restart CPR, beginning with chest compressions first.

  15. Why is there a need for cardiopulmonary resuscitation?
    To help a person breathe and circulate their blood.

  16. What is the compression-to-breath ratio for 2-rescuer CPR for a child?
    15:2

  17. Child CPR How do you check an infant for responsiveness?
    Tap the infant's feet.

  18. What is the depth of compression for an infant victim?
    At least 1.5 inches (4 cm)

  19. How long will it last?
    This is usually done for 15 to 30 minutes.

  20. When should you intubate a patient under emergency conditions?
    When the pulse oximetry (O2 saturation) is less than 90%, without any underlying respiratory conditions or hypoxemia.
    Severe hypoxemia occurs when the O2 saturation falls below 85%. If there is a history of suddenly falling unconscious, intubate the patient. Place the patient on a mechanical ventilator. See further guidelines.

  21. When should you start an on-the-spot intravenous line?
    1. Volume infusion therapy, such as what might be needed in post resuscitation care or closed-container hypotension
    2. IV access in hypotensive patients
    3. Administering intravenous medications
    4. Prehospital blood collection for testing such as verifying blood glucose results or rapid cardiac Troponin levels upon hospital arrival
    5. Hypovolemic Shock and Fluid Resuscitation
    November 30, 2012, case scenario of Aswell Selmon.

  22. When should cardiopulmonary resuscitation be stopped?
    1. The person is revived, starts breathing, and has a pulse.
    2. Other medical help arrives to take over.
    3. The person performing CPR hands it over to another person due to physical exhaustion.
    4. Obvious death. The person cannot be resuscitated after 30 minutes of cardiopulmonary resuscitation.

  23. When is cardiopulmonary resuscitation not indicated?
    Obvious death before initiating cardiopulmonary resuscitation. This has happened many hours before.
    Cold to the touch
    Rigor mortis
    Livor mortis (lividity)
    Injuries not compatible with life

    That is all relevant to cardiopulmonary resuscitation.
    The next lesson is coma.
    A medical emergency physician must know everything about comas.

  24. Medical emergency physician: What are the skills and knowledge required for this job?
    1. Cardiopulmonary resuscitation skills and knowledge.
    2. Coma skills and knowledge.
    3. 11 medical issues that need on-the-spot diagnosis and treatment.
    4. 155 medical issues that need diagnosis and treatment by a medical emergency physician in an emergency room.
    These are essential skills and knowledge required of a medical emergency physician.
    There are many more.
Case scenario 1.
Case scenario 2.

Questions that need further answers.
Who must do regular research relevant to cardiopulmonary resuscitation and share it with the public?
Whose responsibility is it to teach cardiopulmonary resuscitation to the public?
Which guidelines are best for cardiopulmonary resuscitation at this point?
Whom should the public contact if they have further questions?

Case scenario 1.
What is cardiopulmonary resuscitation?
Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful when someone’s breathing or heartbeat has stopped.

How long will it last?
This is usually done for 15 to 30 minutes.

Why is cardiopulmonary resuscitation important?
These examples will help you understand.

Case scenario 1.

What apparently happened?

Date: Thursday, October 1, 2020
Name: Javid Ahmad
Age: 31
Incident: Suddenly fell unconscious. He was travelling in a passenger bus.
Location of incident: Pattan area in Kashmir.
He was on his way to Srinagar from the Watergam area of the Baramulla district. Javid was a resident of the Watergam area of Rafiabad. He was rushed to a nearby hospital, where doctors declared him dead. He was a senior correspondent of a Srinagar-based English daily. He died on October 1, 2020.

The causes and circumstances of his death mentioned heart attack. This needs further investigation. A young man rarely has a heart attack (myocardial infarction). Cardiac arrest is the last scenario in all human deaths. There can be other causes and circumstances. Questions that need further answers from specific physicians: What were the causes and circumstances of his death? How did you verify the causes and circumstances of his death?

What should those who attended him on the spot have accomplished?
Those who saw him suddenly fall unconscious should have started cardiopulmonary resuscitation on the spot.

How do you start cardiopulmonary resuscitation in adults who suddenly fall unconscious?
Start by asking, “How are you?” You can translate this into the local language.
If there is no reply, tap or shake the person’s shoulder and loudly ask, “Are you okay?”
If there is no reply, place the person on the ground.
Check to see if the person can hear, see, and talk.
Verify if there is a pulse and breathing.
If there is no pulse and no breathing for 10 seconds, begin chest compressions.
Give 30 chest compressions before giving two rescue breaths.
Call for emergency or more help. Give them the location.

When should you intubate a patient under emergency conditions?
When the pulse oximetry (O2 saturation) is less than 90%, without any underlying respiratory conditions or hypoxemia.
Severe hypoxemia occurs when the O2 saturation falls below 85%. If there is a history of suddenly falling unconscious, intubate the patient. Place the patient on a mechanical ventilator. See further guidelines.

Who officially received remuneration, income, and grants to circulate these guidelines on or before October 1, 2020?
Stop their income, remuneration, and grants.
Suspend them from services.
Terminate the services of those who were alerted ahead of time.
Record the findings in their service book on or before October 1, 2020.
Failure to provide public health guidelines publicly at least through internet that they have responsibilities. Circuit Court supervision of all grants resources, income, salary, human resources for these services including for www.grants.gov. They are taking salaries, grants, resources and keeping quite without public services that is not justified.

Here are further guidelines.

Case scenario 2.
Cardiopulmonary Resuscitation
Case Scenario Investigations
At 9 PM on Friday, November 5, 2021, 8 people were dead and several injured in a crowd surge at the Astroworld Festival in Houston, Texas. Many more injuries are expected to be reported. The crowd included 50,000 attendees.

What is another word or term for crowd surge?
Stampede

What did the eye witnesses reveal?
Houston Police Executive Assistant Chief Larry Satterwhite, who was near the front of the crowd, said the surge happened all at once.

Questions that need to be answered.

Were several people down on the ground because of the stampede or something else?

What exactly did you see relevant to this incident at 9 PM on Friday, November 5, 2021, in Houston, Texas?

What exactly went wrong?

8 individuals died: Is that correct?

Was cardiopulmonary resuscitation done for all 8 individuals on the spot?

Who exactly administered cardiopulmonary resuscitation for the 8 people who later died?

How long was the cardiopulmonary resuscitation continued?

Did they have any type of cardiopulmonary certification or any medical experience?

How could this tragedy have been prevented?

Before allowing this gathering of 50,000 people to happen, did anyone determine whether it was safe to do so?

Coma
How many causes of a coma are there?
At least 47.
You have to correlate the causes of a coma and the causes of reversible cardiopulmonary arrest.

How many reversible causes of cardiopulmonary arrest are there?
At least 14.

The treatment is to fix the underlying cause.

Are there any differences between cardiac arrest and a coma?
Yes.

Cardiac arrest: What are the symptoms?
Sudden collapse
No pulse
No breathing
Loss of consciousness

Sometimes other signs and symptoms occur before sudden cardiac arrest. These might include:
Chest discomfort
Shortness of breath
Weakness
Palpitations

In a coma, the individual has a pulse and is breathing.
In a coma, the individual cannot engage in spontaneous eye opening, talking, or walking.

What are the reversible causes of cardiac arrest?
Hypoxia
Hypovolemia
Hypoglycemia
Hypokalemia
Hypothermia
Hydrogen ion excess (acidosis)
Hyperkalemia
Tamponade—cardiac
Tension pneumothorax
Toxins
Thrombosis (pulmonary embolus)
Thrombosis (myocardial infarction)
Trauma
Tachycardia ventricular. Pulseless cardiac arrest, including PEA, asystole, ventricular fibrillation, and ventricular tachycardia. The treatment for pulseless ventricular fibrillation and ventricular tachycardia is defibrillation.

Many different disease processes and traumatic events can cause cardiac arrest, but in an emergency, it is important to be able to rapidly consider and eliminate or treat the most typical causes of cardiac arrest. To facilitate remembering the main, reversible causes of cardiac arrest, they can be organized as the Hs and the Ts.

The Hs Symptoms/Signs/Tests Intervention
Hypovolemia Rapid heart rate, narrow QRS complex, Fluid resuscitation
Hypoxia Decreased heart rate Airway management, oxygen
Hydrogen Ion
(Acidosis)
Decreased heart rate Airway management, oxygen
Hypoglycemia Fingerstick glucose testing IV Dextrose
Hypokalemia Flat T waves, pathological U wave IV Magnesium
Hyperkalemia Peaked T waves, wide QRS complex Calcium chloride, sodium bicarb,
insulin/glucose, hemodialysis
Hypothermia History of cold exposure Rewarming blankets/fluids
The Ts Symptoms/Signs/Tests Intervention
Tension Pneumothorax Slow heart rate, narrow QRS complex, acute dyspnea, history of chest trauma Thoracotomy, needle
decompression
Tamponade (Cardiac) Rapid heart rate and narrow QRS complex Pericardiocentesis
Toxins Variable, prolonged QT interval, neuro deficits Antidote/antivenom (toxin-specific)
Thrombosis (pulmonary) Rapid heart rate, narrow QRS complex Fibrinolytics, embolectomy
Thrombosis (coronary) ST segment elevation/depression, abnormal T waves Fibrinolytics, Percutaneous intervention
What should happen on or after April 10, 2020, relevant to these issues?
I/we should not wait until a patient dies and then ask the medical examiners office to determine the causes/circumstances of death.

Intervention should happen before the death of the patient.

When should the intervention relevant to such a patient happen?
As soon as the patient goes into coma and before death.

All governors and state department of public health directors must alert all medical emergency and critical care units about these facts.
As soon as a patient goes into a coma, the state should display the patient’s profile and facts on the Internet.
The state department of public health should display a list of coma patients.

On or after April 11, 2020, make this an emergency public health law.
When a patient goes into a coma, his/her profile with answers to these questions must be displayed on the Internet.

For example:
Illinois coma patient list with date and time of circulation.
New York coma patient list with date and time of circulation.
California coma patient list with date and time of circulation.

Spain coma patient list.
Italy coma patient list.

Wuhan coma patient list

Kashmir coma patient list.

Similar entities.

Patients are dying from causes and circumstances other than the coronavirus.

Doctor Asif Qureshi will provide further emergency medicine doctor guidelines and critical care doctor guidelines on the Internet.

The facts must be updated 24/7 on the Internet.

If video conferencing is possible, it should be displayed.

What should be displayed on the Internet?

Questions you need to answer on the Internet.

What was the date and time circumstances when the patient went into a coma?

What is the name of the patient?

What is the date of birth of the patient?

What is the name of the treating doctor seeing the patient every day, face to face and in person?

What is the name(s) of the nurse(s) who see the patient every day?

At what location is this patient receiving treatment?

What is the patient’s medical history of the main medical problem, from first emergence until now?

What other medical issues does the patient have?

What are the patient’s vitals, including date, time, and location?

What are the last known and previous pulse oximetry blood oxygen saturation results?

What are the last known and previous blood biochemistry results of the patient?

What is the diagnosis?

What is the treatment?

What should be included in a review of the diagnosis?

What should be included in a review of the treatment?

In what situations is a directive like "Do not Resuscitate" justified?
Old age more than 95 years with known complications.

When should you start on-the-spot cardiopulmonary resuscitation?

When should you start on-the-spot cardiopulmonary resuscitation?

Was the patient alive a few minutes before?
Is there a few minutes history of injury?
Is there no pulse, breath movement, or heart sounds?
Are there no signs of rigor mortis?
Are extremities of victim warm like a living human being?

If yes, start cardiopulmonary resuscitation.

Before you begin

Before starting CPR, check:
•Is the person conscious or unconscious?
•If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"

•If the person doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911 or the local emergency number.
•If an AED is immediately available, deliver one shock if instructed by the device, then begin CPR.

Compressions: Restore blood circulation
1.Put the person on his or her back on a firm surface.
2.Kneel next to the person's neck and shoulders.
3.Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.
4.Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters). Push hard at a rate of about 100 compressions a minute.
5.If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to checking the airway and rescue breathing.

Airway: Clear the airway

1.If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.
2.Check for normal breathing, taking no more than five or 10 seconds. Look for chest motion, listen for normal breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth breathing and continue chest compressions.

Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

1.With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.
2.Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle.
3.Resume chest compressions to restore circulation.
4.If the person has not begun moving after five cycles (about two minutes) and an automated external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use. If an AED isn't available, go to step 5 below.
5.Continue CPR until there are signs of movement or emergency medical personnel take over.

To perform CPR on a child

The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:
•If you're alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number or using an AED.
•Use only one hand to perform chest compressions.
•Breathe more gently.
•Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths.
•After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available, for children ages 1 through 8. If pediatric pads aren't available, use adult pads. Do not use an AED for children younger than age 1. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use.

Continue until the child moves or help arrives.

To perform CPR on a baby

Most cardiac arrests in babies occur from lack of oxygen, such as 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.

To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don't shake the baby.

If there's no response, follow the CAB procedures below and time the call for help as follows: •If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number.
•If another person is available, have that person call for help immediately while you attend to the baby.

Compressions: Restore blood circulation

1.Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do. 2.Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.

3.Gently compress the chest about 1.5 inches (about 4 centimeters). 4.Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of 100 compressions a minute.

Airway: Clear the airway
1.After 30 compressions, gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.
2.In 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.

Breathing: Breathe for the baby

1.Cover the baby's mouth and nose with your mouth.

2.Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
3.If the baby's chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If an object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking baby. 4.Give two breaths after every 30 chest compressions.
5.Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.
6.Continue CPR until you see signs of life or until medical personnel arrive.

ACLS

In the in-hospital setting or when a paramedic or other advanced provider is present, ACLS guidelines call for a more robust approach to treatment of cardiac arrest, including the following:

• Drug interventions
• ECG monitoring
• Defibrillation
• Invasive airway procedures

Unconscious patient.

What type of patient needs basic life support?
An unconscious patient.

Do all unconscious patients need cardiopulmonary resuscitation?
No.

How should you evaluate and treat an unconscious patient?
Assessment is very important.
Not all unconscious patients need cardiopulmonary resuscitation.
For adults, assess the victim, activate EMS and get AED, check pulse, start CPR.

When do you start cardiopulmonary resuscitation in adults?
CPR is required someone's breathing or heartbeat has stopped, as in cases of electric shock, drowning, or heart attack. CPR is a lifesaving procedure in this situation.

What is cardiopulmonary resuscitation?
Cardiopulmonary resuscitation is a combination of rescue breathing and chest compressions.
Rescue breathing provides oxygen to a person's lungs.
Chest compressions keep the person's blood circulating.
Permanent brain damage or death can occur within minutes if a person's blood flow stops. Therefore, you must continue these procedures until the person's heartbeat and breathing return, or trained medical help arrives.

In what situations is a directive like "Do not Resuscitate" justified?
Old age more than 95 years with known complications.

What is unconsciousness?
Unconsciousness means being unable to see, hear, and talk.
Often, this is called a coma or being in a comatose condition.
An unconsciousness person will be unresponsive to activity, touch, sound, or other stimulation.
He or she will not be able to communicate and won’t respond to stimulation.

Conscious means able to see, hear, and talk.
In pediatric patients younger than six months of age, the ability to make any verbal noise or cry is equivalent to talking.

A person may be unconscious for a few seconds (as is the case with fainting) or for longer periods of time.

What are the causes of unconsciousness?
Alcohol use.
Drowning.
Electric shock
Substance abuse
Severe blood loss
8 H's and 6 T's: mnemonic for mechanisms
Hypoxia
Hypovolemia
Hyperkalemia
Hypokalemia
Hypoglycemia
Hypothermia
Hyperthermia (heat stroke)
Hydrogen ions (acidosis)
Thrombosis (MI/heart attack)
Tension pneumothorax
Tamponade
Toxins/therapeutics
Thromboembolism
Trauma

What is the difference between being asleep and being unconscious?
Being asleep is not the same thing as being unconscious.
A sleeping person will respond to loud noises or gentle shaking; an unconscious person will not.

An unconscious person cannot cough or clear his or her throat. This can lead to death if the airway becomes blocked.

Is there a difference between unconsciousness and cardiopulmonary arrest?
Yes.

What is the difference between unconsciousness and cardio pulmonary arrest?
Unconsciousness is usually without cardiac arrest.
If unconsciousness is associated with cardiac arrest or respiratory arrest, cardiopulmonary resuscitation is required.

When should you start an on-the-spot intravenous line?
If there is blood loss with hypotension.
In case of cardiopulmonary arrest.
Here are further guidelines.
Last Updated: November 7, 2021