CARDIOPULMONARY ARREST IN ACCIDENT & TRAUMA AND CPR

What is cardiopulmonary arrest?

Cardio (means the Heart) and Pulmonary (means Lung) cannot do their functions. The result is “stop heart beating and breathing suddenly and fall down” is so called Arrest.

What are accident and trauma?

1. Car crush (e.g., hit by car, head on collision means a crash of two vehicles that are moving directly toward each other. And the car hit the objects while driving) etc.
2. Fall from a height (e.g., fall from high building or tree)
3. Being Attacked by weapons (such as knife, Guns, etc.)
4. Fire injuries
5. Bomb blast injuries

What happened when the people faced above accidents?

In car crash, the patient can suffer from broken bones, head injury, neck injury, muscle injury or wounds, etc. If the patient is stabbed by knife or hit by bullet to his chest or abdomen, it may get lung problem such as Hemothorax (the chest filled with blood), pneumothorax (the chest is filled with unnecessary air and his lung is pressed) or his main blood vessels or abdominal organs may be severely injured. (You can read more about Hemothorax and pneumothorax at the article of “the physical and psychological effects of war“)

In fire injuries, the patient can suffer from burns and breathing problem due to its smoke. The patient cannot breath due to lower oxygen in his surroundings.

In Bomb blast injuries, the patient can suffer above all kinds of problems mentioned above and can be more dangerous or worst conditions. And also, partial loss of parts of limbs) due to injury.

Is the accident can be fetal or cardiac arrest?

It may depend on how severe the injuries were. A lot of injuries and the major vital organs damage can lead to death. Loss of too many bloods can cause shock, breath smoke can cause coma (loss of conscious due to poor oxygen level in brain) and also get shock due to pain or head injury.

Finally, if the patient is cardiac arrest, what would you like to do?

Cardiopulmonary Resuscitation

It is a team work job. So first of all, shout for help and call for ambulance.

Talk to the patient and check the environment.

The patient cannot response back and now we need to carry the unconscious patient to a safe place. Because the patient may fall down in unsafe or dangerous area. If you don’t think this step, you will become a next patient, too.

Check the patient’s carotid pulsation.

Place your index (pointing) and middle (long) fingers on patient’s neck to the side of her windpipe or when your two fingers place under her jaw. Be aware of not to place in both side of neck because you can block the vessels which supply blood to the brain.

Access whether patient is breathing by look, listen and feel. (Breathing)

You should kneel right side of the patient (prepare comfortably yourself). If there is any foreign bodies/objects or blood clot can block the airway (mouth and nose), they must be taken out carefully from the mouth and nose. But never blind swab or remove foreign bodies from mouth or nose because this action may worse the conditions. So. look carefully before removal.

Place your pointing finger and long finger under the patient’s chin and lift it up to open the airway. Now, you can look the patient chest whether it move up and down, you can listen the patient’s breath by your breath by your ear and you can feel the air in and out of patient’s breathe by your cheek.

If the patient stop pulsation and breathing, CPR (Cardiopulmonary resuscitation) must be started.

Body position of rescuer …

Stay side of the patient (prefer right side), kneel down, Your knee must be slightly apart each other to more comfort.

Your elbows must be straight. When you press the chess, use your shoulder force. Place your hands over the patient chest (two finger breadth from the end of the bone (sternum, the bone at the middle of the chest) (Not important which hand place above)

Compress 30 times to chest in 1 cycle to beat the heart within the rate of 100 to 120 per minute. Press down at least 1/3 depth (2 inches) of the chest to give enough force to beat again. In chest compressing, be aware of too shallow (not enough compress down) and not lift up your hands fully to previous chest height (at that time, you can be nervous and forget to release the chest fully when you lift up your hand). When you press slowly, it may not be enough rate to beat a heart. When you press too fast, you will be tired within 2 mins.

After 30 chest compression, give 2 rescue breaths. (30:2)

Put the patient chin lift up, close his nose tightly with your fingers and place your mouth to cover the patient’s the whole mouth. After you breathe fully, you must slightly put the air into the patient lungs through his mouth.

When you successfully put the air into the lungs, the patient’s chest must be raised (elevated because of enough air entry).

You can use a plastic mask to cover the patient’s mouth to protect yourself when the patient’s mouth is bleeding. (To protect from transmitted diseases via blood such as HIV, Hepatitis B and C, etc.)

You can use a mask if it is available. (If the patient bleed from mouth)

You can cut the Cola bottle to make a temporary mask. But this is not enough to give a full breathe. You should use only in the condition where there is no other options-mask or plastic bags when the mouth of the patient is continuously bleeding.

To prevent Hypothermia (reduce body temperature)

Cover the patient with tower or blanket to prevent heat loss from his body. Because  hypothermia (heat loss) (reduce body temperature) which is lethal usually take place in trauma patients.

When to stop resuscitation?

• when the patient fully gets back his breathing and heart beating. Then you should continue to open his airway by lift his chin up and cover the patient with tower or blanket to prevent heat loss from his body.
• when another trained doctors or nurses or trained person or ambulance reach and take over the case, you should hand over the case and continue to help them.
• when you are too tired to continue CPR.
• the scene or environment becomes unsafe or dangerous conditions such as explosive risks.
• Although the victim’s brain is severely damaged due to lack of oxygen for 9 mins, his brain functions is unlikely to return and he may get brain coma. But you can stop resuscitation after 20 mins of resuscitation is a fair enough, because the longest time to recover from arrest is 20 mins. (there is only one patient who get back fully after cardio-pulmonary arrest for 20 mins)

You should not do CPR followings conditions.

• if the patient is severely injured and unconscious. e.g., The body is torn apart from waist in bomb blast, or gun shot to head and neck. (Death is certain for these conditions)
• if there are too many victims and you have to choose the right patients to help (the number of victims is more than rescuers)
• during war, when the environment is unsafe.
• In hospital setting, if the patient signs the DNR (don not resuscitate, means he does not allow to do CPRR when he gets arrest by any cause) and if the patient with terminal illness such as cancer get arrest by any cause. (Usually they sign DNR)

Thank you very much for reading. This is about the CPR, and you can continue learning by searching in YouTube. CPR training is important and advice to train. You can give comments if you want to know or discuss something about CPR.

Any advice is welcome. Sharing is caring. Sharing CPR method can save your life.

Give some ideas for next topic in comments.

Author – Linkar Dipa