Basic resuscitation procedures

CPR is performed on a person who is unconscious (unresponsive), not breathing or he is not breathing normally and he is not moving. If the affected person makes occasional ineffective attempts to “catch” his breath, we must suspect that cardiac arrest has occurred and begin CPR.

Signs such as the color and temperature of the skin and the width of the pupils can mislead us and represent parallel signs of cardiac arrest.

Basic resuscitation procedures include early recognition of conditions that can quickly lead to sudden death, calling tel. 112, performing external heart massage and artificial respiration, using an automatic defibrillator, and taking action in case of airway obstruction by a foreigner. The instructions below are for adults.

CPR steps

1. We ensure the safety of the rescuer and the victim.

2. Assess the state of consciousness - gently shake the victim’s shoulders and ask loudly: “Are you okay?”

3. A) If he answers the question whether he moves:

• leave it in its existing position (if there is no danger from the surrounding area);

• we ask what happened and how he feels, if necessary we call him on tel. 112;

• we check the condition of the affected person at regular intervals.

3. B) If the victim is NOT responding:

• we try to call for help, loudly exclaiming “Help!”;

• turn him on his back and open the upper part of his clothes;

• relax the airway by tilting the head back and raising the chin;

• place the palm on the forehead and roll the head with pressure;

• lift the chin with the tips of two fingers, avoiding pressure on the soft parts of the neck;

• only visible foreign objects are removed from the oral cavity (including ill-fitting dentures).

4. We make sure that the airway is free and determine the presence of normal breathing:

• we observe the movement of the chest;

• breathing noises are heard at the mouth;

• we try to feel the exhaled air of the affected person on our face;

• observe, listen and feel for up to 10 seconds before deciding that the affected person is not breathing or not breathing normally; if in doubt, act as if he is NOT breathing.

5. A) If the affected person breathes normally (not just individual breaths):

• place him in the unconscious position (NOT if spinal injury is suspected, see below);

• call on tel. 112 or send someone for help while monitoring breathing.

5. B) If the affected person is NOT breathing or not breathing normally:

• call the EMS service on tel. 112 and obtain an automatic defibrillator if it is located nearby;

• if there are more rescuers: we send someone to call;

• if we are alone: leave the affected person for the duration of the call;

• use an automatic defibrillator as soon as it is available;

• we start with an external heart massage;

• kneel on the side of the affected person;

• place the palm of the dominant hand in the middle of the chest;

• place the palm of the other hand over the first hand and interlace the fingers so as not to press on the adjacent ribs;

• lean over the affected person and with outstretched elbows press perpendicularly on the chest, so that it gives in by 4-5 cm;

• release the pressure, but do not move the hands away from the chest and press again;

• we try to spend the same amount of time pressing on the chest and releasing the pressure;

• perform 30 chest compressions;

• during the massage we can count out loud to ensure the necessary frequency of the massage, which is 100 compressions/min (ie slightly less than 2 compressions per second).

6. A) We combine external heart massage with artificial respiration:

• after 30 chest compressions, give 2 artificial breaths;

• artificial respiration technique: release the airway by tilting the head back and raising the chin;

• squeeze the soft part of the nose with the thumb and forefinger of the hand on the forehead;

• open your mouth slightly and raise your chin at the same time;

• inhale normally and embrace the affected person’s lips so that they seal well;

• evenly blow air into the affected person’s mouth and observe the rise of the chest, the inhalation should last 1 second (the amount of air blown in should be approximately 0.5-0.6 liters or enough to see a visible rise of the chest);

• we move our mouths away, maintain a free airway and observe the descent of the chest;

• inhale normally again and perform the second inhalation, the same as the first;

• if a cervical spine injury is suspected, the airway is opened with the already described adapted triple maneuver, and artificial respiration is administered by pinching the nose with the edges of both palms next to the thumbs.

NOTE: If after the first inhalation the victim’s chest does not rise as it does during normal breathing, before the second inhalation check:

• is the head moved back enough and the chin raised enough;

• the oral cavity and remove any visible obstruction;

• if the second breath was also unsuccessful, continue with external heart massage.

6. B) We continue with external heart massage and artificial respiration (in a ratio of 30:2):

• external heart massage and artificial respiration in a ratio of 30:2 are performed continuously until:

• the EMS service does not come,

• the affected person does not start breathing normally,

• we are physically capable,

• if there is no automatic defibrillator available, then proceed according to the defibrillator’s instructions.

NOTE: Doing CPR properly is very tiring. If several laypeople are present, each performs CPR for 1-2 minutes. CPR in a pair can only be performed by 2 trained paramedics, otherwise laypersons in a pair are NOT resuscitated. The first rescuer should provide artificial respiration and check for signs of life, while the second should perform external cardiac massage. The ratio between external heart massage and artificial respiration is always 30:2 if one or two rescuers are resuscitating.

6. C) CPR with external heart massage only:

• if breathing of the affected person is not possible (extensive facial damage, poisons, poor sealing, inability to open the mouth) or in the case of subjective reservations about artificial respiration, we can only perform external heart massage with a frequency of 100 compressions/minute;

• maintaining a free airway during external heart massage enables at least partial air exchange in the lungs;

• the described method of CPR is acceptable for laymen, but not for trained rescuers, as there are many devices available that protect against the transmission of infection during artificial respiration.