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What we are going to talk about now is cardiopulmonary resuscitation. What we are trying to achieve by doing CPR and the intended outcome. When a patient goes into a cardiac arrest, the heart stops. Normally, in an adult, it will beat somewhere between 60 and 100 beats per minute. But various things can cause that to stop, a heart attack being one. We must quickly recognise that the heart has stopped and replicated the function of the heart to maintain cerebral perfusion. That is to say, we need to pump oxygen via the bloodstream through to the brain. We do this by pressing on the patient's chest. Our intention is to squeeze the heart between the sternum and the spinal column, which are two solid structures; the heart being a hollow structure, with valves in that will only allow blood to flow through in one direction. Now, as much as we would like to replicate the normal function of the heart, we can only do that to a certain amount of efficiency. It is important that we use a correct technique, using the correct speed and the correct depth to maximize the amount of cerebral perfusion that we can achieve by artificial methods.

When a patient goes into a cardiac arrest, often the first thing that we will notice is they will appear to have a... Something that looks like a small seizure. They may make incomprehensible sounds. The eyes may well be open at this stage, but very quickly, the perfusion through to the brain will drop and the patient will become unconscious. Breathing may continue for a few minutes after the initial cardiac arrest; it will not be a normal pattern of breathing it will something more akin to agonal gasps, which is just the occasional gasp of air. And often, the rescuer will misinterpret this for breathing. When we suspect that a patient has gone into a cardiac arrest we must first confirm that the patient is unresponsive and not breathing normally. In order to do that, we would start off by shaking our patient and applying some stimuli. And also a verb... See if we can get a verbal response: "Hello. Hello, can you hear me?" If the patient does not respond, we must then check inside the airway, see if there is any obstruction in there and if it is safe to do so, using a head tilt, chin lift method, tilt the head back and feel for respirations and the pulse at the same time whilst listening for any air movement.

We do this for up to 10 seconds. If the patient is unresponsive and not breathing normally that is our cue to start chest compressions. Expose the patient's chest, identify the lower half of the sternum, interlock our fingers and begin. Okay, it is important, when we start chest compressions, that we are in a suitable position to be able to compress the patient's chest adequately and at the right rate. As we can see in this scenario, I am not in the ideal position and I quickly begin to tire. In order to be able to get into the ideal position, I am gonna lower the stretcher. It is important to be able to get into the correct position to carry out just compressions, so we can do it effectively. It is difficult to compress a patient's chest five to six centimetres for any length of time and we will quickly tire. But the further you are over the top of the patient and the more your body weight is used to compress the chest the more efficient you will be able to do it for longer.

I am just going to demonstrate how you would do 30 compressions at a rate of 100 to 120 per minute. Identify the chest, interlock the fingers... Following 30 compressions, we then need to consider ventilating the patient's lungs. It is not essential to do this, particularly with an adult cardiac arrest, as when the patient goes into an arrest, the body is generally flooded with oxygen anyway and the arrest in the adult is quite sudden. We can circulate the blood and the haemoglobin and the oxygen around the body for quite... For up to about six minutes before it starts to become ineffective. If you have a bag-mask or a face mask, we can replicate the functions of the lung by giving two inflations after the 30 compressions. And then immediately back to chest compressions. In a single-rescuer scenario like this, it is easy to see how quickly you will become tired and how less efficient your chest compressions will become. But you must not stop. For every compression that we do, we build up the blood pressure and the perfusion pressure inside the body. As soon as we stop doing those chest compressions, the perfusion pressure drops and the brain is no longer perfused. If you are on your own doing CPR, make sure that you have called for help. In a hospital setting, call the crash team and continue doing CPR at a rate of 30 compressions to two inflations until help arrives.