European Resuscitation Council Guidelines for Resuscitation 2010 ...

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1280 R.W. Koster et al. / Resuscitation 81 (2010) 1277–1292 Fig. 2.7. Place the heel of one hand in the centre of the victim’s chest. Fig. 2.5. Head tilt and chin lift. • start chest compression as follows: ◦ kneel by the side of the victim; ◦ place the heel of one hand in the centre of the victim’s chest; (which is the lower half of the victim’s breastbone (sternum)) (Fig. 2.7); ◦ place the heel of your other hand on top of the first hand (Fig. 2.8); ◦ interlock the fingers of your hands and ensure that pressure is not applied over the victim’s ribs. Keep your arms straight (Fig. 2.9). Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone); ◦ position yourself vertically above the victim’s chest and press down on the sternum at least 5 cm (but not exceeding 6cm)(Fig. 2.10); ◦ after each compression, release all the pressure on the chest without losing contact between your hands and the sternum; repeat at a rate of at least 100 min −1 (but not exceeding 120 min −1 ); ◦ compression and release should take equal amounts of time. 6a. Combine chest compression with rescue breaths. • After 30 compressions open the airway again using head tilt and chin lift (Fig. 2.5). • Pinch the soft part of the nose closed, using the index finger and thumb of your hand on the forehead. • Allow the mouth to open, but maintain chin lift. • Take a normal breath and place your lips around his mouth, making sure that you have a good seal. • Blow steadily into the mouth while watching for the chest to rise (Fig. 2.11), taking about 1 s as in normal breathing; this is an effective rescue breath. • Maintaining head tilt and chin lift, take your mouth away from the victim and watch for the chest to fall as air comes out (Fig. 2.12). • Take another normal breath and blow into the victim’s mouth once more to achieve a total of two effective rescue breaths. The two breaths should not take more than 5 s in all. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions. • Continue with chest compressions and rescue breaths in a ratio of 30:2. • Stop to recheck the victim only if he starts to wake up: to move, open eyes and to breathe normally. Otherwise, do not interrupt resuscitation. Fig. 2.6. Look, listen and feel for normal breathing. Fig. 2.8. Place the heel of your other hand on top of the first hand.
R.W. Koster et al. / Resuscitation 81 (2010) 1277–1292 1281 Fig. 2.9. Interlock the fingers of your hands. Keep your arms straight. If your initial rescue breath does not make the chest rise as in normal breathing, then before your next attempt: • look into the victim’s mouth and remove any obstruction; • recheck that there is adequate head tilt and chin lift; • do not attempt more than two breaths each time before returning to chest compressions. If there is more than one rescuer present, another rescuer should take over delivering CPR every 2 min to prevent fatigue. Ensure that interruption of chest compressions is minimal during the changeover of rescuers. For this purpose, and to count 30 compressions at the required rate, it may be helpful for the rescuer performing chest compressions to count out loud. Experienced rescuers could do combined two-rescuer CPR and in that situation they should exchange roles/places every 2 min. 6b. Chest-compression-only CPR may be used as follows: • If you are not trained, or are unwilling to give rescue breaths, give chest compressions only. • If only chest compressions are given, these should be continuous, at a rate of at least 100 min −1 (but not exceeding 120 min −1 ). 7. Do not interrupt resuscitation until: • professional help arrives and takes over; or • the victim starts to wake up: to move, open eyes and to breathe normally; or • you become exhausted. Fig. 2.10. Press down on the sternum at least 5 cm. movement. 49 Therefore, the lay rescuer should open the airway using a head-tilt-chin-lift manoeuvre for both injured and noninjured victims. Recognition of cardiorespiratory arrest Checking the carotid pulse (or any other pulse) is an inaccurate method of confirming the presence or absence of circulation, both for lay rescuers and for professionals. 50–52 There is, however, no evidence that checking for movement, breathing or coughing (“signs of a circulation”) is diagnostically superior. Healthcare Opening the airway The jaw thrust is not recommended for lay rescuers because it is difficult to learn and perform and may itself cause spinal Fig. 2.11. Blow steadily into his mouth whilst watching for his chest to rise.
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