Human lives may be saved if they are given timely and effective cardiopulmonary resuscitation (CPR), early defibrillation and post-resuscitation care after their heart stops beating or they stop breathing. This may be due to various circumstances such as heart attacks, choking or suffocation, sustained trauma from traffic accidents, near-drowning episodes, toxin poisoning, drug overdose, smoke inhalation, shock, hypothermia, electrolyte imbalances or electrocution.
Step 1: Get bystander help and call 112 for medical assistance
First, always ensure to check the surrounding environment for hazards that could also put you in danger, such as moving traffic, fire or falling rocks. Next, check the victim to determine if they are in need of immediate help. Tap on their shoulders and shout: “Are you OK?”. If they are not responding, ask a bystander to call for an ambulance via 112, and if possible, to search for an automated external defibrillator (AED). Download the app ‘AED Malta’ to help you locate any nearby devices in Malta and Gozo.
Step 2: Place the victim on their back and open their airway
Gently place the victim on their back on a firm, flat surface, and if no obvious cervical spine injuries are present, opt to tilt the head back slightly by lifting the chin. Then, open the mouth, check and remove any visible obstruction, such as food, foreign body particles or vomit.
Step 3: Check for breathing, and if trained, also check for a pulse
Kneel down as close as possible to the victim, place your ears next the victim’s mouth in order to listen for breathing and observe for any chest rise for no more than 10 seconds. If you are trained to do so, feel for a central pulse in the neck.
If you do not hear any breathing or only hear occasional, agonal gasps or feel no central pulse, it is time to begin CPR.
It is vitally important to only perform CPR if a person is not breathing and their blood circulation has stopped. Thus, if the victim is unconscious but is still breathing, there is no need to perform CPR at this stage. Instead, if they do not have an obvious spinal injury, opt to place the victim on their side in the recovery position and keep monitoring for any deterioration.
Download the app ‘AED Malta’ to help you locate any nearby devices in Malta and Gozo
Step 4: Perform 30 chest compressions
Place your hands on top of the other and clasp them together. With the heel of the hands and straight elbows, push down on the centre of the chest; at least 5cm to 6cm deep and at a rate of approximately 100 to 120 times per minute, while allowing the victim’s chest recoil fully in between compressions. This will ensure that blood circulation will reach the victim’s brain while unconscious. Of note, if there are other rescuer bystanders present, you can opt to rotate positions every two minutes to prevent providing ineffective chest compressions, due to the rescuer tiring.
Step 5: Perform two rescue breaths
If present, put on a mouth-to-face shield, tilt the victim’s head back slightly and lift the chin. Pinch the nose shut, place your mouth fully over theirs and blow two times to make their chest rise. If their chest does not rise with the first breath, re-tilt their head and reattempt the rescue breathing.
Due to COVID-19 or other hygienic issues, one can also opt to provide chest compressions-only CPR.
Step 6: Repeat this 30:2 CPR cycle, until the victim shows signs of life, an AED or an ambulance arrives
Repeat this CPR cycle of 30 chest compressions and two rescue breaths until the victim starts breathing or return of spontaneous circulation occurs, or if further medical assistance arrives on the scene.
Moreover, if an AED is available, carry on performing CPR and do not interrupt chest compressions until the AED is fully set up and ready to use.
Step 7: Using an automated external defibrillator
The use of an AED during CPR permits the analysis of the victim’s heart rhythm and, if necessary, it will deliver an electrical shock to the heart to help re-establish a viable rhythm.
Thus, once available, turn on the AED and follow the easy-to-use visual or audio instructions. Then open the victim’s shirt and wipe the bare chest dry. Attach the two AED pads in their designated places; one beneath the right clavicle and the other one beneath the left nipple. Prior to delivering a shock, make sure that no one is touching the victim and that the victim is not in a puddle of water. Then, allow the AED to analyse the heart rhythm, and if a shock is indicated, advise everyone to stand clear of the victim prior to delivering the shock. Then press the ‘shock’ button, and resume CPR as soon as the shock is delivered. If no shock is advised, continue CPR in two-minute cycles and continue to follow the AED’s prompts.
Here are links to view two short CPR video demonstrations, and the use of an AED:
https://youtu.be/n7kqiAu2gC8 https://youtu.be/fb29LCjX4-E
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Georgiana Farrugia Bonnici, Medical doctor