Category: CPR

Almost everyone has heard of CPR – it’s been taught in schools, shown in television shows, used as seminar topics in company events, and has basically been in every media platform in the form of videos and educational posts. All for a very important reason, too: it literally saves lives.

Except when you’re actually in a spontaneous, life-and-death situation, and all you have is a recent video you’ve watched of a man repeatedly pushing an unconscious person’s chest, with little to no professional knowledge on CPR – chances are you’d probably just call 911. But life waits for nobody. Whether it’s just a random person passing by or one of your loved ones, you should be the person to take the wheel and save a life.

Taking classes and getting a CPR certification, for example, can get you prepared and amp up your confidence. And if you’re in Chicago, then that wouldn’t be a problem. CPR Associates, Inc. will guide you through everything you need to know about first aid and ‘saving a heart’.

When and How to Do CPR

When you happen to pass by a stranger inconveniently lying down, probably unconscious and in need of help, then act. Don’t be one of those people who stand by and wait for somebody else to get on the scene. BE that somebody because every second counts. Especially if you have a CPR certification – put it to good use.

Also, CPR isn’t immediately doing chest compressions on an unconscious person. There are a series of steps you need to take to perform it in a proper manner:

1. Observe your surroundings. If you’re in the middle of a busy street, then it’s best to move to another area. Try to find out why the person ended up like that, too (did they get injured? or are they simply drunk?).
2. Gently shake the person or get them to respond. If they are conscious, then there’s no need to do compressions (at least ask them what happened and call an ambulance). If not, call 911 and start the first aid.
3. Check for signs of breathing by tilting their head back and listening/feeling if they are breathing properly. Occasional gasping or grunting noises do not count as normal breathing, and you need to quickly perform CPR.
4. Position yourself beside the person and place your hand (specifically the heel) on the center of the chest, just below the breastbone. Then place your other hand on top and interlock your fingers, all while keeping your arms straight and your shoulders directly above the chest.
5. Press down at a depth of about 2 inches (or depending on the person’s chest depth) and repeat 30 times at a rate of 100 compressions per minute, or until paramedics arrive.

During cardiac arrests though, studies have shown that it’s better to perform hands-only CPR for a higher chance of survival to increase blood pressure and flow to the brain.

What you’ve read is just the tip of the iceberg in performing CPR, as there are still tons to know in terms of techniques in other situations. This is where we come in. CPR Associates is dedicated to providing this knowledge and proper training as a certified training center of the American Heart Association in Chicago communities. We offer CPR training, certification, and even online classes to ensure that our trainees are well-equipped to handle emergency situations not just in Chicago, but in everywhere they travel.

Dedicated to having quality and advanced education and skills, we aim to be not only a renowned and trusted center for health education, but to also spread awareness on how important knowing CPR is and to, essentially, save more people’s lives.

Emergency cannot be predicted. An emergency situation can occur anywhere. As a personal trainer you should have cpr/aed and first aid knowledge because when clients are working with weights and machine we can never predict anything and we don’t even know complete health situation of a client. Client who looks healthy can have any kind of cardiac problems or something else. Almost everyone will be involved in a health issue at some point in their lives. Someone slips falls and can’t get up. Someone cuts themselves by mistake and can’t stop bleeding. Another client’s heart fails all of a sudden. Anything might happen. Knowing what to do in these situations can make the difference between someone living or non living, between a temporary or permanent disability. This is where a trainer with knowledge of cpr/aed and first aid can save their life risk. CPR/AED and First aid are two different things. Lets us see how both helps in emergency case.

First aid is classified in three critical issues.

• Airway, making sure that the client can breathe
• Blood, making sure the client is not going to bleed to death
• Cardio, making sure the client’s heart is beating

It is known as ABC of First aid.

Beyond that first aid is about making sure client has got some injuries. Making client comfortable if he or she has some injuries by putting alcohol and a bandage on wound.

Even someone who appears fit might have a health issues that can lead to a heart attack or cardiac arrest. When you see such situation you have to call doctor as soon as possible but till doctor reach destination it might be too late. This is where you give CPR/AED.

CPR Performed

• Make sure the patient is lying straight on his back on a firm surface. Kneel beside him and place your hand on the center of the chest.
• Keeping your arms straight cover the first hand your other hand and interlock the fingers of both hands together. Keep your fingers raised so they do not touch the client’s chest or rib cage.
• Lean forward so that your shoulders are directly over the client’s chest and press down on the chest about two inches. Release the pressure, but not your hands, and let the chest come back up and repeat same again.
• Move to the client’s head. Tilt his head up wards and lift his chin to open the airway again. Let his mouth fall open slightly.
• Pinch the nostrils closed with the hand that was on the forehead and support the client’s chin with your other hand. Take a normal breath, put your mouth over the client’s, and blow until you can see his chest rise.
• Place your hands on the chest again and repeat the cycle of chest compressions

AED Performed

• Turn on the AED and follow the visual or audio prompts.
• Open the client’s shirt and wipe his or her bare chest dry. If the client is wearing any medication patches, you should use a gloved to remove the patches before wiping the client’s chest.
• Attach the pads available in AED, and plug in the connector. Make sure no one is including you is touching the client. Tell everyone to stand clear.
• Push the analyze button and allow the AED to analyze the client’s heart rhythm.
• If the AED recommends that you deliver a shock to the client, make sure that no one, including you, is touching the client and tell everyone to stand clear. Once clear press the shock button.
• Begin CPR after delivering the shock if no signs are seen or if no shock is advised by AED begin CPR. Give 2 minutes about 5 cycles of CPR and continue to follow the AED’s prompts. If you notice any signs of life, discontinue CPR and monitor breathing for any changes in condition.

In the UK in 2018, 30,829 patients were treated during an out of hospital cardiac arrest (OOHCA), with 29.4% admitted to hospital with a return of spontaneous circulation (ROSC) and 9.3% surviving to discharge (Out-of-Hospital Cardiac Arrest Outcomes Registry Epidemiology Report, 2018 p.18). The current RCUK guidance state ‘Provide artificial ventilation as soon as possible in any patient in whom spontaneous ventilation is inadequate or absent’(Resuscitation Council UK ,2015 p.7) but it has been said that the standard ‘Airway Breathing Circulation’ should be replaced with ‘Circulation Airway Breathing’ (Henlin et al., 2014). This essay aims to critically analyse the use of positive pressure ventilation and explore the idea that passive ventilation may provide a superior prognosis for patients in cardiac arrest.

Cardiopulmonary resuscitation (CPR)interruptions can be a major contributor to the consistently poor outcome seen in OOHCA as it results in no circulatory support (Valenzuela et al., 2005) and therefore ‘interruptions to CPR due to advanced airway placement should be avoided’ (Resuscitation Council UK, 2015). Shekerdemian and Bohn (1999) supports positive pressure ventilation by stating that respiratory support is fundamental to maintaining cardiopulmonary function and that the heart and lungs have a close relationship in providing tissue perfusion. Bobrow et al. (2009) found that passive insufflation was superior to positive pressure ventilation in OOHCA patients with an initial ventricular tachycardia or ventricular fibrillation rhythm. This observational study has a degree of bias as it focusses purely on potential cardiac causes of cardiac arrest and dismisses any non-shockable rhythms. However, it could be argued that benefits of passive insufflation or positive pressure ventilation could be more obvious in patients with a potentially cardiac cause of arrest due to the close relationship between the heart and lungs. Bobrow et al. (2018) discuss the result of Miminally Interrupted Cardiac Resuscitation (MICR) training, arguing that a 100% non-rebreather mask and good quality chest compressions was sufficient in providing adequate tissue perfusion. It was found that there was a survival-to-hospital discharge increase from 1.8% to 5.4%. However, due to the change of not using a bag-valve-mask (BVM) during CPR, paramedics involved in the study were permitted to continue using a BVM at a rate of 8 breaths per minute, which threatens this study’s validity. Witnessed cardiac arrests by emergency medical staff were also excluded but witnessed cardiac arrests are more likely to survive when Basic Life Support is administered by paramedics (Vukmir 2004). With this study being conducted in urban Arizona, it lacks external validity and consequently, it is challenging to apply it to paramedic practice in the UK; as per ‘Ambulance Quality Indictators: Clinical Outcomes 2018’ London Ambulance Service had a rate of 8% survival-to-discharge as opposed to the much more rural South East Coast Ambulance Service of 5.7% (NHS England 2018).

NHS Pathways accurately identifies 75.9% of adult cardiac arrests and as a result, call handlers are able to facilitate bystander CPR (Deakin, England and Diffey 2017). Chest compression only CPR is now an integral part of initial by-stander CPR protocol (Cabrini et al. 2010). There is an increased survival rate of patients receiving chest compression only CPR as opposed to standard CPR, consisting of compressions and ventilations, or no bystander CPR at all (Bobrow et al. 2010, Svensson et al. 2010). However, this may be due to members of the public being more willing to start CPR if it involves chest compressions only. Some bystanders admit their reluctance to start standard CPR is due to the concern of contracting disease from mouth-to-mouth contact (Kern et al., 1998). Svensson et al., found no significant difference in survival rates past 30 days between compression only CPR and standardised CPR. It can be inferred that positive pressure ventilation is not paramount to patient survival and that passive insufflation may be sufficient.

‘Several clinical studies of ventilation…during a cardiac arrest have demonstrated respiratory rates far in excess of the 10 per minute recommended by the ERC’ (O’Neill and Deakin, 2007 p.82). Delayed ventilation and the use of passive oxygenation may decrease the risk of hyperventilation during cardiopulmonary resuscitation as it allows less time for the patient to be hyperventilated. Pitts and Kellerman (2004) discovered that paramedics were ventilating at approximately 37 breaths per minute. Ventilations that were supplied at the recommended 12 breaths per minute were more likely to be successfully resuscitated. Ventilations in excess of 20 per minute produced significantly higher mean thoracic pressures and lower coronary perfusion pressures and could be detrimental against patient survival (Pitts and Kellerman 2004, O’Neill and Deakin 2007). While there are ethical implications of using a human sample, the pigs that Pitts et al. use in their study cannot represent the human population due to, while similar, different pulmonary anatomy. Porcine tracheas are longer than humans and more cartilaginous, as well as smaller in diameter (Judge et al. 2014). It can thus be argued that these anatomical differences would have an effect on the sample numbers that survived. Despite further training, paramedics of the Milwaukee Emergency Medical Services were still hyperventilating their patients at 22 breaths per minute (Pitts and Kellerman 2004). Human factors regarding excessive positive pressure ventilation must be acknowledged. ‘The prevalence of hyperventilation during CPR is a consequence of many factors including…the stress and excitement of responding to a cardiac arrest’ (Graham et al., 2015). Heart rate among ambulance staff was found to consistently increase with each emergency call, significantly so when called to acutely unwell children (Karlsson, Niemala and Jonsson 2011). Positive pressure ventilation has an impact on the preload and afterload of the heart and therefore impacting circulation (Lansdorp et al. 2014). Increased intrathoracic pressure and the consequential decrease in blood flow to the right side of the heart reduce cardiac output despite effective chest compressions (Pitts and Kellerman 2004). Pitts and Kellerman (2004) suggest that the increased intrathoracic pressure and the resulting decrease in blood flow to the right atrium was the cause of the failure to achieve ROSC. However, the Resuscitation Council UK (2015) state ‘hyperventilation-induced vasoconstriction may worsen cerebral oxygen delivery’ (Resuscitation Council UK, 2015 p.6). This is paradoxical to Sigurdsson et al. (2003) who consider that ventilation is paramount to refilling the cardiac ventricles and increasing cardiac preload.

Marcy (1993) observes that hyperinflation can cause alveolar rupture, pneumothoraces and other lung trauma. Schulman, Beilin and Olshwang (1987) reveal that intrapleural pressures were twice as high with the use of simultaneous chest compressions and ventilations. Dogs resuscitated using this method were all found to have barotrauma at autopsy. Unfortunately, the CPR techniques in this study are outdated and are not in line with current resuscitation guidelines but the pathophysiology of hyperinflation would not change. Dogs are likely to tolerate different peak inspiratory airway pressures and it can be claimed that they are more susceptible to barotrauma. Despite the high intrathoracic pressures involved in positive pressure ventilation, cases of pulmonary barotrauma are relatively few (Hillman and Albin 1986).

A further by-product of positive pressure ventilation is air entering the stomach, causing gastric distension and increasing the risk of a soiled airway through regurgitation. It can be argued that tracheal intubation avoids gastric insufflation and protects against aspiration (Newell, Grier and Soar, 2018). However, there are concerns regardless of airway device of the risk of aspiration with positive pressure ventilation (Bernardini and Natalini, 2009). Kahzin et al. (2008) discovered that during their randomised study, the frequency of gastric regurgitation was similar in all airway devices using positive pressure ventilation. Therefore, it could be poignant to investigate the use of passive insufflation in current paramedic practice instead. A key component that these scholars fail to acknowledge is the use of oesophageal tubes to relieve the building pressure inside the stomach and prevent gastric regurgitation.

There is a high failure rate amongst paramedics when intubating a patient (Fullerton, Roberts and Wyse, 2009), resulting in delays in chest compressions, which can be seen as a major contributing factor to the continuing high mortality rates in OOHCA (Valenzuela et al. 2005). While these patients are still being ventilated via a BVM, Fullerton, Roberts and Wyse (2009) state that there were failure rates of 15-30% in cardiac arrests where a paramedic attempted to intubate; furthermore, there were no significant differences in failure rates between paramedic and doctor led intubations in OOHCA and therefore the skill level demonstrated in this study is irrelevant when applied to delays in chest compressions due to intubation attempts. Fullerton, Roberts and Wyse (2009) fail to account for human factors such as stress, hierarchy etc. as to why intubation was unsuccessful and chest compressions delay as a result. Seligman et al. (2017) state that loss of airway is a common cause of death among patients, highlighting the importance of having an established airway and therefore, one could argue that it is important to insert an airway as soon as possible. Conversely, both Fullerton Roberts and Wyse and Seligman et al. fail to recognise that each OOHCA job is unique and no other causes of difficult intubation or loss of airway are highlighted. While, passive insufflation removes the need or stress in attempting to insert an advanced airway, alternative methods of advanced airway such as Supra-glottic airways and I Gels, remove the interruption in chest compressions and still provide positive pressure ventilation. Also, inserting an endotracheal tube with continued chest compressions had a minor influence on their effectiveness, and therefore it can be inferred that chest compressions do not need to be stopped in order to intubate (Gatward et al. 2008).

The purpose of positive pressure ventilation is to prevent hypoxia and hypercapnia (Kill et al., 2013). Hypercapnia is associated with higher rates of mortality (del Castillo et al., 2012) and thus ‘ventilation is associated with improved rate of return of spontaneous circulation compared with non-ventilated animals’ (Idris et al., 1995 p.3063). Idris et al. (1995) used a laboratory model of cardiac arrest to look at the effects hypercapnia in pigs. While this is a laboratory model and so is difficult to apply to out of hospital, adequate positive pressure ventilation was fundamental for successful resuscitation. It is a common finding in post-ROSC patients that they are acidotic (Chazan, Stenson and Kurland, 1968) whether it is due to respiratory acidosis or metabolic acidosis caused by a myocardial infarction. Post-ROSC, ineffective ventilation will result in hypercapnia which may have cerebral vasodilation consequences and prevent the patient returning to neurological normality (Newell, Grier and Soar, 2018), the main objective when resuscitating a patient. Thus, it can be inferred that by using passive insufflation as oppose to positive pressure ventilation, there would be a significant increase of hypercapnic patients post-ROSC. Del Castillo et al. (2012) found that in a study of 223 children, mortality rate for patients with hypercapnia was 59%. While this is a noteworthy figure, the results are not only limited due to sample size but the distinct physiological differences between children and adults.

In conclusion, there are findings that support passive insufflation as an intervention that is easy to teach and removes the adverse effects of positive pressure ventilation. However, these studies are observational and to progress further, randomised controlled trials should be conducted as there is very little evidence of the adverse effects of passive insufflation. Furthermore, the majority of trials that have been done are completed in a laboratory setting and samples have been primarily swine. It is clear that positive pressure ventilation has been a part of CPR guidelines due to its ability to maintain tissues perfusion and its effect on cardiac output, but while the likelihood of surviving an out of hospital cardiac arrest is higher than it used to be, the general likelihood of survival-to-hospital-discharge is still low. The only way to improve this prognosis is to explore ways in which to adapt our current guidelines.

“The use of CPR dates all the way back to 1740, most Americans don’t know how to perform it.” CPR is a miraculous technique that if given properly and immediately to sudden cardiac arrest victims the more likely people’s lives would be saved. It is a lifesaving skill that everyone should be taught but unfortunately most people do not know the skill. Unfortunately, most people who suffer a cardiac arrest outside a hospital do not get CPR from a bystander, which significantly lessens their chances of survival. Anyone can be put in a circumstance when lifesaving skills are crucially necessary for themselves or someone else present near them. Of course, the majority of the people would definitely want someone around them to be able to know the live-saving skills needed to save them, if ever needed. Furthermore, it is uncommon for young adolescents and people in general, to engage in first aid and CPR training and dedicate their time to learning the life-saving skill. Our generation today is quick to be able to watch six or more episodes on netflix in just one sitting but complain about not having enough time to take a CPR class. Yet, we people still make time to binge-watch shows when one could have used that time to learn how to save a life. Not only is it for this reason, that I believe that that CPR instructions and classes should be taught at high schools and be mandatory as a high school requirement but also because of the numerous benefits CPR classes will provide throughout the world.

A CPR class usually is about two and a half hours to 3 hours and is a realistic way to be sure that you won’t be in a situation where you stand hopeless and feel useless when someone needs you. People may think that they’ll never be in a situation where CPR is needed. However, according to the American Heart association, “88 percent of cardiac arrests occur at home”, which is equivalent to about 1.32 million people out of 1.5 million people that have heart attacks at home and inside the hospital. About 70 percent of Americans that is ( 227.5 million Americans out of 325 million U.S) don’t know CPR so the chances of one being around in an emergency are not very good. Also according to the American Heart Association, “performing CPR before the paramedics arrive can double or even triple the chances of survival.” Everyone knows that babies are bound to put small objects in their mouth but what would happen if that baby was present near a person who does not know how to perform CPR, started choking on a piece of toy, struggling to breathe. What would that person do? Young children often put items in their mouth which leads to choking, CPR may then be needed to help the child start breathing again. “CPR helps maintain vital blood flow to the heart and brain and increases the amount of time that an electric shock from a defibrillator can be effective,” Four to six minutes after cardiac arrest, the brain begins to die if CPR is not provided, and the average response time of 911 is about 11 minutes. If CPR is performed within 4 minutes, up to 200,000 lives can be saved each year. The statistics show that the life you would be saving with CPR would most likely be family or friend, since like stated earlier 88 percent of cardiac arrests happen at home (American Heart Association).

One might infer that the decision of making CPR mandatory in high school would eventually take licensed teachers and organizations like the American Heart Association out of business due to the fact that more people will be educated. That could be the case, however, one must look at the bigger picture. If CPR were to become mandatory, then there would be more than a sufficient amount of people who would be able to encourage others to take classes. A more educated community signifies the more motivation spread throughout others to continue training whether they would like to pursue in a career that would be required, or not. The installation of CPR classes in a high school, filled with young students can potentially inspire others to take part in that knowledge and carry it with them in every aspect of their life, of course, taking initiative to take classes. If the citizens realize that the youth are being educated with a wonderful life-saving skill, they would come to the realization that anyone is capable of learning and performing CPR, regardless of age. The youth is the future generation. With that being said, having CPR taught at high schools to young citizens would benefit not only themselves, and the ability for them to carry out their training throughout their lives but also as a whole community where we can create a culture in which CPR training could become fundamental to the educational system as any other subject in school.

The duration of a class can depend on the goals of the training and how it is functioned, Dr. Atkins says, but can be completed effectively in just a short, one-time 30-minute session. Moreover, if one wishes to be properly licensed, in terms of receiving a card that indicates that you’ve been trained, then training altogether, would takes a little more time such as a few hours ,Atkins says. According to Surefire CPR, if all high schools made CPR training mandatory, “Our communities would benefit from more bystanders who are confident to administer immediate CPR and could save thousands of lives.” CPR training can take as short as 30 minutes during a regular, physical education class, and there’s no reason why it shouldn’t be included in a student’s education. CPR training can be incorporated in a health class so that a student can be able to maintain a flexible schedule.

‘Sudden cardiac arrest is a common problem, not necessarily in young people, but in older people and they may be learning a skill to save an aunt or an uncle or a grandparent or even a parent,’ says Dr. Dianne Atkins, who works with the Emergency Cardiovascular Care Committee of the American Heart Association. For this reason, some states have made the decision of starting to require cardiopulmonary resuscitation and automated external defibrillator instructions and training to be taught in high schools. In some states, like Illinois , learning CPR is a high school graduation requirement (Pannoni).

In 2015, it has been recorded that the amount of U.S states that require high school students to take mandatory CPR classes are 21 states, and the number is luckily increasing. There are “more than one million high school student annually” across the United States who need to take CPR classes in order to graduate. If we as a society came to a consensus to widespread CPR training to the broader U.S, high school, students would be in a well-positioned role to improve rates of bystander CPR initiation in our country. The involvement of these students would increase the survival rate of people who experience cardiac arrest outside of the hospital through immediate engagement in CPR. Just imagine the many lives that could be saved if all high school students were to take mandatory CPR classes in all 50 states across the United States.

Take for instance, a real life story of a high school student’s experience of putting CPR training into use in a real-life emergency. Senior Alex Cowie from Hillsboro High School in Oregon helped a senior citizen who collapsed at the gym she works at, come back to life. “I looked over and he fell and hit his head on the machine,” said Cowie. “It was very scary. It was very frantic at first. But, of course, you have to do something to help.” The reality is that some teenagers might not have known what to do in that situation but luckily, Cowie had the knowledge from her classes at school that helped save the elderly man, as she joined other bystanders perform CPR.“For the amount of time that he was unresponsive it was crucial that there was two of us there because it does take a lot out of you,” said Cowie. Alex’s experience was a memorable one that gave her confidence to know that she’s ready to overcome the many hardships life sometimes throws at her. .“I never thought that I’d be in a situation where I’d need to use that, but I’m glad I had the knowledge”, says Cowie. She hopes other students can hear her story and take CPR training very serious (Bissell).

Overall, CPR is a lifesaving skill that everyone needs to learn. With these previous statistics, one can conclude that time plays an important role. Think about the benefits of 2.5 or 3 hours of training and how it can save a life. It starts with you; your decision to use your time wisely and take action to save a life. We know we have time, so what’s better than making CPR classes mandatory? This ensures that people will participate and get involved. You may never be in a situation where you will need to resuscitate a person using CPR, but are you willing to take that risk? The next time netflix prompts you with a new show suggestion, will you say yes and continue watching or say yes to learning how to save a life, knowing you could make a difference in a person’s life?

Drawing on Jodha (1986), ‘Common Property Resources’ (CPR) can be defined as the resources available to whole communities but to which no individual has exclusive rights to possession. These may include pastures, forests and grazing lands among others. In India, emerging factors such as urban expansion, land acquisition and property development have caused a rapid decline in the countries’ pool of CPRs (Narain and Vij, 2015). While some authors suggest that advances in agricultural technology and the increased availability of external inputs and supplies have compensated for the decline and degradation of India’s CPRs, it is widely accepted that CPRs still play an important role in the fulfilment of the basic needs of the rural community, particularly the rural poor, who have limited options available that are able to make up for these lost resources (Jodha, 1994). As Narain and Vij (2015) emphasise, CPRs in India serve not only as a source of livelihood and sustenance for the rural community but have also become intricately woven into a part of their cultures. For the rural Indians then, the importance of CPRs is unquestioned, and its decline, threatens their very survival.

The problem of India’s missing commons, however, poses not just a problem for the rural Indians, but for society at large as well. As Jodha (1994) highlights, the ultimate consequence of CPR degradation is the ‘elimination or permanent disruption of vital biophysical processes and nature’s regenerative activities’ both within and outside the CPR area. This thus brings us to the idea of ‘The Web of Life’. As David Harvey (2002) points out, we are all ‘active agents caught in a web of life’. Humans are but a single thread in the web of interconnections that make up the living world. As our actions filter through this web, they bring about a whole host of unintended (and often undesirable) consequences, both to ourselves as well as the world around us. The ‘Web of Life’ metaphor thus serves to highlight that ultimately all things are bound together; all things connect. What affects one part of an ecosystem will eventually affect the whole in some way.

It is for this reason that CPRs are highly relevant to natural resource politics—the fact that their impacts transcend political boundaries often makes their management a source of international conflict and strife. In fact, Barkin and Shambaugh (1996) assert that most, if not all international environmental issues are CPR problems, or at the very least, have CPR aspects. As long as the environment is believed to have sufficient carrying capacity for use and consumption by all involved parties without bringing about any adverse effects to any one of them, then CPR use and consumption remains non-confrontational and non-political. It is once limits to the supply of resources are realised and indivisibility of supply ceases that the use and management of CPRs become political in nature.

A prime example of this would be the case of the Mekong River. Rapid development of large hydropower dams and reservoirs in the upper reaches of the Mekong has altered the stream ecology. In particular, the flood-pulse system of the Tonle Sap Lake—the driving force behind the region’s productive freshwater fisheries and rice paddies—has been directly affected. With the Mekong accounting for approximately 15% of global rice production and 18% of the global freshwater fish catch, a decline in fish and rice stocks threatens the food security not just of Vietnam, but of the entire world. Unsurprisingly, the dam has incited worldwide opposition as well as local protests and violence.

It is plain to see that CPRs are inextricably enmeshed within our ecological landscape. Yet, their power and agency is often downplayed and their significance relegated to the backseat in natural resources policy and decision-making circles. As Jodha (1994) points out, this is reflected by the ‘indifference, insensitivity or outright negative approach of the state and its development interventions to CPRs’. In Budheda, a small village in North-western India, large tracts of grazing land have been acquired by the state to support urban expansion in the City of Gurgaon. The result is the loss of livelihoods for countless of rural Indians (Narain and Vij, 2015). Such conscious exploitation of the commons highlights how CPRs still remain largely invisible in the polices made by the state, while at the same time also reflects the unequal power relations that pervade all aspects of our ecological landscape—powerful actors are able reallocate control of CPRs and dominate their decision-making processes, severely eroding and altering the local rules that govern CPRs.

In conclusion, this essay has shown that the CPR problem is by no means a local one; it always straddles international borders. Consequently, it necessarily needs to be considered in the broader political context.

References

1. Barkin, J. & Shambaugh, G. (1996). Common‐pool resources and international environmental politics. Environmental Politics, 5(3), 429-447. doi:10.1080/09644019608414281
2. Harvey, D. (2000). Spaces of Hope. Berkeley: University of California Press.
3. Jodha, N. (1990). Rural Common Property Resources: Contributions and Crisis. Economic and Political Weekly, 25(26), A65-A78. Retrieved from http://www.jstor.org/stable/4396434
4. Jodha, N. (1994). Common Property Resources and Dynamics of Rural Poverty. Retrieved from: http://dlc.dlib.indiana.edu/dlc/bitstream/handle/10535/5688/common%20property%20resources%20and%20dynamics%20of%20rural%20poverty.pdf?sequence=1
5. Narain, V. & Vij, S. (2015). Where have all the commons gone?. Geoforum, 68, 21-24. doi:10.1016/j.geoforum.2015.11.009.

Introduction

Accidents can occur at any time, and in many situations, someone ends up in the emergency room. However, if everyone has basic first aid and CPR knowledge not only do you benefit from having this knowledge but others around you also benefit from it as well. We do not always need professionals to save lives. In fact, if everyone could give first aid or CPR they could prevent people from losing their lives unnecessarily.

As I have already said in my introduction accidents occur at any time and it is important for everyone to learn CPR and first aid because it can save someone’s life. This could be the most basic reason why everyone should learn CPR and first aid. Based on statistics from the Palms Beach Post, Dr. Alan Zelcer a cardiologist at Delray Medical Centre stated that about 400,000 people die each year from out-of-hospital cardiac arrest. If someone around these people could perform CPR then these people could have had their brain function preserved during an emergency as it would keep the blood circulating through their body and increase their chances of survival.

Also, not every accident requires hospitalization. That is why having the basic first aid knowledge would increase patient comfort. For example, if a person is bleeding profusely and there is a person with knowledge on how to clean and dress the injury, the injured person would be more comfortable as the person with the first aid knowledge would help in easing their pain. These things as easy as they may seem could be tasking for an inexperienced individual, or for people that try to do it themselves without the knowledge of how to go about it.

Why is CPR Important?

Learning first aid and CPR could also prevent a situation from becoming worse. I will use the same example as my first point a person who is bleeding profusely, if no one has first aid knowledge they would be unable to stop the bleeding which could worsen the situation drastically and cause a lot of blood loss. If everyone has first aid knowledge, worsening of medical emergencies can be prevented. The patient would be stable until emergency medical services arrive and take control of the situation.

Another reason why everyone should learn CPR, and this could be one of the most important reasons, and that is to prevent brain death. Performing CPR is not an arduous task especially if you are well trained. If a person can perform CPR they stand the chance of rescuing a person from loss of life or being in a coma for a long time it keeps the patient’s brain function intact long enough for them to be fully resuscitated.

Conclusion

So therefore, everyone should find a center to learn CPR and first aid. You never know whose life you might save, or whose pain you could ease just from learning these two simple things.

Introduction

This assignment will describe the “Whole team approach” to resuscitation with a well-organised multi-disciplined team, taking in to account human factors, Crew resource management (CRM) and non-technical skills. The Resuscitation Council (UK) Guidelines 2015 outline advanced life support (ALS) algorithm which should be followed step by step for in hospital and out of hospital cardiac arrests, this providing the staff can perform and are trained in ALS (Resuscitation Council UK, 2015).

Influencing performance as an effective team leader in cardiopulmonary resuscitation (CPR) is a well-recognized and crucial factor, focusing on the task requirements for leadership training for leading and non-leading team members on crisis resource management (CRM). CRM is designed for team leaders of advanced life support that in turn supports the whole team in the resuscitation setting (Fernandez Castelao, et al., 2015).

In a case in 2005, a patient died as a consequence to failings within the National Health Service (NHS) and sparked an inquiry into her death. This showed that mistakes were made on this day but come down to the system failing due to training and communication within this team of clinicians. Sir Robert Francis who was the investigation officer into the failings in the Mid Staffordshire NHS Foundation trust has described ‘action plans’ of the national health service ‘as the worst disease of the English National Health Service (Bromiley, 2015).

The team approach to resuscitation

A well-coordinated team approach with defined roles is important as is high-quality skills for high-performance cardiopulmonary resuscitation (CPR). What goes into making a successful emergency team for an improved response to cardiac arrest resuscitation, is a multi-disciplined team with an effective team leader to improve the outcome for patients (Fernandez Castelao, et al., 2015). Early interventions for CPR and defibrillation are crucial to reducing mortality and morbidity in patients after cardiac arrest, every minute that CPR is delayed, the survival rate drops between seven and ten percent (Ibrahim, 2007). When someone has an out-of-hospital cardiac arrest (OHCA), there is a chain of events that can increase their chance of survival (Cardiac Science, 2019). This is known as the chain of survival, a term first coined by the American Heart Association in 1991, their paper ‘Improving Survival from Sudden Cardiac Arrest, which follows The Chain of Survival Concept’ highlights that all communities should recognise and accept the principle of early CPR and defibrillation (Cummins, et al., 1991). It is made up of four links; members of the public or community first responders who are trained in basic lifesaving and defibrillation skills can perform the first three links in the chain. This is known as basic life support (BLS) (Cardiac Science, 2019). Advanced life support (ALS) is the final link, which should to be carried out by paramedics with a disciplined team approach, ideally comprising of four individuals. They should between them preform roles such as team leader, management of the airway, deliver high quality chest compressions with minimal interruptions, gain vascular access and deliver advanced life support drugs (Resuscitation council UK, 2015). If good quality BLS and ALS are carried out in quick succession, a person’s likelihood of survival from a cardiac arrest is increased. The first link in the chain is early recognition of cardiac arrest and to call 999 for help. The second link in the Chain of Survival is early CPR; this involves performing chest compressions in order to maintain an element of tissue perfusion until a defibrillator arrives. Thirdly, early defibrillation to restore a patient’s heart to a normal rhythm, this could be a member of the public using a public access defibrillator (PAD) or a first responder trained in defibrillation. The fourth link in the chain is early advanced care (Zoll, 2019). This relates to having a fast response from paramedics who can perform more advanced lifesaving procedures, advanced life support and should arrive within eight minutes form the call for the best chances of survival (NHS England, 2017). The philosophy of basic and advanced life support are very similar for the out of hospital setting but can be influenced by a combination of factors, this including lack of trained staff, equipment, drugs, weather and access to the patient. Other considerations are the area in which the patient has collapsed and or found (Chen, et al., 2015). Treatment should be started promptly to identify and treat any immediate life-threatening problems known as the 4 H’s and 4 T’s, these are all reversible causes of cardiac arrest, these should be reversed to achieve return of spontaneous circulation (ROSC) (Save a Life, 2018). As soon as paramedics arrive, a team leader needs to be appointed, who has been trained in ALS resuscitation, has good communication skills, the ability to distribute tasks, gather information and maintain an overview of the tasks. The team leader should assign tasks to each clinician dependent on skill level and training (Fernandez Castelao, et al., 2013). Known as the ‘pit crew approach’ to resuscitation, 360-degree access should, if possible be achieved around the patient and each member of the team will be given a position from one to four (Hopkins, et al., 2016). Position 1 should be at the head end of the patient to manage the airway and have a full range of airway management skills to include; basic airway manoeuvres to intubation including emergency cricothyrotomy. Position 2 should ideally be on the left side of the patient and deliver high quality chest compressions and defibrillation, this position should be alternated every 2 minutes to overcome fatigue, but if available, a mechanical chest compressor known as a Lucas can be used. This device can perform chest compressions when moving the patient and provide continuous compressions when needed. Position 3 should be on the right side of the patient who can alternate with chest compressions, gain vascular or interosseous access; this team member will also deliver the ALS drugs to the patient if indicated. The fourth member of the team is the team leader, who can stand back and manage the resuscitation attempt and will only become involved if needed. The team leader oversees the whole picture and ensures the team are preforming high quality resuscitation in all areas (Resuscitation Council UK, 2015). Paramedics can remain on scene to achieve ROSC, though if any reversible causes that cannot be dealt with on scene and skills and interventions are not available, the patient should be transported to hospital immediately (Goodwin, et al., 2018). Clinical staff must ensure they are competent and up to date with current guidelines and algorithms in the skills they use to give the best possible care to their patients, this being achieved through training and clinical experiences (Rasmussen, et al., 2014).

Cardiac arrest statistics in England

Reducing premature death is a priority for the NHS. Each year in the UK, approximately 60,000 people sustain an out-of-hospital cardiac arrest (OHCA). In England in 2013, there were approximately 28,000 cases of OHCA resuscitations attempted by the Emergency Medical Services (EMS) (Hawkes, 2017). This equates to less than 50% of workable cardiac arrests. Resuscitation is not attempted for reasons such as advanced directives declining cardiopulmonary resuscitation, (do not attempt resuscitation (DNACPR)), or conditions unequivocally associated with death, as stated in the JRCALC, (2019). Approximately 80% of cardiac arrests happen in the home and 20% in public places, with only 20% being in a ‘shockable rhythm’. Ventricular fibrillation and pulseless VT are shockable rhythms, which can be treated with an automated external defibrillator (AED). The AED delivers a controlled shock to the patient’s heart; this presentation of a shockable rhythm has a much high success rate compared to a non-shockable rhythm (BHF, 2015). This could be even higher if a patient in cardiac arrest receives immediate and effective CPR from relatives or bystanders giving the patient the best chance of survival (American Heart Association, 2019). Out of the 28,000 who were treated for OHCA to hospital discharge in England is 8.6%. In contrast this is considerably lower compared to other developing countries for example; North Holland 21%, Seattle 20% and Norway 25%. This shows that England can make some changes to increase survive rates (BHF, 2015). In 2013 it was identified by the Department of Health in the Cardiovascular Disease Outcomes Strategy, it was a priority for the Resuscitation Council (UK), the British heart foundation (BHF) and NHS England to improve survival rates for OHCA across the United Kingdom (UK) (Gov.uk, 2013). The BHF is determined to tackle this, by creating a Nation of Lifesavers and improving survival numbers for OHCA. Ensuring that all students are educated in CPR and public access defibrillator awareness at secondary schools will be vital to achieving this goal (BHF, 2014).

In England, if survival rates were increased from the overall average, which equates to approximately 8% to the national average of around 12%, it is estimated that an additional 1250 people could be saved from cardiac arrest annually (BHF, 2014). This compared to the best performing health system at 25%, saving an additional 4500 lives each year (Perkins, et al., 2015).

The team approach

The importance of education and training in the resuscitation setting is key to improving patient mortality (Sutton, et al., 2012). Medical errors and adverse events are alarmingly high in hospitals, and has been reported that one in eleven patients suffer from a medical procedure during their hospital stay (Edwards and Siassakos, 2012). Edwards and Siassakos, (2012) states many of the procedures have minor consequences but one in fourteen are fatal as in the Elaine Bromiley case, this healthy mother of two was admitted for an elective surgical procedure which did not take place as her airway suddenly become compromised when she was anaesthetised. This patent could not be intubated and could not be ventilated, a well-known emergency in anaesthesia, this is rare but a recognised complication (McClelland and Smith, 2016). Despite nursing staff setting up for an emergency airway procedure the team of surgical and anaesthetic doctors, managing this patient did not execute this option. Mrs Bromiley passed away some days later due to severe hypoxic brain injury (Bromiley, 2015). In this case, the team failed not because they were bad at their job, but because they had never been exposed to such an emergency before. In this vital lesson, the team delivered everything predictable but failed to deliver emergency contingency planes for emergency airway followed by admission to the intensive care unit. Bromiley, (2015) the husband of Elaine Bromily, formed the Clinical Human Factors Group (CHFG) in 2007 aiming to promote an understanding of human factors within healthcare. This brought a better understanding to clinicians who recognised the fundamental benefits of human factors, promoting safer outcome for patients in day-to-day practice.

Non-technical skills (NTS) are important to support teamwork on human behaviour and conduct. The core principles included in resuscitation are decision-making, leadership, task management, situational awareness and communication (Krage, et al., 2017). Poor NTS can potentially lead to poor patient outcome within the resuscitation team, resulting in significantly longer time off the chest and intervals between defibrillation (Andersen, et al., 2010). On the other hand, linking high quality effective education, local implementation and science can ensure clinicians are delivering high quality CPR to all patients. It is a well-known fact that high quality CPR relies not only on an individual clinical expert who can deliver high quality chest compressions, ventilations and deliver defibrillation shocks competently, but also interact with an expert team that can work closely together and respond to the complex and challenging conditions of a patient in cardiac arrest (Yeung, 2016). Previously teamwork had little value in resuscitation training; however, in the latest American and European resuscitation Guidelines, it states that teamwork and non-technical skills should be incorporated into the training to improve resuscitation and outcome. Crew resource management (CRM) training that was first introduced into the aviation industry has now been translated into the medical setting. This has seen a reduction in medical errors in the Emergency Departments (ED) with the introduction of CRM style training (Edwards and Siassakos, 2012). Andersen, et al. (2010) believes that NTS should be linked to the cardiac arrest algorithm to support teams of clinicians training in resuscitation. Positive results have shown that NTS has improved performance in multi-professional cardiac arrest teams; clearer leadership is linked with more efficient cooperation in the team, thus increasing task performance (Hunziker, et al., 2011).

Conclusion

This paper has described the whole team approach to resuscitation, taking into account human factors, crew resource management (CRM) and non-technical skills. It has shown that putting a good team of clinicians together with technical and non-technical skills, the patient in cardiac arrest can have a better out come by reducing mortality and morbidity. By combining high quality CPR and advanced life support with the ‘chain of survival’ and ‘the pit stop approach’ and having 360 degree access to the patient, more people are surviving out of hospital cardiac arrests.

With education and training for the likes of members of the public and community first responders who are quite often the first person on scene, can start the chain of survival by calling for help, stating CPR and early defibrillation if available. On the contrary, paramedics must arrive in a timely fashion to deliver high quality ALS and ideally comprise of four clinicians. Between them, they can undertake roles as team leader, airway management, deliver CPR and gain intravenous or interosseous access for ALS drugs. If ROSC cannot be achieved on scene, patients need a rapid transfer to the Emergency Department (ED).

Having a member of the team who has been trained in ALS and crew resource management as a team leader has seen an improvement in resuscitation, reducing the number of errors that frequently happen within healthcare as in the case of Elaine Bromiley. Communication and failings within the system were to blame, staff had not had sufficient training in the event of cannot intubate cannot ventilate scenario, leading to this patients death.

In this critique, I will be covering the benefits that CPR has on cardiac Arrest, this will be accomplished by studying research that investigates the effectiveness of cardiopulmonary resuscitation on patients (Kaplow. R. et al. 2021). I specifically chose to exert this research as it is linked to my chosen topic (CPR). It is also related to my previous work experience in an emergency room, where I witnessed cardiac arrest as a dialysis complication. An empirical study of IHCAs was performed in a single experimental accredited university in the Southeast from September 6, 2016, to December 19, 2018. The experiment was performed by a group of set direction by Kaplow in 2016 to see what impact CPR accuracy and compliance with long-term established protocols have on in-hospital patients, age range from 18 to 98 years old were included in the report. (Kaplow. R. et. al 2021).

A systematic search of the literature was conducted to find appropriate reading. Utilising a well-known E-database CINAHL complete and medicine Full Text (May and Holmes, 2012). In advance search using a keyword; Cardiac Arrest, Cardiopulmonary Resuscitation, CPR and Resuscitation. A text filter by using Boolean operator ‘AND’ for the words, guidelines or protocols as well as practice guideline or clinical practice guideline plus recommendation, In-hospital cardiac arrest, and patients’ outcomes were used to narrow down the search to papers that combined words with an expander of related topics to find those that were contextually identical. To find complete texts among the most recent studies: full text, year limiters, and English language were used.

The title accurately depicts the study subject, emphasising the recommendations for life support and patient outcomes to entice readers to see if the research is applicable to their experience (Parahoo, 1997). The title also contains key points from the article that enable the listener to make an educated decision without having to read lengthy quantities of material.

The thesis was conducted to determine the cause of death from heart disease all over the world. The abstract outlines the study’s main purpose, approach, conclusions, summary, and keywords in brief. The study’s goals were straightforward, and the goal was to see whether there was a connection between in-hospital cardiac arrest clinical results and two independent variables: resuscitation procedure compliance and patient seriousness of symptoms, as determined by the number of organs supporting procedures used before cardiac arrest.

Data from a convenience sample that was collected prospectively was used in a quantitative study. Types and medical records linked to cardiopulmonary arrest were checked at a university hospital. The RescueNet Code Review software was used to evaluate compliance with resuscitation orders by using the ZOLL R Series console or defibrillator. In 200 cases, 37% of compressions were performed within the recommended rate range and 63.9%were performed within the recommended depth range. Just 125 (62.5%) of the 200 patients regained normal circulation. After 24 hours, only 94 patients (47%) were still alive. When they were released from the ICU, only 50 people (25%) were alive. (Kaplow. R. et. al 2021).

The significance of this analysis is contextualised in the research report, which discusses how high-quality CPR improves patient outcomes. In-hospital cardiac arrest (IHCA) is one of the major causes of death in hospitals. An approximate 209,000 people die in hospital from heart disease in the United States each year (Hazinski MF, 2015). This research aimed to see if there was a correlation between following resuscitation procedures and treatment response, as well as a link between treatment outcomes and disease severity, as determined by the amount of organ supporting therapies used before heart failure. In a landmark report, only 63% of patients received the minimum dosage of CPR chest compressions (Abella BS, 2005). Two researchers (Roberta Kaplow and Ray Snider) reviewed CPR test findings and code documents to assess compliance with American Heart Association (AHA) and Advanced Cardiac Life Support (ACLS) protocols.

The investigator examined the pioneering study and discovered that only 63% of the patients received CPR compressions at the minimum dosage (Abella BS, 2005). According to another analysis, the depth of compressions was too shallow and erratic (Abella BS, 2005). This was an experimental analysis that used evidence from an appropriate sample that had been obtained ahead of time. Participants ranged in age from 18 to 98 years old and were tested in a single regional university hospital in the United States’ south-eastern region. This review was based on the findings of the report. This article was based on the findings of the report. A more recent study of 272 hospitals conducted between 2007 and 2010 showed a 21.1% progress rate. Increased palliative care intervention, forward guidance, non-resuscitative protocols, and the use of formalised post-resuscitation instructions can also help to improve results (Chan PS, et.al 2013).

In this quantitative research, there are 3 different methods used and clearly explained by the author they are as follows:

• Respondents and design
• Data collection
• Analytical Statistics

Respondents and design: This was an empirical analysis that used information from a convenient survey that was gathered prospectively. In the South-eastern, they also looked at IHCAs in a single urban academic medical centre. Patients undergoing ventricular assist devices or extracorporeal membrane oxygenation treatment were not included in the study.

Cases that lacked main data elements were also ruled out. Since the thesis met the requirements outlined in government guidelines for waivers of written evidence, the hospital’s study protocol waived the provision for informed consent (Chan PS, 2016, US (United States) Department of Health and Human Services, 2016).

Data Collection: Using the hospital’s system, they were informed of all IHCAs. Since 2013, the ZOLL has been the defibrillator of choice on all inpatient units. Every year, all nurses and nurse practitioners are given a refresher course on pad positioning and system service. Two researchers (RS and RK) looked through all CPR examination results and protocols. The study participants were not blinded to the study objectives as they were part of the analysis squad.

During CPR, an observation for the existence and duration of pauses were overseen. Compression rate and depth were used to measure adhesion. The seriousness of the participant’s condition prior to CPR can be an indicator of resuscitation success (Roberts D, 2017). The research team created a data collection form that was used to assemble and document all of the information. All of the information was inserted into a Microsoft Excel workbook that was password-protected.

Analytical Statistics: Both demographic features, code variables, adherence to chest compression and survival evaluations were obtained with descriptive statistics. The tests of comparison between the survivors and the non-surfacers of each survival point were conducted for both demographic features and clinical measures. With a sample size of 200 individuals and a base chance survival rate of 30%, an impact size odds ratio of 1.57 was detected for every 1-unit increase in CPR compression compliance (Cohen J, 1988). The hospital’s Resuscitation Committee tracked resuscitation results and came up with a 30% survival figure. We could detect a modest impact size correlation among percent compliance to CPR guidance and survival with a study population of 200 and an estimated success rate of 30% (lower-bound estimation based on latest information) (Faul F et.al, 2007).

There are some drawbacks to this report. The accuracy of CPR data is dependent on the location of sensors during the process. It is possible that some employees did not follow the 2015 AHA guidelines’ advice to use improved feedback technologies (Christenson J, 2009). Only bedridden patient care sections had access to code info. Children may have been included in the study, their support needs would have been different. There was no evidence that participants were safe from harm.

They found no connection between the number of pauses in compressions longer than 10 seconds and the code duration. Patients with longer codes are expected to have further pauses, and this relationship should be explored more in the future. The hospital’s emergency response staff taught the basic care unit nurses how to properly position pads, which improved compression compliance. Recovered patients should have been monitored within 3-6 months, to detect any problem or health related issues that they may have developed after recovery.

The findings have been organised into four categories, each of which explicitly specifies the outcomes.

• Characteristics of the Research Sample
• Adherence to the Basic Life Support Guidelines
• Information Coding
• Data on the Results

Characteristics of the Research Sample: The median percentages of conformity to goal for compression depths during each code were: 1.4% above, 63.9% at, and 34.7% beneath. The programme requiring help ranged between 0 and 4, with 94 cases (47%) one or more (Kaplow. R. et. al 2021). The IHCA evenly divided between day (49 %) and night shift (51%). The majority of the participants (56%) were men. Initially, all of the participants are pulseless (58.5%), with little asystole (19.5%), ventricular tachycardia (11.5%), and ventricular fibrillation (10.5%). This report contains numerical observations.

Adherence to the Basic Life Support Guidelines: The ZOLL estimated that average compression conformity to CPR standards was 27.4% when a pace of 100 to 120 per minute was combined with a depth of at least 2 inches. The count of guidelines with at least 80% of their compressions at target depth and the rate was also counted. Just 13 codes (6.5%) had 80% upwards of the compressions at policy rates, compared to 79 codes (39.5%) that had 80% or more of the compressions at target depth.

Information Coding: 16 of the 200 participants were defibrillated incorrectly. More than 50% of the time, therapies were not provided according to AHA guidelines. This poor adherence rate, on the other hand, had no clinically relevant relationship with all recovery ends.

Data on the Results: A total of 125 of the 200 patients achieved ROSC, 94 individuals survived 24 hours following resuscitation, 50 got through ICU, and 47 were released alive from the centre. Two variables were found to be strongly linked to ROSC and ICU release. Patients undergoing more organ supporting therapy have a lower chance of surviving ICU release (Mann-Whitney Z = 2.26, P =.02)

The authors of this analysis wanted to see whether there was a connection with following resuscitation instructions and four different outcomes (ROSC, 24-hour survival, ICU discharge, and hospital discharge). Recovery was slightly higher in groups that spent 61% to 80% of their period in chest compressions relative to teams that spent 0% to 20% of their period in chest compressions, with a probability of 3.01 for recovery to discharge (Christenson and his associates). The basic fact is that the results were compared to other research conducted by other experts. Patients’ demographic profiles were not correlated with higher recovery, according to the authors’ own measures. Patients in the ICU were more critically sick than on general units, which may result in poorer success rates (Chan PS, 2013).

They discovered that patients in our sample had a higher recovery to discharge than those published in a research of 374 hospitals from 2000 to 2009 that looked at patterns in recovery after IHCA, with the authors reporting increased recovery over the past decade (Girotra S 2012).

Overall survival rates are close to those observed in previous research, according to these preliminary findings. The number of compressed breaks was the reliable factor in the success of IHCA. Capnography evaluation assures the chest compression supplier of its effectiveness. Patients with one or more organ systems supported at the time of IHCA were probably less likely to be recovered alive from the ICU, according to the report. The revised curriculum for teaching functional life care established by the AHA needs to be reviewed accordingly. As part of the Resuscitation Quality Improvement programme, quarterly CPR practice is permitted to improve professionalism (Panchal AR, 2019. And RQI Partners. RQI 2020).

Directions: Use this worksheet as a guide to create your speech outline (The number of main points, sub-points, and support may vary according to your unique content). The final product needs to be typed, in 12-point Times New Roman font, double-spaced, have 1-inch margins, and include internal source citations (at least 1 per main point and 1 in the introduction) in APA formatting. Please retain the concept labels below. On a separate references page, all source citations should be listed in APA style.

Preparation

1. General Purpose: To Inform
2. Specific Purpose: To inform my audience about the importance and process of cardiopulmonary-resuscitation
3. Type of Informative Speech: Conceptual
4. Central Idea: CPR is a life-saving technique; it has a function and process that is important to know about.

Introduction

1. Attention Getting Device: (Photo of Dwight Schrute from The Office, with a CPR manakin face). You’ve all probably seen this photo, and if you have, you probably have an idea of what my speech is about.
2. Thesis: In 2013, According to Doctor Nishiyama, CPR can triple the chances of survival with bystander intervention. CPR is quite literally a life-saving skill to have, and the history as well as the functions and processes of CPR are extremely important to know and understand.
3. Justification/Significance: I personally believe that CPR is a skill that you can and may have to use in everyday life. It is very relevant for you, and the other people around you.
4. Preview of Main Points: To help you understand more about CPR, I want to talk about the history of CPR, its purpose, common mistakes, and how to actually perform CPR.

(Transition) First of all, the history of CPR.

Body

• I. Main Point (Major Claim): CPR has undergone many changes and reviews since its first-born concept.
  • A. Sub Point (Sub Claim). According to the 2018 American Heart Association, a renowned health organization with Dr. Berg, CPR started as early as the 1700s. beginning with breathing techniques on a coal miner that were successful and studied.
    • 1. Grounds. Beginning with breathing techniques on a coal miner that were successful and studied, Doctors then began experimenting on chickens, using instruments such as bellows to restore breathing and compressions. This prompted further experimentation when people realized that open-massaging the heart would increase circulation in the 1800s..
      • a. Warrant. After this period of testing basic ways to resuscitate, people began forming very simplistic methods for revival.
  • B. Sub Point (Sub Claim). It wasn’t until the late 1900s that we began to see something like the CPR we have today.
    • 1. Grounds. In 1960, doctors finally combined the use of compressions with mouth-to-mouth breathing and gave way to CPR. This method has been used, reviewed, and revised multiple times for efficiency.
      • a. Warrant. This goes to show that the history of CPR is constantly changing and continuing as we know it.
• (Transition) The history of CPR is very interesting, but more importantly it leads into its function.
• II. Main Point (Major Claim): We know that CPR works to bring someone back to life. But there are reasons why do we do it the way we do.
  • A. Sub Point (Sub Claim). Current CPR methods require that you give the patient two breaths in between compressions.
    • 1. Grounds. According to the Researcher R. Berg and associates in 2010 who studied American Heart Association CPR, it is important to not excessively ventilate, or give breaths, and to pair these breaths with chest compressions. This should be done with a mask, mouth to mouth contact is not recommended on strangers due to spread of diseases.
      • a. Warrant. Although breathing is not always possible, especially without a mask, it significantly helps the body to compensate.
  • B. Sub Point (Sub Claim). It is also important to give the patient thirty, solid chest compressions.
    • 1. Grounds. In essence, this gives the heart almost a “fake beat” which allows blood to still flow throughout the body. This lets cells, which are carrying oxygen from the breaths you gave, to flow to the brain and other areas of the body to prevent quick and excessive tissue death.
      • a. Warrant. It’s still not the same as having a working heart, it just helps to kickstart a dying heart back into motion.
• (Transition) The function and purpose of CPR seems like a lot, and because it is so powerful, and lot of things can go wrong that you need to know about.

III. Main Point (Major Claim): If CPR is done incorrectly, it can do more harm than damage.

A. Sub Point (Sub Claim). Simply not knowing how to do CPR is a common occurrence, and an unfortunate one.

1. Grounds. According to research studies by in 2018 Fiona Dobbie and her team for Systematic Research, bystander CPR significantly increases the chance of survival. It also becomes significant if you have to perform CPR on a family member or loved one.

a. Warrant. By knowing CPR, bystanders can have a significant effect on how emergency situations can turn out.

B. Sub Point (Sub Claim). People who have no experience with CPR but are kind of enough to help, may not be doing suffering people much of a favor.

1. Grounds. If the position of the hands is too low, a bone called the Xiphoid process breaks off of the sternum and can move around the inside of the body and stab vital organs. Their compressions may also be too soft and too few, which does not circulate enough blood throughout the body.

a. Warrant. This is why it is important to know the basics of CPR: to avoid mistakes and situations that could otherwise be handled correctly.

(Transition) Finally, I would like to give you some tips and instructions on how to perform basic CPR on adults.

IV. Main Point (Major Claim): CPR involves certain steps and tricks in order to be performed correctly.

• A. Sub Point (Sub Claim). According to Dr. JJustad in 2013, early recognition is the most important part of CPR. There are a couple of steps that actually need to happen prior to beginning CPR: Making sure the scene is safe, assigning tasks for people to retrieve help, and checking the person for breathing or a pulse.
  • 1. Grounds. First, check to see if the scene is safe; if someone is hurt, there’s a chance you may get hurt too. After, see you if you can get the person to respond by tapping their shoulders. Check their pulse and their breathing, and if others are around you, ask them to get help or a first aid kit.
    • a. Warrant. Doing all of this not only helps you and the victim, but the medics who will be on their way.
• B. Sub Point (Sub Claim). The following steps are the most important in keeping your patient alive.
  • 1. Grounds. The ratio of compressions to breathing is thirty compressions for every two breaths. When you breathe, make sure you cover their nose, make a firm seal around their mouth, and tilt their head back. For compressions, place your hands perpendicular to the sternum and parallel to the heart. You want to lace your fingers, keep your elbows straight and push about 2-3 inches into the chest and wait for recoil. There should be about 100 compressions in a minute that you accomplish.
    • a. Warrant. By following this method correctly from the American Heart Association, you could save someone’s life.

Conclusion

1. Summarize Main Points: The history of CPR, its function, its difficulty, and its process is a lot for one person to handle; but knowing about each component is vital.
2. Restate Thesis: You could end up saving someone’s life by knowing how to perform CPR and be able to tell someone why and how you do it.
3. Close with Impact: So, my apologies, but I have now ruined any portrayal of people doing CPR in TV shows and movies, including the Office because you’ll know they’re doing it wrong.

References

1. American Heart Association. (2018). History of CPR. CPR & First Aid Emergency Cardiovascular Care. Retrieved from https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/HistoryofCPR/UCM_475751_History-of-CPR.jsp
2. Berg, RA et al. (2010). Adult basic life support. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, 124(15), 402
3. Dobbie, F. (2018). Protocol for a systematic review to identify the barriers and facilitators to deliver bystander cardiopulmonary resuscitation (CPR) in disadvantaged communities. Systematic Reviews, 143(7), 1-5.
4. JJustad. (2013). The importance of CPR. Health Guidelines, 27(6), 1-2.
5. Nishiyama, C. et al., (2013). Long-term retention of cardiopulmonary resuscitation skills after shortened chest compression-only training and conventional training: a randomized controlled trial. Society for Academic Emergency Medicine, 47-48.