Misplaced Pages

Cardiopulmonary resuscitation

Article snapshot taken from Wikipedia with creative commons attribution-sharealike license. Give it a read and then ask your questions in the chat. We can research this topic together.

An emergency procedure is a plan of actions to be conducted in a certain order or manner, in response to a specific class of reasonably foreseeable emergency , a situation that poses an immediate risk to health , life , property , or the environment . Where a range of emergencies are reasonably foreseeable, an emergency plan may be drawn up to manage each threat. Most emergencies require urgent intervention to prevent a worsening of the situation, although in some situations, mitigation may not be possible and agencies may only be able to offer palliative care for the aftermath. The emergency plan should allow for these possibilities.

#387612

73-592: Cardiopulmonary resuscitation ( CPR ) is an emergency procedure consisting of chest compressions often combined with artificial ventilation , or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest . It is recommended for those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations . CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at

146-461: A deeply comatose, ventilator -dependent patient. Identification of this state carries a very grave prognosis for survival; cessation of heartbeat often occurs within a few days, although it may continue for weeks if intensive support is maintained. In the United Kingdom , death can be certified on the basis of a formal diagnosis of brainstem death, so long as this is done in accordance with

219-527: A nearby AED defibrillator should be used on the patient as soon as possible. As a general reference, defibrillation is preferred to performing CPR, but only if the AED can be retrieved in a short period of time. All these tasks (calling by phone, getting an AED, and the chest compressions and rescue breaths maneuvers of CPR) can be distributed between many rescuers who make them simultaneously. The defibrillator itself would indicate if more CPR maneuvers are required. As

292-534: A press release by BP on the 8 September 2010, BP's outgoing chief executive Tony Hayward said of this: The investigation report provides critical new information on the causes of this terrible accident. It is evident that a series of complex events, rather than a single mistake or failure, led to the tragedy. It is common practise with emergency procedures to have review processes where the lessons learnt from previous emergencies, changing circumstances, changes in personnel, contact details, etc. can be incorporated into

365-545: A procedure established in "A Code of Practice for the Diagnosis and Confirmation of Death", published in 2008 by the Academy of Medical Royal Colleges . The premise of this is that a person is dead when consciousness and the ability to breathe are permanently lost, regardless of continuing life in the body and parts of the brain, and that death of the brainstem alone is sufficient to produce this state. This concept of brainstem death

438-441: A rate of 1 breath every 6 to 8 seconds (8–10 ventilations per minute). In all victims, the compression speed is of at least 100 compressions per minute. Recommended compression depth in adults and children is of 5 cm (2 inches), and in infants it is 4 cm (1.6 inches). In adults, rescuers should use two hands for the chest compressions (one on the top of the other), while in children one hand could be enough (or two, adapting

511-440: A rate of at least 100 to 120 per minute. The rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose ( mouth-to-mouth resuscitation ) or using a device that pushes air into the subject's lungs ( mechanical ventilation ). Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving only chest compressions

584-620: A review by a Working Group of the Royal College of Physicians of London , the Conference of Medical Royal Colleges formally adopted the "more correct" term for the syndrome, "brainstem death" – championed by Pallis in a set of 1982 articles in the British Medical Journal  – and advanced a new definition of human death as the basis for equating this syndrome with the death of the person. The suggested new definition of death

657-497: A slight variation for that sequence, if the rescuer is completely alone with a victim of drowning, or with a child who was already unconscious when the rescuer arrived, the rescuer would do the CPR maneuvers during 2 minutes (approximately 5 cycles of ventilations and compressions); after that, the rescuer would call to emergency medical services, and then it could be tried a search for a defibrillator nearby (the CPR maneuvers are supposed to be

730-415: A sort of arrhythmia that will stop the heart immediately), it is recommended that someone asks for a defibrillator (because they are quite common in the present time), for trying with it a defibrillation on the already unconscious victim, in case it is successful. Order of defibrillation in a first aid sequence It is recommended calling for emergency medical services before a defibrillation. Afterwards,

803-509: A sufficient speed and depth of compressions, completely relaxing pressure between compressions, and not ventilating too much. It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation. A normal CPR procedure uses chest compressions and ventilations (rescue breaths, usually mouth-to-mouth) for any victim of cardiac arrest, who would be unresponsive (usually unconscious or approximately unconscious), not breathing or only gasping because of

SECTION 10

#1732830098388

876-602: Is also accepted as grounds for pronouncing death for legal purposes in India and Trinidad & Tobago . Elsewhere in the world, the concept upon which the certification of death on neurological grounds is based is that of permanent cessation of all function in all parts of the brain – whole brain death  – with which the British concept should not be confused. The United States ' President's Council on Bioethics made it clear, for example, in its White Paper of December 2008, that

949-407: Is easier to perform and instructions are easier to give over a phone. In adults with out-of-hospital cardiac arrest , compression-only CPR by the average person has an equal or higher success rate than standard CPR. The CPR 'compressions only' procedure consists only of chest compressions that push on the lower half of the bone that is in the middle of the chest (the sternum ). Compression-only CPR

1022-416: Is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia , rather than asystole or pulseless electrical activity , which usually requires the treatment of underlying conditions to restore cardiac function. Early shock, when appropriate, is recommended. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until

1095-466: Is effective only if performed within seven minutes of the stoppage of blood flow. The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures, as sometimes seen in near-drownings, prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain stem death , and allows the heart to remain responsive to defibrillation attempts. If an incorrect compression rate

1168-415: Is manual squeezing of the exposed heart itself carried out through a surgical incision into the chest cavity , usually when the chest is already open for cardiac surgery. Active compression-decompression methods using mechanical decompression of the chest have not been shown to improve outcome in cardiac arrest. A defibrillator is a machine that produces a defibrillation: electric shocks that can restore

1241-405: Is necessary for the ventilations, because of the size of the baby's neck. In CPR, the chest compressions push on the lower half of the sternum —the bone that is along the middle of the chest from the neck to the belly— and leave it rise up until recovering its normal position. The rescue breaths are made by pinching the victim's nose and blowing air mouth-to-mouth. This fills the lungs, which makes

1314-607: Is not as good for children who are more likely to have cardiac arrest from respiratory causes. Two reviews have found that compression-only CPR had no more success than no CPR whatsoever. Rescue breaths for children and especially for babies should be relatively gentle. Either a ratio of compressions to breaths of 30:2 or 15:2 was found to have better results for children. Both children and adults should receive 100 chest compressions per minute. Other exceptions besides children include cases of drownings and drug overdose ; in both these cases, compressions and rescue breaths are recommended if

1387-441: Is not indicated if the patient has a normal pulse or is still conscious. Also, it is not indicated in asystole or pulseless electrical activity (PEA) , in those cases a normal CPR would be used to oxygenate the brain until the heart function can be restored. Improperly given electrical shocks can cause dangerous arrhythmias , such as the ventricular fibrillation (VF) . When a patient does not have heart beatings (or they present

1460-413: Is recommended for untrained rescuers. With children, however, 2015 American Heart Association guidelines indicate that doing only compressions may actually result in worse outcomes, because such problems in children normally arise from respiratory issues rather than from cardiac ones, given their young age. Chest compression to breathing ratios is set at 30 to 2 in adults. CPR alone is unlikely to restart

1533-430: Is revised and reissued, previous versions must be withdrawn from point of use to avoid confusion. For the same reason, a revision numbering system and a schedule of amendments are frequently used with procedures to reduce the potential for errors and misunderstandings. The document itself may be just a few lines, perhaps using bullet points, flow charts or it may be a detailed set of instructions and diagrams, dependent on

SECTION 20

#1732830098388

1606-470: Is superior to compression-only CPR. Standard CPR is performed with the victim in supine position . Prone CPR, or reverse CPR, is performed on a victim in prone position , lying on the chest. This is achieved by turning the head to the side and compressing the back. Due to the head being turned, the risk of vomiting and complications caused by aspiration pneumonia may be reduced. The American Heart Association's current guidelines recommend performing CPR in

1679-538: Is that the CPR ventilations (rescue breaths) are considered the most important action for those victims. Cardiac arrest in drowning victims originates from a lack of oxygen, and a child would probably not suffer from cardiac diseases. The reason is that the phone call is considered urgent. In 2010, the AHA and International Liaison Committee on Resuscitation updated their CPR guidelines. The importance of high quality CPR (sufficient rate and depth without excessively ventilating)

1752-416: Is used during CPR, going against standing American Heart Association (AHA) guidelines of 100–120 compressions per minute, this can cause a net decrease in venous return of blood, for what is required, to fill the heart. For example, if a compression rate of above 120 compressions per minute is used consistently throughout the entire CPR process, this error could adversely affect survival rates and outcomes for

1825-425: Is usually in the style of a table, which rates a risk on its likelihood and severity. An emergency procedure identifies the responsibilities, actions and resources necessary to deal with an emergency. Once drafted, a procedure may require a consultative period with those who could be involved or affected by the emergency, and a programme set out for testing, training and periodic review. When an emergency procedure

1898-434: The cerebral blood flow is inadequate to support synaptic function, although there is still sufficient blood flow to keep brain cells alive and capable of recovery. There has recently been renewed interest in the possibility of neuronal protection during this phase by use of moderate hypothermia and by correction of the neuroendocrine abnormalities commonly seen in this early stage. Published studies of patients meeting

1971-410: The cortex appears, on the basis of electroencephalographic (EEG) studies, to be awaiting the command or ability to function. The role of diencephalic (higher brain) involvement is stated to be uncertain and we are reminded that the arousal system is best regarded as a physiological rather than a precise anatomical entity. There should, perhaps, also be a caveat about possible arousal mechanisms involving

2044-473: The medulla  – the 'respiratory centre'. In the UK, establishing a neurological diagnosis of death involves challenging this centre with the strong stimulus offered by an unusually high concentration of carbon dioxide in the arterial blood, but it is not challenged by the more powerful drive stimulus provided by anoxia  – although the effect of that ultimate stimulus is sometimes seen after final disconnection of

2117-463: The supine position , and limits prone CPR to situations where the patient cannot be turned. During pregnancy when a woman is lying on her back, the uterus may compress the inferior vena cava and thus decrease venous return. It is therefore recommended that the uterus be pushed to the woman's left. This can be done by placing a pillow or towel under her right hip so that she is on an angle of 15–30 degrees, and making sure their shoulders are flat to

2190-447: The "plasticity" of the nervous system. Other theories of consciousness place more stress on the thalamocortical system. Perhaps the most objective statement to be made is that consciousness is not currently understood. That being so, proper caution must be exercised in accepting a diagnosis of its permanent loss before all cerebral blood flow has permanently ceased. The ability to breathe spontaneously depends upon functioning elements in

2263-750: The British concept and clinical criteria are not considered sufficient for the diagnosis of death in the United States. The United Kingdom (UK) criteria were first published by the Conference of Medical Royal Colleges (with advice from the Transplant Advisory Panel) in 1976, as prognostic guidelines. They were drafted in response to a perceived need for guidance in the management of deeply comatose patients with severe brain damage who were being kept alive by mechanical ventilators but showing no signs of recovery. The Conference sought "to establish diagnostic criteria of such rigour that on their fulfilment

Cardiopulmonary resuscitation - Misplaced Pages Continue

2336-436: The UK's Department of Health Code of Practice governing use of that procedure for the diagnosis of death reaffirms the preconditions for its consideration. These are: With these pre-conditions satisfied, the definitive criteria are: Two doctors, of specified status and experience, are required to act together to diagnose death on these criteria and the tests must be repeated after "a short period of time ... to allow return of

2409-552: The blood and maintain a cardiac output to keep vital organs alive. Blood circulation and oxygenation are required to transport oxygen to the tissues. The physiology of CPR involves generating a pressure gradient between the arterial and venous vascular beds; CPR achieves this via multiple mechanisms. The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. Typically if blood flow ceases for one to two hours, then body cells die . Therefore, in general CPR

2482-421: The brain. In 1995, that claim was abandoned and the diagnosis of death (acceptable for legal purposes in the UK in the context of organ procurement for transplantation) by the specified testing of brainstem functions was based on a new definition of death – the permanent loss of the capacity for consciousness and spontaneous breathing. There are doubts that this concept is generally understood and accepted and that

2555-568: The bystander is trained and is willing to do so. As per the AHA, the beat of the Bee Gees song " Stayin' Alive " provides an ideal rhythm in terms of beats per minute to use for hands-only CPR, which is 104 beats-per-minute. One can also hum Queen 's " Another One Bites the Dust ", which is 110 beats-per-minute and contains a repeating drum pattern. For those in cardiac arrest due to non-heart related causes and in people less than 20 years of age, standard CPR

2628-403: The case of babies. Water and metals transmit the electric current. This depends on the amount of water, but it is convenient to avoid starting the defibrillation on a floor with puddles, and to dry the wet areas of the patient before (fast, even with any cloth, if that could be enough). It is not necessary to remove the patient's jewels or piercings, but it should be avoided placing the patches of

2701-433: The chest and the other on the back (no matter which of them). There are several devices for improving CPR, but only defibrillators (as of 2010) have been found better than standard CPR for an out-of-hospital cardiac arrest. When a defibrillator has been used, it should remain attached to the patient until emergency services arrive. Timing devices can feature a metronome (an item carried by many ambulance crews) to assist

2774-568: The chest to rise up, and increases the pressure into the thoracic cavity. If the victim is a baby, the rescuer would compress the chest with only 2 fingers and would make the ventilations using their own mouth to cover the baby's mouth and nose at the same time. The recommended compression-to-ventilation ratio, for all victims of any age, is 30:2 (a cycle that alternates continually 30 rhythmic chest compressions series and 2 rescue breaths series). Victims of drowning receive an initial series of 2 rescue breaths before that cycle begins. As an exception for

2847-479: The complexity of the situation and the capabilities of those responsible for implementing the procedure during the emergency. Business continuity planning may also feed off of the emergency procedures, enabling an organization to identify points of vulnerability and minimise the risk to the business by preparing backup plans and improving resilience. The act of producing the procedures may also highlight failings in current arrangements that if corrected, could reduce

2920-472: The compressions to the child's constitution), and with babies the rescuer must use only two fingers. There exist some plastic shields and respirators that can be used in the rescue breaths between the mouths of the rescuer and the victim, with the purposes of sealing a better vacuum and avoiding infections. In some cases, the problem is one of the failures in the rhythm of the heart (ventricular fibrillation and ventricular tachycardia) that can be corrected with

2993-475: The correct shocks if they are needed. The time in which a cardiopulmonary resuscitation can still work is not clear, and it depends on many factors. Many official guides recommend continuing a cardiopulmonary resuscitation until emergency medical services arrive (for trying to keep the patient alive, at least). The same guides also indicate asking for any emergency defibrillator (AED) near, to try an automatic defibrillation as soon as possible before considering that

Cardiopulmonary resuscitation - Misplaced Pages Continue

3066-579: The criteria for brainstem death or whole brain death – the American standard which includes brainstem death diagnosed by similar means – record that even if ventilation is continued after diagnosis, the heart stops beating within only a few hours or days. However, there have been some very long-term survivals and it is noteworthy that expert management can maintain the bodily functions of pregnant brain dead women for long enough to bring them to term. The diagnostic criteria were originally published for

3139-412: The defibrillator are considered urgent when the problem has a cardiac origin). Defibrillation The standard defibrillation device, prepared for a fast use out of the medical centres, is the automated external defibrillator (AED), a portable machine of small size (similar to a briefcase) that can be used by any user with no previous training. That machine produces recorded voice instructions that guide to

3212-440: The defibrillator directly on top of them. The patches with electrodes are put on the positions that appear at the right. In very small bodies: children between 1 and 8 years, and, in general, similar bodies up to 25 kg approximately, it is recommended the use of children's size patches with reduced electric doses. If that is not possible, sizes and doses for adults would be used, and, if the patches were too big, one would be placed on

3285-467: The electric shock of a defibrillator . So, if a victim is suffering a cardiac arrest, it is important that someone asks for a defibrillator nearby, to try with it a defibrillation process when the victim is already unconscious. The common model of defibrillator (the AED) is an automatic portable machine that guides to the user with recorded voice instructions along the process, and analyzes the victim, and applies

3358-405: The findings from animal experiments as illuminated by pathological studies in humans. The current neurological consensus is that the arousal of consciousness depends upon reticular components which reside in the midbrain, diencephalon and pons . It is said that the midbrain reticular formation may be viewed as a driving centre for the higher structures, loss of which produces a state in which

3431-618: The first and second cranial nerves (serving sight and smell) which are not tested when diagnosing brainstem death but which were described in cats in 1935 and 1938. In humans, light flashes have been observed to disturb the sleep-like EEG activity persisting after the loss of all brainstem reflexes and of spontaneous respiration. There is also concern about the permanence of consciousness loss, based on studies in cats, dogs and monkeys which recovered consciousness days or weeks after being rendered comatose by brainstem ablation and on human studies of brainstem stroke syndrome raising thoughts about

3504-408: The functional capacity to have a chance of even partial recovery and those where no such possibility exists". Recognition of that state required the withdrawal of further artificial support so that death is allowed to occur, thus "sparing relatives from the further emotional trauma of sterile hope". In 1979, the Conference of Medical Royal Colleges promulgated its conclusion that identification of

3577-494: The ground. If this is not effective, healthcare professionals should consider emergency resuscitative hysterotomy . Evidence generally supports family being present during CPR. This includes in CPR for children. Interposed abdominal compressions may be beneficial in the hospital environment. There is no evidence of benefit pre-hospital or in children. Cooling during CPR is being studied as currently results are unclear whether or not it improves outcomes. Internal cardiac massage

3650-427: The heart. Its main purpose is to restore the partial flow of oxygenated blood to the brain and heart . The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage . Administration of an electric shock to the subject's heart, termed defibrillation , is usually needed to restore a viable, or "perfusing", heart rhythm. Defibrillation

3723-432: The lack of heart beats. But the ventilations could be omitted for untrained rescuers aiding adults who suffer a cardiac arrest (if it is not an asphyxial cardiac arrest, as by drowning, which needs ventilations). The patient's head is commonly tilted back (a head-tilt and chin-lift position) for improving the air flow if ventilations can be used. However, in the case of babies, the head is left straight, looking forward, which

SECTION 50

#1732830098388

3796-443: The latest version of the documentation. Some typical emergency procedures are: Other potential emergencies that may affect an organisation include the following Brain stem death Brainstem death is a clinical syndrome defined by the absence of reflexes with pathways through the brainstem  – the "stalk" of the brain, which connects the spinal cord to the mid-brain , cerebellum and cerebral hemispheres  – in

3869-476: The mechanical ventilator can be switched off, in the secure knowledge that there is no possible chance of recovery". The published criteria – negative responses to bedside tests of some reflexes with pathways through the brainstem and a specified challenge to the brainstem respiratory centre, with caveats about exclusion of endocrine influences, metabolic factors and drug effects – were held to be "sufficient to distinguish between those patients who retain

3942-463: The normal compression-to-ventilation ratio of 30:2, if at least two trained rescuers are present and the victim is a child, the preferred ratio is 15:2. Equally, in newborns, the ratio is 30:2 if one rescuer is present, and 15:2 if two rescuers are present (according to the AHA 2015 Guidelines). In an advanced airway treatment, such as an endotracheal tube or laryngeal mask airway , the artificial ventilation should occur without pauses in compressions at

4015-429: The normal heart function of the victim. The common model of defibrillator out of an hospital is the automated external defibrillator (AED), a portable device that is especially easy to use because it produces recorded voice instructions. Defibrillation is only indicated for some arrhythmias (abnormal heart beatings), specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) . Defibrillation

4088-473: The patient has died. A normal cardiopulmonary resuscitation has a recommended order named 'CAB': first 'Chest' (chest compressions), followed by 'Airway' (attempt to open the airway by performing a head tilt and a chin lift), and 'Breathing' (rescue breaths). As of 2010, the Resuscitation Council (UK) was still recommending an 'ABC' order, with the 'C' standing for 'Circulation' (check for a pulse), if

4161-435: The patient's arterial blood gases and baseline parameters to the pre-test state". These criteria for the diagnosis of death are not applicable to infants below the age of two months. With due regard for the cause of the coma, and the rapidity of its onset, testing for the purpose of diagnosing death on brainstem death grounds may be delayed beyond the stage where brainstem reflexes may be absent only temporarily – because

4234-439: The person has a return of spontaneous circulation (ROSC) or is declared dead. CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest . If a person still has a pulse but is not breathing ( respiratory arrest ), artificial ventilations may be more appropriate, but due to the difficulty people have in accurately assessing

4307-441: The presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a pulse. In those with cardiac arrest due to trauma , CPR is considered futile but still recommended. Correcting the underlying cause such as a tension pneumothorax or pericardial tamponade may help. CPR is used on people in cardiac arrest to oxygenate

4380-419: The priority for the drowned and most of the already collapsed children). As another possible variation, if a rescuer is completely alone and without a phone near, and is aiding to any other victim (not a victim of drowning, nor an already unconscious child), the rescuer would go to call by phone first. After the call, the rescuer would get a nearby defibrillator and use it, or continue the CPR (the phone call and

4453-414: The public, the environment, the business, their property and their reputation. Before preparing a procedure, it may be appropriate to carry out a risk assessment , estimating how likely it is for an emergency event to occur and if it does, how serious or damaging the consequences would be. The emergency procedure should provide an appropriate and proportionate response to this situation. A risk assessment

SECTION 60

#1732830098388

4526-409: The purpose of identifying a clinical state associated with a fatal prognosis (see above). The change of use, in the UK, to criteria for the diagnosis of death itself was protested immediately. The initial basis for the change of use was the claim that satisfaction of the criteria sufficed for the diagnosis of the death of the brain as a whole, despite the persistence of demonstrable activity in parts of

4599-418: The rescuer in achieving the correct rate. Some units can also give timing reminders for performing compressions, ventilating and changing operators. Emergency procedure Organizations are frequently required to have written emergency procedures in place to comply with statutory requirements; demands from their insurers, their regulatory agency , shareholders, stakeholders and unions; to protect staff,

4672-572: The risk levels. Even with a well documented and well practised procedure using trained staff, there is still the potential for events to spiral out of control, often due to unpredicted scenarios or a coincidence of events. There are many well documented examples of this such as: Three Mile Island accident , the Chernobyl disaster and the Deepwater Horizon drilling platform explosion in April 2010. In

4745-400: The specified purely bedside tests have the power to diagnose true and total death of the brainstem, the necessary condition for the assumption of permanent loss of the intrinsically untestable consciousness-arousal function of those elements of the reticular formation which lie within the brainstem (there are elements also within the wider brain). Knowledge of this arousal system is based upon

4818-399: The specified testing is stringent enough to determine that state. It is, however, associated with substantial risk of exacerbating the brain damage and even causing the death of the apparently dying patient so tested (see "the apnoea test" above). This raises ethical problems which seem not to have been addressed. It has been argued that sound scientific support is lacking for the claim that

4891-474: The state defined by those same criteria – then thought sufficient for a diagnosis of brain death – "means that the patient is dead". Death certification on those criteria has continued in the United Kingdom (where there is no statutory legal definition of death) since that time, particularly for organ transplantation purposes, although the conceptual basis for that use has changed. In 1995, after

4964-438: The user along the defibrillation process. It also checks the victim's condition to automatically apply electric shocks at the correct level, if they are needed. Other models are semi-automatic and require the user to push a button before an electric shock. A defibrillator may ask for applying CPR maneuvers , so the patient would be placed lying in a face up position. Additionally, the patient's head would be tilted back, except in

5037-465: The ventilator in the form of agonal gasps . No testing of testable brain stem functions such as oesophageal and cardiovascular regulation is specified in the UK Code of Practice for the diagnosis of death on neurological grounds. There is published evidence strongly suggestive of the persistence of brainstem blood pressure control in organ donors . A small minority of medical practitioners working in

5110-448: The victim is a child. It can be difficult to determine the presence or absence of a pulse, so the pulse check has been removed for common providers and should not be performed for more than 10 seconds by healthcare providers. For untrained rescuers helping adult victims of cardiac arrest, it is recommended to perform compression-only CPR (chest compressions hands-only or cardiocerebral resuscitation, without artificial ventilation ), as it

5183-403: The victim. The best position for CPR maneuvers in the sequence of first aid reactions to a cardiac arrest is a question that has been long studied. As a general reference, the recommended order (according to the guidelines of many related associations as AHA and Red Cross) is: If there are multiple rescuers, these tasks can be distributed and performed simultaneously to save time. The reason

5256-405: Was emphasized. The order of interventions was changed for all age groups except newborns from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB). An exception to this recommendation is for those believed to be in a respiratory arrest (airway obstruction, drug overdose, etc.). The most important aspects of CPR are: few interruptions of chest compressions,

5329-470: Was the "irreversible loss of the capacity for consciousness, combined with irreversible loss of the capacity to breathe". It was stated that the irreversible cessation of brainstem function will produce this state and "therefore brainstem death is equivalent to the death of the individual". In the UK, the formal rules for the diagnosis of brainstem death have undergone only minor modifications since they were first published in 1976. The most recent revision of

#387612