CPR arid Asth 8

What Everyone Should Know!

By Holly Jarek, RN, MS

ost people have heard the term CPR--perhaps referred to on a

, ~ . ~ medical drama television show. But what exactly is CPR and how is it used? Can it be helpful in the event of an asthma emergency?

CPR is the abbreviation for cardiopul- monary resuscitation. It is an emergency procedure that can be employed without special equipment--by anyone who is pre- sent when a person's breathing and heart have stopped. It is a technique that, when done properly, can keep the essential oxy- gen supply circulating through a person's body until emergency medical help arrives.

CPR is taught to people around the country in local settings, such as schools, hospitals and community centers. A CPR course takes only a few hours to complete, yet it trains people to be able to help in a variety of emergency medical situations, such as a heart attack, stroke, shock,

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drowning, or even in the case of a life-threatening asthma episode, where the person has stopped breath- ing.

Fortunately, most people will never have the need to administer or be the recipient of CPR due to an acute asthma episode. Such an event is rare. However, people with asthma, their family members and caretakers should be aware of the possibility of a severe or life-threatening episode and know what steps to take if such an event were to occur. If breathing stops completely due to asthma, CPR should be started immediately.

W h o I s a t R i s k f o r L i f e - T h r e a t e n i n g A s t h m a ?

Anyone who has asthma is at some risk of having a severe asthma episode, although the risk increases with the increased severity of the dis- ease. In some cases, asthma severity can be difficult to judge; there can be a lack of predictability with asthma. Some people experience severe episodes separated by long periods of normal lung function or only mild symptoms. Other people with asthma will never experience a severe episode.

According to the National Institutes of Health, certain people are at higher risk for a fatal or near- fatal asthma episode. Those at risk include people who have a past histo- ry of sudden, severe exacerbations; those who have had a prior admission to an intensive care unit due to asth- ma; or those who have had two or more hospitalizations for asthma within the past year.

Acute-onset asthma may be part of a severe allergic reaction known as anaphylaxis. Anaphylaxis is most commonly triggered by a severe aller- gic reaction to certain foods (such as peanuts, nuts or shellfish) or to cer- tain medications (most often antibi- otics). Research with children sug- gests that anaphylactic reactions tend to be more severe in those who also

have asthma. People whose asthma is brought on by exposure to aspirin or other non-steroidal anti-inflammat0ry drugs (NSAIDs), commonly known as "aspirin-sensitive asthma," also have a tendency to experience sudden and severe asthma episodes.

P r e v e n t i n g a n A s t h m a E m e r g e n c y

Of course, the best response to a severe asthma episode is to recognize it as such and get the person medical help before the situation becomes a crisis. It is important to be able to recognize signs or symptoms that may be an indication of imminent respira- tory arrest. They include the follow- ing: �9 Feeling drowsy or confused �9 Breathing using chest and stomach

muscles, so it appears that the chest is being sucked in with each breath and taking a deep breath is difficult

�9 Heart rate slowing down, below 60 beats per minute

�9 Hearing no wheezing; at this stage little or no air is moving through the airways, so there are no sounds

�9 Rescue medications not providing

immediate or sustained relief If any of these signs are present,

seek emergency help immediately. If breathing stops before you can get the person emergency care, CPR should be started at once.

W h a t I s C P R ?

There is a close relationship between the heart, lung and brain. When a person stops breathing, the heart con- tinues to beat for a short period of time. However, if there is no new oxygen being picked up by the blood as it passes through the lungs, the heart will soon stop.

The goals of CPR are to force oxygen into the lungs and create cir- culation for the heart. (It is also hoped that the lungs and heart will start functioning again on their own.) Specifically, CPR is performed by blowing air into the victim's lungs and pressing repeatedly on the vic- tim's chest (known as "compressions") to manually cause the heart to expand and contract, pumping the newly oxygenated blood. These respirations and compressions are delivered in a certain order and frequency, depend- ing on the victim's age and size.

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O v e r v i e w o f C P R S t e p s

CPR should be performed as soon as it is discovered that a person is not breathing or has no pulse (meaning that the heart has stopped). It should be continued until emergency med- ical assistance arrives, or until the vic- tim is breathing independently.

Note: The following guidelines are intended as an overview of the CPR technique, but should not be seen as a substitute for the thorough training that is given in a certified CPR course.

As~bssment: g~

Fir{t, the responder (the person doing tl';~ ~PR) determines that the victim is unresponsive. The victim cannot be aroused when shaken. The responder then activates the emergency medical system by calling the local emergency number--typically by dialing 911. In many areas of the country, emergency dispatchers who answer these calls are trained to assist callers with CPR by relaying to them step-by-step instruc- tions over the phone. It works best, when possible, to have two people available to help so one person can perform the CPR while the other relays the instructions coming from the dispatcher.

Airwa �9 ',y.

TEe vmtlms airway needs to be opened. The responder tilts the vic- tim's head back, with the face point- ing toward the ceiling. This position allows the airways to be open and helps to keep the tongue out of the way.

Breathing. The ~sponder pinches the victims n:'0:~t~*'rils closed to prevent air from leaking out. He or she takes a deep breath, seals the victim's mouth with his or hers, and brows out forcefully. The responder repeats this once more, watching the victim's chest rise and fall.

F Cirf~lation:

ponder checks the "carotid pulse~{o(felt in the artery on the side of the neck) to see if the heart is beat- ing. If not, compressions are started. These are done by applying pressure to the chest, which pushes on the heart. This forces blood out of the heart and through the circulatory sys- tem, thus supplying oxygen to the vital organs of the body.

Steps o f Compressions (on adults):

1. Move the victim to a flat surface. 2. Knee[ on one side of the victim,

keeping elbows straight and shoulders parallel directly over the victim's sternum.

3. Locate the correct spot on the victim's chest by measuring a two- to three-finger distance above the base of the breast bone.

4. Place the heel of the working hand on the spot with the heel of the second hand directly on top, interlacing fingers.

5. Apply sufficient downward pres- sure to depress the sternum. Release pressure to allow the heart to refill. (The rhythm, manner and depth of depressions are determined by the age and size of the victim, with children needing compressions done more rapidly and with less force than adults.)

After about one minute of alter- nating depressions and breathing, the responder checks to see if the breath- ing and heart beat have begun inde- pendently. If neither are present, he or she continues CPR. CPR must be continued until medical help arrives.

CPR can be a lifesaving proce- dure, not only in the case of respira- tory arrest due to severe asthma, but for anyone whose breathing and heart beat have stopped. Any lay person can be taught how to do this proce- dure correctly and effectively. Your local branch of the American Heart Association or the American Red Cross can instruct you as to where such courses are given in your area. No one wants to find themselves faced with an emergency medical sit- uation and not know how to react. Prepare yourself to help others by enrolling in a local CPR course today. There is no time like the present.

Holly Jarek, RN, MS, is the director of Home Care Services at Franciscan Children's Hospital in Boston, Massachusetts, where she is actively involved in developing patient educa- tion materials in the area of asthma management.

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