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CARDIOPULMONARY RESUSCITATION
Start CPR immediately if there are no signs of life:
commence external cardiac massage
commence assisted ventilation.
External cardiac massage
Place the heel of one hand in the centre of the patient’s chest. Place the heel of the other hand on top, interlocking the fingers. Keeping the arms straight and applying a vertical compression force, depress the sternum 5–6 cm at a rate of at least 100 compressions/min (but not exceeding 120/min):release all the pressure on the chest without losing contact with the sternum after each compression do not apply pressure over the upper abdomen, lower end of sternum or the ribs, and take equal time for compression and for release.
Perform 30 compressions, which should create a palpable femoral pulse.
Use a one- or two-hand technique to compress the lower half of the sternum in small children by approximately one-third of its depth, at a rate of at least 100 compressions/min but not greater than 120/min:
use the tips of two fingers in infants, also at a rate of at least 100/min.
Warning: avoid using excessive or malpositioned force causing rib fractures, flail chest, liver lacerations, etc.
Assisted ventilation
Open the airway again using head tilt and chin lift.
Start mouth-to-mouth/nose or mouth-to-mask respiration without delay if breathing is absent, using a pocket mask such as the Laerdal.
Deliver two effective rescue breaths that should be completed within 5 s total time, and immediately resume compressions.
Use a bag-valve mask setup such as an Ambu or Laerdal bag with oxygen reservoir attached and face mask instead, if trained in the technique quickly look in the mouth and remove any obstruction with forceps or suction. Leave well-fitting dentures in place or try inserting an oropharyngeal (Guedel) airway if necessary check for leaks around the mask or convert to a two-person technique if the chest fails to inflate consider possible obstruction of the upper airway, if ventilation is still ineffective.