Common pitfalls in CPR certification exam: Tips & guidance

Ahmed Raza

Reviewed by Jessica Munoz DPN, RN, CEN, providing nurse training at Yale New Haven Health-Bridgeport Hospital since 2022. Previously in healthcare and education at Griffin Hospital, St. Vincent's College of Nursing and Sacred Heart University Medical Center.

Hands-only CPR is indicated in

In many emergencies, like a cardiac attack or near drowning, where a person’s breathing or heartbeat has stopped, cardiopulmonary resuscitation (CPR) proves to be a useful and lifesaving technique. By providing proper CPR, the brain and other vital organs can receive a supply of oxygenated blood until medical treatment can restore the normal cardiac rhythm. Hands-only CPR (compression-only) reduces the time to initiate CPR and result in more chest compressions with fewer interruptions for the first few minutes of cardiac arrest. According to the AHA ECC Committee, the delivery of high-quality chest compressions (adequate rate and depth of compressions with minimal interruptions) will benefit all victims of cardiac arrest. In some cases like airway obstruction, acute respiratory diseases, trauma, a victim of drowning, pediatric victims, and apnea (associated with drug overdose), additional interventions taught in a conventional CPR course are required. Hands-only CPR can adversely affect victims of asphyxial arrest and pediatric victims if incorrectly applied.

Prior to beginning compressions

Cardiopulmonary resuscitation (CPR) includes a combination of techniques, designed to pump the heart to keep the blood circulating in the body and delivering oxygen to the brain until medical help arrives. CPR is most effective when provided as promptly as possible without delay. CPR should be immediately provided to the person who shows no signs of life, is unresponsive, or does not have normal breathing. It takes only 3 to 4 minutes for the person’s brain to be dead due to the inadequate supply of oxygen if no CPR is provided. If a person is not breathing, gasping or having irregular breathing provide immediate CPR. It is not important to find the pulse in a person who is not showing any signs of life as it is sometimes difficult to find the pulse. CPR must be initiated without any delay to elevate the survival rate.

AED

An AED checks the cardiac rhythm, and if needed, sends a shock to the heart to restore normal rhythm which helps in saving lives of people having a sudden cardiac arrest (SCA). The shock can restore normal rhythm after SCA and can possibly stop an abnormal heartbeat (arrhythmia). The device is battery-operated, lightweight, portable, and contains electrodes (i.e, sticky pads with sensors) that are attached to the chest of the patient witnessing cardiac arrest. Use of the correct approach to AED pad placement checks the victim’s cardiac rhythm by a built-in computer. The computer then finds out whether defibrillation is needed or not. If defibrillation is needed then AED will charge automatically and a recorded voice prompts the rescuer to press the shock button on the device. This shock temporarily stops all activity and stuns the heart, giving the heart a chance to restore normal rhythm. Recorded instructions guide the user through the process.

Spinal injury following blunt force trauma

Direct contact of a blunt object with the body causes blunt impact injury. An external or internal hemorrhage may be caused by blunt trauma depending upon its location and mechanism. Spinal cord injuries (SCI) are mostly caused by trauma to the vertebral column, thus affecting the spinal cord’s ability to send and receive messages from the brain to the body’s systems that control motor, sensory, and autonomic function below the level of injury. Though in the acute early stages of treatment, doctors focus on preventing further spinal cord damage by immobilizing your neck. In this case, to begin CPR if the person shows no signs of circulation (coughing, breathing, or movement) and to open the airway, use fingers to grasp the jaw gently and lift it forward.

Mouth-to-mouth ventilation

COVID-19 has the potential to be transmitted through the droplets and aerosols generated during chest compressions. It is recommended to use proper personal protective equipment (PPE) when in close contact with someone suspected to have COVID-19. It is not recommended to perform mouth-to-mouth ventilation due to the high risk of disease transmission.

If COVID-19 is not suspected and the patient does not have normal breathing, compressions should be initiated. The use of a bag valve mask or barrier device is recommended to provide rescue breathing.

Reference

1. https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600
2. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cardiopulmonary-resuscitation-cpr
3. https://www.heart.org/-/media/files/health-topics/answers-by-heart/what-is-an-aed.pdf
4. https://www.nhlbi.nih.gov/health/defibrillators
5. https://www.aans.org/patients/conditions-treatments/spinal-cord-injury/
6. https://www.mayoclinic.org/first-aid/first-aid-spinal-injury/basics/art-20056677
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180674/
8. https://www.semanticscholar.org/paper/44-%E2%80%93-Airway-Management-in-the-Adult-Artime/52ac0e3e364ea497192b137050a9bb28caa15edf
9. https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.I-22
10. https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.I-253