Common pitfalls in CPR certification exam: tips & guidance

Ahmed Raza

Reviewed by Jessica Munoz DPN, RN, CEN

Hands-only CPR is indicated in

In many emergencies, like a cardiac arrest 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 oxygenated blood until medical treatment can restore normal cardiac rhythm. Hands-only CPR (compression-only) reduces the time to initiate CPR and results in more chest compressions with fewer interruptions for the first few minutes of cardiac arrest. According to the AHA ECC Committee, delivering high-quality chest compressions (adequate rate and depth with minimal interruptions) will benefit all victims of cardiac arrest. In cases such as airway obstruction, drowning, drug overdose, trauma, and pediatric cardiac arrest, conventional CPR with rescue breaths is recommended rather than hands-only CPR. Hands-only CPR is primarily recommended for adults and teenagers in sudden cardiac arrest of likely cardiac origin and is less effective for asphyxial causes of arrest.

Cardiopulmonary resuscitation (CPR) is a combination of techniques designed to pump the heart, keep blood circulating in the body, and deliver oxygen to the brain until medical help arrives. CPR is most effective when provided promptly. CPR should be immediately provided to the person who shows no signs of life, is unresponsive, or does not have normal breathing. Brain injury can begin within about 4 to 6 minutes without oxygen, and irreversible brain damage may occur within minutes if CPR is not provided. If a person is not breathing, gasping, or having irregular breathing, provide immediate CPR. In trained healthcare providers, pulse checks should be performed, but should not delay CPR. For lay rescuers, pulse checks are not recommended; instead, CPR should begin if the person is unresponsive and not breathing normally (or only gasping). CPR must be initiated without delay to improve survival.

AED

An AED checks the cardiac rhythm and, if needed, delivers a shock to help restore a normal rhythm in a person experiencing sudden cardiac arrest (SCA). The shock is intended to terminate life-threatening rhythms such as ventricular fibrillation or pulseless ventricular tachycardia, allowing the heart’s normal rhythm to resume if possible. The device is battery-operated, lightweight, and portable, and it uses adhesive electrode pads placed on the patient’s chest. The AED analyzes the victim’s cardiac rhythm and determines whether defibrillation is needed. If a shock is advised, the device charges automatically and provides voice prompts to guide the rescuer to deliver the shock safely. The shock briefly depolarizes the heart muscle, which may allow the heart’s electrical system to re-establish an organized rhythm. Recorded instructions continue to guide the user throughout 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 suspected spinal injury, to open the airway, use the jaw-thrust maneuver without head tilt to minimize cervical spine movement.

Mouth-to-mouth ventilation

During the COVID-19 pandemic, CPR may generate aerosols, so appropriate personal protective equipment (PPE) should be used when available, especially in suspected or confirmed cases. Mouth-to-mouth ventilation is not recommended for untrained bystanders; trained rescuers should provide ventilations using a bag-mask device or barrier when indicated.

If the patient is unresponsive and not breathing normally, CPR should be initiated immediately. Trained providers should provide compressions with ventilations; untrained bystanders may perform hands-only CPR in adult sudden cardiac arrest. The use of a bag-valve mask or barrier device is recommended for 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.nhlbi.nih.gov/health/defibrillators
4. https://www.aans.org/patients/conditions-treatments/spinal-cord-injury/
5. https://www.mayoclinic.org/first-aid/first-aid-spinal-injury/basics/art-20056677
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC6180674/
7. https://www.semanticscholar.org/paper/44-%E2%80%93-Airway-Management-in-the-Adult-Artime/52ac0e3e364ea497192b137050a9bb28caa15edf
8. https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.I-22
9. https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.I-253