How to Do CardioPulmonary Resuscitation (CPR) on a Child.

Though CPR (cardiopulmonary resuscitation) should be administered by individuals trained at a certified first aid course, lay bystanders can also make a significant difference in the survival of children undergoing cardiac arrest. For youth under one year of age, follow infant CPR protocol and for adults, follow adult protocol. Basic CPR involves chest compressions, airway opening and rescue breathing. If you are not formally trained in CPR, it is recommended that you use compression-only. Child CPR could be divided into two parts such as:

Part : 01	Part :02
Check the scene for danger Check the victim for consciousness  Check the victim's pulse for consciousness Understand the importance of reacting quickly.	Perform CPR for two minutes Remember CAB Position your hands for the compressions Perform 30 compressions Make sure airway is open Give two rescue breaths Repeat the cycle of 30 chest compressions and two breath USE an AED

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Part 01	: Assessing the Situation
1.1	: Check The Scene for danger

If you come across someone who is unconscious, you need to quickly make sure there are no dangers to yourself if you choose to help them. Is there a car exhaust running? A gas stove? Is there a fire? Are electrical lines down? If there is anything that could endanger you or the victim, see if there is something you can do to counteract it. Open a window, turn off the stove, or put out the fire if possible. 

• However, if there is nothing you can do to counteract the danger, move the victim. The best way to move the victim is by placing a blanket or a coat underneath her back and pulling on the coat or blanket. 
• If there is a chance the person has suffered a spinal injury two people should move her to prevent any twisting of the head and neck. 

1.2	: Check the victim for consciousness

Shake or tap his shoulder and saying in a loud, clear voice, "Are you okay? Are you okay?" If he responds, he is conscious. He may have just been sleeping, or he could have been unconscious. If it still appears to be an emergency situation — for example, he is having trouble breathing or he appears to be fading in between consciousness and unconsciousness — call for help and begin basic first aid and take measures to prevent or treat shock

1.3	: Check the victim's pulse for consciousness

If the child is unresponsive, the first thing to do is check her pulse. If the child does not respond, you need to begin CPR immediately. Do not check the pulse for more than 10 seconds. If the victim does not have a pulse, her heart is not beating and you will be required to perform chest compressions. 

• To check the neck (carotid) pulse, feel for a pulse on the side of the victim's neck closest to you by placing the tips of your first two fingers beside the Adam's apple. (Be aware that the Adam's apple is usually not visible on a female, and may not even be very visible on a boy who has not yet gone through puberty.)
• To check the wrist (radial) pulse, place your first two fingers on the thumb side of the victim's wrist.
• Other pulse locations are the groin and ankle. To check the groin (femoral) pulse, press the tips of two fingers into the middle of the groin. To check the ankle (posterior tibial) pulse, place your first two fingers on the inside of the ankle

1.4	: Understand the importance of reacting quickly

If you see someone whose heart has stopped beating or has stopped breathing, reacting quickly and performing rescue breathing and CPR could save his life. When someone starts CPR before an ambulance arrives, the patient has a considerably better chance of surviving. Being able to respond quickly by performing CPR, which can help get oxygenated blood back flowing to the brain, is essential.

• If the person has a pulse but is not breathing, only perform rescue breathing, not chest compressions. 
• A human brain can typically go for around four minutes without oxygen before suffering permanent brain damage. 
• If the brain goes without oxygen for between four and six minutes the chances of brain damage rise.
• If the brain lacks oxygen for six to eight minutes brain damage is probable. 
• If the brain is without oxygen for over ten minutes, brain death is probable.

Part 02	: Performing CPR on Child
2.1	: Perform CPR for two minutes

Once you have quickly assessed the situation and checked the consciousness and circulation of the victim you need to act very quickly. If there is no pulse you must begin CPR immediately, and continue it for two minutes (which is about five cycles of CPR) and then call for Emergency Medical Services. 

• If you are alone it is important to start CPR before calling for help. 
• If someone else is there send them for help. If you are alone, do not call until you have completed two minutes of CPR. 
• Dial your local emergency number.

2.2	: Remember CAB

CAB is the basic process of CPR. It stands for Chest Compressions, Airway, and Breathing. In 2010, the recommended sequence changed with chest compressions placed before airway opening and rescue breathing. Chest compressions are more critical for correcting abnormal heart rhythms (ventricular fibrillation or pulseless ventricular tachycardia), and because one cycle of 30 chest compressions only requires 18 seconds, airway opening and rescue breathing are not significantly delayed. 

• Chest compressions or hands-only CPR is recommended if you have not been properly trained or are worried about performing mouth-to-mouth resuscitation on a stranger.

2.3	: Position your hands for the compression

When performing CPR on a child the positioning of your hands is especially important, given that a child will be more fragile than an adult. Locate the child's sternum by moving two fingers to the bottom of the rib cage. Identify where the lower the ribs meet in the middle and then place the heel of your other hand on top of your fingers. Just use the heel of this hand to do the compressions.

2.4	: Perform 30 compressions

Compress the chest, with elbows locked, by pushing straight down about 2 inches (5.1 cm) deep. The smaller body of a child needs less pressure than an adult would. If you begin to hear or feel a cracking sound that may indicate that you are pushing too hard. Continue, but apply less pressure with the compressions. Do 30 of these compressions, and do them at a rate of at least 100 compressions per minute if you are the only rescuer.

• Allow complete chest recoil after each compression. 
• Minimize pauses in chest compression that occured when changing providers or preparing for a shock. Attempt to limit interruptions to less than 10 seconds.
• If there are two rescuers, each should complete a round of 15 compressions.

2.5	: Make sure airway is open

Place your hand on the victim's forehead and two fingers on his chin. Lift the chin gently with the two fingers while carefully pushing down on the forehead with your other hand. If you suspect a neck injury, gently pull the jaw upward rather than lifting the chin. Once you have done this you should look, listen and feel for breathing.

• Put your ear close to the victim's mouth and nose and listen carefully for any signs of life. 
• Watch for chest movement and feel for any breath on your cheek.
• If there are no signs of life, place a breathing barrier (if available) over the victim's mouth.

2.6	: Give two rescue breaths

Keeping the airway open, take the fingers that were on the forehead and pinch the victim's nose closed. Make a seal with your mouth over the victim's mouth and breathe out for about one second. Make sure you breathe slowly, as this will make sure the air goes in the lungs not the stomach. Make sure you keep your eye on the victim's chest.

• If the breath goes in, you should see the chest slightly rise and also feel it go in. If the breath goes in, give a second rescue breath.
• If the breath does not go in, reposition the head and try again. If it does not go in again, the victim may be choking. You'll need to do more chest compressions in this case. Keep in mind abdominal thrusts (the Heimlich manuever) should only be performed on someone who is conscious.

2.7	: Repeat the cycle of 30 chest compressions and two breath

You should do CPR for two minutes (five cycles of compressions to breaths) before checking for signs of life, a pulse or breathing. Continue CPR until someone takes over for you; emergency personnel arrive; you are too exhausted to continue; an AED is attached, charged, and the person running it asks you to clear the body; or pulse and breathing return.

• Don't forget to call the emergency services after the first two minutes of CPR. 
• After you call them, continue to administer CPR until they arrive.

2.8	: USE an AED

If an AED becomes available, turn on the AED, place the pads as instructed (one over the right chest and another over the left side). Allow the AED to analyze the rhythm, and give one shock if indicated, after clearing everyone from the patient (yell "CLEAR!" first). Resume chest compressions immediately after each shock for another 5 cycles before reassessing.

• If the victim begins breathing, gently manoeuvre them into the recovery position.

TIPS

•  Always call Emergency Medical Services.
• If you must move the victim, try to disturb the body as little as possible.
• You can get guidance on correct CPR technique from an emergency services operator if needed.
• If you are unable or unwilling to perform rescue breathing, engage in compression-only CPR with the victim. This will still aid the victim in recovering from cardiac arrest.
• Get proper training from a qualified organization in your area. Training from an experienced instructor is the best way to be prepared in an emergency.
• Don't forget to place your hands in the middle of the breastbone at the level of the nipples.

সিরাজগঞ্জ হার্ড পয়েন্ট কিন্তু এখন আর হার্ড নেই

মিজানুর রহমান

স্যোস্যাল এন্ড ইন্সটিটিউশনাল এক্সপার্টৃ

জাতীয় ভূমি জোনিং প্রকল্প, ভূমি মন্ত্রনালয়

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বেশীদিন আগের কথা নয়, সেই মার্চ ২০১৬ এর মাঝামাঝি। শীতের আমেজটা পুরাপুরি যায়নি। অফিসিয়াল কর্মশালায় সিরাজগঞ্জ গেলাম, সাথে প্রকল্প পরিচালক ও অতিরিক্ত সচিব জনাব কফিল উদ্দিন স্যার ছাড়াও আরো ছয় (০৬) সহকর্মী। আমাদের টিমে এনভায়রনমেন্ট স্পেশালিস্ট ড. গোলাম মাহবুব সরওয়ার, রিসার্স এ্যাসিসটেন্ট মাজেদুল ইসলামা ও প্রোগ্রাম অর্গানাইজার বেলাল। জেলা প্রশাসক মহোদয়ের আতিথিয়তায় সার্কিট হাউসে থাকার ফাইনাল হলো। আকষ্মিক বন্যার মত মন্ত্রি মহোদয়ের সিরাজগঞ্জ সফরের বার্তায় সরকারী অফিসের যা হয় তাহাই হলো; আমাদের স্থান হলো হার্ড পয়েন্ট পার্শ্ববর্তী পানি উন্নয়ন বোর্ডের বাংলোয়। ভালই হলো কাছ থেকে সকাল সন্ধ্যা যমুনা নদীর প্রাকৃতিক সৌন্দর্য্য উপভোগ করার সুযোগ হলো। খুব ভোরবেলা ঘুম থেকে উঠে যমুনার তীর ঘেষে পূর্বদিকে হাটতে থাকলাম। কূয়াশা এখনো কাটেনী, মাত্র ৫ মিনিট কদম ফেলতেই হার্ড পয়েন্টে এসে পড়লাম। ওকি! ইতিমধ্যে ২ জোড়া হার্ট সুর্যকে স্বাগতম জানানোর জন্য এখানে এসে উপস্থিত। 

হার্ড পয়েন্ট নয় হার্ট পয়েন্ট

 এর মধ্যে ১ জোড়ার আয়োজন দেখে মনে হচ্ছে তারা মনে হয় আরো মিনিট ১৫ আগে এসে অধোদেশদ্বয়কে এককরে সরকারের স্থাপিত ব্লকগুলির সর্বোত্তম নিশ্চিত করে সিরাজগঞ্জ পানি উন্নয়ন বোর্ডের ঋন শোধ করছে। আধুনিক এই ভালবাসার ফেরিওয়ালাদের সময় জ্ঞান, কমিটমেন্ট ও সময়ানোবর্তিতা দেখে আমি মুগ্ধ হলাম ও ভাবলাম দেশ মনে হয় সত্যি অনেক দুর এগিয়েছে। বাংলাদেশের সর্বত্র যদি এ তিনটি বিষয় বিরাজমান থাকতো তাহলে আমাদের অবস্থা যে আরো আগেই পরিবর্তন হতো তাতে কোন সন্দেহ নেই। ইতিমধ্যে আধুনিক দ্বিচক্রযান -ব্যাটারি চালিত, ফুলপ্যান্ট পরিহীত ড্রাইভার, এমপি থ্রি সুবিধা সমৃদ্ধ রিক্সা- যোগে জোড়ায় জোড়ায় প্রাতঃভ্রমন নয় প্রাত:প্রেম করার জন্য আসতে থাকলো। কারো হাতে স্কুল ব্যাগ ও বইপত্র দেখা যাচ্ছে। সহকর্মী বেলাল বললো আধুনিক ছওল-পওল তো স্যার! অবশেষে আমাদের প্রাতঃভ্রমন শেষ করে, তাহদের প্রাতঃপ্রেম দেখে বাংলোয় এসে জটপট রেডি হয়ে কাজীপুর উপজেলার কর্মশালায় যোগদান করার জন্য রওয়ানা হলাম। ফলে সকাল, দুপুর ও অপরাহ্নে হার্ড পয়েন্টের অবস্থা অবলোকন করা না গেলেও অনুধাবন করার দায়িত্ব আপনাদেরকে দিলাম। 

হার্ট পয়েন্টের একাংশ

 কাজের ব্যস্ততায় ও অফিয়াল কিছু ফর্মালিটি সম্পন্ন করতে গিয়ে ঐদিন আর বিকালবেলা হার্ড-পয়েন্টের দিক আর যাওয়া হয়নি। পরের দিন বিকালবেলা সহকর্মী বেলাল, মাজেদুল ও পরিবেশ বিশেষজ্ঞ ড. গোলাম সরওয়ারসহ হার্ড পয়েন্টে গেলাম। ও আল্লাহ... এ যে এলাহী কান্ড। যমুনা নদী শুকিয়ে খা খা অবস্থা, ধুসর বালুচড়ে আমাদের গ্রামের আলী আশ্ববের মাথার চুলের মত কাশিয়া গাছগুলি উকি-ঝুকি দিচ্ছে আর দুরের গ্রামগুলি যেন মনে হচ্ছে শিল্পির আকা কোন ক্যানভাস। পাতিলের তলা থেকে ঝিনুক দিয়ে উঠনোর মত তলানীতে ঠেকছে যমুনার পানি। অথচ মানুষের হৃদয়ে (হার্টে) যেন ১৯৯১ সালের ২৯ এপ্রিলের সমান উচু ও তীব্র জোয়ার, পাগল করা এতো বড় ঢেউ, এতো প্রেম জল, এতো আউলা আবেগ কেউ কাছ থেকে না দেখলে বিশ্বাস করতে চাইবেনা। সেলফি, কোলফি, ব্লকফি, নৌকাফি, ঘেষাফি ও পানিফি তোলার হিরিকতো আছেই। বাদাম,ফুচকা, চটপটি, ভ্রাম্যমান চা-কফিওয়ালাদের সংখ্যা ও ব্যস্ততা দেখলে আপনি অতিসহজে বুঝতে পারবেন এটা নিত্যদিনের ঘটনা। 

কুকুর বাদ যাবে কেন হার্ট পয়েন্টের রোমান্টিকতা থেকে

লও ঠেলা! দেখলাম ১ জোড়া কুকুর এই স্বর্নালী বিকালে একটু বেশীই রোমান্টিক হয়ে উঠলো। তবে তারা উপস্থিত মানব সন্তানদের তুলনায় একটু শালীনমোডেই ছিল বলে আমার মনে হয়েছে। ছোটকাল থেকে শুনে আসছি কুকুর-কুররীরা সাধারনত কার্তিক মাসের দিকে একটু বেশীমাত্রায় রোমান্টিক হয়। ফাল্‌গুন-চৈত্র মাসের অ-অশালীন রোমান্টিক হওয়ার কারণ হিসেবে বৈশ্বায়িক উষ্ণায়ন চেয়ে হার্ডমা পয়েন্টের মানুষের হৃদয়োষ্ণায়ন বেশী দায়ী বলে আমার বিশ্বাস। পৃথিবী সৃষ্টি হয় বিধাতার ভালবাসা দিয়ে, ভালবাসা ছিল যুগ-যুগ ধরে, ভালবাসা থাকবে কেয়ামত পর্যন্ত এমনকি কেয়ামতের পরেও হয়তবা। ভালবাসা প্রকাশের ধরণের পরিবর্তন হবে এটা স্বাভাবিক। সেই ভালবাসার আবেগ প্রকাশে করতে গিয়ে বিধাতার সর্বশ্রেষ্ট সৃষ্টি মানুষের কাতারে যেন আমার থাকি, এবং সেটা আমাদের থাকা উচিৎ। সিরাজগঞ্জ শহরকে রক্ষার জন্য দেশ-বিদেশ থেকে বড়-বড় পাথর এনে, ব্লক তৈরি করে খুব শক্ত করে(হার্ড করে) বাঁধ তৈরি করে এখানকার যে নাম দেয়া হয়েছিল হার্ড পয়েন্ট; সেই সিরাজগঞ্জ হার্ড পয়েন্ট এখন হার্ড নয়, হার্ট পয়েন্ট হয়ে গেছে।
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Cardiopulmonary Resuscitation (CPR) is a lifesaving tools for the Cardiac arrest Patient: How would a common people apply CPR.

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Md.Mizanur Rahman
Social and Institional Expert
National Land Zoning Project
Ministry of Land
email: info.mmizan@gmail.com

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As we are well aware of that cardiac arrest become very common in all over the world which caused the heart attack and sudden death. Cardiac arrest is the abrupt loss of heart function in a person who may or may not have diagnosed heart disease. In another word, is a sudden stop in effective blood circulation due to the failure of the heart to contract effectively or at all. Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that involves chest compressions and giving breaths. This technique can help keep oxygenated blood circulating in the body, which can help prevent brain and organ damage. CPR may be done when a person is showing signs of no breathing or does not respond when you tap them or ask if they are okay. If a person is not responding and has an advanced life-threatening illness (such as cancer) or is dying, CPR may not be the best option. It's important for the person, family members, and their doctor to talk about this issue early, before the need arises. When someone affected by cardiac arrest, he has nothing do by own but some general measure especially Cardiopulmonary resuscitation (CPR) by the people who are around him could save his life or reduce the severe damage of prime organ of the patient. Here are some CPR techniques are given:

How to apply CPR on an Adult CPR for Adult could be divided into five parts. ·          Taking Vitals ·          Administering CPR ·         Continuing the Process Until Help Arrives ·          Using an AED ·          Putting the Patient in Recovery Position

Part :1		Taking Vitals
	1.1	Check the scene or immediate danger

Make sure you're not putting yourself in harm's way by administering CPR to someone unconscious. Is there a fire? Is the person lying on a roadway? Do whatever is necessary to move yourself and the other person to safety. 

• If there is anything that could endanger you or the victim, see whether there is something you can do to counteract it. Open a window, turn off the stove, or put out the fire, if possible. 
• However, if there is nothing you can do to counteract the danger, move the victim. The best way to move the victim is by placing a blanket or coat underneath their back and dragging it

1.2	Assess the victim’s consciousness

Gently tap his or her shoulder and ask "Are you OK?" in a loud, clear voice. If he or she responds agreement "Yeah" or such, CPR is not required. Instead, undertake basic first aid and take measures to prevent or treat shock, and assess whether you need to contact emergency services. If the victim does not respond, continue with the following steps. 

1.3	Send for help

The more people available for this step, the better. However, it can be done alone. Send someone to call for emergency medical services (EMS).

• Give the dispatcher your location, and notify him or her that you're going to perform CPR

1.4	Do not check for a  pulse

Unless you're a trained medical professional, odds are you'll spend too much valuable time looking for a pulse when you should be doing compressions.

1.5	Check for breathing

And, make sure that the airway is not blocked. If the mouth is closed, press with your thumb and forefinger on both cheeks at the end of the teeth and then look inside. Remove any visible obstacle that is in your reach but never push your fingers inside too far. Put your ear close to the victim's nose and mouth, and listen for slight breathing.

If the victim is coughing or breathing normally, do not perform CPR.

Part :2		Administering CPR
	2.1	Place the victims on her or his back

Make sure he or she is lying as flat as possible - this will prevent injury while you're doing chest compressions. Tilt their head back by using your palm against their forehead and a push against their chin.

2.2	Place the heel of one hand of victim’s breath bone

Make sure 2 finger-widths above the meeting area of the lower ribs, exactly between the nipples.

2.3	Place your second hand on the top of the first hand

Make sure palm-down, interlock the fingers of the second hand between the first.

2.5	Perform 30 chest compression

Press down with both hands directly over the breastbone to perform a compression, which helps the heart beat. Chest compressions are more critical for correcting abnormal heart rhythms (ventricular fibrillation or pulseless ventricular tachycardia, heart rapidly quivering instead of beating).

• You should press down by about 2 inches (5 cm).

• Do the compressions in a relatively fast rhythm. Some agencies recommend doing compressions to the beat of the chorus of "Stayin' Alive," a 1970s disco hit, or at roughly 100 beats per minute.

  

Part:3		Continuing the Process Until Help Arrives
	3.1	Minimize pauses in chest compression

Continuing the Chest compressions that occur when changing providers or preparing for a shock. Attempt to limit interruptions to less than 10 seconds.

3.2	Make sure the airway is open

Place your hand on the victim's forehead and two fingers on their chin and tilt the head back to open the airway.

• If you suspect a neck injury, pull the jaw forward rather than lifting the chin. If jaw thrust fails to open the airway, do a careful head tilt and chin lift.
• If there are no signs of life, place a breathing barrier (if available) over the victim's mouth. 

3.3	Give two rescue breaths( optional)

As the chest compressions are more important. If you are trained in CPR and totally confident, give two rescue breaths after your 30 chest compressions. If you've never done CPR before, or you're trained but rusty, stick with only chest compressions

• Keeping the airway open, take the fingers that were on the forehead and pinch the victim's nose closed. Make a seal with your mouth over the victim's mouth and breathe out for about one second. Make sure you breath slowly; as this will make sure the air goes in the lungs and not the stomach.
• If the breath goes in, you should see the chest slightly rise and also feel it go in. Give a second rescue breath.
• If the breath does not go in, re-position the head and try again. If it does not go in again, the victim may be choking. Do abdominal thrusts (the Heimlich maneuver) to remove the obstruction.

  

3.4	Repeat the cycle of 30 chest compressions

If you're also doing rescue breaths, keep doing a cycle of 30 chest compressions, and then 2 rescue breaths; repeat the 30 compressions and 2 more breaths.

• You should do CPR for 2 minutes (5 cycles of compressions to breaths) before spend time checking for signs of life. 

3.5	Continue the CPR

Please continue CPR until someone takes over for you, emergency personnel arrives, you are too exhausted to continue, an Automated External Defibrillator (AED) is available for immediate use, or signs of life return.

Part :4		Using an AED
	4.1	Use an AED ( Automated External Definbrillator)

If an AED is available in the immediate area, use it as soon as possible to jump-start the victim's heart.

• Make sure there are no puddles or standing water in the immediate area.
• Turn on the AED. It should have voice prompts that tell you what to do.

  

4.2	Fully expose the victim’s chest.

Remove any metal necklaces or underwire bras. Check for any body piercings, or evidence that the victim has a pacemaker or implantable cardioverter defibrillator (should be indicated by a medical bracelet) to avoid shocking too close to those spots.

• Make sure the chest is absolutely dry and the victim is not in a puddle. Note that, if the person has a lot of chest hair, you may need to shave it, if possible. Some AED kits come with razors for this purpose. 

4.3	Attach the sticky pads with electrodes the victim’s chest

Follow the instructions on the AED for placement. Move the pads at least 1 inch (2.5 cm) away from any metal piercings or implanted devices.

• Make sure no one is touching the person, when you apply the shock.
•  Press analyze on the AED machine. If a shock is needed for the patient, the machine will notify you. If you do shock the victim, make sure no one is touching him or her. 

4.4	Do not remove the Pads

Do not remove pads from the victim and resume CPR for another 5 cycles before using the AED again. Stick on adhesive electrode pads are intended to be left in place.

Part :5		Putting the patient in the recovery position
	5.1	Position the patient ( Position 01)

Please position the patient ONLY after the victim has been stabilized and is breathing on his/her own.

5.2	Flex and raise one knee joint

Flex and raise one knee joint, push the victim`s hand that's on the opposite side from the raised knee, partially under the hip with the straight leg. Then position the free hand onto the opposite shoulder, and roll the victim onto the side with the straight leg. The raised knee/bent leg is on top and helps stop the body from rolling over onto the abdomen. The arm with the hand tucked under the edge of the hip is kept from sticking out in the way when rolling the patient onto that side.

5.3	Use the recovery position to help the victim to breath more easily

This position keeps saliva (spit) from accumulating in the back of the mouth or throat, and helps the tongue to hang to the side without it falling/flopping into the back of the mouth and obstructing the airway.