WHY CPR?

Cardio Pulmonary Resuscitation (CPR) has been around quite some time now. Actual methods to help people stay alive through resuscitation date back to the 18th century but two doctors successfully developed a process they called CPR in 1954. Teaching it to the public began in the ‘70’s. CPR was developed around a medical concept that is known as the A B C’s. This stands for Airway, Breathing and Circulation. These three aspects of a human’s condition determine if CPR is necessary. Today we teach that one performs CPR when a “victim” in unconscious and not breathing. Formerly the pulse was checked to go along with these components. This is no longer the case. CPR is a physical process. It is often exhausting for the person performing it. However it is a skill that ANYONE can, and should, learn. The basic steps for CPR can be broken down into 4 Steps. The steps never change and should always be followed in the order given below. 1) Make sure that the area is safe for you to enter and offer assistance. It is of no use to risk making yourself a victim also. 2) Check the victim to see if they are conscious or not. 3) If the victim is unconscious you must immediately notify your emergency response system. In many areas this means instructing someone to call 911. You also want someone to try and find an AED (Automated External Defibrillator). If no one is available to send to accomplish these tasks you must call the emergency response number yourself and get an AED if you know where one is. 4) Once the call for help and the AED are accomplished we now go to our A (airway), B (breathing),C’s (circulation) steps: a) OPEN THE AIRWAY. When a person is unconscious (we have already determined this in Step 2) and lying on their back (which is how we want them positioned) the tongue will fall to the back of the throat and block the airway. We perform a simple maneuver called the“head tilt, chin lift” to relieve the obstruction of the tongue. This is simply done by placing one hand on the victim’s forehead and two fingers of the other hand under the jaw bone, being careful not to push on soft tissue. Then tilt the head back and lift the jaw to lift the tongue off the back of the throat. b) CHECK FOR BREATHING. As you perform the head tilt/chin lift you place an ear just over the person’s mouth. You will take 5 seconds to look at the chest to see if it is moving. You will also be listening for breaths from the mouth and feeling against the side of your face for breaths from the nose and mouth. If the person is breathing place them on their side and wait for trained help to arrive. If the person is NOT breathing go to the next step…. c) GIVE 2 BREATHS. Always maintain that open airway with the head tilt/chin lift. Giving two breaths helps give oxygen to someone when they are not breathing and can aid in their resuscitation. Giving breaths should only be done with a “barrier device” in order to keep you safe. Remember the first step is your safety. You learn about barrier devices in a CPR class. Some classes will have various types available for practice and purchase. They generally range from $5.00 to $20.00. d) BEGIN CPR. If the person is not breathing at this point. Remove all clothing that covers the chest. Begin compressions by doing 30 and then do a head tilt/chin lift and give two breaths. You will repeat 30 compressions and 2 breaths until the victim starts breathing or help arrives. The techniques of CPR are simple enough to describe in print for you to read. Taking a CPR class is important because you get specific guidance from a trained instructor to help you through the process and ensure you understand the mechanics properly. How do we do CPR? As stated earlier you do thirty compressions and 2 breaths over and over. The compressions require a great deal of pressure to be effective. The process is tiring. To properly perfuse (deliver through a person’s body the correct amount of blood and oxygen) properly you must compress the chest approximately 1 ½ to 2 inches. Throw out everything you have seen in TV shows and movies. They do not do CPR even closely resembling what is needed. You must be extremely aggressive when you push on the chest to achieve the compression of 1 ½ to 2 inches. Each time you press down you need to take the weight off of your hands to allow the chest to come back to its normal position. This will allow the chest to fill with enough blood for you to perfuse on the next press down. You do these compressions at the rate (speed) of approximately 100 per minute. A good way to learn what 100 per minute is is to practice tapping to the Bee Gee’s “Stayin’ Alive.” This hugely popular song from the 1970’s is 103 beats per minute. Perfect for CPR. So, as I always tell my classes, if you want to help someone to be stayin’ alive do your compressions to “Stayin Alive”. After you reach 30 compressions (counting out loud is important here) you quickly do a head tilt/chin lift and give two breaths (using a barrier device). After the 2nd breath quickly go back to compressions and keep repeating the sequence. WHY CPR? When you either witness or find an adult who is unconscious and not breathing the likelihood of cardiac arrest is either present or imminent. Cardiac arrest IS NOT a heart attack. When a person suffers a heart attack they are usually conscious and breathing. A blocked artery in the heart causes the pain they feel. The blocked artery does not allow blood through and since blood carries oxygen no oxygen gets through. Every cell in our body needs oxygen to survive. Tissue death starts occurring around that blocked artery. This is the cause of the pain a person feels. If there is enough tissue death the heart will cease to function and death will result. This person needs immediate hospital care and likely surgery to get blood and oxygen to the portion of the heart that is being deprived of it. This is often done by angioplasty or bypass surgery. When a person suffers cardiac arrest they suffer a condition where their heart just stops. This is often caused by a condition known as ventricular fibrillation. When VF is present we have a fibrillating heart. The cure for this would be DEFIBRILLATION. When a person’s heart stops the brain has about 4-6 minutes before brain death will occur. Our bodies lose 11% of our capacity to survive, when there is no circulation, every 60 seconds. Unless early CPR occurs, along with early defibrillation the person stricken with cardiac arrest will not survive. Think about anyone you know who suffered a heart attack, stroke or cardiac arrest. Think about where they were when it occurred. Likely it was not in a medical setting. Being able to recognize and react to sudden emergencies is vital in the efforts to cut down on the fatalities from SCA (Sudden Cardiac Arrest). SCA is the nation’s largest killer with over 350,000 dying each year in the United States. Of that number approximately 7,000 are children. Cardiac arrest can just happen without any prior knowledge or awareness of a condition. It is not related to age as heart attack so often is. Statistics show Seattle Washington as the role model we should all strive to be like. It is said that if you live in Seattle you have a 5x better chance of surviving a cardiac arrest episode. The primary reason is more people trained (great community based CPR training) and more AED’s per capita available in public situations. The statistics further state that if we could expand the Seattle model nationwide we would save somewhere around 15,000-25,000 lives each year. Over the years we have let people believe that calling emergency services is the best course of action. Now we have to retrain people to realize that their actions to assist in an emergency will often mean the difference between life and death. By the time a professional responder gets to the scene the person suffering an SCA (also known as sudden death) episode will be too far gone for resuscitation to have any effect. Early CPR and early defibrillation is the only answer. Early CPR will help keep organs alive (the brain, heart, lungs etc) hopefully until an AED can get to the scene. It does this by circulating blood and oxygen that cannot be circulating as the heart has stopped pumping. CPR does not restart the heart. The electric shock from an AED can. AED’s (Automated External Defibrillators) are so simple to use a young child can be taught to use it successfully. However, an AED needs to be used in conjunction with CPR to be effective. The first defibrillation occurred in 1947. The first closed chest (outside of the operating environment) occurred in 1956. The first time a patient received a shock without the presences of a doctor was in an ambulance in Belfast in 1969. AED’s today are extremely easy to use and one CANNOT make an error. All you have to do is remember to TURN THE AED ON. Once it is turned on it will prompt you with voice instruction. What you do after pressing the on/off button is put the pads on the victim. The pads have pictures to show you where to place them. Once they are on the patient and connected to the AED (some require you to plug them in which is evident if the pads are packaged separately and not previously attached to the AED) you clear the area to let the AED analyze the heart rhythm. The AED tells you to do this. The AED will then either come back with a “shock advised” message or a “no shock advised message.” If it finds a rhythm that can be shocked it will tell you when to push the shock button. You can push the shock button until you are blue in the face and you CANNOT issue a shock by accident. The AED must find a shockable rhythm and then will instruct you when to push the flashing button and issue the shock. Unless the person begins breathing or regains consciousness you will be told to begin CPR. Two minutes later the AED will tell you it is analyzing the heart again. You stop and let it analyze. The AED will again instruct you what to do. This will be the repeated routine for the AED. Analyze the heart rhythm (you clear the area of people so no one touches the victim), then it will issue a message to shock or not to shock and tell you to begin CPR for two minutes. After two minutes this process once again and you will continue repeating this sequence until trained help arrives. A well constructed CPR course will help you to understand the elements of safety that you should follow when doing CPR. It’s easy. Mostly common sense. A good course will also help you realize how hectic it can be when a situation arises and prepare you to maintain your composure. A good course will also help you understand the legal elements and why it is not possible to be held liable for anything. According to the American Safety and Health Institute, there is no evidence of a successful lawsuit in the United States against anyone having performed first aid for anyone in good faith. Get involved. As we say at HealthSav, “Learn CPR…Become A Lifesaver. Lenny Nathan President HealthSav 7 Elmwood Drive New City NY 10956 1 877 CPR N AED (277 6233) www.healthsav.com