Who needs full CPR - breaths & compressions?

The easiest way to remember this is to think about what CPR accomplishes: it causes the oxygen-caring blood to circulate.

...and where does that oxygen come from?

1. There is some residual oxygen in your blood when you die;
2. There is some residual air in your lungs when you finish exhaling;
3. Some air will move in and out of the lungs when you perform chest compressions, particularly if you can get the victim's head into the "sniffing position." [Sniff to see if you can smell something. Freeze. That's the sniffing position.]

So what about the person who drowned? That person used up every shred of residual air in the lungs and nearly every shred of residual oxygen in their blood. They will get a little bit of air in-and-out of the lungs as you perform chest compressions, but not a lot. They could really use a little help in the oxygen department.

And what about the child who arrested, whether or not they drowned? The residual air in the lungs doesn't help a lot, because their lungs are so small. The amount of air that is going to go in and out with chest compressions is very small compared to their need. And children "compensate" very well - they won't have much residual oxygen in their blood stream when they arrest. They also could really use a little help in the oxygen department.

Personally, I don't have a problem doing mouth-to-mouth CPR on any young child I've just pulled out of a pool. You're blowing in, not sucking out, after all. What you really want to watch out for is doing mouth-to-mouth without a barrier device on someone who perhaps bit his tongue when he fell down in cardiac arrest and has blood flowing out of his mouth. That's when - as a bystander - the "If it's not safe, don't do it!" rule ought to occur to you. On the ambulance, we have a duty to respond. When you have a duty to respond, you don't have the protection of a Good Samaritan law, and you don't have a choice regarding whether the victim is going to get mouth-to-mouth or not.

One last point: if you position a toddler on his or her back on the floor, the disproportionately large back of the head will cause the head to tilt "chin-down" and thus effectively pinch off the air path to the lungs. You may have to improvise, but to maintain a viable airway in those victims, a phone book under the shoulder blades will really help, unless you are from a really small town, in which case two phone books might be needed. The nice thing about phone books is that they are not compressible.

Bob

A hard, flat surface and how to get the patient onto it.

CPR saves lives because chest compressions cause blood to circulate in the cardiovascular system until the heart gets re-started. Without the oxygen that the blood caries to the brain, the brain will die.

Chest compressions don't work when the patient is on a "squishy" surface. You cannot do effective CPR on a person who is in bed or on a person seated in a chair. Even if you have a CPR board handy, it's not as effective as getting the patient onto the floor.

(You cannot do effective CPR on someone who is lying face-down, either. This possibility would not have occurred to me, had I not walked into a residence on a 911 call, only to see someone trying this.)

So how do you get a really large patient onto his or her back on the floor? The first step is to get the patient onto the floor, without worrying about the "on his or her back" bit.

If you are alone and if you can't pull the patient out of bed or roll the patient onto the floor, walk around to the side of the bed you don't want the patient on the floor next to, untuck the bottom sheet and throw it over the patient. Walk back to the other side, grab the sheet, and pull it as if you were playing tug-of-war. The patient will roll out of bed and onto the floor. The bigest problem with this strategy is that many people let their fear that they will hurt the cardiac arrest victim interfere with the degree to which they really try. To them, I can only offer this: "That victim is already dead, and unless you get that victim onto his or her back on a hard, flat surface, they almost assuredly will stay dead. Don't worry about hurting the patient. Just do it."

The same holds for a victim who arrests in a chair. If you cannot pull the victim out of the chair, tip the chair over. Use the handle of a broom as a pry bar, if you need to, but get the victim onto the floor.

Victims dumped onto the floor seldom are considerate enough to land on their backs. Here's how to get them there:

1. Straighten the limbs: it's a lot easier to roll someone whose legs are straight and in line with the torso. Ditto for the arms, either at their sides or over their head.
2. Roll the victim unto the back, and start pumping that chest. If you are in a cramped space and there's no room to roll the patient, stand over the patient with one foot on each side of the patient, grab whatever clothing you can grab at the side - not the top - of the patient and using your knees so you don't hurt your back, pick the patient straight up and then set the patient down. You many have to do this several times.

Let me know if this isn't clear, and I'll make a video of it.

Bob

Heart attack vs. stroke vs. sudden cardiac arrest

Heart attacks and the majority of strokes are very similar: a blood vessel gets blocked up, and the down-stream tissue begins to die from lack of oxygen. When the heart stops pumping - either because it is not contracting at all or because it is quivering in a dis-organized manner - we call it a sudden cardiac arrest.

Please see http://www.slicc.org/AMI-CVA-SCA.m4v for a more complete description and some illustrations.

Sudden cardiac arrest is the number one killer in the U.S.A. - it kills more than breast cancer, prostate cancer, motor vehicle crashes, and homicides, combined.

Sudden cardiac arrest must be treated by using chest compressions to maintain the blood flow to the brain until the heart is re-started by electricity or chemicals.

Bob

Hand Placement

For CPR chest compressions you will want to place the heel of one hand - either one - on the chest on the spot where an imaginary line drawn between the nipples crosses the breast bone.

The one big "no-no" during CPR chest compressions and during the Heimlich Maneuver is pressing on the xyphoid process. This is also known as "That thingy at the bottom of the breast bone". It can snap off the breastbone if you push hard on it. If that happens, every time you press the chest, that sharp object has an opportunity to lacerate something inside, resulting in an internal bleed-out and making it impossible to bring the victim back.

To avoid hitting the xyphoid process during chest compressions, find the bottom end of the sternum and make sure your hands are positioned at least an inch above it.

You can see an example of where to place your hands at www.slicc.org in the second video down from the top. It's important to keep your elbows straight and rock from the hips. If you try to press the chest by repeatedly bending and extending your arms, you won't last until help arrives.

...and what if you can't get down onto the ground to do the compressions? You can use a foot! Take your shoe off - particularly if you are wearing spiked heels - and place your foot on the sternum with the heel closer to the head, but not over the throat. You may want to use a chair to steady yourself. Remember that compressions don't have an impact to them: you are not going to be "kicking" the victim's chest, you are going to be compressing it 1.5 to 2 inches, 100 times a minute - just about the same speed as the BeeGee's 'Staying alive'. There are no style points for chest compressions. All the victim needs is 1.5 to 2.0 inches of compression - with full recoil so that the lungs can re-fill - 100 times a minute.

...and what if you can't press on the victim's chest with your hands because of bad arthritis? Place your forearm on the victim's sternum - elbow closest to the chin but not over the throat - and place the other hand or forearm on top of the first forearm, rocking at the waist to pump the chest. See http://www.slicc.org/RegularAndArthritic/RegularAndArthritic.m4v

The need to keep the blood flowing to the brain trumps everything.

Bob

Five simple, surprising facts.

Let me share with you five simple facts that many people don’t know:

1. There is a 1 in 7 chance that you, personally, will witness at least one sudden cardiac arrest during your lifetime.

2. The odds are 85 percent that the victim will be a family member, a friend, or someone you know.

3. If all you do is call 911, that victim has a 1 in 20 chance of getting out of the hospital with major brain functions intact. These are the survivors

4. The other 19 out of 20 people don’t all die – just the lucky ones. Some of the 19 will spend the rest of their lives with terrible neurological deficits, frequently in long-term care facilities, unable to perform the activities of daily living without assistance. The victim doesn’t want this, the family doesn’t want this, and the cost can be ruinous.

5. If in addition to calling 911 you also start CPR, the chances of the victim’s surviving the arrest go up….way up. And the number of victims who would have otherwise spent the rest of their life in a care facility will go down.

Now that you know these five facts, let me share one more: if – knowing what you now know – you don’t learn Bystander CPR before you witness a family member, a friend, or an acquaintance die of a cardiac arrest, the odds are high that you will have a difficult time dealing with the knowledge that you might have been able to save that person, had you only invested an hour in learning what to do.

My name is Bob. I’m a paramedic and the president of a public charity in Savannah, GA. We’re informally known as “SLICC” – as in Saving Lives in Chatham County. We exist to teach people how to perform Bystander CPR, how to use an external automated defibrillator - commonly called an AED, how to safely resolve a choking emergency, and how to recognize when someone is having a stroke. We took our test zip code from about five percent trained to more than twenty-seven percent trained in 2 years.

We are applying for a grant from the Pepsi Refresh Everything project to permit us to expand our program across all of Chatham County and eventually across the U.S.A. Whether we get the grant or not depends upon how many votes we get in October.

I’m asking three things of you:

1. Learn CPR now! Please!
2. Register as a “follower” on this blog site so that when it’s time to vote, we can get instructions to you regarding how to vote.
3. When you receive the voting instructions in late September, make it a point to vote.

When and where do you learn CPR?

1. If you need CPR certification for your employment, you need to take a CPR class in advance of the expiration of your certificate. The best place to do this is via the local Red Cross Chapter or a solid provider of American Heart Association Certification. In Chatham County, the pertinent contacts are Donna Dale 912.651.5313 at the Savannah Red Cross or Carol Crockett or Misty at Rescue Training, Inc. 912.692.8911. There are similar places across the country. (currently the right-hand side of the Red Cross site - http://www.redcross.org/ - has a box into which you can type your zip code to find a Red Cross course near you.) The American Heart Association site - http://www.americanheart.org/presenter.jhtml?identifier=3012360p - similarly has the ability to search by zip code. You are looking for a Heart Saver course.
2. If you don't need certification for your employment, you can take a Bystander course, ,and you ought to take one every two years, even if your memory is good, because CPR changes and evolves as researchers learn more and more about what works best. Bystander CPR courses are less expensive than certification courses and don't last as long. A 30-minute CPR-AED course (AHA Family & Friends) was proven to be equal to the 3+ hour certification course for CPR and equal to or better than the 3+ hour course for AED use. (Resuscitation 2007 Aug; 74(2) 276-85) In Chatham County. The Red Cross (912.651.5313) has a short Bystander course. The American Heart Association has a Family & Friends CPR Anytime! course in a box (available from SLICC (912.308.3639), and the St. James School Neighborhood Training Center holds classes in Bystander CPR, AED use, choking emergencies, and stroke recognition on the second Monday evening of most months. (Register at http://www.SLICC.org/StJames/ ).
3. If you are troubled by the thought of needing to know how to perform CPR before you can take a class, you can always pull down the SLICC class video from www.slicc.org/ClassVideo/100412_CVschh.m4v This is no substitute for attending a class, but it will let you sleep better tonight before your class next week and will provide some measure of proficiency that will be better than no training at all.

Bob

Adult or child: who needs deeper compressions?

The answer may surprise you.

For an adult, you need to push one and one half to two inches deep.

For a child, you need to push one third to one half of the front-to-back thickness of the chest at the nipple line.

Let's examine two examples: if a child's chest is six inches thick, you will be pushing anywhere from two to three inches - deeper than you would push on an adult's chest. If the child's chest were nine inches thick, you would be pushing three to four and one-half inches deep.

If the child shows any signs of puberty, treat the child as an adult.

Bob