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

When do you stop CPR?

There are a limited number of events that would prompt you to stop chest compressions:

1. when something happens that makes it no longer safe for you to continue;
2. when someone else takes over chest compressions from you;
3. when an attached AED (Automated External Defibrillator - a device that, when appropriate, will shock the patient's heart so that it can start beating normally again) tells you to "stay clear of the patient" or "don't touch the patient"; or
4. when the victim says "Stop doing that to me."

Absent one of these circumstances, you continue chest compressions with no interruption. You don't need to stop compressions to have someone else take over compressions - the relief person can put their hands on top of yours and take over without missing a beat as you pull your hands away, and you don't need to stop compressions while someone else is applying the defibrillator pads. It's that important.

Interrupting chest compressions for three seconds results in more than a three-second interruption in blood flow to the brain: when you resume compressions, the first few compressions simply prime the pump. Interruption in compressions is often the reason that there are so many people who don't die but who also don't survive with neurological functions intact.

Bob

p.s., a note for health care providers: you don't need to interrupt compressions during endotrachial intubation of adults anymore. Check out the S.A.L.T. airway by MDI. The insertion of the FDA-approved S.A.L.T. device is a simple, blind insertion, and once the device is in place, the ETT is inserted through the hole in the middle of the device. The results of a cadaver study will be published shortly. I have tried it on many different manikins and have been unable to make it fail. It's less expensive than a King Airway or Combitube. It's in the same range as an LMA, and it gives you the airway control of an ETT. Sweet.

Calling 911

Calling 911 is really pretty simple, once you think through what the 911 operator needs to know:

You might feel a little silly practicing a 911 call out loud, but it will make the real call easier.

Bob

When do I perform CPR on someone?

You've just seen someone - probably a family member, a friend, or someone you see every day - become non-responsive. You sense there's something wrong, but you are not sure what to do.

Here's a really simple way to think this through:

1. If it's not safe, don't do it. There is no sense in turning the chance to save a life into two obituaries.
2. If a person becomes non-responsive - if you cannot wake them up - you need to call 911. It doesn't matter why the person is non-responsive.
3. If there is any doubt in your mind as to whether the victim is breathing normally, you need to get that person onto his or her back on a hard, flat surface and begin chest compressions - 1.5 to 2 inches deep - at a rate of 100 compressions per minute.

I should point out that step 3 is more conservative than the American Heart Association protocol in that the AHA - in an effort to eliminate all possible confusion from the process - skips the breathing check before commencing chest compressions. SLICC, with the backing of members of its Medical Advisory Board, feels that the average citizen can tell if a non-responsive person is breathing normally or not. It would be inappropriate to begin chest compressions on someone who was breathing normally.

But that's how simple it is to decide whether to start CPR or not. If the victim is non-responsive, call 911. If the scene is not safe, call 911 and wait. If the scene is safe and the patient is not breathing normally, start chest compressions.

One in seven of you will witness at least one sudden cardiac arrest during your lifetime. Think it through so that you can act with confidence. Please take a CPR course - either from SLICC or the American Red Cross or the American Heart Association.

Bob

Misconceptions about CPR

I'm all set: I took a CPR course three or four years ago.

• It's not your memory that will let you down - it's the fact that CPR has changed a lot in the past few years, and it's probably going to change on October 18th this year.
  
• Bystander CPR courses are available from the American Red Cross, from the American Heart Association in kit form, and in some locations from SLICC.org. (If you want to get a SLICC.org operation going in your town, we can show you how. Just contact BobT@SLICC.org .)
  

I'm not going to do mouth-to-mouth on some stranger!

• First of all, the vast majority of witnessed arrest victims are family members, friends, or associates.
  
• Second, if you see an adult arrest, you're not supposed to do mouth-to-mouth. The victim's chances are about 25% better if you skip the mouth-to-mouth and just pump that chest.
  

I'm not going to do CPR on a stranger - I'll get sued!

• First of all, the vast majority of witnessed arrest victims are family members, friends, or associates. (Yes, it bears repeating.)
  
• Second, all fifty states (plus Washington DC) have 'Good Samaritan' laws. They vary a bit in some states, but the essence is that, if you see someone arrest and if you take action without compensation and with goodness in your heart, you cannot be taken to court.
  

A cardiac arrest is a matter of life-or-death.

• Many people wish it were. It's really a matter of life or death or something worse. If all you do is call 911, the victim has a 1 in 20 chance of surviving with major brain functions intact.
  
• What about the other 19? Some of them - the lucky ones - die.
  
• The rest spend the rest of their lives with neurological deficits that interfere with some or all of the activities of normal daily life - activities such as walking, talking, speaking, hearing, seeing, bladder and bowel control.
  
• Starting chest compressions immediately after calling 911 will increase the number who survive and will decrease the number that don't survive but also don't die.
  

I can't do CPR on someone - I might break a rib.

• Think about it - what's better for the victim? Alive with broken ribs? ...or dead with ribs intact.
  
• It does happen, and the odds of it happening increase with the age of the victim. You can minimize the chance of ribs breaking by proper hand placement.
  
• If it does happen, just keep on pushing.