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

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