What is CPR?
Cardiopulmonary Resuscitation (CPR) is a life-preserving maneuver that has been around since 1957. It keeps the brain and vital organs functioning until the root cause of the cardiac arrest can be determined and fixed, and when the heart will regain its own ability to circulate blood. While some of the details have changed over the decades, the basic concept remains the same: compress the chest, to compress the heart, to pump blood out of the left ventricle and to the brain.What causes cardiac arrest?Cardiac arrest occurs for many reasons: cardiac disease, respiratory failure, drug overdoses (recreational, prescription, intentional and unintentional), metabolic issues (too much sugar, not enough sugar), trauma (too many holes, not enough blood), among others.
When should you perform CPR?
CPR should be provided whenever the victim's heart is not circulating blood. The question remains, how do you tell when blood is not circulating? While your first instinct might be to check for a pulse at the neck or wrist, research has shown that even paramedics, nurses and physicians have trouble determining the presence or absence of a pulse in chaotic and dire situations. Lay-rescuers should look for obvious signs of life'- basically, if the victim appears as though their heart has stopped, it probably has. Look for:
- No obvious breathing - slow (less than one every 6 seconds), gulping breaths are NOT good breaths, this is Agonal Breathing and is not compatible with life.
- Complete lack of movement (even the chest stops moving up and down)
- Pale, bluish and/or gray skin
- Arms and legs are loose and floppy, lacking any muscle tone
- The skin may feel warm to the touch still if the heart has only recently stopped circulating blood (especially if the ambient air temperature is high!)
What's the best way to perform CPR?
Over the past few decades, CPR has evolved as research has shown us what's working and what's not. Currently, research indicates that compression-only (or hands-only) CPR is very effective for adult cardiac arrest victims. Adults, realizing that something is wrong, typically will take a deep breath (filling their lungs with oxygenated atmospheric air) right before they collapse. When a bystander provides compressions, they circulate that last, full lungful of air until all the oxygen has been used up. (NOTE: We inhale 21% oxygen and typically exhale 16% oxygen - we only use 4-5% per respiratory cycle.)
How to perform compression-only CPR on an adult:Kneel beside the victim.Place one hand on top of the other, interlacing fingers together.Keep arms straight, lock elbows, and position shoulders directly over hands. Arms should not bend during compressions. The actual motion of compressions happens primarily at the hips! With arms, shoulders and back rigid, the torso is rocked up and down at the hips. While this sounds bizarre, it allows the rescuer to use the larger muscles of the back and lower core to do the work. Compressing the chest becomes hard work quickly. The smaller muscles of the arms, shoulders and upper back will tire and compressions will become ineffective. The goal is at least 100 compressions EVERY MINUTE! You might be able to gut out the first 100 with your arms, but after that, they'll be wet noodles! By using the big muscles of your lower back to make the compressions happen, you'll provide better compressions for a longer period of time.Locate the center of chest. If an imaginary line is drawn between the nipples (the nipple line), the middle of that line is the landmark. It generally falls on or near the middle of the sternum or breastbone.Begin chest compressions.
How do you know when to stop providing chest compressions?
First, and foremost, if the victim no longer appears as though they need CPR, STOP providing CPR! I have personally witnessed CPR performed on an elderly woman who screamed "Ouch!" with every compression...if they begin to move around, breath normally, talk, moan, grunt, or say "What happened?", please stop compressions. Otherwise, CPR should continue until trained responders arrive and take over. If you have been providing CPR for a prolonged period of time and you are physically exhausted (it is hard work!), stopping efforts may be considered, but that's a decision the rescuer will have to make for themselves. There are many stories of victims surviving after hours of CPR. Most of these scenarios include either very cold temperatures or submersion in icy, cold water, but they're out there. Knowing that, once started, CPR may continue ceaselessly for some time, it's important to consider any other victims in the area as well. Are their other victims bleeding or having breathing trouble who may AVOID going into cardiac arrest if care is provided? This is a difficult and terrible situation to be in, but the goal should always be to do the most good for as many victims as possible. Placing a tourniquet on victim #1 and rolling #2 into the recovery position before starting CPR on victim #3 may result in three lives saved rather than none.
By knowing these simple steps, and having access to quality medical supplies, you can save lives while an ambulance is en route. If you're interested in learning how to stop the bleed, check out our blogs on how to apply a Tourniquet, QuikClot, and a Pressure Dressing. Something to add to this blog? Share it in the comments!