CPR Revisited: Hands Only, AED, Etc.
November 20, 2008 by dr. lam
I had to take my ACLS (Advanced Cardiac Life Support) renewal this past weekend, as a requirement for maintaining my surgery center’s credentialing. I have always been bored out of my skull during these courses but not this time. Robert Twite, RN, brilliantly created a session that allowed me to sense his passion and his “why” (see Tuesday’s blog). His mission in life was to help others truly save others’ lives. I assume his vision for myself and as part of his crusade (see Wednesday’s blog), I posted a video on how to do good CPR and why to do it. My teaching skills for CPR pale in comparison to his so forgive me Robert for my feeble attempt but I need to get this message out to my readers and followers of this website.
What I found very interesting were a few things. First, he mentioned the idea of “hands only CPR” that has come into vogue recently was very very intriguing. He argued that many advocates have shown that just doing chest compressions without mouth-to-mouth can have very similar or same outcomes in survival. There are a few reasons for this. First, the air that is recycled from your lungs and breathed into the individual is filled with CO2. Second, if you breathe too often and too much (which is the natural tendency to do), you can make chest compressions less viable owing to a rise in pressure inside the chest wall. Rapid, early, and hard chest compressions can save a life.
Second, he talked about how we believe in the past that we better check a pulse before starting CPR. Well, yes, that is not a bad idea but not at the expense of starting early CPR. What he argued is that without chest compressions in someone who does not have a pulse will lead to a quick death. If you perform chest compressions in someone who has a pulse, the only negative outcome is a sore chest. Even if you find a weak pulse, additional CPR can oftentimes supplement the cardiac output of blood and lead to a better outcome. He offered the example that in children who even have a pulse but a slow one like at 60 beats per minute (that is slow for a child), the advice is to actually do CPR to improve blood flow. So if you check a pulse, then I check a pulse, and we both don’t know if there is a pulse, we are wasting precious time for no reason. Forget all that and start high quality CPR. Crappy chest compressions do nothing. High quality chest compressions only offer 25 to 30% of a normal amount of blood to flow out of the heart. Also, remember that you must lift off the chest, i.e., let the chest completely recoil back to an inflated position because you need the blood to return to the heart as well.
Finally, if your business does not have an AED (automatic extrenal defibrillator), you need to get one. Early shocks from this device will lead to a life saved. Without one, even chest compressions might not be enough. These devices will actually guide you when to shock and when not to. Basically today, the goal is 2 minutes of sustained high quality CPR with chest compression to breaths of 30:2 followed by the AED announcing when 2 minutes are up to determine if you need to be shocked or not. Even after a shock or not shock, continue CPR until told to stop. The AED however should interrupt CPR at the earliest time possible since the earlier you get an AED on someone the higher chance of survival for that person in many cases if the rhythm is shockable like ventricular fibrillation, which is a common cause of cardiac arrest.
This blog is not intended to replace formal basic life support training but to encourage you to get certified. In the meantime, if you haven’t yet and the occasion arises where you need to save a life remember early and hard chest compressions with recoil time and get an AED fast and furiously then continue until help arrives. Don’t err on the side of checking pulses, checking pulses, then looking at each other. Most likely CPR and an AED will save a life more than whatever the ambulance or physician can do. Outcome studies have shown that only 2 things matter for survival: good quality and early CPR and an AED early, not fancy drugs or airways. Two things in conclusion: get CPR certified and make sure that your workplace has an AED on site. Thanks Robert for the brilliant education. I hope I can spread your message out there to all who can hear.
Comments
Feel free to leave a comment...
and oh, if you want a pic to show with your comment, go get a gravatar!