Everyone knows about CPR. It's all over the media. Unfortunately most people know about it in the sense they know that smoking is bad for you or that we should do something about those wars in Africa. We seem prone to think that we can pick it up once we start needing it, that we can control our lives enough for that. I did, until a passer-by keeled over into my yard and died of a heart attack. Male. Early fifties. Short hair.
May all of you lose this impression during your lives, preferably with less spectacle.
The basic steps are simple and Lockheart describes them excellently above, but resusciation is pestered by small details that make its effective use unintuitive. For instance:
- CPR is exhausting. Compressions don't wear the helper out as fast when the helper's body weight is used to help push. It's best to lean over the patient, arms going straight down, the upper hand gripping the lower one, pumping at 100 compressions per minute like a flesh piston.
- The head has to be tilted a surprisingly large amount to clear the airway, and it's best to use a hand on the temple and a couple of fingers on the jawbones because pushing on the soft tissue can pinch that airway closed. An ordinary breath is fine.
- All the pointers in this node are completely useless if they're vaguely remembered instead of studied and practiced. Academic knowledge of what the xiphoid process is and what's done with it will not spring to mind when he's not breathing he's not BREATHING oh God oh God oh God oh God -- I dramatize, but studies cited below show that most people with the opportunity to receive bystander CPR are not given it, especially if the bystander is a family member. Get yourself trained.
CPR instructions apparently go out of date as fast as computers, if not nearly as badly. The techniques are revised to balance direct effectiveness, speed and the likelihood of actually being used. The current ratio is 30 two-handed chest compressions to 2 breaths, five initial breaths and one hand with kids, two fingers with infants. Swift and accurate pulse detection is a pipe dream, so it has been dropped entirely. To save further time, compressions are now administered to the middle of the sternum, between the nipples. Each helper should do two sets alone before switching, to give everyone else time to recover better.
The view from the ground
At present I've completed the first of three levels in Finnish Red Cross first aid courses and an emergency first aid course. These took sixteen hours in one weekend and nine hours in five or six weekly meetings, respectively - less time than it takes to procrastinate properly on a busy week. The certificates are in force for three years. CPR is prime among my new superpowers, along with the use of the recovery position and an increased likelihood of freaking out quietly.
Learning CPR was a quirky business which featured theory as well as practice on one of the ubiquitous Resusci Anne mannequins. For instance, all practical exercises started with shaking and speaking to the "patient," checking its breathing (which works well with the back of the hand but is best done with the ear) and making a faux 911 call, apparently so that those things will happen in an emergency when the alternative is panic. The phone call stands out: that's the lifeline. We weren't trained to deal with people coming to during resuscitation, because that's theoretically possible but still not going to happen. The purpose of bystander CPR is to keep a body inhabitable until professionals arrive with their magical lightning machines and oxygen masks. Until that happens the patient is moved onto a hard surface, which in real use involves hauling some sixty to ninety kilos of limp flesh, and CPR is applied.
The phone really is a helper's best friend. It works best with three people: One to give CPR, one to place the call, and one to run and check the street name and number, or any other sign of exact location. The dispatcher can give some basic instructions, and cell phones that can hold text files can also be equipped with compact first aid instructions. In contrast there are some popular illusions that die a swift but painful death. Take the romance novel medical idea that resusciation is intimate or somehow romantic: a notion that can dissuade people from learning it. This is as pucky as pucky can be. The ominous clanking in the Resusci Anne's chest is only a suggestion of what may happen in a real situation. You're trying to work the heart from the outside of the body, using your bare hands. We were taught that if you aren't accidentally breaking ribs, you're doing it wrong.
Finally, maintaining a grueling pace of compressions is a challenge in and of itself. Counting aloud is a necessity. An external source for the rhythm will provide better timing and more reason to stick to it; news that is sure to delight all those who carry pocket metronomes. A preliminary 2008 study from the University of Illinois reported very good results with CPR tests accompanied by the immortal unkillable disco hit Stayin' Alive (The Bee Gees, 1977), with its beat of 103/min. Played or in memory, it resulted in an average of 109 and 113 compressions per minute, respectively, when the optimum is 100 and too many is better than too few. The choice of song is likely a moment of dazzling medical humor, since its particular rhythm has to be far from unique. The Associated Press reports a fairly credible rumor that Another One Bites the Dust (Queen, 1980) has a similar beat, but comes with some practical problems.
Everything2 medical disclaimer: I am a random person on the Internet. My job is to catch your attention and take it somewhere interesting, not to make you think you know stuff you haven't drilled.
References:
Wikipedia. In the interest of using it as a secondary source, the references for the relevant bits are the studies "Bystander CPR, ventricular fibrillation and survival in witnessed, unmonitored out-of-hospital cardiac arrest" (Swor, RA, June 1995) and "Quality of bystander cardiopulmonary resuscitation influence outcome after prehospital cardiac arrest" (Wik, L; Steen PA; Bircher NH, December 1994).
Stayin' Alive: BBC,
CNN, the Associated Press
Incredible Finnish sources, incomprehensible to you: Here,
here and here.
TV Tropes articles:
CPR Clean Pretty Reliable
Magical Defibrillator
Kiss Of Life
Wertperch says CPR is tiring. I once managed to keep it up for ten minutes, and was a wringing pile of sweat when the ambulance arrived. Thankfully, they pulled him through just long enough for his wife to say goodbye to him, for which she was duly grateful. I had a commendation from the ambulance service for that one, even though he had another major arrest, from which he never recovered.
MaxClimb says White polyester suit and shirt open to navel helps with the disco beat, but be careful of swinging pendants...
gwenllian says Especially be careful of the swinging pendants if you're using an AED... ;)