I know how to do CPR, have been trained and all of that, but I’m still a little unsure on whether its a, sort of, all-purpose thing to do in teh event of uncounsciousness. I’m assuming the primary objective of CPR is to supply breathing for a victim who is not breathing. Another objective is to stimulate heart pumping /activity (and therefore blood/oxygen flow) for a patient who has no pulse.
Questions: Do you need to do the chest pumping if there is a pulse? (Assuming "No’) Do you need to do any of the CPR steps if the patient is unconscious, but still breathing and has a viable pulse? (Again, assuming 'No)
And what about a fairly common scenario: A heart attack victim who has (ostensibly) all the classic symptoms of heart attack: If there is still respiration going on, should one just do the chest pumping while waiting for ambulance? If it truly is a heart attack and there’s a clot in there somewhere, is there any special risk to run-of-the mill CPR cardio pumping (ie, exacerbating things)?
drpepper While it is admirable that you have learned CPR, your instructor should have covered all of these scenarios.
And if you are certified for CPR, you should really ask a trained instructor or a physician for the real answers.
My certification has expired for CPR and I wouldn’t presume to tell you the precise answers.
The only thing I remember accurately from my class that the first thing you do in CPR for an adult is to call 911 and get trained professionals on the scene. Then you can try to work on your own.
IANA Doctor so take this how you wish but I remember being told the following Rules of First Aid by a doctor:
First Aid is as easy as ABC:
A = Airway
Make sure the airway is clear, move the head backwards, don’t worry about the severed leg just yet. Don’t bother digging around in the mouth trying to clear the throat unless it’s something obvious in there. If it’s just vomit, there’s no point in trying to clear it all out because it’ll be right down the throat. Just move the head backwards so you get a clear airway.
B= Breathing
Are they breathing? If not, you need to administer mouth-to-mouth right now (still ignoring the severed limb).
C = Circulation
Now we can finally deal with that pesky severed limb. Grab cloths or whatever to stem the bloodloss.
Apologies to any doctors reading if I’ve got it wrong and a BIG WARNING to people that I am not a doctor but I think that’s the gist of it.
IANA CPR instructor, or a physician but I am a nursing student who has taken the courses (recertification just a few weeks ago). Yes, the main objective of CPR is to supply oxygen to the cells.
You do not need to do the chest pumping if there is a pulse, UNLESS the patient is choking AND unconscious. If not unconscious, do the Heimlich maneuver.
You do not give rescue breaths or chest pumps when the patient is unconscious but is breathing on his own and has a heartbeat.
Anyone who is breathing has a heartbeat. You do not need to do chest pumping on anyone who is breathing on his own.
If it is true cardiac arrest, go through your CPR steps, don’t worry about anything else. Your only concern is delivering oxygen to the cells.
I strongly recommend you take a CPR course again. You should have been taught these things in the course.
BobT, the rules have been changed. First administer two rescue breaths, and THEN call 911.
No, circulation means the heartbeat. Even if there is a severed limb, don’t worry about it, even if it’s gushing. Just do the chest pumping and rescue breaths because if the patient isn’t getting oxygen to the cells, he’s going to die. I questioned this myself…if he doesn’t have any blood to deliver the oxygen, what’s the point? Just do it anyway! When the pulse returns and the patient is breathing on his own, THEN deal with the bleeding.
You really should re-take the course. Any CPR course will cover why and when as well as how. My understanding is that the chest compressions could conceivably stop someone’s heart if they are done and the heart is actually still beating.
Calling 911 and getting advanced medical help on the way is a priority. The way I was taught, the steps are “check”, “call”, “care”. “Check” means assess the situation, including the number and condition of the victims, but also make sure you’re not going to become a victim yourself, as in a hazardous chemical spill or a downed power line or something of that nature. Then “call”, that is, 911 (if your area has 911 implemented, of course). If there’s more than one person around, you can delegate, so these things happen more simultaneously.
Checking the victim involves checking for breathing and checking for a pulse. Rescue breathing–mouth-to-mouth–is used when a person isn’t breathing. Chest compressions are used when a persons heart isn’t beating. Basically, someone may not be breathing, but their heart is still beating, in which case you need to get oxygen into them; or they may not be breathing and their heart not beating either, in which case you need to get oxygen into their lungs and then circulate the blood to the various organs by externally mimicing the pumping action of the heart. I don’t think you’ll ever see someone breathing but with no pulse. And, if they’re conscious, this means their heart’s beating and they’re breathing. I don’t think anyone will stay conscious very long at all if their heart isn’t beating. A caveat to this: Chest compressions are now taught to clear the airway of an unconscious choking victim.
Yeah, it has been a few years since I’ve taken it; definitely skills that can be updated and reinforced, as the classes are generally quickie-deals, and the specifics haven’t really stuck with me.
I taught first aid, advanced first aid, emergency medicine and CPR for more than 15 years. It’s been a while so this advice may be dated in this politically correct era.
Sorry for any terse interpretations …
You claim to be trained in CPR but your questions indicate otherwise. I suggest you got get retrained and certified again, through the American Red Cross or the American Heart Association.
CPR = Cardio-Pulmonary Resuscitation —
Cardio - Heart
Pulmonary - Of, relating to, or affecting the lungs.
Resuscitation - To restore consciousness, vigor, or life to.
CPR means manual external stimulation of the heart (beating) and breathing for the victim until the victim is able to breathe and have a heartbeat on their own, or until relieved by qualified personnel. Once you begin CPR, you do not stop it until either of these occurs. (There are exceptions to this but your CPR instructor is in a better position to explain them than here.) Of course, if the heart begins again, but breathing does not, you continue with artificial respiration.
Generally speaking, if there is a pulse, you do not do chest compressions! There are exceptions to this, however, a CPR class with a qualified instructor should explain this to you.
Unconcious with breathing and a pulse? Monitor the victim. Should be self-evident that you do not perform CPR. Again, a qualified CPR instructor should have pointed this out to you in class.
As a lay person, you are not qualified to make an assessment that someone is definitely having a heart attack. There are known symptoms of a heart attack you should study and understand, however, many people have heart attacks and do not express all, some or no symptoms at all.
Basic physiology - If a person is breathing, the heart is beating. Do not do CPR. It is impossible to have respirations and no heartbeat.
If not breathing, there may or may not be a heartbeat. You should have learned this in CPR class.
Ignore your scenario about blood clots. As a lay person you have no knowledge of this.
As a trained and certified lay person you should only treat and act according to the symptoms in front of you. No more and no less. While you may believe there may be other problems, you are not qualified to make that assessment. Provide emergency care up to the level of your training and abilities, but do not exceed this.
As others have mentioned, you should already know the ABCs of CPR and emergency care. From the nature of your questions, if you wish to be a CPR provider in an emergency, I strongly suggest you retake the CPR class, ask those questions in class, study, pass the exams and become certified.
essentially with CPR survival rate of major heart attack about 2-3%, without 1%. Alot of the survivors are brain damaged. Not very encouraging. Some of this is due to poor CPR technique.
Based on the composition of your post you are not properly trained in CPR and have little business trying. Where were you certified? If you were awarded a certification and lack this knowledge your instructor neets to have his instructor certification revoked. By allowing you and others to believe yourself trained without the proper knowledge of how to apply them he is endangering the lives of people who may not need CPR.
Having done CPR on many occasions (and on a couple who survived) it is not any kind of magic trick that fixes the problem. All CPR will do is stretch how much time you have to initiate advanced cardiac life support. ACLS certifications are posessed by paramedics and most ER staff. They consist of tools and skills like:
Defibrillation and cardioversion (when they zap them with the little shocker paddles)
Intubation to get 100% oxygen to lungs in a consistent manner
Drugs to combat metabolic acidosis, sodium/calcium imbalances, and stray electrical impulses from other areas of the heart (IIRC ectopic foci??)
Thrombolytic drugs that dissolve clots
and much more.
Without CPR patient will be pretty much unsalvageable in 4-8 minutes with no pulse or respirations. With CPR that time can be extended significantly. IIRC people have been resuscitated after 30-45 minutes of CPR on many occasions by ACLS techniques.
Poor CPR technique is a minimal part of the problem. You cant “kill somebody deader” with poor technique. Even minimally effective CPR can give someone a few more minutes to recieve more advanced treatment. Blaming poor survival rates and brain damage on poor CPR is a piss poor way to look at things. That type of attitude is why many people are scared of trying because they are afraid someone will “blame” them for trying. This is why things like the good samaritan act were put in place to open up the public to at leasttry to help without fear of legal repurcussions.
Based on the composition of your post you are not properly trained in CPR and have little business trying. Where were you certified? If you were awarded a certification and lack this knowledge your instructor neets to have his instructor certification revoked. By allowing you and others to believe yourself trained without the proper knowledge of how to apply them he is endangering the lives of people who may not need CPR.
Having done CPR on many occasions (and on a couple who survived) it is not any kind of magic trick that fixes the problem. All CPR will do is stretch how much time you have to initiate advanced cardiac life support. ACLS certifications are posessed by paramedics and most ER staff. They consist of tools and skills like:
Defibrillation and cardioversion (when they zap them with the little shocker paddles)
Intubation to get 100% oxygen to lungs in a consistent manner
Drugs to combat metabolic acidosis, sodium/calcium imbalances, and stray electrical impulses from other areas of the heart (IIRC ectopic foci??)
Thrombolytic drugs that dissolve clots
and much more.
Without CPR patient will be pretty much unsalvageable in 4-8 minutes with no pulse or respirations. With CPR that time can be extended significantly. IIRC people have been resuscitated after 30-45 minutes of CPR on many occasions by ACLS techniques.
Poor CPR technique is a minimal part of the problem. You cant “kill somebody deader” with poor technique. Even minimally effective CPR can give someone a few more minutes to recieve more advanced treatment. Blaming poor survival rates and brain damage on poor CPR is a piss poor way to look at things. That type of attitude is why many people are scared of trying because they are afraid someone will “blame” them for trying. This is why things like the good samaritan act were put in place to open up the public to at leasttry to help without fear of legal repurcussions.
Perhaps I didn’t make myself terribly clear in the original post. I mentioned that I had been trained in CPR. On three separate occasions, in fact. However the last occasion was a number of years ago. I did not mean to imply that I am currently certified or that I go around telling people to turn to me in the event of an emergency, or that I remember everything. It’s not as if I’ve had the occasion to use it on a regular basis. And I certainly did not mean to imply that my questions were not covered in the class; they undoubtedly were, and of course, re-taking it would clarify all these scenarios. I was simply idly thinking about my abilities of recalling the most crucial information if I were to find myself in a critical situation tomorrow; it occurred to me that under pressure perhaps I might misapply something.
Problem being with your case, applying CPR to someone who is in trouble but does not need it will probably kill them. Plan on going to jail. Even a weak or irregular pulse is more effective than the best CPR.
Apparently, even if a patient is already in the hospital and then has a heart attack, there is only a 20% chance they will live. I don’t have the cite in front of me, but I believe I remember this from “How We Die” by Sherwin Nuland.
There are about a bazillion variable attached to surviving a heart attack. In an acute care hospital patients still are often only checked hourly and could be long dead before being checked on. If you had a heart attack standing at the triage desk of an emergency department or in an intensive care unit you have a pretty good chance of surviving even some pretty serious ones. cardiac ICU teams are well know for keeping patients alive through several.
I did find one site supporting the statistic of a 3% survival rate (even with CPR, I think the article implies). However discouraging that may be, it is worth noting thatthis site mentions that survival rates drop 7 to 10% each minute CPR [and, in the interest of accuracy, defibrillation, says the article] is delayed.
Your muscles need to be fed with oxygen and glucose constantly. If they are not they will spasm and or cease to function. Your diaphram and intercostal muscles that you use to breathe will shut down and or cramp/spasm from metabolic acidosis in a matter of probably 15-30 seconds without an oxygen supply. So no pulse, you will not keep breathing for more than a few seconds.
Another matter which often leads to confusion: Artifical respiration (generally mouth-to-mouth) is not the same thing as CPR, although artificial respiration is part of CPR. Artificial respiration (also called “rescue breathing”) is used when breathing has stopped, but the heart is still beating, and it does not involve chest compressions. This is often the case, for example, with drowning victims: The lungs generally don’t actually fill with water, they close off so that they won’t fill with water. Your objective here is to get the lungs open and working again, after which the victim will generally recover on his or her own (but call the experts, anyway).
Full CPR is only called for when the heart has stopped (usually due to a heart attack or electrocution) While it’s true that you can’t get deader than dead, applying CPR when the heart is still beating can and probably will cause severe problems. Therefore, the single most important thing to know about CPR is when to do it and when not to do it. If the person’s heart is genuinely stopped, then nothing you do can make it worse (unless you’re getting in the way of someone else who really can help), but if the heart isn’t stopped, then you can and probably will make the situation worse if you don’t know what you’re doing. In any event, professional help will definitely be needed.
If there’s also severe bleeding (blood spurting out of the body), then the situation is more complicated. Stopped heart and severe bleeding are both considered “hurry cases”, which means that the victim can die within two minutes if nothing is done to save them. Since CPR must be continued until help arrives, and bleeding can be stopped without having to maintain first aid, if I were ever in a situation where the victim had both, I’d try to stop the bleeding first. But realistically, nothing a single rescuer can do is likely to save the victim in that case.
Um Chronos…you don’t get spurting blood, with a stopped heart. You can stop perfoming CPR on that little straw man hes a goner.
The fact that you did not realize this makes me seriously question your ability to answer appropriately in this thread. Your "rescue breathing scenario is a one in a million shot, by the time a drowning victim or one of many other situations could be treated, the respiratory component of thier problem will have already cascaded into cardiac arest.
Which is oh, roughly 99.5% of the time. FUll CPR is called for when the heart is not pumping effectively enough to sustain life. In fibrillation, electromechanical disassociation, pericardial tamponade, or congestive heart failure for example, the heart has not “stopped” it just ins’t generating an effective pumping action. The time lapse is only a matter of seconds between the two failures. Someone is probably more likely to win a lottery than catch a patient in this state and maintain respirations without cardiac arrest. If I am barking up the wrong tree here I would happily accept a correction from quadgop or the like who I know will have far greater knowledge than me and my wife (a labor and delivery RN) who both read your post and went “Huh?”
