Some questions about CPR

Factual Questions
21

The C is for circulation. So, if someone is down and they don’t appear to be breathing (under the new guidelines the rescuer does a quick eval w/o look, listen and feel) you C - check for Circulation. If they don’t have a pulse I can assure you, they are not breathing. If they do have a pulse then check Airway and Breathing. The powers that be love to change things every couple of years. Cynics would claim that it is just to sell more training materials but there is actually research behind it.

What I find to be interesting is that, under the new guidleines, there is no stopping to check for a pulse once CPR is started. At least not the AHA program that we teach. I guess if the patient starts talking to you, you can stop.

22

I think the idea is that you’re supposed to just keep on doing it until the paramedics or other professionals arrive and take over. Your goal isn’t to get the patient recovered; it’s to keep the patient alive until the pros can get them recovered.

23

Except we were told not to start compressions on someone with a pulse, because it can stop the heart or cause other problems. You’d occasionally check for a pulse because if their heart was pumping it would do better than any external compressions. I suspect the reason they dropped that is because compressions don’t often restart the heart - a defibrillator does that. Stopping to check is wasted time.

24

Right, and it’s the pros who have the defibrillators (and the training to use them).

25

Except defibrillators don’t restart the heart - they stop it. The idea is to correct an abnormal rhythm by briefly stopping the heart and allowing it to reset with the correct sinus rhythm. If the heart is stopped already, the defibrillator does nothing. To restart a heart, you use an injection of atropine and CPR. Defibrillators only restart hearts on TV and in movies.

26

epinepherine is the first line drug for pulselessness

27

Atropine has been pretty much removed from ACLS (except for bradycardia) . Epinephrine is still in all the arrest algorithms, even if there’s really no evidence in its favor, either.

St. Urho
Paramedic

28

You are both correct. The funny thing is I knew that, but I still wrote atropine for some reason. My bad.

29

I’m not a physician, but I did go to medical school.

I just wanted to stress one or two points that were brought up earlier, in case anyone finds themselves in an unfortunate situation. First, don’t try to do chest compressions on a mushy surface. Don’t believe TV, it doesn’t do much of anything. Second, when it comes to the Heimlich and chest compressions, if you don’t hear ribs cracking you’re probably not doing it right. (Alright; that’s hyperbole, but not really. 10/10 people who got a rib broken when given the heimlich say that’s better than dying).

30

I think the AHA is shooting themselves in the foot with these new recommendations, actually. I understand where they’re coming from, but having two radically different “kinds” of CPR based on whether you’re a health care provider or taken a CPR class or you’re a layperson is leading to all kinds of confusion. Confusion leads to self doubt. Self doubt leads to people standing around the body going, “Wait, what do we do first?”

Latest recs: no pulse checks for anyone. It wastes time. Even doctors have trouble finding a weak pulse in the field.

If you’re not a health care provider, no breaths. Not only does it reduce the number of people willing to try CPR, but it tires you out quicker. We’d rather you have the energy to keep pushing until the paramedics arrive.

The new steps: Try to rouse the person. Call for help. Start compressions. Compressions should still be done at the rate of 100 per minute, the beat to “Stayin’ Alive”. (Or “Another One Bites the Dust,” your choice.) Make sure you’re pushing in 2 inches on an adult, and make sure the chest is recoiling all the way up before you push down again. If you’re doing it right, you’ll be exhausted within 5 minutes. Stop compressions when help arrives or when the person starts moving on their own.

Compressions on a beating heart do NOT seem to cause all the problems we once thought they might. If it’s an unwitnessed event and you can’t rouse the person, assume it’s cardiac arrest and start compressions. If they wake up, you were wrong. If they don’t, they don’t.

IF you’ve taken a class in CPR you’re considered a “health care provider”, even if you aren’t one. In that case, you can check the airway and do rescue breaths, but still AFTER you’ve done 30 compressions. You’ve also learned to use an AED, and should do so as soon as possible, with as little delay as possible between compressions and starting the AED machine.

(My recent (August 2011) instructor said that the “airway” step is now in question, as well, because again it slows things down. In his humble opinion, better to do the head tilt and blow. If you can’t get air in, THEN check the airway for occlusion. Since 90% of the time, you can get air in, your airway check is unnecessary. Makes sense to me, but it’s not official doctrine yet.)

The reason babies are excepted and still get breaths first is that cardiac arrest as the precipitating incident is exceedingly rare in infants and children. While adults often have a heart stop and thus stop breathing, infants more often stop breathing and then their heart stops. So we do want to get some fresh air into an infant before we start compressions.