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By Richard Pass, RN,
BS: Director, Save A Little Life, inc
During my 18 years as a CPR instructor
I have seen new guidelines come and go. They appear
about every 5-6 years and are often accompanied
by declarations of "new and improved." For
the thousands of parents I have worked with over
the years, new and improved is only meaningful
if it translates into "can I remember
what to do if my baby isn’t breathing?"
Well, here we are, approaching the summer of ’06 and the international
guidelines* have undergone appreciable changes. Finally, however, these changes
reflect the simplicity of action required if a serious health crisis is upon
us.
I have always instructed CPR in a simple way, for two reasons. Simple works,
and if there is a real crisis, simple is what most of us can realistically
muster. The new clarion call of the American Heart Association is "Push
fast & Push hard." If that isn’t simple, I don’t know
what is. Yet, it does require that we look at the changes with an eye toward
understanding some of the basic science that gave birth to them.
During the mid 1990’s we discovered many Good Samaritans, willing to
help a stranger if CPR seemed necessary. Yet many of these folks were frightened
of possibly catching a disease from contact with bodily fluids (vomit or
blood) in the victim’s mouth. Consequently, many were willing to push
on a chest, but wanted nothing to do with the mouth. What was noted was stunning:
Many of these victims (usually adult) did quite well when the paramedics
arrived with their advanced tools (defibrillators in particular). What was
going on? Why did pushing on the chest seem to do as much as the traditional
CPR, pushing and breathing?
The answer lies in what occurs when adequate chest compressions occur when
the victim isn’t getting blood & oxygen to the brain. Similar to
an Iron Lung of days gone by - where a polio victim was put in a machine
to assist breathing – the mechanical movement of the chest cavity drew
oxygen into the body when the upstroke of the compression occurred (the letting
go part). This simulated breathing and assisted until the patient improved,
or not.
Let’s now look at why pumping on the chest is so valuable. The pumping,
and subsequent recoil, draws the oxygen into the victim while then the next
pump pushes that oxygen out of the chest (heart) and into the victim’s
brain. This, as it turns out, is more effective than traditional breathing
for the victim, which the scientists tell us, now, does not really do much.
The new guidelines, which become official on July 1, clearly reflect the
benefits of pumping over the artificial breathing. The steps of CPR will
now look like this:
· Stimulate the victim…ask, "are you OK" (call for help,
9-1-1)**
· Tilt their head back slightly to "open the airway" & check
for breathing
· Give two effective breaths (just enough to get victims chest to rise)
· Begin chest compressions at a 30:2 ratio, compressions to breaths ***
· Continue efforts until help arrives or the victim arouses
Parents should notice that all of the "steps of CPR" are essentially
the same except for the significant change in pushes to breaths. What is
additionally impressive with these changes is the fact that we now do this
for everyone. Yes, all victims now receive the 30:2 ratios of pushes to breaths,
and all at about the same rate (roughly 100 times per minute).
Remember, we no longer waste time checking the victim’s pulse as it
is too hard to find and confuses the issue. If there are significant signs
of life (moving, breathing or coughing) then consider holding off on CPR,
but watch the victim very closely and begin CPR if things deteriorate.
What happens if I do it wrong?
Years of science and feedback from community based CPR data show that most
errors in CPR are actually errors of omission…meaning that people
get worse because we don’t act…not because we mess it up. It
has long been known that less-than-perfect CPR is often very helpful, certainly
more so than leaving someone alone in a real time of need.
Keep in mind the simple fact that taking a CPR course is the best and only
way to really be prepared to deal with a family health emergency. Ask your
OB/GYN or pediatric specialist for a recommendation or contact americanheart.org.
*International
Liaison Committee on Resuscitation (of which
American Heart is part of)
** If alone with a victim under the age of 8, do 2 minutes of CPR before
calling 9-1-1.
*** Depth of compression is 1/3 the depth of the chest cavity.
Richard Pass, RN, Bs is the owner
and director of Save A Little Life and can be reached
via his website: www.savealittlelife.com or by
calling (818) 344-1442
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