The Beat Goes On!
In December of 2007, Congress declared the first week of June each year as National CPR/AED Awareness Week in an effort to increase the number of people certified in cardiopulmonary resuscitation (CPR) and trained to use an Automatic External Defibrillator (AED). In today’s advanced technological world, the American Heart Association (AHA) has determined that in order to increase the survival rates for victims of sudden cardiac arrest, we need to go back to the basics of CPR. This is not limited to healthcare workers but includes lay people as well. According to the AHA there is a 95 percent mortality rate for over 300,000 Americans who are victims of sudden cardiac arrest each year. It is also estimated that on average it takes 8 to 10 minutes for 9-1-1 to reach a victim. Survival rates for individuals with ventricular fibrillation treated by AEDs have been reported between 0% and 31%. Comparatively, the survival rates for performing CPR alone are reported between 0% and 6%. More lives could be saved if members of the general public have training in the use of AEDs and CPR. .
Why is this important?
The reason that this is so important is after four minutes without oxygen going to the brain it will begin to die. After eight minutes it becomes the point of no return, irreversible brain death begins to occur. So even if the heart is restarted, the damage after eight minutes can never come back. This is why we need people to do CPR. In cases where CPR is performed immediately, this risk is cut in half. Victims’ chances of survival decrease by 7 to 10 percent each minute that they go untreated after their heart stops, so bystanders’ knowledge of CPR is a matter of life or death.
Why did they change CPR?
New CPR Rules: Pump First, and Save the Breaths for Later If you have ever been trained in CPR, we were all trained A-B-C, for “airway, breathing, compressions”. But the American Heart Association (AHA) recommends a different approach. The new mnemonic is C-A-B; we’re now supposed to start chest compressions right after calling 911; adjust the airway and leave the rescue breaths for last. The AHA wants to encourage people to be willing to administer CPR; so making the mouth-to-mouth breathing a less prominent part may make the procedure more palatable. In recent years, the results of study after study have supported the fact that the victims who receive compressions alone from bystanders survive as well as those who received traditional CPR. The guidelines apply to adults, children, and infants but exclude newborns.
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- Establish responsiveness, if victim is not responsive, roll the person onto their back. Check for a pulse for no more than 10 seconds.
- Call 911 or ask someone else to do so.
- Start chest compressions. Place the heel of your hand on the center of the victim’s chest. Put your other hand on top of the first with your fingers interlaced.
- Press down so you compress the chest at least 2 inches in adults and children and 1.5 inches in infants. “One hundred times a minute or even a little faster is optimal,” Sayre says. (That’s about the same rhythm as the beat of the Bee Gee’s song “Stayin’ Alive.”) Allow for a complete recoil of the chest after each compression. Give at least 30 compressions before you proceed to rescue breathing.
- If you’re been trained in CPR, you can now open the airway with a head tilt and chin lift.
- Pinch closed the nose of the victim. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch for the chest to rise.
- Continue compressions and breaths – 30 compressions, two breaths – until help arrives.
These guidelines apply to children and adults alike, since AHA officials did not want separate and potentially confusing advise for different groups of people. The change in CPR is part of a larger revision of its emergency heart care recommendations.
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AEDs are user-friendly devices that untrained bystanders can use to save the life of someone in cardiac arrest.
- Before using an AED, check for puddles or water near the person who is unconscious. Move him or her to a dry area, and stay away from wetness when delivering shocks (water conducts electricity).
- Turn on the AED’s power. The device will give you step-by-step instructions. You’ll hear voice prompts and see prompts on a screen.
- Expose the person’s chest. If the person’s chest is wet, dry it. AEDs have sticky pads with sensors called electrodes.
- Apply the pads to the person’s chest as pictured on the AED’s instructions.
- Place one pad on the right center of the person’s chest above the nipple.
- Place the other pad slightly below the other nipple and to the left of the ribcage.
- Make sure the sticky pads have good connection with the skin. If the connection isn’t good, the machine may repeat the phrase “check electrodes.”
- If the person has a lot of chest hair, you may have to trim it. (AEDs usually come with a kit that includes scissors and/or a razor.) If the person is wearing a medication patch that’s in the way, remove it and clean the medicine from the skin before applying the sticky pads.
- Remove metal necklaces and underwire bras. The metal may conduct electricity and cause burns. You can cut the center of the bra and pull it away from the skin.
- Check the person for implanted medical devices, such as a pacemaker or implantable cardioverter defibrillator. (The outline of these devices is visible under the skin on the chest or abdomen, and the person may be wearing a medical alert bracelet.) Also check for body piercings.
- Move the defibrillator pads at least 1 inch away from implanted devices or piercings so the electric current can flow freely between the pads.
- Check that the wires from the electrodes are connected to the AED. Make sure no one is touching the person, and then press the AED’s “analyze” button. Stay clear while the machine checks the person’s heart rhythm.
- If a shock is needed, the AED will let you know when to deliver it. Stand clear of the person and make sure others are clear before you push the AED’s “shock” button.
- Start or resume CPR until emergency medical help arrives or until the person begins to move. Stay with the person until medical help arrives, and report all of the information you know about what has happened.
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RESOURCES: American Heart Association. 2010 Guidelines for CPR and Emergency Cardiovascular Care, October 2010
http://mycprcoach.com/hands-only-cpr/ Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. Apr 20 2010;55(16):1713-20.
Automatic External Defibrillation Author: Joseph J Bocka, MD; Chief Editor: David FM Brown, MD http://emedicine.medscape.com/article/780533-overview
AED use: National Institute of Health – AED proceedures
Graphic and CPR Data: American Heart Association CPR Awareness Page