The Survival Doctor: 4 things I learned from this year’s CPR course for professionalsby James Hubbard, MD, MPH

Every two years, to update my skills, I retake a basic CPR course sponsored by the American Heart Association, along with their Advanced Cardiovascular Life Support course for health care professionals. And it never fails, I always learn something new and remember things I shouldn’t have forgotten. Here are a few highlights from this year.

CPR

1. Why has the advice changed to focus so much on chest compressions?

As a The Survival Doctor reader, you already know that modern CPR usually only involves chest compressions, rather than additional artificial respirations.

You may recall that one of the reasons is, in the typical adult CPR situation, the heart is the problem. It stops beating because something has gone wrong with it (not the breathing). At the time the person collapses, they’ve been breathing just fine, thank you, so they still have enough oxygen in their body to keep their organs alive—if the oxygenated blood can just be circulated around. That’s what the chest compressions are for.

What this year’s class clarified is how really important it is to keep compressions continuous and how devastating it can be to have too many interruptions.

A video provided online by the AHA as part of the CPR course explains that in order to get the blood from the heart to the organs, a minimum amount of significant pressure needs to build up, and that takes several pumps.

Think of priming a water pump. Stop the pumping, the pressure goes back down, and it takes several more pumps to get it back up. And that’s what happens a lot when doing CPR. It is estimated that, in typical cases, only about half the time is spent in doing quality chest compressions. It should be more like 95 percent.

The video recommends trying to never stop for more than 10 seconds max. And that’s for something like clearing for an AED shock. If there’s a second person, continue pumping while that person is placing the chest pads on the victim and charging the machine. Only stop when the machine says to—just before you press to button to perform the shock.

Keeping the pressure up also means smoothly switching from one person to another after about two minutes of chest compressions. That’s the average amount of time we can perform quality deep, fast chest compressions before fatigue sets in.

Now, of course, all of this is ideal. Any compressions are better than none. And even with the best CPR, few people are going to be revived without the electric shock. But it can occur. People have been revived after prolonged CPR.

3 More Reminders From CPR Class
  1. Just doing a little wimpy pumping won’t cut it in CPR. It has to be hard, fast, and constant. On an adult, the chest needs to compress about 2 full inches. And this compression needs to be repeated at 100 beats per minute, or maybe a little more. (Just make sure you give the chest time to rise fully before the next compression).
  2. Regarding artificial respirations: Children, choking, and drowning are different. In these situations, breathing tends to be the primary problem. The victim can’t get oxygen via the lungs to the heart, and the heart stops. So artificial respirations are deemed more important initially. Read more about exceptions here.
  3. The AED is so simple to use. Find the machine, turn it on and follow instructions. That’s it. The backs of the included pads illustrate where to put them on the chest, but truthfully, you can’t go wrong with positioning. The way the electric current works in the machines these days, anywhere on the chest will do.
2. Why don’t you don’t check for a pulse when looking for signs of life?

Because it is so hard sometimes to tell if it’s your pulse or the victim’s. Just think, you’re excited, full of adrenaline. Your heart is probably pumping really hard. So you feel the pulse, or think you do, or think you don’t.

The current thinking is, if the person has no sign of life (no breathing, moving, groaning), that’s about as good an indicator as you’re going to get that the heart has stopped.

On the other hand, don’t go overboard. Some people get so gung ho they start doing compressions on someone who’s talking or groaning.

Choking

3. People sometimes die from choking with no one realizing it.

Many times, there’s no indication that a choking person isn’t breathing other than the fact that they’re silent. In fact, some people who are choking may go in another room and close a door. Check on them. Ask them directly if they need help, and look for an answer.

4. There’s a different technique you can use when a large person is choking.

If a choking victim is too big to get your arms around for an abdominal thrust and they’re standing, push their back up to a wall, and push into their upper abdomen.

 

I cover more about CPR and choking in my video-based training course. One thing I mention there was pointed out in this year’s course: If no one is taking charge to your satisfaction, it’s up to you. If others are around, point or nod to one and give specific orders. “You, call 911. You, look for an AED. You, get down and help me.”

And please, if you haven’t, also take a hands-on course. The knowledge gained is so vital and comforting.

What about you? Have you taken a course lately? Have you ever had to perform chest compressions?