Emergency CPR

emergency-cprHere’s the scenario: You are at your local grocery store. You have gotten everything that you need and are standing in the line to the checker. You notice that the line is unusually long and that you are probably going to be here for a while. The next think you know, you hear a “thud” and some commotion behind you. The person behind you is on the ground, unconscious.

You call 911 and half a dozen EMS workers show up with their big red truck, and ambulance and a gurney. They have their heart monitor, a big bag of equipment and oxygen. In just a few minutes, they have picked that person up and brought them out of the store.

The commotion has gone away, you pay for your groceries and are walking to your car. You see the guy that passed out sitting in the back of the ambulance. He looks OK, and you are thankful he’s awake, but you can’t help but think “what could I have done? Could I – or should I – have helped that guy before the paramedics arrived?”

Believe it or not, this is not an uncommon situation for many people. One of the most common calls I run as a paramedic are for people passing out (or syncope). There are several reasons why a person may lose consciousness, and a paramedic will try to figure out some of those causes.

Before a paramedic starts checking blood sugars and doing EKG’s they will always first address the CAB: Circulation, Airway, and Breathing. An obstruction of any of these three things constitutes an immediate threat to life.

This is where you can come in.

With little or no equipment, you can assess and address these life threats before the paramedics arrive by employing emergency CPR.

Editor’s Note: First point – We are literally talking about saving lives here. Still, in America at least, people will sue you at the drop of a hat. Understand the Good Samaritan laws in your state (yes, they vary widely from state-to-state). See here for a starting point.

Second point – As a lay person, what follows caught me a bit off guard. The old ABC (Airway, Breathing, Circulation) of doing CPR has been turned on its head. Why? It saves more lives.

We STRONGLY suggest that you go to the American Heart Association to fully understand the new practices (in place since 2010). Click this link (PDF – “Guidelines for CPR and ECC”) and you’ll be taken to a summary of the changes that have been made.

Then sign up for an emergency CPR class!

Read the information provided below, then come back and go to the AHA site.

Check for Responsiveness and Start Compressions

If a person collapses, call 911 if you have a phone available.  Follow the instructions of the person on the other end of the line.

They will likely have you try to wake them up.  If you do this, and they do not respond, then you should start chest compressions. And by “try to wake them up”, I do not mean, give them a little nudge and see if they are just napping.

Ask them in a loud voice “Sir/ ma’am are you OK?”.

If they do not respond to this, then apply a painful stimulus. One that is very effective on most people is the sternal rub. Make a fist and rub your knuckles on their breast bone in the middle of their chest.

If you still have no response, try to check for a carotid pulse on the victim’s neck. Check for no more than 10 seconds. If you do not feel a pulse or are unsure if you feel one AND you DO NOT see or hear signs of breathing (a snoring or gurgling sound, or the chest heaving), then it is time to start CPR.

That’s right: Start CPR right now. As noted, the AHA saw that too many lay-people waited too long to start emergency CPR – primarily spending too much time checking for a pulse and signs of breathing – and the incidents of death and brain damage rose.

Emergency CPR sounds complicated right? Actually, it’s pretty easy and you do not need any special training to do so. It is so easy, in fact, that several public health agencies are teaching people “Hands Only CPR”.

You start by positioning yourself on the side of the victim. Next, place one of your hands on the victim’s breast bone between the nipples. Then place your other hand on top of you first hand. Straighten your arms and press down on the victim’s chest. This movement should come from your hips, not from your shoulders or elbows.

Last, press hard and fast. Pressing “hard and fast” are the exact guidelines given by the American Heart Association, not a ratio of breaths to compressions. Just press hard and fast.

How do you know if you’re pumping fast enough? Play a song in your head! Seriously, two VERY ironic songs have the proper tempo for chest compressions:

Staying Alive, and Another One Bites The Dust!

Just keep playing the song in your head, and pump.

It’s important that you allow the chest to fully recoil with each push. This is critically important, as you need to ensure ALL of the blood in the heart is being pushed out.

It is worth noting that this is a violent process. The AHA states that the compression must be AT LEAST 2 inches for adults (1/3 of the chest cavity depth for children). There is a high likelihood that you are not doing it right if you do not break the victim’s ribs. This may sound like you are injuring the victim, but you are literally pumping their heart with your body weight.

Bones heal. Dead doesn’t.

Even if this is only thing you do before the paramedics show up, you will have dramatically increased this person’s chances of survival by starting emergency CPR early.

Learn How to Clear an Airway

 Let’s say you followed the initial steps above of checking for responsiveness, and the victim responds by moaning, but appears to be snoring or trying to gasp for breath. The next thing you should do is manage the victim’s airway.

The number one most common obstruction to a person’s airway when they are unconscious is their own tongue. When you lose consciousness, generally you lose the muscle tone to keep your own tongue from flopping back into your own throat.

How do you move the victim’s tongue from out of their own throat? Easy. You use the “head tilt-chin lift” technique.

Start by placing a hand on the victim’s forehead. Place your other hand on the victims chin, and tilt the head back as if the person were trying to look up or in “sniffing position”.

You may be thinking “Hey, what if this person hurt their neck? Isn’t opening their airway with the head tilt-chin lift technique potentially injuring this person’s neck?”

While this is a concern, especially in older people due to weaker/brittle bones, this person’s blocked airway is going to kill them faster than their neck injury.

On top of that, true spinal injuries are difficult to sustain from a ground level fall, and if they are going to have a spinal injury, they will have already have had it from the fall. It is very unlikely that moving the victim’s neck will actually CAUSE a neck injury.

Just by positioning the victims head this way, their tongue will be moved in a way that does not occlude (block) their airway. This person may start breathing at this point, and may even regain consciousness.

So what if this person starts to vomit or starts having a seizure? You should roll this person onto their side. You do this to reduce the risk of the victim choking on their own vomit.

I know, disgusting, but sadly, it happens. The reason you do this with a seizure victim is because they may vomit as well.

NOTE: Under no circumstances should you place your hands or fingers in the victim’s mouth! If they start to have a seizure, they could bite your fingers and severely injure you.

Finally, if you must perform Rescue Breaths, move on to the next step.

Learn How to Give Rescue Breaths

The AHA recommends that an UNTRAINED lay-person ONLY perform the “Hands Only” emergency CPR. No breaths. They DO suggest that a TRAINED lay-person provide 2 rescue breaths for every 30 chest compressions.

We have all seen on TV how the paramedic does mouth-to-mouth rescue breathing on someone right? I am here to say, “don’t do that”, especially if this is someone you do not know.

The last thing you want is a mouth full of someone’s vomit.

This is the only step where I suggest you have a piece of equipment. A 1-way valve pocket mask is a cheap piece of equipment that you can carry in your purse, backpack or glove compartment.

You simply place this mask over their nose and mouth, create a good seal by pressing down on it, then breathe into the valve. Only breathe enough air to make the victims chest rise. If this victim were a child, that might only take the amount of air in your mouth.

This is a step that you should practice beforehand, and if you are not confident doing it, you should skip it and just hold open the airway with the head tilt-chin lift technique.

So there you have it, 3 techniques for emergency CPR to care for someone who loses consciousness. I highly recommend taking a basic emergency CPR class because you will be able to practice all of these techniques on dummies.

Emergency CPR classes that are certified by the American Heart Association or the Red Cross are the most thorough. You can even look up “Hands Only CPR” on Youtube to get an idea of how these techniques are performed.

But until then, just remember to care for CAB: Circulation, Airway, and Breathing!


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