Chest Compressions - Back From The Dead

Ok..So now you have completed your assessment and you are certain there is no breathing and no pulse (if you are checking). By all rights, this person can be considered dead. But.....there is a possibility that you can get them back. What? Bring them back from the dead? Yes! If you work quickly and efficiently. What this person needs right now is CPR, fast hard chest compressions in the center of the breast bone at a depth of about 1/3 to 1/2 the depth of their chest. If you are providing breaths as well you will need to give them two breath for every 30 compressions. Pump em up! If you are not comfortable putting you mouth on this person, then you can pump only, which is better then nothing.

What you are buying this person is time. Time is critical here. CPR keeps oxygen rich blood circulating until and AED is available to administer a shock (if they qualify). Whether by ambulance or by community, the AED is critical in the picture. Paramedics will be using cardiac monitors that are looking to shock in the same way a community AED does.

So pump em fast and hard until an AED is available or until you are too exhausted to continue. This will keep the patient from going brain dead and contributes to a successful resuscitation. This is how you bring em back from the dead.

ABC (Airway, Breathing, Circulation)

In basic life support the ABC's are part of the primary assessment. A BLS provider must determine if the patient is able to maintain there own ABC's (Airway Breathing Circulation). Patients who are unresponsive, but still breathing may need ventilatory assistance depending on the rate and quality of there breathing. Patients who are not breathing definitely need ventilatory assistance and may need chest compression if there is no pulse.

When assessing for breathing you will need to look, listen, and feel for breathing for 5-10 seconds. The patient will need to be on their back face up (supine). Your ear should be close to the patients mouth and you should be looking at the chest. If there is no indication of breathing, tilt the head and lift the chin. Depending on the setting and what you have available, you may use a breathing device to give breaths or if appropriate, use your mouth. If using your mouth, pinch the nose and give two slow breaths watching for the chest to rise and fall. Make sure that you have the head tilted back with the chin facing up (adults). Then you will need to go to the carotid artery and check for a pulse. If you find a pulse, this means that the heart is working and no chest compressions are needed. In this case the patient needs rescue breathing until help arrives or their condition changes. If there is no pulse present of you are unsure if a pulse is present, then CPR needs to be started.

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CPR and Patient Assessment

CPR is an intervention within the BLS (Basic Life Support) scope of practice. When you are taking a "CPR" class you are actually taking a BLS class. BLS training or "class", is a more accurate definition then "CPR class". When taking a BLS course there are other skills in the class that are taught other then CPR. The class includes rescue breathing, using the AED, recovery positions as well as other skills. One of the most critical skills in the BLS programs is patient assessment.

Before an intervention can be applied to a patient in a situation, there must first be an accurate assessment of the condition. This is very important to understand, and it is the responsibility of the instructor to address this area in detail. If an accurate assessment isn't done prior to application of a skill, then it is very possible that the BLS provider can be going down the wrong road. It is not enough to just do CPR on someone who is unconscious. It may very well be the wrong thing to do. Many victims experience having low blood sugar, or have taken an excess amount of medication causing their level of consciousness to be very decreased.

If these people are still breathing, CPR is NOT what they need. In many cases they simply need to be put on their side in the recovery position, and someone needs to call for EMS. To do CPR on a person who doesn't need it can be fatal. 5-10 minutes of chest compressions on an 80 year old diabetic female who weighs about 90 lbs, (when it wasn't needed) does more harm then good. She will be very lucky to survive that kind of trauma.

Problems with the care that is given to a patient almost always occur from an inaccurate assessment. In regards to BLS, if an assessment is complete, the treatment needed really "jumps" out at you and is not something that you have to figure out. New BLS providers who struggle with which skill to apply in a scenario do so because either they have not done a correct assessment or they do not understand what their assessment findings mean.

Remember that patient assessment is a skill in itself. Master the patient assessment skill, and the other BLS skills will always be applied appropriately.

M.Morales EMT-Paramedic

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