Stockbyte/Thinkstock CPR can save lives, and you don't have to be a doctor to learn how to give CPR.
You're playing your usual weekend pick-up basketball game with friends. Without warning, one of your teammates suddenly crumples to the ground. You scream out his name, but there's no response. His face turns pale and bluish, and you can't see his chest rise and fall tobreathe. You listen for a heartbeat, but you can't find apulseat all. You quickly grab your cell phone and dial 911.
Every year, this type of scenario is played out more than 600 times a day in the United States alone. Without rapid medical intervention, the prognosis is grim. Suddencardiopulmonary arrestis theleading cause of deathfor all adults, male or female.
Fortunately, modern medicine has come up with a number of tools to combat cardiopulmonary arrest. Many of these emergency procedures require medical training and/or complex equipment, but one,cardiopulmonary resuscitation (CPR), can be used in the field by lay people with only a little bit of training.
In this article, we'll explore how this simple first aid technique can help save lives.
PLEASE NOTE:This article is not intended to be used as a method for teaching CPR. For proper CPR training, consult your local hospital or American Red Cross location for available classes.
Checking for a Pulse
Cardiopulmonary arrest means that both heart and lungs have stopped working properly, so it would make sense to check and see whether a victim is breathingandwhether or not their heart is beating. However, current CPR guidelines don't require a layperson to check the victim's pulse before starting CPR. Why is this?
The answer is that the average person has a lot of trouble finding and determining pulse accurately. Think about how difficult it can be to find your own pulse, and then imagine trying to repeat the process on an unresponsive person. If someone is not breathing, their heart is already in danger of quitting (if it hasn't already) due to lack of oxygen. Since the first steps in CPR address the victim's respiratory state, you can try and get them breathing again right away. Then, you can check for a pulse. Skipping an initial pulse check simplifies CPR and saves valuable time; every minute that you delay starting CPR reduces the odds that the victim will survive by 7-10 percent.
What should you do to help a seemingly unconscious victim? The first thing you'll want to do is to figure out whether or not the victim is reallyunconscious. Just like you were trying to get them out of bed, you shouldcall outto them,tapthem, andgently shakethem to try and provoke a response. You also should check to see if they are breathing. If you try and perform CPR on someone who is not in cardiopulmonary arrest, you can actually hurt them!
If you can't rouse them, the very next thing to do is have someonecall 911so that professional paramedics will be on their way to the scene while you are performing CPR. This is very important, because, with the exception of choking, CPR doesn't address the underlying causes of cardiopulmonary arrest. It is only meant to buy time until the victim can get intensive medical care.
After you've called for medical assistance, you need tobegin CPR. In order for CPR to work, the victim must be lying on his or her back on a flat surface. If the victim is face-down, gently roll the person toward you while making sure that you support their neck. Once the person is on their back, you can then use theAmerican Heart Association's"ABCs of CPR"to guide you through the rest of process:
Airway: clear obstructed airways
Breathing: perform mouth-to-mouth breathing
Circulation: start chest compressions
We'll talk about each of these steps in detail in the following section.
Cardiopulmonary arrestsimply means that yourheart(cardio) andlungs(pulmonary) aren't working -- your heart isn't beating, and you aren't breathing. Many different things can lead to cardiopulmonary arrest, including:
Carbon monoxide poisoning
Aheart attack, for example, can damage the heart muscle and impede its ability to vigorously contract, resulting in cardiopulmonary arrest. If you've readHow Your Heart Works, you know that the heart is amusclethat expands and contracts under the electrical control of a special group ofpacemaking cells. The pumping action of the heart pushesbloodteeming with oxygen and other nutrients out to the rest of your body. If your heart isn't beating properly or at all, blood isn't supplied to your body, and oxygen and other vital nutrients don't get delivered to your tissues and organs (including your heart). With no energy to power your body, vital organs like your heart and lungs stop working, and you are in a state of cardiopulmonary arrest.
In a heart attack, something like a blood clot obstructs one of your coronary arteries and cuts off blood flow to your heart.
Cardiopulmonary arrest is an extremelydangerous situation. Within4 to 6 minuteswithout oxygen, your brain cells begin to die off rapidly. With each additional minute, the damage builds up. Most people cannot survive long in such a state.
Cardiopulmonary resuscitation (CPR) is afirst-aid techniqueused to keep victims of cardiopulmonary arrest alive and to prevent brain damage while more advanced medical help is on the way. CPR hastwo goals:
keep blood flowing throughout the body
keep air flowing in and out of the lungs
While the modern emergency room has high-tech equipment and an arsenal of drugs to help treat victims of cardiopulmonary arrest, CPR is a simple technique that requires little or no equipment. What you do is pretty basic:
Blow into the victim's mouth topush oxygenated airinto thelungs. This allows oxygen to diffuse through the lining of the lungs into the bloodstream.
Compress the victim's chest to artificiallyre-create blood circulation.
Here are the steps that make up CPR:
Photo courtesy ofUniversity of Washington
It sounds pretty simple, but as you can see above, CPR must be performed in aspecific, timed sequenceto accurately mimic your body's natural breathing pattern and the way your heart pumps. When someone collapses right in front of you, your first reaction is often sheer terror. But while you're panicked and unable to act, valuable minutes are slipping away. To counter this, many organizations such as theAmerican Heart Associationand theAmerican Red Crossoffer classes that train you in CPR and basic first aid and give youhands-on practiceto hone your CPR skills. Then, if you are confronted with an emergency situation, you are prepared to jump into action.
Here's a summary of how you might perform CPR on anon-responsive adult.There is actually a different procedure used to save infantsand young children). To learn all about CPR in detail, so that you could actually practice and perform this life-saving act, you should sign up for training from an organization like the American Red Cross.
A is for Airway
When you pass out, yourtonguerelaxes, and it can roll back in your mouth and block your windpipe. Before you can start CPR on an unconscious person, you'll probably need move their tongue out of the way. Here's how to clear a blocked airway:
Place the palm of your hand across the victim's forehead and push down gently.
With the other hand, slowly lift the chin forward and slightly up.
Move the chin up until the teeth are almost together, but the mouth is still slightly open.
Tilting the head back and lifting the chin move the tongue out of the airway. At this point, you should check again for breathing. If the victim ischokingon something, you may see their chest heave as they try to breathe, but you won't be able to feel or hear air being exhaled. You'll have to take additional measures toclear out what's blocking their windpipe, including:
Compressing the abdomen with forceful thrusts. This creates pressure that forces the object up and out of the windpipe.
Trying to manually dislodge the object with your fingers.
Once this is done, you have to check for signs of breathing again. Just clearing out the windpipe may sometimes be enough to allow the victim to start breathing on their own! If the victim starts breathing and moving around on their own, you can stop CPR. If this doesn't happen, you'll have to help them breath, by providingmouth-to-mouth resuscitation.
B is for Breathing
Your lungs have one main function: remove carbon dioxide and take up oxygen. Normally, the muscles in your chest contract and expand your chest cavity, allowing your lungs to fill up with air. Oxygen and carbon dioxide diffuse across the immense surface area of your lungs. Finally, your chest muscles relax, and you exhale. (To learn more about lungs, seeHow Your Lungs Work).
Rescue breathinguses your lungs to force air into the victim's lungs at regular intervals. The timing of each breath (about 1.5 to 2 seconds per breath) mimics normal breathing. However, the process is much more like blowing up a balloon than real breathing. Youinhaledeeply, form atight sealwith your mouth over their mouth, andexhalestrongly to push air out of your mouth into theirs. Because you also pinch the victim's nostrils closed, the air has nowhere to go except down into the lungs, which expand as they fill with air.
Mouth-to-mouth breathing is hard work. Normally, when you inhale, the chest muscles drive the process. In artificial respiration, you're working against the victim'srelaxed chest muscles. When the chest muscles are relaxed, the chest cavity is small, keeping the lungs in adeflatedstate. As a rescuer, you have to exhale forcefully into the victim's mouth for 1 to 2 seconds to overcome this resistance. As the lungs fill with air, the victim's chest is pushed up at the same time; you can actually see it rise. When you remove your mouth from the victim's and break the air seal, their chest falls and once again deflates the lungs. As in normal breathing, this results in air being exhaled from the victim's mouth.
Does air exhaled from someone else's mouth really provide enoughoxygento save an unconscious person? Normally, the air you inhale contains about 20 percent oxygen by volume, and your lungs remove about 5 percent of the oxygen in each breath. The air you blow into a victim's mouth thus contains about15 to 16 percent oxygen, which is more than enough to supply their needs.
After you've given the victim two breaths, you then check to see whether or not they have a pulse and whether they are able to breathe on their own. This will determine what you do next.
If the victim . . .
Is breathing and has a pulse
stop CPR, and stay with them until help arrives.
Is not breathing and has a pulse
continue rescue breathing.
Has no pulse
begin chest compressions, alternating with rescue breathing.
C is for Circulation
If the victim's heart is not beating, all your breathing efforts are for naught; the oxygen that you're getting into their circulation isn't going anywhere! Once again, you have to take over for a failing organ. This time you essentially become asurrogate heartto pump oxygenated blood out to the rest of the victim's body. How can you have any effect on blood flow from outside of the body? All it takes is your hands and some strength. The steps are simple:
Kneeling by the victim, place the heel of your hands one atop the other about .4 to .8 inches (1 to 2 cm) from tip of the breastbone.
Using the weight of your body, push the victim's chest down. You should compress their chest 1 to 2 inches (2.54 to 5.08 cm).
Hold in this position for half a second, then relax for half a second
Repeat steps two and three 29 more times.
Give the victim two rescue breaths as you did before to deliver more oxygen to the blood.
Repeat steps 1 through 5 three more times, then check for a pulse.
In reality, all you are doing is squeezing the heart between the breastbone and the backbone to force blood out. Compressing the chestcreates positive pressureinside the chest thatpushes oxygenated bloodout of the heart through the aorta. From here, it travelsto the brainand then on to other parts of the body, delivering oxygen for cellular respiration. When you relax, the pressure inside the victim's chest subsides. Deoxygenated blood moves back into the heart from the veins.
As the chest is compressed, positive pressure is created inside the chest, and oxygenated blood is pushed through the arteries to the brain and other organs. When you release, the pressure drops, and blood flows back into the heart from the veins.
CPR's Role in Rescue
Jim Arbogast/Digital Vision/Getty Images With CPR, respirators and defibrillators, we now have ways of bringing the dead back to life.
CPR extends the window of opportunity to perform more elaborate first aid procedures. By itself, CPR cannot save the majority of victims of cardiopulmonary arrest. CPR only temporarily restores circulation to only 10 to 30 percent of what it would be with ahealthy heart. Further, in about two-thirds of people in cardiopulmonary arrest, the heart goes into what's known asventricular fibrillation. In this state, the heart muscle quivers rapidly, like a bowl of Jell-O™, and is unable to beat properly. CPR cannot stop ventricular fibrillation, and only about 4 percent of patients who receive CPR alone will survive an attack.
In order to restore a normal heartbeat, an electrical shock must be delivered to the heart. This is calleddefibrillation. The shock itself doesn't switch the heart back on - it's not like flipping a tripped circuit breaker. Instead, defibrillation actuallystops the heartbriefly! This gives the pacemaking cells a chance to re-establish a normal heartbeat.
So why do CPR at all if it can't address the root causes of cardiopulmonary arrest? The bottom line is that CPR is an important part of acomprehensive responseto a cardiac emergency. Defibrillation requires special equipment that has to be brought to the patient, and CPR can keep a patient alive until a defibrillator arrives. When CPR is started within 4 minutes and defibrillation within 10 minutes of an attack, thesurvival rateskyrockets to 43 percent. Otherfactors that contribute to survivalare:
Rapid access to emergency care from paramedics and other medical professionals.
Quick provision of other supportive medical care, such as epinephrine, a drug that stimulates the heart.