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Now in all CPR or patient care, the most important thing to check before you engage in care
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is whether or not the scene is safe. If the scene is safe, there isn't any electrical hazards
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there are no chemical hazards, there is nothing in the environment that is going to cause us harm
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the scene can be declared safe. Along with that, it also means, does the rescuer have
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personal protective equipment. Gloves, and a CPR shield with a one way valve barrier
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to protect the rescuer from bloodborne pathogens. If the scene is safe, if your gloves are on
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and your shield is available, or there's no blood or body fluid in the environment
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you're now ready to be able to rescue safely. As always we're going to see the patient is on the ground
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they appear to need some help. But, we don't know what's going on yet.
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We call out to the patient. Are you alright? There's no response.
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"Are you alright, can you hear me?" I tap and shout on the collar bone.
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At the same time, I'm assessing this person to look to see if they're breathing normally or not.
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If they're not breathing normally, chances are they're in agonal respirations. Agonal respirations
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is a condition where the body just hasn't stopped trying to take a breath yet.
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It's kind of that ..ghgh.. that occasional gasp where they're trying to breath but they can't.
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It's not exchanging gases and it's not effective respirations. We're going to consider agonal respirations
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no respirations at all. If the patient is breathing abnormally or not breathing at all, we're going to
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make note of that. So, no movement, no response, no breathing...at that point if there is a bystander
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I'm going to activate EMS or call a code. You in the plaid shirt, go call 911 and come back.
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I might need your help. Come on back and help me when you're done.
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Then I'm going to turn back to the patient and at this point, as a healthcare professional,
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I'm going to check for a carotid pulse. Now you'll notice I'm finding the adam's apple.
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and I'm walking my two fingers off the side of the windpipe, in that valley between the neck muscle,
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and the windpipe. I'm checking for no more than 10 seconds. But please keep in mind,
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this is not really the most important aspect when we prepare to do CPR. If you can't tell
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whether there's a pulse or not and the patient is not breathing normally, and is unconscious,
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we're going to begin chest compressions and CPR. Because, there are a lot of studies showing us
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that if you can't tell if there's a pulse after you've been trained to check for a pulse,
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chances are, if they're unconscious and not breathing, they don't have one.
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So, we're going to move to CPR. In this case you do not feel a pulse. I'm going to find the
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center of the chest, interlock my fingers and begin my 30 chest compressions.
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at least 2 inches deep and at least 100 times a minute. That's more than one a second. This is fast.
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It's a lot of circulatory type compressions, and it's going to become exhausting in time.
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We'll cover that in just a minute. Now we'll start our compressions. Leaning over the patient's body,
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elbows locked straight, fingers intertwined. I'm going to pull up on the bottom hand so that all
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that's on the chest is my palm. I begin my 30 compressions... 1 and 2 and 3 and 4 and 5.....
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(counting)
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27...28...29...30. I'm going to get my mask, cover the nose and mouth. With a head tilt, chin lift
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I'm going to go ahead and give 2 rescue breaths.......both breaths went in. Now 30 more compressions.
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1 and 2 and 3 and 4....... up to 30 more. I'm going to continue this 30 compressions and 2 breaths
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until an AED arrives or until emergency medical services arrives or a code team arrives and takes over.
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If I have a bystander... I told you that this is exhausting...and it is. Every couple of minutes or so
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I'm going to start feeling like I can't go on, because the chest compressions are going to get
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less deep and less effective. If there is a bystander who could be quickly taught how to do chest compressions
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or already knows CPR, we're going to get them in on this to give me a break so that I can restore
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my own strength and hopefully then take over for them in a couple of minutes, so that we can continue this
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100 compressions or more per minute, nice deep, at least 2 inches deep over and over
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to try to circulate the residual oxygen and the oxygen that we're putting in the body
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to try to save the brain, save the heart, save vascular organs if possible. Or at least slow down
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the dying process so that when an AED arrives or when help arrives, we have a viable patient that has a chance
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at making it out of this cardiac arrest situation.
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The scene is safe, my gloves are on, my CPR shield is available. "Sir, can you hear me,"
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"Can you hear me?" There's no response. "Help! Somebody help me! You in the plaid shirt,"
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"Go call 911 and come back." Check for a pulse.....there's no pulse.
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1 and 2 and 3 and 4 and 5.........28...29...30 (breath), (breath). 1 and 2 and 3 and 4 and......
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28...29...30. Two more breaths, 30 more compressions. I continue this until an AED arrives or EMS shows up.
