Learn how to save lives with CPR
Heartsaver CPR. Be the heart of a patient whose heart beats no more. As a former paramedic, I know how critical CPR was when determining potential survival outcomes of patients who were in Sudden Cardiac Arrest (SCA). A patient in SCA is unconscious, not breathing, not breathing “normally” or gasping. Ironically, my final EMS call was for a man who went into Sudden Cardiac Arrest at home while watching the Toronto Blue Jays play the Baltimore Orioles, he was 20. This patient had an undiagnosed irregular heartbeat (arrhythmia), which resulted in his unexpected demise. My partner and I used an AED (Automated External Defibrillator) administered powerful and aggressive CPR, in addition to the administration of numerous intravenous medications. In the end, we couldn’t save him. My paramedic career ended that day as I injured my back during that call, and this young man lost his life. The date was Apr 16, 2005. It was then I knew my next career goal in life would be to educate people on how to help those in need using CPR and First Aid. CPR and First Aid certifications are as important as learning how to drive. You must be skilled, constantly practicing and take nothing for granted. You never know when you will be called upon to act where literally seconds can be the determining factor as to whether or not somebody lives or dies.
Heart Attack vs. Sudden Cardiac Arrest
A Heart Attack, otherwise referred to as a Myocardial Infarction (MI) is the death of heart muscle cells in response to prolonged oxygen deprivation. Any phenomenon that completely interrupts the flow of blood through the coronary arteries (blood vessels that feed the heart muscle) will cause a heart attack. Culprits such as blood clots and fatty deposits lining the artery walls are common causes. When the heart muscle becomes completely deprived of blood and oxygen, the heart begins to fail and therefore, blood is not adequately circulated to the rest of the body. An oxygen-deprived heart muscle becomes susceptible to life-threatening electrical conduction disturbances called arrhythmias, the most common being Ventricular Fibrillation (VF). Heart attacks are very serious and potentially life-threatening Conditions that can ultimately lead to Sudden Cardiac Arrest.
Signs and symptoms of a suspected heart attack are as follows: denial, chest pain, chest pressure, chest ache, chest tightness, chest heaviness, chest constriction, and “it feels like an elephant is sitting on my chest”. Shortness of breath, nausea/vomiting, cool, pale and sweaty skin, anxiety, racing heartbeat, right and or left-arm pain, jaw pain, neck pain, back pain, shoulder pain, toothache, indigestion, heart burn, acid reflux, dizziness, heart racing and clutching of the chest.
What is Sudden Cardiac Arrest (SCA)?
SCA does not discriminate against age, gender, race or physical fitness level. SCA is the leading cause of death in both Canada and the United Stated. More people die from SCA each year than from breast cancer, colon cancer, gun-related deaths and AIDs all combined, no one is immune.
Sudden Cardiac Arrest is the sudden cessation of consciousness, breathing and circulation. The most common cause is an electrical disturbance (arrhythmia) in the heart’s conduction pathway, which causes the heart to start beating in a disorganized and irregular fashion. If left untreated, this will lead to sudden death. The most common arrhythmia leading to SCA is Ventricular Fibrillation (VF). Another life-threatening arrhythmia is Ventricular Tachycardia (VT). SCA is a medical emergency and can be reversed in many instances with the use of a Defibrillator, or Automated External Defibrillator (AED). An AED is a device that provides an electric shock to the heart with the ultimate goal of restarting the heart into a normal and beating rhythm.
There are numerous causes of Cardiac Arrest. Most often, causes of Cardiac Arrest are due to heart disease, which leads to a heart attack and subsequent Cardiac Arrest. There are often other types of heart conditions, which can lead to Cardiac Arrest such as: structural heart abnormalities and irregular heart beats/rhythms (Ventricular Tachycardia and Ventricular Fibrillation). Non- cardiac conditions which lead to Cardiac Arrest are cancer, low blood volume (hypovolemia), lack of oxygen (hypoxia) for example, asphyxia and drowning, electrolyte imbalances (generally low potassium levels), low blood sugar (hypoglycemia), electrocution, drug overdose, hypothermia and trauma.
Signs and symptoms of SCA are as follows, unconsciousness, not breathing, not breathing “normally” or gasping. These patients will have no heart beat.
Back to Reality
40,000 Canadians experience Sudden Cardiac Arrest (SCA) each year with 80% of them occurring outside of a hospital setting, either at home/residence or in a public place. "For every minute that defibrillation is delayed, an individual loses 10% chance of survival. Brain cells begin to die between 4-6 minutes post SCA with irreversible brain damage occurring between 8-10 minutes." The average response times for Emergency Medical Services (EMS) in urban centers is between 9-11 minutes with even longer response times in rural settings. An individual experiencing an “out of hospital” SCA, has a less than 5% chance of survival. If an AED is attached to a SCA victim in less than 5 minutes, and proper CPR has been administered, the chance of survival can reach between 73%-76%. You do not have to be trained in CPR to perform CPR. The 9-1-1 call-taker will help you while you are on the phone with them. They explain how to perform the skill and make it very easy to understand.
The History of CPR
CPR dates back all the way to the 1700’s, when in 1767 The Society for the Recovery of Drowned Persons setup and began researching ways in which to deal with patients who went into SCA.
In 1891, Dr. Friedrich Maass had the honor of being the first person to perform chest compressions in humans. Fast- forward to 1960 where CPR was officially developed by the American Heart Association (AHA). In 1992, the International Liaison Committee on Resuscitation (ILCOR) was created with the goal of fostering relationships and providing a medium for other Countries around the globe to share vital research, training, funding and education. In the year 2000, ILCOR and the AHA launched the first ever International CPR guidelines. The most recent and updated version was introduced to the world in 2020.
Making my Head Spin
To this day, my head still spins every time I hear someone ask me what CPR stands for, why it’s needed, when it’s needed and is it really that important. Here are the answers to these questions. Cardiopulmonary Resuscitation (CPR) increases chance of survival by 2-3 times in patients who are in SCA. When a patient stops breathing, their heart stops beating.
Blood will no longer circulate around the body and eventually cells, especially in the brain get injured and even die. CPR helps circulate blood throughout the body, which contains oxygen and nutrients, with the goal of slowing down the progression of cell death. It’s required immediately when a patient in unconscious, not breathing, not breathing “normally” or gasping. This helps increase chance of survival while waiting for the AED and advanced medical help to arrive. Yes, it’s incredibly important to learn CPR. Everyone should be CPR trained, and most are not. CPR certification and CPR re- certification along with First Aid certification and First Aid re- certification are invaluable skills everyone should know.
Heartsaver CPR for Everyone
I have some great news to share, in 2020; new CPR protocols were unveiled by ILCOR and the AHA… drumroll please. Breathing is no longer a requirement when helping someone who requires CPR. Yes, it’s true, if you come a cross a person who requires CPR, you DO NOT have to place your mouth over theirs and give them breaths. Don’t panic; let me explain the rational for you.
Those of you reading this article who have had to perform CPR on a stranger or someone you love, know the amount of stress and anxiety you will experience. You freeze, your brain shuts down, panic takes over, and you lose all control and rational thought. You become ineffective at helping the patient in crisis. The majority of people do not perform CPR when it is warranted and I can see why.
Previous CPR Protocols in a Nutshell (Prior to 2015)
Scenario. It’s a beautiful Sunday afternoon, you and your husband are out for a stroll when all of a sudden he turns to you, looking pale as a ghost and says, I have crushing chest pain and I can’t breathe. He drops to the ground, has turned gray and has stopped breathing, now what?
You try and recall your CPR protocols from a course you took just two years ago. You ask yourself, how many breaths am I supposed to give? How many pumps? How fast? When do I start CPR? Do I pump first or breathe first? Do I place my mouth over someone’s mouth that has blood and vomit visible? How hard to I pump? How deep? What is that song I am supposed to sing…? Your husband lay there unconscious and not breathing while you wrestle to find answers to these questions. It’s too late. Your husband wasn’t resuscitated, as CPR was never performed prior to EMS arrival.
CPR protocols prior to 2015 were too complicated for average responders who have never had to deal with such critical life and death situations. Call 9-1-1, that’s an obvious one, now, perform a head-tilt-chin-lift. Look, listen and feel for breathing (10 seconds). If the patient isn’t breathing, begin chest compressions. Place your hands in the center of the chest and push 2 inches or 1/3 the depth of the chest wall. Begin with 30 compressions, approximately 100 pumps/minute, and then stop compressions to deliver 2 breaths (mouth-mouth). Pinch the patient’s nose and deliver two breaths, back to back and stop each breath after you see the chest rise. Start back with your 30 compression and make sure to only do 5 cycles of 30:2 before switching partners if you have others who are able to help and if no one else is around, don’t stop!
Compression-Only or Hands-Only CPR is an extremely effective way to help someone who is in Sudden Cardiac Arrest. In this method, no rescue breaths or mouth-to-mouth breathing is performed. Here, the First Aider will perform continuous chest compressions, which has been shown to be extremely beneficial at providing the brain and other organs with much- needed oxygen and nutrients. Between 100-120 compressions (continuous) should be performed each minute. Ideally, you would want to have bystanders help, as this can be very tiring and intense.
If a First Aider isn’t highly trained, hands-only CPR is the way to go. Many complications can occur if rescue breaths are not performed properly. Blowing too much air into a patient can cause their belly to expand and the patient may vomit. You are also at risk of disease transmission if you do not have a CPR barrier device.
CPR During the COVID-19 Pandemic
If you recognize a patient to be in Sudden Cardiac Arrest, try and wake them and look for signs of breathing or odd breathing. Do not listen or place your face anywhere near the patient’s face. Just look at the patient and make your best choice. In these situations, call 9-1-1, ask someone to retrieve and AED, if one is close by, and begin your hands-only CPR. In order to decrease the risk of contamination, lay a cloth or towel over the patient’s mouth and nose to prevent any potential spread of COVID-19. Don’t worry; you are not preventing the patient from getting air, as they are not breathing. Laying something over the patient’s mouth will not make them worse. Your safety is paramount.
Disheartening statistics, revealed by St. Michaels Hospital researchers in Toronto, demonstrated that less than one in three bystanders, approximately 30% (consistent with other major cities in Ontario), would help a fellow citizen who is experiencing a medical crisis or who is in distress. One of the most common reasons for lack of bystander help is because people are not trained in life-saving First Aid and CPR skills.
In the end, it’s a family member, a wife, a husband, a daughter, a son, and a friend, who ends up suffering, as we are all potential patients. Complacency and apathy are deadly and I speak from experience. It’s never too late to take control and empower yourself with the knowledge to help save a life. It’s better to know First Aid and CPR and ideally not have to use it than have to use it and not know it. Learn what you need!
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