Valuable lessons in how to save a life
Last week, I attended an update course on CPR – also known as cardiopulmonary resuscitation.
As doctors, it is part of our ‘‘fitness to practise’’ to make sure that we do a refresher course at least every three years. Every time I do it, I am amazed how much I learn – and how essential this skillset is.
In New Zealand, as in many other similar countries, sudden cardiac arrests are common. In fact, more than 2000 people a year will have a cardiac arrest in the community and, if CPR doesn’t happen within a small number of minutes, their odds of surviving are minuscule. A statistic I learned on my course was that for every minute CPR and a defibrillator shock are delayed, the chance of survival goes down by 10 per cent. That’s a hugely compelling reason as to why we should all know how to do effective CPR, regardless of whether or not we are a health provider.
Relying on the slim chance that if you or a loved one do have a cardiac arrest, you will be lucky enough for it to happen in hospital where you will be surrounded by specialists, isn’t necessarily going to pay off.
Cardiac arrest occurs when our hearts have stopped beating, we stop breathing and we become unconscious. In this state, no oxygenated blood is being circulated around the body and our vital organs, most importantly our brains, start to die. Cardiac arrests happen for all sorts of reasons, but are most common in older people as a result of a massive cardiac event – such as a big heart attack or an abnormal heart rhythm.
They can also occur as a result of blood clots, overwhelming infection, trauma with significant blood loss, drug overdose and severe allergy known as anaphylaxis.
In children, thankfully, cardiac arrest is much less likely, but can occur as a complication of accidents (such as drowning or choking), or congenital heart defects.
For some people, a cardiac arrest can happen
with no warning sign at all – but for others, they may experience chest pain, palpitations, faintness, or shortness of breath. If anyone you know develops symptoms like these, don’t panic as there could be lots of other things going on, but pick up the phone and talk to someone who can give you advice immediately – this might be the ambulance service on 111 if they look very unwell, or healthline on 0800 611 116 if they don’t.
Once someone has actually had an arrest, they will be unconscious (so you won’t be able to get a response by either talking to them, or trying to ‘‘stimulate’’ them by squeezing or gently shaking their shoulders); they won’t have any sign of breathing and they won’t have a pulse. If this happens, the time to act is now.
If you witness an arrest, or are asked to help by someone else, it is really important to know roughly what to do – you certainly don’t need to be an expert, but even doing some simple things can save a life.
The first thing to make sure of is that you and others aren’t in any danger – if you are, don’t get involved until the situation is safe – there is nothing to be gained by putting your life on the line, to try to save someone else’s, then there will just be two people in a critical condition, instead of one.
If the situation is safe, call for help immediately – you can’t manage this on your own, so getting specialised help there as soon as possible is crucial. Ask a passerby to call an ambulance, or use your phone to do this yourself – the ambulance will need to know that you are with an unresponsive person (either adult or child) who isn’t breathing. They will then prioritise this and should arrive within a
few minutes depending on where you are.
Once you have called for help, you need to start doing CPR – first you need to check the airway to make sure there is no blockage (for example some vomit, or their tongue). Do this by slightly tilting their head back, lifting their chin forward, then gently opening their mouth – if there is an obvious obstruction, try to remove it with your fingers. Then check for breathing by listening for breath sounds and watching for any rise of the chest. If you do see or hear breathing once you have opened their airway, try to put them into the recovery position on their side until help arrives.
If they are not breathing despite opening up their airway, you need to start chest compressions immediately – compressions are the only way to push blood around the body and give a chance of survival. In an adult, you need to place the heel of one hand onto the centre of the chest, and then place the heel of the other hand directly over the first one. Lock your elbows and push down hard directly into the chest. If you don’t push hard enough, your compressions won’t be effective so aim for pushing down about one-third of the depth of the chest – often a lot further than you think. In a child, you will usually only need to use one hand, or even just a few fingers depending on their size.
Try to do compressions at a rate of 120 per minute – you can do this by either asking someone standing there to put a metronome on their phone and set the rate to 120, or by thinking of the song lyrics ‘‘Tell me what you want, what you really really want’’ from the Spice Girls’ hit Wannabe – apparently that’s the right speed! If you do compressions well, they are very tiring, and even experienced CPR-providers usually need to swap out after a couple of minutes – obviously this is dependent on having someone else there who can help.
After 30 or so compressions, you should try to give two quick breaths into the mouth, holding the nose at the same time, then straight back to compressions again, repeating this cycle until help arrives.
Our course organisers encouraged us to buy mouth ‘‘shields’’ that can be kept in the glove box of the car, or even ones that can be attached to a keyring, in the event that you need to do CPR breathing – these can be purchased for a few dollars on Ali Express and other online outlets – and can be really worthwhile investing in.
Although good CPR can prolong someone’s life, the gold-standard treatment for cardiac arrest is to use an AED or automated defibrillator – this machine is super simple to use and they now all come with instructions. By placing the rubber pads on the chest wall, the AED will read the heart rhythm and instruct you when and if a shock needs to be given to restart the heart. The ambulance crew will arrive with one of these but, if you have people around to help, I’d send someone off immediately to grab the nearest one – you can find the location of AEDs in your neighbourhood by logging on to AED locations (aedlocations.co.nz/) and putting in the nearest address you can to where you are.
Personally I don’t think I could learn to do CPR by reading about it – so I’d really encourage you to get some training. Whether you are an organisation, group of friends, church, sports team or business, you really could save someone’s life and often courses are either free or relatively inexpensive when there is a group. I did mine through the Wellington Free Ambulance Service, but St Johns and the Red Cross are great providers as well.
And once you are trained, join ‘‘Good Sam’’ (goodsamapp.org) – an amazing network of trained resuscitators who are alerted if an arrest happens near them … I’m about to sign up right now.
With cardiac arrest, for every minute CPR and a defibrillator shock are delayed, the chance of survival goes down by 10 per cent.