THE ABC’s OF CPR
the truth about attempting to save a life
Jack Herlocker, first off, thanks for taking a CPR course. And obviously thanks to Sherry Kappel for stepping up and doing what was required. The idea of taking a CPR course and the reality of what could mean in a real situation can be a scary thing, but is something everyone should do. You also bring up a good point, as does Jason Stelzner when he says that standards have changed a few times. Frankly, and this is part of the problem, they change a lot more often than most people update their CPR. Technically, the standard that is being taught for CPR today is that you give 100 to 120 compressions per minute, with a depth of 2.0 to 2. 4 inches for an adult or teen who has been determined to be in cardiac arrest.
Having said that, I have been teaching CPR since I was a 18, working as a lifeguard. I have seen compression rates go from 80 a minute to 120, back to 80, and then to 100 more times than I can count. I have seen the depth of compressions go from the currently recommended 2.0 to 2.4, to 1.0 to 1.5 to 2.0 and back again. I have seen artificial respiration recommended in conjunction with CPR, not recommended, recommended only with a pocket mask, etc. to infinity.
So, the obvious question becomes, which is the best way to do it? The answer, although The American Heart Association would likely not conquer, is that we just don’t know. Each change in recommendation is based on studies that have been carried out in the 4 years prior to the change, and are based on not just direct findings but on correlated findings, and a host of variables that may or not be present when you are called on to do it. What may seem like a positive finding may, in fact, just be correlated. And of course correlation does not necessarily imply causation. Is it wrong to implement those types of guidelines? Not, not necessarily. Which brings me to my main point; and that is why instead of calling them CPR standards, that are now referred to with the more intentionally appropriate term, CPR Guidelines.Meaning, if an instructor (and I know a lot of them do) is telling people that they have to do exactly as they are being taught or they shouldn’t do anything, or that they are putting a life in danger by doing out dated CPR, then they are teaching dangerous information and frankly shouldn’t be teaching anyone.
Look, if CPR is required, then that means the person is dead. As in gone, aren’t coming back. They can’t get any worse. No matter what you do when you perform CPR, the worst thing that can happen is it may be ineffective and they will stay dead. It’s really no more complicated than that. We have a saying in emergency medicine that I think is relevant here:
Air goes in and out, blood goes round and round, any variation on the above is a bad thing.
Truer words have not been spoken. If a person is in cardiac arrest outside of a hospital, the only thing that will save them, is bystander CPR. What will increase chances even further are the 2nd and 3rd components to emergency cardiac care and those are early defibrillation followed up with intubation and emergency cardiac drugs given IV (commonly called ACLS interventions). So what does that mean? It means having the most people possible trained in CPR, that’s the 1st component. The 2nd component is having the most amount of public access defibrillators installed in high traffic public areas as possible, and the 3rd component is having an EMS system that staffs advanced and critical care paramedics who can provide the 3'rd phase of care ie. intubation and ACLS interventions.
Early CPR. Early defibrillation. Early ACLS. The key here is time.
The bottom line? CPR outside of an ICU is a low to moderately effective stop gap. The unfortunate truth is that usually it is not going to work (like 55–60% ineffective even if done perfectly). But it’s also the only chance the person has. The dead person won’t really care if you give 90 or 120 compressions a minute or if you go too deep and break a rib. If you don’t, they’ll be a corpse with a nice intact rib cage. So, if you break a rib, keep fucking going. They cannot get worse.
All of that being said, what can cause damage is doing CPR on a person who has a pulse. So … make sure, by checking a pulse for at least 10 to 15 seconds at the neck. Practice doing it on yourself and other people. CPR is not appropriate for anyone but people who are in cardiac arrest. So, because someone collapsed, and is unresponsive does not mean they need CPR. They might, but that is why you check for breathing and pulse. Think ABC. If someone is unresponsive, then call an ambulance because you will need one even if they are breathing sand have a pulse. After that is done, you need to remember ABC.
ABC
First, A for airway. Do they have an airway and is it clear? If it isn’t, you treat for choking (how to is included in a CPR course), if it is clear, then you move on to B, for breathing. Are they breathing? If yes, wait for the ambulance and keep checking breathing and pulse. If they aren’t breathing, then you move on to C, for circulation. Do they have a pulse? If no, start CPR.
By God this turned into a long comment, but the confusion that results from these must-stick-to-exactly-what-the-manual says prohibitively stringent requirements of instructors that have no more than technical knowledge of doing CPR are a real pet peeve of mine. Those types of stringent standards have nothing to do with helping someone who is in dire need of live-saving measures. Sherry Kappel, you did the right thing. Congratulations, because you saved a life. Not maybe, not “kind of”, you did. Without doing what you did, I can say with 100% accuracy, your friend would not have made it.
