We’re excited that you’ve decided to take CPR, and that you’ve chosen us to direct your learning experience. Despite technological advances and new scientific discoveries, heart disease remains the number one cause of death globally, with 17.3 million deaths per year; 38.7% of cases of out of hospital cardiac arrests (OHCA) are witnessed by a bystander (AHA, 2015). Learning CPR can save lives- you can save a life. In this course, you will learn:
The Chain of Survival and your place within the chain
How to provide high quality chest compressions for adults
How to initiate early use of an AED (automated external defibrillator)
How to provide rescue breathing for victims of respiratory arrest
How to provide CPR with 2 rescuers
How to assist adult victims of choking
Let’s get started!
The Five Fears
Many bystanders are reluctant to perform CPR. There are many reasons why bystanders are reluctant to get involved. Let’s take a look at some of these reasons so that you can understand why they have no real basis of support.
Fear of Disease: Use universal precautions when the possibility exists of coming into contact with bodily fluids. Use gloves, mask, and/or gown when you have them available. The benefit of initiating lifesaving resuscitation in a patient in cardiopulmonary arrest greatly outweighs the risk for secondary infection in the rescuer or the patient. Nevertheless, use of simple infection-control measures during CPR and CPR training can reduce a very low level of risk even further (Mejicano & Maki, 1998).
Fear of Lawsuits: These laws state that a person acting in good faith who is rendering reasonable first aid will not be held accountable for damages to the person to whom the aid is rendered, unless gross and willful misconduct are involved. Good Samaritan laws may differ for professional health care providers versus lay rescuers from state to state. Implied consent means that there is an assumption that if an unconscious person were able to request care, they would do so.
Fear of Uncertainty: People sometimes fear that they won’t remember what to do. Remembering the correct number of compressions or the number of compressions to ventilations is not as important as the willingness to respond and to push hard and fast. Hands-only CPR is designed to provide simple life support. No mask, no worry- performing compressions alone has been shown to be effective at saving lives.
Fear of Harming the Victim: A victim in need or clinically dead can only be helped by your intervention efforts. You can’t hurt someone who is dead, and any injuries you may unknowingly cause (such as injured ribs) can be dealt with in a surviving victim of cardiac arrest.
Fear of Injury to Self: As you will learn, scene safety is of utmost importance, and checking the scene for safety should be your first action when you come across an unconscious victim. If the scene is not safe for you to enter, you must not enter. This will only result in more victims. Under no circumstances should you risk becoming a victim. Instead, you should call for help (activate EMS).
Basic Anatomy and Physiology
Before you learn how to perform CPR, it’s important to understand how the heart, lungs, brain and cells perform. Here is a brief review of these systems.
The heart consists of four chambers, the right and left atria (singular: atrium) and the right and left ventricles. The atria are located above the ventricles, as can be seen in the above diagram. The heart is a muscular organ supplied by the coronary arteries. It is located below your breastbone (sternum) and, in an adult, is approximately the size of your fist.
The heart pumps blood that has been deoxygenated after supplying the body’s tissues into the lungs, and when that blood has been oxygenated again in the lungs, it exits the lungs to the left side of the heart, where it is pumped out into the body once again, to provide oxygen to the vital organs.
Your body has about 5 liters of blood, which circulate through this system approximately 3 times per minute.
What is known as the cardiovascular system is composed of the heart, arteries, capillaries, and veins.
Your lungs are spongy, air-filled sacs, with one lung located on either side of the chest. The trachea, which is sometimes called the windpipe, conducts air down into the lungs through the bronchi, which are smaller tubular branches. The bronchi then divide into smaller and smaller tubules called bronchioles. Air is exchanged in the alveoli, which are tiny sacs that allow oxygen and carbon dioxide to move between the lungs and the bloodstream via tiny capillaries.
Your lungs take in oxygen to supply your body’s organs and tissues. They release carbon dioxide, a waste product, into the atmosphere when you exhale.
Room air at regular atmospheric pressure contains 21% oxygen. Our bodies utilize approximately 4-6% of that oxygen and release about 16-17% back into the atmosphere, along with carbon dioxide, when we exhale. This 16-17% that we exhale can provide just enough oxygen to sustain someone in cardiac arrest, at least for a short time.
Your brain needs a constant supply of oxygen. Without oxygen, brain cells begin to die in 4 to 6 minutes.
On average, the brain weighs three pounds, and uses a whopping 20% of the body’s oxygen!
The medulla is located in the brain stem and controls automatic bodily functions, including consciousness and respiratory and cardiovascular function.
The Body’s Cells
All of the body’s tissues are made up of cells.
All cells require oxygen to carry out their normal functions. They also require nutrients. Oxygen deprivation, or hypoxia, will cause cells to die within a few short minutes.
The body’s cells use oxygen and produce carbon dioxide as a waste product. Carbon dioxide must be eliminated via the lungs through ventilation.
Red blood cells transport oxygen throughout the body.
As mentioned previously, cardiovascular disease is the number one cause of death worldwide. While it is important to learn what to do when cardiovascular disease leads to a heart attack or stroke, it is equally as important, if not more so, to understand how to prevent cardiovascular disease from occurring in the first place.
There are numerous factors that can increase an individual’s risk of heart attack. Some of these factors can be controlled (modifiable risk factors), while others cannot (non-modifiable risk factors.
Modifiable risk factors, or factors that can be controlled to a certain degree by an individual, include:
sedentary lifestyle (lack of exercise)
high blood sugar (in diabetes)
poor diet (diet high in sugar, fat)
Non-modifiable risk factors, or risk factors that individuals cannot change, include:
genetics/hereditary factors (i.e. hereditary high cholesterol or hyperlipidemia)
race (i.e., certain groups may be at higher risk for hypertension, or high blood pressure)
Cardiovascular disease is the number one cause of death in the United States, According to the center for disease control (CDC). The CDC estimates that more than 650,000 americans die from cardiovascular disease (1 in 4 deaths) each year in the United States.
Cardiovascular disease damages the heart and blood vessels, and frequently causes heart attack and/or stroke. Americans of all ages should focus on prevention of cardiovascular disease by eating healthy foods, exercising 30 minutes (at least) each day, controlling weight, minimizing stress, consuming healthy fats and oils, and avoiding cigarette or cigar smoking.
Atherosclerosis, or hardening of the arteries, is a condition caused by the building up of plaque inside the body’s arteries, the large blood vessels that carry blood away from the heart to the body’s organs. Plaque is composed of fatty substances, cholesterol, fibrin (a clotting substance in the blood), calcium and cellular waste products. When plaque builds up, it can partially or totally block the flow of blood through an artery in the brain (which causes stroke), the heart (which causes a heart attack), the kidneys, the arms, the legs and other vital areas. Plaque may break off to block an artery, or a blood clot (thrombus) may form on the surface of the plaque- either of these two circumstances can lead to a heart attack or stroke.
A heart attack often presents with one or more of the following symptoms:
Chest tightness, pressure, or discomfort
Shortness of breath
Pain in the jaw or arm
Pallor (pale color of the skin)
Women and people with diabetes often present with atypical symptoms, such as nausea and vomiting or back pain. About one-third of patients report no chest pain at all.
What Can You Do?
Recognize the symptoms and signs of a heart attack.
Don’t let the patient drive him or herself to the hospital
Keep the patient calm and seated in a position that is comfortable.
Offer 1 adult aspirin or 2 baby aspirin- aspirin should be chewed before swallowing to speed absorption (Note: do not give if the patient has already taken aspirin or if the patient has an allergy to aspirin)
Be prepared to start CPR if it becomes necessary
You should suspect stroke if a patient or victim presents with:
Severe headache with no known cause
Numbness or weakness of the face, arm or leg on one side of the body
Drooping eyelid or mouth on one side
Confusion or trouble understanding
Difficulty speaking (slurred speech or difficulty finding words)
Loss of balance or coordination
Trouble with vision (i.e. blurred or double vision, loss of vision in one eye)
What Can You Do?
Know the signs and symptoms of a stroke
Don’t give the patient food or drink
Keep the patient calm and quiet
Monitor the patient
Be prepared to begin CPR if it becomes necessary
A stroke is caused by one of two mechanisms: it can be caused by a ruptured blood vessel in the brain (called a hemorrhagic stroke) or by a blockage in one of the arteries that causes loss of blood flow and oxygen to a part of the brain (called an ischemic stroke). Ischemic strokes are more common. Remember that “Time is brain,” and act quickly. Stroke is the 3rd leading cause of death in the United States.
For anyone who has taken CPR prior to 2010, there have been a few key changes since the 2010 Guidelines were instituted. These changes include:
Changing from the ABCs (Airway-Breathing-Circulation) to a C-A-B sequence of steps. This was one of the major changes that took place in 2010, when research showed that decreasing the delay in beginning chest compressions lead to a higher incidence of ROSC (return of spontaneous circulation). Rescuers are now trained to provide interventions in the following order: 1) Chest Compressions, 2) Airway, and 3) Breathing. Decreasing the delay in beginning compressions increases survival rates.
The removal of “Look, listen and feel” for breathing. It is often hard for even trained providers to identify effective breathing. It is no longer recommended to look, listen and feel to determine whether a victim is breathing. Rather, if the victim is not responsive, has no pulse, and is not breathing or is breathing in an irregular fashion (i.e. only gasping), begin CPR immediately!
Emphasis on high-quality CPR. High-quality CPR is defined as:
Compression rate of 100- 120 beats per minute on victims of all ages;
Compression depth of AT LEAST 2 inches in adults (but no greater than 2.4 inches). Allow the chest to completely expand (recoil) after each compression (do not lean on the chest between compressions);
Not interrupting CPR except to use an AED (keep interruptions in chest compressions to less than 10 seconds);
Avoiding excessive ventilations;
Above all else, PUSH HARD AND FAST!
Since many responders (even professionals) are unable to feel or palpate a pulse quickly, the recommendation is to feel for a pulse for NO MORE THAN 10 seconds. If you can’t feel a pulse or if you’re not sure you can feel a pulse, begin CPR.
It has been recognized that health care professionals should call for assistance when they come upon an unconscious victim, but they may also simultaneously assess breathing and check for a pulse before fully activating the emergency response system. This may encourage efficiency in assessment and response, rather than following a step-by-step response.
Health care professionals may tailor their response to an unconscious victim by altering the response sequence to fit the situation or scenario (using an AED immediately when one is close by and the arrest is witnessed, or providing ventilations first when the cause of arrest is known to be an anoxic event (i.e. drowning).
Rescuers should provide 1 breath every 6 seconds when an advanced airway is in place and compressions are ongoing continuously (rather than trying to remember a range of ventilations for adults, children and infants).
The Adult Chain of Survival
The Adult Chain of Survival represents a continuum of care, from early recognition of the victim in cardiac arrest to post-resuscitation care to provide the best chance of survival from cardiac arrest. The five links in the Adult Chain of Survival include:
Early recognition of cardiac arrest
Activation of the Emergency Response System
Early CPR, with an emphasis on high-quality chest compressions
Comprehensive post- cardiac arrest care
Note that in the diagram above, the first two of the five steps (early recognition of cardiac arrest and activation of the emergency response system) have been combined to acknowledge the fact that these steps often occur simultaneously when multiple rescuers are present.