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CPR For General Adults: Processes, Protocols, Ethical Points
CPR For General Adults: Processes, Protocols, Ethical Points
by admin | September 06, 2022 | CPR | 2 comments

One question that always perplexes people is why seemingly healthy adults suddenly get heart attacks (or cardiac arrests). This question occurs even more strongly to us when we witness someone who appears completely normal and then collapses in front of us in a public space and seems to need urgent CPR to stay alive.

There is a belief prevalent among most medical writers that “a heart attack strikes someone about every 34 seconds”. How old this information is and whether it is still valid today is anyone’s guess … but given today’s lifestyles, many adults, much younger than we expect, have sudden heart attacks. And the numbers of sudden cardiac attacks are clearly on the rise.

In men, the risk for heart attack is said to increase significantly after age 45. In women, heart attacks are believed to be more likely to occur after age 50. But these kinds of numbers again demand a review.

Young men and women, even those just past their twenties or thirties, who seem to be otherwise fit and healthy, and who go to their gyms regularly, seem to keel over with sudden cardiac arrest that calls for immediate first-aid to make them survive. All this underscores the idea that more and more people need to learn CPR.

 

Adult CPR and its standard techniques

When you, as a bystander (with or without formal life-support training), see that an adult man or woman has had a sudden reason to collapse to the ground unconscious, the two things to check instantly are if the person is breathing and has a beating pulse.

If the breathing has stopped, it could be a lung failure (pulmonary arrest) … and if the pulse isn’t beating, it could be a heart attack (cardiac arrest). If both conditions of no-breathing and no-pulse occur, here’s what you need to do, according to HealthDirect (Government of Australia):

 

1. Get someone to call for an ambulance and medical aid

Once you get help making that emergency call to the nearest medical services or hospital, see if the patient is in the right and safe place for CPR. If you have to deal with a patient who is heavier than you, get help to move the patient to a safer place, away from traffic and crowds, to begin a CPR routine without delay.

 

2. If the patient is breathing but has no pulse, here’s what to do

Kneel by the patient’s side, press the lower part of the palm of your one hand on the patient’s chest (between the nipples) and clutch this hand with your other palm.

Then start compressing the chest, pumping in at least 2 inches deep, and relax a bit to let the chest rise back to position. Then compress again and let the chest return to position.

You have to do 100-120 such compressions per minute (you can time your compression frequency to the beat of the song “Stayin’ Alive” by the Bee Gees).

 

3. If the patient has no pulse and also no breathing, follow this sequence

You must do 30 chest compressions, then tilt the patient’s face and chin up to open the airway − and with your mouth over the patient’s mouth, you have to breathe air out of your lungs into the patient’s lungs.

Do 2 such “rescue breaths” (1 second each) with a bit of a gap to let the chest rise in between.

This process is a sequence … 30 chest compressions, face/chin tilt-up, 2 rescue breaths … then again 30 chest compressions, face/chin tilt-up, 2 rescue breaths … and so on.

 

4. Continue your CPR till professional medical help arrives

Yes, CPR is exhausting, and you never know how long you will have to persevere at such a fast tempo of compressions and rescue breaths till the ambulance and the medical experts arrive. That’s why it is vital to get someone to call the medicos even before you begin CPR so that you can get trained help on the scene as fast as possible.

 

5. If there are two people available, do CPR as a team

One person must do the chest compressions, and the other must give the rescue breaths. After 5 repeats of the whole process (i.e., 5 cycles), the two rescuers need to switch roles – so that neither of them gets fatigued before medical help arrives.

This is basic CPR to know and perform to save an adult with cardiac arrest.

 

The concept of the “chain of survival”

While being familiar with rudimentary CPR is essential for anyone, it helps further to know the “Chain of Survival” concept. What is this concept?

According to the Sudden Cardiac Arrest Foundation, the “Chain of Survival” refers to the sequence of actions rescuers must follow in rapid succession to maximize the chances of survival of general adult patients who suffer from sudden cardiac arrest. The standard “Chain of Survival” protocol has been evolved by the American Heart Association and is followed by the entire medical fraternity.

The “Chain of Survival” process is slightly different if followed in-hospital versus outside-hospital. The outside-hospital process consists of six steps:

 

    1. Activate emergency services. Make that call for an ambulance and medical help before all else.
    2. Provide high-quality CPR – do your best without let up until medical help arrives.
    3. When medical help arrives, they will bring an AED device. An AED (Automated External Defibrillator) is a sophisticated yet easy-to-use device that can analyze the heart’s rhythm and, if necessary, deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm.
    4. The medical team will then decide when it is the right moment to transfer the patient to the hospital for advanced resuscitation.
    5. The next process will be post-arrest cardiac care at the hospital.
    6. All the in-hospital patient recovery procedures will follow at this stage.

 

Bystanders can help save lives by addressing the first two links in the Chain of Survival – or at the most, be of help through the third stage. The rest of the chain is all in the hands of professional medical staff.

 

Ethical issues concerning bystander CPR

The CPR Consultants Training Center (authorized by the American Heart Association) states that there can be many occasions when bystanders are afraid to try CPR − and may even get stymied or refuse to give help to a patient who has fallen from a cardiac arrest.

Often, big-built male rescuers may feel afraid they may harm the female patient or crack her ribs if she is of a slight build. Or contrarily, small-built female rescuers may feel inadequate for the deep CPR compressions needed when the patient is an adult male of big build.

But it is considered unethical – even unlawful – in many countries worldwide to refuse to help, whatever the reason. This is because doctors believe it is everyone’s bounden duty to help, whether their CPR skills are great or not.

In the US, for instance, Good Samaritan Laws mandate that if you are near a patient who needs urgent CPR, you have to help.

That’s why knowing CPR and getting trained and certified in it is critical. This is important even in countries where the laws and ethics aren’t so strongly articulated.

 

In summary …

It’s humane to help. Would you not want some CPR help – good or bad – if you were the cardiac arrest patient? Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. HealthDirect. “How to perform CPR.” Accessed August 25, 2022. https://www.healthdirect.gov.au/how-to-perform-cpr
    2. Sudden Cardiac Arrest Foundation. “The Chain of Survival from Sudden Cardiac Arrest.” Accessed August 25, 2022. https://www.sca-aware.org/campus/the-chain-of-survival
    3. CPR Consultants Training Center. “Problems with CPR.” Accessed August 25, 2022. https://www.cprconsultants.com/problems-with-cpr/

 

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