A "Real World" Cardiac Arrest! -

A “Real World” Cardiac Arrest!

As you make your way through the sea of people at the airport it is painfully clear…..today is your last day in Hawaii. The amount of email currently building in your inbox is starting to take over your mind and you didn’t even realize you are supposed to be at an appointment early tomorrow morning until your phone alerts you and solidifies, vacation is officially OVER! Your quiet now, walking to your gate deep in thought, tactically planning the next 48 hours and how you will …….wait, what is going on up here?!?! As you approach you see a small mob of people gathered around what appears to be a business man, laying on the ground gurgling unproductively and a shade of a bluish gray that you have never seen before. Some people are yelling at each other to do something, some people are just staring paralyzed with fear and some people are just simply annoyed that they have to step around the man on the floor to get to this morning’s destination. What are you going to do? Would you know what to do? Do you feel like in this very moment, you would be able to organize your thoughts and actions with this mob to start helping this man? Yes! I just took a CPR class and……I have no idea where to start!

Wow! Crazy scenario, but it does happen, and most likely when it is least expected. In a crisis situation such as this I think it is difficult to know how you will respond, let’s work our way through this scenario and see if we can apply what you may have learned with your most recent CPR class and really apply it to a “real life” situation.

Is the scene safe? 

Many times this important step is forgotten and quite frankly, could be a life or death decision for both you, and the patient. Be sure to scan the immediate area looking for hazards, are you in position where you could become a patient? Are you on a street or roadway, in a dangerous area maybe? Your personal safety is most important and even Firefighters, EMT’s and Paramedics are taught to ensure that the scene is safe before entering and providing care to the patient. If for one second you think that you are not safe, leave the immediate area and call 911 immediately.

In our scenario you conduct your survey, you have scanned the immediate area and it appears safe for you and a small team to help this potential patient ……Now what?

Approach and Access!

As you approach, use your senses to assess the person on the floor. Are they awake? Do they make eye contact with you? Does the patient look blue or pale? Can you hear noisy breathing or see the patient gasping? Talk as you walk toward the patient, “Sir! Are you OK!” This general impression of the potential patient is taking mere seconds to complete, but is giving you copious amount of vital information on the condition on the person. As you arrive at the persons side you simply have 2 questions to answer;  Are they breathing, yes or no? Do they have a pulse, yes or no? These 2 assessments should be checked simultaneously and should take you at least 5 seconds, but no longer than 10 seconds to answer. If the person is making some sort of respiratory effort, but seem labored or unproductive like gasping, just ask yourself does this look like normal breathing that would sustain life? To evaluate a pulse put your pointer finger and next finger on the right or left of the persons windpipe located in the center of the front of the persons throat/neck area. A pulse can be sometimes difficult to detect, checking for at least 5 seconds but no more than 10 will give you a good window of time to locate a pulse if the person has one. Once it has been determined that the person has no pulse, no breathing and is unresponsive someone will need to go and retrieve an AED and call 911.

In our scenario, as you approach you notice that the person’s mouth is just moving and appears he is just gasping, he is a bluish gray color around his face and mouth and does not respond when you call out to him. You kneel down next to the person checking his pulse and breathing status, he is not breathing productively and has no pulse, you turn to the group and designate someone to retrieve the AED and call 911…….Now what?

Start CPR!!

As soon as it has been determined that the person has no pulse and no breathing, CPR needs to be started immediately at a rate of at least 100 compressions per minute and the chest should be compressed at least 2 inches or 1/3 the thickness of the persons chest from front to back allowing full recoil in between each compression. Push hard and fast in the center of the person’s chest until help arrives, trying to limit all pauses to chest compressions to less than 10 seconds. A new compressor should take over compressions approximately every 2 minutes to ensure that the quality of CPR is maintained during the entire event. As soon as the AED arrives it needs to be applied to the person’s bare chest, preferably without stopping chest compressions. Once the AED has been applied and turned on, continue doing chest compressions at 100 per minute and follow the instructions from the AED. The AED will analyze the person’s heart rhythm every 2 minutes to determine if the persons heart will benefit from an electrical shock, if the AED determines that a shock should be delivered it will give instruction on how to do so. Continuous chest compressions will help prepare the persons heart for the shock and possibly a return of spontaneous circulation.

In our scenario, you start chest compressions immediately making sure that you are compressing the chest at a rate of 100 per minute ensuring that you are going at least 2 inches deep and allowing full chest recoil after every compression. The AED arrives at the person’s side, you instruct it to be put on the patient’s bare chest while you maintain continuous compressions. For the next 10-12 minutes you continue to follow the instructions of the AED, maintain continuous compressions with the help of several others doing 2 minute cycles of CPR and inform the Fire and Ems crews of your actions.

You have done it! When we take second to really apply what you have learned from your most recent CPR class in a “real life event” it will hopefully give you some idea as to how things may happen and give you a mental image to draw from. Make sure the scene is safe, approach and access, call for help and get the AED and most importantly do the best CPR that you can for the patient!