Now in all CPR or patient care, the most important thing to check before you engage in care is whether or not the scene is safe. If the scene is safe, there isn't any electrical hazards there are no chemical hazards, there is nothing in the environment that is going to cause us harm the scene can be declared safe. Along with that, it also means, does the rescuer have personal protective equipment. Gloves, and a CPR shield with a one way valve barrier to protect the rescuer from bloodborne pathogens. If the scene is safe, if your gloves are on and your shield is available, or there's no blood or body fluid in the environment you're now ready to be able to rescue safely. As always we're going to see the patient is on the ground they appear to need some help. But, we don't know what's going on yet. We call out to the patient.
Are you alright? There's no response. "Are you alright, can you hear me?" I tap and shout on the collar bone. At the same time, I'm assessing this person to look to see if they're breathing normally or not. If they're not breathing normally, chances are they're in agonal respirations. Agonal respirations is a condition where the body just hasn't stopped trying to take a breath yet. It's kind of that ..ghgh.. That occasional gasp where they're trying to breath but they can't. It's not exchanging gases and it's not effective respirations.
We're going to consider agonal respirations no respirations at all. If the patient is breathing abnormally or not breathing at all, we're going to make note of that. So, no movement, no response, no breathing...at that point if there is a bystander I'm going to activate EMS or call a code. You in the plaid shirt, go call 911 and come back. I might need your help. Come on back and help me when you're done. Then I'm going to turn back to the patient and at this point, as a healthcare professional, I'm going to check for a carotid pulse. Now you'll notice I'm finding the adam's apple.
And I'm walking my two fingers off the side of the windpipe, in that valley between the neck muscle, and the windpipe. I'm checking for no more than 10 seconds. But please keep in mind, this is not really the most important aspect when we prepare to do CPR. If you can't tell whether there's a pulse or not and the patient is not breathing normally, and is unconscious, we're going to begin chest compressions and CPR. Because, there are a lot of studies showing us that if you can't tell if there's a pulse after you've been trained to check for a pulse, chances are, if they're unconscious and not breathing, they don't have one.
So, we're going to move to CPR. In this case you do not feel a pulse. I'm going to find the center of the chest, interlock my fingers and begin my 30 chest compressions. At least 2 inches deep and at least 100 times a minute. That's more than one a second.
This is fast. It's a lot of circulatory type compressions, and it's going to become exhausting in time. We'll cover that in just a minute. Now we'll start our compressions. Leaning over the patient's body, elbows locked straight, fingers intertwined. I'm going to pull up on the bottom hand so that all that's on the chest is my palm. I begin my 30 compressions... 1 and 2 and 3 and 4 and 5....
(counting) 27...28...29...30. I'm going to get my mask, cover the nose and mouth. With a head tilt, chin lift I'm going to go ahead and give 2 rescue breaths.......both breaths went in. Now 30 more compressions. 1 and 2 and 3 and 4....... Up to 30 more.
I'm going to continue this 30 compressions and 2 breaths until an AED arrives or until emergency medical services arrives or a code team arrives and takes over. If I have a bystander... I told you that this is exhausting...and it is. Every couple of minutes or so I'm going to start feeling like I can't go on, because the chest compressions are going to get less deep and less effective. If there is a bystander who could be quickly taught how to do chest compressions or already knows CPR, we're going to get them in on this to give me a break so that I can restore my own strength and hopefully then take over for them in a couple of minutes, so that we can continue this 100 compressions or more per minute, nice deep, at least 2 inches deep over and over to try to circulate the residual oxygen and the oxygen that we're putting in the body to try to save the brain, save the heart, save vascular organs if possible. Or at least slow down the dying process so that when an AED arrives or when help arrives, we have a viable patient that has a chance at making it out of this cardiac arrest situation.
The scene is safe, my gloves are on, my CPR shield is available. "Sir, can you hear me," "Can you hear me?" There's no response. "Help! Somebody help me! You in the plaid shirt," "Go call 911 and come back." Check for a pulse.....there's no pulse. 1 and 2 and 3 and 4 and 5.........28...29...30 (breath), (breath). 1 and 2 and 3 and 4 and...... 28...29...30. Two more breaths, 30 more compressions.
I continue this until an AED arrives or EMS shows up.
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