First Aid/C for Compressions
Introduction — Issues in Providing Care — Primary Assessment & Basic Life Support — Secondary Assessment — Circulatory Emergencies
Respiratory Emergencies — Soft Tissue Injuries — Bone & Joint Injuries — Environmental Illness & Injury
Medical Conditions & Poisoning — Advanced Topics — Appendices — Meta pages
Contents |
Principles
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The purpose of doing chest compressions is to effectively squeeze the heart inside the victim's chest, causing blood to flow. This allows the normal gaseous exchange between the lungs, bloodstream and tissues to occur. Compressions are now usually performed before any rescue breaths due to the fact that when normal breathing and circulation stop, there is still a good amount of residual oxygen left in the bloodstream (as it has no way to exchange out of the body).
Technique
The aim is always to compress in the center of the chest, regardless of the victim. This means that compressions are performed on the sternum or breastbone of the victim, approximately in line with the nipples on males and children.
- For adults (>8) - place the palm of one hand in the centre of the chest, approximately between the nipple line (on adult males - for females, you may need to approximate the ideal position of this line due to variations in breast size and shape). Bring your other hand to rest on top of the first hand, and interlock your fingers. Bring your shoulders directly above your hands, keeping your arms straight. You should then push down firmly, depressing the chest to about one third (1/3) of its depth.
- For children (1-8) - place the palm of one hand in the centre of the chest, approximately between the nipple line. Bring your shoulder directly above your hand, with your arm straight, and perform compressions to one third (1/3) the depth of the chest with one arm only.
- For infants (<1yr) - Use your forefinger and middle finger only. Place your forefinger on the centre of the child's chest between the nipples, with your middle finger immediately below it on the chest, and push downwards using the strength in your arm, compressing the chest about one third (1/3) of it's depth.
Give 30 compressions in a row, and then two (2) rescue breaths.
Then restart your next cycle of compressions
Making compressions effective
You MUST allow the ribs to come all the way back out after each compression, followed by a brief pause. This allows the heart's chambers to refill. Spacing compressions too close together will lead to them being ineffective.
You are aiming for a rate of 100 compressions per minute, which includes the time to give rescue breaths. In practice, you should get just over 2 cycles of 30 compressions in along with breaths per minute.
Almost everyone compresses the chest too fast - Experience shows that even well trained first aiders tend to compress the heart too fast. The rate you are aiming for is only a little over one per second. The best equipped first aid kits should include a Metronome with an audible 'beep' to match your speed to. Many public access defibrillators have these included in their pack. If one is not available, count the number of compressions with the word 'and' between them. When you press down on the chest, say the number, when the chest rises say 'and'. this way, you will be saying 'one-and-two-and-three...'
Keep your arms straight - A lot of television and films show actors 'performing CPR' bending their elbows. This is not correct - you should always keep your arms straight, with your elbows locked and directly above your hands.
It often helps to count out loud - You need to try and get 30 compressions per cycle, and it helps to count this out loud or under your breath. Performing compressions is tiring, and you may not be able to count out loud for the duration, but ensure you keep counting.
If you lose count, don't stop, just estimate - It is important to carry on once you've started, so if you lose count, don't panic, and simply estimate when 30 compressions is over, and do 2 breaths, then start over counting again.
You are likely to break ribs - When performed correctly, especially on older people, compressions are more likely than not to break ribs or the sternum itself. You should carry on regardless of this occurring. It is a sign that you are performing good, strong compressions. Oftentimes the cracking sound you will hear is just the cartilage of the ribs and sternum breaking, and not the bones themselves. If bystanders are concerned about injury to the victim, you may want to remind them of the life over limb principle and assure them that it is normal to hear these sounds.
When to Stop
You should continue giving the victim CPR until:
- The victim starts breathing spontaneously - This does not include gasping, called agonal breathing. Victims are also likely to make sighing noises or groans as you perform chest compressions - this should not be mistaken for breathing.
- The victim vomits - This is an ACTIVE mechanism, meaning the victim moves and actively vomits. Not to be confused with regurgitation, where stomach contents make their way passively in to the mouth. If the victim vomits, roll them to their side, clear the airway once they're done vomiting and reassess ABCs.
- Qualified help arrives and takes over. This could be a responder with a defibrillator, the ambulance service or a doctor. However DO NOT STOP until told to do so. They are likely to require time to set up their equipment, and you should continue with CPR until instructed to stop. They are likely to work around you, placing defibrillation pads on the victim's chest while you continue compressions. Continue working as normal, and let them work around you.
- You are unable to continue - CPR is physically very demanding, and continued periods can be exhausting. Try to change places frequently with another trained rescuer to lessen the chance of exhaustion.
- You put yourself in danger by continuing - Hazards may change, and if your life is endangered by a new hazard, you should stop CPR. If possible, remove the victim from the hazardous situation as well.
Obstructed Airway
If your ventilations don't go in, try adjusting the angle of the head (usually tilting it further back) and re-attempt ventilation. If the breath still doesn't go in, then do your compressions, and check the airway for obvious foreign obstructions after the compressions. If you see a foreign obstruction, remove it with your fingers if possible. Do not discontinue CPR because the airway is occluded.
