Welcome to this edition of The First Aid Show.
What we are going to look at in this edition is how to deliver effective CPR.
In order to deliver effective CPR, we have to understand a little bit more about the
heart, and what happens when the heart goes into cardiac arrest.
So, can you tell us what is actually happening in the heart for someone who is at all okay?
Okay.
So, as we are standing here quite nicely now, the sinoatrial node, or the heart's own pacemaker,
is firing off impulses.
And then that is going across the top two chambers of the heart, and they are responding
to that by just squeezing as they...
And that is what is happening.
That then gets to the middle impulses in the heart.
That then goes through the AV node, and then the electricity flows down.
And by that then, the bottom two chambers of the heart then contracting.
So that is as you and I are standing here now, and we are not even thinking about it,
the heart is just doing that all the time.
When somebody goes into what is called a cardiac arrest, for whatever reason, that is interrupted.
So, it could be due to electrolytes.
So, potassium maybe has interfered with it.
Or quite often, it is cardiac in nature.
So, a heart attack, for whatever reason, the electrics are interfered with.
And they then.
That electrical pathway is interfered with.
And the electrics just spark all over the place.
And in response to that, the top two chambers of the heart and the bottom two chambers just
start wriggling in the chest in response to the rhythm that they go into, which is known
as ventricular fibrillation or ventricular tachycardia.
And they are just wriggling in the chest.
And the only thing that will sort them out is defibrillation.
And that is why defibrillation is the key in this instance.
But before that, we need to get on the chest and start compressions, because that is what
is going to keep them going.
It is not going to bring them back because they need the defibrillator to sort them out.
That is what is going to keep them going until the defibrillator gets there.
And that is why we have got an automated defibrillator all across the country and all across...
In the countryside, to try and help.
Because the higher the chance of survival is if we get to that quicker.
So, the defibrillator works by passing electricity across the heart, momentarily stunning it,
allowing the heart's own pacemaker to sort itself out.
Hence, like I have just said, if you get there quicker, the chances of survival are higher
because you are then putting that impulse in so it will sort itself out.
If it has been in that rhythm for longer, then it just stays in that and that is what
the electrics will do.
So, that is when they are in ventricular fibrillation or ventricular tachycardia.
So, the electrics are just sparking all over and the heart is just wriggling around.
There are types of cardiac arrest where the electrics are okay, and there are other reasons
why people have had a cardiac arrest.
So, it could be that due to lack of oxygen.
It could be due to a bleed etcetera, etcetera.
And that is when we will put the defibrillator on, but the defibrillator will say, "No need
for" and it will be analysed, and then it will say, "No need for a shock.
Check the patient.
Check for signs of life and continue basic life support."
And in that instance, the electrics are all okay, but like I say, for whatever reason,
the heart isn't responding.
So that is when good quality compressions are vital.
It is important in both types of cardiac arrests but is absolutely vital that we then are continuing
good effective compressions, so we are maintaining that rate of 100 beats per minute to a 120,
and we are pressing down that 5 to 6 cm.
And if we are getting tired, we must tell somebody.
The guidelines from the Resuscitation Council UK say that we should be going and change
the person on the chest every 2 minutes.
But sometimes people get tired, which again is absolutely fine.
It can get very hot depending on where people are, and so they must realise that effective
basic life support is pressing down that 5 to 6 cm, keeping that rate.
They are really struggling.
Go back to doing 100 beats per minute rather than 120, but pressing down that 5 to 6 cm.
There has been research performed all across the world, mainly in America, but to say,
all across the world.
To say that that is the right rate and depth for a return of spontaneous circulation.
And if they are in a hospital then it is actually to get to survival to discharge from a hospital.
And if they need defibrillating, to actually make that first shock work better.
The guidelines changed in...
Four years ago, and they are due to change again next year, but they are basically saying
that that is the right rate and depth that we need to do, to make sure that people are
actually, hence the chance of survival.
So, the breathing is important, but certainly in the community.
And again, research is showing that there is no difference in the outcome whether they
receive oxygen for the first 5 minutes or not.
So, it is the compressions that take priority.
They are the most important.
So, making sure your hands are in the centre of the chest and you are really pressing down,
not using your arms.
So, using all your body weight, your back nice and straight, and keeping that depth
and rate going.
If you are tired, tell somebody else.
Communication is vital.
And if you want to count those 30, if someone is there to deliver the breaths, then they
know within the cycle of where they are, so that you are not in silence.
And everybody knows exactly what is going on and what is happening.
And if say, if you are tired, it is very important to say to somebody, "I am really tired", rather
than just think that a little bit is better than nothing.
Because it is not.
You might as well not bother.
So, it is keeping that rate and depth, to keep the pressures up within the heart, within
the coronary arteries to get that blood and oxygen around the body.
So, is the release as important as the press down?
Definitely.
It is to allow proper recoil so that you then, yes, get the pressures up to get that blood
and oxygen around.
And can anybody do CPR?
Yes.
And hence, the DVDs that have been out in the British Heart Foundation.
It is important, but you must get that right rate and depth.
Get your hands in the centre of the chest, and make sure that you are over them and you
are really pressing down that 5 to 6 cm.