I’ve never seen CPR (cardiopulmonary resuscitation) in real life. I’ve never been in a CPR class. Before Saturday, I had never done CPR on a dummy, or even known the least bit about its mechanism besides the fact that, with disturbing parallels to Sleeping Beauty and other fairy tales, it involves putting your mouth on a stranger’s to revive him or her.
Apparently, I’m not entirely alone. The term and idea of “mouth-to-mouth” has caused a silent but pervasive stigma against performing CPR—so much so that the emergency medical service world now touts “hands-only” CPR as a viable option for germaphobic bystanders, preferable to them just wringing their hands and wondering if they’ll contract mono in the precious minutes after a patient goes down. While a person on the street may not want to administer breaths to just anyone, doing chest compressions doesn’t involve the same germ-swapping, so when minutes count, there are less excuses to make.
We had a “lab day” in our EMT (Emergency Medical Technician) class where we learned how to immediately support unconscious patients with irregular blood circulation and breathing—the symptoms of cardiac arrest—by performing CPR and using an AED (automated external defibrillator). The point of CPR is to press down on the heart and manually pump it—while also providing oxygenated air—and therefore restore flow of oxygenated blood through the heart, brain, and rest of the body. The point of an AED is to take whatever erratic rhythm the heart currently has and jolt it back to a normal, regular one.
After a quick scan of pulse and breathing to determine if CPR is necessary, you should jump right into it—and while doing it, pick out a bystander from the inevitably forming crowd and instruct him or her to call 9-1-1 and acquire an AED if available. We were told that pointing and picking out a specific person is crucial—otherwise, if you just shout orders into a crowd, everyone will assume someone else is taking action, and no help will come.
In reality, CPR takes much longer than it does in the movies, and is far less obviously successful. “It’s like a manual heart and lung machine until advanced help arrives,” was the pithy definition. “Rarely does the person quickly wake up.” Specifically, you are supposed to do 30 compressions for every two breaths you give the adult patient. If you have a partner, you can switch after 5 cycles of this (about 2 minutes). You can count out loud–or you can sing. “Stayin’ Alive” and “Another One Bites the Dust” are two songs whose cadences match the minimum 100 chest thrusts per minute rate we are expected to internalize for CPR. As our instructor put it: “Your choice of song really reflects whether you’re an optimist or a pessimist in these situations.”
My hands were actually sore from all the CPR practice we did over the course of the day on adult, child, and infant mannequins. With the base of our dominant hand’s palm down on the middle of the patient’s sternum (the “nipple line”) and other hand interlocked on top for support, we’re supposed to use our full upper body weight to push down rapidly, at least 2 inches down into an adult chest. In our case, we had to push until hearing the mannequin emit a clicking sound—obviously not a sound we’ll hear in real life, although if we do, we’ve broken something. While we all worried aloud about the horror stories of cracking a patient’s sternum or ribs, we were told emphatically that the patient will thank you if you saved his life even if he has a broken bone.
A return to normal circulation and breathing is the ideal end point of CPR. The other end point, we were told matter-of-factly, would be that the patient dies or the person administering CPR herself passes out from exhaustion. “How can you tell if the patient has died?” our instructor asked. No one really wanted to answer the question, almost as if it would give life to the idea of death under our watch. “The patient becomes cold and clammy. There’s dependent lividity—pooling of blood in certain areas since the heart is no longer pumping blood against gravity and throughout the body.” This was rather sickening to think about—the idea of blood just sinking, pooling, like water gathering in puddles after rainfall.
The AED is the little red lunchbox in my house that I discussed in a previous post. As it turns out, the AED is pretty simple. Once you press power, it tells you what to do—attach the pads, one on the patient’s upper right chest, another on the patient’s lower left, wait for the AED to analyze the heart rhythm. If the rhythm exists but is irregular, it will yell at you to stand clear as the “shock” button is pressed. If it determines a shock is not necessary, it won’t be delivered. This may mean you either read the patient’s pulse wrong and it’s actually quite regular, or the patient’s heart has flat-lined and a shock will do nothing to get it back to normal—two ends of the spectrum. The hard part is using the AED in tandem with doing CPR. And unlike in the movies, there is no need to straddle the patient, unless you simply can’t do without a theatrical flair.
With the AED come some interesting limitations: clothing, water, jewelry, “prison tattoos,” pacemakers, medicine patches, and…chest hair. To perform CPR but especially to attach the AED pads, you need to remove all clothing and jewelry quickly. You don’t want to compress a necklace into a person, or conduct electricity through the interesting tchotchkes they have attached to their chest. Apparently even some tattoos—especially “prison tattoos,” we were told—are an issue because they contain lead. Medicine patches must be removed, and you have to steer clear of the bumps in the chest that indicate implanted pacemakers. If the person is wet (a victim of drowning, for example), you have to dry him off before you attach the pads and administer the AED. Being on ice or even in snow is okay. What’s not okay is significant chest hair, which often doesn’t allow the pad enough contact with the body. What do we do in this scenario? Either shave the chest with that handy razor you always carry around, or, more likely, rip all the hair off with the pad you’ve stuck on and then re-stick it to the now red and clean-shaven area. All the guys in our class groaned at this—but as our instructor pointed out, the person is unconscious. In the unlikely scenario that they revive and howl in pain, hey, that’s a good thing.
For choking, we learned, the necessary actions are no longer called the “Heimlich” maneuver but just “abdominal thrusts.” Most people know how to do this—pretend to hug someone around their abdomen, from behind, and surprise! Thrust back and upward in a “J” motion just under their stomach until they expel things. If they’re obese or pregnant, we were told, it might be more effective to push just under the chest instead, or have them stand against a wall and push their stomach from the front. And, if you’re choking alone, you have no choice but to hurl yourself onto the top of a chair until you force whatever it is out, and then pat yourself on the back, I guess.
All of it seemed like a lot of information, but was much easier to internalize as we practiced it. What’s hard is remembering the exceptions. Tilt the head back and lift the chin to open the patient airway when giving them air—unless there’s a spinal injury! Press two inches deep into the chest for CPR—unless it’s a child! Give one breath every 5-6 seconds for someone who can’t breathe—but more quickly if it’s an infant! Wrap your arms around someone’s abdomen if they’re choking—but if it’s a baby, balance the small body on your forearm and alternate between backslaps and chest thrusts until something comes up!
We are constantly told that mannequins provide a different feel than humans, but that we must be ready to perform the exact same actions on humans. Mannequins keep our manual pumps well-oiled and ready for an emergency if it happens. Still, it’s strange to forcefully lift the mannequin’s head back—its plastic trachea is such that it simply won’t inflate the lungs unless the head is almost at a grotesque angle—and think of manhandling a real, warm, and possibly familiar face in such a way. It’s strange to think that even though we’re okay with our mannequin never showing real signs of life (in fact, that would be horrifying), our single endpoint for a human is eventual revival. But it’s nice to remember that at the core of CPR is hope, and its beauty lies in its universality—the ability of anyone to perform it.