I walk in a commercial area where I see the sign for a business I’m unfamiliar with:
HeartSafe America
CPR Training and AED Distributor.
I have taken CPR training three or four times, and it is useful information. But it does change over the years, so you really should take it frequently. In this time of COVID-19, I doubt there is much mouth-to-mouth resuscitation going on, but chest compressions can still be done. I have never had to perform CPR but am glad I have taken the training. I just need to take it more often, so if I do have to use it, the training will be like second nature to me. The Heimlich maneuver for choking is often taught with CPR training. I do have experience with it, although I didn’t perform the Heimlich maneuver myself. I was in a restaurant in Tulsa with my two sisters and my father who was in his 80s. He ate a large piece of shrimp and started choking on it. A man from a nearby table realized Dad was choking, rushed over and performed the Heimlich maneuver, saving his life. I have never been so grateful to a stranger. Fortunately, the restaurant was close to St. Francis Hospital, so there were nurses dining there who helped monitor Dad’s progress. Everything turned out OK, but it was very scary. CPR and Heimlich maneuver training literally SAVES LIVES.
According to HeartSafe America’s website at http://heartsafeusa.com, helping people is in our blood. Every person in North America has an immediate family member, relative or friend presently affected by a heart condition or that will experience a heart-related trauma.
At HeartSafe, we've all been touched by this truth, and so have our customers. It's something that draws us together and inspires us to do whatever we can to make life-saving technology and training available to as many people as possible.
A compassionate social network
HeartSafe America is instrumental in supplying automated external defibrillators or AEDs and teaching training courses to thousands of businesses, industries and organizations requiring specific AEDs and CPR Training governed by various laws in cities and states throughout the United States.
CPR Training Classes Offered by HeartSafe America:
Basic AED
Basic CPR
Basic Life Support
Pediatric First Aid
First Aid CPR AED
CPR Mannequins and Supplies
History of CPR
According to Wikipedia, in the 19th century, Doctor H. R. Silvester described a method — the Silvester method — of artificial ventilation in which the patient are laid on their backs, and their arms are raised above their heads to aid inhalation and then pressed against their chest to aid exhalation. The procedure is repeated 16 times per minute. This type of artificial ventilation is occasionally seen in films made in the early 20th century.
A second technique, called the Holger Nielsen technique, described in the first edition of the Boy Scout Handbook in the United States in 1911, was a form of artificial ventilation where the person was laid face down, with their head to the side, resting on the palms of both hands. Upward pressure applied at the patient's elbows raised the upper body while pressure on their back forced air into the lungs, in essence the Silvester method with the patient flipped over. This form is seen well into the 1950s — it is used in an episode of “Lassie” during the mid-1950s — and was often used, sometimes for comedic effect, in theatrical cartoons of the time. See “Tom and Jerry’s ‘The Cat and the Mermouse’ in 1949. This method would continue to be shown, for historical purposes, side-by-side with modern CPR in the Boy Scout Handbook until its ninth edition in 1979. The technique was later banned from first-aid manuals in the UK.
Similar techniques were described in early 20th century ju-jitsu and judo books, as being used as far back as the early 17th century. A New York Times correspondent reported those techniques being used successfully in Japan in 1910. In ju-jitsu — and later on, judo — those techniques were called Kappo or Kutasu.
It was not until the middle of the 20th century that the wider medical community started to recognize and promote artificial ventilation in the form of mouth-to-mouth resuscitation combined with chest compressions as a key part of resuscitation following cardiac arrest. The combination was first seen in a 1962 training video called "The Pulse of Life" created by James Jude, Guy Knickerbocker and Peter Safar. Jude and Knickerbocker — along with William Kouwenhoven and Joseph S. Redding — had recently discovered the method of external chest compressions, whereas Safar had worked with Redding and James Elam to prove the effectiveness of mouth-to-mouth resuscitation. The first effort at testing the technique was performed on a dog by Redding, Safar and JW Pearson. Soon afterward, the technique was used to save the life of a child. Their combined findings were presented at the annual Maryland Medical Society meeting on September 16, 1960 in Ocean City, and gained widespread acceptance over the following decade, helped by the video and speaking tour they undertook. Peter Safar wrote the book “ABC of Resuscitation” in 1957. In the U.S., it was first promoted as a technique for the public to learn in the 1970s.
Mouth-to-mouth resuscitation was combined with chest compressions based on the assumption that active ventilation is necessary to keep circulating blood oxygenated, and the combination was accepted without comparing its effectiveness with chest compressions alone. However, research over the past decade has shown that assumption to be in error, resulting in the American Heart Association’s acknowledgment of the effectiveness of chest compressions alone. On June 4, 2011 Jeremiah Kliesing "coded" at the Michael DeBakey VA Medical Center in Houston, Texas. Kliesing underwent 5 1/2 hours of CPR by 20 doctors and nurses before being stabilized and transferred to St. Luke's Episcopal Hospital, where he was the second patient to receive the syncardia artificial heart. One of the doctors who performed CPR was Dr. Donald Lazarus.
CPR has continued to advance, with recent developments including an emphasis on constant, rapid heart stimulation, and a de-emphasis on the respiration aspect. Studies have shown that people who had rapid, constant heart-only chest compression are 22% more likely to survive than those receiving conventional CPR that included breathing. Because people tend to be reluctant to do mouth-to-mouth resuscitation, chest-only CPR nearly doubles the chances of survival overall, by increasing the odds of receiving CPR in the first place.
Cardiopulmonary resuscitation or CPR is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.
CPR involves chest compressions for adults between 2 and 2.4 inches deep and at a rate of at least 100 to 120 per minute. The rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose — mouth-to-mouth resuscitation — or using a device that pushes air into the subject's lungs, mechanical ventilation. Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving chest compressions is only recommended for untrained rescuers. In children, however, only doing compressions may result in worse outcomes because, in children, the problem normally arises from a respiratory — rather than cardiac — problem. Chest compression to breathing ratios is set at 30 to 2 in adults.
CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed in order to restore a viable, or "perfusing", heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. Early shock, when appropriate, is recommended. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation or is declared dead.
Medical uses
CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest. If a person still has a pulse but is not breathing, artificial ventilations may be more appropriate, but, due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving health care professionals the option to check a pulse. In those with cardiac arrest due to trauma, CPR is considered futile but still recommended. Correcting the underlying cause such as a tension pneumothorax or pericardial tamponade may help.
CPR oxygenates the body and brain for defibrillation and advanced life support. Even in the case of a "non-shockable" rhythm, such as pulseless electrical activity where defibrillation is not indicated, effective CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.
Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden ventricular fibrilation cardiac arrest dramatically improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent if a witnessed "shockable" arrest. In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest.
Similarly, in-hospital CPR is more successful when arrests are witnessed or are in the ICU or in patients wearing heart monitors, where the arrests are noticed immediately.
Injuries
Injuries from CPR vary. 87% of patients are not injured by CPR. Overall, injuries are caused in 13% (2009-12 data) of patients, including broken sternum or ribs (9%), lung injuries (3%) and internal bleeding (3%). The internal injuries counted here can include heart contusion, hemopericardium, upper airway complications, damage to the abdominal viscera — lacerations of the liver and spleen, fat emboli, pulmonary complications such as pneumothorax, hemothorax, lung contusions. Most injuries did not affect care; only 1% of those given CPR received life-threatening injuries from it.
Bones heal in 1–2 months. Training and experience levels have improved since the study in the 1990s which found 55% broken ribs among CPR patients who died before discharge, and the study in the 1960s which found 97%.
The costal cartilage also breaks in an unknown number of additional cases, which can sound like breaking bones.
Where CPR is performed in error by a bystander, on a person not in cardiac arrest, around 2% have injury as a result, although 12% experienced discomfort.
A 2004 overview said, "Chest injury is a price worth paying to achieve optimal efficacy of chest compressions. Cautious or faint-hearted chest compression may save bones in the individual case but not the patient’s life."
CPR in movies
According to the article “CPR in Movies” in First Edition First Aid, the movie San Andreas is yet another film featuring Dwayne the Rock Johnson. In this scene, CPR is the only thing standing between the life and death of his character’s daughter. In this scene, Raymond Gaines is trying to save his daughter, Blake, who is trapped in a room as the building is beginning to tumble down around them. The water level begins to rise in her new prison and soon she realizes that she will drown. Saying her final goodbyes to her father, she falls below the water and soon becomes unconscious. Raymond refuses to give up and swims around to find an alternative route to get to her. Finally, he is able to kick down a submerged window, grabs his daughter and swims to air. They bring the limp Blake to a nearby table and Raymond begins to perform CPR on her while the building continues to collapse. The group narrowly escapes the demolished building by way of boat and all the while Raymond continues giving Blake CPR. For a while nothing happens, and the others begin to think she is dead. Raymond continues compressions until finally Blake spits out the water and returns to consciousness.
Here is what they did right and wrong:
RIGHT: The scene is filmed in an action sequence, so the screen often cuts from one shot to another. With this in mind, it is difficult to say whether Raymond gives a total of 30 chest compressions or not. Otherwise, the depth and strength he uses for each compression seems to be accurate.
WRONG: Unfortunately, the film shows Raymond giving only one breath before going back to compressions. Two breaths should be given for every 30 compressions!
WRONG: The final mistake made was the pace that Raymond was giving the compressions. He was going much too fast for it to be the most effective. Compressions should be given to the tune of “Staying Alive” (roughly 120 per minute). Although in this scene, given that the family was on the escape from a collapsing building, we will forgive the speed of his compressions and justify it as his fear and anxiety overwhelming him.
DID YOU KNOW: The CPR displayed in this film was actually the reason for another life saved – IN REAL LIFE! A young boy named Jacob, saved his brother from drowning using the skills he learned from the San Andreas film. Dwayne Johnson was so proud that he took the time to meet this real-life, young hero!
In this scene from The Hunger Games: Catching Fire, Katniss and Peeta are on the run to survive the unknown dangers found in this year’s Hunger Games. Traveling with Finnick and Mags, the going is slow, but Peeta uses his machete to cut through the dense jungle in their path. Just as he goes to cut another section down, Katniss notices a small flicker in the sky and realizes too late that it is the barrier of the arena. Peeta swings once more as Katniss shouts a warning, but Peeta hits the barrier and is shocked and thrown backwards. Finnick pushes Katniss out of the way and immediately begins CPR — giving compressions and breaths to the unconscious and not breathing Peeta. After pausing to check for breathing Finnick continues performing CPR, and after a while Peeta takes a gasp for air.
Here is what they did right and wrong:
RIGHT: Finnick ensures that between compressions he is giving two good breaths, and then moving back to compressions. The compressions are well paced and appear to be of a good depth.
WRONG: The only thing that may cause some doubt in Finnick’s skills is the amount of compressions he is giving. It is unclear with the constant switching of scenes (back and forth from Katniss’s expression to the unconscious Peeta), how many compressions he is actually giving.
WRONG: Another thing that may be in question of Finnick’s CPR skills is when he takes a moment to stop and look for any signs of breathing. He puts his ear towards Peeta’s mouth to listen and looks for any movement of his chest. Although this may be acceptable prior to starting CPR, it does not make much sense to do it between compressions. It is better to continue performing CPR until the person is noticeably conscious and breathing.
In this scene from Spider-Man 3, after a duel with the newest Goblin, now identified as his old friend Harry, Peter is able to get the upper hand and sends the Goblin falling to the ground after some harsh hits. Peter runs over to Harry to ensure he is down and to stop the fight. He yells Harry’s name but gets no response. He leans over and notices that Harry is completely unconscious. After a closer look, it also appears that Harry is not breathing. Peter rips open Harry’s shirt and begins to give compressions. After about 11 compressions Peter stops, leans down and checks again for any sign of breathing. Hearing nothing, he sits up and looks around for help. No one is around so Peter finally picks up Harry and carries him to the nearest hospital. In the hospital, Harry is shocked by a defibrillator but is not revived, much to the sadness of Peter.
They got EVERYTHING wrong.
WRONG: When realizing that his friend wasn’t breathing, Peter immediately ripped open Harry’s shirt to give compressions. Although it is not a significant error, Peter would not need to remove the clothing unless he was going to use an AED.
WRONG: The compressions that Peter gives are more like heavy, drawn out punches made upon Harry’s chest. He does a poor job to keep any sense of timing and does not seem to count how many compressions he is doing.
WRONG: Although breaths are not required for CPR (doing the compressions only option is found to be just as helpful), it is worth noting that Peter does not give any breaths. Instead he spends his time giving poor compressions and yelling at his unconscious friend.
WRONG: After only a dozen compressions, Peter seems to give up and looks around for help. He stops giving CPR and instead takes the time to carry Harry to the nearest hospital. The problem is that every second without oxygen getting to the brain is another second closer to severe brain damage, if not death. The time he wasted carrying him to a hospital would have been better served giving more compressions (no matter how delayed or incorrect they were).
WRONG: One thing to note about the scene is that once Harry is brought to the hospital he is given shocks from an AED by the medical staff. Assuming that the hospital was not close by, Harry would have been deceased, deprived too long of oxygen. Once brought in, the doctors would have quickly realized that Harry had died and an AED would not have been helpful at that time. AEDs are only used to stabilize a sporadic heart rate, not to revive a flat-lined heart.
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