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Hands-Only CPR

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3 minutes
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Now we're going to talk about hands only CPR. In this scenario, we're going to utilize the skills of hands on CPR because we're looking at the lay rescuer or someone who is not comfortable giving mouth to mouth resuscitation. We're going to approach our victim but we're going to make sure that the scene is safe. There are no electrical wires. There are no hazards that could make us a patient and then if the scene is safe, we go into the tap and shout. Sir, are you all right? Are you okay? They do not respond to our verbal taps and shouts. They do not appear to be breathing normally. It's at that time that we're going to utilize technology if we have it. We're going to call 911 or activate emergency medical services and then touch the speakerphone so that the dispatcher on the other end can assist in helping us to do proper CPR compressions. We're going to go to the center of the chest or the lower third of the sternum and we're going to begin our 2 inch to 2.4 inch deep compressions. Now we want to do these compressions at a rate of between 100 and 120 compressions per minute. We're going to begin CPR compressions. So we're going to continue these deep 2 to 2.4 inch compressions until EMS arrives or help arrives and can take over for us. Now it's important for us to break out a little bit about what hands only CPR is designed to do. Hands only CPR is designed for the untrained lay rescuer that may not know how to do formal CPR. It's also able to be used by anyone who for whatever reason does not feel confident or comfortable giving mouth to mouth or mouth to mask resuscitation breaths. Now it's important to understand that hands only CPR by research is really most effective for adults. When we start getting into pediatric, we understand that the majority of their cardiac problems are related to the respiratory insufficiency and deficiency and so when we talk about pediatrics, infants and children, if you can do full rescue breath and compression CPR, that's really the best CPR for their needs. But if you can't, and the only thing that you feel comfortable doing or the only thing you know to do is compression only CPR, it's better than no CPR at all. And that's the case with adults as well. Now remember that when we do the compression only CPR, it's important to continue with that consistent 2 to 2.4 inch deep compression, 100 to 120 times per minute and we don't stop until help arrives and takes over.

Hands-only CPR is designed for the untrained lay rescuer or someone who isn't comfortable or confident giving mouth-to-mouth resuscitation.

Research suggests that hands-only CPR is most effective on adults, as cardiovascular problems are often the cause of their cardiac arrest. Whereas, in children, the majority of their cardiac arrest events have to do with respiratory deficiencies.

Of course, performing full CPR – a combination of 30 compressions to two rescue breaths – is always going to provide the best chances for a positive outcome. However, hands-only CPR is better than no CPR at all; even on children.

How to Provide Care

The first thing you want to do is make sure the scene is safe and begin calling out to the victim to assess whether or not he or she is responsive.

Are you OK? Can you hear me?

If you don't get a response, proceed with the following steps.

  • Call 911 and activate EMS. Put your phone on speaker so the dispatcher can assist you.
  • Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.
  • Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them.
  • Conduct compressions that go 2-2.4 inches deep – for adults – or 1/3 the depth of the victim's chest and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.

Pro Tip #1: Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.

  • Continue to perform chest compressions until help arrives or the victim is responsive and breathing normally.

Pro Tip #2: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.

Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.

A Word About Other Cardiovascular Emergencies

There are a number of conditions that can mirror cardiac arrest or make diagnosis difficult. Knowing what those are and how they're caused may help eliminate any confusion.

Angina Pectoris

Angina pectoris is a medical term that simply means pain in the chest. It occurs when the heart requires more oxygen than it is receiving, usually due to the arteries being too narrow. It's often triggered when the patient is exercising or becomes too excited or emotionally upset.

Arrhythmias

Arrhythmias are electrical disturbances in the heart that affect its regular rhythm. Some people with arrhythmias don't experience any cardiovascular problems, while in others, an arrhythmia can indicate a greater underlying problem that could lead to heart disease, stroke, or heart attack.

Atrial Fibrillation

Atrial fibrillation is a common type of abnormal heart rhythm, where the upper two chambers (the atria) are not coordinating their beats with the two lower chambers (the ventricles). This causes an irregular and often rapid heart rate that results in inadequate circulation to the ventricles. Atrial fibrillation is usually not life threatening, however, it could lead to a stroke or heart attack.

Congestive Heart Failure

Congestive heart failure is a chronic condition in which the heart can no longer pump blood effectively, thereby limiting circulation throughout the body. This can result in high blood pressure and fluid buildup – which can contribute to difficulty breathing and weight gain. People with congestive heart failure will often experience swelling of the face, hands, feet, legs, and ankles.

Hypertension

Hypertension, or high blood pressure, is one of the many risk factors for heart attacks and stroke. A person has hypertension if their blood pressure is higher than 140/90 mmHg. There are numerous causes of hypertension, including certain medications, stress, and high sodium intake, or underlying conditions like kidney abnormalities and/or an adrenal gland tumor.

Diabetes

People with diabetes often experience problems with their nerves and nervous system. In these cases, a person with this type of diabetes-related complication may experience what's known as a silent heart attack, as the brain and nervous system don't produce any symptoms, or produce warning signs that are too mild to notice. If this is the case, special diagnostic tests may be required to get confirmation of a heart attack.