Cardio = HEART Your heart is a big, strong muscle that expands and contracts more than 60 times a minute

without you even thinking about it. It is automatically driven by electrical impulses and runs 24 hours a day, 7 days a week, with no vacation time. That's around 33 million beats a year! Your heart has a simple, but important job. It pumps oxygen-rich blood from the lungs out to the rest of your body. If your heart stops pumping, oxygen does not reach vital organs and they stop working. That's when you get in trouble. Pulmonary = LUNGS You breathe about 15 to 25 times each minute and every breath you take brings oxygen into your lungs and gets rid of carbon dioxide. Your lungs function automatically just like your heart - you don't have to think about breathing, it just happens. Oxygen is important to your body because it gets combined with sugar to burn as fuel. There is very little oxygen stored in your body's tissues so it needs to be replenished often. (There is a big supply of sugar so you can go a long time without eating.)
If your body stops bringing air with oxygen in it into your lungs or your heart stops circulating the oxygenrich blood to your organs, then bad things start to have real fast. When the oxygen runs out, the body only has a few minutes in an anaerobic state before cells start to die and brain damage results. Typically, cells last 4 to 6 minutes before they begin to die and, after 10 minutes, the body is unrevivable. Some things that might prevent oxygen from reaching the cells of your body:
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Choking- something blocks the path for air to reach the lungs. Poisoning- some other gas takes the place of oxygen, such as carbon monoxide. Drowning or suffocation- there is no air available to breathe in. Electric shock- an electric impulse disrupts the normal heart pattern and causes it to stop. Heart attack- the heart stops beating. Oxygen is available in the blood in the lungs, but the heart is not moving it around. Ventricular Fibrillation (VF) - the heart gets out of synch and quivers instead of pumps, causing cardiac arrest. This is the most common cause of sudden cardiac arrest and is what Automated External Defibrillators (AEDs) are for.

CardioPulmonary Resuscitation (CPR)- is a combination of simulating the breathing of the lungs and the pumping of the heart. You should know that CPR is effective less than 30% of the time. Does that mean it is futile? No way! The types of victims you will probably run into will most likely be on the high end of the probability scale. Recovery rates for people already in the hospital are about half that and less than 5% for elderly people with other medical problems. So, even though there's a good chance your efforts will fail, that person has a 0% chance if you do nothing. Let's talk about what CPR is and how it works.
CPR is made up of two parts: Rescue Breathing and Chest Compresssions

Rescue Breathing- You exhale air from your lungs into the victim's lungs so they can absorb oxygen. This assumes that there is adequate oxygen in your exhaled air. Air contains approximately 20% oxygen at sea level, 16% at 5000 feet elevation, and 13% at 10000 feet. When we breathe in air, our lungs absorb about 25% of whatever is available. So, at sea level, we exhale air with about 15% oxygen which is more than exists at 5000 feet and is adequate. When you breathe into a victim's mouth and have their nose closed, the air is forced into their lungs and you can see the chest rise. You have successfully gotten some amount of oxygen into the system. Chest Compressions- You manually compress the heart by pressing down on the chest. When you let up on the chest, the heart expands. The hope is that by compressing and expanding the heart, the blood flows through it as designed. Unfortunately, you don't have an easy way to tell if blood is flowing. You can't feel for a pulse or see results. You just need to believe in your efforts.

CPR Effectiveness When properly performed, CPR simulates from 20 to 40% of normal circulation. That is not enough to sustain life indefinitely, but will be sufficient to put off the start of cell death in the hope that revival tools arrive soon. You should not expect CPR to restart a heart and have the victim pop back to life like is shown on TV. Your job is to keep oxygenated blood flowing until life support services arrive. In communities with a thorough CPR training program and fast access to ACLS through an efficient Emergency Medical Services program, CPR can be effective up to half the time. Other places where CPR training is not promoted or where little ACLS support is available, the results are much less. Remember, your goal of administering CPR is to buy a little time for an emergency rescue team to arrive and revive.
So, what does CPR stand for? It stands for saving a life.

CPR STEPS: ADULT=These adult CPR steps are intended for victims over 12 years old. Check the Scene - make sure it is safe for you to help. Don't become another victim. Check the Victim - tap and shout to get response. Call for Help- call 9-1-1, or tell someone to call. If you are alone with an adult, call first then start CPR if needed. Call for any unconscious victim, whether they are breathing or not. Circulation- pump the chest 30 times. Place the heel of one hand in the center of the chest and your other hand on top of it. Press chest down 2 inches at a rate of 100 per minute (16 compressions in 10 seconds). Airway- tilt head back, lift chin up to open airway. Breathing- Pinch nose closed, take a normal breath, cover victim's mouth with yours and blow out your breath until you see the chest rise. Give a second breath. Take about 1 second per breath. If chest doesn't rise, open airway again.
Repeat C - A B-- until help arrives or the victim begins breathing. If there are two rescuers, one does the breathing and one does the compressions - CPR steps and ratios remain the same.

CHILD=Perform 5 cycles of CPR (about 2 minutes) before calling 9-1-1 if you are alone Check the Scene- make sure it is safe for you to help. Don't become another victim. Check the Victim- tap and shout to get response. Call for Help- If no response, tell someone to call 9-1-1. If you are alone, perform 5 cycles of CPR First, then call 9-1-1. Even if the child is breathing, call 9-1-1 for any unconscious victim. Circulation- pump the chest 30 times. Place the heel of one hand in the center of the chest and your other hand on top of it. Press chest down about 2 inches at a rate of 100 per minute (16 in 10 seconds). Airway- tilt head back, lift chin up to open airway. Breathing- Pinch nose closed, take a normal breath, cover victim's mouth with yours and blow out your breath until you see the chest rise. Give a second breath. Take about 1 second per breath. If chest doesn't rise, open airway again.

INFANT:

Notice that these infant CPR steps for victims under 1 year old are nearly identical to adult CPR steps with the following key differences:
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Be careful not to tilt the head too far. If you are alone, perform 5 cycles of CPR (about 2 minutes) then call 911 Cover mouth and nose with your mouth. Use two fingertips instead of two hands for chest compressions.

Check the Scene - make sure it is safe for you to help. Don't become another victim. Check the Victim- tap and shout to get response. Call for Help- If no response, tell someone to call 9-1-1. If you are alone, perform 5 cycles of CPR First, then call 9-1-1. Call 9-1-1 for any unconscious victim, including an infant that is breathing. Circulation- pump the chest 30 times. Place two fingertips of one hand in the center of the chest. Press chest down about 1 1/2 inches at a rate of 100 per minute (16 in 10 seconds). Airway- tilt head back, lift chin up to open airway. Breathing- Take a normal breath, cover victim's mouth and nose with your mouth, and give a breath until the chest rises. Give a second breath. Take about 1 second per breath. If chest doesn't rise, open airway again.

CPR SKILLS SUMMARY:

Step/Action Adult over 12 years Child 1 to 12 years Head tilt / chin lift Infant under 1 year

Airway Breaths Initial

2 breaths at 1 second/breath

Foreign body airway obstruction

Back blows Abdominal thrusts

Back slaps and chest thrusts

Compressions Compression landmarks In the center of chest

Compression method Push hard and 2 hands: Heel of 1 hand, 2 hands: Heel of 1 hand with second fast Allow complete recoil second hand on top on top or 1 hand: Heel of 1 hand only

2 fingers

Compression depth

at least 2 inches

about 2 inches

about 1 1/2 inches

Compression rate Compression Ventilation ratio Defibrillation

at least 100/min 30:2

AED

Use adult pads. Do not use child pads.

Use after 5 cycles of CPR. Use child pads if available. If not, use adult AED and pads.

ADULT AND CHILD CHOKING: Check the Scene - make sure it is safe for you to help the choking victim. Don't become another victim yourself. Check the Victim - Ask if they are choking. If they can not cough, speak, or breathe, then they need help. Call for Help - Tell someone to call 9-1-1. If you are alone with an adult, skip this step until later - it's more important to fix the choking. Back Blows and Abdominal Thrusts
y

Give 5 back blows: o Stand slightly behind the victin. o Place one arm diagonally across the victim's chest for support and lean him forward. o With the heel of your other hand, strike the victim firmly between the shoulder blades. Give 5 abdominal thrusts: o Place the thumb side of your fist just above the victim's belly button. o Grab your fist with your free hand. o Pull quick, upward thrusts to dislodge the object.

Repeat Back Blows and Abdominal Thrusts--until the object is forced out, the victim can breathe, or the victim becomes unconscious. INFANT: Check the Scene - make sure it is safe for you to help the choking victim. Don't become another victim yourself. Check the Victim- If the parent is there, identify yourself and ask if you can help. If the infant cannot cough, cry, or breathe, then they need help. Call for Help - Tell someone to call 9-1-1. If you are alone with an infant, skip this step until later - it's more important to fix the choking. Blows and Thrusts
y y y

Carefully hold the infant face down on your forearm, your hand supporting its head and neck Strike the infant directly between the shoulder blades with the heel of your other hand 5 times Turn the infant over and position two fingers in the center of the chest

Give 5 1/2 to 1 inch deep chest thrusts

Repeat Blows and Thrusts -- until the object is forced out, the infant starts breathing, or the infant becomes unconscious.

Automated External Defibrillators (AEDs)- are the latest, most important, advancement in sudden cardiac arrest response. They are amazing little gadgets that pretty much anyone can operate with little aed training and they are popping up all over the place, from schools to churches to health clubs to homes. Ventricular Fibrillation (VF)- is an electrical abnormality where the heart stops pumping because the electrical impulses in the heart are out of synch, causing it to quiver instead of beat. I like the analogy of this being like an hysterical person who is screaming and crying and beyond reason - a rude slap in the face shocks them into gaining composure. If VF is treated quickly, the heart can get back to work just fine - if not treated, VF degrades to something called 'asystole' which is generally fatal.
SELF CPR: is a coughing procedure that has been widely publicized on the Internet since 1999 and was published in the Journal of the American Medical Association in 1976. Since it is widely publicized, it needs to be mentioned by well-known CPR authorities - see the American Heart Association's stance and the American Red Cross's stance on this topic. Both of them acknowledge that self CPR is possible, but limited to clinical situations.

The thought is that forceful coughing puts pressure on the heart, forcing it to pump blood. This may work for a few seconds while an abnormal heart rhythm passes, but only on a conscious, responsive person in specific situations. This topic is not taught in CPR classes for the simple reason that CPR intervention is based on a victim's unresponsiveness and coughing CPR would just be additional data to remember with virtually no application in the field. This may change as more is learned over the years, but for now the best thing a person can do when he begins to experience cardiac arrest or heart attack is to call 9-1-1. If there are any people around, get their attention so they know you need help too.