Oh stop moaning! It is getting better.

The A.R.C (Australian Resuscitation Council) has been reviewing data from America and Europe following a 5 year study.

We have always known that for C.P.R to be successful the operator had to deliver adequate compressions to the chest and for this to do perfectly the operator has to went through the CPR Course or CPR training. The current research has now shown that the focus really must be about the compressions.

The means compressions come first! Remember the point of C.P.R is to move oxygen via the blood around the body; the body contains enough oxygen in the blood to last for at least 4 minutes without extra oxygen being supplied. Hence, by commencing compressions immediately the transport of blood continues and you then supply oxygen via 2 breaths following the first 30 compressions.

As of mid January our new Basic Emergency Life Support Flow chart looks like this:

ü  Danger: check for any dangers to you, the bystanders or your causality.

ü  Response: Check for any response by using “touch & talk”

ü  Send for Help: If there is no clear signs of Response, send for help ASAP. The first 10 minutes are critical

ü  Airway: Check if the airway is blocked, if any signs of fluids roll them on the side to clear it.

ü  Breathing: When checking the Airway, check for signs of normal breathing, this will take about 10 seconds

ü  Compressions: If no normal breathing, give 30 compressions at a rate of 2 per second. For an adult you MUST push at least 5cm (about a match box).

ü  Defibrillation: Attach a Defibrillator (A.E.D) ASAP and follow the prompts.

So why change it again??

We know we can hold our breath for 3 to 5 minutes without any brain damage or damage to other organs or cells, but what they do need is the blood that contains the oxygen moved around their body with the help of our compressions.

DONT delay the compressions. Now after checking for a response and calling for help if there is no NORMAL BREATHING we begin with compressions, this ensures the rapid movement of what remains of the oxygen contained within the blood.

Often first aiders are concerned about opening the airway, finding a mask lost in the glovebox or buried deep in their purse or even worse, the feeling of “ick” at having to put their lips onto those of a stranger, with or without vomit. This all takes time, time the casualty does not have.

In summary it is best explained like this:

In the older D-R-A-B-C-D sequence chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths or retrieves a barrier device or other ventilation equipment. By changing the sequence to D-R-S-A-B-C-D, chest compressions will be initiated sooner and ventilation only minimally delayed until the completion of the first cycle of chest compressions (30 compressions should be accomplished in approximately 18 seconds).

Other considerations that HAVE changed

Push a little harder. How deep you should push on the chest has changed for adult CPR. It was 4-5 cm, but now you should push at least 5cms deep in to the chest of an adult.

• Push a little faster. Instead of pushing on the chest at about 100 compressions per minute, you should to push at least 100 compressions per minute. At that rate, 30 compressions should take you only 18 seconds.
• Don’t stop pushing. Every interruption in chest compressions interrupts blood flow to the brain, which will lead to brain death if the blood flow is interrupted for too long. It takes several chest compressions (about 20) to get blood pressure to the level that is affective. You should keep pushing as long as you can. Push until an A.E.D is in place and ready to analyse the heart. When it is time to perform mouth to mouth, do it quick and commence compressions again immediately.

_{One thing that has not changed is the simple but very true motto of the A.R.C}

_{“Any attempt at resuscitation is better than no attempt at all”}

For people who have never performed CPR or even been at the scene of an incident while it is being done there is a range of different images of exactly what the scene may be like. For some it is the image of the person who has been pulled from the water by a bronzed Lifeguard from Bondi Rescue. The causality receives 2 quick breaths, coughs, splattering up water and maybe some lunch. They thank the Lifeguard for saving their life and go off to the hospital to be checked over. Or maybe it is a little more dramatic; it is an elderly stranger in a shopping centre, he collapse just meters from you, and his partner is screaming for help. You are the only one who comes forward to help, your mind races back to that First Aid Training Course you HAD to take; it all comes back in a flood of images. Breaths, Compressions, don’t stop, must move the blood around his body, before you know it, the Ambulance has arrived and take over. That 1 day you spent doing a First Aid course because you HAD to have saved this man’s life, it could have been your dad, your partner or your child, could you have done it?

But what are we doing when we perform CPR?
The air around has contains approximately 21% of oxygen, when we breath that air in our body uses only 5% and we exhale 16%, it is that 16% of oxygen that we exhale that helps to replace the oxygen that is no longer getting in to circuitry system of a person who has no movement of their heart (it has arrested).

We know that between 3-5 minutes without oxygen to our cells the cells will start to die, particularly our brain cells, our brain needs about 20% of the oxygen that we have in our system and is very sensitive to a lack of oxygen.

So we now have oxygen in the blood but how does it move to the cells?

A normal healthy adult hearts beats between 60 – 100 times a minute when resting, this ensures that the oxygen rich blood can reach all of the millions of cells in our body. When we perform CPR you must deliver your compressions at a rate of 100 per minute so as to replicate the action of a beating heat.

The skills that are taught in a First Aid Course are ones that could save a life, it is always hoped that you may never have to be in the position to have to perform CPR. But if you do the skills will be with you and you may be able to assist.
Remember, any attempt at CPR is better than no attempt at all.

When you mention heart attack to most people, their first thoughts are that it is fatal.
Often they are right, but what is heart attack and heart disease? Can you avoid it? What do you do if you see a person suffering from pain on the chest?

How do heart attacks occur?
Over time, plaque can build up along the course of an artery and narrow the channel through which blood flows.
Plaque is made up of cholesterol build-up and eventually may calcify or harden, with calcium deposits. If the artery becomes too narrow, it cannot supply enough blood to the heart muscle when it becomes stressed.

Just like arm muscles that begin to ache or hurt when heavy things are lifted, or legs that ache when you run too fast; the heart muscle will ache if it doesn’t get adequate blood supply.

This ache or pain is called angina. It is important to know that angina can manifest in many different ways and does not always need to be experienced as chest pain.

If the plaque ruptures, a small blood clot can form within the blood vessel, acting like a dam and acutely blocking the blood flow beyond the clot. When that part of the heart loses its blood supply completely, the muscle dies. This is called a heart attack, or an MI – a myocardial infarction (myo=muscle +cardial=heart; infarction=death due to lack of oxygen).

Signs and Symptoms of a heart attack
Any chest pain should be considered a medical emergency. A call to the emergency services should be your first action.

Warning signs include:

• Pain or pressure in the chest
• Discomfort spreading back, jaw, throat, or arms
• Nausea, intergestion or heartburn
• Weakness, anxiety, or shortness of breath
• Rapid wreak or irregular pulse
• Clammy skin

Heart attack Signs and Symptoms in women

Women do not always have the pain or heavy weight feeling in the chest.

Women are more likely than men to have:

• heartburn
• tiredness
• loss of appetite
• weakness
• Heart flutters.

None of these symptoms should be ignored the longer you leave treatment the greater the risk of damage to the heart and to the risk of death.

How do I help if they are having a heart attack??
If there is any pain on the chest, call 000 immediately, they will guide you through with instructions on how to manage this causality or if you are a first aider or did any of CPR courses or training you can help the casualty. Such type first aid courses help you very much in such crucial time as well as in your day to day life.

If they are conscious:
o Ask if they have any medical history/medications
o Keep them in a sitting position
o Loosen any tight clothing
o Try to reassure them
o Try to monitor their breathing and their pulse

If they are unconscious:
o Follow the Basic Life Support Flow Chart
o If there are bystanders have them assist by calling for help
o Begin CPR as soon as possible

Any attempt at CPR is better than no attempt at all.

What is sudden cardiac arrest?
A medical emergency with absent or inadequate contraction of the left ventricle of the heart that immediately causes body wide circulatory failure.

The signs and symptoms include:
o Loss of consciousness
o Rapid shallow breathing progressing to apnea (absence of breathing)
o Profoundly low blood pressure (hypotension) with no pulses that can be felt over major arteries
o And no heart sounds.

Cardiac arrest is one of the greatest of all medical emergencies. Within several minutes, there is lack of oxygen (tissue hypoxia), leading to multiple organ injury. Unless cardiac arrest is quickly corrected, it is fatal.

The most common causes of cardiac arrest are electrical problems in the heart with ventricular fibrillation representing the major type. In ventricular fibrillation, there is loss of coordinated ventricular contractions leading to immediate loss of effective output of blood by the heart, resulting in circulatory arrest.

How do I manage Sudden Cardiac arrest?
The Chain of Survival
The Chain of Survival is the term applied to a sequence of actions that, when put into motion, reduce the mortality associated with cardiac arrest.
While each action in the chain is unlikely on its own to revive a casualty, when all actions are effectively used together they can improve the outcome for the casualty.

Sudden cardiac arrest is the unexpected collapse of a casualty whose heart has stopped. Cardiac arrest occurs suddenly due to a disturbance in the electrical signals of the heart and is closely linked with sudden chest pain.

It is estimated that more than 95% of sudden cardiac arrest casualties die before reaching hospital as the casualty has only minutes from the time of collapse until death. If all four links in the Chain of Survival are strong the chance of survival for a sudden cardiac arrest casualty can rise from 5% to as high 49%.

How important are First aid courses?
First Aid courses and CPR courses give instructions on how to react to emergencies brought on by natural calamities, keeping your household safe in case there is such occurrence.

There are many programs to learn basic first aid course taught by schools, Fire Departments, hospitals, and community organizations that are a great tool for everyone. First Aid is usually administered under the premise of immediate care for an illness or injury. Members of the general public are taught to administer this care until the arrival of qualified medical personnel at the scene of a medical emergency.

What is the difference of being a first-aider or not?
It resumes being the same difference between saving a life and losing someone, especially if it is a loved one.

“So Do not hesitate to start CPR“

Australia adopted the new international guidelines for CPR Courses (cardiopulmonary resuscitation) in 2006. With these new guidelines we have seen an increase to survival rates for cardiac arrest victim’s increasing to about 10%.

We have been CPR training to follow the Emergency Action Plan of:

• Danger
• Response
• Airway
• Breathing
• Compressions
• Defibrillation

But may it be about to change!!

The ARC (Australian Resuscitation Council) has been reviewing data from America and Europe after a 5 year study.

We have always known that for CPR to be successful the operator had to deliver adequate compressions to the chest, this is often easier said than done. The current research has now shown that the focus really must be about the compressions.

The means compressions come first!  Remember the point of CPR is to move oxygen via the blood around the body; the body contains enough oxygen in the blood to last for at least 4 minutes without extra oxygen being supplied. Hence, by commencing compressions immediately the transport of blood continues and you then supply oxygen via 2 breaths following the first 30 compressions. To do all this first aider should have knowledge acquired in formal CPR Courses.

As of mid December our new Emergency Action Plan may look more like this:

• Danger
• Response
• Compressions
• Airway
• Breathing
• Defibrillation

So why change it again??

We know we can hold our breath for awhile without any brain damage or damage to other organs or cells, but what they do need is the blood that contains the oxygen moved around their body with the help of our compressions.

DONT delay the compressions. Now after checking for a response and calling for help if there are no signs of life we begin with the compressions, this ensures the rapid movement of what remains of the oxygen contained within the blood.

Often First Aiders are concerned about opening the airway, finding a mask lost in the glovebox or buried deep in the purse or even worse, that “ick”feeling when putting your lips on to those of a stranger, with or without vomit.

This all takes time, time the causality does not have. Remember between 3-5 minutes without O2 the cells will die, particularly the brain cells which are very sensitive to a lack of oxygen.

In summary it is best explained like this:

In the D-R-A-B-C-D sequence chest compressions are often delayed while the responder opens the airway to give mouth-to-mouth breaths or retrieves a barrier device or other ventilation equipment. By changing the sequence to D-R-C-A-B-D, chest compressions will be initiated sooner and ventilation only minimally delayed until completion of the first cycle of chest compressions (30 compressions should be accomplished in approximately 18 seconds).

Push a little harder. How deep you should push on the chest has changed for adult CPR. It was 4-5 cm, but now you should push at least 5cms deep on the chest of an adult.

• Push a little faster. Instead of pushing on the chest at about 100 compressions per minute, you should to push at least 100 compressions per minute. At that rate, 30 compressions should take you 18 seconds.
• Don’t stop pushing. Every interruption in chest compressions interrupts blood flow to the brain, which leads to brain death if the blood flow stops too long. It takes several chest compressions to get blood moving again. AHA wants you to keep pushing as long as you can. Push until the AED is in place and ready to analyse the heart. When it is time to do mouth to mouth, do it quick and get right back on the chest.

_{Never forget the simple motto of the ARC}

_{“Any attempt at resuscitation is better than no attempt at all”}