The recommended rate is 100- 120 BPM, which ironically roughly corresponds to the beat of ‘Staying So now if someone is unconscious and either not breathing or not breathing normally then the recommendation is that you should just start CPR. Confusion always surrounded where to push to perform CPR and how fast and how deep to push. The worst thing that can happen is that no one pushes at all! Push on the sternum (breast bone) in the middle of the chest, push hard and push fast. The recommended rate is 100-120 BPM, which ironically roughly corresponds to the beat of ‘Staying Alive’ by the Bee Gees! It takes a number of compressions to get the blood going to the heart; every time you stop it takes a while to get the flow going again, so try not to interrupt your CPR. Keep pushing hard and fast, singing ‘Staying Alive’ until someone comes with a defibrillator to help you, or you simply can't keep going any longer. If a defibrillator arrives, don’t be afraid to use it – just open the box and follow the instructions, it’s actually quite simple. If you are able to restore the rhythm and get the heart going again, most patients then require a cardiologist to investigate the heart and open any blocked vessels. This is where we come in! Our specialised cardiac catheterisation lab is open 24 hours a day, seven days a week – we’re even open on Christmas Day! Drowning, on the other hand, is a completely different kettle of fish. Usually the victims are children with good hearts and the problem relates to breathing. Checking for danger and calling for help still apply obviously, but in this case it is recommended that you breathe for your patient. Sometimes people drown because they have injured their neck or back, so taking care not to move them vigorously is important. However if you are too worried about the neck to actually breathe for them then the outcome is likely to be bad anyway. Move them carefully but get on and resuscitate them as quickly as possible! Again there is no replacement for proper training, but in principle, tilting the head back, lifting up the chin and breathing over the mouth - or both the mouth and the nose - is the aim. Cardiac compressions are performed in the same fashion as described above and at the same rate (100-120 per minute). Changing the ratio of compression to breaths for adults and children was previously confusing, so now we just use two breaths to 30 compressions for everyone! The final common scary event you might encounter this silly season is a choking episode. The respiratory tract really doesn't like having foreign objects in it and has a tremendously Alive’ by the Bee Gees! effective safety mechanism called a cough, which it uses to expel things it doesn't like. If someone appears to have inhaled a foreign object and is still coughing they should be encouraged to cough but closely observed while they do so. If they are unable to cough and their windpipe appears to be obstructed, they are choking and attempts must be made to externally dislodge the blockage. If your patient remains conscious then attempting to remove the blockage by hitting them firmly in the centre of the upper back is the first recommended step. These “back blows” can be repeated five times but with the aim being to dislodge the foreign body with each blow. This can be done with adults standing or sitting. Smaller children and infants can actually be picked up and supported upside down - along one’s leg for example - whilst delivering back blows. If five back blows have been unsuccessful then up to five chest thrusts should then be employed. Chest thrusts are similar to the manoeuvre used in CPR with hands placed in the centre of the breast bone but should be done with more vigour to try and express the object. If your attempts prove unsuccessful and your patient becomes unconscious then one should start standard CPR with two breaths to 30 compressions. The worldwide Advanced Paediatric Life support algorithm for choking can be found at this link. https://apls.org.au/sites/default/files/ uploadedfiles/Algorithms%20-%20Choking%20 Child.pdf Traditionally the Heimlich Manoeuvre was promoted as a way of removing a lodged foreign body. This involved placing a clenched fist in the upper abdomen then pulling up under the ribs from behind. Unfortunately there were a number of case reports of fatal abdominal organ injuries due to this technique and its use is no longer encouraged. Interestingly, in May this year at the age of 96, the retired surgeon Dr Henry Heimlich used the technique that he had developed. This was the first time he had the opportunity in real life to use his famous technique and was able to save the life of a fellow nursing home resident, Patty! Have fun this holiday season but try and stay safe. If however you do have a mishap of some description the doctors and nurses at our brand new state-of-the-art Emergency Department will be there 24/7 to help patch things up! pindaramagazine.com.au Pindara Magazine 15
Pindara Private Hospital Magazine - Issue Nine
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