Proper hand positioning is helpful to perform effective CPR. To begin, you should kneel at the patient's side with your knees shoulder width apart. After baring the patient's chest, trace your finger up their ribcage until it joins in the center. You should feel a small bone at the bottom of the sternum (breastbone). This bone is called the xiphoid process and need to be avoided. From the xiphoid process, measure 2 finger widths up the sternum and place one of your hands flat on the patient's chest. Now, place your other hand on top of the first. Your hand position should be approximately mid-sternum, mid-nipple line.

Good body positioning will also be a great credit to your CPR skills. By locking your elbows and bending from the waist during compressions, you will allow your body to do the majority of the work. Compressing with only your arms yields ineffective compressions and is exhausting. You will feel yourself get the `adrenaline rush' when you do compressions and this will allow you to perform CPR much longer than you anticipate you can. Remember, early access to 911, good body mechanics, proper hand positioning and common sense will yield excellent CPR skills, thereby offering your patient the best chance of survival.

Rescue breathing is utilized anytime you encounter a patient who is not breathing but still has a pulse. Although relatively uncommon, this condition can occur in situations such as drug overdoses and trauma. You may also utilize rescue breathing when a patient is not breathing adequately, as in the case of asthma or emphysema. In these cases you must breathe for the patient. Rescue breathing consists of giving one breath every five seconds. It is common to deliver an excess volume of air during rescue breaths, so you must be aware not to over-inflate the patient's lungs.

Excess air will flow into their stomach, which can induce vomiting. By providing slow breaths into an open airway and stopping when you begin to feel resistance, you can greatly minimize this problem. If your patient vomits during rescue breathing, quickly and carefully turn the patient's head to the side and clear the airway. You should then begin breathing again.

To perform effective rescue breathing, plug the patient's nose with one hand. Keep upward pressure on their chin with your other hand. This will maintain an open airway. Open your mouth wide and completely cover theirs to get an airtight seal. Breathe slowly but steadily into the patient's mouth until you feel resistance. Pull away from the patient and allow them to exhale. Take a breath and begin again. It is imperative that you use some type of barrier device during rescue breathing. Faceshields, a face mask or bag-valve mask are the preferred barriers.

I'm worried about disease transmission during CPR.

Although you should be concerned with your own safety, the probability of a rescuer becoming infected with HIV or hepatitis during CPR is very minimal. In fact, there has never been a reported case of transmission during CPR. It is still recommended to utilize barrier devices such as gloves, pocket masks or faceshields while performing CPR. This further reduces an already minimal risk.

What do 1 do if my patient vomits?

Although very common during a cardiac arrest resuscitation attempt, it must be dealt with quickly and efficiently. The concern to the patient is possible aspiration into their lungs. Simply turn the patient's head to the side and clean the vomit out of the patient's mouth before continuing CPR.

How will 1 know if I'm doing an effective job?

During CPR, you should continually monitor the skin condition of your patient. This is a good overall indicator of the effectiveness of CPR. The skin will turn from gray or blue to a more pink color. Additionally a second rescuer should be able to feel a carotid pulse with every chest compression.

Can I treat a cardiac arrest patent while they're lying on a couch?

No. It is crucial to perform chest compressions with the patient lying on a hard surface such as the floor. Quickly and carefully transfer the patient to the floor. This is true of chairs, beds or surfaces too high to perform effective chest compressions.

What do 1 do if I'm alone?

First, determine unconsciousness in your patient. Then call 911 to get help coming. Leave the patient if you must to access a phone. Quickly return to your patient and begin the ABC's. This is a time when cellular or cordless phones offer a great advantage as you will be able to call for help without leaving your patient. Keep your ears and eyes open for bystanders that may show up and be able to offer assistance.

When more than one rescuer is available, how do we switch?

The most effective way to perform CPR with 2 rescuers is to have one immediately begin patient care, while the second notifies EMS. When the first rescuer begins to tire, plan a switch. Vocalize this switch: "We're going to switch after compressions, ready 13, 14, 15, switch." The second rescuer will then take over with breaths and allow the first rescuer the opportunity to step completely away and take a break.

To more positively impact the outcome of sudden cardiac arrest across the United States, a rapid, coordinated emergency response is required. This response is a sequence of four events.

Early Access to Care

Since the inception of the 911 system, continued training anti modifications have been done to increase the effectiveness and access to everyone. Dispatchers are the link that gets the EMS system to you. They are medically trained to help you provide life-saving care until EMS personnel arrive.

Early CPR

CPR provides minimal blood flow and oxygenation to the vital organs of the body. It has been estimated that perfectly performed CPR produces only 30% of what the body can. CPR merely prolongs the act of dying but buys valuable time until defibrillation can occur. We must accept the fact that CPR does not represent definitive treatment for ventricular fibrillation.

Early Defibrillation

One of the most important factors in the treatment of sudden cardiac arrest is rapid defibrillation. The sooner a patient is defibrillated, the more likely their chance for survival. Early defibrillation hopefully converts the heart to a perfusing rhythm. The current prognosis for cardiac arrest survivors continues to improve.

Early Advanced Cardiac Life Support

When the time from cardiac arrest to defibrillation is kept to the absolute minimum, it may be the only emergency treatment required. As time passes, the heart will continue to fibrillate. Then, advanced airway management and IN. administration of cardiac drugs are usually needed to successfully defibrillate and restore normal heart function.

In the 1960s, the revolutionary concept of paramedicine was introduced.

 At that time, the focus was bringing skilled emergency personnel and equipment to the patient. This began improving survival rates in the pre-hospital setting, especially for heart attack victims. During the 1970s, defibrillation was introduced to the pre-hospital environment but only for paramedics. At that time, the defibrillators were manually operated.

The paramedic had to read and interpret the cardiac rhythm displayed on the monitor. Then, determine if a shock was indicated, that is, if it was necessary to apply electricity to the patient's heart. After several more steps they were finally able to deliver the shock. Too often, it took several minutes for this critical series of events to occur. If you add these minutes to the minutes that passed simply waiting for trained medical help to arrive, it should come as little surprise that the nationwide survival statistics for victims of SCA has averaged only 5% for the past several decades. Too much time was going by before patients were being defibrillated.

The first person who was successfully defibrillated in-flight on a US airline occurred in 1998. Michael Tighe was traveling from Boston to Los Angeles on American Airlines when he collapsed in his seat. His wife began CPR and a flight attendant showed up with an AED. the pads were applied and 5 shocks were administered. Michael then began to breathe and his pulse returned. The AED onboard the aircraft had been installed just three days earlier!