Saturday, May 16, 2015

New CPR Guidelines

Changes in CPR Guidelines are Comprehensive

By Richard Pass, RN, BS: Director, Save A Little Life, Inc

During my 22 years as a CPR instructor, I have seen new guidelines come and go. They appear about every 5-6 years and are often accompanied by declarations of "new and improved." For the thousands of parents I have worked with over the years, new and improved is only meaningful if it translates into "Can I remember what to do if my baby isn't breathing?"

Well, here we are, approaching the summer of 2012 and the international guidelines* have undergone appreciable changes. These changes reflect the simplicity of action required if a serious health crisis is upon us.

I have always instructed CPR in a simple way, for two reasons. Simple works, and if there is a real crisis, simple is what most of us can realistically muster. The new clarion call of the American Heart Association is "avoid delay in getting started." If that isn't simple, I don't know what is. Yet, it does require that we look at the changes with an eye toward understanding some of the basic science that gave birth to them.

In the last decade, we discovered many Good Samaritans were willing to help a stranger if CPR seemed necessary. Yet many of these folks were frightened of possibly catching a disease from contact with bodily fluids (vomit or blood) in the victim's mouth. Others were worried about hurting a victim and somehow being responsible for those injuries. This resulted in frequent delays in acting - resulting in brain damage to the victim from nothing having been done until the paramedics arrived.

The message we are now trying to get to parents & care providers is that your CPR can be just as effective as anyone else's and that waiting for help (especially for pediatric victims) can have disastrous consequences.


The recently added "Two Minute Rule" is of immense importance when it comes to trying to revive a pediatric victim with CPR. It goes as follows:
IF YOU ARE ALONE WITH A VICTIM UNDER THE AGE OF 8 YEARS, START CPR BEFORE YOU MAKE A PHONE CALL TO 9-1-1. If there is a response (especially spontaneous breathing by the victim) before two minutes, stop CPR immediately and make your phone call. Two minutes is the MOST you are asked to do under these circumstances before making the 9-1-1 call. If there is a second rescuer present, the 2 minute rule goes away as CPR and the 9-1-1 call can occur at the same time.

The new guidelines, which became official in December 2011, clearly reflect the benefits of pumping over artificial breathing. The steps of CPR will now look like this:

* Stimulate the victim...ask, "are you OK".  For babies and small children, this can include tickling their feet and clapping to try to get a response.

* If no response, perform 30 chest compressions FIRST.

* If still no response, provide 2 "rescue breaths" via mouth and nose on the victim and observe for the chest to rise with each.

* Continue this 30 compressions:2 breaths ratio until a response occurs OR the paramedics arrive and take over.

The new effort is in place to simplify and streamline the CPR steps and make them as universal as possible for all victims. This means that the old method, known as "The ABC's" of CPR have actually been flipped around and now the steps are "CAB" - meaning that we start with chest compressions, then look for breathing and deliver the 2 breaths if needed.

Remember, we no longer waste time checking the victim's pulse as it is too hard to find and confuses the issue. If there are significant signs of life (moving, breathing or coughing), then consider holding off on CPR, but watch the victim very closely and begin CPR if things deteriorate.

What happens if I do it wrong?

Years of science and feedback from community based CPR data show that most errors in CPR are actually errors of omission...meaning that victims get worse because we don't act...not because we mess it up. It has long been known that less-than-perfect CPR is often very helpful, certainly more so than leaving someone alone in a real time of need.

Keep in mind the simple fact that taking a CPR course is the best and only way to really be prepared to deal with a family health emergency.

*International Liaison Committee on Resuscitation (of which the American Heart Association is part of)

Article written by: Richard Pass, RN, BS, of Save a Little Life, who teaches our Infant & Toddler CPR and Family Safety Class, which are held about once a month here at A Mother's Haven Boutique & Educational Center in San Fernando Valley.

Richard Pass, RN, BS is the founder of “Save A Little Life” Inc, a local provider of both CPR and First-Aid for infants &children. He has been a Registered Nurse & Health Educator for over 30 years. He is on staff at Cedars-Sinai Medical Center in Los Angeles and is currently a part-time clinical instructor of nursing at California State University, Northridge. The goal for Save a Little Life is to provide a simpler, more “user friendly” CPR course for parents, grandparents, and caregivers.

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