If proper CPR involves compressing the chest so much such that the ribcage might break - doesnt that breakage risks a bone puncturing the heart?
Yes, more common however is a rib puncturing a lung. Regardless, the (slim) possibility of that happening is preferable to the certain death that would happen if you didn’t perform CPR
This. When I got my CPR training, the consensus was: if you hear or feal something crack, don’t stop. Messing up is better than doing nothing.
Also, if you’re concerned, don’t be afraid to perform CPR on a female. Their modesty is worth a lot less than their life.
Wow… That’s incredible. What does it matter in that instance if you touch someone „inappropriately“ whatever that even means in this circumstance… I kinda get that in the ridiculous US juristictions where someone could sue you for trying to help you (change that already ffs…)
Imagine having to talk to the family/friends of someone you found on the street:
„Hey I‘m so sorry your friend/wife/girlfirend/mom/daughter died. But at least I didn’t touched her breasts and no one hndressed her for the defibrillator!“
WTF! I‘m incredibly conscious of my body (trying to lose weight currently) but if helping me survive means getting me but naked on Times Square, fucking go for it -.-”
External compression isn’t exactly the normal mechanism of blood circulation.
If you’re doing chest compressions to save someone who has stopped breathing there roughly a 10% chance they will survive but a 0% chance if you don’t So it’s often worth it anyway.
However it does keep the blood flowing and can prevent brain damage until a defibrillator is available which has a much higher chance of saving someone who has stopped breathing.
The heart is also protected by the lungs and breast plate.
Doesn’t the defib stabilise the heartbeat rather than getting it going again?
Yes if the heart has flatlined completely then it won’t be started again by AED. But if they are in cardiac arrest then the heart rate is erratic and doesn’t function normally but can be returned to normal with a defibrillator.
Yes, a heart that has completely stopped beating cannot be restarted by defibrillation. It only works in a condition called ventricular fibrillation, when the muscle fibers of the heart are still contracting, but are no longer “in sync”. This causes the heart to twitch chaotically, which is not an effective way to pump blood. And without blood pumping, the heart itself does not receive any oxygen as well, so it will eventually go into a complete flatline after a few minutes of untreated ventricular fibrillation.
The electric shock helps the fibers resynchronize. If you want to see the effect directly, here’s a video:
https://www.youtube.com/watch?v=HCbawp9ZSnY
Be warned, it shows an open chest and an exposed heart, most likely during heart surgery. They are using spoon-shaped internal defibrillation paddles. In the beginning, you can see the heart in ventricular fibrillation. It’s twitching chaotically and not pumping any blood. After defibrillation, it starts contracting rhythmically again.
That’s incorrect.
Someone might be not breathing for a number of reasons. Most likely however, when you find them unconscious & not breathing on the street it’s for cardiac reasons. And then a defibrillator is the one best treatment for that (if the heart has a shockable rhythm that is).
So I’ve done lots of cpr. First off it’s kind of a misconception that you’ll break ribs from cpr. You are more likely to break cartilage than actually break bones and appropriate cpr isn’t going to break bones unless they’re the smallest most frail person and the individual doing cpr is going crazy doing compressions.
Even if you break ribs you’re probably not going to have a displaced rib fracture as there’s muscles and tissue holding those bones in place, it’s pretty rare to have ribs break so bad they risk puncturing organs and it usually involves catastrophic trauma, not what you get from cpr.
I have, thankfully, never done CPR live, but I’m certified to teach CPR by the Danish First Aid Council. So I have a interest in learning from actual practitioners, although I’m obviously not allowed to alter the course.
Where do you stand on ventilation? Currently I have to teach 30:2 mouth to mouth, but I know that there’s talk about skipping ventilation either entirely or at least for adults. The thinking being that children don’t suffer spontaneous cardiac arrests, but that it’s usually a result of blocked airways.
Do you do ventilation and does it make a difference in your experience?
I’ve had a few different First Aid courses and the instructors all have slightly different reasoning. One argument for compression only is potential for passing disease mouth to mouth, the newer courses tend to teach this because sometimes people that don’t feel comfortable doing rescue breaths will fail to do CPR at all. Another is that in cases where you’ve witnessed the event, the blood is already fairly well oxygenated and if medical help has a good response time the benefits of breaths are minimal. The first is more about compression only CPR being better than nothing, breaths are still advised where the rescuer feels comfortable doing so. The second is pretty situational.
So it depends on the setting and patient. Kids tend to have respiratory causes of cardiac arrest so the focus is more on airway management and positive pressure ventilation. Kids don’t generally code just out of nowhere like say a 90 year old might keel over. There’s usually a specific cause and if you can correct that cause they will rebound.
As for adults it’s about the setting. Outside of the hospital we should be teaching cpr only. Especially for lay people. It gets too complicated and they’re too stressed out to remember 30 and 2, 15 and 2. Plus most people have a reserve of air in their airway and lungs that gets circulated with compressions so focusing too much on trying to get breaths in causes too many delays and confusion.
Now for ems you can debate whether they should do cpr only with a non rebreather, a bls airway and bagging, a biad, or a definitive airway. It hugely depends on your protocols, provider availability, and who the patient is.
In hospital we are almost always going to secure the airway during a code to remove that from the equation. We have the resources and it can be done relatively quickly without the need to delay cpr for more than a pulse check in many cases.
Dude if my heart’s not beating, by all means, break my ribs. Broken ribs are better than being dead.
Alive with broken ribs and other injuries > being dead
