It was 6 pm on a cool spring evening when I began my commute to work at a large medical center in Philadelphia. I merged into heavy traffic on the expressway. Having worked in the neurotrauma ICU the night before, I was thinking about the patients I expected to care for that night when I spotted a dark blue passenger van parked askew on the side of the road.  A teenage girl was next to the van, frantically waving her arms, trying to get someone to stop.

I pulled over and carefully exited my car as traffic whizzed by. The girl ran over to me and shouted, “Please help my Dad!” over the din of the noise of a passing truck. She opened the passenger side door to reveal that her father was unconscious in the driver’s seat and slumped sideways over the center console with his head awkwardly flexed forward. He had suddenly lost consciousness while driving, and the girl had grabbed the steering wheel and somehow managed to steer the van to the side of the road.

I called 911 as I climbed into the van to assess the man. With my phone on the dashboard on speaker, I relayed my assessment findings to the dispatcher: unresponsive, no pulse, no respirations. S#*%!

My training kicked in. I asked for the girl’s name (Sarah) and reassured her that help was on the way. I told her that I was a nurse and would need her help. I disengaged his seatbelt, pulled him across to the passenger seat and, with Sarah’s help, lifted him under his arms and eased him to the pavement. I placed my hands on his chest and started compressions.

Another vehicle pulled up. A woman ran up to me, said she knew CPR, and asked how she could help. I told the woman to prepare to take over chest compressions and that I would say “switch” when she was in a good position. At that moment, Sarah’s father made a gasping noise and began to breathe spontaneously. He had a radial pulse but was still unresponsive.

After what felt like an eternity, we heard the distant wail of sirens. A police car and ambulance pulled up. I gave a quick report to the paramedics, who took over in a flurry of activity and whisked the patient away. A policewoman took my statement and kindly notified my charge nurse at work that I would be late for my shift.
I had quite the story to tell my coworkers when I finally got to work.

Cardiopulmonary Resuscitation (CPR)

Over 400,000 individuals experience sudden cardiac arrest (SCA) outside of a hospital setting each year in the U.S. (Elmer, 2023). Delivery of effective basic life support (BLS) is linked to improved survival and recovery after SCA. Cardiopulmonary resuscitation (CPR) training is required for all nurses in direct patient care and certification must be renewed every two years. Training and recertification may be offered by your facility or by local American Red Cross providers.

Years ago, we were taught the ABCs of BLS: airway, breathing, compressions. That has since been revised into the compressions-airway-breathing (C-A-B) method, as compressions are the most critical component to survival. Key concepts to remember when performing BLS and CPR outside the hospital setting include the following (Elmer, 2023):

• Recognize SCA as soon as possible. Signs include unresponsiveness or absent, gasping, or abnormal breathing.
• A lone responder should activate emergency services first, then begin resuscitation.
• Pulse check
  • Non-medical rescuers should not attempt to check for a pulse. Instead, begin CPR for any unconscious or unresponsive victim with abnormal or absent breathing. Note that performing CPR on an unresponsive person not in SCA has very few harmful effects while not performing CPR on an individual in SCA can result in a poor outcome.
  • Trained healthcare providers may perform a carotid pulse check for no more than 10 seconds before beginning CPR in an unresponsive individual.
• Chest compressions provide perfusion and oxygen delivery to the heart and brain.
  • Push hard and fast on the victim’s chest.
  • Maintain a rate of 100 - 120 compressions per minute.
  • Compress the chest at least 2 inches but no more than 2.5 inches, allowing the chest to recoil completely after each downstroke.
  • Minimize interruptions.
  • Continue compressions until a defibrillator becomes available and is ready to deploy.
• Ventilation becomes increasingly important as pulselessness persists.
  • In patients without a protected airway, provide rescue breathing at a 30:2 compression-to-ventilation ratio. Continue until an advanced airway is placed.
  • Give each breath over no more than one second and only enough air to observe the chest rise (withholding compressions during this time).
  • Avoid excessive ventilation (rate or volume).
• Defibrillation:
  • As soon as an automated electronic defibrillator (AED) becomes available, follow the prompts, check the rhythm, and deploy the shock as soon as possible.
  • Apply AED pads to bare dry skin when possible.
  • A single shock is recommended in all protocols followed immediately by the resumption of chest compressions.
  • Deliver shock at the highest available energy for adults, 200 joules for biphasic AED and 360 joules for monophasic AED.
• Compression-only CPR is appropriate in the following:
  • If a sole non-medical rescuer is present or multiple lay rescuers are reluctant to perform mouth-to-mouth breathing.
  • Compression-only CPR is reasonable in adults but should not be performed in children.

If you are a nurse or other healthcare professional interested in becoming a BLS/CPR instructor, look for classes with the American Red Cross or with a local provider.
 
 

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