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RESUSCITATION
An
in-depth discussion of resuscitation procedures is beyond the
scope and intent of The Infirmary. However, there are basic
principles that can be utilized when writing FanFiction that
will add credibility to your story. For more detailed and in-depth
information, check out the American Heart Association at www.americanheart.org,
or this site, (which on a quick overview looked good) www.acls.net.
Disclaimer: While the information presented is accurate, please
do not use this information as a guide to actually performing
CPR on a real person. Do not attempt CPR unless you have been
properly trained and certified in an American Heart Association
sponsored class on cardiopulmonary resuscitation.
THE
BASICS OF CARDIO-PULMONARY RESUSCITATION (CPR) IN THE ADULT
The
basics of resuscitation are always the same and are always Airway,
Breathing, Circulation-the ABC's. When
an individual has collapsed, the first step is to establish
unresponsiveness. "Shake and Shout" is the mnemonic-shake the
victim (carefully if other injuries are present) and loudly
ask, "Are you okay?" Never start resuscitation procedures on
someone who doesn't need them!
If
the victim is unconscious, then ascertain whether they are breathing
or not. Establishing an open airway does this. With the
victim on his or her back, the 'head-tilt, chin-lift' maneuver
is performed. The head is tilted back slightly by gentle pressure
on the forehead and the chin is lifted with a gentle touch under
the chin. Don't put your hand under the victim's neck and lift
up to do this maneuver, as that could aggravate possible spinal
injuries. The head-tilt, chin-lift-when performed properly-maintains
spinal alignment. Put your face down next to the victims, looking
towards the victim's chest and look for chest movement,
listen for the sound of air moving in and out of the
mouth/nose and if you can feel air coming out of the
victim's mouth/nose. If the victim is breathing adequately,
then position them in the 'rescue position' (lying on the side
with the head resting on the lower arm, the lower leg straight
and the upper leg bent at the knee to provide stability and
support). This position will protect the airway.
If
the victim is not breathing, then give him or her two
breaths. Now, in this day and age of HIV, mouth-to-mouth resuscitation
is rarely performed. All rescue and medical personnel will have
access to some type of barrier device that allows for 'mouth-to-device'
breathing, thus protecting the rescuer from any secretions,
etc from the victim. Mouth-to-mouth is usually only performed
in emergency situations by family members. Of course, mouth-to-mouth
is much more dramatic and literary license may prevail. But
if your victim has collapsed at the SGC, then mouth-to-mouth
will not be performed, some barrier device will be used.
Whatever scenario you choose, one thing doesn't change-two breaths
are given.
Now,
you might be wondering, when do the chest compressions start
and when do we bring out the defibrillator? The next step after
airway and breathing is circulation. After giving the
two breaths, the rescuer next determines whether the heart is
beating. It is pointless to check circulation first, if the
victim is not breathing. Oxygen must get into the body to be
circulated by the heart to help the victim. The rescuer feels
for the carotid pulse, which is just to the outside of the windpipe
on the neck. It's a large artery and if the heart is beating,
you will feel the pulsation. Check for ten seconds. If there
is no pulse, then your rescuer may begin chest compressions.
Kneeling
at the victim's side, (after dramatically ripping his or her
shirt off), the rescuer feels along the rib cage closest to
him or her and runs his or her fingers up towards the sternum
(breastbone). Once there, the heel of one hand is placed on
the lower one-third of the sternum-not on the very end (the
xiphoid process) as this is a bit of cartilage that will get
easily broken if vigorous compression is placed upon it (which
can result in internal laceration and bleeding). The rescuer
places his or her other hand on top of the hand resting on the
sternum and locking the fingers together, compressions are started.
Okay, use only the heel of the hand, keep the fingers
up and off of the chest. The elbows are locked (which you don't
see on TV because they really aren't doing CPR) and the chest
is compressed (in an adult) two inches or so. In the normal
course of things, fifteen chest compressions to two breaths
is the normal cycle. You're aiming for sixty to eighty compressions
per minute (more or less) and eight to ten breaths per minute.
Every few minutes the rescuer may pause and check for a carotid
pulse and the return of spontaneous respirations.
Performing
CPR is very tiring, so do bear this in mind when writing it
into a story. A single rescuer (depending on his or her general
fitness) will only be able to sustain resuscitation efforts
for maybe an hour or two before becoming too tired to continue.
So,
what if you're not in the field but back at the SGC? And that
defibrillator is just begging to be used? Defibrillator usage
is considered part of Advanced Cardiac Life Support. In the
real world, Automated External Defibrillators (AED's) are in
wide usage and found in a variety of locations (i.e. airports,
airplanes, stadiums, shopping malls and casinos) and can be
used by anyone as the machine tells the rescuer what to do.
But at the SGC, there seems to be only the standard defibrillator.
Defibrillation
is the use of a direct electrical current to temporarily stop
the heart, hopefully allowing the normal electrical path of
the heart to be re-established. There are only two heart rhythms
that respond to defibrillation-ventricular tachycardia (v-tach--a
very fast rate where the ventricles are contracting too fast
to pump blood adequately) and ventricular fibrillation (v-fib--an
unorganized, fast rate where the heart muscle is not contracting
at all but merely quivering). A heart that is not beating (asystole
or 'flat-line') is not a shockable rhythm, it is however, appropriate
to give CPR to those individuals. So, if your victim is in V-tach
or V-fib, you can use the defibrillator.
How
will you know this? You will either have the patient connected
to a heart/cardiac/EKG/ECG monitor or the defibrillator paddles
(when placed on the chest in their proper positions) can also
be used as a monitor. If the victim is unresponsive and in V-tach
or V-fib you can defibrillate them. Expose the victim's chest,
place the defibrillator paddles on the chest, one on the upper
right chest, just below the clavicle, the other below the left
nipple and slightly off to the side. There are 'hands-free'
options available, but they're generally not as dramatic. The
paddles are 'charged' to 200 joules first. After ascertaining
that no one is touching the patient and usually accompanied
by shouting 'Clear!' the paddles are discharged, sending an
electrical charge of 200 joules through the victim's heart.
Hopefully, the shock will temporarily stop the patient's heart
and when it restarts, it will naturally start back in it's intrinsic
(normal) rhythm. If not, then the paddles are charged again
to 300 joules and discharged. If there is no change in the rhythm,
then charge again to 360 joules and discharge them.
With
any luck at all, your victim will have a dramatic recovery and
go right into normal sinus rhythm. If not, IV's are started
and the victim is intubated with an endotracheal tube to allow
for ventilation. Drugs and defibrillation are then used according
to standard algorithms for the treatment of whichever heart
rhythm the victim is displaying. In the normal course of things,
advanced measures will be performed for sometimes up to an hour,
depending upon the victim's general medical condition and the
reason for the cardiac arrest. When there seems to be no chance
of recovery, the resuscitation procedures are stopped by the
physician in charge and time of death called.
If
your victim does recover, he or she will be kept in the ICU
for at least twenty-four hours, or longer, depending upon any
other injuries or problems you've inflicted upon them. The victim
may or may not need to be intubated and on a ventilator, spontaneous
breathing often returns when the heart is beating normally.
Any other injuries are treated once the victim is successfully
resuscitated.
Again,
this article is meant to only present basic information to help
in writing medical scenarios where your victim is in need of
resuscitation and not meant to be used in any real-life situation.
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