Heart, Resuscitation of (Cardiac Arrest)
When a victim's heart stops beating, it is not easy to tell whether his life might be saved by external cardiac massage (resuscitation of the heart). So the only safe rule is to give the patient the benefit of the doubt and apply external cardiac massage in every case of heart stoppage.
To stimulate the heart to resume beating, it used to be thought necessary to make an incision in the chest and actually reach in and squeeze the heart. It is now recognized that this same stimulation can be accomplished in most cases by exerting pressure through the chest wall. The heart is located near the middle of the chest between the breastbone, in front, and the vertebrae, behind. By exerting firm pressure over the lower part of the breastbone and depressing it about two inches, the heart is effectively squeezed between the breastbone and the vertebrae. This pressure forces blood out of the heart and allows other blood to enter the heart, once the pressure is relieved, thus keeping the blood moving throughout the body.
Usually, when a person's heart has stopped beating, his breathing has also ceased. The reverse is not necessarily true, however. In a case in which the heart is not beating, then, it is usually necessary to give artificial respiration while external cardiac massage is administered.
It is not easy to administer artificial respiration and external cardiac massage at the same time. If two rescuers are
available, one can employ artificial respiration (mouth-to-mouth, method) while the other administers external cardiac massage. In such cases, the lungs are filled with air after every fifth compression of heart through the chest.
If only one rescuer is available, he should discontinue the cardiac massage after each twelve cycles, long enough to
blow air into the victim's lungs twice.
He then resumes the massage for another
twelve cycles.
WHAT TO DO
1. Lay the victim on his back on the ground or floor.
2. The operator should work at the victim's side. The second operator who inflates the victim's lungs, works at the victim's head.
3. For an adult, the heel of one hand is placed over the lower third of the victim's breastbone with the heel of the other hand making pressure on top of the first hand. Firm pressure on the victim's chest should be exerted once every second (as the operator counts slowly, "One little second, two little seconds"). Sufficient pressure should be exerted to depress the breastbone about two inches.
For babies, the pressure should be gentle, exerted through the tips of the operator's fingers as they press against the center of the baby's breastbone. There is danger of pressing so hard that the heart muscle is bruised. For children of about ten years of age, pressure should be exerted by the heel of one hand against the child's breastbone.
4. After each downward pressure, the operator's hands should be relaxed to permit the chest to expand again. Do not exert excessive pressure, for it is possible to break the patient's ribs.
5. Continue this procedure (with artificial respiration) until the patient's heart begins to beat on its own, or at least for as long as one hour. If the patient is moved to a hospital, external cardiac massage and artificial respiration should be continued, as necessary, while the patient is being moved.
