Monday, September 02, 2013

Learn CPR Cardio Pulmonary Resuscitation

We have heard of runners collapsing while running in races due to cardiac arrest or due to Myocardial infarction (MI). Both situation should not be confused as the same thought the layman will just call it "heart attack". Cardiac arrest is due to inability of the heart to contract properly and thus fail or become erratic. MI is caused by the heart stopping to work due to blocked arteries. MI are caused mostly due to lifestyle and diet. 

Learning to perform CPR may saves life. However, before you read on, please read the following:

1. Only perform CPR if you know what you are doing and potentially will be doing. It requires commitment and confidence.

2. DO not perform CPR unless you obtain clearance from family members or being instructed by a medical professional attending to your emergency call.

3. Even if you think you know how to perform CPR, always listen to instruction given by the medical professional attending to your emergency call.

4. THIS IS NOT AN OFFICIAL CPR TRAINING. I suggest you get trained or attend a class that shows how to perform CPR.

My involvement with Red Cresent Society (Persatuan Bulan Sabit Merah) back in primary school and knowledge I picked up by reading, and subsequently being trained as part of the requirement to work in an American Company requiring basic 40-hours HAZWOPER (Hazard Waste and Emergency Response under (OSHA) Standard 1910.120). It has since lapse because I left the organisation. Now that I am back to work for an American Company (and in the same line I left 2 years back), I know it will be a matter of time before I get re-certified again. 

The sharing below is from what I know and remember, with references made to newest online available training to CPR. Staying inform is potentially able to save life. 

Assess The Situation
THis is the toughest decision as one wrongly made may potentially kill the person you will be helping. Before you do anything, check if the person is conscious. If the person is conscious, DO NOT PERFORM CPR. 

If the person is UNCONSCIOUS, shout for help and call emergency number. For Malaysia is it 999 (Polis and Ambulance) or 112 from mobile phone. Get help. 
In emergency, every minute count. You may have to make calculated decision and it is important you remain calm and non-emotional. I am assuming the worse and there is a need to perform CPR. This happen ONLY IF the person is
  • Unconscious; and
  • NOT breathing. 
The ABC of CPR
  • If the person is not laying flat on his/her back, roll him/her over in one movement. If there is someone to help, do so, otherwise, the best way to do this is to cross the person's arm over his/her shoulder and you roll them over. 
  • When someone is unconscious, their tongue may roll back down and block the airway. Lift up the chin gently and tilt the head back. In the event of an accident (vehicle) or a bad fall involving the neck, be very careful and do not tilt the head backwards. Chin-lift will do. You are now resetting the airway. 
  • Now, check for breathing. Put your ears to the nose or mouth of the person and listen for breathing. If he/she is breathing. DO NOT PERFORM CPR. Doing so may stop the heart. be cautioned!
  • If the person is not breathing, you have to start providing Expired Artificial Resuscitation (EAR) or Mouth-to-Mouth or Rescue Breathing.
  • Pinch the person's nose shut with your finger and rest the base of your palm on the forehead to maintain the head tilt. Keep the other hand under the chin to lift it up. Remember Airway.
  • Inhale normally and give the person two full breaths. Make sure there is a seal between your mouth and the person. If contact is not preferred, you can use a piece of cloth as a buffer. 
  • After the Breathing (two full breaths), you will start the chest compression. Make sure the person is laying FLAT as any other position may cause you to inflict more injury on them during the compression.
  • Position yourself on the side of the person. I prefer the left. Knell on both knees.
  • Place the heel/base of your hand on the sternum aka between the nipples of the person. For me, I am a right-hander, naturally my right hand were placed on that area first.
  • Now place the other hand on top of the first hand. Place the top hand fingers between the first hand, interlocking it. 
  • Position your shoulder directly over the person. The CPR will now start.
  • PRESS DOWNWARDS with BOTH HANDS STRAIGHT. Push hard and FAST. The first few pushes need to be at least 1/3 to 1/2 of the person's chest depth. Once you established the Rhythm, lay off the pressure from the sternum and compress for 2-inches or 1/3 depth.
  • Continue to do this at the rate of about 100 compression/minute. Do not remove your hands or you will have to start the first hard push again.
  • Every 30 compress, stop and check for breathing, If none, repeat BREATHING. The rate is 30:2 or 30 Compression-2 Breaths.
  • HOWEVER, If you are NOT sure or NOT TRAINED, keep the chest compression going at 100compression per minute. THIS IS TO ENSURE BLOOD CONTINUES TO FLOW.
  • If you are under instruction from the medical responder on the phone, listen and follow their instruction. 
  • Continue CPR until advance help arrive.

A cross reference to American Heart Association website on CPR noted that it is MORE important to provide QUALITY CPR than ventilation. It is more essential to keep the pressure on the compression to encourage circulation.
AHA Website
I re-confirmed this with a few doctor friends that has mentioned it is mainly A and C nowadays. This is what is termed as "Hands-Only" CPR. So, do not fret if you are not comfy about giving EAR or Mouth to mouth resus.

On the evening of August 27, 2013. I found myself having to perform this on my mother-in-law's neighbour. Knowing how to do it and doing it was two different situation. Guided by the ER responder on phone, we followed the instructions given for almost an hour performing CPR. 

However, the person I help performed CPR did not make it. This blog entry is dedicated to Uncle Phillip. May he rest in eternal peace. Condolences to the family. I wished I could had done more. 


  1. You are right, new CPR compression is more important than EAR, and 100/min is a challenge for many ppl, even just to perform on dummy doll.

    just wanto comment, a 90 degree hands on top of the chest allow delivery of force on the compression using body weight, which is less effort required.

    1. YK - spot on. I was over the victim's body using my weight rather than my arms to press down. 100/min was a challenge, but had to keep going on and hope for the best.