Locating midway in CPR

[dazle]

Alrighty

What's the best technique to locate the sternum midpoint when administering CPR?

I've been shown 3 techniques. The 1 I like best is 2 hands, little fingers find sternum, chosen other fingers find midpoing, lower hand down and bob's your uncle.

The 1 I'm weiry of is find the nips and go for the middle, what do you think of that 1???

Cheers

(Not medicine I know but should get a more informed answer here)

 

[BigJetDriver]

According to AHA, the "classic" method is still that of sliding a finger up the abdomen to find the xiphoid process (that little "point" between the halves of the ribcage), putting one finger down above that, and then the heel of the hand down above that.

The other method is still, sorry old chap, finding the mid-point on the line between the nipples.

Hope that helps! =-)

 

[divemed06]

Take a look at this link

 

[The Iceni]

dazle once bubbled...
What's the best technique to locate the sternum midpoint when administering CPR?

Hi dazle,

I do hope you never have to administer CPR but it is like so many things that we are taught to do just-in-case and (to my possibly jaundiced mind) a lot of unecessary time and effort is expended on teaching the "DIR" method.

I've had to do this one or two times and when the proverbial hits the fan you just get on with it.

The principle of chest compressions is to restore a circulation in an otherwise stalled heart to prevent it (and the brain) from suffering catastrophic irreparable damage. It is seldom curative and must be maintained until definitive treatment is give - most often and successfully by defibrillation in the public first aid situation. In diving it is likely that the cause of a cardiac arrest is other from heart disease, such as pulmonary barotrauma, and in general these will not respond to defibrillation.

In CPR the theory is that compression of the chest wall flattens the heart against the spine expelling the blood contained in it. In addition it causes movement of the blood within the chest.

On release of the compression, due to its natural elasticity the heart expands and this expansion sucks blood into it, while the expansion of the chest likewise causes venous blood to enter the chest. Divemed's link shows what is supposed to happen.

I may get flamed for this, but I honestly believe in the circumstances of a cardiac arrest (and chest compressions should not be given when there is no arrest!) the sooner it is started the better and why waste several seconds finding the exact spot? This procedure is "time critical".

It is my impression that within a couple of compressions even the inexperienced rescuer will adjust his position to suit and find the best way to continue.

It is VERY tiring I might add!

(I know, I have just failed my ACLS exam!!! )

 

[Firediver]

I am a first aid instructor, and teach CPR..

To land mark or find the middle of the sternum, as one other person pointed out on here is by finding the xyphoid process. Find the bottom of the rib cage and walk your fingers up until you find where the ribs meet this is the xyphoid process.. when you find it place two fingers just above with your free hand to mark.. and the put the heel of your hand above the two fingers.. you should be on the sternum. IF you some how miss and you are on the xyphoid process, and that is broken.. it can me very painful and can also cut other organs. The Ratio of compressions to breaths is 15 com-2 breaths<adult> 5com-1 breath<Child>(same for an infant.) The same land marking for CPR is used for an unconsious choking person as well.. I hope this helps any...

 

[mwilding]

Dr. Paul

I basically agree with you with the proviso that you take care not to compress the Xiphois as that could greatly worsen the situation. An extra second to find your landmarks before the first compression is still a good idea for the inexperienced.

 

[The Iceni]

Firediver once bubbled...
I am a first aid instructor, and teach CPR.. The Ratio of compressions to breaths is 15 com-2 breaths<adult> 5com-1 breath<Child>(same for an infant.) The same land marking for CPR is used for an unconsious choking person as well.. I hope this helps any...

HI Firediver,

The European Resuscitation Council now recommends 15:2 in all scenarios. In my opinion all these differing recommendations only serve to confuse. The point I was making is to get in there and do something and not to worry about any finesse as a life can be saved by early CPR, however badly it is performed.

An important point, not emphasised enough in first aid teaching, is that chest compressions need only be given when there is a cardiac arrest. Not only is it counterproductive when there is no arrest it is energy wasted and compromises the ability to prolong efficient ventilation.

In my own case of near drowning my life and health were saved by early and continuous ventilation with 100% oxygen, for which I am eternally grateful. Thank you Fluff! (No chest compressions were needed as I still had an output). In spite of this they tell me I was black and blue because of the rough handling during my rescue and had a couple of fractured ribs. Who cares?

As for locating anatomical landmarks - quite difficult when the diver is dressed in an immersion suit. Get it off ASAP! Sea Snips or similar are a must have!

By the way, I was joking about failing ACLS (advance cardiac life support).

What is your experience of successful CPR, Firediver? My own experience it is pretty dismal because of the frequent presence of irreversible dire underlying pathology.:doctor:

 

[BigJetDriver]

Dr Paul Thomas once bubbled...
The European Resuscitation Council now recommends 15:2 in all scenarios. In my opinion all these differing recommendations only serve to confuse. The point I was making is to get in there and do something and not to worry about any finesse as a life can be saved by early CPR, however badly it is performed.

An important point, not emphasised enough in first aid teaching, is that chest compressions need only be given when there is a cardiac arrest. Not only is it counterproductive when there is no arrest it is energy wasted and compromises the ability to prolong efficient ventilation.

In my own case of near drowning my life and health were saved by early and continuous ventilation with 100% oxygen, for which I am eternally grateful. Thank you Fluff! (No chest compressions were needed as I still had an output). In spite of this they tell me I was black and blue because of the rough handling during my rescue and had a couple of fractured ribs. Who cares?

As for locating anatomical landmarks - quite difficult when the diver is dressed in an immersion suit. Get it off ASAP! Sea Snips or similar are a must have!

:doctor:

All excellent points as always, Doc. By the way, American Heart has gone over to the 15 to 2 ratio for adults (except for two-man CPR where an artificial airway has been established, which is outside the scope of normal CPR situations).

The rest of your points are great to emphasize, and you are a living example of their efficacy!

 

[Firediver]

Standing around watching never saved anybody. Dr Paul Thomas I agree with what you said as just go and help and don't worry about finess.. I just say stay off the xyphiod..

 

[SparkySFD]

I unfortunatly have done this a few times. Actually I cannot begin to even count, well over a hundred. I am a Fireman/EMT. Actually have saved a couple.

Like some have said. You dont have to be totally precise. You do want to stay off that xiphoid. Where you will have trouble is, forgive my bluntness......big fat people. Use the nipples for the times you just cannot find it.

Exposure suits would be a problem but you should CUT them off anyway. One of the first rules they teach you is "You cant treat what you cant see". Memorize that one. Trust me if your buddies heart stops he aint gonna raise hell with you for cutting off his suit if you save his life.