[music plays] [no dialogue] >>Lori Banks: Next on Being Well, Registered Nurse Rachel Kelley from Paris Community Hospital Family Medical Center will be in our studio to talk about CPR and AED.

The CPR process has been simplified over the years.

We'll learn about how to do it for infants, children, and adults.

The AED has become a common life-saving device in schools and other public buildings.

Rachel has brought one along so you can see how easy it can be to administer.

Stay tuned for this important edition of Being Well.

[music plays] Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

HSHS St. Anthony'’’s Memorial Hospital, delivering health care close to home.

From advanced surgical techniques and testing, to convenient care for your family.

HSHS St. Anthony?s makes a difference each and every day.

St. Anthony'’’s.

Where you come first.

[no dialogue] Thanks for joining us for this edition of Being Well.

I'm your host, Lori Banks.

And today we're going to be learning some life saving techniques.

And with me today is RN Rachel Massey from Paris Community Hospital Family Medical Center.

>>Rachel Kelley: Hello!

>>Lori Banks: Thank you for coming back.

Last time we had you on, you were talking about stroke and the symptoms of stroke.

Today we're talking about CPR and AED.

Tell us al little bit about what you do at the hospital, first and foremost.

>>Rachel Kelley: At the hospital I do a lot of education, internally and externally.

I do go out to the community a lot and push some education out that way.

I also am responsible for helping the staff understand the regulatory processes there at the hospital, as well.

So, it's fun.

>>Lori Banks: Well we have been joined on set by several new friends to the show, I guess.

We're talking about CPR and AED.

Let's, first of all what does CPR stand for?

What does it do?

>>Rachel Kelley: Well CPR stands for cardiopulmonary resuscitation.

You'll often hear people refer to it also as BLS, which is also called basic life support.

And those are both the same things.

It refers to the fact that unfortunately someone loses their pulse, they're unresponsive and they're no longer breathing.

>>Lori Banks: Mmhmm, and does it actually bring people back to life?

What is it doing?

>>Rachel Kelley: It does, so CPR alone, basically the mechanism behind it is compressions and breathing.

And the compressions circulate blood enough to try to bring someone back to life.

So, CPR I like to always talk about the fact that unfortunately they're no longer with us.

And the person that's responding has to become their heart beat, so essentially their heart.

And then they also become their lungs, so.

>>Lori Banks: What do you think is the biggest fear people have if they come across a situation, and oh my gosh, I may have to do CPR?

[laughing] >>Rachel Kelley: Just the fact that they don't remember what to do.

So, really when we go out and we advocate for CPR, we teach everybody the fact that if you just remember to do compressions and nothing else can come to you, compressions will save a lung.

So, we do teach different versions of CPR to the community.

There's friends and family, there's hands-only, and then of course there's healthcare provider.

So, with part of those training sessions, we do focus and emphasize compressions.

>>Lori Banks: Alright, so I took CPR many, many, many years ago, I think high school or college.

I recall it being very complicated, and it has changed.

Talk a little bit about how it's changed to make it simpler to remember.

>>Rachel Kelley: Yes, the American Heart Association has basically taken the stance so that people aren't fearful to respond to say, to eliminate that fear, and say let's simplify this.

So, basically when you do respond, despite the age, when it's a child or an adult the numbers are the same.

And we can kind of go into that here in a little bit.

So that you'e not so focused on what was right for the child, and how deep do I press, and what was the rate for the adult, and then the infant.

It does change a little bit for an infant, but remarkably it's not that much different to where you're not fearful to respond.

And that was the goal of that.

>>Lori Banks: So, should someone, if they come across a situation and think, oh my gosh, I'm not certified in this, I shouldn't do it at all.

>>Rachel Kelley: I would recommend that the very first thing you do is to call 911, and a dispatcher can actually walk you through the steps of hands-only CPR.

Hands-only would be for someone that you didn't know, for more or less a stranger.

But for family they would recommend that you go ahead and try to give breaths, just because you know that victim.

The hands-only is for folks that, you know, may be fearful to put their mouth on a stranger's mouth.

>>Lori Banks: When you're giving breaths to someone, are you adding oxygen into their blood system?

Is that what that does?

>>Rachel Kelley: Actually what happens is when you're delivering breaths, it goes into the trachea and it fills the lungs up.

And it's the mechanism for breathing.

So again, we have enough oxygen in our blood that if we circulate through compressions, and hopefully help will arrive in time, that hands-only is okay.

But giving breaths is also a good thing, as well.

So, but we do hold oxygen in our blood, and if we're circulating it appropriately in our compressions, we're in good shape.

>>Lori Banks: Alright, well we're going to talk about AED in a little bit because that's something new that has come on, that has saved even more lives.

Let's go through some basic CPR.

>>Rachel Kelley: Okay, so basically I have three different mannequins here.

I have an adult, a child, and an infant.

So, for CPR as I had alluded to, the compression rate is now 100 to 120 per minute.

So, it's a pretty fast compression rate.

>>Lori Banks: Alright, I'm going to move our juvenile over, and I'm going to put our adult right in the middle.

So, this is actually physically, this could be a lot of work.

>>Rachel Kelley: It is very physical.

And so, that's why it's always good that if you do have an extra set of hands or arms, we like to say, available, that is perfect because you will get worn out.

If we did actually roll through a whole minute, you would probably be breathing very heavily.

And we do prep our students and community folks for that physical activity.

So, because it is very physical, we always recommend that in the event that let's just say that you start to have chest pain during the event or not feeling well, we do say stop at that point.

Relax, rest.

But in addition to that also is because it is that fast, and if help isn't coming, you may have to pause again because if you're ineffective with compressions, you're not circulating it, you're not doing it the right way.

So, the numbers to all this are we have to compress two inches, at least two inches on a child, and at least two inches on an adult.

Now when I say two inches, it's going to be different for a child than it is for an adult.

So, it's about one-third of the depth on a child and one-third of the depth on an adult.

But again, the ratio or the amount that you press down is going to be a lot different.

So, it's better to compress a little deeper than not deep enough.

So, our mannequins are set up to have some noise with them, so that kind of gives a good cue to whether or not you're compressing deep enough.

So, if you're doing an adult and a child, two inches, 100 to 120 per minute.

And again, if you need to pause for breath, we can do that, as well.

But we'll go ahead and demonstrate a chest compression first.

So, do you want me to... >>Lori Banks: You go ahead.

>>Rachel Kelley: Okay, so basically you find your landmarks on the chest.

And it's the chest, and it's about the lower half of the chest bone.

Okay, so you place one hand, and then you cup it with your other hand.

And then you compress two inches.

Did you hear the click?

For students the nice thing about that is that when they hear the click, they do know that they're compressing at least two inches.

So, it's good for training so they know, you know, that they're going the appropriate depth.

So, if you would like to try that.

>>Lori Banks: Yes, I have taken CPR.

It's been a few years.

The one thing I do remember is the straight elbows and not this.

So, you use kind of your body weight to push down.

>>Rachel Kelley: Exactly, and the higher that you can get up above somebody.

A lot of victims will collapse on a floor.

>>Lori Banks: Yeah, we're kind of...

I'm on my tip-toes right now trying to, you know, get above the person.

>>Rachel Kelley: And you definitely want to do that.

>>Lori Banks: So, if you're doing 120 a minute, I want you to demonstrate how fast you're actually going.

>>Rachel Kelley: Okay, so I'll do a little demonstration of that.

So... [clicking sounds] >>Lori Banks: Oh, that is really fast.

>>Rachel Kelley: Yes, so the important part of a good compression also is that you don't completely keep the heart compressed by going too fast, because then you're not circulating anything.

So, it's kind of like a pump.

When you compress the chest, it kind of pulls the blood in, and then as you allow for what's called recoil, it pushes the blood out to the different organs.

So, you do have to allow for that recoil.

And it gets a little tricky, so we do spend a lot of time on demonstrating and practicing chest compressions in our courses.

>>Lori Banks: So, when you do this on a real person, do you break people's ribs?

I think that is like that number one fear, oh I don't want to press so hard... >>Rachel Kelley: There is the potential for doing that if you are doing two inches on an adult chest.

Kids and infants, their chests are a little more pliable, so they do have more give and they don't typically break.

But in the elderly, especially if they've had osteoporosis or anything like that, unfortunately you do see that.

So, we tell folks don't stop until we actually have them back.

And on the other side of it, we'll contend with the fact that we broke a rib during CPR when the paramedics get there.

>>Lori Banks: So, run us through the sequence.

We come upon the scene, and we'll just say we're at, you know, a park and someone's down, and they're a stranger.

What do you do?

>>Rachel Kelley: So, immediately, the American Heart Association says, when you see someone collapsed or you recognize that someone's in trouble, you're already thinking I may have to utilize these skills.

So, they want you to come up, "Hey, are you okay?"

Check for a pulse, which is a carotid pulse.

At the same time you're looking for chest rise and chest fall.

"Hey, I need help, give me an AED now," because otherwise people will stand and watch, and you may have to direct them.

And if you go ahead and start your compressions at that point, you can still yell, "Hey, give me an AED now," because a lot of people will get nervous about those steps.

But the big thing is if they're not responding... And let's say you're not sure if you feel a pulse, but they're not responding, and it may look like they're breathing but you're not really sure, do compressions.

Because, the minute that you compress the chest, it's a painful thing, if they don't need it they're going to let you know.

They will let you know, so err on the side of doing that, as opposed to not doing it.

>>Lori Banks: Okay, so then you just keep compressing?

Do you stop and check for a pulse at some point?

>>Rachel Kelley: So, that was old school.

We used to do "look, listen and feel" and "ABC."

And now that has all changed.

No more "look, listen and feel" because people were taking too long to determine whether or not someone was breathing.

So, basically within 10 seconds of noticing that someone collapses, you need to be doing your first chest compression, number one.

And then we changed it to something called "CAB," which is compressions, airway and breathing.

So, compressions have moved up, and they are the most important component of CPR now.

>>Lori Banks: Alright, so if this is a family member, someone you know, and you want to breathe into their mouth, what do you do?

>>Rachel Kelley: Or if you have a mask, because a lot of places now with the AED's have masks and things like that.

So, we'd now move into a ratio of what is 30 to two.

And usually if you have a second person, go five cycles of 30 to two, which is about a minute-and-a-half, and you're swapping off-- >>Lori Banks: So, that's 30 compressions to two breaths?

>>Rachel Kelley: To two breaths, yep.

And then you switch the person off, they do 30 to two until help arrives.

Now when an AED arrives, the timing for the five cycles changes just a little bit.

All AED's are set up on two-minute cycles.

So, really you just keep going until the person responds.

>>Lori Banks: Okay, so you've got some different apparatuses here for assisting in breathing.

Why don't we get those out?

>>Lori Banks: Okay, so when we teach healthcare providers, they use an Ambu bag for two or more rescuers.

So, I thought, you know, I'd go ahead and show you what an Ambu bag looked like.

And then a mask goes into this.

So, when you see the paramedics arrive, they will... And again, this will be in the hospital with two ore more.

So, if you've seen this, I just wanted to bring this so that you would recognize that this is for assistive breathing.

Now a person can have a pulse and we would still use this in a hospital to help their breathing.

>>Lori Banks: Alright, Rachel.

That's a scenario for if you're in the hospital.

What do you do if you're going to do breathing on a family member, and you're in your home?

>>Rachel Kelley: Okay, so if you have access to masks, most of the masks come with what's called a one-way valve.

And you blow into it, but no air comes back up through it from the victim.

So, a lot of masks that you'll pull out of AED's will look a little bit like this one, maybe a little different.

But there will be an apparatus attached to it.

What you do is you line that up with the nose of the victim, you lift their head and pull their head back pretty far, and then you blow until you see enough air to make that chest rise and fall.

And that's it.

>>Lori Banks: Okay, and these kind of have, it's sort of like a blow-up thing.

It's kind of cushiony, and it sort of forms a seal.

>>Rachel Kelley: Exactly, because everybody's face is a little bit different.

And the goal is for this to kind of mold around their nose and their mouth to keep that air in there.

Then also there, when you do mouth to mouth you'll squeeze their nose, lift, you put your mouth on their mouth.

And that is for an adult and a child.

You'll squeeze their nose and pull their head back.

>>Lori Banks: Okay, let's talk a little bit, I want to go back.

Chest compressions you said are basically the same for children and adults.

What about for an infant?

>>Rachel Kelley: So, for an infant, there's a couple things that are a little different for an infant.

So, to test an infant's responsiveness, to take it from the top, you pick up their feet.

Everybody knows that babies don't like their feet messed with, and adults too.

So nonetheless, when you do that, if the baby does not respond if you tap their feet, something's wrong with the baby.

The next thing with the baby because their necks are all chunky, you can't get up there to get the same kind of pulses you do for an adult and a child.

So, you check what's called a brachial pulse.

So, if you do feel something in an infant, the pulse has to be 60 or above.

If you are feeling something faint and slow, the baby does not have a pulse is what we say.

So, if you think you're feeling something, it's faint or not, then you move into the next step, which is look for breathing, chest rise, chest fall normal for a baby, "Hey, I need help, get me an AED."

Now for single response for a baby, if you're all by yourself, again it's 100 to 120 per minute for all three victims.

And it's a 30-compression to two-breath ratio.

So, you use your two fingers, and it's right below the nipple line of the baby.

And it's one-and-a-half inches.

>>Lori Banks: Okay, because their chest is much more flexible than an adults, and everything is tinier.

That's why you just use the two fingers.

>>Rachel Kelley: Exactly, and you do not have to compress as deep.

Again, it's one-third of the depth of their chest, and it's one-and-a-half inches, which isn't as deep.

And again, the deeper it is, the better because that's what's going to give you that nice pull in and that nice flow of blood.

But again, you have to allow for that recoil of that chest-- >>Lori Banks: Okay, and this I would imagine is even more scary when you're doing it on an infant.

>>Rachel Kelley: It is.

Emotions run high, adrenaline runs a little bit higher with those kinds of events.

>>Lori Banks: Okay, so we should cover real quick, choking is another one that uses some of the same concepts from CPR.

>>Rachel Kelley: Yes.

>>Lori Banks: Okay, so what do you do for choking?

>>Rachel Kelley: So, basically your victim's 100% alive, everybody eats, and then they find themselves choking.

If you've ever choked, you know what it feels like to try to get that out of your lungs.

Your lungs do not like anything in there.

And we've all felt that.

If someone is coughing and they're making noise, and they're able to talk, let their body work to get that out.

The minute that they're no longer responding with a sound, and they're using the universal sign, yeah, and they look panicked, then basically what needs to happen at that point is we need to rush very quickly to do the Heimlich and not hesitate.

>>Lori Banks: Okay, I'm going to get the adult here.

And I'll switch out the baby.

>>Rachel Kelley: So with that, if they're using the universal sign, we then are going to perform the Heimlich.

So, in order to do the Heimlich you're going to come up behind somebody, and it's going to look like a big bear hug.

So, we'll use him to kind of show.

So, we're going to come up behind and then find your landmarks.

So, with your landmark that's right about where the diaphragm is, so the soft area.

Okay, so you're going to put your fist there.

You're going to come up behind the victim, and you're going to put your other fist.

Okay, so one thing to keep in mind is you're going to, with force, pull this body's, person's body weight into you and up.

So, when I was teaching a class, the members of the class of paramedics about 15 years ago said, "Hey, you might want to mention the fact that you ought to have a good stance."

>>Lori Banks: Uh huh, like put one foot behind you a little bit so you're ready for that.

>>Rachel Kelley: Because you don't want the victim falling on top of you.

So again, it's in and up with force with that mechanism.

And then the other thing is there's recoil from the head.

So, if you like your face, you might want to throw it off to the side.

[laughing] So, once you do that, if the victim, if you're successful the food that's blocking the trachea, which is your windpipe, will fly out.

And then they'll take a nice gasp of breath.

In addition to that, there sometimes is vomit when you do this.

We call this celebration vomit.

[laughing] But then if they do, if it's not removed and suddenly they do collapse, we do put them on the floor and we perform CPR with one exception.

And then that is looking in the mouth to see if we can remove the... >>Lori Banks: Okay, what about, is it the same for a child?

Same process?

>>Rachel Kelley: Yes.

>>Lori Banks: Okay.

>>Rachel Kelley: Now it becomes different with the infant.

So, if you're able to hold a child in the manner that I'm about ready to show you, then this method is preferred.

So, the reason this is preferred is because you want to use gravity to remove that.

>>Lori Banks: Yeah, the baby is down, yeah.

>>Rachel Kelley: So, you use your two fingers, and they're a little bit up underneath that's the soft spot on the baby and the diaphragm.

And you five times with force, one, two, three, four, five.

Cup the baby's head and neck, flip them over.

Use the heel of your palm, one, two, three, four, five.

And a lot of people think that that's too tough, too rough.

I want you to keep in mind that the baby, or the adult or the child's airway is completely blocked.

And if we don't use some force to get this out, they're going to die.

So, we need to get that out of there.

So, there is some force.

Now we don't want to hurt the baby's neck, but we also, that's why we're supporting their heads and we're doing five.

You continue to do that until the food bolus comes out, or whatever they swallowed, or they go unresponsive and we do CPR.

>>Lori Banks: Alright, so we're running short on time.

We've only got about three minutes left.

I want to talk about AED.

That is something that has come onto the scene that has saved a lot of lives.

>>Rachel Kelley: So, your percentages go up 30 to 40% when an AED comes, so always yell for it because you never know where it might be.

The only thing you have to do for AED's is turn it on, because it will tell you everything else, up to and including anything that you're not doing right or something that's not connecting appropriately.

Now there are adult pads, and there are baby pads in some of them.

>>Lori Banks: It says right on the pads where to put them, so.

>>Rachel Kelley: There's pictures.

Baby pads will not work on an adult.

If you accidentally grab them to put them on the adult and you realize they're not the right size, grab the adult ones.

Now some AED's only have the adult ones.

So, and that's fine.

You can put those on the baby, front and back, alright?

So, what we'll do here is put these on the victim.

>>Lori Banks: And so, this is actually delivering a shock to the heart.

>>Rachel Kelley: This is an electrical shot, 360 joules.

So, when you do get this all hooked up, one of the most important things to remember with an AED, you follow the prompts because it's going to let you know what to do.

You need to clear your victim before you deliver a shock.

The AED will not deliver a shock on its own.

You have to clear your victim.

So, before you do that you say, "Clear."

Everybody clears because it is an electrical shock, and we don't want to harm anyone.

>>Lori Banks: Shock anyone else.

>>Rachel Kelley: Yeah, so one of the things with AED's, there is a misconception, is the fact that everybody thinks when you put one on, it's going to shock them.

And that's not necessarily the case.

The only thing that this is looking for is something called fibrillation.

And this is called an automated external defibrillator.

So, it's going to defibrillate a fibrillating heart.

So, the heart will be doing this.

There's some electrical activity, and it's going to wake it up and shock it.

Otherwise it's not going to shock or call for a shock.

So, if it's not calling for a shock, it doesn't mean-- >>Lori Banks: It won't let you, okay.

>>Rachel Kelley: Yeah, and you can't shock unless it's in that rhythm.

So, you plug in, you turn on your machine.

And he or she will begin talking to you.

>>AED Voice: Do not touch the patient.

>>Rachel Kelley: Because it doesn't want to pick up any false readings.

>>Lori Banks: Okay.

>>AED Voice: Shock advised.

Charging.

Stay clear of patient.

Deliver shock now.

>>Rachel Kelley: So, there's an orange button.

So, make sure you clear your victim first.

Say, "Clear."

>>Lori Banks: Okay, "Clear!"

>>AED Voice: Shock delivered.

Analyzing heart rhythm.

Do not touch the patient.

[no dialogue] Analyzing heart rhythm.

No shock advised.

>>Rachel Kelley: When it says, "No shock advised," you go right back into your compressions with the pads on.

And then the next two minutes it will say, "Stop, need to analyze."

We switch compressors and ventilations at that point, and then we just keep going until we can get advanced folks there to help out.

>>Lori Banks: So, now is there a law that says where these AED's are located in public buildings?

>>Rachel Kelley: They haven't defined exactly where they need to go, other than schools and healthcare places where people will be there to get help.

I think the push is to have them at ball diamonds, and churches, and senior citizens and those kinds of areas.

But there is no law indicating that those have to be in those locations just yet.

>>Lori Banks: Okay, but if you work in a place in that you know there is one, make sure you know where it's at, and everybody knows where it's located.

>>Rachel Kelley: Yeah, and a lot of people are getting them.

So, just yell for it.

You may be surprised at where one may come up.

And actually sheriffs and police officers are starting to carry these in their cars, or volunteer fire department.

So, out in the rural areas there's someone with these in their cars.

>>Lori Banks: Okay.

Rachel, this has gone so fast and we've learned a lot.

And it sounds like the process has been simplified.

And you know, you never know when you may come across an emergency situation where you could actually save someone's life.

>>Rachel Kelley: Yes, absolutely.

>>Lori Banks: Thank you for coming on Being Well.

And thank you for joining us, and we'll see you next time.

Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

HSHS St. Anthony'’’s Memorial Hospital, delivering health care close to home.

From advanced surgical techniques and testing, to convenient care for your family.

HSHS St. Anthony?s makes a difference each and every day.

St. Anthony'’’s.

Where you come first.

[no dialogue] [music plays]