Literal heartbreak
And why you need to learn CPR.
“Starting CPR!” I yelled, jumping up onto Mr. X’s bed as my colleague Alice put out the crash call.
I placed my palms on his sternum, arms out straight, and started compressions, using my bodyweight to push his sternum down in time to this ridiculous song in my head.
Crack went a rib. No time to think about it.
The 2222 call went out, my pager bleeping in time with that of every other member of the cardiac arrest team in the hospital.
“Adult cardiac arrest, ward 4. I repeat, adult cardiac arrest, ward 4.”
A flood of highly trained nurses entered the room, crash trolley in tow.
“I’ll put the pads on while you carry on with CPR!” a nurse said, beads of sweat on his forehead.
The pads were applied as I continued to huff and puff. The medical registrar (aka med reg) was still not here, and neither was the anaesthetist.
The pads were on.
“I’m going to step back in a moment and we’ll analyse the cardiac rhythm”, I panted in between compressions. I could feel the broken rib moving under my hands, an unpleasant feeling.
“Three, two, one.”
I stepped back as the defibrillator analysed the cardiac rhythm and a nurse stepped in to take over compressions.
“Shockable rhythm, everyone stand clear!” I said, looking at the wave pattern on the defib as I pressed the Charge button. This would power up an electric shock that I hoped would Frankenstein the patient to life.
I quickly glanced at the head of the bed. There was another nurse on airway, the mask she had been using to deliver held well away from the patient. Good. I didn’t want to go out in a fireball.
There was nobody else touching the patient either, the nurse next on compressions standing away, the rest of the team standing back too with their hands up to show they were clear.
“Clear!” I said, delivering the 150 Joule shock.
Nothing happened. The ECG remained a chaotic squiggle of doom on the screen.
“Back on the chest!” I said.
In medical school, we were taught to use the ABCs for every sick patient. It stood for Airway, Breathing, Circulation, Disability, and Exposure/Everything else. My version of the ABCDs for the cardiac arrest was a little different.
A is always for Airway. The anaesthetist helpfully chose that moment to stride in, displacing the nurse at the head of the bed. He had his fancy gear out and ready, the calm eye of the CPR storm.
Compressions were now happening at the usual ratio, 30 compressions then a pause to deliver 2 breaths, ensuring chest adequate chest rise with each breath.
B is for bloods and intravenous access via a cannula. I pointed at another F1 who had entered, easily recognisable by the colour of his lanyard and the uncertain look on his face.
“Happy to get a cannula in and take bloods, Chris?”
“Of course”, he said, the uncertainty gone. As the junior-most member of the team and having just come out of med school, this is what he would have been getting tons of experience in on the wards.
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In a cardiac arrest situation, always try and allocate jobs to people who know how to do them best.
C is for compressions. High quality compressions are the most important thing by far in most arrests and it is important to have at least two people taking turns to do this, preferably more. The team was highly trained and there were three volunteers lined up. Good.
D is for defib and drugs. Alice was competently womanning the defib. We needed an allocated person for drugs. I pointed to Andrew.
“Happy to administer drugs?” I asked.
“Aye”, he replied, “I’ve already got adrenaline prepped.”
Good man.
It’s essential to have a named person for every job on an arrest. Usually we’d meet in the morning and have a huddle, allocating specific jobs to every person on the cardiac arrest team, but in this hospital that did not always happen.
S is for Scribe. Timekeeping is essential for an arrest. You need to know when to pause for rhythm and pulse checks, drug timings and dosages, and so on.
“20 seconds to rhythm check.” Matron was on it like a bonnet.
We paused for a few seconds to check the rhythm. Still bad, still shockable.
“Back on the chest and let’s charge the defib ”, I said.
The anaesthetist had intubated (aka shoved a massive straw-like tube down the throat) so it was safe to keep the oxygen going.
The defibrillator charged and the compressions continued.
“Over to you Alice.”
“Charged, stand clear!” she went.
We all stood back again, ensuring nobody was touching Mr. X.
Alice pressed the button. 150 Joules of pure energy slammed into the patient’s body, as his chest jerked off the bed.
And then, on the tiny screen on the defib, I could see the crest of the P wave, the narrow spike of the QRS complex, the slope of the T wave. Everything perfect and beautiful and synchronised.
“Normal rhythm! Has he got a pulse?”
The anaesthetist checked the carotid.
“Got a pulse!” he exclaimed, and we all heaved a sigh of relief.
X was not out of the danger zone yet, far from it. But at least he now had a fighting chance.
I idly wondered if he’d sue me over the broken rib, and smiled at the ridiculous thought. That would never happen. Wouldn’t it?
That sounded fun, didn’t it. A team of highly trained individuals with decades of experience between them coming together like a well-oiled machine to revive the dying patient. But it’s often much, much simpler to revive the patient in cardiorespiratory arrest. All it takes is one person with the right training at the right place at the right time.
Worrying data shows that less than 1 in 10 people in the UK survive an out-of-hospital cardiac arrest, due to low bystander CPR rates. In countries where CPR is taught in schools, as many as 1 in 4 survive.
We all know how important CPR is, yet most of us have never taken a class or received any training in this vital skill. If you haven’t already committed yourself to saving someone someday, now would be an excellent time! Take an hour out of your schedule today and check out life-saver.org.uk to join the 2 million+ people who have used it to learn basic life support.
Learn CPR, and let’s save lives together.
