CPR Guidelines

To say there is some confusion among authors as to what constitutes lifesaving measures really should not be a surprise. After all, most people not involved in medicine can have a difficult time with the concept.

Lifesaving measures is a broad term. It can be used to describe any futile care to a patient that is likely not to live. However, often times these same lifesaving measures are really a bridge to get a patient through a critical illness that they can fully recover from and still lead a long life but will certainly die if they are withheld.

What you should do is examine each of these areas and think through the possibilities of what situations you would be okay receiving these and which you wouldn’t and make that decision clear to your family.

So– what are some of these lifesaving measures.

1. CPR: This is chest compressions. Generally, when people are a DNR (Do Not Resusitate), this is its basic definition. If your heart stops and you’re a DNR– we won’t do compressions. You can delineate this further by also saying I don’t want drugs or electricity. Some patients are fine getting the medications but they don’t want their chest to be pounded on. However, CPR is the one mechanism that will MOST LIKELY bring you back in conjunction with these other therapies.

2. A ventilator: This is a breathing machine where a tube is inserted into your mouth, through your vocal cords, and into your trachea to assist with breathing. Being on a ventilator is hard. It is not anything like the natural way we breathe. A patient can say– I don’t want to be intubated. However, this can also be short term. Say a healthy, young male has a severe pneumonia. He’s just not able to maintain his oxygen levels and his breathing worsens. In most circumstances– as a nurse– I would not expect the patient to die but he NEEDS that breathing machine to buy him some time for the antibiotics to kick in…etc.

3. Vasopressors: These are drugs that help support blood pressure. Many shock states will cause lower blood pressure which is bad. You need normal blood pressure to heal. This is another area that might be short-term to buy the patient the time they need to get better.

4. Nutrition: I’m going to lump this all into one category. It can include everything from IV fluids, to TPN (which is IV nutrition) to a feeding tube. If this is withheld, what you die from is dehydration and starvation. This is what the Terry Schiavo case centered on. Some people believe withholding food and fluid is unethical as it is a basic requirement to live. How about you?

5. Oxygen: You can get oxygen many ways without being on a ventilator. Through nasal prongs, through a mask, and sometimes via a machine called CPAP or BiPAP. Again, this may be a short term measure to help a patient through an illness and most often is used for that very reason. But, if you take them of their oxygen– they will die.

Patients and families need to be well-educated in what these terms actually mean well before they are sick enough to be forced to make a decision during a crisis.

Lifesaving measures and End-of-Life Care are not really interchangeable. Have these conversations with your family now.

What about you? What would you want and not want? Under what kind of circumstance?

At some point in your novel, perhaps you’ll have a character that has a life-threatning event and will require CPR. If so, it’s important to know that there has been a big change in how CPR is delivered to victims from lay people all the way to the healthcare professional.

Why change? Every five years, the American Heart Association (AHA) examines available scientific study to determine if the current guidelines are the best way to resuscitate a patient who is not breathing and does not have a pulse. Over the last ten years, what’s been found, is that compressions are paramount to delivering residual oxygen loaded up on hemoglobin to the cells. The only way to do that is to keep the blood moving.

Another couple of components was the general discomfort among the lay public to initiate CPR, particularly mouth-to-mouth resuscitation. Also, several studies showed that people (including healthcare professionals) were not that great at determining whether or not the patient was breathing and/or had a pulse. Some people mistook agonal respirations (which are gasps of air when a patient is near-death) as breathing and thus would delay support of the patient.

In the new guidelines, there is a quick check for responsiveness. If not responsive and you’re alone, you should get an AED if one is available and call 911. Then return to the patient and attempt resuscitation by starting chest compressions. If you’re with someone then one stays with the patient to perform CPR and the other will get the AED if available and call 911.

The sequence goes as follow:
1. Check the patient for responsiveness and no breathing.
2. Call for help.
3. Check the pulse for no more than 10 seconds.
4. If no pulse, give 30 compressions.
5. Open the airway and give 2 breaths.
5. Resume compressions.

Consider these new AHA guidelines when writing scenes that involve resuscitating a patient. Another thing to keep in mind is that some fire departments are instituting protocols whereby the arriving EMT and/or paramedic will provide 200 compressions before delivering a shock as a way to “prime the pump”. This has been shown to increase the effectiveness of electrical defribillation. If you’re writing a location specific novel, check the local fire department to see what their protocol dictates.