Heart massage during CPR?

Question

I just went on a first aid course and after I was home I suddenly realised that at no point were we told to check for a pulse before commencing CPR (including heart massages).

I know it is a long time ago, but I was told when I was a Scout that if you did heart compressions on a beating heart it could stop it, so it should only be done on a stopped heart.

Has medical opinion changed or am I missing something? It seems odd that if someone is choking and you can't dislodge it you should start to massage their (possibly still beating normally) heart.

Anyone assist me?

They handed out a book which sets everything out step by step and there is never a mention of checking a pulse. And it clearly says that CPR should be started if they are not breathing, no mention of "and there heart has stopped".

And the man was a retired paramedic.

Answer 1

I am a current, certified CPR instructor for the Red Cross, and you are right- you DO NOT check a pulse on an adult who is not breathing- you go straight to CPR.

This is as of June 2006, as per new national guidelines, and most of the other certification programs teach it this way now.

Here is the deal:
- 70% of people in the field mess up the pulse (professionals included). When you realize that the 'field' is messy, noisy, stressful, etc., it makes sense.
- About 85% of adults who stop breathing are having a heart emergency (we still teach taking a pulse on infants and children, who usually have breathing emergencies.)
- In a CPR emergency, the thing we want, the primary goal, is a steady flow of oxygenated blood in the brain. We want to interrupt this as rarely as possible and get it going as quickly as possible.

Without going over the entire process again, once you have checked for breathing for 10 seconds, you would give two rescue breaths, do a quick scan for bleeding, then begin CPR.

You remember things right, but when I teach class, I always explain why this happens just to avoid this situation.

(Oh, and a lot of posters here obviously need to retake CPR!)

Answer 2

I did a first aid course two weks ago ...we were told exactly as you were .....that point was raised and the latest uptodate research is to assess whether the casulaty is breathing ...if not start cpr including heart massage ...without checking for pulse etc .....infact for an adult the rules are now to give 30 heart massages then two rescue breaths .November 2005, the UK Resuscitation Council published its revised guidelines on First Aid protocols. These changes are based on the new European Resuscitation Council
guidelines.....http://www.resus.org.uk/pages/guide.htm

see also st johns website

http://www.sja.org.uk/sja/first-aid-advice/life-saving-procedures/cpr/cpr-for-adults.aspx

Answer 3

You must ALWAYS check for a pulse, Remember A.B.C. never start chest compressions if there is a pulse as you can cause damage to the heart. The heart doesn't stop by the way it just goes into an irregular rhythm, the defibrillator stops the heart and then hopefully the heart starts up again in it's proper rhythm

Answer 4

Your first check is the artery at the neck for a pulse. This is the point at which the pulse is at it's best as it is the blood supply to the brain. If you have a pulse then there is really no need to do CPR. Next check is for breathing followed by a check for any obstruction to the breathing passages down the throat. This will include false teeth, bits of food, medication tablets etc.

Answer 5

new guidelines state that only if in a clinical situation do you check 4 a pulse as classed as time wasting. you need to give continuous chest compressions with the head tilted and chin lifted as evidence suggests that air is taken into the lungs when compressing the chest. so no need for mouth to mouth

Answer 6

Either you had a lame instructor or just missed it-I have been certified in BLS for over 30 years and they have not changed that part.