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Guidelines For Performing CPR


In this KERA Health Checkup, a refresher course on cardiopulmonary resuscitation or CPR. Two years ago, guidelines for the procedure changed to put emphasis on chest compressions. Doreen Riccelli of Lake Pointe Medical Center in Rowlett explains.

Riccelli: Well, they did some evidence-based practice studies; American Heart Association is really big on that. They want to make sure that CPR increases the chances of survival. So they see what works and what doesn’t.

Baker: So we have actually seen that borne out in terms of survival rate since then?

Riccelli: They found out that the people they did compressions on first really had a better survival rate than the ones that we did the two breaths in the beginning.

Baker: So exactly now, what are the steps for CPR?

Riccelli: The American Heart Association switched the ABCs to CAB.

Baker: So ABC meaning?

Riccelli: Airway, breathing and circulation. And we switched that around because we found out circulation was much more important, so now we do circulation, airway and then breathing.

Baker: What is the procedure for doing that?

Riccelli: You don’t even have to check a pulse. The layperson can just see someone, they look like they need help, they’re not breathing automatically. Just put the heel of your hand right between the nipple line on the person and start pushing as hard and fast as you can. Because you’ve got to push hard, you’ve got to push fast. Ain’t no time to stop, you just have to keep going.

I know you said do it as hard as you can, as fast as you can. Is there any sort of rate, rhythm or whatever that you should try to follow when doing that?

If you can remember this song, if I can say it on the radio, it’s called ‘Stayin’ Alive.’ Bum, bum, bum, bum --

Baker: The Bee Gees song.

Riccelli: Push those hands just pushin’ em down, pushin’ em down. If you can go that fast, very hard, then you’re gonna do good. You want to push at least with 100 pounds of your own pressure, that’s over half of most people’s bodies, they’re pushing down on that chest. That’s a lot of work.

Baker: Are there concerns about what damage you might do to the ribcage?

Riccelli: It’s very common for the ribs to actually break during CPR. Sometimes people might have weak bones, and that’s not because you’re doing it wrong. It’s just because they have issues with their bones. Bones will heal. They’ll heal in six weeks. Your heart won’t heal if you let it stop. So we don’t want that heart to ever stop beating, that’s why we want to push on it all the time. If that person doesn’t come around, you need to go ahead and pick up the phone and dial 911 and get some help. Go right back to chest compression until the ambulance comes.

Baker: Should you attempt the airway portion of the procedure if you have not had training?

Riccelli: You’re doing CPR to the best of your ability. So if you feel like you want to give some breaths, go ahead and try it. It’s not going to hurt. The compressions are the most important thing.

The Good Samaritan law will help you as well. That means if you do CPR to the best of your ability, you don’t even have to do it correctly. We said to the best of your ability. You can’t be sued. You’re doing the best job you could, and the layperson should want to help that person.

Baker: One possible upside to the change in the guidelines is that it will make people feel more comfortable about doing CPR. But you don’t actually have to train with the dummy beforehand.

Riccelli: Right. It’s always best to do that. So if you really want to learn CPR, you can. But if you haven’t learned it yet, or if you’ve learned it and you just feel uncomfortable with it, if you don’t feel comfortable breathing, at least just start those compressions. We have seen survival rate increase with just compressions, so we ask that you at least try the compressions.

If that person doesn’t come around, you need to go ahead and pick up your phone and dial 911 and get some help. Go right back to chest compression until the ambulance comes. 

Doreen Riccelli is a critical care nurse and Director of Staff Development and Education at Lake Pointe Medical Center in Rowlett.

Doreen's Rap Video on CPR Instruction:

BJ Austin's CPR Instruction Video

For more information: CPR Page

Web MD CPR Guidelines