The “Golden 4 Minutes” That Save Lives

Author: Li Jibo, Associate Chief Physician, Shenzhen Hospital of University of Chinese Academy of Sciences (Guangming)

Reviewer: Feng Yongwen, Chief Physician, Shenzhen Second People's Hospital

There are about 500,000 people suffering from cardiac and respiratory arrest in my country every year, 80% of which occur at home or in public places. If the patient can be rescued correctly within the effective rescue time, precious rescue time can be gained for him.

Ten seconds after cardiac arrest, the patient loses consciousness and suddenly falls to the ground. After 60 seconds, spontaneous breathing gradually stops. After 4 minutes, brain cells begin to suffer irreversible damage. For patients with cardiac arrest, if cardiopulmonary resuscitation can be performed within 4 minutes, half of the patients may be successfully revived, which is called the "golden 4 minutes."

The relationship between the success rate of cardiopulmonary resuscitation and time is shown in the figure below.

Figure 1 Copyright image, no permission to reprint

For patients with cardiac arrest, the survival rate decreases by 10% for every minute of delay in rescue. Therefore, we must seize the 4 golden minutes of emergency treatment and race against time to save the patient's life!

Steps and key points of cardiopulmonary resuscitation:

1. Assess your surroundings

Before rescuing a patient, you must first assess the surrounding environment and ensure your own safety; then transfer the patient to a safe and easy-to-rescue location and place the patient on a relatively hard surface.

2. Judge consciousness and breathing

**Judge consciousness: ** Pat the patient's shoulders with both hands and call into both ears in turn: "Hey! What's wrong with you?" Observe whether he responds. The judgment time should not exceed 10 seconds.

**Judge breathing: **Observe whether the patient's chest rises and falls. The judgment time should not exceed 10 seconds.

Checking the carotid artery pulse : This is limited to medical personnel. Non-professionals can directly start chest compressions on the premise of unconsciousness and breathing, and the judgment time should not exceed 10 seconds.

3. Call for help

Before performing cardiopulmonary resuscitation on the patient, don't forget to ask people around you to quickly call 120 emergency number.

4. Chest compression, airway opening, and ventilation

Chest compressions should be started first, followed by airway opening and rescue breathing (CAB) to reduce the time delay to the first compression.

C - Chest compressions

Patient position: supine position, lying on a hard bed or on the floor, remove all objects from under the head and body, and undress.

Normal position: the intersection of the midline of the sternum and the line connecting the two nipples.

Key points: Place the base of one palm on the pressing area, overlap the base of the other palm, interlock the fingers, raise the fingertips without touching the chest wall, and keep the shoulder, elbow and wrist joints perpendicular to the ground.

Compression rate and depth: It is recommended that rescuers perform chest compressions at a rate of 100 to 120 times per minute; the chest compression depth for adults is at least 5 cm, and should not exceed 6 cm; ensure that the chest cavity fully recoils after each compression, minimize compression interruptions and avoid excessive ventilation; the ratio of chest compressions to artificial respiration is 30:2.

Figure 2 Copyright image, no permission to reprint

A - Open airway

First, tilt the head to one side, remove oral and nasal secretions or dentures; use the forehead-pressing and chin-lifting method, place the base of one hand on the patient's forehead, push the palm backward, and use the index and middle fingers of the other hand to hold the chin and lift it up, so that the line connecting the tip of the chin and the earlobe is perpendicular to the ground. If there is a neck injury, use the two-handed jaw-lifting method to open the airway.

B——Artificial ventilation

Mouth-to-mouth artificial ventilation is used outside the hospital: pinch the patient's nostrils, completely cover the patient's mouth after natural inhalation, blow air into the patient's lungs, and lift the patient's chest; after blowing, release the fingers that pinch the patient's nostrils, and see his chest rebound.

Note: International cardiopulmonary resuscitation guidelines suggest that if the rescuer is unable or unwilling to perform mouth-to-mouth artificial respiration, he or she does not have to do it, but chest compressions must be continued because chest compressions are more important than artificial respiration.

The ratio of chest compressions to artificial respirations is 30:2, that is, 30 chest compressions and 2 artificial respirations are one group; after 5 groups, determine whether the resuscitation is effective (observe whether there is breathing). As soon as the defibrillator arrives at the scene, the heart rhythm should be checked immediately. If the heart rhythm is defibrillable, it should be defibrillated immediately.

5. Electric Defibrillation

This mainly refers to AED (Automated External Defibrillator) defibrillation. 80% of cardiac arrest patients will experience ventricular fibrillation (VF). If a defibrillator is used for defibrillation, VF can be eliminated and sinus rhythm can be restored; early electric defibrillation can play a key role in the patient's resuscitation.

AED has four simple steps to operate, and everyone can be a life-saving hero!

Step 1: Turn on the power.

Step 2: Attach the electrodes.

Step 3: Analyze the heart rhythm (the patient should not be touched or moved at this time).

Step 4: Electric shock (if the machine indicates that electric shock is needed).

For adults, one electrode is placed on the 2nd to 4th intercostal space on the right side of the patient's midclavicular line, and the other is placed on the intersection of the 4th to 5th intercostal space and the midaxillary line outside the left nipple.

For children under 8 years of age or weighing less than 25 kg, one electrode is placed at the level of the 3rd to 4th intercostal space on the left side of the sternum, and the other is placed on the back in the subscapular area.

After defibrillation is completed, continue cardiopulmonary resuscitation immediately.

Figure 3 Copyright image, no permission to reprint

If the injured person starts to respond and can speak, blink or move his limbs, etc., the ambulance will transfer the patient to the nearest hospital for further examination and treatment.