CPR for Choking and Drowning

• Annie, Annie, are you OK?
• You call 911.
• You get the automated external defibrillator (AED).

If you have taken a cardiopulmonary resuscitation (CPR) and First Aid course, and you know how to perform it on an adult, child or infant, the script is familiar. If somebody is found unconscious or otherwise injured, a rescuer goes to their side and assesses whether they are breathing and have a heartbeat, or if there is an object blocking the airway. If other people are around, point to them, and assign them two potentially life saving tasks:

1. get medical help, and
2. find an automatic external defibrillator (AED) that may be able to shock a heart into beating.

If you have taken a CPR course, you recognize "Resuscitation Annie," the practice manikin, who spends the class helping people learn chest compressions and mouth-to-mouth resuscitation. The instructor positions your hands on the chest wall to get good blood circulation when you press down on the chest wall. Use the wrong hand placement, and maybe ribs get broken or internal organs like the liver or spleen get damaged. While the complications are important, remember that you're doing a good deed.

You finish the CPR training and get a wallet card saying that you're certified to perform it. You tuck it away hoping that you never have to use the skills on family or friends. But do you secretly wonder if you could rescue someone as you walk down the street? Could you rush to the side of the fallen pedestrian and say the lines..."Annie, Annie are you OK?"

Some people can, while others freeze. And it's understandable if you can't act when a medical emergency occurs. The training may give you the technical ability to do CPR, but there is a huge emotional side that comes with the words..."Annie, Annie, are you OK?"

People want to step forward and help but sometimes are frozen by fear:

• Is the person really unconscious?
• What happens if I start to do something on an awake person?
• What if I perform the CPR wrong? Will I cause damage and injure the victim if I administer CPR?
• If I do mouth to mouth resuscitation, will I get sick?
• Is the person really choking? Do they need abdominal thrusts to remove an object from the airway?
• How do I know if I am doing the right thing?

This same emotion exists in medical personnel as well. If they don't routinely care for victims who collapse, doctors, nurses, and aides may "freeze" in an emergency situation. Even EMS technicians and other medical folk can't act instinctively if they don't routinely care for medical crises. Skills training does not translate into action training, and the CPR card in your wallet has not given you the skills to cope with your emotions during a frightening situation. In your lifetime, you may never see a person in the midst of a medical emergency, when you are the only person around to help.

So what is the reality?

• A person collapses, unresponsive, on the sidewalk; there is no breathing, there is no heart beat or pulse. This person is dead. Can you make them any worse?
• You go their aid, check for breathing, check for bleeding, feel for the sign of a pulse.
• "Annie, Annie...are you OK?"
• You start chest compressions. You attempt to do them the right way.
• Are my hands in the right place? Am I pushing hard enough? Fast enough? (By the way, newer recommendations suggest you don't have to worry about the breathing part of CPR, just the chest compressions.)
• Do I need to remove any obstruction blocking the airway to their lungs?
• Does the person need abdominal thrusts to clear their airway?

The fact is, you're doing fine. The reality is that the victim was dead when you started. You are trying to cheat death with your actions. You may or may not succeed, but you are giving the victim a chance that he didn't have had you not been around. What if the person had collapsed sitting in his car. Who would notice? What if the person was home alone watching a movie? Who would say..."Annie, Annie are you OK?"

You should be congratulated for taking the CPR or First Aid Course, the first step in saving a life. You have joined thousands of people who understand that we are our brothers' keepers. While you may freeze for a few moments, if nobody else is there to help, it is likely you will take that second step. "Annie, Annie...are you OK?"