On to part two!:
4) INTERRUPTIONS IN CPR SHOULD BE MINIMAL, AND SWITCH PROVIDERS EVERY 2 MINUTES!
When a patient has no pulse, and no one is pushing on the chest, brain cells are dying. It is as simple as that. ALL interruptions in CPR should be 10 seconds or less.
When the CPR compressor gets tired, there is a tendency to be ‘lazy’ and not allow complete chest recoil. Doing compressions is hard work, and studies show a noticeable decline in CPR quality within a minute or two. The person doing CPR generally does not notice this decline, so it is important to switch out every two minutes (or 5 cycles of 30 compressions and 2 breaths)
5) AVOID HYPERVENTILATION!
Giving breaths too fast and too forcefully forces air down the esophagus and contributes to stomach inflation and regurgitation, making the job of CPR harder. This is the simple ‘book answer,’ and it is true. What is also important to know is that hyperventilation increases the amount of positive pressure in the chest. As discussed previously, in order for CPR to be effective, there needs to be negative pressure (a vacuum) in the chest when allowing chest recoil in order to bring blood back into the heart. Hyperventilation creates positive pressure in the chest ALL the TIME, decreasing venous return and rendering CPR less effective. My personal opinion is that this is the single biggest thing that Healthcare Providers do on a regular basis that contributes to poor outcomes! The patient is getting at best 30 percent of their normal cardiac output during CPR, they do not need extra air in the chest. (They can’t use it!) Just enough to see the chest rise is enough air in the lungs. Hyperventilation is a classic example of too much of a good thing.
6) EARLY DEFIBRILLATION!
Generally, the earlier the defibrillation attempt, the better the chances are of achieving ROSC. CPR buys time by preserving vital organs until a defibrillation attempt, but usually a patient needs defibrillation to recover.