How to tell
1. Person unconscious.
2. Person looks pale or blue-grey.
3. The pupils of the eyes (the back part in the centre) are very large.
4. No puise over the carotid artery (left in the groove at the side of the Adam’s apple).
5. No heartbeat heard on applying your ear to the left side of the breast bone.
What to do
1. Lie the person on his back on a hard surface. If on a bed, quickly but carefully lift him on to the floor.
2. Give one sharp, hard blow with the side of the hand over the lower left side of the breastbone. This may ‘shock’ the heart into re-starting spontaneously. Send someone else for an ambulance or doctor while you :
3. Start cardiac massage — but only if you are sure the heart is not beating.
4. Kneel on the person’s right side facing him.
5. Put the heel ot one hand over the lower half of the breastbone (not on its lower end). The rest of your hand should not exert pressure on the chest at all.
6. Place the heel of the other hand on the back of the first hand.
7. Keep your arms straight and rock backwards and forwards. Do not apply pressure by bending your arms or you will be exhausted within no time — let your body weight do the work. Keep your hands in position all the time.
In adults : Depress the chest wall about 5 cm (2 in), 60 times per minute.
In children : Use one hand only at 80 times per minute. In babies : Use two fingers only at 100 times per minute and press higher up the breastbone so as not to damage the liver which is large and easily ruptured.
How long to continue
1. Until the person looks a better colour.
2. Until his pupils reduce to normal size.
3. Until the neck pulse returns or he starts to recover.
If any of these signs is apparent, stop and check for the heartbeat or pulse.
If you are alone
1. Inflate the lungs quickly twice.
2. Do 15 heart compressions (as detailed above).
Repeat this circuit time after time while someone goes for help or an ambulance.
Do not go on compressing the chest of someone whose pulse has returned. Although breathing may stop on its own, the heart stopping also causes breathing to fail. So with someone whose heart has stopped you have a double problem.
When another person arrives
One person should do mouth to mouth resuscitation (the kiss of life) while the other does cardiac massage.
Keep the sequence as follows :
You breathe one breath — he does five heart compressions — you do one breath — he does five heart compres¬sions and so on until successful or until professional help arrives. The person doing the breathing part should also check the neck pulse.
Why heart massage works
Contary to popular belief, the heart lies almost centrally in the chest and not under the left nipple. If the breastbone is depressed sufficiently (about 5 cm (2 in) in an adult) the heart will be physically compressed between the breastbone in front and the spine behind. This is not the way the heart normally performs but is a useful first aid procedure. This is why when you do cardiac massage you must only press in the centre of the chest, over the breastbone. If you press over the ribs you may break them but worst of all you would not be doing anything useful to the heart so the whole thing will be a waste of time.