(Today's post is a guest post by longtime reader Matty P. If you would like to guest write for us, please check out our guest post guidelines. We look forward to publishing reader posts on future Thursdays.)
I hit him hard against the chest and met resistance. I hit him a second time, harder, directly against his sternum. Adrenaline is speeding my motions. I have to pace myself, find my timing, control my blows. A co-worker joins in my struggle, stabbing at the man's arm. Another person tries to strap him down so he can’t flail at us while we go about our brutal task. I continue to my attack and hear a crack. But I don't relent. I continue hard against his chest. I pause, allowing another co-worker to force something down our victim's throat. We all stand back as we electrocute him.
This goes on in cycles for several minutes. And if we've done everything perfectly, we've saved his life.
It's called a full arrest. Our patient's heart has stopped or doesn't have the ability to supply the body and brain with the blood they so desperately need. In order to correct the situation we assault the patient's body. It sounds like a back ally beating. Cardiopulmonary resuscitation is not a gentle process. Chest compressions require forcing the chest wall in a direction opposite of its normal direction of expansion. More often than not, ribs break. If done improperly a portion of the sternum can sever. Or the xiphoid process can detach and puncture an internal organ. More than that, the compressions have to be timed correctly with precise depth while simultaneously allowing for recoil so the heart can not only pump blood, but fill up with blood as well.
Meanwhile, paramedics must start an intravenous line to push medications that affect the heart. This requires an eighteen gauge or larger bore needle to ensure the vein doesn’t collapse. Medications are given that directly affect the body's normal physiology, forcing the heart to act the way we want, constricting blood vessels, and dilating the smooth muscle of the lungs. We intubate by placing a tube down the throat so we can supply oxygen directly to the lungs. With a bag, we provide positive pressure to the lungs to cause them to expand and fill with oxygen. Finally, we use controlled burst of electricity to affect the heart rhythm. Though it can benefit the normal electrical cascade, each shock infarcts muscle, killing a small portion of the heart.
Saving a life that is nearly gone requires vigorous and violent effort. Without an understanding of what is happening our actions seem barbaric and malicious. Such is the importance of context. Without it actions are purposeless. Violence is incomprehensible. Without context CPR seems like an assault. Similarly, without context, a war on terror is interpreted as a military invasion and occupation, or a suicide bombing is construed to be a man wanting to die while causing others to die. There is context to these actions and events that go missing. It’s important to understand and address the motivations and purposes of such actions in order to prevent further violence.