Just go around savin' lives, resuscitatin' each other willy-nilly.

May 30, 2006 12:56 AM

Did you learn CPR before 1988? If so, did you they teach to to shake your resusci-Annie and say "Annie, Annie, are you okay?"

The first time I learned CPR in swim class in the 1990s, that's what we did. When I got retaught this year, we didn't use Annie's name--it was more of a shake and go "HEY! HEYYYYYY!" sort of thing. Also, the ratio of compressions to breaths had increased significantly. And the AED portion of the course was new. Since things were different between those decades, I was wondering if there were other changes before. Or is what is said to the mannequin too little of a detail to be mentioned in what AHA says must be taught in an official course, so that there's variations between instructors?

I've found out that the dummy's name was always Annie since her inception in the 1960, but was the procedure always to say "Annie, Annie, are you okay?"

full disclosure: I'm kinda asking because I've always wondered if the CPR phrase or the Smooth Criminal line came first.

posted by neda to grab bag (38 comments total)

It's quite possible that the "Annie" bit was unique to your instructors. I learned "Are you okay?" I doubt people were ever taught specifically to say "Annie," because frankly that doesn't make very much sense at all (and how weird would it be for bystanders?) I believe the AHA only mandates some sort of "shake and shout" step take place.

As far as the compressions/breaths, they tweak around with it almost from year to year. In the seven years I've been certified I think the ratios have been changed in one way or another three or four times.

For a while, the trend seemed to be toward a high number of compressions between breaths; I assume this was to prevent more fiddling with the airway than was necessary.

Then, at least according to one training video I saw, people in high stress situations started losing count in the middle of the 15 adult compressions, and they'd either start over or forget to stop, and the ratio would balloon out to 30 or 35 to 2, compressions to breaths. So they went back to a 5 to 1 for adults all the time.

Infant CPR's gone through some changes too, as far as airway clearing.
posted by Yelling At Nothing at 1:44 AM on May 30, 2006

Ca. 1983 we definitely did "Annie, Annie, are you okay." It was folllowed by sending someone for help, and then the procedure.
posted by sagwalla at 1:47 AM on May 30, 2006

Since I've learned CPR (just over 10 years ago now) we've used a 'Hello, hello, can you hear me' while shaking the shoulders (tap on the foot for baby) to assess casualty's response.

The protocols change all the time in line with new research, but more specifically aimed at getting the skills out to a wider audience. Since December last year the guidelines have changed to 30 compressions for every 2 breaths which will be put in practise by all the major organisations (red cross etc) throughout this year. The idea is to make it as easy to remember as possible for the general public who will most likely only have attended a two day first aid course, usually for work.

AED's should soon be as common as fire hydrants around the area as research has shown that early defibrillation ups the survival rate by a huge amount. The machines themselves are virtually foolproof as they will not administer a shock unless they detect a shockable heart rhythm and they provide clear voice instructions to the user.

The mannequin is known as resusci Anne, as she is named after the daughter of the man who invented it. His daughter drowned in a river or pond out the back of his house and no-one in the household at the time knew CPR.
The face is actually the death-mask of an unknown French girl from around the time of the revolution!

Can't say whether the song was written after a hectic day at a first aid course or not but hope the info is useful anyhoo!
posted by TwoWordReview at 2:31 AM on May 30, 2006

Last year we were taught the acronym "DR. ABC". You move through it and stop off on the path to CPR if any of the following are positive:

D= Danger? (is there still any danger to you as a first aider)
R= Response? (Can you hear me?)
[D+R= Call a doctor - not a check but a reminder.]
A=Airway - is it clear?
B=Breathing?
C=Circulation (where the preference now seems to be to get you to check the colour of the lower lip rather than look for a carotid pulse)

The Annie! Annie! bit would be part of "Response"
posted by rongorongo at 2:32 AM on May 30, 2006

Actually just read the snopes link there which obviously has the correct version of that story as opposed to my hazy second hand version!!
posted by TwoWordReview at 2:42 AM on May 30, 2006

In North Florida in 82 or 83 we said "Annie, Annie, are you ok". I was in middle school and I remember feeling supremely silly saying it.

My guess is they wanted us to use the victim's name if we knew it. I was in an emergency room once with someone who had lost consciousness, and the doctor made a point of saying the patient's name very loudly over and over as he tried to resuscitate. I could imagine it's the case that someone would respond better to her own name, even from an unconscious state, than to someone yelling "HEYYYYY!" but I don't know if there's any evidence for that.
posted by jay.jansheski at 2:42 AM on May 30, 2006

Good heavens... is that the origin of the line in the Michael Jackson song `Smooth Criminal'?
posted by tomble at 3:03 AM on May 30, 2006

On further review - of course it is!


So they came into the outway
It was sunday what a black day
Mouth to mouth resuscitation
Sounding heartbeats intimidations
Annie are you okay
So, Annie are you okay
Are you okay Annie
Annie are you okay
Annie are you okay
Are you okay Annie
Annie are you okay
So, Annie are you okay
Are you okay Annie
Annie are you okay
So, Annie are you okay
Are you okay Annie

posted by tomble at 3:05 AM on May 30, 2006

Phildelphia area, 1988ish. Absolutely. "Annie, Annie, are you okay?"
posted by filmgeek at 4:17 AM on May 30, 2006

The high ratio of compressions to breaths is to keep blood flowing to the brain.

The whole point of cpr is not to revive the unconscious victim (as most believe) and in fact, from a handy "ask the doctor" faq:

What chance does the person (on whom I perform CPR) have of surviving?

If you do CPR on a person whose heart has stopped beating there is a 30% chance the person will live if a defibrillator can arrive within several minutes to shock the heart.

CPR is designed to oxygenate the blood and keep it moving to prevent extensive damage while waiting for help to arrive. Ten minutes is a critical number for brain damage. If you stop every 15 compressions and then take a long time getting two breaths in, you haven't moved much blood.

(I know all of this because in Florida all dental offices must have an AED on the premises, and I am Red Cross CPR and Emergency First Aid certified. I have had occassion to use my certification. Though I am a dental office manager, I am moving and thus unemployed. End of Public Service Announcement.)
posted by bilabial at 4:20 AM on May 30, 2006

Absolutely, if you knew their name. We were taught to ask if anyone did know it. The theory was, the name would be more likely to get a response.
(EMT training, Midwest, circa 1977 or so.)
posted by unrepentanthippie at 4:34 AM on May 30, 2006

Oh yeah, we definitely did the "Annie, Annie are you okay?" thing when I learned CPR in middle school (1987, upstate New York). At the time, I couldn't decide which was worse: having to talk to a dummy, or having to put my mouth where the mouths of 20 of my classmates had been. I found it all quite traumatic at that tender age.
posted by purplemonkie at 4:48 AM on May 30, 2006

I don't think we used her name, I just remember saying "hey, heeeeeey" the same way you did. I learned in high school, 1986-ish, New England.
posted by jessamyn at 5:04 AM on May 30, 2006

We were taught, "Annie? Annie? Are you okay?" in junior high health class in Texas in 1990. I remember the instructor correcting us that we had to use her name. It was quite embarrassing at the time.
posted by unknowncommand at 5:07 AM on May 30, 2006

In actual fact the critical response time for commencing CPR is as low as 4 minutes, after that time the survival chances begin to drop off exponentially.

Also, the statistics tend to show that if you're trained in CPR and you ever have to use your skills, the likelihood is extremely high that you already know the person you'll have to perform it on, as scary as that may seem. So it does make sense to use their name when checking for response. If you have done training in the past, please make sure you get refresher courses as the skills do diminish with time. I teach lifesaving classes and have seen big drops in skill levels after only a few months without training, so it is important to keep in practise.

For what it's worth, the two places in the world to be to have a heart attack are Las Vegas and Seattle. Las Vegas Casinos tend to have on-site doctors and AED's all over the place and the Seattle school system (or is it the whole state of Washington?) I believe has CPR training as part of the school curriculum, so the highest survival rates for heart attack in the world are these two cities.
posted by TwoWordReview at 5:39 AM on May 30, 2006

I was taught to say "Annie, Annie..." with the understanding that I should substitute the actual victim's name should an emergency occur. I don't know if every instructor has the same protocol, but I had at least one that did. That would have been southern Ontario in the late 80's.
posted by GuyZero at 5:50 AM on May 30, 2006

I was taught to use "Annie" in CPR class. I made a YTMND about this months ago. It sucked.
posted by sourwookie at 5:56 AM on May 30, 2006

Virginia 1980 -- the first line was definitely "Annie Annie are you okay?" We got a lot of laughs out of it.
posted by JanetLand at 6:18 AM on May 30, 2006

I took CPR in middle school, right around 1990/91, and again a few years later. Both times it was:

"Are you OK? Are you OK?" (point at an onlooker) "You! In the Green shirt! Quick, call the EMS!"

Which we thought was funny, because there was never anyone in a green shirt around and none of us knew what EMS meant or how to call it.
posted by croutonsupafreak at 6:57 AM on May 30, 2006

We were instead told to say, "Help me Obi-Wan, you're my only hope." Seemed to make sense at the time, but that's back when I was a wookie.

But seriously, I took the course in high school in early 90s and we never had this demand made to us.
posted by umlaut at 7:03 AM on May 30, 2006

New Jersey, 1980, Annie Annie are you OK.

Things that have changed since then include the compression ratios, the jaw lift instead of hand under the neck, protocol for two person CPR, etc.

FYI - Annie was not modeled after the creator's deceased daughter (at least according to Snopes).

This girl's name is Annie
She lives in a box
She has a plastic fanny
But wears no little socks

Annie's feeling frisky
She goes for a jog
Something's just not right now
'Cause she's lying like a log!
posted by plinth at 7:14 AM on May 30, 2006

We were taught that shaking the victim was a really bad idea, because if they had a broken back or neck that guaranteed paralysis.
posted by Steven C. Den Beste at 7:27 AM on May 30, 2006

Another "Annie, Annie..." here -- Michigan, circa 1986.
posted by pardonyou? at 7:35 AM on May 30, 2006

If you suspect a casualty to have a broken back or neck then it is best not to shake them alright. This should be ascertained from the mechanism of injury, how the accident or injury happened. If there is signs of trauma or witness accounts that might imply a fall from a height (eg off a ladder) then you may suspect spinal injury and take extra care not to move them unnecessarily. Slow controlled movements are permissable but still undesirable.

However your priority in this case is still DR. ABC as mentioned above, but if there is a spare person they should hold the head and maintain neutral alignment with the neck and back and ensure there is no unnecessary movement.

Ensure the scene is safe beforehand and establish whether or not the casualty is responsive.
Establish an airway, in this case do not tilt the head back like you would normally but rather push the jaw forward and if necessary tilt the head back in tiny increments until an airway is established.

After that the sequence is basically the same. If the casualty does require cpr then really there's no way to give compressions without risking further damage. Even with the casualty on a spine board there is still a high risk but unfortunately unavoidable.
posted by TwoWordReview at 8:28 AM on May 30, 2006

Definitely "Annie, Annie, are you okay?" Red Cross, Massachusetts, 1992, 1993, 1994, 1995, 1996, 1997 maybe 1998. (We were taught to use the person's real name if we knew it, or not use the name at all if we didn't. But in class, she was Annie.)

We learned that the whole CPR doll concept came about because some girl named Annie drowned, and her family created the program. Or something like that.
posted by Amizu at 9:06 AM on May 30, 2006

The high ratio of compressions to breaths is to keep blood flowing to the brain.

Bilabial, that's a myth. If you've ever performed CPR on a person who has arterial and central venous pressure transducers, you can see that the arterial pressure fluctuates much as it would if a heart is beating. If you're vigorous the peak of the pressure tracing can reach 200 mmHg.

The venous tracing mirrors it exactly, and the pressure reading is exactly the same. Result: no, or very little net blood movement.

A recent review commission concluded that compressions are effective to empty the lungs of the air that rescue breathing blew into them, and that that accounted for their beneficial effect.
posted by ikkyu2 at 9:24 AM on May 30, 2006

So there is no blood going to the brain? Why does the Red Cross still insist that this is the reason? What good does it do to get the air out of the lungs if it's not nourishing the brain at 20% ish normal blood flow? Why are we doing CPR at all? Is it helping the heart? The lungs? I'm utterly confused. (Glad there's a doctor in the internet!)

[/threadjack]
posted by bilabial at 9:31 AM on May 30, 2006

Here's the link to Dr. Hanley's report (2005) on the new guidelines for CPR and defibrillation. The emphasis this time round is clearly on the community first respnders, getting the AED into widespread use, and also as mentioned minimising the interruption to chest compressions. This is due to the fact that interruptions reduce the chance of converting a heart in ventricular fibrillation to another rhythm (which is what the AED does)
posted by TwoWordReview at 9:51 AM on May 30, 2006

Sorry that's 'Handley', and he was a contributor to this report not the sole author, should really read these things properly before I link them!
posted by TwoWordReview at 9:56 AM on May 30, 2006

"Buddy, Buddy are you ok?"

CPR as part of a WFR course, 2006. saying the name was important, we got that stat about how we'd probably know their name.

I couldn't decide which was worse: having to talk to a dummy, or having to put my mouth where the mouths of 20 of my classmates had been.

you didn't use the pocket masks or face shields? what about when the patient pukes?
posted by eustatic at 10:15 AM on May 30, 2006

Rural Ohio, circa 1985: "Are you OK? Can you cough, speak or breathe?"

Maybe the reason she never responded was that we didn't call her by name...
posted by M.C. Lo-Carb! at 10:18 AM on May 30, 2006

Last one I promise (I have a damned thesis to write!), here's the important paragraph re: 30:2 compression ratio

There is insufficient evidence that any specific compressionventilation
ratio is associated with improved outcome in
patients with cardiac arrest. To increase the number of
compressions given, minimize interruptions of chest compressions,
and simplify instruction for teaching and skills
retention, a single compression-ventilation ratio of 30:2 for
the lone rescuer of an infant, child, or adult victim is
recommended. Initial steps of resuscitation may include (1)
opening the airway while verifying the need for resuscitation,
(2) giving 2 to 5 breaths when initiating resuscitation, and (3)
then providing compressions and ventilations using a
compression-ventilation ratio of 30:2.

I'm not a doctor (I just teach people to push up and down on the chest a lot when needed!) perhaps ikkyu2 can explain what's actually going on, but you are still attempting to replicate the normal workings of the lungs and the heart in getting oxygen to the body particularly the brain, while waiting for defibrillation!
posted by TwoWordReview at 10:24 AM on May 30, 2006

In the UK in the late '80s we were taught to say the person's name. No Annie, though. (And thanks for making that weird Smooth Criminal song make some soft of sense!)
posted by jack_mo at 10:28 AM on May 30, 2006

It is really weird to think about Michael Jackson learning CPR.
posted by unknowncommand at 10:52 AM on May 30, 2006

It's weird to think about Michael Jackson DOING CPR too!

Also, we learned it as "Hey $clever_name, you ok?"
Lots of people just refer to any generic CPR dummy as a "Resusci-Annie" (or some variant that includes "Annie") because it's a trademarked name. Kind of like folks that call a BVM an "Ambu-bag" all the time. Same thing, different name.
(EMT-B, 1994, Red Cross 2005, EMT-B 2006)
posted by drstein at 11:13 AM on May 30, 2006

you didn't use the pocket masks or face shields? what about when the patient pukes?

Nope, we weren't training as EMTs or anything -- it was just a requirement for a middle school health class -- so ol' "Annie, Annie" just got a couple of swipes with a cotton pad dipped in Scope and she was good to go. Thankfully the dummy we used did not come equipped with the optional RealPuke(tm) expansion kit.
posted by purplemonkie at 12:52 PM on May 30, 2006

I became certified as an EMT in 2000, and one tip they gave us for approaching someone lying on the ground for unknown reasons was to approach from the feet end and tap their foot with your own. I guess a few EMTs/medics had knelt down next to someone's head and gotten punched or worse when the sleeping or delirious victim had reacted to being surprised.
posted by oats at 6:30 PM on May 30, 2006

Bilabial: my gut feeling is just what ikkyu2 says, though I can't recall why: there is little, if any, blood flow to the brain. That said, a colleague of mine gave me an article that was published in Current Opinion in Critical Care this year (2006, 12:198-203), titled "Haemodynamics of Cardiac Arrest and Resuscitation" that's pretty fascinating. Here are the highlights:

1) During ventricular fibrillation without CPR, bloodflow continues for ~5 minutes until the pressure gradient between the aorta and right heart falls to zero (this occurs exponentially).
2) Chest compressions restore flow into the aorta.
3) Carotid blood flow takes over a minute to reach a plateau, and even brief interruptions in compressions can cause significant delay, requiring another minute or so to reach plateau levels.
4) The perfusion pressure during the release phase of compressions that allows blood flow into the vessels supplying the heart is a powerful predictor of the likelihood of recovery of spontaneous circulation.

That's from the abstract. There's a section in the paper entitled "How does CPR eject blood into the aorta?" In this part, they, well, I dunno. It's interesting:

Closed-chest CPR results in phasic blood flow. The mechanism(s) responsible for forward blood flow have been the subject of considerable debate...

More recently two studies employing trans-esophogeal echocardiography concluded that the mechanism of anterograde flow during CPR was consistent with the cardiac pump theory. This conclusion was based on the observations that the mitral valve closed during the compression phase and opened during the decompression phase and that the left- and right-ventricular cavity sizes fell during the compression phase.

The paper goes on to cite a small study showing that forward flow was achieved through a couple of other mechanisms.

The paper itself is based on animal models as well as the results of other studies. It's pretty fascinating stuff. If anyone ends up reading it, be sure to separate the results related to v. fib out.

Whether or not there's any flow that's actually of any use is debateable. It's not just enough to have flow, you've got to have enough of it, especially where the brain is concerned (this is where I defer to ikkyu2). This paper, apart from using animal models and mechanized compression-simulation devices, bases things on "optimum" CPR. What's optimum? Hell if I know. I have a hard time judging even the smoothest of codes as being optimal.
posted by herrdoktor at 7:19 PM on May 30, 2006