Texas OnSite First Aid Headlines

COMMON ERRORS IN FIRST AID BY  CITIZENS

Thu, 19 Jan 2012 08:30:16 -0600

 by Jay Wiseman, Emergency Medical Technician -  Ambulance  Copyright 1977 by Jay Wiseman

1. FAILURE TO  INITIATE RESUSCITATION. Rescue squads frequently arrive at an  emergency scene and find a victim in need of resuscitation surrounded  by a crowd of people doing nothing at all to help. Too much  time has elapsed. The "save" rate for victims who  have received _any_ sort of reasonable resuscitation before arrival  of rescue squads is much higher.

1. GROSSLY IMPROPER CPR.   This is, in many ways, even more frustrating. The person has  tried some sort of resuscitation attempt, but it is a very old  method, or it is too slow, or the compressions are too shallow.   It's heart-breaking to rush into a house and see quarter-inch deep  compressions in progress.

1. FAILURE TO ATTEMPT TO CONTROL  BLEEDING. The same situation is commonly found with badly  bleeding patients. Everybody stands around. Nobody  helps. The victim dies. Any attempt to control the  bleeding could have made the difference.

1. OVERUSE OF  TOURNIQUETS. I have never, not even once, been in a situation  where I felt that I needed to apply a tourniquet to stop bleeding,  but I have seen tourniquets used all the time. Furthermore, I  have never once seen a tourniquet applied in the right way for the  right reasons. Most of the time they put the tourniquets on too  loosely, and doing that actually _increases_ the bleeding.

1. USING WET DRESSINGS TO TRY TO CONTROL BLEEDING. This is another common, major blunder. You can wash out the wound, or you can  stop the bleeding, but you can't do both at the same time. Get  the bleeding under control with a _dry_ dressing and wash it out  later as needed.

1. OVER CONCERN ABOUT SHOCK. People who  have a sketchy knowledge of first aid commit this error. True  shock is a relatively rare occurrence. Most types develop  somewhat slowly and take time to make themselves apparent.   Citizens mishandle the situation by elevating the legs of a victim  with a severe head or chest injury, wrapping the victim in so  many coats and blankets that overheating develops, and yelling  "he's in shock" within earshot of the victim.

1. MAKING NEGATIVE STATEMENTS ABOUT A VICTIM'S CONDITION. The  peace of mind of the patient, relatives, family members, and  bystanders can be disturbed for years to come by some comment like  "he's dying" or "he'll never walk again."   Leave statements about the diagnosis and outcome of the situation to  the doctors.

1. IMPROPER POSITIONING OF A COMATOSE PATIENT.   Common mistakes in dealing with the comatose patient include laying  them flat on their back or sitting them up. Aspiration can  easily result. Another common blunder is putting a pillow or  other padding under the head of a supine, comatose patient, closing  off their airway and killing them.

1. MISMANAGEMENT OF  CONVULSIONS. Errors in this situation include slapping,  screaming at, or throwing water on a patient having a seizure.   Other common mistakes include forcing a hard object like a spoon or  pencil between the patient's teeth. Sometimes this object is  forced so far back into the patient's mouth the airway is  obstructed.

1. LEAVING AN UNSTABLE PATIENT ALONE. This  can be disastrous. A patient may aspirate, stop breathing,  fall, develop an obstructed airway, or otherwise complicate their  condition if left alone. Sometimes I think patients may  actually wait until left alone to develop a complication.   Murphy's Law applies strongly here. Stay with the victim.   Losing a savable patient in this way is extremely tragic.

1. IMPROPERLY POSITIONING A PATIENT IN RESPIRATORY DISTRESS. Most patients who are having trouble breathing due to a medical problem will breathe more easily in a sitting position. This position  allows fluid which may have accumulated in the lungs to drain and  open air passages that may have been blocked. NEVER force a  person in respiratory distress to lay flat. They could drown in  the fluid trapped in their lungs.

1. FAILURE TO CALL FOR HELP, OR IMPROPERLY CALLING FOR HELP. In the chaos of a medical emergency everybody thinks that somebody else called for help.  If it takes an ambulance an hour to arrive at the scene of a medical emergency, it's a good bet that it took forty-five minutes for it to  get called. Even if you forget everything else you know about  first aid, you can give a victim a fighting chance by putting in  an immediate call for help. If you don't know who else to call,  remember that you can always get first aid service and an ambulance  by calling the fire department.

1. NOT HELPING EMERGENCY CREWS TO FIND THE SCENE. This is not an error so much as an oversight. You can cut the time it takes the rescue squad to arrive by carefully giving the address, by standing outside the house and flagging them down as they approach, and by guiding them to the  victim if the victim is in a large area such as a factory or  school.

1. MAINTAINING INADEQUATE EMERGENCY SUPPLIES.   Your first aid kit doesn't have to be fancy or expensive but it does  have to be equipped with basic supplies and available when you need  it. If you don't stock your kit carefully, you can bet that you  won't be able to find the supplies you need at exactly the moment  when you need them most. Scissors, bandages, flashlights,  flares, fire extinguishers, and other items will seemingly vanish in  an emergency. Your ability to badly injured, bleeding victim  laying in a roadway in the middle of the night will be severely  limited without dressings, flares, and a flashlight. Keep the  proper tools ready. You might be able to improvise, but don't  rely on that as your main coping method. Improvised measures  are generally unreliable, unsafe, and third-rate.

1. MOVING A PATIENT UNNECESSARILY. This type of mistake includes jerking a person who has fallen immediately to their feet, picking up a person  who has fallen down the stairs in your arms and carrying them to bed,  and pulling a badly injured person from a car because "it might  catch fire" even though there is no spilled gasoline, smoke,  sparks, or other hazards present. Moving an injured person  needlessly in probably the most common error made by ordinary  citizens.

1. FAILURE TO STABILIZE AN ACCIDENT SCENE.   Omitted actions include failure to shut off the ignitions of autos  involved in the crash, allowing smoking at the scene, failure to  cover spilled gasoline with dirt or other materials, not placing  flares or placing them too close to the scene, and not putting out  small fires.

1. IMPROPER HANDLING OF A MENTAL PATIENT.   Wrong actions here include arguing with the patient or calling them  names, ridiculing the patient, restraining them unnecessarily or  harshly, and assaulting or slapping them. It is against the law to  encourage someone to commit suicide. You can destroy a mental  patient's trust in anybody trying to help them if you lie to the  patient. Don't _ever_ lie to a mental patient unless necessary  to save a life.

1. ALLOWING A PATIENT WITH CHEST PAIN TO WALK  OR EXERT THEMSELVES.  This can be a major, disastrous blunder.   A person having a heart attack can easily kill themselves this way.   _Any_ extra strain on the heart could induce a fatal attack.   Anyone complaining of chest pain should be made to sit quietly in a  chair before the rescue squads arrive. Do anything short of  wrestling with the patient to accomplish this.

1. RACING TO THE HOSPITAL. It's a scary thing to leave the scene under red light and siren conditions, and find some of the same people you left  at the scene waiting for you at the hospital dock! Don't allow  somebody to race to the hospital, particularly if they are not  themselves transporting a patient. There have been cases in  which friends and relatives racing to the hospital were more badly  injured than the original patient. Some have even been killed!   Keep your driving under control when you're headed to the  hospital.

Gasping Misunderstood in Heart Attacks

Tue, 27 Dec 2011 05:50:46 -0600

Gasping Misunderstood in Heart Attacks

By ERIC NAGOURNEY New York Times

Published: January 5, 2009

When a heart attack victim gasps for air, bystanders often take it as a sign that they do not need to start giving CPR. But a new study reports that the people who gasp are more likely to survive — especially if they are given chest compressions right away.

Gasping During Cardiac Arrest in Humans Is Frequent and Associated With Improved Survival (Circulation)

Writing in the December 9 issue of Circulation, researchers said health professions needed to do a better job of educating people about the significance of gasping. The study was led by Dr. Bentley J. Bobrow of the Mayo Clinic in Arizona.
There has been some debate about the likelihood of gasping in heart attacks and what it means. Some bystanders who know how to do cardiopulmonary resuscitation do not do so because they do not associate gasping with a heart attack, the study says.
Others realize a heart attack has taken place but think that the gasping means there is no need to begin resuscitation right away. Even emergency medical workers make these mistakes, the study said.
But when the researchers reviewed 1,200 cardiac arrest cases that occurred outside the hospital, they found that the patients were gasping about a third of the time. And as the minutes went by, the gasping went away, as did the chances of saving the patient.
The study found that among those patients given CPR, the survival rate was 39 percent for those who gasped. For those who did not gasp, it was 9 percent. Gaspers did better than nongaspers even when CPR was not given.

Symptoms and Diagnosis of Heart Attack

Tue, 13 Dec 2011 07:04:00 -0600

Symptoms of heart attack
If you are concerned that you may be experiencing a heart attack, call 9-1-1. Minutes matter! Learn the warning signs to familiarize yourself in case of an emergency.
Symptoms of heart disease which may lead to a heart attack
You may be experiencing cardiovascular problems if you notice that ordinary physical activity causes you to experience the following symptoms:
• Undue fatigue
• Palpitations --- the sensation that your heart is skipping a beat or beating too rapidly
• Dyspnea --- difficult or labored breathing
• Anginal pain --- chest discomfort from increased activity
◦ Stable angina (or chronic stable angina) refers to "predictable" chest discomfort such as that associated with physical exertion or mental or emotional stress. Rest and/or nitroglycerin usually relieve stable angina.
◦ Unstable angina refers to unexpected chest pain and usually occurs at rest. It is typically more severe and prolonged and is due to a reduced blood flow to the heart caused by the narrowing of the coronary arteries in atherosclerosis. Unstable angina is an acute coronary syndrome and should be treated as an emergency.

Diagnosis: How do I know if a heart attack has occurred?
A doctor who's studied the results of several tests must diagnose a heart attack. The doctor will
• review the patient's complete medical history.
• give a physical examination.
• use an electrocardiogram (ECG or EKG) to discover any abnormalities caused by damage to the heart. An ECG is a medical device that makes a graphical record of the heart's electrical activity.
• sometimes use a blood test to detect abnormal levels of certain enzymes in the bloodstream.

Blood tests confirm (or refute) suspicions raised in the early stages of evaluation that may occur in an emergency room, intensive care unit or urgent care setting. These tests are sometimes called heart damage markers or cardiac enzymes.
Heart attack: a signal of heart disease
Although you may have warning signs prior to a heart attack, the heart attack itself may be your first symptom of an underlying problem: cardiovascular disease such as coronary artery disease (CAD) which narrows and hardens your arteries around the heart or atherosclerosis which is often responsible for artery-blocking clots.
To diagnose the condition, heart attack patients may be asked to undergo a number of diagnostic tests and procedures. By learning what these tests are and why they're being done, you'll feel more confident. These tests are important and help the doctor determine if a heart attack occurred, how much your heart was damaged and also what degree of CAD you may have.
Diagnostic measures — "non-invasive" and "invasive"
The tests screen your heart and help the doctor determine what treatment and lifestyle changes will keep your heart healthy and prevent serious future medical events. There are "non-invasive" diagnotic tests and "invasive" diagnostic tests.
• Non-invasive tests don't involve inserting needles, instruments or fluids into the body.
• Invasive procedures can include a simple needle prick for a blood test or shot, insertion of a tube, device or scope and major surgeries such as open-heart surgery.

Likely diagnostic procedures
If you've had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition.
• Thrombolysis: Many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery. This procedure is administered within a few (usually three) hours of a heart attack.
• Coronary Angioplasty/ Coronary artery bypass graft surgery (CABG): If thrombolysis treatment isn't done immediately after a heart attack, many patients will need to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG) later to improve blood supply to the heart muscle.

Use the following At-A-Glance charts to gain a quick understanding of possible treatments that a heart attack patient may undergo.
• Cardiac Procedures and Surgeries At-A-Glance
• Implantable Medical Devices At-A-Glance
• Cardiac Medications At-A-Glance

See Diagnostic Tests and Procedures At-A-Glance to better understand the tests you may have to undergo to find out if you had a heart attack, how much damage was done and what degree of coronary artery disease (CAD) you have.

Few Stroke Patients Get Clot-Busting Drug

Wed, 30 Nov 2011 09:08:55 -0600

tPA can save lives and reduce disability, but less than 3% of Medicare patients receive it, study shows
By Kathleen Doheny
HealthDay Reporter

THURSDAY, Feb. 19 (HealthDay News) -- A powerful clot-busting drug approved by the U.S. Food and Drug Administration for use in stroke patients in 1996 is still rarely used in Medicare patients, new research shows.
Only 2.4 percent of the more than 495,000 admissions for stroke at the 4,750 hospitals evaluated were given tissue plasminogen activator (tPA), said study author Dr. Dawn Kleindorfer, an associate professor of neurology at the University of Cincinnati College of Medicine. She was to present the finding Thursday at the International Stroke Conference in San Diego.

"The smaller your hospital was, the less likely it was to use tPA," she noted. "The strongest association by far was how big your hospital is."
Larger hospitals may be more likely to have a stroke team or to treat more strokes, and they were therefore more likely to use the drug, she said.
Kleindorfer reviewed national Medicare claims-based database records for every Medicare-eligible hospital discharge in the United States from July 1, 2005, through June 30, 2007.

About 64 percent of the hospitals did not give the clot-buster within the two-year study period, she found.

Across the United States, the use of tPA occurs in no more than 3 percent of all stroke patients, Kleindorfer noted. In this new study, the percent was even lower, at 2.4 percent.

Not every stroke patient is eligible to get tPA, she said. The drug is meant for ischemic stroke, the most common type (in which the blood vessel is clogged by a clot), and the drug must be given intravenously within the first three hours of the onset of symptoms.

Some patients don't make it to the hospital within that time frame, Kleindorfer said, and others are ineligible due to factors such as bleeding in the brain or recent surgery.

Still, the low percentage noted in the study falls far short of the percent of people who should be eligible to get tPA, she said. In fact, Kleindorfer believes that up to 29 percent of stroke patients are probably eligible for the clot-buster drug if they get to medical care within the three-hour window.
From the study, Kleindorfer also found that "40 percent of the U.S. population lives in a city with a hospital that does not treat at the national average [of 3 percent]."

Use of the drug may have been higher, she said, if she had studied younger, non-Medicare patients. In younger patients, she said, it's likely they would have fewer problems such as bleeding in the brain that would rule out use of tPA.
Another expert familiar with the study expressed disappointment at the low percent of tPA usage. "It's still unfortunate that the number of hospitals that can provide acute stroke therapy is still limited," said Dr. Ralph Sacco, chairman of the department of neurology at the University of Miami Miller School of Medicine.

The number of hospitals with stroke teams is increasing, he noted. As more hospitals are designated as a primary stroke center by the Joint Commission on Accreditation of Healthcare Organizations, the use of the drug may increase, experts said.

In the meantime, Kleindorfer had some simple, strong advice for family and friends of those suspected of having a stroke: "Call 9-1-1." Getting help quickly is crucial, she said.

Once at the hospital, she said, tell staff right away that you believe your loved one is having a stroke. "Ask, 'Do you have a stroke team?' 'What about that clot-buster medicine?'"

Why Is It Vital for a Trauma Victim to Remain Conscious?

Tue, 29 Nov 2011 11:18:33 -0600

There are two reasons for urging a trauma victim to remain conscious in such a situation, said Soumitra R. Eachempati, head of trauma surgery at NewYork-Presbyterian/Weill Cornell Medical Center.

First, remaining conscious by volition allows the increased release of body chemicals that help blood pressure to remain elevated, Dr. Eachempati said. “Critical drops in blood pressure in the trauma situation can cause organ failure or death,” he said.

Among those chemicals are catecholamines, hormones normally found in the bloodstream that can elevate heart and blood pressure. During times of stress, these changes prepare the body for the “fight” situation, Dr. Eachempati said. Epinephrine or adrenaline is one of the major catecholamines. The increase is partly responsible for the increased blood flow to the tissues needed to combat the effects of trauma.

A second reason to keep a patient conscious, Dr. Eachempati said, is that it protects a victim’s airway and prevents aspiration, or breathing fluids or foreign bodies into the lungs, another potential cause of death.

CLAIBORNE RAY The New York Times

Good Samaritan Laws

Thu, 31 Dec 2009 08:09:52 -0600

Probably the question that gets asked the most in First Aid and CPR Classes I conduct is “Do I have to worry about getting sued if I try to help someone?”. I did a little research on the internet and came up with one case in California where a judgement was made against a Good Samaritan who may have caused further injury to a car crash victim by pulling them from a car apparently causing a spinal cord injury. Within weeks of the judgement the California Legislators rewrote the Good Samaritan Laws hopefully effectively blocking the loophole that had brought on the judgement. Lawmakers it seems clear, want to do everything in their power to insure that Good Samaritans are protected from law suits.

So while there has been at least one successful lawsuit against a good samaritan in general courts have proven to be extremely supportive to those who stop and render aid in an emergency. The consensus seems to be that one needs to act within the scope of their training. Don’t do a tracheotomy on a choking victim just because you saw McGiver do it on a TV show. Act in a responsible manner according to the training you have received and the Good Samaritan Laws will protect you.

Here is the Texas Good Samaritan Act

Texas Good Samaritan Act
Article 6701d, Vernon's Civil Statutes ; Chapter 74, Civil Practice and Remedies Code Section 74.001
LIABILITY FOR EMERGENCY CARE
(a) a person who in good faith administers emergency care at the scene of an emergency or in a hospital is not liable in civil damages for an act performed during the emergency unless the act is willfully or wantonly negligent.
(b) This section does not apply for care administered:
(1) for of in expectation of remuneration;
(2) by a person who was at the scene of the emergency because he or a person he represents as an agent was soliciting business or seeking to perform a service for remuneration;
(3) by a person who regularly administers emergency care in a hospital or emergency room; or
(4) by an admitting physician or a treating physician associated by the admitting physician of a patient bringing a health-care liability claim.
(V.A.C.S. Art. 1a (part).)

Section 74.002.

UNLICENSED MEDICAL PERSONNEL.
Persons not licensed in the healing arts who in good faith administer emergency care as emergency medical service personnel are not liable in civil damages for an act performed in administering the care unless the act is willfully or wantonly negligent. This section applies without regard to whether the care is provided for or in expectation of remuneration.
(V.A.C.S. Art. 1a (part).)

CPR FAQ’s

Mon, 30 Nov 2009 20:12:48 -0600

When should I do hands-only CPR?
• The American Heart Association in an Advisory Statement of March, 2008 recommends hands-only CPR in the following circumstances: If a bystander, not trained in standard CPR, sees an adult suddenly collapse then he or she should call 911 and provide chest compressions by pushing hard and fast in the center of the chest. Interruptions should be kept to a minimum until trained rescuers arrive. For bystanders previously trained in standard CPR, hand-only CPR may be performed if the bystander is not confident or is unwilling to perform mouth-to-mouth ventilation. The advisory goes on to state that the recommendation of hands-only CPR is limited to bystanders who directly witness out-of-hospital cardiac arrest of likely cardiac origin (sudden collapse after signs consistent with a myocardial infarction).
What is the correct action where someone needs to be moved to perform CPR, such as a car accident? Does the risk of additional harm (such as spinal injury or bleeding) outweigh the benefits of CPR if nobody qualified is on scene?
• If the person is in need of CPR and must be moved, move the person and begin CPR. Remember if you don't do CPR the person will die. The neck injury is only theoretical if you move the person. Death, if you don't do CPR, is 100% certain. Whenever you move a person with a possible neck injury try to support the head during movement and keep it as straight as possible.
During the CPR, what is the percentage of heart efficiency as a pump?
• The best estimate of the heart efficiency during CPR is 20-30% of normal.
I heard that no matter if a person is unconscious that you should perform CPR. Is this true? When should you not perform CPR?
• It is true that sometimes a person may be unconscious and their heart is still beating and they may still be breathing. Such a situation, for example, may occur in someone who has just had a grand mal seizure. If you tried to do CPR on such a person he or she would probably groan and even try to push you away. This would be your clue that CPR was not needed. CPR is intended only for someone whose heart and breathing has stopped. If the victim moves or pushes you away, you should stop CPR.
What is the ratio of 2-person CPR?
• The ratio of chest compressions to mouth-to-mouth is the same for 2 person CPR as for 1 person CPR, namely 30:2.
How do I perform CPR on a person who has a tracheal stoma? Do I have to cover their mouth or just breath directly into the stoma?
• There are two types of stomas, one which communicates to the nose and mouth and one which doesn't. Since you won't know which type you are dealing with, it is best to pinch the victim's nose closed, keep the victim's mouth closed and breathe directly into the stoma opening.
When you are giving mouth to mouth are you actually breathing oxygen into the victim's lungs or are you trying to stimulate breathing by breathing carbon dioxide into their lungs?
• You are breathing oxygen into the lungs. Your exhaled breath contains 16% oxygen which is close to the 20% contained in the air you breathe in.
When performing CPR, how do I know if it's working?
• You can tell if the chest rises with ventilation. It is hard to determine if the chest compression results in a pulse. Do the best you can and don't stop. It's better to perform CPR imperfectly than not at all.
If a person has had bypass surgery, and a situation occurs that they require CPR, are there any special considerations that need to be made?
• No, CPR should be done in the regular fashion.
Is it easier to break an overweight person's ribs or a skinnier persons ribs when performing cpr?
• The weight of the victim has little to do with the chances of breaking a rib, instead the age of the victim seems to determine the fragility of the bones.
Can I kill someone if I do CPR incorrectly?
• No. Remember the person in cardiac arrest is already clinically dead. CPR can only help. Even if it's not done "letter perfect" it will probably provide some benefit to the victim.
What if I crack a rib when I do CPR?
• Frequently ribs are broken with the pressure CPR places on the sternum. Some studies quote up to 30% of cardiac arrest victims have broken ribs as a result of CPR. This happens more frequently the older the victim since the cartilage is less compliant and the bones more easily crackable. But remember, it's better to have a cracked rib than be dead.
Will CPR always save a life?
• No, in fact, most instances of CPR for cardiac arrest are unsuccessful.
What is the recovery position?
• Assuming the person has a pulse and is breathing, the recovery position means placing the person on his or her side. This allows for the person not to choke on saliva and helps keep the airway open. The downside arm may be raised to suport the head.
What should you do for a person who has been accidentally shocked by electricity?
• A person with electric shock (assuming the shock doesn't severely damage the body) often dies from the heart going into ventricular fibrillation. Such a person needs CPR and it should be performed in the regular fashion. If CPR begins quickly and if a defibrillator arrives quickly this person has an excellent chance of survival.
I want to know what the current teachings are on helping a choking victim. I have heard conflicting information on back blows for an adult. Is it still recommended, or discouraged?
• The first action to take in adults and children is the Heimlich maneuver. Back blows are the first thing to do only in infants who are conscious. In doing the back blows the infant should be in a face down position with the head lower than the body.
What if the victim vomits?
• Vomit is obviously unpleasant. If it happens (and it may in one out of 20 cardiac arrests) merely turn the head to the side and wipe out the vomit as best you can with your finger.
If someone has an asthma attack and collapses, what should a person do? Will CPR help?
• If someone collapses from an asthma attack, it is because he or she is not getting enough oxygen. This is because all the lung's small airways have narrowed and are not allowing enough air to reach the air sacs. Mouth to mouth respiration may help a little. The real need is to get this person to an emergency department so that the patient can receive medications and emergency endotracheal intubation (a tube in the main airway).
What are some of the causes of CPR being used for in infants and children?
• Usually CPR in infants and children is performed for respiratory arrest such as severe asthma. Ventricular fibrillation is rare in children but very common in older adults.
In regards to administering the Heimlich Maneuver to a victim while they are lying down, should the head be facing up, as when administering CPR (in order to clear the airway), or to the side?
• The victim's head should be facing up with the victim on his/her back. Since the airway is blocked you shouldn't spend much time positioning the head. The Heimlich maneuver is the most important thing to do and should unblock the airway
What if the victim is wearing dentures?
• Keep them in place if possible as they will allow for a better seal of your mouth on his/hers.
Can I get AIDS from doing CPR?
• No. There has never been a documented case of AIDS transmitted by CPR.
Can I get sued if I perform CPR?
• You theoretically could but there has never been a successful suit brought against someone performing CPR.
Does the Good Samaritan law protect me?
• Yes, if you give assistance, including CPR, for a medical emergency Good Samaritan laws cover you.
What are agonal respirations?
• When the heart stops beating in cardiac arrest the breathing center in the brain is still alive for a couple of minutes and will cause the victim to take a few abnormal breaths. These abnormal breaths associated in dying are called agonal respirations. They may appear like snoring, gasping, or snorting and will disappear in a couple of minutes. Don't let abnormal breathing stop you from starting CPR.
In cardiopulmonary arrest occurring outside of a hospital what are statistics regarding successful uncomplicated recovery? Also in this situation how many patients are successfully resuscitated but are then in a vegetative state?
• The statistics vary from locale to locale. In New York City or Chicago the survival rate (discharge alive from the hospital) is 2 or 3%. In Seattle the survival rate is 20% overall and 35% for ventricular fibrillation. Less than 5% of those discharged have severe neurologic damage. Over 60% return to their prior level of mental status. Persistent vegetative states (PVS)s are very unusual.
Can CPR be performed on dogs?
• CPR can be performed on dogs. To give respiration you will need to keep the dogs mouth and lips closed and breathe through the nose. Cover the dogs nose completely with your mouth to prevent air from leaking out. You should see the chest rise if you are doing it properly. To give chest compressions you might need to press side to side instead of straight down on the chest. This is especially true for funnel chested dogs. The rates of respiration to chest compression are the same as for humans. In general, most instances of CPR for dogs will involve accidents of smoke inhalation or drowning. Respirations may indeed prove life saving especially if the dog has a heart beat. Once the dog's heart stops beating it is unlikely that CPR will be of benefit. By the way, the name gingy in my address is for my 13 year-old golden retriever.
If a person moves when I do CPR should I stop?
• Yes, if a person moves his arms or legs they don't need CPR.
When should I stop CPR?
• When help arrives to take over, or the victim starts to move.
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.
What should I do if I'm alone and I do not know CPR?
• If you are alone and don't know how to do CPR call 911 and ask the emergency dispatcher to give you instructions over the phone.
If a pregnant women chokes should I do the Heimlich Maneuver or can it harm the baby?
• You should do the chest thrust in a very pregnant woman. This is like the Heimlich except you grab around the middle chest instead of the upper abdomen. Click here for more info.
What is the reason calling 911 occurs after 2 minutes of CPR for infants and children whereas for adults, the call is made immediately?
• It is because airway problems are the main cause of cardiac arrest in infants and trying to correct that problem takes precedent over calling 911.
If successful CPR is dependent on a defibrillator arriving, are there any portable defibrillators available?
• Portable defibrillators which operate automatically (they are called automated external defibrillators - AEDs) are available and may be purchased without a prescription. They cost around $1500. The training is very simple and takes only minutes. You should talk to your doctor as to whether one of these might be indicated in your situation.
In a trekking guidebook I own it states that if there has been a trauma fall and the victim has no pulse, then CPR is futile, is this true?
• Doing CPR in the wilderness is futile. I would, however, make an attempt to open the airway and perhaps give several ventilations. You may be dealing with respiratory arrest and a little mouth to mouth could be lifesaving.
Is it true that if a victim "regains" a pulse after doing CPR he/she has probably had a pulse all along?
• You are partially correct. The most common cause of cardiac arrest is VF and this cannot be converted with CPR alone. Electricity is required. However there are some instances when the heart is going very slowly and CPR can oxygenate the system enough to get the heart going again. Also there are instances when the person is really in respiratory arrest and the heartbeat is too faint to feel. In this situation CPR may be enough to get the heart beating stronger.
• I found the following FAQ’s at:

http://depts.washington.edu/learncpr/askdoctor.html

Aspirin in Heart Attack and Stroke Prevention

Tue, 3 Nov 2009 05:20:45 -0600

AHA Recommendation
The American Heart Association recommends aspirin use for patients who've had a myocardial infarction (heart attack), unstable angina, ischemic stroke (caused by blood clot) or transient ischemic attacks (TIAs or "little strokes"), if not contraindicated. This recommendation is based on sound evidence from clinical trials showing that aspirin helps prevent the recurrence of such events as heart attack, hospitalization for recurrent angina, second strokes, etc. (secondary prevention). Studies show aspirin also helps prevent these events from occurring in people at high risk (primary prevention).
You should not start aspirin therapy without first consulting your physician. The risks and benefits of aspirin therapy vary for each person.
If you’re taking aspirin and you must undergo even a simple surgical procedure or dental extraction, you must tell the surgeon or dentist your aspirin dosage.
What about aspirin and alcohol?
There is a risk of stomach problems, including stomach bleeding, for people who take aspirin regularly. Alcohol use can increase these stomach risks, so ask your doctor if it is safe for you to drink alcohol in moderation.
Should I take aspirin during a heart attack or stroke?
The more important thing to do if any heart attack warning signs occur is to call 9-1-1 immediately. Don't do anything before calling 9-1-1. In particular, don't take an aspirin, then wait for it to relieve your pain. Don't postpone calling 9-1-1. Aspirin won't treat your heart attack by itself.
After you call 9-1-1, the 9-1-1 operator may recommend that you take an aspirin. He or she can make sure that you don't have an allergy to aspirin or a condition that makes using it too risky. If the 9-1-1 operator doesn't talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it's right for you. Research shows that getting an aspirin early in the treatment of a heart attack, along with other treatments EMTs and Emergency Department physicians provide, can significantly improve your chances of survival.
Taking aspirin isn't advised during a stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots, but some are caused by ruptured blood vessels. Taking aspirin could potentially make these bleeding strokes more severe.
Related AHA publication(s):
• Aspirin, Heart Disease and Stroke brochure
• Are You at Risk of Heart Attack or Stroke? brochure
• Controlling Your Risk Factors brochure
Related AHA scientific statements: Aspirin

History of CPR

Mon, 12 Oct 2009 07:24:03 -0500

Myths and Popular Culture
The resuscitation technique that many of us older readers may first remember was described in the first edition of the Boy Scout Handbook in the United States in 1911, as a form of artificial respiration where the person was laid on their front, with their head to the side, and a process of lifting their arms and pressing on their back was utilized, essentially the Silvester Method with the patient flipped over. This form is seen well into the 1950's (it's used in an episode of Lassie

during the Jeff Miller era), and was often used, sometimes for comedic effect, in theatrical cartoons of the time (see Tom and Jerry's "The Cat and the Mermouse"). This method would continue to be shown, for historical purposes, side-by-side with modern CPR in the Boy Scout Handbook until its ninth edition in 1979. However it wasn't until the middle of the 20th century that the wider medical community started to recognize and promote it as a key part of resuscitation following cardiac arrest. Peter Safar wrote the book ABC of resuscitation in 1957. In the U.S., it was first promoted as a technique for the public to learn in the 1970s. Early overly aggressive marketing efforts oversold the effectiveness of CPR in rescuing heart attack and other victims, and this misperception continues even today.
CPR is often severely portrayed in movies and television as being highly effective in resuscitating a person who is not breathing and has no circulation. A 1996 study by the New England Journal of Medicine showed that CPR success rates in television shows was 75% [4]. The real survival rate of an unwitnessed, out-of-hospital sudden cardiac arrest is in a range of 6% to admission and even less to hospital discharge. The current rise in the distribution and use of Automated External Defibrillators (AED's) is improving the survival rate dramatically.
3000 BC
Mayan hieroglyphics and Peruvian Incas performed resuscitation by rectal fumigation. One can only surmise that while not very successful this technique certainly kept anyone from faking a heart attack to get off work for the day.
896 BC Biblical Reference to Resuscitation
The first description of a successful resuscitation is recounted in the Bible, in the Book of Kings. A child of a Shunemite couple complained of a headache and died. The prophet Elisha prayed and then: "...placed himself over the child. He put his mouth on his mouth, his eyes on his eyes, and his hands on his hands, as he bent over him. And the body of the child became warm. He stepped down, walked once up and down the room, then mounted and bent over him. Thereupon the boy sneezed seven times, and the boy opened his eyes." (2 Kings, iv, 34.)
500-1500 AD
Various methods including flagellation, external heating, rolling over a barrel, or strapping across the back of a horse which then ran around a field. The first report of an experimental intubation of the trachea was probably by the great Muslim philosopher and physician Avicenna (Abu Ali Al-Hussein Ibn Abdallah Ibn Sinna) in approximately the year 1000. "When necessary, a cannula of gold, silver or another suitable material is advanced down the throat to support inspiration." Andreas Versalius published "De humani corporis fabrica" which described blowing into a tube to resuscitate an animal.
Early Ages- The Heat Method
Very early in our history, people realized that the body became cold when lifeless and connected

heat with life. In order to prevent death from taking the person, the body was warmed. The use of warm ashes, burning excrement, or hot water placed directly on the body were all employed in an attempt to restore life. Undoubtably this technique had rather limited success over the years.

Early Ages - Flagellation Method

In the early ages, the would-be rescuers would actually whip the victim in an attempt to stimulate some type of response.

1530 - Bellows Method
In the 1500's it was not uncommon to use a bellows from a fireplace to blow hot air and smoke

into the victim's mouth, a method that was used for almost 300 years. Unfortunately, not many people carried fireplace bellows with them, but the success of this procedure motivated various manufacturers to design and manufacture Bag-Valve-Mask Resuscitators. However, in those days, the medical authorities were not aware of the anatomy of the respiratory system and did not appreciate the need to extend the victim's neck in order to obtain a clear airway. Phillipus von Hohenheim wrote about using a bellows to resuscitate people 1493-1541 In 1829, Leroy d'Etiolles demonstrated that over distention of the lungs by bellows could kill an animal, so this practice was discontinued.
1711 - Fumigation Method
In the 1700's a new method of resuscitation was used. This "new" procedure involved blowing

tobacco smoke into the victim's rectum. According to the literature, smoke was first blown into an animal bladder, then into the victim's rectum. It was used successfully by North American Indians and American colonists an introduced in England in 1767.  This practice was abandoned in 1811 after research by Benjamin Brodie when he demonstrated that four ounces of tobacco would kill a dog and one ounce would kill a cat.
1740-Mouth to Mouth
The Paris Academy of Sciences officially recommended mouth-to-mouth resuscitation for drowning victims.
1770 - Inversion Method
Other methods were developed in the 1700's in response to the leading cause of sudden death of that time, drowning. Inversion was originally practiced in Egypt almost 3,500 years before and it again became popular in Europe. This method involved hanging the victim by his feet, with chest pressure to aid in expiration and pressure release to aid inspiration. In response to the increasing numbers of drowning during this time period, societies were formed to organize efforts in resuscitation. England's Royal Humane Society was founded in 1774.

Although it was the most famous, it was not the first. It was preceded by the Dutch Society for Recovery of Drowned Persons, established in 1767. The Dutch recommendations included:
1. Warming the victim (which sometimes required transporting the body to a different location) by lighting afire near the victim, burying him in warm sand, placing the body in a warm bath, or placing in a bed with one or two volunteers;
2. Removing swallowed or aspirated water by positioning the victim head lower than his feet and applying manual pressure to the abdomen, vomiting was induced by tickling the back of the throat with a feather;
3. Stimulation of the victim, especially the lungs, stomach and intestines by such means as rectal fumigation with tobacco smoke, or the use of strong odors;
4. Restoring breathing with a bellows;
5. Bloodletting.
These and other methods had been applied for years as documented in the report of Anne Green's hanging, resuscitation and recovery in 1650. Other methods included physical and tactile stimulation in an attempt to "wake up" the victim. Yelling, slapping, even whipping were used to attempt to resuscitate.
1773 - Barrel Method

In an effort to force air in and out of the victim's chest cavity, the rescuer would hoist the Victim onto a large wine barrel and alternately roll him back and forth. This action would result in a compression of the victim's chest cavity, forcing air out, and then a release of pressure which would allow the chest to expand resulting in air being drawn in. This technique was in many ways a precursor to modern CPR techniques as it attempted to force air in and out of the lungs.
1778 Defibrillation First Suggested
Goodwin and Kite deduced that asphyxia causes the heart to stop. Kite suggested electric shock treatment (defibrillation). However, airway problems produced by the tongue were not appreciated.
1803 - Russian Method

This concept involved reducing the body's metabolism by freezing the body under a layer of snow and ice. Unfortunately, what the medical authorities did not realize at the time, was that the most critical organ which needed to be frozen in order to accomplish a reduction of the body's metabolism was the brain.
1812 - Trotting Horse Method

In 1812 Lifeguards were equipped with a horse which was tied to the Lifeguard station. When a victim was rescued and removed from the water, the Lifeguard would hoist the victim onto his horse and run the horse up and down the beach. This resulted in an alternate compression and relaxation of the chest cavity as a result of the bouncing of the body on the horse. This procedure as banned across the United States in 1815 as a result of complaints by "Citizens for Clean Beaches".
1850 Mouth to Mouth
Mouth to Mouth replaced chest pressure except for babies resuscitated by midwives. Anesthetics were also introduced in 1850, resulting in an increase in respiratory arrest in people under medical supervision!
1856 - Roll Method
As late as 1856, manual ventilation was given low priority, concentration was on maintaining body heat. These were the same recommendations as provided by the Dutch nearly 100 years earlier. A significant change in priorities occurred when Marshall Hall challenged the conventional wisdom of the Society. His contention that time was lost transporting the victim; that the restoration of warmth without some type of ventilation was detrimental; that fresh air was beneficial; and that if left in the supine position, the victim's tongue would fallback and occlude the airway.
Because the bellows were no longer an option, Marshall Hall developed a manual method in which the victim was rolled from stomach to side 16 times a minute. In addition, pressure was applied to the victim's back while the victim was prone (expiratory phase). Tidal volumes of 300 ml to 500 ml were achieved and soon became adopted by the Royal Humane Society.
1858 Silvester method introduced
A now obsolete method of artificially resuscitating still-born children, and for restoring persons apparently drowned or dead. The patient would be on his or her back, with arms raised to the sides of the head, held there temporarily, then brought down and pressed against the chest. Movement repeated 16 times per minute.
1891-First Modern Chest Compressions
Dr. Friedrich Maass performed the first equivocally documented chest compression in humans.
Late 1892 - Tongue stretching
Other methods still used included stretching the rectum, rubbing the body, tickling the throat with a feather, waving strong salts, such as ammonia, under the victim's nose. In 1892, French authors recommended tongue stretching. This procedure was described as holding the victim's mouth open while pulling the tongue forcefully and rhythmically.
1932 Holger-Neilson
Prone position, hands under head, expire by pressing on chest, inspire by lifting elbows.
1947 First successful defibrillation.
1954 Mouth to Mouth Advances
James Elam was the first to prove that expired air was sufficient to maintain adequate oxygenation and by 1956 Peter Safar and James Elam invented mouth-to-mouth resuscitation. 1957 The United States military adopted the mouth-to-mouth resuscitation method to revive unresponsive victims.
1960 - Cardiac Massage
The next major step in resuscitation was closed chest massage which was introduced in the 1960's by Dr. Kowenhoven, The crucial aspect of this technique is that the patient receives oxygen which is transported to the brain by the development of a minimal blood circulation. On this basis many national and international guidelines to perform CPR came out. The American Heart Association started a program to acquaint physicians with close-chest cardiac resuscitation and became the forerunner of CPR training for the general public.
1972 - CPR practice for the population
1972 Leonard Cobb held the world's first mass citizen training in CPR in Seattle, Washington called Medic 2. He helped train over 100,000 people the first two years of the programs. During the Vietnam War the US army introduced CPR to the people for the first time. Then, in 1973 the American Red Cross and the American Heart Association (AHA) began a big campaign to teach the American population this method.

copyright © Thomas McMillan Texas OnSite CPR 2007

Hands Only CPR

Mon, 12 Oct 2009 06:54:51 -0500

The American Heart Association came out with a revolutionary new approach to CPR in 2008 known as “Hands Only CPR”. This technique was in response to the many bystanders worried that they might do something wrong or make things worse. That’s why the AHA has simplified things to 2 basic life saving steps:

1. Call 911
2. Push Hard and Fast in the center of the chest.

If you are interested in learning more about the science behind this initiative here are a few links of interest:

Hands Only Video Demonstration

Hands Only FAQ’s

American Heart Press Release

Snake Bite Treatment

Mon, 12 Oct 2009 06:09:03 -0500

From Wikipedia, the free encyclopedia

It is not an easy task determining whether or not a bite by any species of snake is life-threatening. A bite by a North American copperhead on the ankle is usually a moderate injury to a healthy adult, but a bite to a child's abdomen or face by the same snake may be fatal. The outcome of all snakebites depends on a multitude of factors: the size, physical condition, and temperature of the snake, the age and physical condition of the victim, the area and tissue bitten (e.g., foot, torso, vein or muscle, etc.), the amount of venom injected, the time it takes for the patient to find treatment, and finally the quality of that treatment. Promptly securing qualified medical treatment is the best course of action, and conservative management in the meantime is recommended.

Treatment for Snake Bites
1. Protect the patient (and others, including yourself) from further bites. While identifying the species is desirable in certain regions, do not risk further bites or delay proper medical treatment by attempting to capture or kill the snake. If the snake has not already fled, carefully remove the victim from the immediate area.
2. Keep the victim calm. Acute stress reaction increases blood flow and endangers the patient. Keep people near the patient calm. Panic is infectious and compromises judgment.
1. Call for help to arrange for transport to the nearest hospital emergency room, where antivenom for snakes common to the area will often be available.
1. Make sure to keep the bitten limb in a functional position and below the victim's heart level so as to minimize blood returning to the heart and other organs of the body.
2. Do not give the patient anything to eat or drink. This is especially important with consumable alcohol, a known vasodilator which will speed up the absorption of venom. Do not administer stimulants or pain medications to the victim, unless specifically directed to do so by a physician.
3. Remove any items or clothing which may constrict the bitten limb if it swells (rings, bracelets, watches, footwear, etc.)
4. Keep the victim as still as possible.
5. Do not incise the bitten site.
Here are some good links for more information:
http://en.wikipedia.org/wiki/Snakebite
http://www.aafp.org/afp/20020401/1367.html

Bee Sting Removal

Sat, 1 Aug 2009 17:10:06 -0500

Many medical texts and first aid courses, including the American Heart Association recommend a time-honored approach for treating bee stings: grab a sharp object, apply it to the skin and gently scrape away the stinger. The theory behind this approach is that the imbedded stinger left by the bee has a small venom sack attached to the abandoned stinger that if pinched while removing will inject more venom into the victim.
A study by the University of California has come to the conclusion that speed of removal is more important than technique. Their research indicated that the imbedded stinger and venom sack continued to inject the venom even after the bee had left, meaning that removing the venom sack immediately was a more important consideration than removal without pinching the venom sack.
My instinct would be to follow their advise, scrape it, try not to pinch it... whatever it takes, just get the stinger out ASAP.