CPR for older people?

[DaleC]

If you're really serious about becoming proficient at pre-hospital emergency care (a good investment that will serve you and those around you your entire life) stick with the winners and practice/learn from those who are positive about what they do. It may appear cynicism is the new cool but it wears pretty thin, pretty fast. The key to success is not cynicism - it is curiosity.

Just to recap:

Forget survival rates, they don't mean anything to you as a care provider - statistics always break down at the individual level and when you provide care you are treating an individual, not a statistical average.

You do not break ribs every time you do CPR. The best thing you can do is gain access to a CPR-Doll with performance tracking capacity and practice practice practice until you can adequately and repetitively simulate a pulse. Not too hard, not too soft. You can't do it once during a course and expect to be good at it but if you do practice, it becomes somewhat like riding a bike.

Old bones heal too, just slower. As I said, I work as a rehab assistant in a complex care facility and deal with elderly fractures every day. It ain't pretty but it isn't the doom and gloom proclaimed by those so called experts.

Older people still have a lot to offer, if they choose and are able, and are not the drains on society some might suggest.

 

[Allison Finch]

As a former medic and current CPR instructor....

You cannot HURT these people when you give CPR. They are DEAD!! You can't survive death. Breaking ribs/sternum is not going to hurt them. The whole idea is to keep them fresh enough that they have a chance of resusitation. IF that happens, they will heal. They CAN survive broken bones.

Drowning, as in the case of a diver, is one of the times you have a chance of resusitation. The worst worry, if you are successful, is not broken bones, but secondary drowning, especially with salt water. THAT will kill them if they aren't cared for carefully.

 

[bilsant]

As a former EMT and first responder instructor....and "older diver" (whatever the heck that means) who dives some of the same waters as you do....

If I'm in cardiac arrest you totally have my permission to give it your best try.

I promise to do the same for you if the situation is reversed.

Thank you in advance.

 

[Tigerman]

As a former EMT and first responder instructor....and "older diver" (whatever the heck that means) who dives some of the same waters as you do....

If I'm in cardiac arrest you totally have my permission to give it your best try.

I promise to do the same for you if the situation is reversed.

Thank you in advance.

Im not older, but I agree fully. Should I need emergency help of any kind, please do try your best and should you break my ribs trying to resucitate me Ill be willing to return the favour

 

[TheAvatar]

Aviator - indeed. I saw your name and thought "I haven't post in this thread yet":shocked2:

I just had to respond to this. This is definitely a country by country basis, but in the USA there is no debate about how you handle a non-DNR situation as a medical provider. You provide the maximum care until it becomes clear that the patient is not going to be resuscitated with everything available and then you call it. Anything less is medical negligence. Only the family has the right to decide to cease care before every option has been attempted to treat the patient. This is entirely directed to emergency situations of course. A doctor doesn't have to take a elective procedure on a high risk patient. A EMT, Paramedic, ED MD, etc. really doesn't have the right to make that decision in the USA from a legal perspective.

Talking about ethics, there IS indeed a debate in the USA. There are lots of parts of your statement one could debate with on ethical grounds. For example, who has the right to decide, especially when it conflicts with patient wishes, or the family disagrees amongst themselves, or a non-family member with durable power of attorney disagrees. I've personally seen all of these situations. There are also several ethical perspectives that might govern a complex situation in which the provider could unilaterally refuse to resuscitate. One of the easiest to argue is medical futility:

I believe we are neither legally nor ethically obligated to perform futile actions. For example, if you have a septic patient already on max life support in the ICU who codes, you are not under an obligation to do CPR on that patient. Similarly with terminal cancer patients.

Of course, this has nothing to do with any discussion of appropriate resuscitation for divers, since I would imagine there would be very few of them with DNRs or terminal conditions.

I agree with the above.

The most obvious example is the medical providers are the ones who decide to terminate unsuccessful resuscitation efforts. They can also use their clinical and ethical judgement to refuse initiation of such efforts. There are MANY situations in the hospital where futility can be argued as a reason to refuse demand for treatment. Now, these arguments are generally gonig to be made by physicians and nurses, not an EMT. Certainly, the complex situations must be understood to make the arguments, thus the genesis of the conversation was an 87 year old female in a facility that only accepted residents on the basis of their being DNR and there was a policy against staff CPR. The resident died, a bystander called 911, and a manager for the facility, who happened to be a RN, follow the resident's and family's wishes and facility procedure to not initiate CPR or facilitate the initiation of CPR.

In prehospital emergency situations, there isn't the time to understand such complexities, nor are providers usually educated in the handling of those more complex ethical situations. However, there are situations besides a valid DNR where the EMS provider can refuse to do CPR because it is futile. There are protocols to protect EMS providers from providing futile resuscitation efforts. Different states and agencies have different names, but usually they are something like "guidelines for termination of resuscitation" or "obvious signs protocol."

The family can demand the EMT do CPR all they want, but no EMS provider should be coding a patient who meets the criteria for those protocols (eg injuries incompatible with life, dependent lividity, decomposition, etc).

TheAvatar, RN, EMT

 

[Quero]

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A ScubaBoard Staff Message...

References to a discussion that took place on a board other than SB have been redacted and posts have been edited/removed as a result. This thread has been cleaned up in an attempt to refocus it on the utility of performing CPR on seniors. Please stay on topic in your continued participation in this thread, and as this is a community of scuba divers, it would be most useful if members were to begin to discuss CPR as it relates to our area of interest.

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[DocVikingo]

Utter poppycock.

I'll take my chances both administering & receiving.

Cheers,

DocVikingo

 

[tc]

Just ran across this-