Back from the Dead and Very Much Alive - April 2012 Costa Rica

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If I my ask...where did you hear that? Just asking.
Red cross will tell you, paramedics will tell you, and I think its safe to take TsandMs word for it being the assimilated medical mod :p

I think btw that CPR work more often than we get to know, cause once someone gets taken over by the ambulance/hospital and is out of your care, most of the time you dont hear back from them amongst other things due to confidentiality.
Although it might not be often a patient actually wake up just from the CPR it gives them a LOT better odds when you get more advanced help in place.
I know for sure I usually dont and I get ambulance support a dozen times or more every year and only in a very few instances I hear back from them.
One of such times was when the ambulance staff tried to blame me and my coleague for them getting lost while a guest died of a massive cardiac event in one of our cabins - thank god for audio logs..

Might of course be more feedback from emergency services other places, but lack of detailed feedback with regards to the patients status is my general experience..
 
I guess the AED's are way better than the old lifepak 10's. because they would light up bystanders in wet conditions. I know this personally. I must have done 50 codes over the last 13 years as a paramedic, but our survival rate hasn't been any where near aviators. Except for the codes at the bar's where drunks save 2-3 people a weekend cause they did CPR on their buddies that were passed out. It works yes 4% of the time,(per new ACLS). AED's work on shockable rhythms only V Tach, and V Fib out of the 12 primary rhythms. They help but don't overrate them. People will expect a miracle every time and want to sue you because your CPR and AED didn't fix someone that had a widow maker.
 
American Red cross wants access to an AED within 4 minutes for all americans. They must be somewhat important/useful. It may not be realistic, but always work for the ideal. I do believe there are laws limiting the liability from using an AED, so I wouldn't hesitate to use one because of fear of lawsuit. If it works even one time it would be worth it.
 
The quality of the CPR is definitely the most important thing in a code situation. Also AED's only shock V-fib. Since V-tach comes in two forms (with a pulse and pulseless) and shocking V-tach with a pulse helps the person to their final destination AED's don't shock it. The good (maybe bad too) news is pulseless v-tach often deteriorates into v-fib.

Just remember to push hard and fast (> 100 per min) and you will do well :wink:
 
American Red cross wants access to an AED within 4 minutes for all americans. They must be somewhat important/useful. It may not be realistic, but always work for the ideal. I do believe there are laws limiting the liability from using an AED, so I wouldn't hesitate to use one because of fear of lawsuit. If it works even one time it would be worth it.
A wonderful idea and maybe attainable for the majority. Having lived most of my life in the wilds of West Texas, working alone on farms, family hikes on parks, and so forth - seems foreign to me. More of a city thing I guess. Good idea on dive boats? Maybe, as I really don't know how well they work on drownings.

For this particular story, it was good that the doc/husband continued with the rescue breaths as Compressions Only CPR does not apply to drownings and some other exceptions as listed above.
 
A couple of other points on CPR and AEDs. In Oregon, any facility with a public building >50,000 square feet, or having more than 25 visitors a day, must have at least one AED. Most employers with >50 employees therefore have AEDs on the wall in Oregon. So there are many available in an emergency in most cities. Here is a news article which the Oregonian wrote about AED requirements as the law took effect. Another law was passed updating the Good Samaritan Laws in Oregon to include AEDs.

Now, about CPR. I think the reason that CPR with rescue breaths is recommended for drowning is that the person is assumed to have been without oxygen for an extended time, and the inflation is necessary to facilitate oxygen transfer. For someone who is not in water, the mouth is in air and for much of the time there was some breathing.

Now, about stopping CPR for drowning; not too many people are currently familiar with cold water near drowning. The current protocol from MedScape for cold water near drowning states:

"Patients with severe hypothermia may appear dead because of profound bradycardia and vasoconstriction. Resuscitation should continue while aggressive attempts are made to restore normal body temperature."

Years ago, Dr. Cameron Bangs of Oregon City, Oregon pioneered efforts to continue CPR for cold water near drowning, and stated in one of our pararescue training sessions that "the patient is not dead until he or she is warm and dead," or something to that effect (that was over 30 years ago). I hate seeing that a drowning victim has been pronounced dead at the scene, especially in cold water (cold water near drowning has occurred in Florida). To me it means that the people involved were not aware that the exceptions for the signs of death include cold water near drowning (and drugs, and electrocution). So in my mind CPR needs to be continued through the ambulance ride, to the hospital until the victim has been rewarmed and is still dead.

John
 
AED's are designed to shock both ventricular fibrillation and ventricular tachycardia without pulses. The key to this is that you must identify the patient to be unresponsive, because as stated above v-tach does occur with pulses and there is a vast difference in treating the two. Vtach with pulses (depending on the stability of the patient) can be treated with an anti arrhythmic medication such as amiodarone (my favorite) or in severe cases a strategically timed shock (which can only occur with advanced monitors (not aeds). The purpose behind CPR is to keep the patient viable. Studies show that survival rate declines by 10% for every minute someone is in cardiac arrest without CPR. That rate drops to less than 5% per minute (depending on the source) while CPR is in progress. The chaos and irritation in the heart will almost never resolve itself with CPR and this is why defibrillation is required.

ALL defibrillation including aeds must be done on a dry chest or dry area. When you stick those two pads on the chest the actually talk to each other and determine the amount of ohms of impedance the chest wall and organs have so the correct dose of electricity can be administered. No amount of science in the world is going to stop electricity from traveling through water so if you're standing in a soaking wet boat deck when you discharge that thing prepare to experience something new yourself.

When you have a hypothermic patient there are some many changes in the body, including a decrease in the metabolic rate that slows the process of death. These patients must be rewarmed while performing CPR and CPR cannot be stopped until they are warm and dead as the poster above me mentioned. There is alot that goes into the resuscitation of these patient from an advanced life support perspective but again CPR is the only thing that gives them a chance.

Just to clarify a point though, not all medics will transport patients to the hospital doing CPR. In the old days it was "load and go" you would race through the city swerving to get to the hospital so a doctor could pronounce them dead. Now studies have shown how ineffective CPR is while driving down the road, and the dangers it presents to everyone racing lights and sirens, coupled with the advances in prehospital medicine medics will often stay on scene and work someone until they achieve ROSC or the patient is pronounced. This does not apply to most cold water cardiac arrests however it was a side bar for anyone who may encounter and emergency and wonder why they aren't racing to the er.

And I know that for some reason my statistics are way above average. As a whole my department has consistantly been well above average nationwide for cardiac arrest ROSC. I attribute it to our training, the size and location of our stations/crews, our equipment and the fact our medical director is amazing at trying I stay cutting edge with our protocols.

---------- Post added March 23rd, 2013 at 12:46 AM ----------

Vincent, I'd love to try to elaborate on yor statement about if there is a defib problem CPR might not be effective, but I'm not entirely certain what you mean by defib problem?
 
Now studies have shown how ineffective CPR is while driving down the road, and the dangers it presents to everyone racing lights and sirens, coupled with the advances in prehospital medicine medics will often stay on scene and work someone until they achieve ROSC or the patient is pronounced

I am alive purely because paramedics performed CPR on me in precisely those circumstances. Twice during a 30+ minute drive.
 
Guess you proved those stats wrong peterbj7 :D
 
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