(no subject)
6 weeks to exams.... 8 weeks to graduation! *looks terrified*
Today I thought I would do something different. As some of you may know, I am currently doing Cardiology, in particular attached to the Coronary Care unit (mostly cos the doctor on duty there the first day was cute and Welsh and actually made an effort to include me, but I digress).
It's pretty unhelpful in terms of exam preparation - basically once you've seen one heart attack, you've seen them all, there's not that much variation in their presentation, diagnosis and treatment. However, this week, I have had TWO young patients come in who had had cardiac arrests (their hearts had stopped working), and in both, the only reason they are alive now is because bystanders did CPR and kept them alive until the ambulance arrived.
Despite what you might see on TV shows, the number of people who survive cardiac arrests is abysmally low. On TV its something like 80% survival, whereas in reality its less than 20%. There are a grand total of TWO things that make a difference in survival rates.
1) Prompt effective CardioPulmonary Resuscitation (CPR)
2) Prompt effective Defibrillation (use of the machine where they zap the chest, usually after someone has shouted "CLEAR!" loud enough to wake the dead patient, at least on the TV version)
So, most of us don't carry defibrillators in our pockets, and although they are almost idiotproof (some of them speak and tell you what to do!) most people don't feel comfortable in using them. Which is fine. Ambulance officers and doctors do it all the time, leave it for them. What you need to do, if you are the bystander, is keep enough blood circulating and oxygen reaching the brain until the paramedics arrive.
Now, let me start by saying that these instructions don't compare with doing a first aid or resuscitation course, and if you have done one of those and the teaching is different, use what you are comfortable with or remember - it doesn't matter that much. The guidelines and teaching has recently changed (Nov 2005) and although the changes are designed to simplify things, there is of course a lot of confusion as the new guidelines are implemented and the two systems overlap.
Many people may be familiar with the simple mnemonic DRABC, and that is what we shall use.
D Danger - check for hazards, risks, make sure you are safe. There's no point us having two dead people, so check for live wires (they might have been electrocuted etc) and make sure you are safe from cars etc.
R Response - try to work out if they are unconscious. They may be semi-conscious, in a drunken stupor, or post ictal (recovering from a seizure). If they are unconscious, or you are worried about them, call for help - this includes other people nearby, as well as calling the ambulance. Often it can help to be specific - instead of saying "can anyone help me!" specify someone ("excuse me, miss, you in the blue dress, I need your help please").
A Airway - Open their airway. You might have heard of people "swallowing their tongue" and dying. You can't actually swallow your tongue, but when you are unconscious it can fall back and block your throat, so the first thing to do is clear the airway. You should have a look in and see if there is something blocking the airway - gum, false teeth, vomit. If there is, turn them on their side and scoop it out. (yes, I know that sounds gross.... it is)
Once they are back on their back, the best way to get the tongue off the back of the throat is to tilt their head back. You can also lift their chin up with a finger under it, or thrust the jaw forward by putting your thumbs behind the angles of the jaw and pushing it forward - try it on yourself, it hurts a bit if you are conscious, but it works!
At this point, you should look for signs of life. No signs of life = Unconscious, Unresponsive, Not breathing normally, not moving.
B Breathing - Often clearing the airway will be enough for them to start breathing again. To check for breathing, put your ear near their mouth and listen for breathing, feel any breaths on your ear/face, and also watch the chest for movement. Do this for about 5 seconds, at the most 10 seconds, and if they are not breathing normally, give them two breaths. You do this by sealing off the nose by pinching it shut, opening their mouth, sealing your mouth over theirs and blowing. Keep their head tilted back so the airway is open, and look for the rise of the chest. Allow them to breathe out and then repeat.
C Circulation - It used to be that you checked for a pulse to see if the heart is beating, but now the suggestion is that if there are no "signs of life" you proceed with chest compressions. (Pulse checks just waste valuable time)
So, chest compressions. You find the sternum, the breastbone. This is what you compress. The general rule is that you have the palm of your hand on the lower half of this. Roughly, the part of your hand closest to the person's head is between the nipples, if that makes sense. (**Discard this rule if big breasts or droopy breasts~! :P**)
You press down on this bone, and it's a very odd sensation, I assure you. Rough guide is that you press about a third of the depth of the chest. You need to do 30 compressions, and you are aiming for about 100 compressions per minute - it's fast. Counting aloud helps. After 30 compressions, stop and give 2 breaths, or let your assistant do so. Then start again... After 5 cycles, 2 minutes, stop and check for breathing and signs of life. If there is someone else nearby who knows CPR, swap with them - trust me, it will hurt and you become less effective when tired.
Continue until either the ambulance arrives or you are too exhausted to continue. Adrenaline kicks in, which helps, but if you can't go on, it's ok to stop.
When you do compressions, a rib might break or something. KEEP GOING! Remember, they are essentially dead without the CPR, so a broken rib or two doesn't matter one bit. Just make sure the heel of your palm is in the centre of the chest, along the breastbone, and keep going.
You can't really do much harm if their heart isn't beating, they are dead already - you are just giving them a chance to live.
People have been known to save lives doing CPR when copying what they have seen on Baywatch - inexperienced CPR is better than none at all!
Right, I don't know that that makes any sense, nor that anyone can read through it. However, it's information that might save your life or someone else's some day. If you have a question, feel free to ask, if I have missed something, got it wrong, or it just doesn't make sense (likely!) let me know... and I thoroughly recommend a first aid or CPR course if you have the time. :)
Today I thought I would do something different. As some of you may know, I am currently doing Cardiology, in particular attached to the Coronary Care unit (mostly cos the doctor on duty there the first day was cute and Welsh and actually made an effort to include me, but I digress).
It's pretty unhelpful in terms of exam preparation - basically once you've seen one heart attack, you've seen them all, there's not that much variation in their presentation, diagnosis and treatment. However, this week, I have had TWO young patients come in who had had cardiac arrests (their hearts had stopped working), and in both, the only reason they are alive now is because bystanders did CPR and kept them alive until the ambulance arrived.
Despite what you might see on TV shows, the number of people who survive cardiac arrests is abysmally low. On TV its something like 80% survival, whereas in reality its less than 20%. There are a grand total of TWO things that make a difference in survival rates.
1) Prompt effective CardioPulmonary Resuscitation (CPR)
2) Prompt effective Defibrillation (use of the machine where they zap the chest, usually after someone has shouted "CLEAR!" loud enough to wake the dead patient, at least on the TV version)
So, most of us don't carry defibrillators in our pockets, and although they are almost idiotproof (some of them speak and tell you what to do!) most people don't feel comfortable in using them. Which is fine. Ambulance officers and doctors do it all the time, leave it for them. What you need to do, if you are the bystander, is keep enough blood circulating and oxygen reaching the brain until the paramedics arrive.
Now, let me start by saying that these instructions don't compare with doing a first aid or resuscitation course, and if you have done one of those and the teaching is different, use what you are comfortable with or remember - it doesn't matter that much. The guidelines and teaching has recently changed (Nov 2005) and although the changes are designed to simplify things, there is of course a lot of confusion as the new guidelines are implemented and the two systems overlap.
Many people may be familiar with the simple mnemonic DRABC, and that is what we shall use.
D Danger - check for hazards, risks, make sure you are safe. There's no point us having two dead people, so check for live wires (they might have been electrocuted etc) and make sure you are safe from cars etc.
R Response - try to work out if they are unconscious. They may be semi-conscious, in a drunken stupor, or post ictal (recovering from a seizure). If they are unconscious, or you are worried about them, call for help - this includes other people nearby, as well as calling the ambulance. Often it can help to be specific - instead of saying "can anyone help me!" specify someone ("excuse me, miss, you in the blue dress, I need your help please").
A Airway - Open their airway. You might have heard of people "swallowing their tongue" and dying. You can't actually swallow your tongue, but when you are unconscious it can fall back and block your throat, so the first thing to do is clear the airway. You should have a look in and see if there is something blocking the airway - gum, false teeth, vomit. If there is, turn them on their side and scoop it out. (yes, I know that sounds gross.... it is)
Once they are back on their back, the best way to get the tongue off the back of the throat is to tilt their head back. You can also lift their chin up with a finger under it, or thrust the jaw forward by putting your thumbs behind the angles of the jaw and pushing it forward - try it on yourself, it hurts a bit if you are conscious, but it works!
At this point, you should look for signs of life. No signs of life = Unconscious, Unresponsive, Not breathing normally, not moving.
B Breathing - Often clearing the airway will be enough for them to start breathing again. To check for breathing, put your ear near their mouth and listen for breathing, feel any breaths on your ear/face, and also watch the chest for movement. Do this for about 5 seconds, at the most 10 seconds, and if they are not breathing normally, give them two breaths. You do this by sealing off the nose by pinching it shut, opening their mouth, sealing your mouth over theirs and blowing. Keep their head tilted back so the airway is open, and look for the rise of the chest. Allow them to breathe out and then repeat.
C Circulation - It used to be that you checked for a pulse to see if the heart is beating, but now the suggestion is that if there are no "signs of life" you proceed with chest compressions. (Pulse checks just waste valuable time)
So, chest compressions. You find the sternum, the breastbone. This is what you compress. The general rule is that you have the palm of your hand on the lower half of this. Roughly, the part of your hand closest to the person's head is between the nipples, if that makes sense. (**Discard this rule if big breasts or droopy breasts~! :P**)
You press down on this bone, and it's a very odd sensation, I assure you. Rough guide is that you press about a third of the depth of the chest. You need to do 30 compressions, and you are aiming for about 100 compressions per minute - it's fast. Counting aloud helps. After 30 compressions, stop and give 2 breaths, or let your assistant do so. Then start again... After 5 cycles, 2 minutes, stop and check for breathing and signs of life. If there is someone else nearby who knows CPR, swap with them - trust me, it will hurt and you become less effective when tired.
Continue until either the ambulance arrives or you are too exhausted to continue. Adrenaline kicks in, which helps, but if you can't go on, it's ok to stop.
When you do compressions, a rib might break or something. KEEP GOING! Remember, they are essentially dead without the CPR, so a broken rib or two doesn't matter one bit. Just make sure the heel of your palm is in the centre of the chest, along the breastbone, and keep going.
You can't really do much harm if their heart isn't beating, they are dead already - you are just giving them a chance to live.
People have been known to save lives doing CPR when copying what they have seen on Baywatch - inexperienced CPR is better than none at all!
Right, I don't know that that makes any sense, nor that anyone can read through it. However, it's information that might save your life or someone else's some day. If you have a question, feel free to ask, if I have missed something, got it wrong, or it just doesn't make sense (likely!) let me know... and I thoroughly recommend a first aid or CPR course if you have the time. :)