CPR: Does it Really Keep You "Stayin' Alive"?
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- Опубликовано: 9 июн 2024
- Roger Seheult, MD of MedCram examines the situations in which CPR may or may not be effective. See all Dr. Seheult's videos at: www.medcram.com/?Y...
(This video was recorded on July 1st, 2023)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.com/?Y...
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
LINKS / REFERENCES:
For many, a 'natural death' may be preferable to enduring CPR (NPR) | www.npr.org/sections/health-s...
CLOSED-CHEST CARDIAC MASSAGE (JAMA) | jamanetwork.com/journals/jama...
It isn't like this on TV: Revisiting CPR survival rates depicted on popular TV shows (Resuscitation) | pubmed.ncbi.nlm.nih.gov/26296...
What CPR means to surrogate decision makers of ICU patients (Resuscitation) | pubmed.ncbi.nlm.nih.gov/25711...
Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis (Cardiovascular quality and outcomes) | pubmed.ncbi.nlm.nih.gov/20123...
Trends in Survival after In-Hospital Cardiac Arrest (NEJM) | www.nejm.org/doi/full/10.1056...
Long-term outcomes after in-hospital CPR in older adults with chronic illness (Chest) | pubmed.ncbi.nlm.nih.gov/25086...
DNR Code Status Explained Clearly (MedCram) | • DNR Code Status Explai...
Ultrasound Courses (MedCram) | www.medcram.com/collections/u...
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#CPR #cardiac #survival
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37 years in EMS, 33 as career firefighter-Paramedic in a suburban setting. Surviving a CPR event to walking out of hospital is so very low.
So many different renditions of AHA protocol’s of CPR and the medications used, really made no difference, unless, good hard and fast bystander CPR was started and an AED was used within the first 5 minutes. The Down time is the bummer of nature.
When did the heart really stop pumping?
5 minutes passed the last, blood pressure producing heat beat is the point when devastating brain damage happens. Not to mention when does the Patients Cyclic ATP stop working?
In my experience, the Unknown down time CPR patient’s rarely leave the hospital being more than technically alive.
Although, the Heart muscle itself can be kick started with enough Epi, vasopressin, shocks, CPR, but the brain is the key factor in all of it.
I feel that the general public needs to taught the reality’s related to death events.
1. Death happens despite best efforts and wishes of the living.
2. Being taught the signs and symptoms of: AMI, PE, AAA, and CVA and what to do if you or a loved one have those symptoms, might lead to a longer life for you or that person.
3. Learning good CPR, and Basic First aid skills might save a life.
My 93 year old mother refused to sign a DNR.
When the Dr explained that she may have broken bones if she has CPR.
She said..."No, I don't want that."
So if your heart stops you don't want CPR?
She said, "of course, if my heart stops."
Just saying, most elderly don't understand.
Opposed to recreational CPR?
My grandmother had CPR and suffered broken ribs in her late seventies. It was delightful to hear her complain of rib pain for two months and to hear her for years and years thereafter, alive. Everyone who is able, please take and maintain CPR education.
@@coronalmassejectionsdontcare Yep - it is part of the scene. We can't depress the rib cage the required two inches without expecting to break ribs in the process.
As a RN, even if you find someone who is obviously dead, even stiff... you are required to call a code and start CPR. At least in the 80's.
@@pantameowmeow.s.1149 - so maybe you should check your facts before you repeat something you're not sure is even factual.
Canadá is allowing euthanasia just recently passed more permissive rules. Many people because of fear or mental illness would choose that program. But these people with a little help could live long happy life instead.
@@pantameowmeow.s.1149 - Yes, but a physician can end the resuscitation and declare death if, in his/her/their opinion, resuscitation is futile.
Outside the hospital, if one begins CPR, then one is obligated to continue until qualified help arrives or the rescuer is unable to continue (risk to or incapacitation of the rescuer, dangerous scene, impending danger, etc.)
This is a good reminder to us all. I'm a retired career RN with years of ACLS. In that terrible moment when my husband postured seated next to me in the car, in the middle of nowhere , I drove like a bat out of hell to a tiny community. It was there that I evaluated him. No pulse. I knew that to stop on a dirt road alone and attempt CPR was futile. I remembered these studies while I was driving. Even though I live with a level of guilt for not having tried, I know it was the correct decision.
Wow, I can only imagine how terrible that must have been. You are right it was the correct decision.
To reduce the incidence of broken ribs... the mechanical engineer in me wants to propose that chest compressions be done by pressing the sternum NOT straight perpendicular inward, but instead on a downward angle toward the navel.
This would achieve the same amount of volume change in the chest cavity, but would do it by letting the ribs rotate downward more (which is how the rib cage normally works) and flex/ bend less (which the rib bones are NOT built for). This angle of action puts less of those fracture-causing stresses on the rib bones.
Medical and CPR instructors like to have students understand the ribs as leaf springs that flex (bend) to change volume in the chest cavity, but this is not mechanically correct: No place in nature do bones ever evolve for the purpose of bending.
How the rib cage actually works is that the soft ligaments anchoring both ends of each rib allow the ribs to rotate up and down, thereby changing chest cavity volume.
Any reasons why this proposal might not work a lot better? It would be way more clear to draw a diagram instead of trying to describe it with all these words.
The aim is compression of the heart, not the chest in general. I was taught to find the xiphoid process (the cartilage at the vertex of the soft V below the ribs) then move up three fingers width so we don't break the xiphoid process.
Before I retired I had OSHA mandated CPR training every two years. We got the short form of what you presented, but with a broader view. Don't exceed the limits of your training, activate EMS (call 911) first, turn to an AED if available - safer and more effective, and once CPR is begun it can only be ended if the patient regains heartbeat, or you are relieved, or are exhausted. It was clear an AED doesn't help if the heart is [edit: not] in fibrillation, but it wasn't clear if CPR would help a quivering heart.
However, I may have saved a life or two _before_ they needed CPR. The most recent one was our 50ish contracted mail delivery guy. He arrived one morning about 8:30, sweating profusely on a cool morning. He seemed exhausted and said the phrase that makes my hair stand on end: "I don't feel good." I asked what I always ask when somebody says that: "What kind of don't feel good?" He said he didn't sleep well - another common complaint for people having heart attacks - and blamed that for his ill health. He said he was barely able to make it the three steps up to the building next door. I urged him to call 911 but he wouldn't hear of it, so I called my boss and he arranged to have him diverted to the nurse at his next stop. I don't know any more but I never saw him again. I can only hope, but no broken ribs and a better chance of survival.
The biomechanics of doing CPR on a floor as opposed to a hospital bed is significant. When I did CPR on a moving gurney I was almost always stretcher surfing with my partners handling the stretcher. CPR is physically much easier if the patient is lower to the ground, and I don't think hospital beds drop that low. If the patient is very large and the person doing chest compressions is small, they need all of the height advantage they can get. If they are standing on the floor I think it would be hard to maintain proper positioning unless the bed or gurney were lowered a lot. At the time I worked in EMS I was in better shape and did some occasional pushups.
Unfortunately, most physicians where I'm at employ CPR not as a bridge but as a knee jerk reaction. They also order things not for their diagnostic-therapeutic value but as litigation barriers.
Unless you live in Seattle where you must know CPR to graduate high school, out of hospital saves are rare...former NYC EMS Paramedic. Combination of no bystander CRP and average EMS arrival to the door, not the patient, exceeds 6 minutes. The patient, unless young and healthy is already brain dead before CPR is started. Sad
Judy.. I consider your statement as irresponsible and, due to lack of full sentences, far from clear or supported with facts. There are many lives saved through bystander-performed CPR. Further, many people for decades and far beyond Seattle high-school students have been trained in and performed life-saving CPR. (All of these facts are searchable). It’s important to have as many people as possible trained, which can be done through The Red Cross, if not other avenues. It would also be helpful if more schools nationwide ensured proper training. But please don’t deny it’s efficacy and discourage awareness of its necessity by such blanket, vague and unsupported statements as you’ve made.
If your opinion is too often no trained bystanders are available and more would save lives, please say that. Thanks.
We’re living in a dangerous time when a huge number of people take snippets of claims to found their beliefs and construe opinions into facts without applying critical thinking and seeking education (also searchable). For these reasons I think great care needs to be taken with online statements. All the more when proclaiming any national problem exists without stating clearly what issue needs to be investigated, understood better and changed. Take Care
@@peaceshepherding529 Clearly you don't read English well.
@judy-uv1bk - The ability to perform high quality CPR is a perishable skill. But even so, I think it's wise to teach teens. Poor quality CPR may be better than no CPR at all. My one experience with out-of-hospital CPR involved a man down on the sidewalk, unresponsive and pulseless. There were about 4 bystanders, one on the phone with 911 but no CPR was being given. I began CPR without assisted breaths because his mouth was a bloody mess and I had no shield, and continued it until EMS arrived shortly thereafter. I did not get ROSC. His arrest was unwitnessed and I suspect he did not survive.
@@wickedcabinboy It's been 7 years since my last training, and age has sapped my stamina, but I could probably do better than nothing. CPR is a last resort on a person who is known to be dead: no pulse, no respiration. We can't restore life most of the time, but we can give the experts a bit more time to arrive. (My last couple trainings included the option of compressions only.)
@@flagmichael - I absolutely agree. The chance, slim as it is, is decidedly worth the effort.
Hey Roger, in 2014 my best friend had a massive heart attack at the age of 37 (smoker, history of surviving heart attack at 26 due to being worked 120 hours/week at a newspaper, currently abusively changing schedule that could have him getting up as early as 4 in the morning or coming home at 10 30 at night) He was found in about 10 minutes and given CPR by one of his managers and I spent 3 days with him in the hospital before they said he would never be able to breath again independently even if he regained consciousness and his family said to unplug him.
I remember a doctor there said that "91% of out of hospital heart attacks don't survive sadly" and I was so angry at him (although I kept it to myself) I couldn't believe that that was true, and it made me feel like he didn't want my friend to recover. I've known for a long time now it was true.
Unfortunately, "survival " is relative.
To me, you haven't survived if you are brain dead.
I carry a dnr with me at all times .
Unfortunately, it probably won't be abided by.
I'm sorry.
Discharged isn't necessarily home, it can be to a " long term care facility ".
It doesn't indicate return to normal function.
Dr Glaucomfleckins wife did 10 minutes of compressions at home with 911 on the phone and he is back to normal. Don't know what his rhythm was but he is a good example of a good save.
And she's not in the medical field. 😊
She is a rockstar, for sure. That must have been grueling!
@@norniea Ten minutes is amazing!
We learn a lot from this channel. We wish them all the best.
Very insightful....
I’ve worked many codes -- and prefer to let my body and soul go gently when my time comes -- ribs and lungs intact.
what do you mean by codes?
@@zahiddigital8301 An team of doctors and nurses responding to a patient requiring resuscitation, or in need of other immediate life sustaining attention -- usually following respiratory or cardiac arrest. Less than 1 in 5 survive, and that’s often with significant impairments.
This was very interesting. Did not know the rates were that low. I took CPR training. I know it can be brutal. Yet, people desperate to save loved ones, sometimes it works.
Sometimes a long shot is the only shot.
Maybe we should show patients videos of what it looks like. It would be easy enough. But certainly the topic deserves more than the 10 seconds typically devoted to it!
thank you for posting a link to the article "For many, a 'natural death' may be preferable to enduring CPR"
I have a DNR order for precisely this reason.
Useful video thank you. Being Mortal by Atul Gawande made me think about this earlier. Discuss resuscitation and end of life care with family and document your wishes.
I survived an Out-of-Hospital Cardiac Arrest 3 1/2 years ago. I was 46 when it happened, which they consider fairly young. It was precipitated by a STEMI caused by an In-Stent Thrombosis on a stent that had been placed 6 1/2 years earlier to open two blockages next to each other in my LAD of 90% and 99% (as opposed to a re-stenosis).
My Vtac/V-fib was was witnessed by EMTs and they got me to the ambulance quickly and used a LUCAS device to perform compressions and bagged me because they had trouble intubating. I'm not sure if the EMTs did any manual compressions or just went straight for the machine. The EMTs worked on me in the ambulance outside my home for 20-25 minutes and even had paramedics drive up to help, but each time they shocked me and got me back, they'd lose me again. The fire chief drove up too, and after the third shock failed, he told them to take me to the nearest ER. The ER achieved ROSC somehow. I'm told I received CPR for 40 minutes.
It was getting late and this was a small hospital, so they put me into a hypothermic coma and sent me by helicopter to a regional trauma center. They cathed me and aspirated the clot. They told my mother they weren't willing to do anything more invasive and expensive like Coronary Artery Bypass Graft because they didn't know if I was braindead or not. They wanted to bring me out of the coma and check my brain function first. I was in a coma for about a day and a half to two days before I woke up. Apparently, I didn't need CABG.
I had several complications, but broken ribs wasn't one of them. I wonder if it was the machine's consistent compressions or my natural joint flexibility (AKA double-jointed). However, I did have problems with my lungs: pulmonary edema, partial collapse, and intubation pneumonia with bloody cough. I had other issues too: DVT in one leg; acute kidney injury; ischemic colitis, anemia, and my chart said Hypoxic Ischemic Encephalopathy. I'm not sure how severe HIE is, because my mental ability mostly came back with only minor aphasia, and I wonder if some of my remaining brain fog is due to anemia and medicine side-effects. I also had really bad sciatica that may have been caused by immobility during the coma, which lasted for 6 weeks and made walking, standing, sitting, and laying down extremely painful.
I know DVT sounds minor, but they gave me a blood thinner for it. The blood thinner caused the Ischemic colitis lesion to start bleeding. That resulted in my H&H crashing which required transfusions. This presented a dilemma: stop the blood thinner and risk the clot breaking and going to my lungs and causing a pulmonary embolism, or keep using the blood thinner and risk further anemia and intestinal injury. Luckily, there was a third option: they installed an IVC Filter to catch any clots and then they were able to stop the blood thinner and the bleeding resolved within a week. All in all, I spent a month in 3 hospitals: ER; CCU (Critical Care Unit) and cardiac floor at an acute care hospital; rehab hospital; back to the acute care hospital where I was in IMC (Intermediate Care) then general wing; back to rehab hospital.
Now, we get to the question of the day: "Would I want to do that over again?" Um... due to my current age (50) and resiliency, I suspect I'd survive again. But I hesitate to say for sure. I have no family of my own, no wife/gf, and I'm currently dealing with PTSD due to the event and unemployment. I was thankful after waking up. However, my convalescence was interrupted by the pandemic, and all the political arguing about that and the election. It all makes me wonder whether this is a world I want to come back to.
Question: Do you think the use of a LUCAS or similar device might be helpful in a hospital setting or in other settings? When I mentioned it to some of the nurses treating me they had never heard of it and wanted to look into it.
Good god. My daughter's boyfriend just got out of the hospital after having 17 clots aspirated with no pain medication which I do not understand.
@jakeaurod
Lucas applied consistent chest compressions and reduced the risk of rib breakage. This combined with EMS beginning CPR so quickly is what helped you survive. I pray you overcome the PTSD and regain your ability to work again.
Later Studies indicate actually improved in hospital aswell out of hospital survival and ROSC (Return of Spontaneous Circulation) by 5%-10% with using LUCAS i know its little but imroving compression efficiency and consistency seems to matter aswell as breathing assistance with Oxygen the most improvmento of survival always came from using oxygen when intubating that is a stat the not alot of paramedics know .aswell miss it alot .
God bless you, you've been through so much! I went through a life or death situation (related to pulmonary necrotizing faciittis) that required a 4 week hospital stay, one week in ICU and three on the general care floor, and a year bedridden being cared for at home because I didn't have insurance for a rehab hospital. I was grateful for having family.
I'm praying for you for guidance, support, love and help to get you through this. There's no telling what form(s) this might take.
You must be here for a very special reason. Embrace faith and hope, knowing this too shall pass, and that this too shall work together for the good, to those who love God and are called according to His Purpose. (Rom 8:28) ❤
As always sir, YOU KNOW YOUR STUFF 😊😊
WHAT ABOUT THEM PFAS Chemicals?
Thank you for this valuable, clear and concise explanation, dr. Seheult!
As usual, very informative video Doc! Most people believe that performing CPR always saves someone's life. Obviously, as you have demonstrated, that is not the case. Thanks for these videos and for keeping us informed! 👍👍
Medcram, it would really helpful for you to explain what a POLST is any other forms of documentation we need to have as part of our medical record. Since I believe just having DNR is not enough. Correct?
A POLST is a nice thing to have but it is not absolutely required. It does give you a bit more flexibility on specifically stating what you want. It has to be signed by a physician for it to be valid.
Dr. Do you know "muon"? Does it make us thought/mean? Thank you very much.
I was lucky but after watching the above, it appears that I was extremely so - symptoms leading to realisation - paramedic arrived in about 5 mins - first cardiac arrest after about 10 mins - I came around after ambulance with 2 more PM's arrived - 40 mile journey to Belfast with a half way detour to another hospital for stabilsation & to give a break to worn out PM. The next day the 2 latter PM's visited me after transfer to a cardiac ward & while jokingly complaining about the paperwork I had caused them, informed me that I had in total been unconscious 5 times, with the last occurring outside the final hospitals entrance, when they thought that they had lost me, while I remember having a short NDE. I had an emergency angioplasty with one stent. I was 57 at the time & afterwards for around 5 months suffered due to torn intercostal ribs. I have been fine ever since & just take aspirin while not behaving like an idiot by undergoing circuit training meant for much younger men - thank you for all of your great work Dr. Seheult.
Natural Death is a way hospitals try to kill people they do consider worthy of living.
I just went through this issue with my father last September.
The hospital staff tried to coerce him into dying. I recorded the conversation.
He had to give a reason he wanted to live, but of course no reason for dying.
Hospitals do not value the elderly.
Hospital staffs are not trailed in high-performance CPR.
Hospital staffs do not value religious values or directives.
I was recently at an EMS conference, and the EMS person told me that ribs should not be broken. Cartridge yes, ribs no!
Excellent video. Thank you. 25 years ICU RN here. In 2011, My 94 year old dad was admitted to the ICU with PNA, emergently intubated in the ED, and a HX of smoking and COPD, on home oxygen. In addition he was maxed out on 4 pressors with SBP 100 - 105 for two days. It was time to allow natural death and my mother and brother and his two adult sons agreed and we made him a DNR with a plan to withdraw support in 24 hours. Then his nephrologist entered the room and without speaking to us first, declared that he could recover from this if we waited two or three more days. I was absolutely furious with him as he had no business involving himself with this admission. And we had not asked his opinion about anything at all. He was a Nephrologist.
One of my nephews then accused me of "giving up" on my dad. While we were in the midst of this discussion outside the room that same nephrologist walked by. I pulled him into the conversation. I insisted he describe what my father's quality of life would be like should he survive with no complications. It would likely mean admission to a nursing home and probably followed by a rapid series of illnesses requiring readmission to the hospital and ultimately his death, likely within a year. My father had said he absolutely did not want to go to a nursing home. Ultimately I was able to persuade my nephew to agree not to go down that road. Twenty four hours later with no change in his condition we said our good byes and withdrew care. He died peacefully and with dignity. I'll never forget that day. Nor will I regret our decision.
But, to this day, what that Nephrologist did still churns my stomach. His actions caused unnecessary and unwarranted emotional upheaval in our family for no reason other than his failure to review the notes in my father's chart before speaking to us.
@@coronalmassejectionsdontcare - agreed. But family is family and even distant relatives can throw a monkey wrench in family medical decisions. I've seen it happen way to often and I wasn't having it.
it happens alot in my country, I am from the most corrupted countries in the world. Hospitals are like big mafia here, They intentionally put people on ventilators despite knowing the survival chance is low and even if the person survived, there would be alot of complications and quality of life would be really decreased.. and all for what? for money.. $150 for a single day on a ventilator.
@0neOver0neThreeSeven what do you think on what should be the things on which we should decide if we are going to allow CPR or not?
@@zahiddigital8301 - This happens in the U.S. very often as well, but corruption isn't the reason. As a society we value every second of life over quality of life. So families will insist that everything possible be done, even if it will be futile. This is not universal but happens so often as to be a very serious problem. End of life medical expenses for the frail elderly - who are unlikely to experience better quality of life - are astronomical.
@@zahiddigital8301 - That's a difficult question to answer. It depends on so many variables that no one can answer for anyone else, especially in a medical system where the family has nearly unlimited say in the matter.
Factors such as patients' wishes as verbally communicated to immediate family (as my father did), whether or not the person has a written advance directive in place. family dynamics, societal/cultural/religious background of the family/patient; socioeconomic status and educational background of the family/patient, patient age, gender, past medical history, the nature and history of the current illness or injury. Medico-legal factors (are the police involved?) and hospital capabilities all contribute to the decision to resuscitate or not. There may well be other factors that I've missed.
This can be an extremely difficult decision in the moment the heart stops, with intense emotions effecting caregivers' decisions, so it's extremely important to have an advance directive in effect that outlines the patient's desires with regards to resuscitation in the case of impending death or sudden death.
Thank you for the information. This is what people with serious heart should know. It could help with making important decisions and help family understand also. ❤️💓♥️💓♥️
I graduated from med school in 2022 and I am now working in isu in cardiosurgery. I am nowhere near an experienced doctor, but I have my observations . More than three quarters of the patients that need CPR at some point end up diseased. Sure we stabilize them hemodynamically , but most of the time they need another CPR and another until the end. My observations are probably not very viable because where I work, but they seem to match with your data.
Hey, I know Jason. Good dude.
Very interesting and thoughtful. I'm not a physician. It seems to some, me, that it is really hard to predict with clarity whether your personal circumstances are such that CPR makes sense. Too many variables.
Unconscious & not breathing.
Calling 911 is always top of the list. Get the professionals coming ASAP and follow instructions from the voice on the phone. If you are not trained, or not recently enough (like me) getting people out to direct the pros to the scene is probably more important. I would be doing well to extend the five minutes or so of grace period to six or seven.
@@nancyd7441 That reminds me of another tidbit from CPR training: a pulse can be hard to detect in the stress of taking on responsibility for the human who is lying inert on the ground. If the victim is breathing his heart is beating.
@@flagmichael Yes , normal breathing which sustains life & to keep monitoring till EMS arrives and takes over .Except for agonal breathing. Agonal breathing =no.breathing.
@@nancyd7441 Good point.
Very helpful to a lay person in clarifying what my choice, which I will document, would be. Thank you.
If you are dead a couple of boken ribs won't bother you
...and the first step in CPR is to confirm the victim is dead - no breathing, no pulse.
Actually, as the video states, pumping blood (CPR) will make an alive patient conscious to feel the ribs break.
@flagmichael without medical training you are not allowed to make that call, at least not in my country
@@candersson7419 Not declaring the person dead, but here it is a formal part of the training for performing CPR. Performing CPR on a living person can kill them.
@@flagmichael you are correct
Of course it should said if you is somebody in the world whose heart is stopped and there status is unknown it is appropriate to administer cpa if one knows how.
We have a repeater who’s been resuscitated 3 times in less than 6 months. The family are idiots and actually bring him food that defies his renal/cardiac diet to the hospital. I can’t believe he’s alive.
My 93 year old mother was in stage 4 kidney failure as a Care Home resident.
My sister kept bringing her cases of Snapple to drink to stay hydrated! Sugary Snapple!!!!
@@ithacacomments4811 🤦🏻♂️
so in normal language, is it a good idea to agree to CPR? do the benefits outweigh the risks?
As always, "it depends".
For example, I'm a 60 year old nurse with a family history of CVD. During COVID I was DNR/DNI specifically because I didn't want scarce resources wasted on me. Now, I'm full code due to (a) emergency's over (had COVID and I had a mild reaction to the infection) and (b) had an echocardiogram recently which showed my heart is fundamentally healthy (still trying to get a CAC to see about atherosclerosis).
Can't really say for anyone else (being a nurse I can't give specific advice) but that's how I look at it. HTH.
I believe we are allowed to help other humans. Yes, we would like people to survive, but the real beauty is when
people care enough to TRY. I also believe when it's your time, that is that. But the ability of the human to think of
someone other than self, maybe a complete stranger, and try to give life back, is far more beautiful, to me, than the acutality
of the life coming back. We are not God, we don't hold that power. We don't know why it is now or not now. But we can be
part of the great circle of life and do what we can.
Will you be the one recording the dying with a cell phone, or will you drop down and get busy?
Too many these days just start thinking of the hits they will get on social media when they upload the video.
Thank you for breaking this down for folks. Some get really discouraged when someone doesn't make it. I see it as not my call,
just my place to help if I can.
Are you with or against use of peep valve during cpr bagging...?
If you have one available, yes. My primary nursing practice was in a PICU where we used anesthesia bags so a peep valve wasn't necessary.
depends on the situation.
@@rogerseheult1312 - very few answers in the field of medicine are straightforward. Very few.
If ribs are going to break anyway, maybe it makes sense to break them intentionally, in a place where it's less likely to cause damage. Hitting someone in the chest with a hammer might look bad, but if it saves lives, it might be worth trying.
In CPR training we were always warned to never exceed our training; good samaritan laws won't protect us if we do.
The basic principles on how to perform a CPR without breaking ribs would have been welcomed. It's the premise of the whole discussion.
In training I was told that broken ribs and vomiting are nearly universal when victims receive CPR. The requirement for 2 inch depression of the chest almost guarantees broken ribs. We were told "if it sounds like you are crushing Rice Krispies you still have to continue because the guy will stay dead if you stop." After all, the first step in the CPR process is to verify the victim has no respiration and no pulse - we don't perform CPR on living people.
@@flagmichael thanks for the info, I guess it depends on the person's age too, cartilage vs calcification. There's more to it undoubtedly.
@@flagmichaelgranted it was more in terms of using the spare AED stickies to yank out the hair on a chest rather than use the razor but my instructor noted, "He's dead! If he minds you've improved matters!"
what's your opinion on giving CPR to people who are suffering some other disease such as diabetes, blood pressure or have some underlying cause such as VT? I mean, is it really beneficial to bring back the person if the doctors at the first were not able to cure the underlying cause? wouldn't this cause more pain with number of things (not in everyone but I have heard in most) such as permanent neurological damage because not enough blood is getting to their brains, broken ribs, injuries to liver, airways internal bleeding and pulmonary complications. So after a person is back, he/she now have to deal with these things alongside the primary underlying cause... what do you think? and educate me.. How long without a pulse before brain damage?@@flagmichael
Needle decompression for tension pneumothorax?
Leave that stuff to the trained professionals. If we exceed our training Good Samaritan laws do not protect us.
@@flagmichael That doesn’t exceed my training. I was a combat lifesaver in the US Army.
Sure. but realize that it only converts it to a regular PTX. Still need a chest tube with suction.
@@Maryland_Kulak Good deal, but I would hate to defend it in court.
@@flagmichael Defend what? That I poked a tiny hole between someone’s ribs so he could inflate his lung?
there is also the problem of forcing blood and ox into the brain and icannot find the article that discusses this.
however, i clearly remember the damage that can be caused to the brain from CPR
just wish i could find the writting.
Reperfusion injuries?
Lots of bad effects, but the victim is dead to start with. CPR is a "Hail Mary" play.
@@flagmichael well, the entire point was, was it , is it, worth it?
the odds were shown as well as the likely after-effects that have to be lived with.
so.....why?????
@@paulpellico3797 No doubt about it - a full recovery is not exactly likely. There will probably come a time - not far away - when I will carry a DNR card and wear a Medic Alert noting that.
CPR was not invented to treat cardiac arrest. If you read the original paper, it was invented in the '60s to help patients with extreme hypotension as a result of mishaps while under general anesthesia.
Like for the clever title
At work we decided that the words are important, too: the Queen song, "Another One Bites the Dust" is also close to the compression rhythm, but may not be as suitable. Just sayin'.
@@flagmichael - especially if the family is present.
We need more medications to make hearts great again.
If
I read the article when it came out & pretty sure I Wouldn't want CPR in any situation. But then I'm in my 60's, I've had my day 😔
Ditto. AED yes, CPR no. The semiannual CPR training at work convinced me of that. I promised my wife many years ago that if I had cardiac symptoms I would go straight to the ER. I had to follow through on that once; as a buddy drove me there I called my wife and told her I was going there to rule out heart attack. It was ultimately diagnosed as a panic attack (common in our crisis driven job) and she knows I will do as I promised.
@flagmichael good call Michael. I'd get AED too, but not CPR. I've made the ER run for panic attack to rule out heart attack too 😔 not fun.
@@JackPackInTheWoods The sudden unexplained fatigue was what got my attention. I also had a sensation like a lump under my sternum; the cardiologist explained panic attacks often cause esophageal spasms.
One of the highest performers in the department was having panic attacks that forced him to take up to a month off once, and a man who worked near us suffered adrenal collapse from working two 100+ hour stretches in quick succession. He was on short term disability for nearly a year and looked like a zombie when he returned. He recovered completely over the next few years. I had been taking workplace stress too lightly.
If you need to switch after two minutes you should exercise more.
Physicians should have good and thoughtful talks with patients and families about their physical conditions and likely outcomes from CPR. The early recognition question is a separate issue if the patient is in a health care facility. By definition, the staff at health care facilities are not bystanders. Hospitals should have competence in early recognition and treatment of cardiac arrests. Out of hospital cardiac arrests have more variables to early recognition and early defibrillation. Of coarse the video raises the question about why CPR was not put in the greater context of working up a cardiac arrest, where restarting the heart comes from delivering a shock to a shockable rhythm. And Dr. Schwelt knows that. Which raises questions about the authenticity of this video. And the DNR wrist band was in my code color and photo edited. I want recusitationn and all the heroic efforts. Thanks.
We were taught two minute switchoffs if a second trained person was available. We did two minutes on the resusci-Annie (actually, "Ken") and it was draining, even though we were tower climbers. We just don't use those muscles often. It is not quite as tiring as doing pushups but it comes close.
" the video raises the question about why CPR was not put in the greater context of working up a cardiac arrest, where restarting the heart comes from delivering a shock to a shockable rhythm." This video does nothing of the sort. "authenticity"? There's no hidden agenda here. It's simply giving people a reality check about the procedure entails. It's called informed consent. Not many people know what the consequences are of such a procedure. They do know what Hollywood portrays. Read the other comments.
For the physical conditioning of doing CPR one could practice at home with a one gallon plastic water bottle with the cap on. It should be able to withstand the force of compressions.
Thanks🫀
Disheartening!
EVERYTHING.
Immediately go into a hyperbaric chamber.
Oh but our hospital doesn't have a room sized chamber.
That's a hospital problem.
F a DNR!
Too many doctors are are just fine with not having to work too hard, and besides there are organs to be harvested.
There's money to be made!
WHF ENTERTAINMENT did a nice little video on that this week.
Can you show us a selective DNR?
No thanks don't give me CPR. And myself I would not give CPR to anybody nowadays as heavy as everyone is and overweight now a days.
You should carry a DNR form in your wallet and a medic alert to indicate that. Even for CPR trained lay people, CPR is just an option. The guy is dead and ain't gettin' no deader. I have not been in that situation, but I would certainly start by calling 911 and following their directions. My training is almost 6 years out of date so I would hesitate to go down that path. However, looking for AEDs (increasingly common in many public places) would be on my agenda. Can't go wrong with those.