Call 911 and start compressions

[Van Canna]

http://www.heart.arizona.edu/news-info/ ... s/cpr2.htm

No mouth to mouth...the new standard...Bill?

[chef]

Yesterday when I was at the doctor's office, Dr. Oz's show was playing on there TV there. He said the following interesting remark on his show: "CPR is more effective when performed to the beat of "Stayin' Alive". Seriously."

So is the pumping action for CPR really that fast?

Vicki

[Bill Glasheen]

This is complicated, Van, in a way that weighs towards KISS (Keep It Simple, Stupid) for the untrained.

Here is the key line in the article, with a little bit of editing on my part.

The Seattle researchers concluded that CPR using chest compressions alone --- may be the preferred approach for inexperienced bystanders.

It's the same old thing, Van. An untrained person's physical capabilities go to hell in a handbasket when under stress. Standard CPR requires a series of chest compressions (5 or so) and then breaths (2 or so) in a back-and-forth sequence. It takes some practice and it takes some coordination. If you have neither, then this is just too complicated. And then we get into the whole mouth-to-mouth thing with a stranger in the age of HIV, herpes, etc. Teach someone how to do "standard CPR" over the phone when someone's on the ground having a heart attack? Forgetaboutit!

KISS is better than nothing.

That being said...

Dr. Ewy emphasizes that standard CPR is almost always essential in children and young adults.

In other words if folks would get their CPR certification from the Red Cross and regularly re-certify themselves, well then no problem.

Now... Here's the interesting part. And you're asking the right person because:

• I was doing my research in the UVa cardiology lab when a colleague was using an experimental mechanical chest compression machine nearby (on pigs).
• I ALMOST did my dissertation on high frequency ventilation. (The department chairman "stole" me from another principle investigator. Executive privilege you know...)
• I've been doing the "in-between" Sanchin breathing for years. I call it dolphin breathing because it's how a dolphin or a whale breathes - in-between the swimming under the water. These days I combine it with "being breathed" during the physical movements.

So why all this? It's a roundabout way of saying that when you are doing chest compressions, you are also doing Sanchin "dolphin breathing" at the same time. You are being breathed by the compression, but you are doing it in quick pulses rather than smooth inhale/exhale cycles. This creates turbulent air flow in the lungs, which causes good air mixing. That in turn means outside air is making its way all the way down to the alveoli (air sacs) of the lungs due to your compressions.

The pauses to do the two breaths are more "standard" laminar air flow breaths. It's good if you have that, but you might survive on the "being breathed" pulses alone.

I've often maintained that the reason the "dolphin breathing" (tsst breathing if you must) works is because of the turbulent vs. laminar air flow nature of the air movement. Turbulence causes eddy currents which cause better mixing. In the lab, you can ventilate an animal with a mere 5 cc tidal volume if you have the pump go 20 cycles per SECOND. Air exchange in-between the lung blood capillaries and the outside air happens as if by magic.

There's a whole lot to ponder here. If you understand first principles physics and physiology here, you can run with it in a lot of different directions.

- Bill

[Bill Glasheen]

Yesterday when I was at the doctor's office, Dr. Oz's show was playing on there TV there. He said the following interesting remark on his show: "CPR is more effective when performed to the beat of "Stayin' Alive". Seriously."

So is the pumping action for CPR really that fast?

Measure your pulse. If you're an average person, then it's around 60 to 80 beats per minute. I don't know what the recommended timing is for Staying Alive, but it sounds about right.

More importantly, "It has a good beat.... Easy to dance to... I'll give it a..." Disco is all about the beat. You can remember the beat of that song.

You may need to change the music though. Your kids will look funny at you. "The Bee Gees? Who are they?"

- Bill

[IJ]

This is part of a larger shift that's not just for untrained people. The objective of CPR is to get oxygen from the environment into the lungs and then to circulate blood through the lungs/heart and out to where it's needed: brain first, heart second, and kidneys and liver after that, and the muscles and guts can wait until there's spontaneous circulation. People get fixated on the breathing part, because it's so familiar and essential to life, and its something so visible. Our pulse on the other hand is generally invisible and less under our control. But it turns out focusing on the pulse is MUCH more important.

It doesn't take much to get sufficient oxygen into the lungs. The dead person isn't using much, and the oxygen content of the lungs falls very slowly because so little blood is circulating and removing it from the air within them. In anesthesia, we'll commonly unhook someone from the ventilator so the terrified med student gets an idea of how very long it takes for that oxygen level to drop. And that's with a pulse. The small amount of air needed can be approximated with the compression of the chest and subsequent elastic recoil. Think about it--if that method doesn't work, we're hosed, because that's how we're working the heart--squashing and releasing the chest. It moves fluids in and out or it doesn't.

On the other hand its remarkably hard to get blood flow going through the body. You have to compress the chest several inches, usually breaking ribs, at a very rapid INCESSANT rate to provide a small, basically inadequate blood flow. The flow and blood pressure are so low the expand-and-squeeze of the major arteries does little to provide constant flow, so what you get is intermittent, and often doesn't even produce a pulse. It makes no difference what oxygen is in the lungs if the blood isn't moving. In practice, things are often worse, what with the stop - start for respirations.

Thus circulation of blood is much more of a priority than breaths for air. Circulation is the rate limiting step. Even when professionals are present, even when the person has been intubated in the ICU and has a bag valve mask ready to squeeze air in, the current message is PRIME THE PUMP AND SPARE THE AIR. Over ventilation reduces blood flow because if you inflate the chest too much the added pressure reduces blood return to the chest. Further, excessive ventilation is thought to do other bad things such as cause dilation of blood vessels via effects on CO2 content and pH.

As for starting compressions first (while calling for 911 or right after doing so yourself), yeah, don't try to wake a person more than one shake/yell, and don't fool around looking for a pulse. Trained professionals asked to find pulses in ideal conditions (take your time, for example) frequently found pulses when there were none (on patients on bypass which is constant not pulsatile flow), and missed pulses that were present (in patients before bypass) in studies of pulse finding performance on bypassed or not patients in the OR. You frequently miss or find your own. YESTERDAY someone couldn't find a blood pressure on a patient of mine who was awake (trust me, he had one, and within minutes before and after it was 130-140 systolic). Thus, unless you really have no judgment, a person who looks dead IS, and the best thing you can do is circulate blood ASAP, before heart and brain are gone forever. If they wake up and curse, stop!

[Van Canna]

Interesting, Bill...once I gave CPR to a student of mine who collapsed due to an epileptic seizure...I had no idea it was a seizure...I was in a state of panic...thought he was going to die in my dojo.

I threw an handkerchief over his foaming mouth to do mouth to mouth along with compression...thankfully a short time later the EMTs arrived...knew exactly what it was.

So you recommend mouth to mouth and compression to a family member and just compression to anyone else?

I know I could not bring myself to do moth to mouth to some hapless victim....

What happens to someone with Chronic Obstructive Pulmonary Disease...suffering a heart attack?

[Van Canna]

Thank you Ian...for the information

[IJ]

Van,

We do compressions only now because of stories from the field such as a daughter who was doing compressions and saw her father coming to a little bit, only to lose consciousness each time she stopped to give breaths. No breaths. Just compressions. Good news either way is your infection risk is very low no matter what. HIV, hep B, hep C, all these things are spread by blood, and sputum and saliva are noninfectious unless there is visible blood. You can catch respiratory infections like the flu, I guess. But mostly its just gross and that's the hesitation.

COPD + heart attack can play out in so many ways based on the severity of each, from no symptoms to sudden death, just like in people without COPD. However, someone with significant COPD will have ischemic muscle sooner than someone without because they'll have less oxygen content in their blood and sometimes a few percent makes a difference. This is one reason why smokers infarct more often--there's less oxygen and more smoke in the blood that might be getting thru to the suffering heart.

[IJ]

No charge for you, Van!

[Bill Glasheen]

So you recommend mouth to mouth and compression to a family member and just compression to anyone else?

That works. As they said, it's better than no CPR at all.

What happens to someone with Chronic Obstructive Pulmonary Disease...suffering a heart attack?

Wow, that's a good one.

They are going to be a step behind before the attack. Already they have compromised breathing for one of several possible reasons.

My instinct tells me that "Standard CPR" would give them a better shot. But I'll check up on this with a pulmonary expert and see what they say.

- Bill

[Bill Glasheen]

Thus, unless you really have no judgment, a person who looks dead IS, and the best thing you can do is circulate blood ASAP, before heart and brain are gone forever. If they wake up and curse, stop!

Good one!

- Bill

[Van Canna]

No charge for you, Van!

Thank you Ian...you are a gentleman indeed and you have my respect for that.

I have a friend in the initial stages of COPD... who worries about the swine flue in addition to possible CV events.

Is there a way to contain COPD_ or is this an irreversible disease leading to death by suffocation?

[Jason Rees]

What happens to someone with Chronic Obstructive Pulmonary Disease...suffering a heart attack?

Same as anyone else. We're taught as EMTs to never withold Oxygen, including with COPD patients now. Used to be different. But with CPR...

30 compressions, 2 breaths for everybody now. It changes with 2 people doing it in some cases, and with advanced airways, but for the untrained layman, compress away!

I would say that any Instructor in anything (especially martial arts or physical sports coaches) should get themselves certified through an organization like the American Heart Association (I say like because I don't know anything about the others). Compressions only is ok for the average uninformed person, but every little bit helps.

[Jason Rees]

Swine flu + other medical conditions = UGLY.

My wife has a friend they're pulling the plug on this evening. She had asthma, and picked up Swine Flu at a wedding. She was hospitalized, and quickly deteriorated, then hovered for weeks now.

Now that they've done all the tests (why they took so long on some of these I'll never know)... she suffered a stroke, something attacked her brainstem, and her bone marrow is so compromised her blood cell production is pretty much at zero. Can anyone say Nosocomial infection?

[Van Canna]