But The Family Said…DO NOT RESUSCITATE!

Posted on August 19th, 2010 by Roy Shaw

A student emailed in a great question and one in which can be a very tough one to answer!      It’s challenging enough to get bystanders to begin CPR.  But when we complicate the scenario with a person yelling; “They have a DNR, don’t do CPR or you’ll get sued!”   This can really complicate matters.  What do you do?   Stop CPR and hope that the withholding of potentially life saving CPR is legitimate?  Don’t stop CPR and continue to upset the people that are yelling stop in the first place?   Whoa! Tough spot to be in.

In this episode I’m going to do my best to explain the very complicated issue surrounding Do Not Resuscitate orders(DNR) when CPR is already in progress or about to begin.

Sample of Proposed DNR Guidelines From BENO-Ethics

Tags: Advance Directives, CPR and DNR, CPR Stopped for DNR, DNR, DNR Liability, DNR Orders, No Not Resuscitate, ProCPR, procpr.org, ProFirstAid, ProFirstAid.com, Roy Shaw, royonrescue, royonrescue.com, royshaw

How to Give CPR to A Ventilator Patient

Posted on August 17th, 2010 by Roy Shaw

This week a student asked:

“I take care of a child who has a trach and is on a ventilator when he sleeps.  Do you have a course for cpr involving a patient with a trach if we were out and did not have access to a vent?”

Though we don’t offer any specific ventilator training, I thought this would be a good time to do a royonrescue episode covering this topic.

I didn’t want to delay this reply any longer than necessary so as Jody Marvin and I were on the road discussing training issues for ProCPR.org, I thought we would take advantage of the drive time and answer this very good question.

It’s hard enough initiating CPR or rescue breathing for a person who doesn’t have any special needs, but then when it’s complicated with something like a tracheostomy, it can really become confusing.  I hope this video blog helps clear things up.  Keep the training questions coming I think it really helps everyone who’s concerned about rescue and saving lives.

Best Wishes,

Roy

Tags: CPR, cpr for trach patients, CPR for Ventilator Patients, mouth to tracheostomy, procpr.org, ProFirstAid.com, royonrescue.com

How to Hit Your Head on Pavement at 17MPH and Survive!

Posted on August 5th, 2010 by Roy Shaw

Imagine riding your road bike and as you near a curve in the bike trail hitting speeds of around 17 miles per hour your front tire instantly goes flat.  Now you’re trying to corner on a metal rim sliding across the pavement which has as much traction as an ice skating rink.   This is exactly what happened to Tom Monett, cycling enthusiast, big mountain skier, hiker and mountain climber.  As Tom’s bike slid out from underneath him, he didn’t have enough time to catch himself let alone think about what was about to happen.  As his head hit the pavement, and his ribs began to break, his wisdom to ride with personal protective equipment most likely made the difference between life and death.  Watch this episode of royonrescue to see the full interview and hear his story about surviving a high speed cycling crash.

Concussion

Warning!  Video contains graphic pictures of injuries and accidents.

Video Gallery of Actual Bike Accidents

Tags: bicycle crash, bicycle safety, bike helmet, bike helmets, broken ribs, Concussion, flat tires on bikes, head injuries, helmet law, hitting your head, injury prevention, ProCPR, procpr.org, ProFirstAid, ProFirstAid.com, ProHomeSafety, royonrescue, royonrescue.com, surviving bike accidents, traumatic injury

“Head and Shoulders, Knees and Toes…”

Posted on August 2nd, 2010 by Roy Shaw

A student emailed a question regarding the Head to Toe exam.  Though this is normally performed as a secondary survey in a more advanced setting, I do think there are times where knowing how to check a person for other injuries is a good idea.  Take a look at the video blog and I hope this helps.
Best Wishes,
Roy

Tags: CPR, finding broken bones, finding injuries, first aid, head to toe exam, primary assessment, procpr.org, ProFirstAid.com, return to play, Roy Shaw, royonrescue, royonrescue.com, secondary assessment

Staying Safe In The Heat

Posted on July 23rd, 2010 by Roy Shaw

QUESTION:

“It’s so hot where we live and it seems that we have elderly people who suffer most when it gets hot and humid.  Is there anything I can do to stay cool myself and maybe even help someone who is having a heat related health problem?”

Signed,

Melting in Florida

Dear Melting,

Benjamin Franklin once said “An ounce of prevention is worth a pound of cure.” This saying applies to many different health care related scenarios, heat related emergencies certainly not the least of them.

When staying safe and healthy in hot and humid weather it is important to understand what types of environments will put one at risk.

To get started, let’s take a look at how a heat index works.

A heat index combines air temperature with relative humidity as a way of determining how hot a person feels.  A person feels hotter in more humid climates because the moisture in the air does not allow one’s perspiration to carry the heat generated by the body away and evaporate as easily.  When the body cannot cool itself by perspiration and evaporation, the body’s temperature rises and one may feel less comfortable or may even lead to more serious heat related problem.

An example of what could take place in certain heat indexes are as follows:

1. 80–90 °F  Caution — fatigue is possible with prolonged exposure and activity. Prolonged activity could result in heat cramps.
2. 90-105 °F  Extreme Caution — heat cramps, and heat exhaustion are possible.  Prolonged exposure and activity could result in heat stroke.
3. 105-130 °F  Danger — heat cramps, and heat exhaustion are likely; heat stroke is probable with continued activity.
4. Over 130 °F Extreme danger — heat stroke is imminent.                                                                                                                                                                                               (Please note that these are shade values.  Exposure to direct full sunshine could increase these heat values by more than 10 degrees.) Closely paraphrased from the public domain article Heat Index on the website of the Pueblo, CO United States National Weather Service.

Most individuals can indeed acclimatize to heat which will help the body tolerate hotter conditions with less stress to the body.  This process for normal healthy individuals usually takes about 5 -7 days.  This should be done gradually and with a person maintaining good hydration.  A person is capable of sweating up to 2-3 gallons of water per day in hot conditions and cannot rely on the thirst drive in order to know when to drink.  During heavy sweating, a person should be drinking approximately 5-7 ounces every 15 minutes 20-30 ounces per hour in order to replenish lost fluids.  Valuable electrolytes such as sodium, calcium and potassium may be lost during heavy perspiration and should be replaced with proper nutrition and diet. http://www.cdc.gov/niosh/hotenvt.html

Those who are most vulnerable to these heat indexes include:

• infants,
• the elderly (often with associated heart diseases, lung diseases, kidney diseases, or who are taking medications that make them vulnerable to heat strokes),
• athletes, and
• outdoor workers physically exerting themselves under the sun.

or

Those who do not have means for escaping the heat.  Some examples of how to escape the heat include:

1. Circulation of air by fan or ventilation,
2. Accessing lakes, ponds or pools
3. Air conditioning or subterranean cooling like a vegetable cellar or cool basement.
4. In certain cases, placing ice bags under arm pits or around the neck or over other arteries like the wrists, ankles, top of head which may help in cooling core body temperatures.
5. Cool or tepid bath water or a cool shower

If an individual does not have means of cooling and succumbs to the heat they may be suffering from heat fatigue, heat exhaustion or heat stroke.  Let’s take a look at each of these and how to treat each problem.

Definition Heat Fatigue: The signs and symptoms of heat fatigue may include heavy sweating, muscle weakness, tiredness, and impaired performance of skilled sensorimotor jobs.

Treatment:  Remove from heat, encourage water intake and good healthy nutrition and allow person to rest.  Allow person to acclimatize longer to increased heat environment.

Definition Heat Exhaustion: The signs and symptoms of heat exhaustion may include all of the above with the addition of heat cramps in legs, abdomen, back, calves and arms, headache, nausea, vomiting, dizziness, confusion and lethargy.

Treatment:  Remove from heat, encourage fluid intake, loosen clothing, poor water over persons body to soak clothing and begin cooling persons body. Monitor person for unresponsiveness, difficulty breathing or cardiac arrest.  If person is not improving with treatment or symptoms worsen, activate EMS or 911.  Heat exhaustion can become heat stroke if body temperature is not reduced.

Definition of Heat Stroke:   All of the above for heat exhaustion but usually progress to the following:

• high body temperature
• the absence of sweating, with hot red or flushed dry skin
• rapid pulse
• difficulty breathing
• strange behavior
• hallucinations
• confusion
• agitation
• disorientation
• seizure
• coma

Treatment: Remove person from source of heat, loosen clothing, begin cooling the person’s body safely as soon as possible in order to lower body temperature.  Nothing should be given by mouth once the person cannot drink safely on their own.  Activate EMS/911 and support with CPR and First Aid for life saving measures. http://www.medicinenet.com/heat_stroke/article.htm

So, next time you’re planning a trip out into hot conditions, take a moment to check the heat index and formulate a plan for protecting, preventing and treating yourself and others who might fall to heat related emergencies.  Oh, and if you know someone who may be vulnerable to hot weather, see if you have an extra fan, or maybe even give them some tips on how to cool down right in their own home.  You could just find that you have some rescue hero in you too.

Tags: cooling down, dehydration, environmental emergencies, fatigue, Heat, Heat Exhaustion, heat fatigue, heat headache, Heat related emergencies, Heat Stroke, hot climates, hot weather, how to get cool, humid weather, lowering temperature, ProCPR, procpr.org, ProFirstAid, ProFirstAid.com, royonrescue, royonrescue.com, staying cool, Staying Safe in the Heat, sweating

Shock and the Capillary Refill Test

Posted on July 9th, 2010 by Roy Shaw

In this RoyOnRescue Video Blog, a student had emailed Roy a question about explaining the Capillary Refill Test and how it may relate to determining if someone is suffering from shock.
Be sure to watch this episode of RoyOnRescue and learn a new trick that could either tell you if someone is going into shock, or that their hands are simply cold.
There are three main reasons why a person may have more than a 2 second capillary refill time:
1. Shock
2. Peripheral Vascular Disease
3. Hypothermia or cold hands
This slow capillary refill time of more than 2 seconds should only be an indication that we should check for other problems. Please don’t assume simply because someone has a slow cap. refill that they are going into shock. It is simply a quick and easy test to help point a first aider in the right direction and to tell us we should check for other issues.

Tags: Capillary Refill, Capillary Refill Time, cold hands, early signs of shock, how to test for shock, hypothermia, procpr.org, ProFirstAid.com, royonrescue, royonrescue.com, shock, signs of shock, treatment for shock

Asthma Attack and No Medication!

Posted on May 28th, 2010 by Roy Shaw

One of the scariest feelings is not being able to breath.  This is exactly what is happening during a severe asthma attack.  I received an email from a person who stated that they have been trained in CPR and First Aid multiple times and though it covers the basics of asthma it never really talks about what to do in depth.  They gave me a scenario where a person may be having an asthma attack and EMS is quite some ways away.  What’s worse, there isn’t any medication for the asthma attack!  Now what?

In this episode we take a look at what asthma is, and how we can confidently handle it even if there isn’t any medications and EMS/911 is delayed.

Asthma Guide
Asthma Symptoms
ProFirstAid.com Training (Allergic Reactions)

Tags: albuterol, Asthma, asthma and no medications, asthma at home, asthma attack, breathing problems, delay in ems, first aid for asthma, how to treat an asthma attack, nebulizer, procpr.org, ProFirstAid.com, ProHomeSafety, rescue inhaler, Roy Shaw, royonrescue.com, treating asthma at home

How to Deal With Death When CPR Doesn’t “Work”

Posted on May 12th, 2010 by Roy Shaw

This response was written after receiving an email from a person, who has a cousin that is a trained CPR provider and attempted to save their own father’s life with CPR but their father remained dead despite their efforts.  This person felt badly and didn’t know what to say to their cousin to help them not feel guilty or that their father’s death was in some way the rescuer’s fault.  I responded to them, and afterward, felt that my response may be helpful to others who have suffered or are suffering or asking themselves the question, “Was there more I could have done?”.   I hope that this response will be of help to anyone who may have feelings of failure or guilt as a result of their cpr efforts not ending in the survival of the patient.

Student’s Email Question:

(Paraphrased to protect students identity)

Dear Student,
One of the most important things to remember when providing CPR to anyone let alone a loved one, is that people who need CPR are already in a state of death.    When the person is not breathing and they don’t have a pulse strong enough to detect  with obvious signs of life, they are clinically dead.  From the point of clinical death, they are only a short distance from biological death, which is permanent.

One way of looking at the success of CPR, regardless of the outcome, helps me and I believe helps my students to be much more at peace with themselves.  The fact that your cousin’s Dad did not survive cardiac arrest has very little to do with the CPR given to him.  It’s important to remember that CPR, in and of itself does not save anyone’s life directly.  CPR is designed to “Buy Time”.  CPR only provides about 25% of the oxygen circulation that is required for someone to stay alive biologically.  CPR was never designed to be life support viewed as a way to keep people alive indefinitely, but rather to slow down the process of clinical death to biological death.  This is to provide a chance to intercept the patient with electrical therapy, advanced therapy and medications combined with CPR and time to fix the underlying problem which caused the person to die in the first place.

In my opinion what your cousin did, is give his Dad the best chance of survival possible if he was indeed going to survive.  Let’s look at clinical death as a heavy iron gate that is slowly dropping to the ground, and once closed the person is biologically or permanently dead.  CPR is like arms holding the heavy gate of possible survival open a bit longer.  Again, not stopping the progression of clinical death to biological death, but slowing it down so that if there is a chance of survival, they would have the greatest opportunity of slipping back through the gate available.  Eventually, the gate is going to close even if CPR is perfect.  As I said earlier, CPR in and of  itself is not enough to keep the human body alive.  But if the person is going to survive and the person needs more time, CPR buys the precious time required to make this a reality.

Now, it’s  important to remember a simple but powerful truth.  Everyone dies.  I have had patients that had everything go right in order for them to survive a cardiac arrest and they still remained dead despite our rescue efforts.   That day was their day to die and nothing that the cpr providers, paramedics, nurses or doctors did changed the outcome.  The CPR helped keep them viable long enough for the rescue and medical team to try and fix the underlying problem but the person remained dead.  I had to realize that as a professional rescuer and paramedic, everyone has a day to die.   It’s not my job to save everyone but it is my job to give everyone the best chance of  survival possible.  When I provided care to cardiac arrest patients, I provided care to them as if they were suppose to survive and didn’t give up hope unless they proved to me otherwise by not surviving.  It may be frustrating but we  just cannot know what day is the day a person is going to live or die until the outcome is evident.

I’m quite sure that no matter what I say, your cousin is really missing his Dad.  I don’t think there is any amount of explanation of science, death, dying and CPR that’s going to change that.   One thing I do know about what your cousin did the day he provided CPR for his Dad though, he showed others and his Dad how much he loved him.  How much he really cared.  Your cousin gave his Dad his own strength when his Dad didn’t have any of his own.  In my opionion, that’s one of the most loving and unselfish ways to tell a daddy goodbye.

May God bless your cousin and all hurting friends and family during these difficult times.

Sincerely,

Roy Shaw, ProCPR, LLC
RoyOnRescue.com

Tags: CPR, cpr didn't work, cpr on mom, cpr on parent, dad died, dealing with death, death after CPR, death of loved one, depression, depression after death, failed CPR, failed rescue attempt, father died, mom died, ProCPR, royonrescue, royonrescue.com, survivor's depression, tried cpr