CPR on Airbeds and Shocking a PaceMaker

We had a student write in about different situations that can make it really difficult to do CPR and use an AED on someone.  I thought I’d include the scenarios and then give a little help on some ways to make it all go as well as possible.
royonrescue@gmail.com

The person writes: I have patients in oversized  beds, usually air beds.  I am a nurse in a nursing home and have this discussion frequently with my CNA staff so they know what to do.  You’d be surprised how many licensed staff attempt CPR in a bed.  Question, can an AED be used on a person with a pacemaker or indwelling defibrillator?

-Help?

Well, these two different situations do throw a small curve ball but nothing that we can’t work through together.   First, let’s talk about the airbeds.  In the medical field, we are constantly finding ways to decrease bed sores and pneumatic air beds are one of them.  When a patient needs CPR compressions there is a golden rule that shoulds be followed.   Chest compressions work best on a hard flat surfaces.  This does not mean that the patient must be moved to a different surface everytime, but it does mean that the surface must be hard/stiff and flat in order to maximize the depth and consistency of the chest compressions.

With airbeds, we usually see them built with a deflate or CPR button?  Or a way to deflate them quickly.  Even the air/sand beds have this feature so make yourself familiar with it and you will instantly have that hard flat surface we are talking about.  If it is a normal hospital or patient bed and the person is not able to be moved safely to the floor, we should have quick access to a CPR board or a back board which will usually stiffen the surface enough for good compression depth.  It’s always a good idea to practice all of these steps to make sure you know just what you are going to do if the emergency arises.

Secondly,  Defibrillators of every type are able to be used with internal pacemakers and internal defibrillators.  When we place the pads of a defibrillator on  a person’s chest, the placement is usually upper right pectoralis region and left lower mid axillary chest.  This will be below the left pectoralis muscle  or breast and mid line with the left armpit.  See http://www.ProCPR.org under AED video training for a demonstration.  If the Pads or paddles are placed in these locations, they will clearly miss the most popular location for an internal defibrillator or pace maker.  Even if for some strange reason the pacemaker is in an abnormal location and you will have to place the pad over the device.  Be sure to seal it to the chest well and follow the AED training procedures.  We would want to move necklaces from the path of electricity and we will wipe off any nitro paste or other medicine patches from the area’s we place the electrode pads.

If you work in a hospital setting, be sure to ask your educators what the hospital or facility procedure or protocol is if you have any doubt on this advice.

I hope this was helpful and keep the good questions coming.  I’ll be looking forward to your emails.

Best Wishes,

Roy

Roy W. Shaw, EMT-Paramedic

RoyOnRescue.com

How to Give CPR to A Ventilator Patient

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

“Head and Shoulders, Knees and Toes…”

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

Knitting Needles and Puncture Wounds?

Knitting Needles can be the source of warm mittens, cozy scarves and comforting winter sweaters.  They can also become sharp pointed weapons or injury causing spikes when fallen upon or when they are thrust into the face, neck, chest or abdomen due to a car accident or accidentally falling onto them.  In this RoyOnRescue episode, we take a look at the hidden danger of sharp pointed objects that usually remain harmless but when not respected and carried safely, they could cause great harm.  Learn about the dangers of pointed objects and how to keep knitting needles a source of pleasure not pain.

Giving CPR to People With Bleeding Chest Injuries

I received an email that I think we can all benefit from.

It read…

“Since most of the first aid measures for a no pulse, no breathing situation is immediate CPR, is it alright to do CPR if the victim has a wound on the chest that is bleeding profusely? This is not that I have seen this situation, but I like to think that if it happens I would know what to do!”
C. H.

That’s a great question C.   Sometimes it’s easy to get distracted by a serious traumatic injury and forget the basics and what needs to be done first in order to try and save the person’s life.  Or, we can look at a complicating injury such as a chest wound and think,  How am I going to do CPR on this person, there chest has a serious bleeding wound right where I’m going to give my compressions?

In this episode of RoyOnRescue we are going to look a proper treatment plan if we ever came across a person who had a serious chest injury and needed CPR.

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

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)

“My cousin has recently lost his dad and he is a trained CPR provider.  He tried CPR on him but it didn’t work. I was wondering if you had a way you deal with death if you could not save them. I just don’t know what to say to him or how to help him.  I’m the only one he is talking to and trusts. So not knowing how to help him bothers me.  If you would email me back that would be great.”
-Thanks

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

Roy Shaw

iRescueRadio 042: Fainting, Aliens, Sleep Paralysis, Dreams

Sleep disorders affect millions of people. Associated problems can range from feeling tired during the day to life threatening cardiovascular damage.  If you have had difficulty with sleep maybe it is  something other than a medical condition. Maybe it is those pesky aliens that keep abducting people in the night.  Are aliens abducting people or could it be sleep paralysis? You’ll have to listen in to find out.   The iRescueradio guys are up to their usual antics with Dan’s fainting,  Roy’s research,  and Jody’s dreaming.

We’ve included a bonus feature this week, a “behind the scenes” blooper.  Jody learned a valuable lesson about reviewing research before trying to use it.

iRescueRadio Episode 42 [Download]

Blooper [Download]

Links:

http://hubpages.com/hub/sleepparalyses

http://www.sleepdisorderchannel.com/rem/index.shtml

iRescueRadio 041:Spiders, Insect Bites, Rescue Dog, Good Sounds

Its been a good week at the iRescueradio studio. A little training, something interesting and lots of fun are all wrapped up in this show. You’ll have to listen to find out why Dan’s going buggy, Jody’s in a different camp, and Roy’s letting out some interesting sounds.

iRescueRadio Episode 41 [Download]

Snake Bites Part 2 of 2

In Part 1 of Snake Bites we talked about the different kinds of poisonous snakes that pose a risk for serious danger. Remember we were talking about an Emergency Responder who who had emailed me? She helps out with California High Desert Racing and the medical response team and is having some issues with Poisonous snake bites and 35-45 minute response times. This due to being so far away from civilization. In part 1 of this response video blog, we took a look at the different types of rattlesnakes that are causing problems, how they might kill a person and how we as rescuers could make the difference between life and death. In this second part, we will get to the bottom of the correct treatment strategy in order to save a snake bite victims life and limb.

Snake Bites Part 1 of 2

An Emergency Responder who helps out with California High Desert Races is having some issues with Poisonous Snake Bites and slow response times due to being so far away from civilization. In this response video blog, we take a look at the different types of rattlesnakes that are causing problems, how they might kill a person and how we as rescuers could make the difference between life and death.