Whoa! It’s been almost a month since my last post!

Shock and the Capillary Refill TestHello Rescue Fans!

I didn’t want you to think that I’d fallen off the planet. I have been extremely busy with some projects that are really detailed and take a large portion of my time. The RoyOnRescue fans are very important to me and I want to make sure that I’m taking care of the subjects that are most important to you. I’m currently working on a new Vlog post related to the bomb blasts that occurred in Boston. As I understand it, there was quite a need for tourniquets and this is really closely related to the types of blast injuries that were seen. It mimics the same type of injuries that are closely associated with war. I’m hoping to get this up by this week.

Thanks for your patience.

Roy

Why Put On Personal Protective Equipment(PPE) Before Checking For Consciousness?

Hello Rescuers!

I just received a question via our ProCPR customer feedback that read: PPE

Dear ProCPR, “Question 16 says you have on PPE (personal protective equipment)  already, then you check for
responsiveness. Why would you put on your PPE before you check consciousness?

– Anthony

In case anyone else may have asked the same question I though I’d address it.  First, Question 16 is the number this person was on while taking the ProCPR.org test.  This is the online portion of the Health Care Provider level BLS certification training in case anyone was wondering.

Okay,  now for the answer.  As professional health care providers, we should always be thinking about cross contamination.  We don’t want to catch what the patient may have and we don’t want to give the patient anything that we may have!  Remember, PPE works both ways.  Can anyone say, nosocomial infection?  Even if the patient isn’t in obvious distress or obviously infectious, we should be thinking about the fact that the person seems to be in need and may require medical treatment.  This means that we may need gloves, CPR shield with one way barrier, goggles, face mask, respiratory protection etc.   This is why it’s so important to think about PPE  whenever we encounter a situation that may call us into action.  Not just when the person is unconscious or not breathing.

Forever, I’ve battled the problem with health care professionals short cutting PPE while giving care or even thinking about care.  We really do need to consider the two way protective properties related to infection control as it relates to appropriate personal protective equipment.

When it comes to layperson rescue, one of the top five reasons that laypeople will not intervene when a person is in distress is the fear of disease!  If the rescuer is approaching a victim and dons their gloves early as well as ensures that they have a CPR shield available, the fear of catching a disease is greatly diminished.  This will  increase the chances that the Good Samaritan may actually get physically involved in the rescue.

Now I know what you may be thinking…”Roy!  Do you really think that I’ll have one of those rescue kits on by belt all the time?  You may be a “Rescue Hero” type but the feasibility of me having PPE on my person when I’m at the beach, shopping, walking, vacationing, or even at a business meeting is slim to none.”  Well, I have to agree!  Unless you are a professional rescuer on duty, you probably won’t have your jump kit, glove pouch or a one way valve mask bag swinging from your belt loop.  So how will you have the PPE you need at the time you need it?  The best way I’ve found is to have a key ring rescue kit.  The catch is having it be small enough to not get in the way and large enough to carry your gloves and a one way CPR shield.  The reason I say a Key Ring style, is that I think that keys are the one item that most people have with them most of the time.  If they don’t have them with them, then they are usually close at hand.  And if we have our keys, we’ll at least have gloves and a CPR shield.   So make sure you get one and then the PPE problem is out of the way.  Still don’t think that PPE is needed?   Well, that’s why the AHA endorses “hands only” CPR!  It’s really not that compression only CPR is better than full Cardio PULMONARY resuscitation, it’s that there are so many non PPE toting people afraid that they may catch a disease if they do mouth to mouth rescue breaths that we had to design a new form of  bystander CPR.  Since implementing  “Hands only” CPR, there has been an increase in rescuer involvement.  And when people get involved and provide CPR, lives are saved!

PPE should be on every rescuer’s mind…and key chain, lay or professional and when we begin to think about PPE as the first step in rescue, lives are saved and infection is prevented more often!

Hope this helps.

Hurricane Sandy Is In Full Force and Now I Need An Ambulance!

Okay Rescuers,

When natural or unnatural disasters strike, the chance of getting emergency help to your doorstep fast while the EMS services are exhausted is very slim.  I wanted to take this opportunity to talk about a situation that doesn’t get discussed much.  What effect does a hurricane or natural disaster have on the rest of the community?  We sometimes forget the fact that though the rest of the world is distracted by a storm or other disaster related buzz, people still get sick, heart attacks still happen, car accidents still happen but we don’t often think about from where the next ambulance, fire truck or police car is going to be responding.  This episode of RoyOnRescue addresses this issue and urges people who may be in high risk of needing an ambulance or other EMS service to think proactively and make arrangements before the emergency happens.  Think about moving loved ones with fragile health to temporary locations that may not be effected by the hurricane.  Can the person stay with a relative until the community has recovered?  What is the back up plan if one can be found?  I hope this RoyOnRescue episode get’s everyone thinking and will hopefully help prevent a needless death due to not having the appropriate plans in place.  Stay safe, our prayers are with everyone who has been and is effected by hurricane Sandy and other storms.

 

Danger When Lightning Strikes!

In this episode Roy takes a look at the dangers of thunderstorms and lightning).  And where there’s thunder, there’s lightning. There was a report of a lightning striking a tree next to a home in Park Township destroyed electrical equipment and appliances in the home and caused minor injuries to a child who suffered mouth burns from her braces.  Twenty-four head of cattle were struck and killed by lightning while standing under a tree. Lightning in West plains also caused power outages and one minor fire to a roof.  A person talking on a cordless telephone in the living room of her house was slightly injured by a lightning strike.  A 29-year old man and a 14-year old child were struck by lightning at a rodeo in Lawrence Township and hospitalized. Two horses were also struck and killed by lightning.  A 34-year old little league coach was killed by a lightning strike while on the field. If you’ve ever wondered what the potential danger is regarding lightning strikes you wont want to miss this episode of RoyOnRescue and become more familiar with the dangers of lightning and how to protect yourself and survive.

Football Helmet Removal During Emergencies

In this episode, Roy answers a question that came in regarding how to remove a football helmet if a person may have a neck injury.  Roy explains that only when the person’s life depends on it, should a helmet be removed before professional rescue personnel arrive.  If the person’s life depends on a rescuer being able to remove the helmet, then it should be removed following a few guidelines.  Be sure to watch this episode of RoyOnRescue to learn when and how a helmet should be removed during an emergency.

Why CPR During Traumatic Cardiac Arrest Doesn’t Work Very Often

In this episode of RoyOnRescue, Roy talks about why cardiac arrests secondary to traumatic injuries, especially rapid deceleration accidents are so hard to resuscitate.  Roy goes a bit  more in depth about how every deceleration or rapid acceleration accident really is more like three different collisions.  Car hits wall, body hits car and organs hit inside of the body…that’s 3.  Now take a closer look at how it happens in this episode of RoyOnRescue.

“Why Are There Different Names For Different Pulses?”

Today I had a great question come in through our customer solutions department. Here’s what it said.
“What and why are the pulses of different ages called different things and what are they called?”

Well, I understood this to mean, what are the different locations for the different age groups in cardiac arrest or unconsciousness and so I gave the following answer.

Hello,

Thank you so much for your question. It’s a great question and I think I might be able to shed some light on it.

It can be a little confusing some times as we try and decode the reason why certain things in medicine are named what they are. Basic Life Support is not immune to this same situation. In regards to the names of “pulses” and how they are named according to the age or size of the patient, I’ll try to clarify.

If I understand your question correctly, you’re talking about the three locations of the pulse check.

1. Radial, which is found in the wrist of the patient, usually used for patients who are adult or child size. Older than 1 year of age. This location is used for general pulse rate and quality but not usually for the unconscious patient.
2. Brachial, which is found in the bicep/tricep region of the upper arm on the inside of the arm. This is the location for an unconscious infant, age 1 year or younger.
3. Carotid, which is found in the neck. This would be located between the trachea and the sternocleidomastoid muscle(located on the side of the neck). One can really see this muscle well when one turns their head to one side or the other. This would be the location of choice for the adult and child(older than 1 year) unconscious patient.

There is yet another location used in emergency medicine but not usually pre-hospital and that would be the femoral artery. This is located in the groin of the patient and again is usually used for trauma patients that have C-Spine collar or the carotid is not easily accessed due to intubation etc.

The reason to use the brachial over the carotid for an infant is primarily due to the fact that most baby’s don’t have necks to speak of. They have milk catching folds of skin but other than that, their anatomy is such that an area to evaluate an accurate carotid pulse is not easily obtained. Therefore, the brachial artery is the location of choice and works extremely well for the health care professional to ascertain whether a pulse is present or absent.

In most cases for adults and children over the age of 1 year, the carotid artery is the location of choice to check for pulse presence due to it being the last place to feel a pulse prior to the blood pressure being too low to feel a pulse regardless of whether the heart is beating or not. Secondly, it’s next to the location where we are performing a head tilt and chin lift while giving rescue breaths and is convenient to the rescuer for checking pulse presence(little perk).

So, though the names of the locations can be a little challenging, they do make great scrabble words, or can make you look really intelligent at dinner parties. Remember, it’s not the feeling of a pulse that will determine if we’re going to start cardiac compressions or not, It’s the absence of signs of life that will determine that. This includes, unconscious and unresponsiveness and that the patient is not breathing normally or not breathing at all. If these two signs are present, begin CPR. Pulse checks have often given false readings and postponed cardiac compressions in a patient who needed cardiac compressions desperately.

I hope this helps anyone who may have had the same question.

Best wishes and keep on rescuing!

Roy
RoyOnRescue.com


Roy W. Shaw, EMT-Paramedic
Director of Training and Compliance

ProTrainings.com

RoyOnRescue End Of Year Wrap Up

In this latest episode of RoyOnRescue, Roy takes a moment to thank everyone for a great year while showing you around the Corporate Office of RoyOnRescue and ProTrainings.com.  Though a few of the professionals may have been caught off guard, you get a chance to see behind the scenes as Roy thanks you and the team for all of the support in 2011.

Enjoy,

RoyOnRescue.com

Did I Do CPR Wrong?

In this episode of RoyOnRescue,  Roy answers an email that was just sent in regarding a person who provided CPR for a cardiac arrest victim but it was different than how the two other certified responders where doing CPR.  Please tell me we don’t give rescue breaths anymore, I hope I did the right thing, “God forbid my way was wrong”.  Roy answers this question in a way that explains how all three of the rescuers did the “Right Thing”.  Be sure to watch this episode to learn how compression only and complete CPR are beneficial for the cardiac arrest victim.

Overcoming Diabetes Part 2 of 2 Interview With Clint Crabtree

This is the concluding episode of the interview between Clint Crabtree, MMA Champion, Brazilian Jiu Jitsu Blackbelt and Owner of Grand Rapids Brazilian Jiu Jitsu.  In this final part of the interview with Clint, he explains in more detail how he manages his diet combined with exercise and how it’s redefining the way we think about living with diabetes type 1 or type 2.  If you have diabetes, want to prevent diabetes or maybe know someone who is diabetic, you won’t want to miss this final part of a very enlightening interview.