In this episode of RoyOnRescue, Roy Shaw visits the new 2010 CPR guideline update regarding activation of Emergency Medical Services and calling a code. Be sure to watch this episode to get the latest guideline release covering this subject.
I’ve been debating on trying to post this before the weekend and now I’m sure I should. It’s not going to be short but I will try and get too the point.
There is a lot of talk going on about Compression Only CPR and how it rivals traditional CPR. I’m going to shed some light on the technique and try to sneak in a bit of synthesized science to help understand what it is and what it’s not. Hold on to your seat…hear we go!
This 2010 CPR update training, I take a look at the 911 and Dispatch Changes. The biggest takeaway from this change is a simplification for the rescuer who is calling 911. The dispatcher is going to ask a series of questions to determine if the victim is breathing or “Not”. Not, can mean not breathing at all, or could mean not breathing normally(Agonal or gasping). Upon this finding as well as deciding if this victim is in cardiac arrest due to asphyxia or medical condition like cardiac disease will change the directives the dispatcher will give to the rescuer.
Watch this RoyOnRescue video to help understand the difference between 2005 and 2010 and why the change was made.
Roy Shaw, EMT-Paramedic and Instructor Trainer for ProTrainings.com has embarked on a quest to cover all of the important updates and topics related to the new 2010 ECC/ILCOR and American Heart Association updates which are in the process of being released and communicated via email, news, TV, blogs, twitter, Facebook and any other means of communication you can think of. Only one problem, many CPR instructors haven’t been told how to handle them yet! So after many emails, phone calls and questions, Roy Shaw has decided to work through the updates topic by topic and give the old and new standards, his take on them and then open them up for converstaion. So if you’re looking for some insight on how to handle the 2010 CPR changes, look no further.
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.
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.
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.
Warning! Video contains graphic pictures of injuries and accidents.
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.
“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?”
Melting in Florida
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:
- 80–90 °F Caution — fatigue is possible with prolonged exposure and activity. Prolonged activity could result in heat cramps.
- 90-105 °F Extreme Caution — heat cramps, and heat exhaustion are possible. Prolonged exposure and activity could result in heat stroke.
- 105-130 °F Danger — heat cramps, and heat exhaustion are likely; heat stroke is probable with continued activity.
- 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:
- 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.
Those who do not have means for escaping the heat. Some examples of how to escape the heat include:
- Circulation of air by fan or ventilation,
- Accessing lakes, ponds or pools
- Air conditioning or subterranean cooling like a vegetable cellar or cool basement.
- 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.
- 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
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.
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:
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.