Refusing CPR

[Aardvark154]

save me some time reading ... wasn't it already determined that this lady DID NOT have a DNR in place??

Jessica to the best of my knowledge she did not.

For me this part of the conversation has moved on to "tell your loved ones to spell out their wishes" - even TERBites (on both sides of the coin) should have an Advanced Medical Directive/Medical Power of Attorney or what term you know it by - on file at hospital/ambulance service etc. . . that gives someone power to make medical decisions for you if you are unable to - and talk with then about what you would do if you were able to in various situations.

Further those have arrived at the place in life where they feel this way should have a DNR.

 

[mrsCALoki]

ventilation?? as in artificial respiration? Hey Doc ... do you know how long it's been since anyone used that term?? CPR in the combination of breathing and chest compressions. Cardio pulmonary .... heart and lungs.

Did you say you attended this course with Loki? you didn't pay much attention. Recently it was decided that 'ventiation' as you put it isn't even necessary. The amount of oxygen carried in the blood is enough to keep the brain alive if chest compressions are continued. UNLESS the person went down fighting for air.. ie drowning or choking.

Better brush up on that ... you still need these skills even if you have an AED as you claim.

Ok hun, lets try to give you enough information so you do not kill someone with your half baked ideas. I will ty and make it very simple.

Mammals have a pump in their chest called a heart. The hot pumps blood by having rhythmic compression. Think of it as a bunch of individual muscles flexing and then signaling the next set of muscles to do their thing. A lot like a wave at a sporting event. So some things can muck up the wave. Things like electric shock, a physical blow, or several other things can knock that rhythm out of rhythm. The muscles all just flutter and no blood gets moved. Got that?

Now if the heart is beating and some stupid little good old girl starts doing cardiac compression when the heart is still beating she can easily stop the heart. The give away is if the person is breathing do not apply CPR. CPR even when done properly can and often does put the subject in danger. Broken ribs are common. More serious injuries are also common. Stopping a beating heart with CPR is NOT a good idea. Got that? Do not stop their heart if it is already beating.

Just go play with an AED . Even if you are so careless and poorly educated that you cannot detect breathing it will not shock the subject unless it detects cardiac arrhythmias of ventricular fibrillation or ventricular tachycardia. They will stop you from killing the patient .

Now some times a person's heart is working but not enough oxygen is getting into their system. Lack of Oxygen will kill you, even if your heart is beating. To get more Oxygen into a patient you have to resort to one of several other procedure. The best include providing oxygen or oxygen enriched air to the patient.

Now sometimes that is impossible so you use a ventilator. You may have seen a large box pumping air into a patient? Ok that same process can be done using a bag valve mask. You got a bag, you got a valve, you got a airway tube or a mask. Pump pump pump. It is called ventilating the patient. Of course there are risks in the procedure so you need to know what you are doing.

You can also ventilate a patient using good old mouth to mouth if you have no other options. It is not CPR. It is ventilating without a mechanical ventilator.

Got it? NEVER EVER EVER apply CPR to a conscious or breathing patient. This woman was breathing if you listen to the tape. Apparently was having trouble but was breathing.

Do not kill someone because of your lack of basic skills. And I can only hope the people who read your comments are bright enough to not damage or kill an accident victim by following your advice.

 

[mrsCALoki]

save me some time reading ... wasn't it already determined that this lady DID NOT have a DNR in place??

We do not know. Apparently she did not have her own, but did sign a standard agreement re medical assistance with the facility and we have no idea what that stated. Not enough information.

 

[mrsCALoki]

Those are both covered by what I mentioned as having a duty to act with reasonable care. In other words good faith efforts are covered, gross negligence (and it has to be the sort of thing a six year old would know better) isn't, neither is swimming out to the drowning person (so others do not bother to do so) and then saying oh the Hell with it and swimming back.

That is changing the situation. You are absolutely correct in the above, but that is not the same as "If you do not ask first and get permission (or the person is unable to respond) you do become liable." Not to be a jerk, but CPR candidates are more or less by definition unable to give consent being unconscious and unable to respond, and that is the very sort of situation you want a Good Samaritan Law to cover.

I bow to your wisdom. I was thinking First Response / First Aid in general not specifically CPR.

 

[mrsCALoki]

From what I understand (which is limited mind you), some longterm care facilities have policies against CPR, given the complications associated with it: low survival rates and even then, greatly diminished quality of life.

I'm constantly re-certifying my first response through SJA and in the nurse's situation, I may have refused too. The chances are so low and the risks are so high.

Another factor in the policy is the prevalence of osteoporosis. Brittle bones become a fatal issue. So yes I am agreeing with you.

 

[mrsCALoki]

Breathing hasn't even been as major part of training in the last year or two. They realized that there is already enough oxygen in the blood to sustain the heart and brain while waiting for paramedics and the ratio is 2:30 now (IIRC).

And giving CPR to a breathing patient is? That is gross negligence in pretty well any court.

 

[mrsCALoki]

from a medical point of view, ventilation is the proper term to use

wow Thank you. Yes it is.

 

[Rockslinger]

Once you are in the nursing home stage, a lot of residents (and their families) just hope they go peacefully.

Was it a nursing home or a senior's residence? Lots of 87 year olds still have years of life left. Hazel McCallion and Betty White are in their 90's. George Burns and Bob Hope lived to 100. Queen Elizabeth II is 86.

 

[Aardvark154]

Another factor in the policy is the prevalence of osteoporosis. Brittle bones become a fatal issue. So yes I am agreeing with you.

Back in the day when I was volunteer someone said if you didn't hear snapping ribs you probably weren't performing CPR properly. :frown:

Thank God I was never in that situation.

 

[Aardvark154]

Was it a nursing home or a senior's residence?

Independent Living Facility so a senior's residence.

I don't know the truth of the matter, but the company is now saying that the woman on the telephone with 911 was not an R.N.

 

[mrsCALoki]

Back in the day when I was volunteer someone said if you didn't hear snapping ribs you probably weren't performing CPR properly. :frown:

LOL I heard something similar. Sadly when the subject is very elderly they do not just crack. And bone fragments can be fatal.

 

[Aardvark154]

I was told the same thing when i got my class "A" and "B". Ribs will break but they will live long enough to sue you i think is how my instructer put it.

Now, I'd tell them sorry I won't represent you.

 

[mrsCALoki]

You really would be better served focusing your attention on your other battles. But l'll play along and assume that "Loki" provided that oh so haughty response, and will reply as follows:

1) I am quite familiar with Health and Safety best practices, which is why I knew your original suggestion that he needed to be first-aid/CPR certified to be a "faculty member" at a university was b.s. - and lets be clear, that is exactly what you meant, when you got called on it and couldn't back it up you back pedalled and came up with the suggestion that:

Hun, this was a couple of years ago when he was in the middle of going from real work to hobby work. He had several different fun projects on the go and was trapped in Ontario. I really find it hard to remember what his exact words were at the time. Why would I care who required it? I went along because I liked being with him and it was a fun giggle.

2) Industrial companies refer to their trainers as "faculty" - which is more bs - it is not a term used in Canada outside institutions of higher learning and "think tanks" style instutions;

Wow I guess GM used the term to fool me so I would look stupid using it We went there for a few days. Same for the Faculty of Culinary Arts, Faculty of Esthetics, etc etc. I bet the Faculty at the Canadian College of Performing arts will have a hissy fit when they discover they do not exist. Of course these are not ones where Loki taught. But most academies and many colleges have faculty. Including everything from Blasting to pastry. And I sort of guess some of them want anyone on their faculty working in the field with students to have first aid training.

3) I also know something of pay scales - "supervisors" and "training faculty" do not earn enough to give their wife their weight in gold or spend five years travelling the oceans - executives are not considered "Supervisors" or "training faculty" and I defy you to show me any major Canadian corporation that requires its executives (vp and above) to be first aid/CPR certified

Dahhhhhh Loki was in the middle of retie retiring when we met. He had fun projects and consulting on his plate. Not things to try and make money.

4) WSIB is certainly NOT the standard in "Canada" - it is the standard in Ontario where it is the only province with any authority - every other province has their own equivalent agency

dahhhhh sorry. I sort of got the impression that any first aid course approved by the WSIB was recognized Canada wide. So what first aid program they approve is not recognized Canada wide?

You know I really do not get what you are trying to prove. Loki will not let me quote where they required the first aid course. He is not willing to let Terb people in general have access to our personal lives. .

There are obviously may faculties that require the First Aid course. You seem hell bent on playing word games and claiming that all faculties are with a university. I guess I will just say "OH WISE ONE YOU MUST BE RIGHT!" Those pesky other groups using the same word are just made up BS.

 

[mrsCALoki]

I think he was joking but there are lot's of lawyers that would. SAd state of affairs to sue some one that saved your life.

Well it is not that black and white. If you do CPR on someone who is breathing it is a procedure with VERY questionable value and you deserve to be sued (IMHO). Especially if you kill them. One might even say murdered them if one was into theatrics.

In the case of a 90 year old woman, in most cases you are not saving her life, you may be condemning her to an agony and death. Are you good enough to know the exact amount of pressure in her case? If she signed a document saying it was inappropriate, do you have the right to over ride her wishes. And her obvious lack of consent?

Life and death are never simple.

It is a personal decision. This particular case lacks way to many facts for me to feel comfortable voicing an opinion. Would I have done CPR? On a breathing patient? No I would consider that murder.

 

[mrsCALoki]

Hey I saw you in chat earlier saying you are a grandma now. You didn't really talk to me but congradulations anyway

Thank you.

niveaman and I were talking about my new born son being a few years younger than my grandson. I am indeed a GILF. But that is my step-daughters son.

I thought it wiser to clarify that before the weird ones jump on the comment

My son is great and loves cuddling between me and the back of the sofa. He has a great future as a hot water bottle <===silly joke, not to be taken seriously.

 

[CapitalGuy]

I thought it wiser to clarify that before the weird ones jump on the comment

My son is great and loves cuddling between me and the back of the sofa. He has a great future as a hot water bottle <===silly joke, not to be taken seriously.

1). YOU are the weirdest of them all. Think it through.

2) Your pretend son would grow up to be one of the most fucked up people in the Western world. Drown him before he realizes who his parents are and puts himself out of his misery. (ps. that is not a real suggestion that a baby be drown, since we all know there is no baby, no husband, no gold, no anything except a sad, lonely old man for whom we should feel loads of sorry).

 

[Aardvark154]

Well it is not that black and white. If you do CPR on someone who is breathing it is a procedure with VERY questionable value and you deserve to be sued (IMHO).

You are the one with the medical training, but if someone has respiration, do they not ipso facto have a heartbeat? I seem to recall being taught that you couldn't breath if you didn't have a pulse.

If she signed a document saying it was inappropriate, do you have the right to over ride her wishes. And her obvious lack of consent?he

Well in the type place where they should know that you have a DNR - a independent living facility, hospital, nursing home, ambulance service etc. . . even an office if you have notified your co-workers (not you had a coronary in the middle of the sidewalk on University Avenue) needless to say you don't have a right to override that DNR and you are likely to be facing a serious lawsuit for doing so, particularly in the sort of situation where you now have issues caused by the coronary.

 

[Eddie401]

1). YOU are the weirdest of them all. Think it through.

2) Your pretend son would grow up to be one of the most fucked up people in the Western world. Drown him before he realizes who his parents are and puts himself out of his misery. (ps. that is not a real suggestion that a baby be drown, since we all know there is no baby, no husband, no gold, no anything except a sad, lonely old man for whom we should feel loads of sorry).

Ignoring LokoLoki doesn't work with quotes...argh. Now have image in my head of obese, hairy, middle-aged nightgown-wearing male clutching hot water bottle and reading TERB posts.

No sleep for me tonight. You have to know that basement has secrets.

 

[mrsCALoki]

You are the one with the medical training, but if someone has respiration, do they not ipso facto have a heartbeat? I seem to recall being taught that you couldn't breath if you didn't have a pulse.

100 % accurate. If the person is breathing and has a pulse you never try cardiac compression although ventilation can berequired.

I wanted to stress it because ...

ventilation?? as in artificial respiration? Hey Doc ... do you know how long it's been since anyone used that term?? CPR in the combination of breathing and chest compressions. Cardio pulmonary .... heart and lungs.

... Recently it was decided that 'ventiation' as you put it isn't even necessary. The amount of oxygen carried in the blood is enough to keep the brain alive if chest compressions are continued. UNLESS the person went down fighting for air.. ie drowning or choking.

Better brush up on that ... you still need these skills even if you have an AED as you claim.

She is so busy trying to put me does she either failed to read my post that the subject was breathing or did not care.

Either way CPR is a life threatening procedure when done on some one who just needs ventilation. Such incredibly risky ideas need to be exposed as dangerous.

Jumping off my soap box now

 

[Possum Trot]

I sure am glad you never made it as a doctor.... we have to thank our lucky stars for that. The fact that you don't know that CPR doesn't just involve compressions is laughable.
I guess she stopped breathing .... maybe that's why they said she stopped breathing ....

slow down maybe you will remember what you typed. YOU'RE THE ONE WHO SAID SHE WAS 'STOPPED BREATHING' ..... duh .......................

One has to wonder how someone like Loki develops the knack of turning everythread into a clusterfuck of argument and wikipedia semi-correct information. I've seen "it" do it on a number of medical related topics as well as investment strategy and God-knows what else. It's almost a skill.