not true the heart can tolerate many hours of ischemia, the brain only 5 minutes.
the sole sole sole purpose of cpr is for the brain.
Refusing CPR
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the sole sole sole purpose of cpr is for the brain.
Bababuey, earlier you stated that "the brain is the least sensitive to oxygen deprivation.", did you mean least tolerant to oxygen deprivation?
my apologies, yes thank you, a typo on my part, the "most" sensitive organ of course to oxygen deprivation
My pleasure. It's funny how others in this thread with a claimed background in medicine did not point this out.
Oh? I must be falling behind. WOW. Can you quote a research paper or study on that? Based on the arterial structures I cannot understand how that can be true so I would like to read the study..
Although I do agree the heart can tolerate extended periods of ischæmia (restricted supply), it is pretty obvious to anyone who has seen a heart arrive for a transplant. It is also true that that I never observed a heart arrive still in ventricular fibrillation. I watched a heart being harvested once and although I was not timing it, after 10 to 15 minutes there was NO sign of any ventricular fibrillation.
On the other hand I have seen evidence of an AED reviving individuals well after a half hour of CPR. I guess it is only anecdotal evidence but for the heart to respond to the AED after 30 minutes it would seem it needed to be oxygenated somehow.
Oh by the way I agree that a heart can be restarted after 6 hrs. 8 hours seems the top end for cold transportation in transplants. But certainly not with a AED, and in the field. Actually the heart in a box systems that keeps the heart oxygenated is closer to 4 times that.
So.... Please send me the research information on the "cpr itself has essentially ZERO influence on coronary artery blood flow". I will love to read it.
If that statement is true.... well AEDs would be useless after 20 minutes and the subject needs to get into a medical facility to have a chance.
Point of this: Until the study bababuey is quoting is widely distributed and understood, and assuming this is NOT a medical professional responce...... just do CPR. Start it STAT. And try an AED as soon as you can
. I absolutely support CPR. Your first sentence is wrong -- an AED can deliver a shock that will restore normal heart function for several common types of heart failure (the AED will detect those conditions and deliver a shock only if warranted). The goal of CPR is to keep blood flowing so that the organs, especially the heart and brain, are still alive when the defibrillator arrives on the scene. You are correct that CPR doubles or triples the survival rate--because it keeps major organs alive while you wait for the defibrillator. Every minute that goes by without blood flow cuts your chance of survival significantly, and CPR staves that off so it is very worthwhile--but if an EMT crew doesn't show up, or someone doesn't come running in with an AED, CPR is really just pushing blood around in a dead body. That heart needs to be restarted.
As others have pointed out, defibs don't restart hearts, they shock an irregular rythm into a normal one. When a heart has completely stopped, the current practice is adrenaline and CPR or cardiac massage. It used to be atropine and defib (atropine increases the effect electrical currents have on the muscles) but that's largely been found ineffective and discontinued. It's currently up for debate in the medical community whether adrenaline even has any effect.
Which is why, when people say CPR has no effect or they discourage it's use, I question their motives. If the current best treatment is adrenaline and CPR, and the scientific and medical community question the effectiveness of adrenaline, they're essentially saying CPR is the key. The leading cause for survival is how quickly someone gets CPR. So if you stand around wondering if you should start because you read on some sex forum that once you start CPR you have to keep going and you're liable, you delay help. But in reality, the reason the survival rates are higher in a hospital is because CPR is administered so quickly after onset and not because of some fancy equipment. There are other factors, of course (namely whether they're on vasopressors already before the episode), but the main one is how quickly CPR is applied. The truth is that with complete flatlining, no heart activity at all, even in a hospital, the chance of surviving with no neurological effects is less than 2%. On the street it's less than 1%. So we're talking about a different of about 1% between hospital staff conducting CPR and strangers on the street. For me, that makes strangers on the street doing CPR extremely effective and worthwhile. They're almost as good as trained hospital staff!!!
Of course, when you factor in other types of cardiac episodes (like irregular rythms as opposed to no heart rythm at all), the results differ. But perhaps most interesting is that CPR in the field may assist a heart in achieving some form of activity. So no pulse, which an AED will report as unshockable, could become some form a tachycardia, which an AED can shock, as a result of CPR. Which is why I encourage people to at least try, provided the subject isn't breathing, and keep trying until you can try no more. And if an AED reports a non-shockable rythm, recheck regularly just in case.
cpr is not about the heart. that is final. cpr is soley about the brain and its protection. an aed only works with specific pulseless rhythms. but its better to err on the side of caution in this case.
It's about the heart as well, not in the sense of restarting it, but in keeping blood flow to the major heart muscles so that they don't die. If they die, you aren't restarting that heart when the AED gets there. But certainly yes brain is key too.
Thanks, I read my original post several times. Not just the tiny bit you posted. Apparently I never said "check pulse" based on my words. I guess you just decided I was implying it?
I dis say (to paraphrase the repeated comments) Do not apply CPR to someone that is breathing or conscious. I guess I was implying that being conscious or breathing was a sign that your heart was beating.
Sorry if it was not clear to you.
What other method do you know of to "be very certain the heart has stopped"?Thanks, I read my original post several times. Not just the tiny bit you posted. Apparently I never said "check pulse" based on my words. I guess you just decided I was implying it?
I dis say (to paraphrase the repeated comments) Do not apply CPR to someone that is breathing or conscious. I guess I was implying that being conscious or breathing was a sign that your heart was beating.
Sorry if it was not clear to you.
Get over yourself. You got it wrong. Just fess up.
Not breathing, not responding, are pretty good indicators for a layperson.
Sorry hun, I sort of say what I mean and mean what I say
.Most protocols do not recommend CPR on people responsive or breathing
CPR on a beating heart is not a great idea and should be avoided.
Laypersons are not encouraged to attempt to take pulse.
Black and white. dahhhh breathing..... heart must be working.
responsive......... heart must be working.
talking........... heart must be working.
Adding words to other peoples comments because you want them there...... heart must be working..... other organs, not conclusive <==Joke
I didn't say it couldn't shock a bad rythm. But in those cases the heart is not stopped, it's considered active, so you aren't restarting it.
And you're also wholly wrong in most of the rest of your reply. An AED won't restart a heart. Why does it matter if an AED is en route if that won't help? Do you know what the EMT's do? They check for obvious signs of death (decapitation, livor mortis, rigor mortis, etc). If found, load the body and respond back code 1. Otherwise, they check for a pulse, check for breathing and verify the airway, start CPR and hook up their gear (either AED or ECG). If the rhythm is shockable, they shock. If not, they do CPR. Oh wow, look!!! CPR!!!! Then respond back code 3.
The body arrives at the hospital. What does a doctor do? First he decides if it's worthwhile to fight. If not, he pronounces them dead. If yes, guess what he does? CPR!!!! Then he proceeds to hook up his gear and administers any drugs he deems necessary. If the rhythm has become shockable, he shocks it. If not, he continues CPR waiting for a shockable rhythm or, if he's really hardcore, opens them up and commences cardiac massage (this used to be viewed as more effective, though that's largely been disproven now but I still know some hardcore docs who think maybe it's negligibly better, but better is better). He continues CPR and checking for shockable rhythm until either the patient regains consciousness or he determines death and pronounces it.
In any case, it's CPR. CPR until the person comes to. So if there's no ambulance and no AED coming, do you know what you can do? CPR. Because that's what the ambulance will do, and that's what the doctor will do. Yes, for VT and VF defibs are more effective than CPR, but CPR is still somewhat effective for them, and is also effective for PEA too.
You're basically saying, "Oh, there's no AED coming? Well then fuck it." That's discouraging CPR. Try to hide that however you want, but it is. And yet CPR is the only known treatment for PEA and a somewhat effective treatment for all other arrhythmia. it's worth trying. Always. No matter who's responding. No matter how long you can do it for. If someone isn't breathing but their head is attached and their limbs aren't stiff, CPR is a viable treatment. In fact, without knowing more, it's the only treatment. If you don't know what the heart is doing, you don't shock. Maybe you have a defic (non-automatic) and no ECG. You don't shock, you just do CPR (though I suppose the doctor might, (s)he'd be a doctor and I bow to their superior knowledge and training).
So CPR, absolutely. Whether EMTs are coming or not. CPR the shit out of that body. CPR it like you're trying to win Cupid's 12-hour contest. And keep doing it until you physically can't, until your palms are bruised, your shoulders and back are cramping, your wrists have gone numb and your knees are bleeding. And maybe 5 minutes more if you can push through it. Because who knows when that next compression will be the one that causes ROSC.
What a second, you just told me AED's do restart the heart. Make up your mind.
In any case, CPR is not about restarting the heart because it's unlikely to do so.... Having said that, it's more likely than anything else. When the heart restarts, it's considered "spontaneous" because we can't prove CPR does it. However, that's what hospitals do when trying to restart a heart. So you're keeping the organs alive in case the heart "spontaneously restarts". Personally, I call that doing CPR to restart a heart. It's not technically correct, but it's practically correct. And I'm a practical man.
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