Refusing CPR

[dtjohnst]

What other method do you know of to "be very certain the heart has stopped"?

Get over yourself. You got it wrong. Just fess up.

Same ways doctors, cops, firefighters and paramedics do? Decapitation, livor mortis, rigor mortis, no brain activity (if they're connected to a brain activity monitoring device), putrefaction, decomposition, etc.

 

[dtjohnst]

I dont see the reason for argueing here. If you see some one and you think you can help you should.

I agree. Which is why I'm trying to clear up misconceptions like "once you start you can't stop" and "if paramedics aren't coming, don't bother."

 

[smiley1437]

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.

Thanks, that was useful. My brain is far too clouded with TV uses of defibrillators

 

[mrsCALoki]

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.

I have to agree with 99.9 % of this.

I might go a little far and talk about 'cold mortis' imitating rigor mortis So unless you have been socially introduced (joke in wording) to death, do not give up even if they feel cold and stiff.

 

[dtjohnst]

I have to agree with 99.9 % of this.

I might go a little far and talk about 'cold mortis' imitating rigor mortis So unless you have been socially introduced (joke in wording) to death, do not give up even if they feel cold and stiff.

Agreed. Good tool for paramedics and doctors, poor tool for an untrained bystander. Of course, the 10 minutes of post-death supervision in case of ROSC is a pretty big deal too.

 

[mrsCALoki]

Ok I have a question.

Someone earlier said AED's will talk to you and give directions. I was shopping for one in UK and their many give visual cues and do not speak. Do all in Canada speak to you?

The unit I settled on has an manual over-ride to shock when I think it is appropriate. Are the automatic / semi automatic ones sold in Canada?

Since 2000 there have been dozens of recalls on AEDs, It is critical to register yours with the the manufacture.

 

[Aardvark154]

I agree. Which is why I'm trying to clear up misconceptions like "once you start you can't stop"

To wade back into this stupidity, as to myself that was not what I posted.

Neither on the other side of the coin can you shout "I'll save them" jump into the water swim ten meters turn around and come back (unless you have a cramp etc. . .) and expect not to to be open to legal liability based upon "it would be too expensive for them to sue me." Then again that is not the same as you swim out try everything you know and finally have to break off and the person drowns and now you will successfully sued - no.


Now can we please discuss AEDs?

 

[dtjohnst]

To wade back into this stupidity, as to myself that was not what I posted.

Neither on the other side of the coin can you shout "I'll save them" jump into the water swim ten meters turn around and come back (unless you have a cramp etc. . .) and expect not to to be open to legal liability based upon "it would be too expensive for them to sue me."

I never mentioned names. But if it makes you feel better, this is the post in question:

I know that if the average person start CPR you are legally obliged to continue until relieved by a qualified person or a doctor declares them dead but there is no obligation for a person to start. Don't know if this applies to medical professionals. it is also possible that the deceased had requested not being resuscitated.

Many people seemed to grab on to that and go with it though. In any case, I interpret that as, "Don't start. It's better for you." Plus it's completely false.

 

[mrsCALoki]

it was me
the only ones I have experience with are at three gyms in my area, and the local community sports centre / pool / arenas ... so that's six. They are all basically the same style, they all talk. I don't have experience with any other types, so can't tell you much about other types. Another note is those sticky pads only have a shelf life of so long ... they need replacing regularly. Our local gyms and pool only keep the adult ones in the AED, I guess they are expensive and they are rarely used. thank goodness. but it is absolutely ok to use the adult pads on a child or infant. Looked sort of like this :

here's a video of an AED in use ... it talks as soon as you open it. I've got a feeling they all do.

batteries also have a shelf life

 

[Aardvark154]

Thanks for posting the video Jessica.

 

[fuji]

Not breathing, not responding, are pretty good indicators for a layperson.

Sure they are, you now know that is in the protocol. But your original statement was crystal clear and related to pulse, not respiration.

You really only dig a deeper hole by denying it.

 

[fuji]

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.

You are unnecessarily argumentative. By restart I just meant restart normal function. When someone is down and not breathing without medical equipment you really have no idea what rhythm, if any, they have. I agree you do CPR. My point is just that you are trying to prevent organ death until more effective treatment arrives. I made my comment in the context of saying you must call 911 first because the real opportunities for resuscitation arrive with the EMT, and CPR just buys them time to get there, so you need to call them first.

 

[dtjohnst]

You are unnecessarily argumentative. By restart I just meant restart normal function. When someone is down and not breathing without medical equipment you really have no idea what rhythm, if any, they have. I agree you do CPR. My point is just that you are trying to prevent organ death until more effective treatment arrives. I made my comment in the context of saying you must call 911 first because the real opportunities for resuscitation arrive with the EMT, and CPR just buys them time to get there, so you need to call them first.

Maybe that's what you meant, but that's not the accepted usage in first aid. Restart means starting what has stopped in that context. Don't get upset if I'm assuming you're using the standard terms and you're using non-standard.

 

[mrsCALoki]

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.

yes you keep saying cpr is not about oxygenating the heart muscles. and that keeping the heart able to respond without drugs is not important. That is news to me, but I am dated. Can you show me the research paper please? I sort of always assumed that was a big factor.

 

[mrsCALoki]

Sure they are, you now know that is in the protocol. But your original statement was crystal clear and related to pulse, not respiration.

You really only dig a deeper hole by denying it.

OK you are tight and the words "check for a pulse" are there, where there all along. Just so small no one but you could see them

There do you feel better now? LOL



^^ Sarcasm

 

[fuji]

OK you are tight and the words "check for a pulse" are there, where there all along. Just so small no one but you could see them

There do you feel better now? LOL

^^ Sarcasm

Your words: "be very certain the heart has stopped"

No other comment required.

 

[mrsCALoki]

she actually told me I was going to kill someone with my half baked ideas ... but you know ... now it's all different. Now that she's been proven so very, very wrong. Again.

arrogance in not even knowing what ventilation is, is not a good sign and is dangerous.

the willingness to apply CPR to a breathing subject is worrisome

Applying cpr to a breathing subject is dangerous, and applying it to a beating heart is dangerous (breathing is a dead give away the heart is beating).

Do you want me to pull out your exact words and quote them?

If a few people here believed your half baked ideas and had not been exposed to more knowledge......... and they just ignored the basic precautions, yes you could have killed someone.

Sorry, I call tham as I see them. Victims come first.

 

[mrsCALoki]

Your words: "be very certain the heart has stopped"

No other comment required.

I am sorry I told you you are right and infallible already.

I was stupid in the original posts to imply breathing people did not have stopped hearts.

Do you need to more assertions to your superiority and wisdom?

:hail: :cheer2: :clap2: :clap2:

Damn I so wish I had said "take a pulse" so I could point to it and you would stop insisting I had told people to take a pulse,

 

[simon482]

arrogance in not even knowing what ventilation is, is not a good sign and is dangerous.

the willingness to apply CPR to a breathing subject is worrisome

Applying cpr to a breathing subject is dangerous, and applying it to a beating heart is dangerous (breathing is a dead give away the heart is beating).

Do you want me to pull out your exact words and quote them?

If a few people here believed your half baked ideas and had not been exposed to more knowledge......... and they just ignored the basic precautions, yes you could have killed someone.

Sorry, I call tham as I see them. Victims come first.

hey brother, missed you while i was gone. not gonna pick a fight or nothing just some friendly advice. you just got done a 3 day shit kicking where you got beaten down pretty hard and got lawyers and stuff and acting all weird. are you sure you really want to be picking fights, talking down to and being condescending in a couple new threads already. how about you take the night off and try to have a normal conversation like normal people would. you know with some jokes and some laughs and a little silliness. you don't have to have your back up all the time. calm down, chill out. have a snickers or deep fried oreo. i had a couple of those tonight and they are delicious.

 

[versitile1]

hey brother, missed you while i was gone. not gonna pick a fight or nothing just some friendly advice. you just got done a 3 day shit kicking where you got beaten down pretty hard and got lawyers and stuff and acting all weird. are you sure you really want to be picking fights, talking down to and being condescending in a couple new threads already. how about you take the night off and try to have a normal conversation like normal people would. you know with some jokes and some laughs and a little silliness. you don't have to have your back up all the time. calm down, chill out. have a snickers or deep fried oreo. i had a couple of those tonight and they are delicious.

it goes back to that definition of insanity I quoted.