Refusing CPR

[PowerDrill]

I have not read this entire thread so I may be repeating a point that someone has already made.

CPR is NOT what most people think it is. Its overall success rate is about 8%. More to it though. 3% of that 8 will be just fine and dandy. Another 3% will spend the rest of their life in a rather horrible vegetative state (seriously). and the remaining 2% will be somewhere in between. CPR is about artificially inducing blood flow throughout someone's body in an effort to continue oxygen flow to the brain until some other medical intervention can be used to get the person's heart/respiratory system back to normal operation. Needless to say, blood/oxygen flow most often is not optimal and you have a brain/body being deprived of oxygen with the unfortunate consequences this presents. Older people with underlying health issues have particularly poor CPR outcomes. Some have even raised the ethical issue of whether is should be a standard procedure at all. A recent survey found that 80% of medical doctors say they would not wish to have CPR performed on them if they were in "need". Bottom line--it's not at all like the tv shows make it to be (& there are worse things than death)

 

[mrsCALoki]

You made a clear statement that CPR should not be delivered to someone with a pulse and that it was very important to check for that. Since it's turned out that you didn't have a clue what you are talking about, you are pretending that all you ever said was check for respiration, which is a true thing. But I quoted your original statement, it's there for all to see.

Really? Odd it is true that you should not apply CPR to someone with a pulse. It is like using a high pressure fire hose to randomly spray hoses that are not on fire. Break a lot of windows.

However most training for lay people does not suggest checking for a pulse. A lay person has enough trouble finding a pulse when they are calm and collected let alone with adrenalin pumping in their veins. Emphasis on "lay people".

I thought I had said:

....

2) YOU DO NOT DO CPR ON A BREATHING PATIENT.

5) It is very important that everyone fully accept and realize that applying CPR is dangerous but an acceptable risk when done to a 'dead' person (no pulse). It is never appropriate to do it to someone breathing. Ventilation is still the gold standard in many situations. SOP for paramedics.

So would you mind posting the actual quote that you are attributing to me so I can see how foolish I apparently was? Random statements attributed to people are so frustrating.

+1

The point that CPR has significant risk was driven home to me when I saw the ribs had speared the lungs of a cadaver someone had tried to save using CPR. (before I get the bad jokes, they had applied CPR when the living individual collapsed, not on the cadaver after the fact).

But.... if the heart has stopped the person is dead. So the risk of damage cannot make them more dead.

But you need to be very certain the heart has stopped.

I can only find this quote, and I do even see the word pulse in it.

 

[great bear]

Really? Odd it is true that you should not apply CPR to someone with a pulse. It is like using a high pressure fire hose to randomly spray hoses that are not on fire. Break a lot of windows.

However most training for lay people does not suggest checking for a pulse. A lay person has enough trouble finding a pulse when they are calm and collected let alone with adrenalin pumping in their veins. Emphasis on "lay people".

I thought I had said:



So would you mind posting the actual quote that you are attributing to me so I can see how foolish I apparently was? Random statements attributed to people are so frustrating.



I can only find this quote, and I do even see the word pulse in it.

Will it ever end?

 

[Celticman]

Will it ever end?

Only Fred Zed can save us.

 

[great bear]

Only Fred Zed can save us.

Does the bingo hall have cell reception?

 

[SchlongConery]

Will it ever end?

Careful there bear, she might sue ya, call the cops or cry to Fred!

She is still hoping to overcome the debilitating physical trauma of my exposing her fantasy until she can reach her lawyer on Monday. Seems like she is trying her best to mitigate her trauma and better clarify the specific details of her trans-Atlantic voyage with her continued posting.

 

[great bear]

I came to the party late today and discovered the "boating" thread. Christ I was in stitches when he/she started yelling foul over what he/she thought were your attempts to discover his/her location. Rolling on the floor laughing reading his/her threats to get a lawyer involved. Trying to imagine this loon walking into a legal firm and explaning why you had to be sued. That is some of the funniest shit I have read for years on and off line. GB

 

[fuji]

Really? Odd it is true that you should not apply CPR to someone with a pulse. It is like using a high pressure fire hose to randomly spray hoses that are not on fire. Break a lot of windows.

However most training for lay people does not suggest checking for a pulse. A lay person has enough trouble finding a pulse when they are calm and collected let alone with adrenalin pumping in their veins. Emphasis on "lay people".

I thought I had said:

So would you mind posting the actual quote that you are attributing to me so I can see how foolish I apparently was? Random statements attributed to people are so frustrating.

I can only find this quote, and I do even see the word pulse in it.

Ahem.

But you need to be very certain the heart has stopped.

 

[benstt]

The CPR training I took, long ago, emphasized assessment first - clear airways, check for pulse, etc.

Also emphasized if you need to choose between cpr and making the call to 911, make the call. The real differentiator was how soon the defibrillator could be used.

I cannot foresee a useful situation where a person is still breathing but their heart has stopped. They are fucked and need to get their heart going.

 

[fuji]

The CPR training I took, long ago, emphasized assessment first - clear airways, check for pulse, etc.

Also emphasized if you need to choose between cpr and making the call to 911, make the call. The real differentiator was how soon the defibrillator could be used.

I cannot foresee a useful situation where a person is still breathing but their heart has stopped. They are fucked and need to get their heart going.

The modern protocol is similar to what you were taught but with the pulse check removed. And yes you always call 911, CPR cannot restart a heart, it can only stave off brain death until something else does that. Small chance of a spontaneous restart so if an AED is not enroute CPR is not likely to help.

 

[dtjohnst]

The modern protocol is similar to what you were taught but with the pulse check removed. And yes you always call 911, CPR cannot restart a heart, it can only stave off brain death until something else does that. Small chance of a spontaneous restart so if an AED is not enroute CPR is not likely to help.

An AED won't restart a heart either. But CPR might keep the blood flowing long enough for the proper drugs to be delivered. So I disagree with your statement. CPR is likely to help. Studies show the survival rate is doubled to tripled when CPR is applied immediately. Are you jumping on the "discourage CPR" bandwagon too by saying it won't help?

 

[fuji]

What if you have an epipen with you for your own needs. Can you give that to someone instead of doing CPR? Would that even have the same effect?

If their heart has stopped they have no blood circulation so an injection won't help. You could then circulate it by doing CPR but who knows whether it would help or harm. Ask the 911 operator and do as you are told.
.

 

[great bear]

never give someone else your medication. The five rights of medication have to be met ..
right person
right medication
right time
right dose
right method

You keep flashing that photo of yourself and I would like to give it to you at the right time, the right dose, and the right method.

 

[fuji]

Makes sense. Watch enough movies and you might think other wise.

If I were out in the woods and help wasn't coming and CPR wasn't working and it was someone I loved I might try it as a Hail Mary because they are already dead anyway.

But if EMT it's on the way do CPR to prevent brain death and let EMT handle it

 

[Aardvark154]

An AED won't restart a heart either.

It won't? Obviously unless you mean something different, I must have hallucinated that.

 

[smiley1437]

An AED won't restart a heart either.

It won't? Obviously unless you mean something different, I must have hallucinated that.

Yes, that's rather interesting to hear that AED's won't restart a heart. What exactly is the point of an AED then?

I mean, unless dtjohnst is pointing out the distinction between recovering from ventricular fibrillation and asystole, ...sure, the window is very small (I think it's not much more than a minute or two) but even in asystole I believe an AED or any defibrillator is your best bet.

dtjohnst - can you elaborate?

 

[bababuey]

it is not that difficult to feel for a pulse in the neck or the wrist. however if you are uncertain re the appropriateness of chest compressions and the person is completely unresponsive you will not be faulted for proceeding with chest compressions.

forget the ventilation (mouth to mouth). the sole purpose of cpr is to protect the brain, as it is the organ that is least sensitive to oxygen deprivation.

for the layperson: if you come across a person who is unresponsive and seems to have no pulse perform chest compressions to the best of your ability.

the issue of breaking ribs etc is a moot point and beyond irrelevant.

 

[bababuey]

whether or not an AED will work is a complex question. it greatly depends on the rhythm. whether it is asystole or vent. fibrillation (both are pulseless). the default position is to compress the chest to protect the brain. if an aed is available then use it. period.

 

[mrsCALoki]

Yes, that's rather interesting to hear that AED's won't restart a heart. What exactly is the point of an AED then?

I mean, unless dtjohnst is pointing out the distinction between recovering from ventricular fibrillation and asystole, ...sure, the window is very small (I think it's not much more than a minute or two) but even in asystole I believe an AED or any defibrillator is your best bet.

dtjohnst - can you elaborate?

Pretty much nailed it. AED can get the rhythm back, but if the heart is "stopped" it is too much to late. BUT if you keep oxygenated blood feeding the heart the heart can stay alive a long time.

Rule of thumb, as long as the heart has been kept oxygenated their is hope for a remarkable amount of time. The delay is the biggest killer for cardiac arrest.

Problem is medicine is 1/3 memory, 1/3 art, and 1/3 luck even though few people like to accept that vision. <=== visualize being said with a shake of the head.

 

[mrsCALoki]

it is not that difficult to feel for a pulse in the neck or the wrist. however if you are uncertain re the appropriateness of chest compressions and the person is completely unresponsive you will not be faulted for proceeding with chest compressions.

forget the ventilation (mouth to mouth). the sole purpose of cpr is to protect the brain, as it is the organ that is least sensitive to oxygen deprivation.

for the layperson: if you come across a person who is unresponsive and seems to have no pulse perform chest compressions to the best of your ability.

the issue of breaking ribs etc is a moot point and beyond irrelevant.

+ 1. well cpr also needs to feed the heart itself. Although it is indeed less sensitive.


Oh and I have not seen any developed country protocol for laypersons that suggest checking for a pulse. Which one are you referring to? Unresponsive and not breathing (other than Arizona) seems to be the accepted standard.