From: st871622@pip.cc.brandeis.edu (not him again)
Subject: Cardiac Arrest
Date: Tue, 28 Jun 1994 03:40:40 GMT


Dedicated to Alan McKendree - hope you like it.

The truth about CPR.

I've performed CPR [based on a modest estimate] on nearly five-hundred
people in the past six years as an EMS [you all know what it stands
for] provider. I'm also an instructor, and train others to perform CPR.
In these classes, we tell people that heart disease is the number-one
killer of people in the 40-60 year old age range, we also tell them 
that performing CPR on a person is one of the neatest things one person
could do for another.

Let's look at a typical cardiac arrest:

A late-fifties male gets up in the morning [wife's still sleeping] to
go to the bathroom. He's overweight, smokes like a chimney, and is now
grunting away - trying to push out the pound of steak he ate for dinner
last night. While he's doing that, the pressure he places on his 
bowels produces a sudden drop in his heart rate, with a corresponding
drop in blood pressure. This is known as 'vagal-ing out' - as the vagus
nerve responds to such stimulus by dropping the heart rate. The man 
gets dizzy, and falls off the can in mid-shit. This is what I call the
classic 'Elvis' presentation: man on bathroom floor, boxer-shorts down
to his ankles, flopping around and leaving skid marks on the floor so
wide you'd have thought a 747 landed nearby.

Now his heart *could* at any moment increase it's rate - but since his
heart is soooo tired after all those years, it decides to pump at this
rate for a while - 'catch a breather' so to speak. Ironically, since 
the heart isn't pumping enough to circulate blood and oxygen 
efficiently, the heart itself does not receive enough blood and oxygen
to continue beating - so it quits altogether.

Anywhere from several minutes to several hours later, this man's wife
wakes up - and follows the 'I had steak for dinner last night'-smell to
the bathroom, where she finds hubby. Naturally, you'd think her first
reaction is to dial 911, to get some help for him. Noooo, wrongo. You
may pick from the following options:

1) She yells "Ralph - wake up."
2) She notices his boxers down to his ankles, and pulls them up.
3) She splashes cold water on his face.
4) She yells "Ralph - wake up" again, just in case he didn't hear her 
the first time.
5) She genuflects, makes the sign of the cross, and throws in an 'Our
Father' for good measure.
6) She calls the family doctor - to ask what to do.
7) She calls the family priest - to ask what to do.
8) She calls another family member - to ask what to do.
9) She does all of the above - _then_ dials 911.
10) Any combination from above.

By the time an ambulance gets dispatched to a cardiac arrest, things
look pretty dim. The fire department usually gets there first, and 
they either: start CPR on an obviously dead person, or withold CPR on
a person who just dropped, to see if we want them to start CPR on the
person when we arrive.

If the fire department _does_ initiate CPR on a person, they invariably
compress the _stomach_, not the chest, providing all responders with
visual confirmation of the man's gastric contents and last meal. By the
time we get there, there is usually feces, urine, and vomit [the unholy
trinity] all over the floor. If the woman has chosen to do any or all
of the options provided above, then he is also soaking wet, and there
is a priest standing next to the body, playing with his beads. The 
phone usually rings - the doctor returning this woman's frantic page.
And let's not forget the woman's extended family - all barrelling into
the house - all trying to get into the same little bathroom we're in.
If the fire department also tries to ventilate the man using an 'ambu'
bag, and doesn't have a good seal of the mask against the face, then
the vomitus is sprayed down the sides of the mask. If by some chance 
a good mask seal is obtained, but the head of the patient is positioned
improperly, then the esophagus - not the trachea, is open. With every
squeeze of the ambu bag, more and more vomitus gets p-u-s-h-e-d down
the trachea, and into the lungs. If by some miracle of God, and the
alignment of the moon and stars, the patient survives, the only thing
he'll have to fight is a nasty case of aspiration pneumonia.

ObAside: Most CPR training mannikins have a little tube that runs from
the mouth to a squeeze bulb. The idea is that this squeeze bulb can
be filled with warm pea-soup, and when an unsuspecting CPR student has
their face over the mouth, and someone does a improperly placed stomach
compression, the instructor [me] can squeeze the bulb full 'o soup into
the face of CPR student. They never make the same mistake again. Used
to be that when I put a can of green-pea soup in my backpack, my 
roommate would say "Teaching CPR today?"

The medic that opts to intubate the patient usually gets a face full of
cheesesteak regurg if he/she hasn't told the firefighter to stop
compressions while he/she makes the attempt. After re-directing the
firefighter's hand over the chest, the next compression usually breaks
the sternum - partly due to calcification of the cartilage in the
sternum, partially due to the depth of compression needed to produce
a palpable compression-pulse. The sound of the sternum and ribs 
cracking is like a Knuckle-Crackers Anonymous convention in full-swing.
Ironically, cracking the sternum makes it easier for subsequent 
compressions, and results in less fatigue when performing long periods
of chest compressions - so most of us try to break the ribs in the 
first few.

The other medic starts an IV, and performs a 'quick-look' with the 
cardiac monitor. In most cardiac arrests, there isn't enough time to
place chest electrodes on the patient - so we pull the 'paddles' and
place them on the chest - a classic 'Johnny 'n Roy' manuever.

AnotherObAside: Does anyone remember the old 'Emergency' series? The
story of two Los Angeles County fire department medics - Johnny Gage,
and Roy DeSoto? It's amazing how many people in EMS were compelled to
enter this field of work because of this show. Anyway, part of the 
opening montage shows Roy at the scene of some accident: he pulls two
parts of a large syringe from his med box, and flicks the yellow caps 
off of them with his thumbs - another classic 'Johnny 'n Roy.' One of 
my very first calls as a medic - I pulled a 'Johnny 'n Roy' with the
syringe: flicked the caps off the syringe - one of which hit a cop in 
the eye as he stood over me. Got me so nervous that after I connected
the syringe together, I expelled the air - and half the contents of the
syringe, onto the ceiling. Nothing beats having some medication drip,
drip, drip onto you from the ceiling as the family stares at you.
'Trust us - we're professionals.'

The advent of new technology now provides us a choice when performing
a 'quick-look.' There are now self-adhesive pads which you can stick onto
the patient's chest, and connect via cables to the monitor. Not only 
can you monitor a patient's cardiac rhythm with them - you can also
provide a 'hands-off' shock to him as well. It's really great - when it
works. The adhesive sometimes grabs on to the dead flaky skin of an
unwashed body - and comes right off. This usually happens in mid-shock,
and a large blue electrical discharge arcs from one pad to another. The
smell of ozone and singed chest hairs come to mind.

Just a reminder - all this takes place in the first five minutes of the
call. 

I could go on - but it's time for my medication.

If you like the first five minutes, I'll post the next five at a later
date. Thorazine makes me sleepy ...

Seizures! (see ya) - Tae

[Whew! It finally loaded - been trying for the last week. Shitty school acct]