Originally Posted by ST911
My department was too poor to afford leeches. We just had a rusty buck knife and a couple of McDonald's straws to let out the evil humors when we needed to!
Man, I haven't thought of MAST trousers in a long long time. What was it, you inflated until you heard the velcro crackle and that was enough?
Still included in a number of DOD kits.
"Yo mama so poor that..."
I remember actually using and testing on them. But that was also when we used to teach mandatory standing-backboard techniques for crash victims that had been wandering around the scene for umpteen minutes just fine prior to our arrival.Man, I haven't thought of MAST trousers in a long long time. What was it, you inflated until you heard the velcro crackle and that was enough?
Anyway, CPR: Still Do It.
الدهون القاع الفتيات لك جعل العالم هزاز جولة الذهاب
Some random thoughts...
I'm 0-1 on CPR results, but in my defense the guy I was trying to save was elderly and had had open heart surgery. I'm still glad that I gave compressions and breaths (this was in the 90's) until the ambulance arrived. His wife thanked me as they were putting him into the ambulance. CPR outcome averages are probably low, but better to try and fail than not to try. For your own peace of mind if nothing else.
When my first son was born he was in respiratory arrest. The German nurse spanked the soles of his feet HARD and he jerked and started breathing and then crying. When my infant grandson went into respiratory arrest due to RSV infection the American nurse pinched his leg hard. That worked too, but if I ever had to deal with an infant in respiratory arrest I'd probably start with the foot spanking...
I know where the AED is in my workplace and make sure my coworkers do too. They may need to save me someday.
Health professionals on this board, if I said anything stupid or dangerous above let me know and I'll remove it.
You spend a lot of time behind bars some Inmates are A holes some are ok towards staff.
Some you have in units from a City Jail all the way up to a Supermax... I knew him for 20 years from all the places I worked he never messed with staff ...just did his time.
Yep. And the Kendrick Extrication Device, and the Kendrick Traction Device....I have no idea if those still exist, but they were tested competencies along with MAST pants. Spider straps for back boards were still not a thing yet.
pat
CPR should be thought of as a form of mechanical circulatory support. There are many others such as ventricular assist devices, ECMO, etc. that replace the pumping function of the heart, and CPR is the least invasive and most temporary since another person is typically providing the mechanical work (there are machines that perform CPR but their superiority is not established). Like all forms of temporary mechanical circulatory support, CPR should be thought of as a bridge - either to recovery (restoration of circulation with defibrillation) or a more durable option such as ECMO, a ventricular assist device, organ transplant, etc. If there is no reasonable chance of recovery or durable option, then the benefits of CPR are highly questionable. What determines the eligibility for durable options are the same factors that determine outcomes from all critical illnesses - the number of failed organ systems and the severity of their impairment.
With that in mind, let’s consider the 2 broad categories of cardiac arrest - out-of-hospital (OOHCA) and in-hospital (IHCA). They are very different in terms of outcomes and and approach.
In OOHCA, the overwhelming majority of patients do not have advance multisystem organ failure - they are able to survive outside of the hospital. In this circumstance, neurologic intact survival is driven by access to defibrillation or some other therapy that restores spontaneous circulation, AND early CPR that minimizes no/low flow time. Again, it is a bridge. Since the overwhelming majority of people living outside of the hospital do not have advanced organ failure before a cardiac arrest, it reasonable to perform CPR liberally in OOHCA. Their neuro intact survival will generally be around 5-25% depending on a number of factors. It is equally reasonable for primary care providers and discharging hospitalist to AGGRESSIVELY pursue DNR orders on patients with advanced organ failure who are living or returning to the community since their neurologically intact survival from a OOHCA is null.
IHCA is a whole different beast. While it is true that survival is much higher (40-50%) due to near instant access to definitive therapies, we can again dichotomize these patients into 1) severe multisystem organ failure prior to cardiac arrest and 2) isolated or mild organ failure prior to cardiac arrest. Category 1 should again get the full court press and have a reasonable chance of functional recovery. Category 2 needs a good goals of care discussion. Generally, physicians who discuss goals of care focus on things like “code status” or resuscitation options with patients having advanced organ failure do a very poor job and typically perform a disservice. The conversations too often sound something like this, “Unfortunately you are very sick. If your breathing gets worse or your heart were to stop, would you want to be put on a breathing tube or receive CPR?” In reality, the conversation should sound more like, “Unfortunately, you are dying; the hourglass of your life is running out. While God doesn’t give me the ability know how much time you have left, experience has taught me that it will measure in days more than weeks (or hours more than days). If you need more time, my team can provide therapies that add sand to that hourglass such as fluids, antibiotics, and medication to support your body in the ICU to try and give you the blessing of more time with your family. Understand, that it will be time spent in this bed and in this room. However, if that time stops being a blessing because you are suffering, let me know and I’ll stop adding sand to that hourglass that is running out, and focus of making your remaining time comfortable.” Ventilators and CPR never enter the conversation since they are non-therapeutic and non-beneficial.
Last edited by Sensei; 08-12-2023 at 11:00 AM.
I like my rifles like my women - short, light, fast, brown, and suppressed.
This is very counterintuitive to me. Is there a simple explanation for why the more severe organ failure patient has a better outcome than the isolated or mild organ failure patient?
Some patients have single system organ failure that requires hospitalization. They have not progressed into multisystem failure, but are at risk for a cardiac arrest due to a severely damaged organ system.
The survivors of IHCA far more are these isolated organ failure patients. They are the patient with a myocardial infarction who has a V-fib arrest on the cath lab table or the trach patient who mucus plugs and PEA arrests until someone replaces their trach. Both are (hopefully) immediately recognized and receive immediate definitive therapy. They did not begin their cardiac arrest with Class IV congestive heart failure, end-stage renal disease, cirrhosis, a devastating prior stroke, or advanced dementia all in one body
The other 50% of IHCA who have prolonged hospitalization with gradually worsening multisystem organ failure do horribly when they eventually arrest…often on max dose vasoactives or while receiving other organ-replacement therapies such as a ventilator (lungs) and continuous dialysis (kidneys).
Contrast this with OOHC who often have single system failure (ie a myocardial infarction resulting in a v-fib arrest or a mucus plugged trach at Our Lady of Neglect Skilled Nursing Facility that is recognized 10 minutes after the fact). In these cases, the fact that the patient started out with a single failed organ system is overwhelmed by the 10 min of “no flow” time before CPR and the 20 minutes of “low flow” time of CPR before high flow spontaneous circulation is eventually restored. If they make it to the hospital, they quickly convert to the multisystem organ failure category over the next 7-10 days as they manifest anoxic brain injury, acute kidney injury, ARDS, and stunned myocardium from the initial prolonged no/low flow time in cardiac arrest. They either die in the ICU when their family decides to end life-prolonging support or have another IHCA when their multisystem organ failure progresses to another cardiac arrest.
Last edited by Sensei; 08-12-2023 at 12:18 PM.
I like my rifles like my women - short, light, fast, brown, and suppressed.
Thank you.
Got more details after visiting grand dads place this weekend. The neighbor that performed CPR was not formally trained at least since boy scouts, so he was coached through CPR by the 911 operator on speaker phone and performed it for 17 minutes straight until EMS took over.
The patient crashed again in the ambulance on the way to the ER but was revived again with paddles. Doctors said it was pretty much a miracle he made it without brain damage or other serious complications.
The neighbor was traumatized enough by the event that he did some therapy sessions.
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