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Tuesday, April 10, 2007

CPR Update (yet another PSA from the management)

I remember back in my first year of high school I took an after-school CPR course offered by the local chapter of the Red Cross. 

It wasn't that I had ambitions of being an EMT or Paramedic or anything.  Rather, there was this gorgeous cheerleader whose locker was two down from mine.  She had the uncanny ability to make me light-headed just by walking past and leaving me in her intoxicating aroma of Noxema and Herbal Essence shampoo that always seemed to waft after her perfectness as she walked down the the hallway.  One day I overheard her telling one of her friends she was planning on taking this CPR course...

Take one adolescent boy and toss in the remote (like Antarctica-remote) possibility of a mouth-to-mouth or chest compression demonstration with a Senior Cheerleader/goddess (or more likely, simply prolonged close proximity and perhaps an exchanged word or two) and one begins to understand how I ended up taking this CPR course.

So much for altruism, right?

So a few weeks after this bit of eavesdropping I found myself in a classroom with about 15 other kids (including you-know-who) where a Red Cross instructor was unpacking a 'Resusci-Annie' doll that was just ghastly enough to banish any, and all, kissy/touchy-thoughts from my over-sexed teen-aged mind.

The CPR course ended up being surprisingly informative and well-run, and I think there was only one small moment of distraction where most of the boys in the room watched this cheerleader performing mouth-to-mouth on 'Resusci-Annie's'  cold-dead lips while silently wishing that G-d would bless us at that very instant with a mild coronary event so that she could practice on a more suitable subject.

Anyhoo...

The reason I've shared this rather embarrassing glimpse at my high school dorkiness with you is that Book of Joe, one of my primary go-to guys when it comes to demystifying medical news, has just dropped a bombshell  - and not the cheerleader sort - regarding CPR:

"In a nod to reality, the medical profession is finally taking a practical position on what CPR should entail when performed by bystanders without medical training, as is usually the case if it happens at all.

Long story short: Forget all the stuff they taught you about rescue breathing and focus on chest compressions — 80 to 100 a minute, forceful enough to depress the breastbone about two inches (ignore the sounds of ribs cracking — that's collateral damage and unavoidable sometimes) and so energy intensive that the average person can't do more than five minutes at a time and remain effective." [emphasis mine]

Did you catch that?  No more dilemma of whether to risk giving mouth-to-mouth to a bleeding stranger (or carrying around a key-chain disposable airway/shield as I have for over a decade), or trying to figure out what to do first if you find yourself alone with someone who seems destined for the old dirt-nap unless you intervene.

The money quote from the article at Book of Joe:

"...a study of more than 4,000 cases of cardiac arrest, the largest on the subject to date, found that patients were more likely to recover without brain damage if their rescuers had focused on chest compressions alone. Published in The Lancet, the study found that 22 percent of people who received chest compressions alone survived with good neurological function, compared with 10 percent who received combination CPR."

I don't know about you, but if Joe buys it (he's a practicing physician, after all), that's good enough for me.   

Oh, and for all you 15-year-old boys out there, the new rules leave alive the fantasy of, um, chest compressions... so there's still that (if you catch my drift). 

Go read the whole thing.

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Posted by David Bogner on April 10, 2007 | Permalink

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Joe is correct. I'm a ACLS (Advanced Cardiac Life Support) instructor in our hospital and we teach the most up to date recommendations for performing CPR. The first important research paper on the subject of ventilation during CPR came out of Seattle in the year 2000 and found no difference in survival in CPR by lay bystanders with or without ventilation. The conclusion was that airway management done by untrained personel wastes time that could be better directed towards chest compressions. Even physicians are urged to use simple ventilation techniques using a bag/mask and leave the advanced airway techniques like intubation to those highly skilled in such techniques (usually anesthesiologists and paramedics).

Posted by: Avner | Apr 10, 2007 1:09:38 PM

Ahh...the things we do for girls. At what age does that stop?
-Signed, 32 and Counting

Posted by: Benji | Apr 10, 2007 2:35:01 PM

At a recent Magen David Adom 3-day seminar for it's EMTs, we did learn that chest compressions are the #1 thing to do for an untrained person to do.

The only caveat is, in case of trauma (such as a car accident) I'm not sure that chest compressions are the correct thing to do.

As we say..."tzarich iyun"

Posted by: Jameel @ The Muqata | Apr 10, 2007 5:27:49 PM

I worked my way through college as a CPR/First Aid Instructor. Students used to worry about what would happen if they broke a rib(s) on the person they were helping.

I used to remind them that if they were doing compressions it meant that the person's heart was not working so whatever they were doing to help was better than the person could do at that moment.

Annie was fun, but the Chris Clean insert made for a lot of silly jokes.

Posted by: Jack | Apr 10, 2007 6:15:22 PM

I didn't take CPR in high school - Beth Newman should be ashamed of neglecting my medical training.

Posted by: Bob | Apr 10, 2007 9:06:04 PM

I took CPR a few months ago, my daughter's preschool teachers were taking the class and needed a few parents to take it as well (I guess to get the "group rate"). Anyway, while I'm happy to know the good news about doing chest compressions only, I also remember that they were EXHAUSTING to do! I think we had to do it with a "ONE and TWO and THREE and FOUR and FIVE and ... etc." After doing it for a minute or two, I was getting pooped! Still, if it is a matter of someone's life or death, I'll keep doing it, but I hope there'll be someone else to trade off with every few minutes!

The interesting point of conversation though, was about how Baywatch taught many people the wrong way of doing CPR.

Posted by: JDMDad | Apr 11, 2007 5:47:10 AM

Hi David,

While I agree with your assessment of how CPR has changed, I would still high;y recommend sticking with the training you (or others) have. The important part is to render care immediately until the professionals arrive.

I was a military medic and I'd rather stick with ABC (airway, breathing, cardio/compressions) than go straight to compressions. I realize the difference, but it's usually better to stick with trained instinct than switch to an untrained "best practice" technique.

I'll update with my next training.

All the best to you and yours!

Shalom,
Maksim-Smelchak.

Posted by: Maksim-Smelchak | Apr 11, 2007 9:18:12 PM

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