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Cardiopulmonary Resuscitation

You just never know when something is going to happen that will require you to act to save a life. You really don’t. I thought of CPR and First Aid as abstract concepts when I was in high school and was trained in them as part of a “magnet school” program for those of us interested in medical and scientific fields. We got to practice with dummies, but it was just that, practice. We mostly joked and laughed our way through the training, and I can honestly say that I learned nothing but how to dial 911 to get help.

What does “911” spell, anyway?
[do action=”credit”]Photo credit: zen / / CC BY-NC-SA[/do]

My first real exposure to a situation requiring CPR came when I was in college and I was on my laboratory practicum rotations at a hospital. I went to draw blood from someone in the emergency department, and there were about 20 people working on a lady who was blue. The amount of organized chaos was impressive to me, so much so that I almost forgot to draw blood on the person a few beds down because I just stood there and watched the physicians, nurses, and techs try to save that woman’s life. What I remember the most was the forcefulness of the chest compressions being given by a tech and sounds of air going in and out of her.

Over the years, as I went from college to actually working at a hospital lab, I was more and more exposed to people in situations requiring CPR, but I didn’t do any of the CPR-ing myself. I was always the lab tech who took blood and ran off to analyze them. The chest compressions, breathing assistance, and drug delivery was left to others. Even my training then was laughable. We just stood around, did one or two rounds of CPR on a dummy, took a written exam, and then we were certified… All to meet the hospital’s requirements, but never really intended for any of us in the lab to do something with it. Saving dummies in dire straits was easy.

Putting them together is a whole other thing.[do action=”credit”]Photo credit: bez uma / / CC BY-NC-ND[/do]

And so it went for several years until I decided to pay attention to what I was doing with regards to CPR. I don’t know why. It just dawned on me that I would come upon a situation where someone would need my assistance, and it would be extremely embarrassing (not to mention dangerous to the victim) if I didn’t know my stuff. So I paid attention to the instructional videos, put a little more effort at the re-certification hands-on exercises, and ran the scenarios in my head over and over whenever I could.

(I’m not going to write about it right now, but all this came in very handy back at the end of April. That’s all I’m going to write about that, for now.)

Last night, I went to get re-certified in CPR, and, let me tell you, I was hurting this morning. It was a good feeling, though, because it meant that the practice rounds of the instruction were physically demanding, just like CPR is in real life. We went at it for three and a half hours, pumping the chests of those dummies and going through all the motions of actual CPR. We also didn’t put the dummies up on a table like all my previous classes. The dummies were on the floor, making it more akin to an actual situation. I had a hard time kneeling for that long a time and bending all the way down to deliver rescue breaths with a mask.

Not only was the training environment more real, the instructor was phenomenal. He had wide experience in the fields of public safety and emergency medical services, and it showed. It was his idea that we go through all the motions of CPR on the ground and in real time, which is why it took us over three hours to get the whole thing done… And why I’m hurting. I really appreciated that, especially in light of my recent experiences with medical emergencies. I really do feel that I’m more prepared now.

I am a strong proponent of First Aid and CPR training for all parents with children in the household, homeowners with swimming pools on their properties, and for people who care for people with special needs. I highly recommend it for everyone else as well. If you are interested in learning these valuable techniques, I recommend contacting the American Heart Association, the Red Cross, or checking with your employer to see if they have a way of facilitating your training. You never know if you’ll need it, but it’s better to know what to do and not have to than to have to do something and be lost in ignorance.

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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2 replies

  1. In my life, I’ve dealt with emergencies, true disasters, mass casualty events and more.
    The scariest were always family medical emergencies.
    When our youngest daughter was 12, we went to a Friendly’s restaurant as a treat with her elder sister, my wife and myself. She inhaled her mozzarella sticks. In one stick’s case, literally.
    It suddenly became quiet across the table from me. I glanced up from my plate to confirm what my peripheral vision was telling me, bulging eyes and hands on throat. She was utterly silent, mouth gaping, a bit of drool leaving her mouth and ineffectively and silently retching.
    Oh shit.
    “Are you alright?”
    Negative shake of the head.
    “Are you choking?”
    Desperate affirmative nod.
    My wife, being quick on the uptake exclaimed, “My God, she’s choking!”
    “Yes, dear, she is. Honey, stand up if you can.”
    I began to administer the Heimlich maneuver repeatedly. No effect. People were getting up from their tables with helpful looks on their faces, so I picked her up and carried her to the ladies room, kicking the door open and entering a stall with her to continue the thrusts.
    I was beginning to consider a contraindicated procedure, an emergency cricothyroidotomy, doing a rapid mental inventory of assets available for the procedure. It is contraindicated due to age, small structures and potential loss of speech in the young. But, one can cope with a loss of one’s voice, one cannot cope with being dead.
    My old SF medic instructor had frequently said, “We can fix or work around everything but dead, dead we can’t fix”.
    A few full strength thrusts were applied again, rupture the diaphragm, don’t care. That can be fixed, dead can’t and surgical is a last resort.
    The offending food was ejected, thank pneumatic force!
    Fortunately, my wife was running interference, as a woman exited the adjacent stall in a bit of a fright and the restaurant manager was wanting to know what the fuss was about, why a man was in the ladies room and overall, whatinhell was going on.
    I’ve been in some hairy firefights in my life, this left me more drained than any of those times!

    Last Friday, my 83 year old father, type II diabetic (controlled), CHF (barely controlled now, the aortic valve suffers from advanced stenosis and is 0.8cm maximum opening with poor pressure differential across the valve), ESRD (on dialysis) and suffering from vascular dementia (advanced markedly after kidney failure and circulatory overload and complicated with uremic encephalopathy which I had to explain to his hospital nephrologist who was against dialysis initially, I won the argument as he responded and mentally improved) was in for an outpatient procedure, the creation of a fistula for his dialysis access. That double lumen IJ line gives me nightmares over potential infection!
    Oops, I forgot another significant issue with my father, due to his career in construction, he is profoundly deaf. He was and remains utterly ignorant of things medical. He knows concrete, plumbing and some electrical, but medicine not at all beyond the barest of basics.
    So, I was answering the questions of the admitting nurse. We had just completed all of the usual questions of medicines, allergies, etc and she asked if he could assist his own transfer from the chair to the transportation bed. He was heavily deconditioned from the prior medical misadventure of pneumonia, secondary to circulatory overload, secondary to ESRD and CHF that resulted in a month long hospital stay, then a month and one week rehabilitation in a skilled care nursing facility, though OT/PT was only one hour per day because of insurance requirements.
    So, I suggested we ask him how he felt about it, osteoarthritis has been limiting his movements more of late.
    At that point, his eyes rolled back, lids dropped to half open, as I shook his shoulder, I took his wrist to feel for a radial pulse and asked if he was OK. No response, still breathing, head rolled back, jaw dropped open, normal, deep respiration began. No radial pulse.
    Shit. Systolic below 90 approximate.
    I was about to perform a sternal rub when it occurred to me that the nurse that was three feet away was now one foot away and wanting to examine the patient. My peripheral vision showed a half dozen other nurses advancing toward us as well and an emergency was being announced on the PA system for our location.
    I exclaimed, “I’m off, see to him, thank you.” and withdrew to permit the professionals to handle my father’s condition. It was instinct, experience and training that was initially guiding my actions, but definitive care was trivially at hand.
    Thankfully, it appears that his BP medication requirement is lower, hence a BP that ran between 90/48 to 90/53 until nearly 11:00AM, the event occurring at 06:45AM.
    Another time that a firefight was far less draining!
    Indeed, I’d rather go into hand to hand combat against the Incredible Hulk than face having to perform CPR on a family member.
    Something that is quite likely inevitable in the future, as we’ve moved into my father’s home to help care for him.

    In the military, we were selected for a few qualities. First, the inability to quit. This was at a constitutional level of the individual, a quitter can get an entire team killed quickly. We were selected for intelligence and the ability to think on our feet very, very quickly. We were selected for good judgement. We also were selected for intense loyalty to one another, we wouldn’t fail because we’d be letting our teammates down, which was out of the question at a constitutional level.
    After all of that selection, we began advanced training, the selection did not end, the numbers pared down.
    We learned how to handle inconsiderable pressure, indeed, pressure unimaginable to a civilian. We learned how to operate under the harshest of conditions, with no resources beyond that which was in the environment or we managed to modify a bit by “cheating”, such as bringing sugar and salt in one’s pockets and using parachute cord as a belt replacement. We learned how to handle the most intense of situations and think our way through it, negotiate, perform some very advanced medical interventions in the field (my personal joke is that I have committed acts of surgery, as one performs surgery in a treatment facility or an OR, one commits it in a field or the desert).
    There is no training or experience that can prepare one to handle a family member in immediate medical emergent distress.
    My training and experience allowed me to consider the clinical situation, but my pulse was over 150, I was combating adrenaline response to see and think (also part of that training). My very last thought that should have been the first was, we are in a hospital, dammit, move off!
    I did mention a lack of radial pulse, but apparent effective respiration.
    That event left me drained and exhausted for two days.
    His fistula was created on Monday, Tuesday he was released.
    He enjoyed my grandson’s first birthday party this afternoon. In spite of a great deal of exertion getting into her house due to a hill.
    Tomorrow: Dialysis, a half hour early. I’ll have them examine the fistula site, which they’ll probably do anyway. Then, pay his property tax, register a POA with the bank (amazing the hurdles they initially tried to put in place) to renegotiate his home equity loan due to his illness and significant copays, get into a fight with his medical insurance company, as they now no longer cover his sleep aid, Lunesta (he had a paranoid delusional episode under Ambien, but tolerates Lunesta well) and get the duck ready for the dinner table, as well as chicken for my father, as he hates duck. I’m sure I’m missing a few things that I’ll recall in the morning.
    Almost fortunately, I don’t have a job presently. It’d be fortunate, save that I have no clue how we’re making all of the bills.
    But, that last part is something I’m also experienced in dealing with, I did have to survive with military pay and raise a family I occasionally saw.


  2. Crud! I forgot, LEARN CPR, PEOPLE!
    The life you save may well be a family member.
    As a small hint, I personally own two CPR dummies to train everyone except my father, who couldn’t manage to get on the floor with the thing.
    And my wife has an L5-S1 herniation with neural deficit.
    I have an L4-L5 herniation with neural deficit and separated shoulder and still train in CPR.
    It hurts, it sucks, embrace the suckage! (I seem to recall a military tee shirt with those words on it.)


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