Resuscitation question...

Please register or login

Welcome to ScubaBoard, the world's largest scuba diving community. Registration is not required to read the forums, but we encourage you to join. Joining has its benefits and enables you to participate in the discussions.

Benefits of registering include

  • Ability to post and comment on topics and discussions.
  • A Free photo gallery to share your dive photos with the world.
  • You can make this box go away

Joining is quick and easy. Log in or Register now!

DeepSeaDan

Contributor
Scuba Instructor
Messages
1,096
Reaction score
281
Location
Ontario, Canada
# of dives
I'm a Fish!
Here's the story:

CPR saves life of man at track meetRescuers revive 81-year-old whose heart quit pumping
.By John Branton
Columbian staff writer

Wednesday, May 26, 2010

An 81-year-old man was standing in the bleachers at McKenzie Stadium on Tuesday afternoon, with a crowd of about 1,000 people gathered to watch a track meet, when he suddenly collapsed.

As the man fell and rolled down a row or two, he hit his head on a seat.

The elderly man had suffered full cardiac arrest, wasn’t breathing, had no pulse and was unconscious — basically dead. But his luck hadn’t completely run out.

Standing next to him, wearing street clothes for the meet, was Kyle Kirby, a nine-year veteran with the Vancouver Fire Department.

Kirby, trained in cardio-pulmonary resuscitation, started performing it on the man only seconds after he fell. About 4:10 p.m. Tuesday, Kirby told someone to call 911 and began the strenuous job of chest compressions.

As Kirby worked, members of the crowd watched — and there was a second streak of luck.

Capt. Tony Fletcher, a 13-year-veteran with the fire department and a CPR instructor, made it through the crowd to help. As Kirby did the compressions, Fletcher performed the head-tilt chin-lift on the man and made sure his airway was clear.

Minutes later, the elderly man started breathing a little, so more rescue breaths weren’t needed. So Kirby and Fletcher took turns continuing the chest compressions.

“The minute they stopped CPR to check for pulses, he would stop breathing,” said Jim Flaherty, firefighter-spokesman.

With the man’s heart not pumping, the chest compressions were the only thing that was circulating blood to the man’s brain and other organs, Flaherty said.

Fighting traffic
Meanwhile, AMR Northwest ambulance paramedics arrived at the stadium near Evergreen High School at 14300 N.E. 18th St., but traffic there, including buses filled with track-meet contestants, made it slow going.

But Fletcher, who had gone down to meet them, told them what was happening. Fletcher told them to bring a lift tarp, with handles on its sides, to carry the stricken man down to the ambulance.

Char Thierfielder, the lead AMR paramedic, and paramedic Remington Becker and intern Thomas Drake put the man in the back of the ambulance.

Setting up a heart monitor, as Fletcher and others continued the chest compressions, they learned the man’s heart was fibrillating, basically quivering, and not pumping his blood, Flaherty said. Vancouver Fire Department firefighter-paramedic Perry LeDoux arrived to help.

As the ambulance rushed to Southwest Washington Medical Center with lights flashing and siren blaring, the rescuers used a defibrillator to shock the man three times to get his heart beating. They also gave him lifesaving drugs through an IV line.

The emergency treatment worked. The man started breathing on his own, and paramedics detected a steady pulse, Flaherty said. And he regained awareness and began following directions.

“By the time they got to (the medical center), the gentleman was speaking with them,” Flaherty said.

Federal medical-privacy laws prevent Flaherty from giving the elderly man’s name and prevent hospital staff from releasing his medical condition. However, an official said he was alive at The Columbian’s press time.

The timeline was this, Flaherty said: Called at 4:10 p.m., as Kirby was performing CPR at the track meet, the ambulance arrived in about four minutes, and Engine 10 arrived four minutes after that.

The rescuers delivered the man to the hospital at 4:36 p.m., which means they worked on him 26 minutes, keeping him alive, before arriving at the hospital.

Training recommended
If there was ever a rescue that showed the importance of CPR, this was it, Flaherty said. In this case, a trained person standing next to the man started CPR only seconds after his heart stopped, and rescuers continued the care nonstop.

“Without the CPR, we most likely would have had a different outcome,” Flaherty said. “The stars lined up for this fellow, at least to get him to the hospital and give him the best chance.”

Everyone should learn CPR in case of such a situation, Flaherty said.

One way to start looking for classes is to call the Northwest Regional Training Center at 360-397-2100. The American Heart Association and local Red Cross chapters also can help, and some fire departments offer the classes.

John Branton: 360-735-4513 or john.branton@columbian.com.


Here's the question:

To my understanding, cpr alone cannot regenerate respirations; respirations can only exist when their is a viable ( read - not "fibrillating" or other arrythmia ) heart rythm. Am I correct? Is what the rescuers deemed "breathing" likely agonal respirations? I see these claims all the time in the media when resuscitations are reported, & I always right it off to innacurate reporting...

Best,
DSD

P.S.: In all my field resuscitations, I've never had anyone start breathing during cpr; only after defib. & i.v drug therapy & a resumption of a viable heart rythm.
 
Here's the story: [snip]

To my understanding, cpr alone cannot regenerate respirations; respirations can only exist when their is a viable ( read - not "fibrillating" or other arrythmia ) heart rythm. Am I correct? Is what the rescuers deemed "breathing" likely agonal respirations? I see these claims all the time in the media when resuscitations are reported, & I always right it off to innacurate reporting...

Best,
DSD

P.S.: In all my field resuscitations, I've never had anyone start breathing during cpr; only after defib. & i.v drug therapy & a resumption of a viable heart rythm.

CPR (when done effectively) provides circulation (albeit with a decreased cardiac output) and so long as the brain is perfused, autonomic functions (such as respiration) can continue. It's unusual, but it does happen. And of course, not all arrythmia are deadly, or even dangerous.

I once had a patient in a V-Fib arrest who woke up during CPR. When he woke up, CPR was stopped to check his underlying rhythm. He was still in V-Fib and immediately became unconcious again. CPR resumed, and he awoke again. I gave him a stiff dose of midazolam and we continued. We did get him back to NSR, he was extubated the next day after a pacer/defib implantation and he ultimately did fine. And yes, he remembers waking up during compressions.

Inaccurate reporting (and bystander CPR on people who don't really need it) is certainly an issue. But wierder things have happened.
 
I too, am puzzled at the report that ventilations were suspended for reasons other than exhaustion or some other obstacle, while continuing compressions. The article's writing is confusing here, inconsistent with what I'd expect, especially from veteran personnel. It seems more reasonable that CPR was momentarily suspended when some breaths were drawn but then immediately resumed when it was realized that the victim was in fact not recovering.

In a sound-bite, normal respirations require functioning portions of the autonomic nervous system (i.e. majorly, the lower brainstem including the pons and medulla and phrenic nerve integrity, especially spinal integrity to at least C3) and of chest structure integrity and movement.

As higher brain centers become hypoxic, the brainstem responds with agonal breathing. There's no consistent description of such breathing -- groaning, snorting, snoring, gasping -- but they're usually clearly abnormal. In the dying, such breathing can continue for hours. In a suspected arrest scenario, these may provide some beneficial perfusion but it's not breathing. At the same time, they also may instill doubts about the situation and delay initiating resuscitative efforts. IIRC, at the time of issuance of the 2005 CPR guidelines, they were reported to be present in about 40% of out-of-hospital arrests.

(Dirty-Dog: Your mention of midazolam for some reason, reminded me of my first use of adenosine. My heart fell through the floor when that line went flat, even though I was intellectually expecting it. What I swore made Satan blush. Then came visions of an ocean of lawyers, courtrooms, and jailbars. It seemed like my jaws and toes would never unclench.)
 
Last edited:
(Dirty-Dog: Your mention of midazolam for some reason, reminded me of my first use of adenosine. My heart fell through the floor when that line went flat, even though I was intellectually expecting it. What I swore made Satan blush. Then came visions of an ocean of lawyers, courtrooms, and jailbars. It seemed like my jaws and toes would never unclench.)

I know the feeling. I teach new nurses and medics that the proper way to give adenosine is to slam it, flush it, and look away from the monitor to prevent their own palpitations.
 
I know the feeling. I teach new nurses and medics that the proper way to give adenosine is to slam it, flush it, and look away from the monitor to prevent their own palpitations.

Awww, don't look away... It's sphincter exercise. :wink:
 
I've actually seen patients with arterial lines and Swan Ganz catheters in place when they have been undergoing CPR. Effective CPR can generate a surprisingly high mean arterial pressure and a significant cardiac output. Although I have not seen a patient breathing in Vfib arrest, I can easily imagine it possible, with a slender patient and well-performed CPR.

There is currently a strong movement toward compression-only CPR, as outcomes have been shown to be essentially equivalent to compression/ventilation resuscitation, and people are reluctant to do mouth-to-mouth resuscitation these days.
 
There is currently a strong movement toward compression-only CPR, as outcomes have been shown to be essentially equivalent to compression/ventilation resuscitation, and people are reluctant to do mouth-to-mouth resuscitation these days.

Oh no.... now you've done it. I mentioned this in another thread once, and it started what amounts to a religous war. I think this may be a phenomenon similar to Godwins Law.
 
There is currently a strong movement toward compression-only CPR, as outcomes have been shown to be essentially equivalent to compression/ventilation resuscitation, and people are reluctant to do mouth-to-mouth resuscitation these days.

This was brought up in my ACLS recert class last month. I can understand peoples reluctance to perfoming mouth to mouth on complete strangers, but I can't see the efectivness. After a few cycles the heart will just be pumping unoxygenated blood.
 
This was brought up in my ACLS recert class last month. I can understand peoples reluctance to perfoming mouth to mouth on complete strangers, but I can't see the efectivness. After a few cycles the heart will just be pumping unoxygenated blood.

It must be one of those "lies, d***ed lies, and statistics" issues. I know there is outcome data, but it just defies that feeling in the pit of my stomach.

After many codes with poor outcomes, it's nice to see one with a good outcome.
 
This was brought up in my ACLS recert class last month. I can understand peoples reluctance to perfoming mouth to mouth on complete strangers, but I can't see the efectivness. After a few cycles the heart will just be pumping unoxygenated blood.
IF I have understood what I have read correctly, while there would logically be some decrease on the O2 levels, the claims are that most can last 10 minutes without a breath as long as the compressions are done well. If anyone can substantiate otherwise, please do?

Even you do stop compressions to do breaths, stop after 30, not 15. I've seen suggestions that it takes 10 to get things moving well every time you start over.
 

Back
Top Bottom