In this RoyOnRescue Video Blog, a student had emailed Roy a question about explaining the Capillary Refill Test and how it may relate to determining if someone is suffering from shock.
Be sure to watch this episode of RoyOnRescue and learn a new trick that could either tell you if someone is going into shock, or that their hands are simply cold.
There are three main reasons why a person may have more than a 2 second capillary refill time:
1. Shock
2. Peripheral Vascular Disease
3. Hypothermia or cold hands
This slow capillary refill time of more than 2 seconds should only be an indication that we should check for other problems. Please don’t assume simply because someone has a slow cap. refill that they are going into shock. It is simply a quick and easy test to help point a first aider in the right direction and to tell us we should check for other issues.
Category Archives: CPR
Giving CPR to People With Bleeding Chest Injuries
I received an email that I think we can all benefit from.
It read…
“Since most of the first aid measures for a no pulse, no breathing situation is immediate CPR, is it alright to do CPR if the victim has a wound on the chest that is bleeding profusely? This is not that I have seen this situation, but I like to think that if it happens I would know what to do!”
C. H.
That’s a great question C. Sometimes it’s easy to get distracted by a serious traumatic injury and forget the basics and what needs to be done first in order to try and save the person’s life. Or, we can look at a complicating injury such as a chest wound and think, How am I going to do CPR on this person, there chest has a serious bleeding wound right where I’m going to give my compressions?
In this episode of RoyOnRescue we are going to look a proper treatment plan if we ever came across a person who had a serious chest injury and needed CPR.
Asthma Attack and No Medication!
One of the scariest feelings is not being able to breath. This is exactly what is happening during a severe asthma attack. I received an email from a person who stated that they have been trained in CPR and First Aid multiple times and though it covers the basics of asthma it never really talks about what to do in depth. They gave me a scenario where a person may be having an asthma attack and EMS is quite some ways away. What’s worse, there isn’t any medication for the asthma attack! Now what?
In this episode we take a look at what asthma is, and how we can confidently handle it even if there isn’t any medications and EMS/911 is delayed.
Asthma Guide
Asthma Symptoms
ProFirstAid.com Training (Allergic Reactions)
Heat Exhaustion vs. Heat Stroke
In this RoyOnRescue, I reply to a question a student emailed me about how to recognize heat exhaustion and heat stroke and how to treat both. If you ever wondered if a person was just “over heated” or if they might be in danger of suffering a life threatening heat stroke, you will want to watch this video blog reply.
In some parts of the country it doesn’t feel very hot but don’t be fooled…Summer is just around the corner. Be ready and don’t allow you or someone you love to become a victim of Heat Stroke!
How to Deal With Death When CPR Doesn’t “Work”
This response was written after receiving an email from a person, who has a cousin that is a trained CPR provider and attempted to save their own father’s life with CPR but their father remained dead despite their efforts. This person felt badly and didn’t know what to say to their cousin to help them not feel guilty or that their father’s death was in some way the rescuer’s fault. I responded to them, and afterward, felt that my response may be helpful to others who have suffered or are suffering or asking themselves the question, “Was there more I could have done?”. I hope that this response will be of help to anyone who may have feelings of failure or guilt as a result of their cpr efforts not ending in the survival of the patient.
Student’s Email Question:
(Paraphrased to protect students identity)
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Dear Student,
One of the most important things to remember when providing CPR to anyone let alone a loved one, is that people who need CPR are already in a state of death. When the person is not breathing and they don’t have a pulse strong enough to detect with obvious signs of life, they are clinically dead. From the point of clinical death, they are only a short distance from biological death, which is permanent.
One way of looking at the success of CPR, regardless of the outcome, helps me and I believe helps my students to be much more at peace with themselves. The fact that your cousin’s Dad did not survive cardiac arrest has very little to do with the CPR given to him. It’s important to remember that CPR, in and of itself does not save anyone’s life directly. CPR is designed to “Buy Time”. CPR only provides about 25% of the oxygen circulation that is required for someone to stay alive biologically. CPR was never designed to be life support viewed as a way to keep people alive indefinitely, but rather to slow down the process of clinical death to biological death. This is to provide a chance to intercept the patient with electrical therapy, advanced therapy and medications combined with CPR and time to fix the underlying problem which caused the person to die in the first place.
In my opinion what your cousin did, is give his Dad the best chance of survival possible if he was indeed going to survive. Let’s look at clinical death as a heavy iron gate that is slowly dropping to the ground, and once closed the person is biologically or permanently dead. CPR is like arms holding the heavy gate of possible survival open a bit longer. Again, not stopping the progression of clinical death to biological death, but slowing it down so that if there is a chance of survival, they would have the greatest opportunity of slipping back through the gate available. Eventually, the gate is going to close even if CPR is perfect. As I said earlier, CPR in and of itself is not enough to keep the human body alive. But if the person is going to survive and the person needs more time, CPR buys the precious time required to make this a reality.
Now, it’s important to remember a simple but powerful truth. Everyone dies. I have had patients that had everything go right in order for them to survive a cardiac arrest and they still remained dead despite our rescue efforts. That day was their day to die and nothing that the cpr providers, paramedics, nurses or doctors did changed the outcome. The CPR helped keep them viable long enough for the rescue and medical team to try and fix the underlying problem but the person remained dead. I had to realize that as a professional rescuer and paramedic, everyone has a day to die. It’s not my job to save everyone but it is my job to give everyone the best chance of survival possible. When I provided care to cardiac arrest patients, I provided care to them as if they were suppose to survive and didn’t give up hope unless they proved to me otherwise by not surviving. It may be frustrating but we just cannot know what day is the day a person is going to live or die until the outcome is evident.
I’m quite sure that no matter what I say, your cousin is really missing his Dad. I don’t think there is any amount of explanation of science, death, dying and CPR that’s going to change that. One thing I do know about what your cousin did the day he provided CPR for his Dad though, he showed others and his Dad how much he loved him. How much he really cared. Your cousin gave his Dad his own strength when his Dad didn’t have any of his own. In my opionion, that’s one of the most loving and unselfish ways to tell a daddy goodbye.
May God bless your cousin and all hurting friends and family during these difficult times.
Sincerely,
Roy Shaw, ProCPR, LLC
RoyOnRescue.com
Roy Shaw
New York Stabbing Victim Ignored Death
“On the surveillance video, a woman is followed by a man, who then appears to accost her.
Tale-Yax walks toward them. What can’t be seen is him being stabbed several times in the torso while trying to save the woman.
Within seconds, the camera captures the apparent attacker running away. Authorities say the woman fled from her assailant.
Tale-Yax, who was homeless, starts to chase the attacker but then collapses.
A minute later, a potential good Samaritan walks right by. And so does the next person and the one after that. A procession of more than 20 people seem to notice and fail to help.”
ABC Video and News Story of Stabbing Victim Ignored
Source: abcnews online
In this Roy On Rescue Video Blog, Roy W. Shaw, EMT-Paramedic explores a most disturbing news story about a man who comes to the aid of a woman being mugged, gets stabbed himself and then is left on the sidewalk to die. The most disturbing part of the whole story is that approximately 20 people walked, drove or rode their bicycle by the dieing man without doing anything to help.
Roy get’s a bit serious in this episode but wants to make sure that if there is a reasonable doubt about getting involved to save another’s life and one is being stopped because of a misconceived fear, that fear must be removed before another person needlessly dies.
Don’t let one of these fears stop you from rescuing:
1. Lawsuit
2. Catching a Disease
3. Unsure of What To Do
4. Might Hurt or Kill The Person by doing something wrong
5. Dangerous Environment (Legitimate)
Roy dissolves the misconceptions and misunderstandings of these top fears and hopes that if you know someone that may not rescue due to being afraid to try, you will pass this story on to them!
If you’re reading this or watching video right now, you are probably one of the ten percent of the total population that this story doesn’t apply to. That’s why we know we are probably “preaching to the choir” but Roy is sure that you probably know someone that wouldn’t get involved in a rescue. Please pass this on to them.
Agonal Respirations Kind Of Look Like Sleep Apnea!
As I reflected on yesterdays video blog; “Gasping for Life”, I thought I should expound on what real agonal respirations really are and maybe even find some examples for you to see or hear. Well, let me tell you this has turned out to be more difficult than I imagined. As I searched the internet for some medical records of what I have seen during episodes of agonal respirations all I could find was one well intentioned but non realistic version of agonal respirations while everything else was simply informational. I then began thinking about the times I had seen low blood sugar patients or postictal seizure patients and thought…I bet a good snoring respiration would be close!
After some time, I found an actual serious sleep apnea(OSA) case and thought I would include the link in the video blog for you to see. Though this is not exactly what agonal respirations look or sound like, it is a far cry closer than other replications I found and will at least get the idea across that any form of agonal or distressed drive to breath is not oxygenating the body well and should be treated with Rescue Breathing or Full CPR depending on the symptoms.
I hope this helps clear up any confusion and please let me know if you would like me to expound on anything else relating to this video blog.
Best Wishes,
Roy Shaw, EMT-P
RoyOnRescue.com
Actual Video Of Sleep Apnea (Warning! This video could be disturbing. Viewer discretion advised.)
Gasping For Life!
If an unconscious person is gasping but not breathing normally should you call 911 and leave them alone, or should you begin aggressive CPR? In this Video Blog, Roy Shaw, EMT-P tells a true story about how a child may have died due to not having life saving CPR because she was showing signs of agonal breathing. This caused the rescuer to stop the life saving CPR and ended tragically.
Watch this Video Blog to learn what agonal breathing is and how to respond to it.
Can a Ball Hitting My Childs Chest Kill Him?
In some cases it has! The velocity of an object striking one’s chest can cause a phenomenon that could disrupt the normal beating heart. If this happens, everyone standing by should hope they can recognize it, and treat it. Here’s how I got on this subject.
An email came in to our offices asking about more information regarding what happens when a child is struck in the chest or abdomen ,ith a ball, puck, bat or other hard object.
Sports can be fun but not when someone gets seriously hurt or dies. One type of injury that is a real concern to everyone is cardiac arrest secondary to chest trauma from a blunt object. This can happen when a baseball, soccer ball, basketball, hockey puck, bat or person hits another persons chest with a great deal of velocity or force.(http://pediatrics.aappublications.org/cgi/content/full/122/2/437) In some cases, it is suspected that if a ball or other object hits a person chest over the top of the location of the heart, the strike works somewhat like a technique that was once used to mechanically cardiovert a heart called a precordial thump(http://www.heartrhythmjournal.com/article/S1547-5271%2809%2900687-0/abstract). This technique used force vs. electricity to create some form of rhythm or Arrhythmia/ Ventricular Fibrillation in order for the heart to be corrected so as to regain a purposeful and organized heart rhythm. This technique though used rarely today, may be the effect that is causing sudden cardiac arrest in children and adults who are involved in a chest trauma from sports. If this does happen, the person may collapse immediately and stop breathing with no palpable(you can’t feel it) pulse. If the person is in cardiac arrest or is not showing signs of life, 911/Activation of EMS and CPR should be started immediately and an AED may be very useful if the person is in a shockable condition. If an AED is not present, CPR will be done continuously without interruption unless the person becomes conscious and begins to move or attempts to speak(signs of life). Be on guard, bruising, punctured lung or other underlying conditions could cause the person to return to a state of cardiac arrest so frequent reassessments will be required until the person is turned fully over to the care of emergency medical services. The best cure for this injury is prevention. Many companies are designing and selling chest guards and protective devices to help prevent this condition from happening.(http://www.allsportsarmour.com/CHEST_ARMOUR_SHIRT_p/asa100%20dual.htm A well trained professional or volunteer coaching team in CPR and First Aid (http://www.profirstaid.com)would be highly suggested and an AED can be purchased for less than a laptop today.(ProFirstAid.com)
In comparison another condition related to a blunt trauma to the abdomen is a condition nick named, “getting the wind knocked out”. This condition usually occurs when a person receives a blow to the upper center abdomen which is approximately where we provide inward and upward abdominal thrusts for a choking victim. This area is physiologically perfect for compressing the diaphragm and compressing the lower lobes of the lungs. This forces residual air out of the lungs and feels scary. Normally, after a few minutes of one trying to breath deeply, fighting hard for that first real deep breath, the spasm releases in the diaphragm and air is gradually brought back into a normal state. Complications related to this fairly common condition could include ruptured or torn internal organs. If a person is hit hard enough, as in situations where a bat or object was used, or the lower half of a steering wheel which is common in unrestrained, non airbag vehicular accidents, the trauma could rupture/tear internal organs and even the descending aorta. If the Aorta is torn or ruptured, it is well know to be a usually fatal injury as time to surgery is quite a few minutes away and one can loose enough blood internally to die from hypovolemia. A condition where there is not enough blood to circulate oxygenated blood or maintain an adequate blood pressure which leads to death if not corrected. Treatment for this more serious condition is activation of emergency medical services while providing CPR, Shock Therapy(http://www.profirstaid.com) and minimization of movement. A way to prevent this injury is to avoid the types of conditions that could present it. Another way is to incorporate an aggressive core strength training program which will build strength in the abdominal muscles so as to help protect against sport related injuries.
It is important to consult with your health care professional or physician before beginning any intense workout program and if you are at all concerned that you or someone you know may have internal injuries, call 911/EMS and seek medical help.
Most of the signs and symptoms related to an internal injury in the chest or abdomen are severe pain that disables a person from performing normal behaviors. Tender abdomen to touch, distending(bulging) belly, rigid or hard belly) bruising or marks over the abdomen or chest, shortness of breath or difficulty breathing, pale, cool, sweaty, increased anxiety, increased respiratory rate, dizziness, fear of dying and unconsciousness. If any of these signs or symptoms are present or appear after an injury, activate the Emergency Medical Services immediately and/or seek medical help right away.
I hope this answers the question and I hope the next time you are by someone who is struck in the chest or simply gets the wind knocked out of them, you’ll better know what it is, what to do, and how to help.
Best Wishes,
Roy Shaw, EMT-P, RoyOnRescue
www.royonrescue.com
Tweet: @royonrescue
P.S. Here’s a link to a real life scenario. It’s worth the read Mom and Dad.
http://www.huffingtonpost.com/2008/05/19/family-of-boy-hit-by-base_n_102439.html
Infant Choking, Back Slaps or Chest Thrusts?
Ever wonder what to do if an infant began choking next to you? Ever wonder if one procedure was more effective than another? Well, one of our students did and emailed me a question about his topic. In this video blog entry I open up the discussion about back slaps and chest thrusts, what they do, and how they work to help a choking victim. Then at the end, I give you the secret about which one is more effective. Enjoy!
Clinical Pediatrics
The Choking Child—A Life-Threatening Emergency
Evaluation of Current Recommendations
Susan B. Torrey, MD
http://cpj.sagepub.com/cgi/content/abstract/22/11/751
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Airway pressure with chest compressions versus Heimlich
manoeuvre in recently dead adults with complete airway
obstruction
Accepted 22 November 1999. published online 17 August 2004.
Abstract
In a previous case report a standard chest compression successfully removed a foreign body from the airway after the Heimlich manoeuvre had failed. Based on this case, standard chest compressions and Heimlich manoeuvres were performed by emergency physicians on 12 unselected cadavers with a simulated complete airway obstruction in a randomised crossover design. The mean peak airway pressure was significantly lower with abdominal thrusts compared to chest compressions, 26.4±19.8 cmH2O versus 40.8±16.4 cmH2O, respectively (P=0.005, 95% confidence interval for the mean difference 5.3–23.4 cmH2O). Standard chest compressions therefore have the potential of being more effective than the Heimlich manoeuvre for the management of complete airway obstruction by a foreign body in an unconscious patient. Removal of the Heimlich manoeuvre from the resuscitation algorithm for unconscious patients with suspected airway obstruction will also simplify training.
http://www.resuscitationjournal.com/article/S0300-9572%2800%2900161-1/abstract
Heimlich vs Back Blows/Chest Thrusts
http://medfraud.info/Koop.html
Consensus Guidelines Not Followed in 1985 Release Encouraging Heimlich Maneuver
