Posted in Preparedness • Roy on Rescue • RoyOnRescue Personal Responses • CPR for Instructors • CPR for Providers • Personal Protective Equipment • Scene Safety • Self Defense Preparedness

Why Put On Personal Protective Equipment(PPE) Before Checking For Consciousness?

Comments:2 Comments

Hello Rescuers!

I just received a question via our ProCPR customer feedback that read: PPE

Dear ProCPR, “Question 16 says you have on PPE (personal protective equipment)  already, then you check for
responsiveness. Why would you put on your PPE before you check consciousness?

– Anthony

In case anyone else may have asked the same question I though I’d address it.  First, Question 16 is the number this person was on while taking the ProCPR.org test.  This is the online portion of the Health Care Provider level BLS certification training in case anyone was wondering.

Okay,  now for the answer.  As professional health care providers, we should always be thinking about cross contamination.  We don’t want to catch what the patient may have and we don’t want to give the patient anything that we may have!  Remember, PPE works both ways.  Can anyone say, nosocomial infection?  Even if the patient isn’t in obvious distress or obviously infectious, we should be thinking about the fact that the person seems to be in need and may require medical treatment.  This means that we may need gloves, CPR shield with one way barrier, goggles, face mask, respiratory protection etc.   This is why it’s so important to think about PPE  whenever we encounter a situation that may call us into action.  Not just when the person is unconscious or not breathing.

Forever, I’ve battled the problem with health care professionals short cutting PPE while giving care or even thinking about care.  We really do need to consider the two way protective properties related to infection control as it relates to appropriate personal protective equipment.

When it comes to layperson rescue, one of the top five reasons that laypeople will not intervene when a person is in distress is the fear of disease!  If the rescuer is approaching a victim and dons their gloves early as well as ensures that they have a CPR shield available, the fear of catching a disease is greatly diminished.  This will  increase the chances that the Good Samaritan may actually get physically involved in the rescue.

Now I know what you may be thinking…”Roy!  Do you really think that I’ll have one of those rescue kits on by belt all the time?  You may be a “Rescue Hero” type but the feasibility of me having PPE on my person when I’m at the beach, shopping, walking, vacationing, or even at a business meeting is slim to none.”  Well, I have to agree!  Unless you are a professional rescuer on duty, you probably won’t have your jump kit, glove pouch or a one way valve mask bag swinging from your belt loop.  So how will you have the PPE you need at the time you need it?  The best way I’ve found is to have a key ring rescue kit.  The catch is having it be small enough to not get in the way and large enough to carry your gloves and a one way CPR shield.  The reason I say a Key Ring style, is that I think that keys are the one item that most people have with them most of the time.  If they don’t have them with them, then they are usually close at hand.  And if we have our keys, we’ll at least have gloves and a CPR shield.   So make sure you get one and then the PPE problem is out of the way.  Still don’t think that PPE is needed?   Well, that’s why the AHA endorses “hands only” CPR!  It’s really not that compression only CPR is better than full Cardio PULMONARY resuscitation, it’s that there are so many non PPE toting people afraid that they may catch a disease if they do mouth to mouth rescue breaths that we had to design a new form of  bystander CPR.  Since implementing  “Hands only” CPR, there has been an increase in rescuer involvement.  And when people get involved and provide CPR, lives are saved!

PPE should be on every rescuer’s mind…and key chain, lay or professional and when we begin to think about PPE as the first step in rescue, lives are saved and infection is prevented more often!

Hope this helps.

Posted in Roy on Rescue • Sports Related • Cold Related • Environmental • Trauma

Lindsey Vonn Super G Skiing Accident Medical Breakdown

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newskicrashthumb

In this episode of RoyOnRescue, I take a look at the details of the recent Lindsey Vonn skiing accident and what mechanism of injury caused the serious knee injury she suffered. Watch actual footage of the accident while I comment on how the crash caused her injuries. Then, discuss what steps you might take to minimize further damage and what you would do as the rescuer on scene prior to air evacuation.

Posted in Medical • Abdominal Pain • Illness • Roy on Rescue

When Abdominal Pain Calls For 911!

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hitinthestomachIs abdominal pain a reason to call 911?
“Abdominal pain is pretty common, how do I know when to call the doctor or when to call 911?” -email sent by rescue fan.

 

I noticed that some Rescue Fans were wondering about when to call 911 or know when they should seek help after they get hit in the stomach. Great question! Abdominal pain can be everything from simple gas to a life threatening bleed. In my opinion, one should call 911 whenever the pain is causing decreased level of consciousness, is unbearable, rigid abdomen, pale skin, blood in urine or feces or anytime that voice inside is saying, “something isn’t right”. Then, if its nothing, great! But if it is serious, time is short and fast action to the hospital is vital. I hope this helps!

Stay well!

Posted in Roy on Rescue • RoyOnRescue Personal Responses • CPR for Providers

Question: Why Dont We Check ABC’s Anymore?

Comments:1 Comment

In this blog,

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I answer a question that came in about why we don’t teach lay rescuers to check for pulses after AED shock. This student thought that we were trying to trick them but in reality, the new standards are what may be tricky. Here’s my answer, I hope it helps.

Hi Shelley,

Thank you for taking the time to comment about the training. I’m writing In regards to your question about AED use and then checking for “signs of life” vs checking for Airway, Breathing and Circulation. Id like to assure you that as wrong as it may seem to do CPR without checking for pulses first, the training you received from ProFirstAid.comis based upon the latest guidelines set forth by the American Heart Association and are correct.

The old standards were to shock with AED Training and then assess for Airway, Breathing and Circulation, if no pulse give CPR. The new standards have eliminated pulse checks for lay rescuers in order to simplify and hopefully reduce pulse check “mistakes”. This is designed to shorten time from arrival of help to first chest compression.

Now, if your feeling a little confused, don’t feel bad… many of us do when there are changes. Be assured that most people who are unconscious, not breathing normally and have received a shock are most probably in cardiac arrest and CPR is called for. Besides, studies show that chest compressions when not needed rarely ever cause severe harm. Better to error on the side if giving CPR.

This however, is the reason for change in training and per the AHA standards it is accurate.

I’d be happy to explain further and in more details if you like.

Best Wishes,

Roy Shaw, paramedic, instructor
ProTrainings.com

Posted in Roy on Rescue • Head Injuries

What Is Cerebral Venous Sinus Thrombosis?

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Hello Rescuers!

I received an email from a RoyOnRescue friend who had suffered a head injury while playing a sport.  After being seen by the doctor he was diagnosed with Cerebral Venous Sinus Thrombosis or (CVST).  He had asked me if I would give my explanation of what it is and if it was something he should be worried about.  His doctor had exCSVTplained it but he was still a bit foggy regarding the diagnosis.  Well, after looking into it from the clinical perspective, I realized that it was a pretty big deal and in some cases may be fatal.  I researched multiple sources to gather credible information and when it all came down to brass tacks, I found that the Wikipedia explanation had done a pretty dog-gone good job of summarizing CSVT.  So, with all credit given to them for most of this article and a link back to their website, here it is.

I have personally responded and treated many different types of head injuries as a paramedic but had not researched this problem to this level.  Then, shortly after receiving this question, I read that  Secretary of State, Hillary Clinton was diagnosed and hospitalized with the very same problem secondary to her head injury!  Ironic.   So, I thought to myself, if two people experienced this problem secondary to a common traumatic head injury(concussion), there may be more with the same question.

Here’s my trimmed-down version of what it is, what it’s symptoms are, how to determine if it is truly CSVT and then what a person may want to do if they think they may be suffering from such a complication.  So let’s dig into some of the questions you may have!  P.S.  You’ll notice there are more links then usual in this article.  The topic is so complex and has so many different facets I thought it wise to allow you to do some of your own information mining and hope the links make it easier.

Q:  What is a cerebral venous sinus thrombosis anyway?

A:  A CVST is the presence of thrombosis (a blood clot) in the dural venous sinuses, which drain blood from the brain. 

Q:  What causes a CVST?

A:  There can be many causes of CVST.  Here is a few I included:

Q:  How might I know if I have a CVST?

A: Headache that may worsen over the period of several days, but may also develop suddenly.  Strangely the headache may be the only symptom of cerebral venous sinus thrombosis.  Stroke, 40% of all patients have seizures, Common symptoms in the elderly with this condition are otherwise unexplained changes in mental status and a depressed level of consciousness.  The pressure around the brain may rise, causing papilledema (swelling of the optic disc) which may be experienced as visual problems.  In severely raised intracranial pressure, the level of consciousness is decreased, the blood pressure rises, the heart rate falls.  This is a common symptom found in closed head injuries which makes sense as the mechanism is very similar.

Q:  How will the doctor know if this is what I have?

A:  The most commonly used tests are computed tomography (CT) and magnetic resonance imaging (MRI), both using various types of radiocontrast to perform a venogram and  visualise the veins around the brain

Q:  How is a CVST treated and cured?

A: Treatment is with anticoagulants (medication that suppresses blood clotting), and rarely thrombolysis (enzymatic destruction of the blood clot). Given that there is usually an underlying cause for the disease, tests may be performed to look for these. The disease may be complicated by raised intracranial pressure, which may warrant surgical intervention such as the placement of a shunt.

AmbulanceQ:  Can this be serious?

A:  Yes.  Like any illness or injury that causes a problem with the circulation of oxygenated blood to our tissues, this type of problem can be very dangerous if left untreated.  It also runs a risk of complication in that it raises the intracranial pressures which can act similar to a closed head injury and this too can cause severe injury or death.  If a person has any of the symptoms listed above, they should be seen as soon as possible to rule out this potentially life threatening disorder.  If a person is reacting with decreased level of consciousness, or any type of life threatening complications, activation of Emergency Medical Services or 911 should be immediate with life saving or time buying intervention given.

 

I hope this helps and keep well!

See Source:

http://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosis

http://neurology.jwatch.org/cgi/content/full/2007/515/2

http://www.medscape.com/viewarticle/705510_3

 

 

Posted in Roy on Rescue • CPR for Instructors • CPR for Providers

Question Answered Regarding Aggresive Chest Compressions and Unconscious Choking Patient

Comments:

Screenshot-2013-12-04-14.22A really good question came in regarding the choking unconscious protocol.  The question was basically this.

Q:  The way the objective is taught regarding choking patients, you progress to chest compressions once the person loses consciousness with or without a pulse.  I can understand that and have taught that to my staff BUT those with ACLS certification quickly point out that ACLS still stresses that you do not do chest compressions in a patient with a pulse.  I am reviewing my ACLS and I can see the confusion.  As I see it, the key is in what you have available to you and in an unconscious choking vs respiratory arrest but I would like to better explain it and to do that I need to make my peace with it too.

Lastly,  In response to your training question regarding choking unconscious patient.  I know it’s hard to understand some of the changes that take place from time to time with the ILCOR and AHA recommendations.

A:  I’ll try and make sense of this particular skill.  Once we asses for unconsciousness or lower the unconscious choking patient down to the floor, and after calling 911, we’re going to begin 30 chest compressions immediately and then open the airway, check for obstruction or object in mouth and sweep it out if we see it.

If we don’t see it, we will attempt two breaths, if breaths don’t go in, we will reposition the head tilt and chin lift and try two more breaths(ideally with a one way valve mask in place).  If breaths do not go in, we will give 30 more chest compressions and then check mouth for object. Repeat until object is clear, airway is open or help arrives and takes over.  If at some point, we sweep an object  out and the breath goes in, we then check for a carotid pulse for no more than 10 seconds, if no pulse and no normal breathing…begin CPR.   If there is a pulse but patient is not spontaneously breathing, begin rescue breathing at 1 breath every five seconds.

Explanation:  The immediate chest compressions are due to a philosophy that the patient was already choking while conscious and instead of assuming that it came out after unconsciousness, we assume that it’s still blocking the airway.  The only thing we need to do if not already done, is activate the EMS or 911 system.  Then after 30 chest compressions, we check for produced obstruction.

Remember, even in ACLS, we are now less concerned about pulses and more concerned about time from non circulating heart activity or arrest to time of first compression. In other words, if we are not able to detect pulses or are unsure, but the patient is unresponsive and not breathing “normally” (agonal) the science and research is promoting aggressive cardiac compressions and minimization of time between arrest and first compression from CPR.  In this scenario, if the choking patient is in cardiac arrest, then they will benefit from  receiving 30 chest compressions before we check the airway.

Therefore, in theory, we’ve potentially circulated some residual oxygen to the brain and other vascular organs.  If the patient is not in cardiac arrest but simply still choking, the compressions should assist in relieving the obstruction and studies have shown that injury due to non-needed compressions is minimal.  This is why the emphasis on aggressive chest compressions.

I hope this helps anyone else who may have had the same question!

Posted in Pets and Animals • Roy on Rescue

Your Dog Is Sick, Could It Be Poisoning?

Comments:1 Comment

In this episode of RoyOnRescue, Roy covers the top ten poisons that most often send “Man’s Best Friend” to the Vet. Over 100,000 dog poisonings occur each year and most of them are from products we have right in our own home. The symptoms can include:
-Upset Stomach
– Neurological problems
– Diarrhea
– Burns
– Respiratory Difficulty
– Cardiac Problems
– Seizures
– Coma
and even death. Dogs are a beloved part of the family and the last thing we’d want to worry about is that our sweet pooch got sick or died because of something we forgot to put away, pick up or clean up. Watch this episode to learn in just a few minutes how easy it is to prevent unnecessary dog poisonings.

Posted in Roy on Rescue • Weather Related • Cold Related • Environmental • Dehydration • Outdoor Emergencies

Could You Survive Stranded In A Snow Storm?

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After hearing about a couple getting stranded in a mountain pass off-roading and the driver dying while seeking help, I thought I should talk about key elements around surviving out in the cold.  People are often overcome by the cold simply due to lack of pre-planning, proper equipment and an adequate plan for survival until rescue help arrives.  If you’ve ever wondered what you would do if you were lost, stranded or overcome by the winter elements, be sure to watch this episode of RoyOnRescue.
In the meantime, remember at least these important points:

1.   Let people know where you are going and what route you’ll be taking…then stick to it!
2.   Dress with layers of clothing or have extra clothing available
3.   Bring warming agents like hand and pocket warmers along with extra blankets
4.   Bring extra food that can handle getting cold or even freezing like granola, nuts etc.
5.   Eat snow for hydration
6.   Bring GPS
7.   Bring Flare Gun
8.   Never drive with low gas tank
9.   If the roads are dangerous, maybe stay home or extend your vacation
10. Repeat steps 1 thru 9

Peace,

Roy, RoyOnRescue.com

Posted in Roy on Rescue • Trauma

Punch To The Face And A Visit To The Doctor

Comments:3 Comments

Hello Rescuers!
I wanted to respond to this question sent in via email from what I think is a Martial Artist. Being active in martial arts myself (TKD and BJJ) I completely understand the question sent in from Michael about eye injuries, face injuries and teeth problems.

Like any trauma, there can be several things to think about right away.  Is there a more serious injury that is being missed because of the blood coming from the face(distracting injury)? Maybe a head injury, brain swelling, breathing problems, neck injury, broken bone, etc. If no life threatening situation, then we may have some more time to think about how bad the injury really is.

If ever there is a loss of sight, loss of limb or loss of life, the answer is simple. Activate your medical emergency services RIGHT AWAY and support the patient with CPR and First Aid. If no life threatening emergency, glove up, clean up the patient and see what’s going on. If the person has an eye injury that makes them unable to see or may be the result of a poking injury, get them to the ER for examination. If the person has a hematoma(blood under skin) that is making their eye swell and unable to open, it may be a good idea to get a cold pack on it right away and then get to doctor or ER for reduction of hematoma, stitches, tetanus shot etc.

Loose, broken or missing teeth? Dentist right away.  Anything less then these may buy you some time to see if it gets better or worse. We have all been hurt while sparring but it’s the possible tears, broken bones, eyes and teeth that we don’t want to let go too far without treatment.  Remember,  if in doubt, call your 911 (EMS) or doctor and run the situation by them. Get a second opinion and see if they want you to come in or treat with first aid.

Now a reminder on prevention. Head gear, mouth-guards, face shields and proper guards are all essential to the prevention and reduction of needless injuries during contact sports. Yeah I know, they’re clumsy and usually not needed but if you’ve ever been kicked, hit or struck in the wrong place you can appreciate their protective abilities. Remind new people that sparring means practice with control not out and out fighting. Warn your sparring partners of injured areas and communicate when things are not going right. Whenever your in doubt about an injury…see a doctor.
I hope this helps. Be Well.

Roy, RoyOnRescue

Posted in Roy on Rescue

What’s All The Fuss About The CPR Numbers?

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In this episode of RoyOnRescue we take a look at the different numbers related to CPR over the years. There can be confusion when it comes to deciding what set of numbers are best for the best outcome. Watch this episode to learn the scoop on how CPR numbers may not be as important as some may think they are.

Best Wishes,

RoyOnRescue Team