In this RoyOnRescue videoblog I answer a request to expound on TIA’s or Transient Ischemic Attacks. I found a great definition at this link.
This “mini stroke” can last from a couple of minutes to around a half hour and looks and acts like a full blown stroke. Take a look at this RoyOnRescue post to learn the difference and what you should do if you come across someone who shows these signs and symptoms.
Best Wishes,
Roy, RoyOnRescue.com
An email came in from a true rescuer who got involved with a man who was in cardiac arrest over the holiday while they were enjoying themselves. They cared enough to get involved and try and save this person’s life but the man stayed dead despite their attempts. This rescuer is struggling with feelings of guilt and that she didn’t do enough. In this episode, I have a very real and honest discussion with understanding living, dying and rescue.
I received a feedback post that I wanted to respond to by video:
The post read as follows:
Roy,
My wife has a heart condition called ARVD. This involves the RIGHT VENTRICAL and the things you are asserting(about CPR) will injure or kill the person. Please see the website at Johns Hopkins on ARVD. This is a congenital heart disease that WILL NOT RESPOND TO STANDARD RESCUE PROTOCOLS. Because it involves the right ventricle the symptoms and treatments are all different. Lynn wears a Medic Alert bracelet and part of the information is to NOT perform standard CPR protocols, but to contact her doctors for information on how to proceed. She has a pacemaker and ICD, and cannot be given lidocaine or any of the standard cardiac resusitation drugs that ACLS requires. We will add that oxygen, lying on the left side and transporting to a facility familiar with heart electrophysiology, and ARVD treatment. This disease is found in athletes (runners, football and basketball players,
tennis and extreme sports) who seem on the outside to be fit, but have a heart that is not functioning as it should. This disease runs in families and it traceable through genetic testing at Johns Hopkins.
-A
It must be difficult having a loved one struggle with a cardiovascular disease as mysterious as arrhythmogenic right ventricular dysplasia(ARVD), but I want to reiterate that CPR performed by bystanders will still give more benefit than doing nothing at all.
The fact that the right ventrical is dysplastic should not have anything to do with CPR performed as an emergency intervention in order to try and circulate any increased amount of oxygenated blood to the brain and vital organs. As with everyone who goes into sudden cardiac arrest, there is no study showing that any amount of CPR would make a cardiac arrest victims biological condition worse. If left alone, and no automatic circulation and oxygenation is present, the body would continue to go without gas exchange circulation. This is why most emergency protocols, and 911 systems will encourage CPR regardless of the underlying pathology related to the cause of death. Out in the field, the goal is to keep the victim biologically alive enough to make it to the hospital or advanced care where when applicable, reversible conditions can be made right. I did contact John Hopkins and after a short discussion with an ER nurse, it was confirmed that ARVD has different protocols for cardiac arrest. Most victims of ARVD do not know they have it and therefore would present as a spontaneous sudden cardiac arrest event. If this occurs, most EMS 911 dispatch systems are going to encourage CPR. I hope this helps and I’ll let you know what I find out from the American Heart Association when they respond to my question for clarity regarding this special case. I hope this helps.
Best Wishes,
Roy, RoyOnRescue.com
Hello Everyone,
I had a person email this question and I thought it may be a good refresher for everyone on a very common accident and injury that effects many different age groups and many different people.
Below is the question and the answer follows below that.
Dear Roy,
I had an injury yesterday playing baseball I ran into another player. I don’t really remember what happened. I was told I hit my head on his chin and on the way down, my chin hit his knee, and then hit my head on the ground. I was knocked out. When I woke, I didn’t know what happened and could not move or talk for about a minute. Then, when I went to get up, my legs collapsed. So I went to the emergency room for a CT scan. No bleeding to the brain, but had an extreme headache. Now the next day, head still hurts and my neck is sore but not as bad. the ER doc said everything looked fine, but could not really say if I have a concussion or not. He said I have the “symptoms”. I guess my question is, when should I go back to work? The doc only took me off for a day but I am still in pain.
Hello J—-,
Concussions can be very tricky. They may not show up on CT or Xray and you can really feel lousy for a while after the initial accident. If you don’t feel capable of returning to work, it’s always best to allow your body the ample time required to heal prior to putting your body back in a stressful situation. However, that’s the perfect case scenario. It’s pretty common that those of us who work, may have to return to work prior to feeling 100%. If this is the case and you cannot get your doctor to write a letter for additional recovery days for your employer, make sure you watch your signs and symptoms and listen to your body. If you become dizzy, nauseated, develop a headache etc., these can lingering signs of a concussion but may not be serious enough for you to be hospitalized. But if you handle heavy equipment or must be at your best to stay safe, keep others safe, or do the level of job required of you, this should probably be communicated to your professional health care provider and see if an extra bit of recovery time could be allowed.
It’s never any fun getting a “Konk On The Melon” and even less fun dealing with the lingering side effects while duty is calling the patient back to work.
Keep an eye on your symptoms and as most any health care provider would tell you, if your symptoms worsen, you become more painful and not less painful over time, if you have numbness, tingling, have a seizure, headache increases, get more dizzy not less dizzy or have a decreased level of consciousness, 911 should be called and you should be seen in the Emergency Room.
Other wise, if the symptoms don’t get worse but get better though are still lingering a few days, it may be within normal recovery expectations and you simply need to take it easy and allow yourself to recover. If you are ever in doubt, don’t hesitate to contact your medical professional and let them know what your symptoms are and see if they want to reassess the situation.
I found a well laid out guideline for definitions and signs and symptoms from a website and I’ll pass the information on to you along with the link for credit to the referenced website.
www.centerforbrainhealth.net
Sports Concussion
It’s more than just a bump on the head
MYTHS about sports concussion…
1. Concussion is a minor brain injury with no long-term effects
2. If you weren’t knocked out, then you didn’t have a concussion
3. Having multiple concussions is common in sports and no cause for concern
4. Symptoms of a sports concussion will always clear up, usually in a few days
5. If there’s no visible injury, everything’s okay
6. You should play through the pain—get back in the game!
FACTS about sports concussion…
1. Twenty percent of all concussions are sports-related
2. A concussion doesn’t always knock you out
3. Having one concussion increases your chances of having another
4. Symptoms of a concussion can last hours, days, weeks, months, or indefinitely
5. Concussion can cause disability affecting school, work, and social life
6. Returning to contact or collision sports before you have completely recovered from a concussion may lead to more serious injury and can increase your chances of long-term problems
What is a concussion?
Concussion is a mild traumatic brain injury that occurs when a blow or jolt to the head disrupts the normal functioning of the brain. Some athletes lose consciousness after a concussion but others are just dazed or confused. Concussion is usually caused by a blow to the head, but can also occur due to whiplash.
How can you tell when an athlete or person gets a concussion?
Sometimes, but not always, the athlete will be knocked out. In cases where there is no obvious loss of consciousness, the athlete may appear to be confused or disoriented (such as running in the wrong direction), and may not remember things that happened before or after the concussion, such as what period it is or the score of the game. Often, the athlete will describe some symptoms of a concussion, such as headache, dizziness, nausea, or blurred vision. It is also common for athletes to describe feeling “fuzzy” or “foggy” after concussion, and to have problems with balance or coordination. For this reason, and also because symptoms can sometimes worsen rather than improve, careful observation of the athlete after concussion is especially important.
What is post-concussion syndrome?
Post-concussion syndrome is a term that describes the physical, cognitive, and emotional symptoms that are caused by concussion and which can last for a varying amount of time after injury. Some symptoms show up right away, but others may not appear or be noticed until the next day or even later. Likewise, some symptoms might resolve fairly quickly, but others—especially fatigue—can persist much longer. The number and severity of symptoms, the speed of recovery, and the impact of symptoms on day-to-day functioning will be different for each athlete.
Physical Symptoms…
* headache
* neck pain
* nausea
* lack of energy and constantly feeling physically and mentally tired
* dizziness, light-headedness, and a loss of balance
* blurred or double vision and sensitivity to light
* increased sensitivity to sounds
* ringing in the ears
* loss of sense of taste and smell
* change in sleep pattern especially waking up a lot at night
Social and Emotional Symptoms…
* mood changes including irritability, anxiousness, and tearfulness
* decreased motivation
* easily overwhelmed
* more impulsive and disinhibited
* withdrawn and wanting to avoid social situations
Cognitive Symptoms…
* feeling ‘dazed’ or ‘foggy’
* difficulty concentrating and paying attention
* trouble with learning and memory (especially for recent events)
* problems with word-finding and putting thoughts into words
* easily confused and loses track of things
* slower in thinking, acting, reading, and speaking
* easily distracted
* trouble doing more than one thing at a time
* lack of organization in everyday tasks
How long does it take to get better?
Most people do recover completely from a concussion, usually in a matter of days. However, it can take up to a year or longer for some athletes to recover, and in some cases the symptoms won’t go away. Recovery may be slower in those who have already had one or more concussions, and in those who have a history of learning disability or attention disorder.
When it is safe to return to play after concussion?
There are several guidelines for return to work/play after concussion. All of these share some common principles:
1. An athlete who has suffered a concussion should be removed from competition immediately and monitored for post-concussion symptoms
2. An athlete should not return to play before he or she is completely symptom-free at rest and after exertion for a specified period of time, which varies based on the athlete’s history and the severity of the concussion.
3. Athletes who have a history of one or more previous concussions should be treated more cautiously (not returned to play as quickly) than those who have suffered their first concussion
4. When in doubt, sit them out!
How can you tell when an athlete is symptom free?
An athlete should only return to competition when it is clear that there are no lingering symptoms of concussion. Unfortunately, because concussion is an invisible injury, and because athletes may minimize or not recognize persistent post-concussion, symptoms, this can be a tricky matter. Also, symptoms may sometimes go away, only to come back after physical or mental exertion.
Most often, return to play decisions are made without the benefit of neuropsychological testing and are based on observation and player report of symptoms. Neuropsychological testing provides the coach or team physician with information that can help to take the guesswork out of concussion management and return-to-play decisions. Using a battery of tests of memory, reaction time & processing speed, we can provide specific information regarding the severity of injury and a standard for evaluating recovery from injury. It is of benefit for athletes to receive baseline assessment prior to or at the beginning of the athletic season to allow for within-subjects analysis of scores following an injury.
I hope this helps J—- and I hope you feel better real soon.
Thanks for the question.
Best Wishes,
Roy, RoyOnRescue.com
royonrescue@gmail.com
In this episode we talk about the subject regarding when a cut may need to have stitches or when it can be simply treated at home. So if this question has perplexed you in the past, you may not want to miss this episode where Roy sheds some light on this sometimes confusing situation.
Happy Memorial Day Weekend!
Roy
Have you ever been surprised by how fast a child can be in one place and the next time you turn around they are in another? Have you ever been shocked by how fast an accident can happen? In this episode, I address lawn mower safety as a result of a terrible tragedy where a 5 year old girl was hit and then run over by a riding lawn mower. It is unknown as to the exact details leading up to this horrific accident or what the abnormal conditions may have been that caused this to happen. The little girl was pronounced dead on scene. There was nothing related to first aid that would have helped her but I have to think that being more sensitive to prevention may be able to save future lives. I pray for a miraculous Grace and healing to be given to the surviving family members of this little girl and I hope to remind us all of some ways to ensure this doesn’t happen.
May God bless and heal this family.
Roy, RoyOnRescue.com
RoyOnRescue.com
Hello Everyone!
I received a question regarding infants having seizures and the proper treatment for them. 
The person asked if it’s proper to handle the patient the same as an adult? This is a great question and one I wanted to address a little more in depth than a simple reply by email.
First, it’s important to understand what a seizure is. The following is a quote by physician, Dr. Fawn Leigh from Duke Health who did a great job describing the two different categories of seizures and how they manifest themselves.
Click here to see the complete article located at: http://www.dukehealth.org/health_library/advice_from_doctors/your_childs_health/childhoodseizures
“Seizures are divided into two major categories (based on 1981 international classification):
Generalized seizures are divided into convulsive and nonconvulsive. Convulsive means that there is muscle movement such as stiffening (also known as tonic) or jerking (clonic) activity. When these movements are combined it may be called “grand mal.”
Other types of convulsive seizure activity include myoclonic and atonic seizure activity. Myoclonus is usually characterized by sudden, single jerks. Atonic seizure activity is typically characterized by dropping quickly to the floor as if suddenly asleep or paralyzed. The child then quickly recovers.
These two latter convulsive seizure types can both be difficult to diagnose and treat because often they are the manifestation of a mixed seizure disorder. In infants these seizures may be called infantile spasms.
Nonconvulsive means that there is alteration of consciousness without muscle movement. This form of seizure activity was formerly called “petit mal,” and is now commonly referred to as “absence.”
Absence seizures are unique in that typically they are characterized by an abrupt onset of staring and end just as abruptly with no confused state following the events. Parents usually report that the child looks like they are “spacing out.” (Teenagers who look like this often are not having seizures — they are simply bored.)
Partial seizures can be simple or complex. Simple partial seizures are focal seizures that involve movement or sensation on one side of the body without altered consciousness. Simple partial seizures are commonly localized to areas in the brain called the motor or sensory strip.
Partial seizures may be with or without aura, which involves associated states such as fear, or changes in heart rate, flushing, or abdominal discomfort.
Complex partial seizures commonly originate from the frontal and temporal lobes of the brain where there are many complex interconnections, resulting in alteration of conscious. Typical complex partial seizures manifest as sudden change in level of alertness with or without aura, blank stare, confusional state, or aimless movements such as wandering around or repetitive behavior.”
Second, it’s important to understand what the main cuases of seizures are:
Thirdly, when it comes to treating an infant compared to an adult, it’s a bit easier, though not any less intense especially if it’s your child. It’s physically easier because baby is smaller and easier to manage.
If this seizure is with a child who has never had a seizure before, 911 or Emergency Medical Services should be activated. The rescuer is going to follow National and International guidelines for treating a seizure patient. Protect the baby from hurting itself while seizing. If it’s in a bath tub, drain the bath tub of water so as to reduce the risk of drowning and then protect the child from hurting itself while seizing. Nothing should be put into it’s mouth which is old school for seizure management in trying to prevent “swallowing the tongue” or biting the tongue off. It is also important that we not try and prevent the baby’s body from convulsing by holding it still or wrapping them tightly. Simply protect it’s head and other parts of it’s body from hitting anything during the convulsive stage of the seizure. After the seizure is over, the baby will usually go into a post seizure phase called the “postictal” phase, and there may be some frothy sputum(spit) around the baby’s mouth or in its nose. A bulb syringe normally used for suctioning mucous or sinus congestion could be used to suction or clear the baby’s nasal passage but it is probably not as necessary as we’d like to think. As a general rule, baby’s have a great gag reflex and if they have any mucous or sputum in their upper airway, it will probably be coughed clear. If the baby begins to breath after the seizure, it could be irregular with some grunting for a short time and then increasingly get more normal. Skin color if it has changed during the seizure to a dusky, purple or blue color should improve as the baby begins breathing more normal and it is perfectly acceptable to comfort the baby in a natural position while maintaining a neutral airway in order for it to recover from the seizure.
If it does not begin breathing, begin basic cardiac life support according to the latest ECC/ILCOR and American Heart Association guidelines. Courtesy of ProFirstAid.com, a Free Online infant CPR training video is available by clicking here!
As many as 2-5% of all children will experience at least one seizure related to a fever over 102 degrees Fahrenheit. The seizure itself is usually harmless and does not cause brain damage nor lead to epilepsy.
Seizures in any age patient can be very scary, and the causes of a seizure are many. Therefore, if it’s the first seizure the person has ever had, we should plan for the worst and hope for the best. This can be done by calling the emergency medical services or 911 depending on your area. Support the patient with basic first aid procedures while waiting for rescuers to arrive and then follow up with your pediatrician after the baby is stable.
If your baby is having a high fever and your afraid that it may cause a febrile seizure, there are some basic steps to help lower your baby’s temperature. Click here to read an article about how to lower a body temperature from a fever.
Well, I hope this helps and I appreciate the great questions so many of you have been asking. Keep them coming and while your waiting for a response, keep on saving lives!
Best Wishes,
Roy
RoyOnRescue.com
royonrescue@gmail.com
Some time ago, I received an emailed question asking if I could do an episode on Food Poisoning. 3 days ago, my little girl, 7, came down with symptoms that were really similar to that of Food Poisoning. After doing my own research and then calling the doctor, I thought it would be a great time to address this somewhat common and sometimes dangerous problem. Some of the suggestions given, are those that the Pediatrician gave me after my daughter had been unable to keep even a sip of water down for over 36 hours! She was pale, dry and if I’m not mistaken, it seemed like her eye sockets were indeed a bit sunken. She’s feeling better now going into hour 49 and is now holding down water, Gatorade, and a BRATY( Bread, Rice, AppleSauce, Toast, Yogurt)diet. I hope this helps anyone else who has been suffering with the flu or food poisoning. Remember, the leading reason people die from vomiting and diarrhea is due to dehydration, electrolyte imbalance and organ failure. Don’t wait until the last minute to get advanced medical attention and if it seems like the person is becoming dehydrated, get help right away. Oh, and if you’re weak or dizzy, don’t try to drive yourself in to the hospital…that’s what 911 is for!
Best Wishes and God bless you as we enter into this most Holy season of Easter,
Roy Shaw, RoyOnRescue.com
In this episode of RoyOnRescue, Roy received a question from an EMT student who was trying to learn more about traumatic asphyxiation. The EMT student wanted more information about this traumatic injury. Many times these injuries happen as a result of a very heavy object dropping onto a persons chest and trapping the person under it’s weight. It’s important to recognize the emergency and take action right away. You won’t want to miss this episode of RoyOnRescue.
I received a question from a person who after watching the “Chest Injuries and CPR” video blog asked:
Dear Roy,
Reading your letter, I would agree if the injury is just soft tissue injury. However if a # is suspected, It would be dangerous to do CPR as the # might or will puncture the lungs and cause immediate death, if immediate intervention is not available.
Kindly comment.
Bent Steering Wheel From Drivers Body
Here is my response:
Hello,
Regarding your question about Chest Injuries and CPR. It’s important to make a distinguishing point whenever we talk about CPR. When a person is in need of CPR, it means that the person is in cardiac arrest. This is to say that they are unconscious, not moving, not breathing normally. If this is the case, they are presumably in cardiac arrest or in a state that justifies Cardio Pulmonary Resuscitation.
If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death otherwise known as biological death(permanent).
This is why, regardless of the chest injury, if the person is “dead” or in need of CPR, compressions are to be given per the American Heart Association guidelines even if the complications could include those of punctured lungs, lacerated organs, or bruised/punctured heart muscle. This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.
If however, the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and complicate the victims injuries. As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services would be contacted and CPR would be initiated regardless of the injuries of the patient.
I appreciate the question and hope that this clarifies any confusion caused by the article. Please don’t hesitate to email me again if you would like to continue dialogue on this subject.
Best Wishes,
Roy Shaw, RoyOnRescue.com
royonrescue@gmail.com
