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The Fight

dcurt.is

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Re: The Fight

#131

Post by FireBeyond »

nvarsj wrote: post #129
JshWright wrote: post #50

Earlier quoted context omitted.

This is a field where a surprising amount of progress is being made. People still tend to assume that CPR is mostly a token effort so bystanders feel like they're doing something. In reality, high quality CPR + rapid access to an AED can give just about any heart a fighting chance at beating again (assuming the underlying problem is transient or easily treatable... if your LAD cardiac artery is 100% occluded and half…

No offense to your passion, but I thought that CPR can be quite dangerous and ineffective. Don't many doctors wear DNR tags because of this? The wikipedia article [1] has some information on this. The survival rate is something like 4% even though immediate recovery is around 40% (they survive long enough to get to the hospital, where they die due to the underlying condition). Meanwhile, the person has to suffer with…

As a paramedic, the "DNR" thing is part "folklore", part reality, but not for the reasons you cite.

If CPR is ineffective, the result is death. Dangerous? Not particularly.

Most people wearing DNR tags (aside: even a DNR tattoo on the chest is not considered legally binding against "heroic measures", unless signed by a physician) do so to provide some measure of what the patient might want (due to life expectancy, illness, etc).

Survival rate to discharge is HIGHLY dependant on many, many variables - I mention elsewhere that in certain parts of the country, due to concerted education and well managed/funded EMS systems, survival rates can approach 50% to discharge. You are right, though, successful CPR isn't going to negate the underlying cardiac condition.

If CPR buys a patient a year to five years, the pain of broken ribs is probably fairly minor in the grand scheme of things.

There are, as mentioned, a whole host of advances. My home EMS system does some fairly deep analysis of all CPR attempts and works to revise protocols, including what drugs to administer, through to 'continuing compression through defib shock' (studies done on medical students showing it to be a viable possibility).

Ultimately, education is the key - the ability to get skilled compressions more quickly on the chest, continuing to perfuse the brain and other organs has a huge impact in survivability, as well as damage done.

Re: The Fight

#132

Post by FireBeyond »

grannyg00se wrote: post #6
pdx wrote: post #5

For those of you who haven't had a CPR refresher in a few years, they now heavily promote the use of AED's [Automated external defibrillator]. The prognosis for recovery after CPR alone is in the single digits and moves well, well into the double digits if supplemented with an AED. Gyms, schools, and works areas should all have a $1000.00 AED onsite. I was surprised that he had to wait for the ambulance to arrive bef…

What are the legalities involved here? If you attempt to help are you opening yourself up to potential blame and legal action? What about DNR wishes the person may or may not have, or religious beliefs?

Good Samaritan laws cover a layperson attempting to do good (so long as you're not doing something a reasonable person would realize to be actively harmful).

In most states, "ignoring" a DNR order is covered similarly. Point of interest:

Even as an EMS provider, with a patient who has a valid and active POLST (Physician's Orders on Life Sustaining Treatment - a more detailed DNR, that offers advice on comfort measures, intubation, and the like) - if the family wants heroic measures (CPR, etc), then we are required to do so (though my personal moral and ethical compass has issues with this).

Re: The Fight

#133

Post by groby_b »

rickdale wrote: post #11
huhtenberg wrote: post #3

It's all good, but if you haven't had a close relative or a close friend die or come close to it, then no amount of preaching - Live now! Fight the momentum! Live it to the fullest! - is going to do any good. You have to experience it, unfortunately there's no other way. My dad died suddenly two years ago. Just like that - here he is, poof, here he is not. I tried to capture the feelings in a written form and then ha…

Going on 10 years, similar experience. People don't understand how much suddenness of the death affects you. What I have come to realize is that there is no right way to deal with people dealing with death. And that everyone will deal with death differently. I remember at my dad's funeral stuff the number one line I heard from people was, "if you ever need anything..." I didn't know what that meant then, or now. But…

That line means "if you need somebody, I'm here". It's there to let you know that while you have to go through this by yourself, you are not alone.

But yes, words are insufficient. Even if the other person speaking them has gone through the same pain.

Re: The Fight

#134

Post by JshWright »

nvarsj wrote: post #129
JshWright wrote: post #50

Earlier quoted context omitted.

This is a field where a surprising amount of progress is being made. People still tend to assume that CPR is mostly a token effort so bystanders feel like they're doing something. In reality, high quality CPR + rapid access to an AED can give just about any heart a fighting chance at beating again (assuming the underlying problem is transient or easily treatable... if your LAD cardiac artery is 100% occluded and half…

No offense to your passion, but I thought that CPR can be quite dangerous and ineffective. Don't many doctors wear DNR tags because of this? The wikipedia article [1] has some information on this. The survival rate is something like 4% even though immediate recovery is around 40% (they survive long enough to get to the hospital, where they die due to the underlying condition). Meanwhile, the person has to suffer with…

It's not the CPR that's particularly damaging. Yes, ribs are dislocated (though rarely broken), and cartilage is torn. Those are fairly minor complications though. The 'damage' is done by the medications we push. Drugs like Epinephrine are very good at getting your heart to beat again. A recent study in Japan suggests that that may be at the expense of your brain, and other vital organs. Other drugs commonly used in ACLS resuscitation are equally nasty (Amiodarone, for instance).

You're absolutely right that we've gotten very good at getting a heart to beat for a few more days until it succumbs to the damage done to the rest of the body (that 40% figure you mention, though out-of-hospital rates are still much lower than that). The exciting research being done is to improve long term outcomes for cardiac arrest patients.

More and more research is showing that the key to a good long term outcome is early compressions, effective compressions (push hard and fast), uninterrupted compressions, and early defibrillation (with an AED or manual defibrillator). Over the past 10 years, resuscitation algorithms have been streamlined to minimize 'off chest' time. Compression to breath ratios have changed (from 5:1, to 15:2, to 30:2). A great deal of emphasis has been placed on keeping the rhythm checks that happen every two minutes as short as possible. We're now teaching people to continue compressions while the defibrillator is charging (and under ideal circumstances, you could easily continue compressions throughout the shock). Intubation is performed without stopping compressions.

The focus of all of these changes is to decrease the number of time compressions are stopped. Every time compressions are stopped, it takes some number of compressions to get the pressure built back up in your circulatory system. Fewer interruptions means fewer 'wasted' compressions, and less time that the brain isn't getting perfused. This is obviously key to a good neurological outcome.

We like to think all our fancy drugs and advanced interventions are doing something effective, but in reality, 'basic' treatments like CPR and defibrillation are what really save lives, and more importantly, save brain.

Re: The Fight

#135

Post by thewisedude »

ForrestN wrote: post #125
xianshou wrote: post #105

Earlier quoted context omitted.

The crux of your argument is the claim that, if the universe becomes a field of equidistant neutrinos, no action or thought in the meantime matters. The implicit assumption behind this view is that events only matter to the extent that they leave a legacy. In particular, it asserts that things only have ultimate meaning if they extend to temporal infinity. I believe that how one reacts to Curtis's post, and to your s…

My point isn't that everything is meaningless necessarily. I would say that the more one thinks about death the harder it is to make arguments for meaningfulness. I wouldn't make an argument for meaninglessness, I would just say that you can't really extrapolate a positive value system from the fact that life is short. It feels like you're arguing in favor of narrowing our vantage as a way to preserve meaningfulness,…

I concur with most of your arguments, I do concur with you that there seems to be over importance given to Job's personal-life than it should. But, your last paragraph about Job's life seems to be out of line with your philosophy. You are claiming that Job's death was unnecessary. Unnecessary in whose terms? Is the purpose of life living the longest possible life? Here, by saying that his death was unnecessary or untimely, you are implying there is a time for a person of his stature to die. Now, its no more about making decisions that make you happy or not worrying about the shortness of life, or the lack of meaningfulness of life, but rather you are now preaching how somebody should live their life(or make certain decisions) just like the author or the article is trying to do.

P.S- I do think Steve Jobs contributed greatly to his field and I admire him & his products. The arguments made above are purely for discourse

Re: The Fight

#136

Post by ForrestN »

thewisedude wrote: post #135
ForrestN wrote: post #125

Earlier quoted context omitted.

My point isn't that everything is meaningless necessarily. I would say that the more one thinks about death the harder it is to make arguments for meaningfulness. I wouldn't make an argument for meaninglessness, I would just say that you can't really extrapolate a positive value system from the fact that life is short. It feels like you're arguing in favor of narrowing our vantage as a way to preserve meaningfulness,…

I concur with most of your arguments, I do concur with you that there seems to be over importance given to Job's personal-life than it should. But, your last paragraph about Job's life seems to be out of line with your philosophy. You are claiming that Job's death was unnecessary. Unnecessary in whose terms? Is the purpose of life living the longest possible life? Here, by saying that his death was unnecessary or unt…

I guess I was making the observation personally that my priorities are very out of sync with wishing for Jobs' life. I don't think anyone else should have the same priorities as I do. I'm terrified of dying and would like to life as long as I can. I would also feel badly if I knew I died earlier than necessary for psychological reasons.

Re: The Fight

#137

Post by crpatino »

JshWright wrote: post #98
Xylakant wrote: post #44

Earlier quoted context omitted.

The helmet must be removed for unconscious injured. If the person is fully able to respond you should leave the helmet on unless asked otherwise, but you must remove the helmet when the injured looses consciousness. Not taking the helmet of may have the injured die of blood or puke inhaled or just his tongue blocking respiration. So you're damned if you do and more damned if you don't. Be careful when you remove the…

Without the means or training to manage the victim's airway, there's no advantage to removing the helmet. Leave it for trained rescuers.

Better yet, become a trained first responder yourself. And urge your family members and colleagues (and anyone you spend significant amounts of time with) to do so as well.

Re: The Fight

#138

Post by apr »

mikestew wrote: post #104
JshWright wrote: post #72

Earlier quoted context omitted.

>But this is exactly what I'm taling about; I'm hoping for a time when medical science has progressed to a point where these issues are very well understood, and seemingly random cardiac arrests like this can be preempted and prevented. I believe it's possible. This is simply a discussion of semantics, and I feel kind of silly for arguing it in the first place. You're absolutely correct that most of the 'random' sudd…

Wolf-Parkinson's, that's me. I was a highly-trained and mostly-healthy bike racer and would occasionally get a rapid, arythmic heart beat under certain conditions that would last for sometimes hours. Finally went in to get it checked, and when I asked "doesn't that result in sudden death in athletes?" He said if it hadn't killed me by now it probably wasn't going to. One heart ablation and it hasn't bothered me since…

Did you feel anything during the ablation procedure?

Re: The Fight

#139

Post by mikestew »

apr wrote: post #138
mikestew wrote: post #104

Earlier quoted context omitted.

Wolf-Parkinson's, that's me. I was a highly-trained and mostly-healthy bike racer and would occasionally get a rapid, arythmic heart beat under certain conditions that would last for sometimes hours. Finally went in to get it checked, and when I asked "doesn't that result in sudden death in athletes?" He said if it hadn't killed me by now it probably wasn't going to. One heart ablation and it hasn't bothered me since…

Did you feel anything during the ablation procedure?

Sorry for the late reply, I don't have reply notifications set up. During the ablation itself, I felt nothing because I was drugged. However, they have to repro the problem in order to know what to zap. That was an interesting process with all kinds of non-painful (though not entirely pleasant) stuff to feel. The details are still up if you care: http://psychocross.blogspot.com/2007/10/next-in-continuing-s...

Re: The Fight

#140

Post by apr »

mikestew wrote: post #139
apr wrote: post #138

Earlier quoted context omitted.

Did you feel anything during the ablation procedure?

Sorry for the late reply, I don't have reply notifications set up. During the ablation itself, I felt nothing because I was drugged. However, they have to repro the problem in order to know what to zap. That was an interesting process with all kinds of non-painful (though not entirely pleasant) stuff to feel. The details are still up if you care: http://psychocross.blogspot.com/2007/10/next-in-continuing-s...

Thank you.
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