Cardio Pulmonary Resuscitation and Terri Schiavo
Posted by: Deane F on 04 April 2005
My wife has just completed a two-day first aid course as required by her employer. They were, of course, given refreshers on CPR and the current opinion on how it should be done.
She told me that the teacher of the course said that CPR revives the patient in 4 percent of cases but that in thirty five years as a first aider, ambulance officer and involvement in associated fields he had used CPR but never successfully revived a patient. Nor did he know of any nurses, ambulance officers or first aiders who had ever revived somebody using CPR techniques. I was surprised but he said that they still consider it worthwhile to teach it on first aid courses.
I thought of Terri Schiavo. She was revived after not breathing for ten minutes - well beyond the four minutes commonly held to be the point beyond which brain damage occurs after respiratory arrest. So, they kept her alive artificially for years and then stopped food and water.
I just don't know what to think about that one.
She told me that the teacher of the course said that CPR revives the patient in 4 percent of cases but that in thirty five years as a first aider, ambulance officer and involvement in associated fields he had used CPR but never successfully revived a patient. Nor did he know of any nurses, ambulance officers or first aiders who had ever revived somebody using CPR techniques. I was surprised but he said that they still consider it worthwhile to teach it on first aid courses.
I thought of Terri Schiavo. She was revived after not breathing for ten minutes - well beyond the four minutes commonly held to be the point beyond which brain damage occurs after respiratory arrest. So, they kept her alive artificially for years and then stopped food and water.
I just don't know what to think about that one.
Posted on: 04 April 2005 by thirty three and a third
A lot of bible-thumpers here in America say the doctors played God by removing her feeding tube. I say they were playing God by keeping her alive all these years.
john
john
Posted on: 04 April 2005 by Bruce Woodhouse
CPR alone is designed to keep people alive whilst a definitive treatment is delivered (such as defibrillation), or until the cause of the collapse is removed (such as choking). People who collapse and need CPR are by definition extremely ill, only a few will have potentially salvable conditions anyway. CPR does save lives, community defibrillators are saving more now the machines are springing up in railways stations, supermarkets and the like. The new automated machines are incredibly easy to use.
I'm unsure about Mrs Chiavo's case. If she collapsed in the community then you can hardly blame a team for attempting CPR on a young person even if a significant delay had occurred. 99.9% of the time she would not have got 'going again' if she had been anoxic for 10 minutes. If the collapse happened in hospital then the 'not breathing for 10 minutes' may reflect her own spontaenous respiratory effort, a CPR team would establish artificial respiration (and some sort of circulation) in seconds.
I'm glad I no longer have to make decisions about ending a prolonged attempt to resusitate someone, but generally it either works quickly or it is not going to work. One exception is afetr cold water drowning-some amazing stories of people recovering after long CPR.
I'm very surprised that nobody on the course had ever seen a succesful resusitation. I can think of many I've been involved in whilst working in hospitals, and at least two in the community.
Bruce
I'm unsure about Mrs Chiavo's case. If she collapsed in the community then you can hardly blame a team for attempting CPR on a young person even if a significant delay had occurred. 99.9% of the time she would not have got 'going again' if she had been anoxic for 10 minutes. If the collapse happened in hospital then the 'not breathing for 10 minutes' may reflect her own spontaenous respiratory effort, a CPR team would establish artificial respiration (and some sort of circulation) in seconds.
I'm glad I no longer have to make decisions about ending a prolonged attempt to resusitate someone, but generally it either works quickly or it is not going to work. One exception is afetr cold water drowning-some amazing stories of people recovering after long CPR.
I'm very surprised that nobody on the course had ever seen a succesful resusitation. I can think of many I've been involved in whilst working in hospitals, and at least two in the community.
Bruce
Posted on: 05 April 2005 by Brian OReilly
quote:Originally posted by Bruce Woodhouse:
CPR does save lives, community defibrillators are saving more now the machines are springing up in railways stations, supermarkets and the like. The new automated machines are incredibly easy to use.
Bruce
Are community defibrillators actually being used then, Bruce ? I've seen them at railway stations and they appear to be foolproof(acording to the instructions at least), but will the general public actually be comfortable/knowledgeable enough to use them in practice ?
BOR
Posted on: 05 April 2005 by Bruce Woodhouse
One of my wife's patients was defibbed on Leeds station by an off-duty nurse. He is well, and grateful.
Incidentally I think CPR saved one Mr Gerard Houllier. Sports grounds are another place with defibs available-more for the crowd than the players (Lee Bowyer is apparently brain-dead anyway).
I am sure that an awful lot of people would be frightened to use the machines, although they are safe and simple. I think it is most likely to be staff in the shop etc who will use the machine, and they should be getting regular training updates. Some US cities have had big public education campaigns about community defibs and have seen good results.
I guess the cohort of people prepared to use them will slowly grow.
Bruce
Incidentally I think CPR saved one Mr Gerard Houllier. Sports grounds are another place with defibs available-more for the crowd than the players (Lee Bowyer is apparently brain-dead anyway).
I am sure that an awful lot of people would be frightened to use the machines, although they are safe and simple. I think it is most likely to be staff in the shop etc who will use the machine, and they should be getting regular training updates. Some US cities have had big public education campaigns about community defibs and have seen good results.
I guess the cohort of people prepared to use them will slowly grow.
Bruce
Posted on: 05 April 2005 by manicatel
I work for a fairly well known airline that carries defibrilators on all its planes. The crew receive training on them,+ yearly refresher courses/exams on their usage.I believe, that the success rate, when carrying out cpr,in conjunction with the defib. is about 15%.This is apparently about normal for this procedure outside of an ICU.Doesn't sound that great, does it, but as bruce said,if you need cpr, you are already in a seriously bad way.If it was me, or a family member, I'd still welcome a 15% chance. Better than nothing.
Can't add anything about the mrs Chiavo situation.
matt.
Can't add anything about the mrs Chiavo situation.
matt.
Posted on: 05 April 2005 by Deane F
Bruce
Your comments have crystalised my thoughts. You're right, a team can't be blamed for attempting to resuscitate a young person and she had been breathing on her own for these past years. The only artificial support was the feeding tube. So her own efforts were responsible for her revival.
On the subject of CPR, we do have a small population in New Zealand (just hit 4 million) so perhaps the dearth of successful CPR stories is more understandable than in a large population like the UK.
Deane
Your comments have crystalised my thoughts. You're right, a team can't be blamed for attempting to resuscitate a young person and she had been breathing on her own for these past years. The only artificial support was the feeding tube. So her own efforts were responsible for her revival.
On the subject of CPR, we do have a small population in New Zealand (just hit 4 million) so perhaps the dearth of successful CPR stories is more understandable than in a large population like the UK.
Deane
Posted on: 05 April 2005 by greeny
quote:I'm glad I no longer have to make decisions about ending a prolonged attempt to resusitate someone, but generally it either works quickly or it is not going to work. One exception is afetr cold water drowning-some amazing stories of people recovering after long CPR.
I know nothing about this, other than what I see on ER. Here they regularly show using CPR for 30mins -> 60mins before 'giving up'. I have noticed in equivilant UK programs the doctors tend to give up after a few minutes (5 ish). Now obviously these programs ar'nt real however they usually try to get things reasonably realistic, so is there a genuine differance to the procedures in the US and UK or is ER using a bit too much artistic licence??
Posted on: 05 April 2005 by Bruce Woodhouse
It depends on the patient and the situation. Someone may arrest due to a heart rhythym problem and be otherwise 'fine'. Whilst the screens are still showing electrical actiivity you can keep trying for a while with some chance of success. If someone has no apparent cardiac activity, or has obviously got major irreversible pathology (such as a massive stroke) then you know it is not really going to work out.
I've never watched ER. I guess if they deal with trauma cases then you'd continue CPR while you attempt to correct blood loss and perform any immediate repair surgery if you can.
Most arrests in hospital are not fit young folk with gunshot wounds but people with worsening multiple pathology.
Artistic licence in a TV health programme? Surely not!
Bruce
I've never watched ER. I guess if they deal with trauma cases then you'd continue CPR while you attempt to correct blood loss and perform any immediate repair surgery if you can.
Most arrests in hospital are not fit young folk with gunshot wounds but people with worsening multiple pathology.
Artistic licence in a TV health programme? Surely not!
Bruce
Posted on: 05 April 2005 by manicatel
One thing that gets me with most tv progs is when they apply a defib to a "flatliner". My (limited) knowledge tells me that fibrilation is when a hearts electical pattern gets erratic/ disrupted,& a defib essentially re-sets the rhythm.With a flatline, there is no electrical activity, so a defib is of absolutely no use. I will happily bow to someone elses greater knowledge on this if I am wrong.
matt.
matt.
Posted on: 05 April 2005 by Bruce Woodhouse
You are right.
Makes good telly though, or so i'm told.
Makes good telly though, or so i'm told.
Posted on: 05 April 2005 by DAVOhorn
Last Time i did my Intermediate course we were told that :
The patient is already dead.
The skills and equipment available may help you to save their lives.
But to all intents and purposes they are dead,
so you cant kill em by your intervention.
But if lucky you may save them or keep things going till the crash team arrive.
Heard of two incidents recently .
Both involved nursing colleagues talking to pts and the pts just rolled their eyes and dropped.
dead before they hit the floor was the report findings so even though emegency measures taken they failed as pts had had massive coronaries and hearts were shot.
I believe in the USA now people start running and run damn fast if they have medical training.
regards David
The patient is already dead.
The skills and equipment available may help you to save their lives.
But to all intents and purposes they are dead,
so you cant kill em by your intervention.
But if lucky you may save them or keep things going till the crash team arrive.
Heard of two incidents recently .
Both involved nursing colleagues talking to pts and the pts just rolled their eyes and dropped.
dead before they hit the floor was the report findings so even though emegency measures taken they failed as pts had had massive coronaries and hearts were shot.
I believe in the USA now people start running and run damn fast if they have medical training.
regards David
Posted on: 06 April 2005 by kevinrt
After public training on defibrillators in some cities in the US, it is said (jokingly) that they are now the safest place in the world to have a cardiac arrest but the most dangerous place if you faint.