Resuscitation after trauma

Legolam

The discussion on the Rio spoilers thread was getting a bit derailed, so here are my answers to Tangled Metal's queries:

So Hannah, at last someone coming out as an expert, what you're saying is you open up the airway with as little disturbance to the neck of the injured person. That is to open up the airway of someone having difficulty to breath.

Yes (although I'm not sure I could call myself an expert, certainly not on trauma resuscitation)

Could something like that crash cause someone to stop breathing and pulse to stop? I must admit I've only seen a drowning accident which caused the injured to need full resuscitation. He.recovered from a full on blue colour BTW but scary all the same.

Again, yes. I watched the AvV crash live and I honestly thought she'd died. There are many mechanisms, but transecting the spinal cord could stop your circulation/breathing fairly quickly for example.

I'm just curious in case I ever need to know. Theoretical case of a potential spinal injury, the person is in a position you could never carry out CPR or whatever you call chest compressions and there's no breathing or pulse detected. Opening the airway as you suggested isn't enough right? You will have to move them to resuscitate right? Not the case I'm guessing with AvV but theoretically you would risk paralysis over prolonged lack of breathing and circulation? It's ABC still in public first aid right?

Yes, with the caveat that it's almost always possible to move the patient whilst protecting the spine from any movement. You might need a few people to do it properly, though. AvV was without medical support for a good couple of minutes and this could be critical.

BTW the above is off topic and not joining the argument over whether flasher is right or not. I'm just being opportunistic and trying to get unofficial training in first aid from a medical doctor who posts on here. Perhaps I'd be better off going on a course but time constraints won't let me for some time.

You should definitely go on a course. The Brotosh Heart Foundation runs basic life support courses all over the country and they are excellent. I did one when I was 12. The single biggest factor in deciding whether a patient leaves hospital or not after they have a cardiac arrest is whether they receive bystander CPR/life support before medical help arrives.

In my day job, I deal with patients who've had heart attacks and I've lost count of the number brought it by ambulance in cardiac arrest who haven't had any CPR done by family members prior to the paramedics arriving. They don't do well.

TheBigBean

The trouble with courses is that without practice the stuff you learn fades away. That probably just means I should do a refresher course though.

I have another question about moving a person. When I did a first aid course for skiing, the instructors emphasised the importance of moving a person into a recovery position (after ABC). They believed that the risk of a person dying from swallowing their own vomit (I think) was far greater than the spinal injury risk. I think this depended on whether they were conscious or not. Is this now outdated thinking, for skiing only or were they just plain wrong?

tangled_metal

Moving a spinal injury patient, even with several people, requires you to one how to do it surely? If CPR is critical are you advised to wait for enough help or take the decision to try your best to safely move the injured to allow for CPR? Doing this second option will be in the full knowledge you cannot control the spine due to lack of knowledge/experience.

BTW I appreciate your input. I've friends working in the cardiac side of the NHS (nurses and a technician). They always say how the cardiac ward is always running with about 2 doctor/consultant posts empty, that's before you talk about nursing and technician roles that are also short of needed staffing levels. Sorry I'm going off topic but I'm sure your stretched at work and rather leave the medical stuff there.

davidof

A few interesting cases:

A cyclist suffers a heart attack on the Ventoux near to Chalet Reynard. A doctor is nearby and goes to the Chalet where there is a defibrillator, connects to cyclist and pushes the button, heart restarted or put back into a normal rhythm. Air ambulance arrives and cyclist should make a recovery.

On the same day a 60 year old suffers a heart attack at the summit. A fireman is on hand, fetches the defibrillator in the observatory and restarts the cyclist's heart. Air ambulance arrives and takes cyclist to hospital and again, he should recover.

In both cases CPR would have been a great help if there had been no defibrillator but you have to keep going until the rescue services arrive, which is no mean feat if you are on your own.

Another case. Last winter a skier is caught under a small avalanche near to where I live. He is recovered in a state of cardio-vascular arrest and hypothermia after perhaps 15 minutes under the snow. One advantage of avalanches is the cold can slow down degeneration in the case of lack of oxygen. A doctor is passing and starts CPR, meanwhile the mountain rescue is called. Due to low cloud they take 1.5 hours to arrive. The doctor and another witness take relays to perform CPR for all that time until a medical team arrives with Adrenalin and a defibrillator. They were totally exhausted by the effort and are evacuated along with the victim who unfortunately is DOA at the local hospital.

That's just to say that don't imagine that having done a first aider course (I'm a first aider for work) you'll be able to jump in like the guys in Casualty and raise the dead. It is useful to know what not to do as much as anything.

tangled_metal

You make a good point. I'd also say defibrillators are becoming very common equipment these days. Near where I live I know of a few. Never more than 5 minutes from one in my little town. My employers are even planning the budget to get one and train people in its use. Although they're supposed to need no training to use. The one in a locked box outside the station gives instruction to call 999 to get access code. Call the ambulance adhd get the defibrillator too.

I've only seen one case of CPR and that was a drowning. Our group was sorely lacking in first aid knowledge which was quickly remedied. A lot of the more experienced in our group went on rescue courses and first aid courses. Rescue equipment was also bought by.them and the club. Luckily they only had 5 to 10 minutes of CPR and most of that was by fire and rescue IIRC. Was a good few years back now.

Casualty really isn't reality for sure. I reckon CPR is hard work. However I'm sure nobody would blame you if you'd tried but wore yourself out doing CPR on your Todd. Better to try.

Garry H

The one thing I remember on CPR from Mountain Rescue training is that it very rarely works on its own. The exception to this is in cases of (near) drowning.

DeVlaeminck

Always worth getting anyone around an emrgency like these to ask if there is a defib in the area because like you say they are getting more common.

I have another first aid course this Friday so I will ask about the jaw thrust technique see what they say - think I may have covered it on a 2 day course I did years ago as it rang a bell when mentioned but wouldn't be confident I could perform it right now. I know some people don't like off topic discussion but if you learn something useful through a robust debate it's all good imo.

TheBigBean

Plus, if we find a resident medical expert, perhaps we can clarify whether it is possible to break your leg in the tour and win the vuelta.

bflk

I had a cardiac arrest, 'luckily' just after finishing a race. I estimate I was out for about 5 mins before the Red Cross got to me with a defibrillator and suffered no permanent brain damage, just lost my memory for a while. Now I have an ICD which can charge up and shock me in about 10 seconds which would beat anything external anyone could do. But that is only dealing with a special set of circumstances which it detects namely ventricular fibrillation. It won't stop a heart attack and I could still die out on a run/cycle on my own.

One statistic I was given was that every minute delay in starting CPR knocks another 10% off your survival chances.

keef66

Garry H wrote:

The one thing I remember on CPR from Mountain Rescue training is that it very rarely works on its own. The exception to this is in cases of (near) drowning.

I think you mis-understand the aims of CPR. It's not meant to 'work' as you put it.
CPR on it's own won't restore cardiac output. All you're doing is buying the casualty some time by getting some oxygen into the blood and getting the blood to circulate a bit. This does make a difference and reduces the chances of brain / organ damage, but a defibrillator and some expert medical intervention is what is needed to restore normal cardiac activity.

markp80

I think it's also worth pointing out that a defib will not restart a heart that has stopped.

A defib will only take a heart that is beating irregularly (fibrilating) and return it to a normal sinus rhythm. The shock interrupts the irregular, chaotic beat. It won't restart a heart with no activity.
Sudden cardiac arrest is usually not in fact a stopped heart, but a heart which has gone into fibrilation - but in either case you won't get a pulse.

An AED will do the analysis and tell you if a shock is appropriate, and warn you it's going to give one. But whatever, CPR is vital.

Cheers,
MarkP

bompington

The best thing about CPR* is the genius who came up with the notion of timing it from the beat of "Staying Alive"



*apart from saving people's lives, that is

keef66

bompington wrote:

The best thing about CPR* is the genius who came up with the notion of timing it from the beat of "Staying Alive"



*apart from saving people's lives, that is

Staying Alive was better than Nellie the Elephant, that's for sure, but at my last first aid requal course they said they are now regarded as a bit slow. It's even more knackering at the increased tempo!

Legolam

I prefer doing CPR to the tune of Nellie the Elephant - lends a surreal and non-PC air to the proceedings.

As for the cases above, I suspect that also illustrates tags, not only are you never far from a defibrillator, but also that you are never far from a member of the emergency/medical services.

I'm not sure about leg-breaking and the Vuelta - but it would appear that it is certainly possible, if you're Spanish at least.

I should say that I've never done Trauma Life Support training, so I can't answer specific questions regarding those guidelines. But I have watched a LOT of Casualty/ER/Scrubs (and have medical and physiology degrees, postgraduate medical and cardiology qualifications, and almost got a PhD in cardiology).

Hannah (GMC no. 6134750)

figbat

I'm no doctor but have had some 1st aid training. I wonder if, perhaps, some of the issues around on-scene response is what is shown on TV. On medical dramas and such we see nearly every patient CPRed or shocked back to life. I was told at my various first aid training courses that CPR is not intended to reanimate the patient, but is intended to keep a supply of oxygenated blood circulating until such time as someone else or something else can take over. The example mentioned above on the mountain is case in point. The patient may come round whilst you are at it, but this image of pumping away shouting "COME ON!!" until the victim coughs, splutters and leaps to their feet is misleading at best.

Additionally, if someone has stopped breathing (whether through injury or positional asphyxia) then they will die without intervention. If they have spinal injuries then they might be injured further through moving them, but the priority is on the breathing and circulation.

Legolam

Agreed.

Although I've always harboured a secret wish to yell "I'm not letting you go!!!" whilst trying to resuscitate someone. Unfortunately, real life is almost never like the movies (Scrubs was always the most realistic medical drama for me)

bobmcstuff

keef66 wrote:

bompington wrote:

The best thing about CPR* is the genius who came up with the notion of timing it from the beat of "Staying Alive"



*apart from saving people's lives, that is

Staying Alive was better than Nellie the Elephant, that's for sure, but at my last first aid requal course they said they are now regarded as a bit slow. It's even more knackering at the increased tempo!

Don't they expect people to go a bit quick anyway? Due to nerves/adrenalin.

graeme_s-2

bompington wrote:

The best thing about CPR* is the genius who came up with the notion of timing it from the beat of "Staying Alive"



*apart from saving people's lives, that is

My wife is an NHS Physiotherapist who now works in cardiac rehab, not long after that ad came out they had an elderly couple in. He'd had an arrest and she'd kept him going until the paramedics arrived purely because she'd seen that advert.

Garry H

keef66 wrote:

Garry H wrote:

The one thing I remember on CPR from Mountain Rescue training is that it very rarely works on its own. The exception to this is in cases of (near) drowning.

I think you mis-understand the aims of CPR. It's not meant to 'work' as you put it.
CPR on it's own won't restore cardiac output. All you're doing is buying the casualty some time by getting some oxygen into the blood and getting the blood to circulate a bit. This does make a difference and reduces the chances of brain / organ damage, but a defibrillator and some expert medical intervention is what is needed to restore normal cardiac activity.

I don't misunderstand it at all. I was making the same point as you. My use of it has been both theoretical and real.

davidof

I filmed this on my mobile from a 1st aid course

https://youtu.be/G4p9gXuaqCw

You get the idea. 30 seconds of cardiac massage followed by two mouth to mouth.

Poor Freddy though, chopped in two by a chainsaw, he was never going to make it.

Garry H

davidof wrote:

I filmed this on my mobile from a 1st aid course

https://youtu.be/G4p9gXuaqCw

You get the idea. 30 seconds of cardiac massage followed by two mouth to mouth.

Poor Freddy though, chopped in two by a chainsaw, he was never going to make it.

Pah, that's just a flesh wound!

iron_duke

Legolam wrote:

I prefer doing CPR to the tune of Nellie the Elephant - lends a surreal and non-PC air to the proceedings.

As for the cases above, I suspect that also illustrates tags, not only are you never far from a defibrillator, but also that you are never far from a member of the emergency/medical services.

I'm not sure about leg-breaking and the Vuelta - but it would appear that it is certainly possible, if you're Spanish at least.

I should say that I've never done Trauma Life Support training, so I can't answer specific questions regarding those guidelines. But I have watched a LOT of Casualty/ER/Scrubs (and have medical and physiology degrees, postgraduate medical and cardiology qualifications, and almost got a PhD in cardiology).

Hannah (GMC no. 6134750)

I would say you are pretty much spot on Hannah.

The spine is just another part of the nervous system which needs oxygen to survive.

In the unfortunate event you are alone with a person who has suffered traumatic cardiac arrest you would not be criticised for doing your best until help arrives. If you have help try to minimise unnecessary movement and if having to move do so in as controlled a fashion as you can manage.

The causes of traumatic cardiac arrest usually differ to that of those having a cardiac event ("heart attack") and so CPR would play a major role in giving the person an opportunity to survive which will likely require the cavalry and more than a defibrillator.

keef66

Garry H wrote:

keef66 wrote:

Garry H wrote:

The one thing I remember on CPR from Mountain Rescue training is that it very rarely works on its own. The exception to this is in cases of (near) drowning.

I think you mis-understand the aims of CPR. It's not meant to 'work' as you put it.
CPR on it's own won't restore cardiac output. All you're doing is buying the casualty some time by getting some oxygen into the blood and getting the blood to circulate a bit. This does make a difference and reduces the chances of brain / organ damage, but a defibrillator and some expert medical intervention is what is needed to restore normal cardiac activity.

I don't misunderstand it at all. I was making the same point as you. My use of it has been both theoretical and real.

Unfortunate choice of words then. You said: " it very rarely works on its own"

I'd say it works every time.

Legolam

I meant to put this link in yesterday, but totally forgot, sorry.

If any of you are interested in learning basic life support, the British Heart Foundation run Heartstart courses all over the country - 2 hours to cover dealing with an unconscious person, signs of a heart attack, recognising cardiac arrest and doing CPR, dealing with choking and dealing with serious bleeding.

https://www.bhf.org.uk/heart-health/how ... heartstart

Garry H

keef66 wrote:

Garry H wrote:

keef66 wrote:

Garry H wrote:

The one thing I remember on CPR from Mountain Rescue training is that it very rarely works on its own. The exception to this is in cases of (near) drowning.

I think you mis-understand the aims of CPR. It's not meant to 'work' as you put it.
CPR on it's own won't restore cardiac output. All you're doing is buying the casualty some time by getting some oxygen into the blood and getting the blood to circulate a bit. This does make a difference and reduces the chances of brain / organ damage, but a defibrillator and some expert medical intervention is what is needed to restore normal cardiac activity.

I don't misunderstand it at all. I was making the same point as you. My use of it has been both theoretical and real.

Unfortunate choice of words then. You said: " it very rarely works on its own"

I'd say it works every time.

True. Should have said "very rarely works without additional medical attention in cases of severe trauma". The salient point, however,was that CPR alone has a much higher rate of success in resuscitating victim of (near) drownings.