A friend of mine recently took a CPR class and commented that much of the teaching focuses now on keeping the person alive until paramedics or other first responders can get to the scene with a defibrillator, rather than the CPR itself being enough.
As such, this got us me to wondering: if you were in an isolated area and there was no defibrillator around when someone has a heart attack, are there any alternatives that might work in a desperate situation? I don’t know a lot about how a defibrillator works, but my guess is that it’s probably high voltage and low amperage, so a car battery and jumper cables likely won’t work. I assume a live electrical wire (110 or 220V) is probably also not going to do the job. What if a cop shows up with a taser? Could that be used? Are there any other common household/business items that might work?
Other than hearing anecdotally of kids using odd things like sink plungers on Dad’s chest instead of the normal “hands-on” approach to CPR, I can’t begin to think of anything short of a defibrillator that would be able to re-start a stopped heart.
A Taser shouldn’t work for this - its contacts land on the body very close together and the delivered power isn’t supposed to penetrate the chest wall.
Is a taser still the right amount of voltage/amperage though? What if I manually pull out the probes, put them across the heart area the same way you would with a defibrillator, and embed them deeper by stabbing the victim with it to specifically penetrate the chest wall?
I am not a medical professional, but my understanding was that a defibrillator was only appropriate in the case of atrial fibrillation, and that’s not the problem in many heart attacks. In short, a defibrillator is used far less frequently in real life than on television.
The success rate for CPR actually reviving someone and saving their life is somewhere between 5% and 10%. While on TV it approaches 90%. You really just want to keep the blood moving while the patient is moved to the hospital. Even the breaths are seen as less important now than moving blood. The blood contains enough residual oxygen to keep organs from failing, if you can just keep the blood moving. One breath in 30 pumps is enough. And you are going to soon be exhausted by the pumping effort, but the pumping is the most important part, don’t worry about stopping for the breaths. Get help from someone else, if available, and keep pumping! 100 times per minute!
The amount of force most people use to perform CPR is not enough to keep blood moving through the system. We were trained in a recent class that we would be breaking ribs away from the sternum in order to get enough compression on the heart to move blood. And not to worry, if you weren’t breaking ribs you were likely not using enough force.
Defibrillators work in a limited number of situations and are not magic ‘jumper cables’ or anything of the sort. Just keep the blood moving while help arrives to transport the patient to the emergency room.
I think that’s probably over-generous. The stats I’ve heard in few different places give the chance of survival of 5-10 % (and usually nearer 5%) for any out-of-hospital cardiac arrest. That presumaby includes people where defibrillation is available or becomes available quickly (ambulance arrives etc). Even long-term survival of in-hospital arrest is only ~15%. The chances are never high, but at least you know you’ve tried everything if you do it.
When I did lifesaving classes 15 years ago we were taught that if ambulance/hospital help wasn’t going to become available within 2 hours, we shouldn’t even start CPR. This was based on the principle that CPR alone will never restart the heart and that the rescuer was putting him/herself in danger by exhausting themself to no avail.
It simply can’t provide enough energy in an effective waveform to work. A typical defibrillator shock has a duration less than 20mS or so and delivers an energy in the range of 100-300 Joules. A typical impedance is around 75 Ohms.
This is not accurate. A defibrillator can be used to in an attempt to convert atrial fibrillation, in which case the procedure is called cardioversion.
Defibrillators are used to treat ventricular fibrillation/ventricular tachycardia. Untreated ventricular fibrillation leads to death, rather quickly. There are a lot of people walking around in atrial fibrillation.
A “precordial thump” is the closest thing to a defibrillator you are going to get when you have nothing else. It is essentially a closed-fist blow to the center of the chest. The idea is that it will stop a heart that is fibrillating, v-tach or v-fib, and have it reset into a perfusing rhythm. CPR compressions will increase arterial and coronary perfusion pressure, but are not designed to convert a heart rhythm from a lethal one to a stable one; defibrillation and/or percordial thumps work by “resetting” the node that stimulates and controls cardiac rhythms.
PT’s are quite out of vogue, although they are still indicated in witnessed arrests – and if you have nothing else, and know how to do one, why not? (Apart from potential trauma that might impede recovery). If you have medics on the way, do CPR compressions, for sure.
Agreed. A good precordial thump can deliver 5 to 20 joules. While defibrillators generally deliver 200 joules and upwards, sometimes one can turn the trick with less.
So if there’s no AED handy, give 'em a thump. You’re not going to make them deader.
They’re putting up defibrillators in a number of public places (in my workplace, for one). They aren’t very clear about when they should be used, though. The general message seems to be, or at least is perceived to be : when someone is in cardiac arrest"
But can they actually “restart” a heart or are they just useful in case of ventricular fibrillation? When would you rather use CPR? Or switch from one to the other? How to determine this?
How as a layman do you even know that someone has a fibrillating heart? Do they have a pulse? If not, how do you know it’s not a cardiac arrest? If yes, how do you know there’s a fibrillation?
Fibrillation wasn’t even mentioned when I took secourism courses (many years ago, I must admit. Defibrillators weren’t even available to/allowed for the general public).
Here is a youtube video
The defibrillator tells you what to do. You open it up, push the huge button labeled start, attach and position the pads as the defibrillator tells you (there are pictures, too) then you let the machine decide if you need to push the button or not, then you push it or you don’t. It really is easy. The only trick is following directions when you are under the stress of trying to help someone who might be dying.
AEDs (Automated External Defibrillators) are meant to be applied to anyone who’s a pulseless non-breather.
If you’re not sure if the person is a pulseless non-breather, put it on them anyway, and activate it. The AED checks for a rhythm or lack thereof, and will only shock if it detects a rhythm which requires shocking. It won’t shock a flatline nor will it shock a person with a normal sinus rhythm, a sinus arrhythmia, or atrial fibrillation. It’ll shock ventricular fibrillation and ventricular tachycardia. Those are the two fatal rhythms which can be converted to more helpful rhythms by defibrillation.
The latest Red Cross guidelines for CPR could probably stand re-naming it to CR. Take out the “pulmonary” as now the recommendation is compressions only, at a rate of 100 per minute. Rather than count, just play Stayin’ Alive in your head and follow the beat. For the young whippersnappers who need to get off my lawn, here’s a sample of the song at Amazon.
Does this mean that someone with ventricular fibrillation won’t have a pulse I could notice?
So, CPR should be attempted only if the defibrillator doesn’t shock and the person has no pulse?
Finally, are people with a ventricular fibrillation or tachycardia always unconscious?
1 Yes
2 Sort of. There are many things that cause pulselessness, some are shockable, some are not. The basic workflow is, establish unresponsiveness (call for help/911/AED), establish pulselessness ( initiate compressions), AED arrives analyze rhythym (shock not advised resume compressions, shock advised- deliver it), after shock (resume compressions), the AED will analyze the rhythym every 2 min, repeat until medics arrive, or your patient regains consciousness.
3 v-fib yes, v-tach maybe, maybe not.
I just took a CPR course that included AED instruction.
The short answer is that if you haven’t had a CPR course with AED instruction, you should leave the AED alone. Instead, call 911, and if the person is not breathing, start CPR. If you don’t know any CPR whatsoever, the 911 operators are now being trained to talk you through on how to do chest compressions, which is the most important part. This works particularly well now that most people carry cell phones, and can usually put them on speaker phone.
The reason why you don’t want to fool around with the AED without training is that the AED is pretty much a one-use device. (Once you apply the adhesive pads, they can’t be re-used.) You don’t want to screw it up and have someone come on the scene 30 seconds later who actually knows how to use it.
One reason why the training is important is to have potential rescuers go through all of the proper actions. Interestingly, they are changing the design of the newer AEDs. The older ones, after being hooked up and having analyzed the person’s heart rhythm, would say out loud, “Recommend shock,” and light up a flashing button for the person to push after shouting out, “Clear!”
The problem was that even trained users were freezing up and not pressing the button (because they were unsure if they had followed the procedure correctly, or feared hurting the person)–and people were dying needlessly. (The AED records the entire event from the time they are activated.)
So the solution is that the newer devices (after being hooked up and conducting the heart rhythm analysis) simply state, “Shocking now! Clear!” They then deliver the shock automatically.
