Thankfully this is not an urgent response required question!
Earlier this evening in San Francisco’s Mission District I witnessed a private security guard hit a belligerent drunken man (who was violently harassing a young couple and their baby) with a single knockout punch to the head which sent the man flying onto the concrete sidewalk and hitting his head on the ground.
After seeing the man was not moving I immediately called 911 whereas my friend crossed the street to offer assistance and specifically check the pulse/breathing and potentially start CPR (except the man was in fact breathing so he determined CPR was not needed).
My question is simply if CPR is typically necessary/medically-appropriate in the above-mentioned scenario? Do concussed people with head-trauma frequently need CPR?
Because this guy was drunk, it’s possible he might have stopped breathing, because his CNS was already depressed from the alcohol. However, if a head injury stops the breathing and heart of a sober person, the chances are pretty good something in their brain has been damaged, and they will never breathe on their own. It doesn’t hurt to attempt CPR, though. One never knows.
If I were there, I would start it once 911 had been called. You won’t be doing it long.
CPR is only warranted if breathing is agonal or has stopped. I work at 9-1-1 and will not tell you to begin CPR in other circumstances.
CPR is generally not needed in the typical unconscious person call. I’ve NEVER had a CPR call that resulted from anything like what the OP described. Other than drownings, CPR is very rare for relatively young (<40 y.o.) patients in 9-1-1 calls.
Well, CPR is rare for someone that young, if it’s natural causes. I’ve done CPR on patients under 40 several times for things like drug overdoses or trauma. Also, CPR is warranted if there’s no heartbeat. Until the patient can be hooked up to a monitor or AED, which would state whether to continue CPR after analysis.
Sure, CPR for asystole. But asystole is rather uncommon in a breathing patient.
The general public has a hard time reliably finding a pulse thus guidance on CPR is given based upon the caller’s description of the patient’s breathing.
Without the ability to see the scene we are limited to providing advice to the caller (and descriptions for the responders) based upon what our caller is telling us. As Next Generation 9-1-1 starts to roll out that may change, with callers being able to send streaming video to 9-1-1 centers. Might be quite useful.
I wasn’t trying to suggest anything regarding a breathing patient and asystole, other than the medical protocols I’ve operated under. Apologies if I didn’t make that clear.
In my experience, I’ve never done CPR on a patient who is breathing, but presents with a concussion. If he’s breathing, as Iggy said, there’s no call for it, and you could end up harming the patient more than helping him.
What’s the current thinking about doing CPR on a stranger without a “shield”?
Years ago I was peripherally involved in a case where an off-duty nurse refused to do CPR on a guy she knew (and despised) because she didn’t have her protective device in her purse. There was some public outcry, but the guy survived and so the outcry faded.
Indeed, survival rates are higher for compression only instead of traditional compressions and breaths, so long as the ambulance can arrive within a certain amount of time. And it is easier to get bystanders to do CPR if I tell them they do not need to do rescue breaths.
I witnessed a similar situation earlier this year. In my case, it was a bicycle accident, but the result was the same: Head trauma, no severe bleeding, victim unconscious but (loudly) breathing. It feels like you ought to do something, but really, all there is to do is to wait for the ambulance and prevent any other bystanders from doing something stupid.
Protective barrier devices are more about isolating patients from care providers who may have dozens of contacts with extremely sick people on a daily basis. 2 random people on the street, betting odds is no big deal especially in a trauma situation.
This fascinates me because the traditinal, pre CPR, treatement for drowning was compression-only. From the discussion and recomendations I’ve seen it’s not clear —
Were they right all along?
or
Is this just a recognition that most Americans are afraid of catching some nasty disease?
Actually drowning is one scenario in which rescue breaths improve survival, particularly in children.
Where compression only wins out is when the patient’s collapse is witnessed, compressions begin promptly, and EMS can arrive on scene promptly (8 minutes or less, IIRC), The theory is that there is enough oxygen in the patient’s blood to last several minutes if you can just keep the blood circulating.
By stopping compressions to give breaths you are allowing blood pressure to fall and it takes a while to build that pressure back up with chest compressions. There will be some passive gas exchange while compressions are underway, but not enough in the long run. Eventually the blood becomes deoxygenated and survival rates fall unless rescue breaths begin.
And yes, people do get squeamish. Refusal rates are frustratingly high as some callers are completely unwilling to do CPR, even on a family member (and not just an elderly relative with a DNR order).
Huh, that’s odd, back when I was in Boy Scouts the training said to use rescue breaths only for drowning, no compressions.
Whenever they come out with new recommendations, though, I always wonder: Is it because the new technique is actually more effective, or just because it’s easier to get people to comply with it?
I took a wilderness first aid course a few months ago, and my understanding of the explanation was that it was actually more effective, just because rescue breathing doesn’t add enough additional value to be worth taking time away from the chest compressions. (And that you should have the Bee Gee’s “Staying Alive” running through your head to get the right rhythm on the compressions).
And, additional information: I’ve just been told that very premature neonates are ventilated with low-frequency vibration. The lungs aren’t developed enough to handle compression/expansion, but the vibration is enough to keep the (added) oxygen mixing with the expired C02.
Also, expired volume is less than inspired volume, so if your lungs are vibrated (say by CR), you will suck in some additional air, which will mix with the lung contents. (Until the gas partial pressures equalize, and the gas volume stops decreasing)