Drowning is either due to aspiration of liquid (WAG semi-supported by literature: 2/3 of cases) vs. immersion in liquid causing laryngospasm and suffocation (1/3 of cases). The ultimate result is passing out from hypoxia.
BTW, there used to be a differentiation between salt-water and fresh-water drowning, due to effects on the lung from immersion by each. But that’s been shown to really make no difference for the vast majority of drowning victims in terms of reviving them and subsequently managing them. Why? It seems that even for those who drown by aspirating liquid, the volume of aspirated liquid required to drown someone is less than the volume required to alter lung chemistry due to saltiness or lack of it. (3-4 ml/kg for the former, 11-22 ml/kg for the latter).
Important nitpick: “Until medical help can arrive” is not the same thing as “until a defibrillator can be used”. A great many public places now have automatic portable defibrillators, which can be used by minimally-trained bystanders. Basically all you have to do is attach the contact patches such that the heart is in between them, and then follow the machine’s instructions. Of course, you should still call the professionals, but there’s a big difference between help being 1 or 2 minutes away and it being 5 or 10 minutes away.
For pulseless nonbreathers, early defibrillation is truly the most important intervention. And the earlier, the better. But until that AED or rescue team arrives, CPR (which provides ventilation and circulation) is by far the most helpful thing to do. Not Heimlich (unless there’s a solid airway obstruction), not postural drainage, not rescue breathing alone.
Yes but a defibrillator is only useful for a heart that’s in Fibrillation or “quivering”. If it’s completely stopped the subject needs the Pulp Fiction treatment and probably is, in all reality, too far gone to be saved.
Most drowning victims go thru a period of ventricular fibrillation before achieving asystole. As do many non-drowning cardiac arrest victims. So it makes sense to defibrillate early and often. You’re not gonna make 'em more dead by doing so.
And besides, I’m pretty sure Mira Sorvino’s character wasn’t in asystole either, or she wouldn’t have responded to intracardiac epinephrine. Not that I think they reached her heart thru her sternum anyway, that’s not the recommended route to take. They should have gone in and up from the bottom of the sternum.
Yes, but the defibrillator will check for that. Once it is hooked up and at regular intervals afterwards, an AED will advise that everyone stand clear so that it can analyze the heart’s rhythm and will advise for or deliver a shock only if it might help. If the heart muscle is not active (asystole) or has a rhythm other that ventricular fibrillation,* then the defibrillator will advise against delivering a shock and (IIRC) will advise that you continue CPR.
*It’s been a while. I could be wrong about the heart rhythms, but you get the idea.
You have misread the dictionary page. “Drown” is a noun that means to die of water intake.
“Drowning”, in the second part of the entry, is a intransitive verb, “to suffocate by submersion especially in water”. One need not die of suffocation.
“Help! He’s drowning!” cried the man while pointing to the distressed swimmer. The swimmer need not have died, or the call for help would be in vain.
Actually “drown” is a verb according to the page I linked:
"drown
verb \ˈdrau̇n\
: to die by being underwater too long and unable to breathe"
Further, M-W says suffocate also means you die:
"suf·fo·cate
verb \ˈsə-fə-ˌkāt\
: to die because you are unable to breathe
: to kill (someone) by making breathing impossible"
I guess it’s possible for people to be revived but the dictionary seems to think the words mean death occurs. Don’t most people use the words in that way?
Sorry for this sidetrack; let’s return to the issue of CPR, if there is more to be said.
Most AEDs will also shock for ventricular tachycardia as well as v-fib. I will leave the why to people who know more than me, but that’s what we were taught in medic training.
Ideally someone should be trained to use an AED but they’re absolutely dummy proof. Most of them that I’ve seen have two buttons, and pictograms on the case itself to tell you exactly how to place the pads and hook up the wires. There is a voice that tells you exactly what to do once you turn it on and it will no matter how much you jam on the button it will not deliver a shock to anything other than VT or pulseless VF. Short of bludgeoning someone with the machine itself, or strangling them with the wires, it’s impossible to cause any harm with them.
Thanks. That answer a question I had for a long time : why are they telling people to use defibrilators on guys who had a cardiac arrest? So, a cardiac arrest isn’t, typically, a cardiac arrest? How long are typically these period of fibrillation (I’m sure it varies, but are we talking of 2 minutes or 2 hours?)
So, there’s no way to restart an actually arrested heart?
I take it to mean asystole (completely void of any rhythm),
I have been trained in CPR for over 35 years, (apparently 5 years short of the arm wave technique) and have revived a few victims over the years with CPR and with our Simi Automatic defibrillator (where we push the shock button after the machine analyzes and with ours displays the rhythm)
Anyway, when first analysis was Asystole (flat line) and "No-Shock Indicated"was displayed and announced our next move was to transport to the Emergency Room while continuing CPR, however after rolling and placing pt. on the backboard the display showed ventricular fibrillation that was then analyzed and a shock was advised and the desired results of return of pulse was obtained.
This patient reverted back into ventricular fibrillation 3 times enroute to the Hospital and was converted each of those times with the use of Precordial_thump’s. This lady lived for several years after this event.
Over the 35 years of CPR training the technique/procedure has changed 10 or more times it seems. I the early years we would have to re-certify annually, and always preform 100% perfection to the guidelines. Trouble is when we are trained so intensely, we have a very hard time NOT preforming in the new guidelines when working a cardiac arrest.
What i believe we as responders must always keep in mind is CPR isn’t a perfect science and the studies done following our work in the field have lead to important changes that truly result in more people being successfully treated.
A bunch of years back one of our retired EMT’s and a very good one that taught for many years was filling in as a driver one day. The two EMT’s attending to a 40 year old cardiac arrest victim were under a year out of training and using the newest guidelines. They saved the man and for our service(BLS) that was like the 2nd save, and we are over 15 minutes from the nearest emergency room at best and Advanced Life Support was not available in those day,
Anyway, the comment made by the old EMT was, “Boy, Those Two Have A Lot To Learn About CPR”!
He had the old techniques so ingrained that success wasn’t on the top of his checklist. :rolleyes:
Yes, I thought about and/or, but AEDs should not be considered replacements for getting medical help. Use the AED, but still call for help.
I took training for CPR and AED at work a couple years ago. It is pretty idiot-proof. The largest part of the AED training is just getting one comfortable with thinking they can use the AED. A little on practicing pad placement and understanding the way it works, but it does have simple graphics and instructions and is basically “apply pads, let AED read heart rhythm, shock if the AED tells you to. Otherwise, perform CPR.”
One item the instructor mentioned that hasn’t been brought up is the importance of getting good skin contact with the pads. Some men (such as me) have a layer of chest hair that impedes that contact. The AEDs at work come with a razor to do a quick shave, but they also come with a set of pads attached to the AED and a spare set of pads. My instructor’s advice was to take the spare pads, stick them to the chest hair, then pull off quickly. If the patient’s heart doesn’t restart, then attach the other pads and proceed with the AED.
What I recall from the training…
The standard heart rhythm is sinusoidal - the classic thump-thump everyone is familiar with. The heart muscle fibers are all firing in sequence.
Fibrillation is the heart muscles contracting, but doing out of sequence and out of rhythm, so the heart is quivering like a bowl of jello. The point of defibrillation is to contract all the muscle fibers at once, then release and hope the heart’s natural pacemaker will restart and the heart will fall back into rhythm.
The other use for shock is ventricular tachycardia, i.e. the heart is beating too fast. I forget the description given, but the intent is the same. You contract all the fibers, release, and hope the pacemaker kicks in.
Both of these uses require the heart muscles to still be firing, just the pacemaker part of the heart having problems. If the heart muscles aren’t contracting at all (asystole), then debrillation won’t help.
A cardiac arrest doesn’t typically start with an immediate complete stop of heart activity. Rather, it means the heart gets kicked out of sync and into fibrillation. I don’t think there is much possibility of fibrillation naturally stopping and normal heart rhythm resuming. Once the heart starts fibrillating, it will typically continue to do so until the brain stops working and the autonomic functions stop telling the heart muscles to contract. The patient passes out quickly, and then dies from lack of oxygen reaching the brain. Thus CPR (get air into lungs, get blood circulated) and defibrillation.
When I was last trained on an AED (a couple months ago) we were told that chest hair wasn’t usually a problem, so we should try hooking up the pads through the hair. If it wasn’t making good contact, the machine would tell us, and then we should use the razor.
And the razor is 98% useless if the hair is thick enough to cause contact issues.
Save the $25.00 electrode and use duct tape, or carry a cheap clipper.
That presumes you are going to carry around supplies just in case. I suppose if you are staging your own AED, packing some duck tape might make sense, but you can’t expect everyone to think of that.
Besides, a $25 electrode is cheap compared to saving a life.
Actually, a better option might be packing the AED kits with electrode grease, like the kind used with electrode caps in sleep studies. Smear that on the electrode and then smoosh against the chest, better contact with or without chest hair, no adhesive to go bad when you need it.
Are you serious? i would then need you to hold the electrodes in place while I bush the shock button, :rolleyes:
When i had a stress test a couple months ago i brought along my own cheap clipper just in case they operated like so many others and try to get by with the disposable Bic razor, but they were on top of it and had the cheap battery operated clipper. The Technician setting up the ECG told me that i was the first one to ever bring there own clipper to a stress test. I always like to be prepared for tests
The stuff I’m talking about is very thick and sticky, so it can easily hold the electrode pad in place without shifting. You’d have to actively pull the electrode to get it to come off.
Seriously, they used the stuff when I did my sleep test. They attached 15 to 20 odd electrodes to my head through my hair, without having to shave my head. And then I slept with it - that means moving my head around on the pillow getting comfortable and shifting in the night and such. No issues whatsoever with the electrodes coming loose.
Downside, it did take some scrubbing to clean my head afterwards.
