I heard about this procedure since highschool still dont know if its correct. (i am not a doctor by the way)
If person has cardiac arrest because of ventricular fibrillation CPR needs to be done untill a deffibrillator arrives. From what i read just cpr alone cannot restart the heart without electricity.
Now what if one is stranded an there is no chance of EMS arriving can a blow to the chest cause heart to start ? Anyone know of this working ?
This is false.
The heart is automatically rhythmic, and will often regain a regular rhythm with a little help. Regular compression, heart stimulating drugs, and, of course, alleviating the condition that caused the heart to stop can all cause heart to restart.
In fact, defibrillation DOESN’T cause the heart to start. The shock is specifically chosen to stop it completely, in the hope that it will restart itself in a regular rhythm. It is actually more efffective when they heart is not beating in a organized regular contractions (e.g. is spasming [fibrillation], beating irregularly [arrhythmia] or beating too fast [tachycardia]), rather than when it is fully stopped.
Defibrillation uses a powerful DC pulse to stop the heart. Though films (especially comedies) may show a heart being restarted by AC (i.e. line voltage) AC is much more likely to stop the heart permanently (i.e. electrocution). AC is used in electric chairs.
I thought this was covered in Basic Life Support (but after 30 years of BLS since Boy Scouts, and then medical school, I don’t bother reading that book at recertification anymore), but you may be able to find a ACLS (Advanced Cardiac Life Support) book in the library.
After some looking around the net I seem to found what I was refering to is called a precordial thum. It is mentioned in this article http://www.pharmj.com/pdf/cpd/pj_20031025_heart9.pdf
So I wonder if one is stranded and know that there is not a chance of EMS ariving why not give it a shot anyway weather you are a professional or not. I figure its not recommended for the public cause someone may try this when one has a pulse that they didnt feel right and actualy kill someone.
The pre-cordial thump is seldom successful, because it delivers such a very low electrical charge (2-5 joules). If it is going to work, it should be employed within seconds of a witnessed arrest. The more time passes, the more energy is needed to successfully establish a normal rhythm. 200-360 joules are generally used by defibrillators.
Is it legal in every state for just anyone(not a trained medical professional) to administer CPR?
No, Susanann. IANAL, however I think this concept is based upon the doctrine that if you are not properly certified to administer emergency care, you should stay away, as you may do more harm than good.
If you’ve passed an AHA or ARC CPR course, that is one thing, even if your card is out of date.
If your only training in CPR is watching prime time TV, that is very much another.
If the patient is a pulseless non-breather, it is very, very difficult to do more harm than good.
Thanks, QTM. Our buddy didn’t make it, but the spectre of lawsuits didn’t stop 3 of us from chest pumping and assisted (mouth-to-mouth) breathing until the EMTs arrived (30 minutes).
I DID know what I was doing (Eagle Scout and Navy), but the other 2 were just following orders.
Aside: question for QTM (relevant to the OP): I understand that a small percentage of folks that actually get quick CPR actually live, but the odds dictate that it’s worthwhile to TRY since some do come back. Any stats in your docbooks?
I don’t trust the stats, because circumstances of the arrest are so important in determining outcome.
The basics are this: Early CPR combined with early defibrillation = more good saves. That’s why AEDs (automatic electronic defibrillators) in places like airports and train stations are such a good idea.
Rule of thumb (and I can’t give a good cite for accuracy): Defibrillation in under 5 minutes from arrest leads to more good saves, while the number of good saves after 5 minutes drops very, very rapidly with each passing minute.
I suspect American Heart and Red Cross probably have some nice statistical summaries.
I was on the cusp of the heart thump with the hand. Back in the late 70s I learned to do the heart thump BEFORE beginning CPR. Later when I went to get certified again they said it wasn’t a good idea. Apparently too many broken bones and other injuries resulted from it being done incorrectly.
I would take some exception (with a degree of reservation) about doing nothing. If nothing is done the person has ZERO chance. Most states (if not all) have Good Samaritan Laws to protect people.
I can see the other side though. I have seen people who are choking and they clearly are coughing and able to talk. It’s not quite yet the time to interfere, though some people would start on them right away. I could easily see some moron trying to do CPR on a guy with chest pain who is walking around and talking.
But on the other hand sitting around doing nothing but watch someone die isn’t helping either.
So to end my circular argument…
From my experience as an EMT on a rural volunteer fire department/ambulance service if the situation is serious enough that CPR has been started prior to our arrival or begins shortly thereafter, the patient is not gonna make it. That doesn’t mean we don’t try, though. We’ll defibrillate on scene and enroute according to protocalls, call for advanced help and transfer the patient enroute, but usually to no avail.
In an urban setting where EMS and difinitive care can be obtained in 10-15 minutes then the patient has a good chance of survival.
In the OP where there was little to no chance for EMS help, a pericardial thump probably wouldn’t do any good for the patient, but it might do a world of good for the care giver. At least he/she would know they did everything in their power to save the patient and sometimes thats a comfort.
New York State Emergency Medical Technician chiming in here. The pre-cordial thump is not permitted as per our protocols.
I’ve never witnessed an arrest and so never have been in the position to wish I could perform that gesture. As for CPR and saves, I can say this:
I have a manual CPR save to my name. It’s very rare to pull someone back from complete lack of pulse, to normal sinus rhythm, with pure manual C.P.R. We were at the ambulance building when the call hit, we were doing CPR within 2 minutes tops of the tones going out, and frankly we got lucky. Our AED failed ( unspeakably bad, but that’s another tale ), and by the time the ALS Paramedics showed up, the lady was conscious, with a reasonable sinus rhythm.
I’ve participated in CPR/ AED Defibrillation perhaps…hmm… more than a dozen times, to be conservative. We’ve had flickers of response as we shock, but nobody has ever pulled back. The problem I have with stats regarding use of CPR or of an AED is that there is such a potpourri of factors involved, that stats are meaningless.
Someone asked me last night at a party, about just this kind of event. He asked what it was like to be in a home, doing this, with the family members around. Interesting conversation…
markxxx is correct, all states have a version of a Good Samaritan Law. ( The attorneys on our Boards, some of whom froth blood when they see me make such statements, will doubtless be happy to disprove me if it isn’t ALL 50 states…). I would actually encourage anybody who witnesses a cardiac arrest to do what they can. The quote from my E.M.T. class instructor tells it all.
You cannot harm a corpse. You may well do SOMETHING in the way of moving some air into lungs and moving some blood along through the heart and lungs, even if you are not properly trained, and just that little bit may keep things going well enough in terms of bare minimum oxygenation in the brain, till trained professionals show up.
Some interesting reading:
American Heart Association CPR article
It is worth pointing something out here. People have “heart attacks” for a variety of reasons. There are in fact only two cardiac rhythms that are “shockable”. By that, I mean that only two rhythms can be ameliorated by the use of an A.E.D. and returned to normal sinus rhythm.
These are Ventricular Fibrillation, and Ventricula Tachycardia. Commonly called V-Fib and V-Tach. In the case of V-Fib, the automaticity system of electrical impulses in the heart muscles are NOT firing in proper synchronized sequences, and instead are firing randomly. This makes for poor blood pumping. In the case of V-Tach, the heart is being pumped very very quickly, but the rapid rate of heartbeat means that the muscle is not pumping FULLY with each beat. The blood is not moved along fully and properly, and lack of oxygenation occurs.
In both of these cases, the use of an A.E.D. can re-set the automaticity system of electrical impulses within the heart muscle, and allow the heart to beat again in a normal way. It’s not re-starting a stopped heart, that is a misnomer in the extreme.
If you are in asystole, or flat-lined, you are dead. One may try using an A.E.D. because of course, you’re dead. There is always that slim chance that somehow, a rhythm may be trickling along and not read by your machine. ( Unlikely with a 12-lead, equally unlikely with an automatic defibrillator, but still…).
There is another fine reason why C.P.R. and the use of an A.E.D. ( or in the case of Paramedics, a manual Defibrillator ) happens even if a person is truly flatlined. The odds are good that the first person who got there, didn’t have a defibrillator on hand. Even if the first responder DID, they started C.P.R. first. It’s protocol, it’s the law and it’s a fine idea. Here’s the thing: Once C.P.R. is initiated, it is not permitted to cease UNTIL you arrive at the hospital and turn over treatment to the ER staff.
At least in my state, it’s illegal and can cost you both your license and would likely earn you a lawsuit. Those considerations aside, it is to me immoral to begin treatment, and then stop before having a Medical Doctor take over treatment. As a field medical person I initiate, continue, and hope for the best until turning over treatment to an M.D.
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