[Ingot]

Someone Collapses in front of you. Would you know enough to save their life?​

Have you ever come across a collapsed person? Or actually seen them fall?
Can you assess their well-being and work out what's wrong fast enough to save them?
Can you locate a pulse?
Assess breathing?
Colour?
Do you know the most likely reasons people fall over unconscious?
Do you know what to do immediately?
Or what to do next?

Being able to answer these questions in a timely manner - not necessarily 100% accurately - could save that person's life.
And it might even save others' lives too.

Let me know your thoughts, and I'll be back later to chat.

* There is no right or wrong here (necessarily) because it is a learning exercise.
There is no one at risk on a forum where we can learn to help one another.
Getting the knowledge BEFORE it is needed, to intervene safely to save a life, is the most loving thing we can do to serve others.

DISCLAIMER: I have been a Reg Nurse for 40 yrs - still registered, but will probably retire fully this year. Life-Saving First Aid is constantly improving. Since I did my last annual update, there are probably things that have changed.
My nursing experience is ED, Cardiac Care, Intensive care, Midwifery, Rural and Remote, General Medical and Surgical, Aged Care.
I don't know it all and never will. And would appreciate anyone offering to correct me.
Purpose here is to build awareness, and dispel hopelessness. There is always something we can do, whether ultimately successful or not. But you will know that your intervention was your best shot, and the best you could do for your patient.
If faced with anything we may discuss here, please make sure you can debrief ASAP.
This very important for you too.

 

[Ingot]

Bit of general knowledge before we go into what to do.

Collapse and loss of consciousness go hand in hand SOMETIMES, but a collapsed person can still be conscious.

How?

Well the cause could be they suffered a
* spontaneous fracture of the femur (upper leg bone - the thigh) - happens with osteporosis occasionally
* Bleed on the brain (mild or severe)
* Blow to the head eg object driven by strong wind, or unwitnessed assault, or caused by head striking ground during the fall
* Obstruction to blood flow in the brain eg a clot, or plaque breaking loose from an artery.
* Cardiac arrhythmia eg very slow heartbeat, very rapid heartbeat, irregular atrial rhythm (atrial fibrillation) or ventricular fibrillation (uncoordinated ventricular rhythm)
* Low Blood Pressure eg could have a cardiac cause, or could be caused by shock, large bleed (internal, such as dissecting aneurism, or visible external blood loss)
* Electric shock eg touched something that conveyed electricity through the body, disrupting cardiac rhythm
The list is never complete, but the above are the main ones, and put here to get you thinking .

 

[Ingot]

First thing to do is to find your voice - you will need to take charge with some authority, to shock others out of their gawking, and bump them into helping mode.

First thing you MUST do is to send someone for help.
That means calling Triple-zero, and it means (depending where you are) sending someone for a defibrillator - even if not needed. Better to have one on standby, rather than not have it when needed.

While you are sending people for help and defibrillator, you will be assessing the person lying on the deck!

The bottom line is this: If you are the first responder, you are immediately "in charge" of what happens next.
The decisions YOU make in the first 30 seconds, can determine whether the person lying in the floor will survive or not.

Doesn't mean you cannot hand over to a more competent person when they appear; but until they do, it's your responsibility.

Really it is NOT all that difficult to render effective life support.
The main thing is to keep the circulation going and oxygen entering the system, until the professionals get there.

That's enough for now.
I am sure you are thinking about this now.
Think also:
"What if this is my wife/husband lying there?"
"What if this is my little grandchild just pulled out of the pool?"
Don't panic (never panic) keep reading and understand that there is plenty you can do NOW to be prepared with a "Plan B" if the need ever arises.

And for some of us - statistically - we may be called upon in the next few months.

BLS = Basic Life Support

 

[Ingot]

The purpose of this article is not to make anyone an expert on Basic Life Support but to allay fears about it, and to encourage people to understand what BLS is, and what it tries to achieve for an unfortunate victim.

So let's go a little further today.

Here is a common acronym that steps through the process of care when a person is found in an unconscious state:

DRS ABCD ... and these letters stand for:

D ---> DANGER
R ---> RESPONSE
S ---> SEND FOR HELP
A ---> AIRWAY
B ---> BREATHING
C ---> CIRCULATION
D ---> DEFIBRILLATOR

Quick explanation:

DANGER: electrical shock- live wire
wet/slippery floor
snakebite
falling objects
roadway, traffic

RESPONSE: is the person conscious
eyes open or shut
talking
able to obey commands (eg squeeze my hand)

SEND FOR HELP: direct someone to dial Triple Zero and get help
send someone to retrieve the defibrillator if in locality
if in shopping centre, send for the centre manager (not critical)

AIRWAY: is the airway clear? - take a look - resuscitation is fruitless if
the person has an obstruction in throat
clear the airway
if turning patient to one side, make sure head - neck - spine
remain in alignment

BREATHING: if not breathing, commence CPR - (Cardio-Pulmonary-Resuscitation)
give one quick breath and obseve for chest rise - this ensures airway is clear

CIRCULATION: It is currently not recommended to search for a pulse,
but can be done if trained.

It is not intended to list all of the compression rates for different
aged patients - this summary is too broad to go into those details.
More later on this.

But for CPR to be effective, the compressions are critical.
Don't be afraid of breaking ribs - the chest MUST be compressed for
approx ONE THIRD of depth, or 2 inches (or 6cm max).

DEFIBRILLATION: If obtained, the attachment and use of the defibrillator
is a critical step.
Getting it attached correctly is also critical, so don't be
nit-picking about removing clothing
the skin HAS TO BE EXPOSED in order to apply pads.
Worry about niceties later.
A person's life is more important than their modesty.

Time is of the essence. How long can you hold your own breath before you are forced to take a breath. And for how long are you puffing to get your breath back after doing that?
So it is easy to see why time is so important to commencing CPR.

The action of CPR is thought to cause the in-flow and out-flow of enough oxygen to sustain life, and this will happen with each compression.

 

[Ingot]

So let's talk about some of these things.
Please contribute your questions and critique.
No one is going to bite you for trying to clarify something.
It's ok to say "That's not what I was taught."
Let's talk about that, plus any improvements.

Now - regarding the number of compressions, and breaths etc ... I will say this:
ANZCOR (Australia and New Zealand Committee on Resuscitation) has listed
30 compressions to 2 breaths.
And the rate is 100 to 120 compressions per minute.
That's roughly two compressions every second.
Hard work when done effectively, so hand over to any eager beaver to give yourself a break.

Having stated the ANZCOR recommendations, there are some courses - run by Paramedic-trained people, who vary these slightly.

My recommendation is that you sign up for a Basic Life Support course.
They have great lectures, and opportunities to ask any questions you have.
The give you practice on a well-designed "dummy" so that you know what it is like to get down beside someone and give CPR.

Now some of us are not capable of jumping up and down on the floor, let alone give cardiac compressions (but it's amazing what we can do when there is no one else).
So be prepared to be authoritative and give directions to someone who can have a go.

Any help is better than no help.
You won't be blamed if it doesn't work out.

Finally, a doctor asked once:
"What's the very first thing you do before commencing resuscitation?"
Answer: "Look at your watch/phone." (so you can tell the Paramedics how long has CPR been going on, and how long since the collapse etc.)
Time passes so fast that few can truly state accurately how long help has been given for.
You might think "Ten Minutes" but the reality might be 30 minutes, or even vice versa.

I've said enough - over to you.
People with knowledge are especially invited to contribute too of course.

 

[VicCiCi]

I learnt CPR when l was a career.l have saved a couple of people,and lost one old bloke as he had a blockage in the heart. We went to my husband’s nephews wedding and it was a warm day and at their new house. As they were getting married l heard a noise behind me. It was my husband as he fell back . He had a turn. I grabbed him and lowered him to the ground. No pulse and as white as a sheet. Started CPR on the spot. We were lucky as there was a paramedic at the wedding. Miss the rest of the wedding. He is OK but thank god l new what to do with out thinking

 

[Suzy Q]

Bit of general knowledge before we go into what to do.

Collapse and loss of consciousness go hand in hand SOMETIMES, but a collapsed person can still be conscious.

How?

Well the cause could be they suffered a
* spontaneous fracture of the femur (upper leg bone - the thigh) - happens with osteporosis occasionally
* Bleed on the brain (mild or severe)
* Blow to the head eg object driven by strong wind, or unwitnessed assault, or caused by head striking ground during the fall
* Obstruction to blood flow in the brain eg a clot, or plaque breaking loose from an artery.
* Cardiac arrhythmia eg very slow heartbeat, very rapid heartbeat, irregular atrial rhythm (atrial fibrillation) or ventricular fibrillation (uncoordinated ventricular rhythm)
* Low Blood Pressure eg could have a cardiac cause, or could be caused by shock, large bleed (internal, such as dissecting aneurism, or visible external blood loss)
* Electric shock eg touched something that conveyed electricity through the body, disrupting cardiac rhythm
The list is never complete, but the above are the main ones, and put here to get you thinking .

J7

 

[Ingot]

I learnt CPR when l was a career.l have saved a couple of people,and lost one old bloke as he had a blockage in the heart. We went to my husband’s nephews wedding and it was a warm day and at their new house. As they were getting married l heard a noise behind me. It was my husband as he fell back . He had a turn. I grabbed him and lowered him to the ground. No pulse and as white as a sheet. Started CPR on the spot. We were lucky as there was a paramedic at the wedding. Miss the rest of the wedding. He is OK but thank god l new what to do with out thinking

That's happy ending.
Shows how important it is to have even a small anount of knowledge.
Your quick action saved him a nasty whack on the head too - well done for not panicking.

I like to hear good news like that.

 

[Jest]

call 000

 

[Liz]

I have had1 success and 1 failure. The success was a girl at work at long time ago who had a heart attack. The one failure was my neighbour. I found her deceased, rang 000 and they made me do the required compressions and 2 breaths and keep at it until the ambulance came, Friday night traffic was horrific. The responder said it was coming lights and sirens and I would hear it. It took at least 45 minutes to get here. At the time I was only very slight, I still have serious chest issues but the responder would not let me stop compressions. When the ambulance finally got here, they continued compessions for another long period of time until the paramedic turned up and called it. I know it was a death at home and the >>>> dr wouldn't take the call to say she had a DNR. I think this was going over the top, when she had obviously been gone for at least an hour, I checked on her at 4pm and she was gone at 5pm when I checked again. Yes I was interviewed by the police etc. Not an experience I wish to go through again. I have been told by a couple of doctors, that I should have walked away but how do you do that. If it came to this situation again, I would have to do it all over and I pray I never have to. I have all my instructions up on my wall in my home and those that come in know they are there, including the DNR and Doctor's name and contact numbers. I think your segment is interesting for those who have never had to do CPR and we should all know that it changes all the time, so you should be guided by the ambulance on the phone when you call 000. Sorry this is long winded but it was not a pleasant time - I was so afraid she would be bought back brain dead.

 

[Jarred Santos]

What an informative series of posts, @Ingot! These are the reminders everyone could use.

To the best of your knowledge, what are some things people always get wrong when it comes to emergencies? It's so easy to forget all of this once you're in panic mode, I think.

 

[Jarred Santos]

I learnt CPR when l was a career.l have saved a couple of people,and lost one old bloke as he had a blockage in the heart. We went to my husband’s nephews wedding and it was a warm day and at their new house. As they were getting married l heard a noise behind me. It was my husband as he fell back . He had a turn. I grabbed him and lowered him to the ground. No pulse and as white as a sheet. Started CPR on the spot. We were lucky as there was a paramedic at the wedding. Miss the rest of the wedding. He is OK but thank god l new what to do with out thinking

I have had1 success and 1 failure. The success was a girl at work at long time ago who had a heart attack. The one failure was my neighbour. I found her deceased, rang 000 and they made me do the required compressions and 2 breaths and keep at it until the ambulance came, Friday night traffic was horrific. The responder said it was coming lights and sirens and I would hear it. It took at least 45 minutes to get here. At the time I was only very slight, I still have serious chest issues but the responder would not let me stop compressions. When the ambulance finally got here, they continued compessions for another long period of time until the paramedic turned up and called it. I know it was a death at home and the >>>> dr wouldn't take the call to say she had a DNR. I think this was going over the top, when she had obviously been gone for at least an hour, I checked on her at 4pm and she was gone at 5pm when I checked again. Yes I was interviewed by the police etc. Not an experience I wish to go through again. I have been told by a couple of doctors, that I should have walked away but how do you do that. If it came to this situation again, I would have to do it all over and I pray I never have to. I have all my instructions up on my wall in my home and those that come in know they are there, including the DNR and Doctor's name and contact numbers. I think your segment is interesting for those who have never had to do CPR and we should all know that it changes all the time, so you should be guided by the ambulance on the phone when you call 000. Sorry this is long winded but it was not a pleasant time - I was so afraid she would be bought back brain dead.

You're both heroes!

 

[Ingot]

I have had1 success and 1 failure. The success was a girl at work at long time ago who had a heart attack. The one failure was my neighbour. I found her deceased, rang 000 and they made me do the required compressions and 2 breaths and keep at it until the ambulance came, Friday night traffic was horrific. The responder said it was coming lights and sirens and I would hear it. It took at least 45 minutes to get here. At the time I was only very slight, I still have serious chest issues but the responder would not let me stop compressions. When the ambulance finally got here, they continued compessions for another long period of time until the paramedic turned up and called it. I know it was a death at home and the >>>> dr wouldn't take the call to say she had a DNR. I think this was going over the top, when she had obviously been gone for at least an hour, I checked on her at 4pm and she was gone at 5pm when I checked again. Yes I was interviewed by the police etc. Not an experience I wish to go through again. I have been told by a couple of doctors, that I should have walked away but how do you do that. If it came to this situation again, I would have to do it all over and I pray I never have to. I have all my instructions up on my wall in my home and those that come in know they are there, including the DNR and Doctor's name and contact numbers. I think your segment is interesting for those who have never had to do CPR and we should all know that it changes all the time, so you should be guided by the ambulance on the phone when you call 000. Sorry this is long winded but it was not a pleasant time - I was so afraid she would be bought back brain dead.

Liz - you were very courageous to continue that CPR, despite your gut feeling it was too late from the outset. There is something in us as humans that won't let us walk away from a vulnerable person in their most desperate time of need.

And very compassionate. I can't thank you enough as person, for what you did.
Obviously you have sustained physical consequences and I have no doubt mental trauma too.
I just want to say I am proud of you.
Thank you.

 

[Ingot]

I was working in a NSW Correctional facility. The inmate transfer truck came to the front gate, and there is a delay (protocol) before it comes through the security zone, and then to the inside proper.

At that point the escort officers became aware of an issue inside the truck, and opened that section door. There were two inmates - one jumped out in fright.
The other was lying on the floor.

When we got him out, he had been on the floor for at least 8 minutes, going by when the accompanying inmate said he collapsed. His colour was a dark blue, and his pupils were dilated.

As nurses, we were obliged to do CPR, and could not get anyone to call it.
One hour later, the doctor arrived and said we could stop.

This was over 20 yrs ago.
The NSW law then was that only a doctor could order CPR to cease.
If someone could produce a "Do Not Resuscitate" signed order, we could have stopped, based on that.

 

[Ingot]

Every situation is different. I can't give a judgement on what people should or shouldn't do if resuscitation is proving unsuccessful.

What I do know is that no one should ever feel guilty if they have tried their best, but have not been successful. Yes - it is a very traumatic, emotional event, to be present at someone's death.

And responders really need to have opportunity to debrief.
It's no use trying to tough it out.
You may think you do not need to talk over what happened, to unload your feelings.
But the reality is that you do. Professionals like doctors, nurses, paramedics always debrief.

It may be true that you can "manage" the traumatic thoughts, but I know of people who many years later were diagnosed with Post Traumatic Stress Disorder (PTSD) because they never debriefed after an extremely disturbing accident.

He was a paramedic, and his story was told to me by his brother, also a paramedic.

I will say this - even if YOU feel you do not need to have a cuppa and a chat afterwards, or later with a professional counselor, the other people involved would definitely be helped by your presence at a debrief session.

So please attend, because you give great comfort and support to others who have been present and likely affected by the tragedy too. And you really will come away with some relief and support, knowing you did what you could.

 

[Ingot]

What an informative series of posts, @Ingot! These are the reminders everyone could use.

To the best of your knowledge, what are some things people always get wrong when it comes to emergencies? It's so easy to forget all of this once you're in panic mode, I think.

Great question, and rather than relying on my own judgement, I have used Google to see what professional organisations have listed.

* Not sending for help ASAP.
Working alone cannot be sustained, and a lone responder will quickly become exhausted and unable to continue.

* Fussing about doing the right number of rescue breaths along with chest
compressions.
Chest compressions alone are thought to be enough, since the movement of blood through the heart will carry enough oxygen to sustain the brain.
If a skilled operator is assisted by another who can deliver rescue breaths - great.
But often people stop doing compressions just to tick the box called "rescue breaths"

Compressions get priority.
Why?
Because the human heart MUST beat at between 60 and 120 beats/min to maintain blood pressure, and thus maintain circulation.
What happens if blood pressure falls?
The person will faint.
And fainting occurs because the brain is short of oxygen.
So imagine what's going on in your patient, when compressions stop and start, or responders "take a rest." They will not be getting adequate circulation support.


(Continued next post)

 

[Ingot]

What is commonly done incorrectly ... (contin)

* Incorrect technique for CPR
Just because people have seen CPR done on television doesn't mean they will be able to manage the exact technique required to successfully resuscitate someone.
For this reason I suggest all of us sign up for a Basic Life Support (BLS) course, and have the opportunity to receive professional instruction.

These sessions are great. You get to hear so much that you would never know without hearing it from a professional trainer, who usually has 30 or 40 years as a paramedic or an ED Nurse and so on.
You will learn all about placement of hands, how to do compressions without bending your elbows, the correct rate and depth of compressions, how to do or not do rescue breaths, how and where to place the Automatic Defibrillator pads on the torso, what to do if the person has a pacemaker, or other significant issue.

You cannot beat hands on practice.
You can't get it from a book, though that's a great first introduction to resuscitation.

* Not caring for your own Safety.
This applies in two critical situations.

1. When a person is drowning, and YOU cannot swim. GET HELP FAST.
You are going to need help. A flotation device needs to be used to help the person remain afloat.
This can be as simple as a 2L plastic milk bottle, or a child's floatie if present -
anything that floats will do.

2. When electric shock is the possible cause of collapse.
DON'T GO NEAR UNTIL POWER IS OFF
Send someone to turn off the power, if suspected electrical shock.
Do not attempt to touch the person until confirmed safe.
A wet floor can conduct electrical current.
If in doubt - don't.

I'm sure most of us would know the two points above, but good to mention.
Amazing what will come to mind when situations call for caution.
No use adding more people to the resuscitation list!

More later.
Don't be shy - you can add your thoughts and questions, anecdotes of things you have seen or participated in. This the place to talk about it, and help others benefit from your experiences and questions too.

 

[Liz]

Liz - you were very courageous to continue that CPR, despite your gut feeling it was too late from the outset. There is something in us as humans that won't let us walk away from a vulnerable person in their most desperate time of need.

And very compassionate. I can't thank you enough as person, for what you did.
Obviously you have sustained physical consequences and I have no doubt mental trauma too.
I just want to say I am proud of you.
Thank you.

I was lucky, my previous doctor heard my phone call to the practice and the doctor refusing to tell of the DNR but she didn't know it was my neighbour I was ringing about. my doctor did some time with me to debrief but that night still stays with me.

 

[Ingot]

I was lucky, my previous doctor heard my phone call to the practice and the doctor refusing to tell of the DNR but she didn't know it was my neighbour I was ringing about. my doctor did some time with me to debrief but that night still stays with me.

At least you got that time to let some of it out.
What a shame doctors don't communicate better.
There are protocols and there are practicalities.
And there is a balance in-between. Privacy figures too I guess.
I hope both doctors learned something that will be helpful in the future.