Singing during CPR

Pi1otguy

Pi1otguy

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Fox McCloud
http://www.cnn.com/2009/HEALTH/07/02/cpr.cardiac.arrest/index.html
CNN said:
Debra Bader was taking a walk in the woods with her 53-year-old husband one morning when suddenly he collapsed.
...
"But I pulled the cell phone out of his pocket and called 911, and then a public service announcement I'd heard on the radio popped into my head."
The one-minute PSA from the American Heart Association instructed listeners, in the event of cardiac arrest, to perform chest compressions very hard to the beat of the 1970s Bee Gees song "Stayin' Alive."
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Really? It's been almost 10 yrs since I did CPR training and I don't remember that part. It'd be bad enough if the victim needs CPR but now he's gotta listen to me sign off key & fumble lyrics like a bad American Idol audition? Isn't it bad enough that I'm fracturing some poor guy's ribs?

I know we got a few docs, EMTs, & others on the board. What do you guys & gals sing on the way ER?

CNN said:
Bader says doctors at the hospital where her husband was treated have an alternative song. "They told me they do CPR to 'Another One Bites the Dust,' which also has about 100 beats per minute," Bader says. "Doctors have kind of a dark sense of humor."
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Pi1otguy said:
It's been almost 10 yrs since I did CPR training and I don't remember that part.
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Well, if it has been 10 years, you may want to take a refresher because some things have changed.


It'd be bad enough if the victim needs CPR but now he's gotta listen to me sign off key & fumble lyrics like a bad American Idol audition?
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If he needs CPR, do you think he cares? Do you think he would be conscious? I think not on both counts.

Isn't it bad enough that I'm fracturing some poor guy's ribs?
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Kind of aggressive, aren't you?

I know we got a few docs, EMTs, & others on the board. What do you guys & gals sing on the way ER?
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It isn't about the song. It is about the rhythm.
 
Greg Bockelman said:
Kind of aggressive, aren't you?
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I read somewhere that about 30% of CPR attempts fractures ribs. I know recovering from fractured ribs is better then death, but 30% seems like poor odds.
Link here



It isn't about the song. It is about the rhythm.
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Rhythm or pace (so to speak?) I'm pretty sure I'd fail CPR training back then if I pounded out a drum track.:D
 
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Pi1otguy said:
Greg Bockelman said:
I read somewhere that about 30% of CPR attempts fractures ribs. I know recovering from fractured ribs is better then death, but 30% seems like poor odds.
Link here




Rhythm or pace (so to speak?) I'm pretty sure I'd fail CPR training back then if I pounded out a drum track.:D
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When your heart has stopped you ARE dead. So if you break the ribs and bring back the patient oh well. The other choice is no broken ribs and continued death.

Please also know that CPR does help but it is not going to be like you see in the movies or on TV, the person is not going to suddenly wake up. CPR is best used to keep circulation and oxygenation of vital organs until the heart can be re-started and death is reversed.
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Keep in mind that the survival right with CPR alone (no AED or ALS guy giving drugs) is also pretty poor. It's typical to break ribs and separate the sternum, especially with the elderly.

When I became an EMT - I studied for paramedic as soon as I could because I wanted to be able to intubate (and avoid the whole getting puked on/in thing), and defibrillate (this was back before AEDs, in the dark days of the Precordial Thump), and medicate! It was amazing the difference prompt ACLS made in short and long term survival rates.

Kinda like the first time I had to divert due to bad weather motivated me to get the instrument rating.
 
Breaking ribs is a perfectly natural thing with CPR, in fact I was told if you don't break the sternum from the ribs you probably aren't doing it right.

As to the song, my EMT instructors played "Another One Bites the Dust" for those who couldn't get the right speed.

Tim, I was told without ALS, any chance of puking just shove the combitube down their throat. Thats a BLS skill.
 
Ah, we didn't have the combitube back when i was in BLS - the EOA (and the pocket mask!) was a brand new development. I agree that now BLS is much better - the AED makes a HUGE difference in cases with convertible rhythms.
 
Pi1otguy said:
http://www.cnn.com/2009/HEALTH/07/02/cpr.cardiac.arrest/index.html


Really? It's been almost 10 yrs since I did CPR training and I don't remember that part. It'd be bad enough if the victim needs CPR but now he's gotta listen to me sign off key & fumble lyrics like a bad American Idol audition? Isn't it bad enough that I'm fracturing some poor guy's ribs?
Click to expand...

I think it was only about two years ago that someone did a study that showed that the rhythm of the music helped keep the pace for the CPR.

On the other hand, attempting the dance moves dramatically reduced the expected survival rate.
 
Pi1otguy said:
http://www.cnn.com/2009/HEALTH/07/02/cpr.cardiac.arrest/index.html


Really? It's been almost 10 yrs since I did CPR training and I don't remember that part. It'd be bad enough if the victim needs CPR but now he's gotta listen to me sign off key & fumble lyrics like a bad American Idol audition? Isn't it bad enough that I'm fracturing some poor guy's ribs?

I know we got a few docs, EMTs, & others on the board. What do you guys & gals sing on the way ER?
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Paramedic for 20 years, ER, ICU and Cath Lab nurse for the past 10...

We dont sing anything. Seriously.

The AHA came out with revised standards a few years ago for lay people and people who DONT do CPR on a regular basis to help them remember key details.

Call it dumbing down, or call it doing what works, it comes down to the reality of the situation. The training tapes for healthcare and for lay providers are the same at this level, but the tapes are meant for the masses - the person who may or may not give CPR ONCE in their lifetime, not people like me who on some days may give it 3 different times in one day (not so much now, outside of the ER and ambulance)

Out of hospital cardiac arrest survival rates are poor. If someone actually sees you drop, followed by immediate CPR and early defibrillation (since most witnessed arrests are caused by arrhythmias that are treatable with defibrillation) have the best outcome.

As for rib fractures, I would put the percentage much much higher. The older the patient, the more likely there will be fractures, but its really not the ribs but the "cartilage" between the ribs and the breastbone that you are breaking. Young folks its soft and flexible. Older folks its calcified, hardened and less flexible, and this tends to be what you are hearing/feeling crunching during the first compression or two

But.. broken ribs heal in 4-6 weeks. Without CPR a pulseless person tends to be unsalvageable after a few minutes. Whats harder to live with? Letting someone die or cracking a rib?

If its been 10 years, you outta get a refresher. The basics are still the same - Pump and blow.. but there has been streamlining and improvements in technique, not to mention a refresher is never a bad idea.

Dave
 
Cert cards that I've received over the years are only good for 2 years. Just noticed a couple of days ago that mine expired in March.

Things do change. I first learned CPR in the late 1970s. It was an all day class and we even learned to do 2 man CPR. They don't teach that to the great unwashed anymore. Funny thing is, with someone else who knew the game I think I could do it today. It isn't that hard a concept.

In any case, time for a refresher. I'm sure they've changed something again since 2007.
 
5+ years of doing telephonic CPR on 911, and I've managed to save 2.

Always seems that by the time the patient is found, the 'finder' gets to a phone and calls 911, we get the info we need to get aid on the way (address/location, phone number, appx age of patient, and what happened, then get the patient on their back on the floor, head tilt, chin lift THEN we start CPR) its usually too late.

Most of the callers we get are beyond hysterical and are probably not doing it right anyways.
 
Ghery said:
Cert cards that I've received over the years are only good for 2 years. Just noticed a couple of days ago that mine expired in March.

Things do change. I first learned CPR in the late 1970s. It was an all day class and we even learned to do 2 man CPR. They don't teach that to the great unwashed anymore. Funny thing is, with someone else who knew the game I think I could do it today. It isn't that hard a concept.

In any case, time for a refresher. I'm sure they've changed something again since 2007.
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I learned two man, pre-cordial thump, etc back then as well. I teach first responder CPR and first aid now. A LOT has changed in the past couple of years. First Aid and CPR is now 911-A-B-C.

First thing call 911. With the almost universal 911 and cellular coverage the idea is get the pros rolling ASAP. Then do your ABC.

For CPR one person is taught. The emphasis one one man started a bunch of years ago when it was figured that most people were not traveling in teams to do CPR. The one person of 15 compressions and 2 breathes has even been de-emphasized. The idea on that one is that people forget the details so may be hesitant to start compressions for fear of doing harm.

Now we teach them 15:2 but focus more on just doing the compressions the right way and not focusing on the count. Even rescue breathing is not as important as it used to be. Some recent research and medical opinion is that keeping a level of circulation is good enough and that the statistics show that not doing rescue breathes gives the same outcome as if they were done.
 
Bystander CPR is very stressful as you might imagine. A couple weeks ago we rolled up on a EMS call where the guy performing CPR on a lodge guest was praying at the top of his lungs. If it helps sing ABBA for all I care. Oh, and though you shouldn't press their sternum all the way to the spine you'd better break some ribs on an adult or you aren't being agressive enough. As Scott says now the emphasis is on compression/circulation more than ventilation. We are at 30/2 ratio now even for two person CPR on adults. The person is clinically dead and is likely to remain so without agressive intervention, hard to make them more dead from a few popped ribs.
 
alaskaflyer said:
Oh, and though you shouldn't press their sternum all the way to the spine you'd better break some ribs on an adult or you aren't being agressive enough. As Scott says now the emphasis is on compression/circulation more than ventilation. We are at 30/2 ratio now even for two person CPR on adults. The person is clinically dead and is likely to remain so without agressive intervention, hard to make them more dead from a few popped ribs.
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Has there ever been any talk to allow open chest massage for EMT's? Open the chest and direct massage the heart? This is a much better wat to pump the heart rather than compressing it. This was taked about decades ago in flat line cases.
 
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no, open cardiac massage is not an EMS skill being taught.

"CCR" (cardiocerebral resuscitation) is the new thing, we are doing it around here in the Madison and southern WI area, and a friend and colleague of mine who was killed last year was a big advocate of the new procedure. Although at this time it is not universally in place in most of the country, it may be soon until the next big thing happens.
 
I took CPR training a couple of years ago and it is very hard work. I'm very out of shape and probably couldn't keep going long enough for it to help. I would be desperately looking for someone stronger and younger to do the work.
 
alaskaflyer said:
Oh, and though you shouldn't press their sternum all the way to the spine you'd better break some ribs on an adult or you aren't being agressive enough.
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Ok, a few ribs may break but at that point it's making the best of a bad situation. That's not the big deal to me. It's the idea of possibly damaging the softer stuff the ribs are there to protect and complicating recovery efforts. Purely a moot point considering the options but something I might ponder after an event.
 
Pi1otguy said:
Ok, a few ribs may break but at that point it's making the best of a bad situation. That's not the big deal to me. It's the idea of possibly damaging the softer stuff the ribs are there to protect and complicating recovery efforts. Purely a moot point considering the options but something I might ponder after an event.
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If after the event the patient has to worry about soft tissue damage, well then you done good! Like I said earlier they are dead, you cannot make them any deader doing CPR. Worse case is that they stay dead, so you can only achieve the status quo or actually save a life. Never hesitate to give CPR to a person that is in need of it.
 
I took a CPR class a couple of years ago and they taught a couple of interesting things: (a) if you don't want to (or forget how to) do the breaths, skip them. The compressions matter more. (b) If you don't do CPR, the survival rate for cardiac arrest in the street is something like 1-2%. If you do do CPR, the survival rate is closer to 5%. This means that once someone needs CPR they are more than likely dead -- which means that your screwing it up is unlikely to change the outcome, but doing something is much better than nothing.

(If someone can correct my stats with actual references, awesome. I'm just going on memory.)

Chris
 
Ghery said:
Cert cards that I've received over the years are only good for 2 years. Just noticed a couple of days ago that mine expired in March.
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The American Heart Association BLS (CPR) cards are, in fact good for two years. But studies we've done demonstrate that health care professionals that take BLS courses every two years for many, many consecutive years generally cannot perform adequate BLS six months after their most recent course.

There are some individuals that use these skills on a regular basis, and they can provide good BLS, but most health care providers do not perform BLS on any sort of regular basis, if at all.

I haven't taught BLS nor ACLS in quite a few years now, but I used to have groups of health care professionals that specifically asked me to give them BLS classes every six months because they realized they didn't use these skills and they needed to retake courses that often to be prepared.

Just a FYI.
 
smigaldi said:
I teach first responder CPR and first aid now. Now we teach them 15:2 . . .
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I haven't really been involved in lay public education of BLS (CPR) in quite some time but didn't this change to 30:2 in December of 2005 when the health care provider BLS last changed ?
 
KLRDMD said:
I haven't really been involved in lay public education of BLS (CPR) in quite some time but didn't this change to 30:2 in December of 2005 when the health care provider BLS last changed ?
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The recommendation changed but not everyone has gotten it into the curriculum yet. The standard I teach finally late last year made the rescue breathes optional. Currently the standards discussion is whether to teach 30:2 OR just teach compression with an occasional breathe.

The idea is that there is data showing that lay people will hesitate to offer compression if they think they are going to do it wrong. As if doing a 18:1 or a 32:3 would make a person more dead. That hesitation does more harm than if the rescuer were to do something, anything other than watching the person lay there.

I mostly teach people who are invovled in teaching sport. That would be scuba instructors, divemaster, personal trainers, etc. For them most of the time they have access to an AED at the place where they would be most likely to have to perform CPR. So we spend more time on using the AED and jsut doing compression until someone retrives the unit.
 
KLRDMD said:
I haven't really been involved in lay public education of BLS (CPR) in quite some time but didn't this change to 30:2 in December of 2005 when the health care provider BLS last changed ?
Click to expand...

I've been a paramedic for 20 years, and a nurse for 10... in the real world, once we put the breathing tube in (which is VERY early in our involvement in a resuscitation) you compress and ventilate asynchronously.. as in.. we bag 10 - 12 times a minute and pump 100 times a minute.. no counting,.. no chanting.. no pauses - except to check pulse or shock (and thats actually in the advanced guidelines)..

I go to the class every two years.. I tell them what they want to hear (the most recent revision).. I get my card and I see them in two more years.
 
Geico266 said:
Has there ever been any talk to allow open chest massage for EMT's? Open the chest and direct massage the heart? This is a much better wat to pump the heart rather than compressing it. This was taked about decades ago in flat line cases.
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It was dismissed decades ago too. Flat line cases have **** poor survival rates regardless of the intervention.

Opening the chest (known as a resuscitative or emergent thoracotomy) should only be performed in environments that are able to provide post thoracotomy care. That pretty much limits you to major medical centers with integral trauma centers. NOBODY is opening the chest in the US in the field with EMS as an EMT/Paramedic.

My experience with emerg. thoraco. has been that it works best with a fresh penetrating trauma patient.. shot or stabbed and bleeding out.. and they lose their vital signs no more than 10 minutes before arriving in the trauma suites. That means you are crashing as they are rolling you in the door. Its almost unheard of for garden variety cardiac arrests.
 
I hate to complain, but that stupid BeeGee's song has been running through my head for three days now. Enough is enough.
 
When I started teaching CPR back in the early 1980's, we were told to emphasize the concept of viability. The goal was to help circulate enough oxygenated blood to slow tissue damage -- period. We also taught that fractured ribs / separation were quite common during properly-performed CPR, especially on the elderly.

As far as the music goes, I think it's a pretty good idea. On recerts, the most common mistakes trainees made were too-shallow, too-slow compressions. I think humming a song like "Staying Alive" (or even "Another One Bites the Dust") would help on both counts (no pun intended).

-Rich
 
Doggtyred said:
I've been a paramedic for 20 years, and a nurse for 10... in the real world, once we put the breathing tube in (which is VERY early in our involvement in a resuscitation) you compress and ventilate asynchronously.. as in.. we bag 10 - 12 times a minute and pump 100 times a minute.. no counting,.. no chanting.. no pauses - except to check pulse or shock (and thats actually in the advanced guidelines).. I go to the class every two years.. I tell them what they want to hear (the most recent revision).. I get my card and I see them in two more years.
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The lay public, the subject of my previous post, is not, has not and never will be taught to place an advanced airway. In ACLS today, if your scope of practice does not include the placement of an endotracheal tube, they don't even allow it anymore. You default to an LMA or Combi-Tube. I personally have no use for a Combi-Tube, though. The American Society of Anesthesiology difficult airway algorithm includes the LMA but not the Combi-Tube. I-Gels are awesome in these scenarios.

The health care professional guidelines do call for asynchronous ventilation and compression once an advanced airway is in place so what you do in practice is perfectly consistent with current guidelines.
 
KLRDMD said:
The health care professional guidelines do call for asynchronous ventilation and compression once an advanced airway is in place so what you do in practice is perfectly consistent with current guidelines.
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Of course it is.. thats why we do it that way :)

I dont know about you, but I have gotten disappointed with American Heart and the way they seem dumbed down their advanced resuscutation training. One of the reasons I quit teaching ACLS.. we were passing people who wouldn't have in a previous time.

Hadn't seen the I-gel before.. had to google it.. saw a youtube video. Thanks for the point out.
 
The i-gel looks really nice - if it really removes the need for laryngoscopy, that's a huge step forward. It does look kind of big, though, and how does it deal with regurgitation? Does it provide a good seal against aspiration?

Could be a big plus if it could be integrated into a BLS scope in conjunction with an AED.
 
TMetzinger said:
The i-gel looks really nice - if it really removes the need for laryngoscopy, that's a huge step forward. It does look kind of big, though, and how does it deal with regurgitation? Does it provide a good seal against aspiration?
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There are different sizes, of course. A #4 fits most adults. I have a #3 and a #4 and haven't needed a #5 yet. The I-Gel, or any LMA is not intubation, but it is so darned easy to place, it makes sense in many situations. As I wrote previously, most people that take ACLS today are not being taught endotracheal intubation as part of ACLS since that is not within the scope of their practice.

Could be a big plus if it could be integrated into a BLS scope in conjunction with an AED.
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I truly believe the I-Gel could be taught in a lay BLS course. The problem, of course is that very few will have access to one when needed, so is teaching its placement an effective use of time and energy ?
 
KLRDMD said:
I truly believe the I-Gel could be taught in a lay BLS course. The problem, of course is that very few will have access to one when needed, so is teaching its placement an effective use of time and energy ?
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Access and the willingness to use it are two big issues. It also looks like you have to size the device to the patient. That could be confusing to the lay person in a stressful situation even if they had access to all three sizes.

In the course I teach we have an option on positive pressure O2 ventilation. Many of the sports people have access to an O2 unit and the option of a PP regulator. For those that have it we teach it. I like the simplicity of PP for lay people like myself. It is an easy concept and the fear of inserting something into someone is relieved form the lay-rescuer's mind. Lots of people freak at the idea of having to push on the chest, imagine if those people were then asked to insert an airway; yikes!
 
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yep.... a new training thing was released in like June/July of this year...
 
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