BY KYLE SHEPHERD
SUMMER 2010
Is there a doctor in the house?”
That’s a line we’ve all heard in a movie at some point. Of course, in the movies there is always a “doctor in the house.” But what do you do when there isn’t a medically trained professional around and something goes wrong with a friend or yourself?
Our first instinct, and rightly so, is to call 911, but in a few scenarios knowing a bit about what to do or what not to do before the emergency personnel arrive can help. Information is power and this information can empower you to perhaps make a life-changing difference in your own life or someone else’s life.
We contacted Dr. Neal Richmond, chief executive officer and medical director of Louisville Metro Emergency Medical Services, to guide us.
Heart attacks, cardiac arrest, and strokes are the biggies and the ones we are most fearful of so let’s begin there in our walk through emergency scenarios and proper navigation.
Scenario #1: No Pulse Detected/Cardiac Arrest
You and your friend Margaret are eating lunch and all of a sudden she falls to the floor, is unconscious and isn’t breathing. You check her pulse and can’t find one. You shout to a nearby table to call 911 although they are already doing so, and then you kick yourself for not taking that CPR class.
In this type of scenario where no pulse is detected, CPR is the key says Richmond. “The most important thing you can do to buy time is CPR. It offers the best chance of survival until EMS arrives.”
Administering CPR can create limited blood flow to the heart and brain to bridge the gap until full normal heart function can be restored when EMS arrives and/or Margaret gets to the hospital. The American Heart Association’s website, www.americanheart.org, defines CPR as a combination of rescue breathing and chest compressions delivered to victims thought to be in cardiac arrest.
Richmond advises that vigorous and strong chest compressions are the most important of these two components.
We also spoke with Christina Breit, M.D. of Dupont Internal Medicine, Jewish Physician Group, and she reminded us that some places now have electrical defibrillators (which shock the heart back into a normal rhythm), known as AEDs, and that the machines will prompt you with instructions. If no AED is available Breit describes what to do manually. “Hands are interlaced over one another and with straight arms the palm is placed two finger widths below the sternum. Thirty chest compressions are needed for every two breaths.” She adds, “With an AED or without, the most important thing is to start compression and continue until help has arrived.”
Richmond also reminds us that starting CPR needs to be swift because, in the window of resuscitation, the sooner the better. When the heart has stopped for more than four minutes, the chances of irreversible damage increase while the chances of survival decrease. “Our ability to save someone is limited unless someone is already doing CPR,” Richmond adds. All the more reason we all need to learn CPR.
Scenario #2: Heart Attack — Your Own
You are reading the latest novel enjoying your leisurely Sunday afternoon and suddenly you feel nauseous and aware of a rapid heartbeat. You experience a pain that spreads from the chest to the neck into your shoulders. You are suddenly short of breath and dizzy. Your heart isn’t receiving enough oxygen and you could be having a heart attack. You know 911 is your first step, but what should you do in the moments after you call and before the EMS arrives?
“The best thing is to take two to four baby aspirin. The key is to chew them because you want them to get into your blood stream as fast as possible,” advises Richmond, adding that “baby aspirin is an incredible drug and almost as good as the drugs that cost thousands of dollars.” Baby aspirin are more palpable, but if not available a regular adult-strength (325 mg) will have the same effect. Aspirin thins blood and helps reduce clots and increase blood flow back to the heart. If you aren’t sure and assume it is merely indigestion, don’t wait. If you take an antiacid and wait 30 minutes (or even wait for your doctor to call back) you potentially could be losing heart function if it is a heart attack. Richmond tells us that for every minute of a heart attack you may lose up to one percent of your heart muscle function.
Another point, sit tightly and wait for EMS to arrive, do not attempt to drive yourself to the hospital.
Scenario #3: Stroke
As your husband readies himself to go get the two of you ice cream, he begins to walk out the door with his coat only on half his body and he doesn’t acknowledge he is only half covered. When you ask him about it, his response is nonsensical. He could be having a stroke. Believe it or not, Richmond says, many people who are experiencing stroke symptoms ignore them and expect things to return to normal. Symptoms may include any or all of the following: weakness in your arm or leg (or both), limited vision field, and trouble articulating with slurred speech. There really isn’t much you can actually do in this instance to prepare the victim for medical personnel to arrive. Recognition and time are crucial. Don’t ignore the symptoms, and know your risk factors, whether they are obesity, high blood pressure, high cholesterol, diabetes, or smoking.
“Time saved is Brain saved” isn’t just a slogan we see on billboards for Louisville’s University Hospital. It is the hard truth of the matter related to strokes. Richmond urges the importance of calling emergency personnel as opposed to calling your general physician because time can affect the level of disability vs. recovery. For every minute of stroke you lose brain function.
Scenario #4: Choking
You’ve invited your friend Susan over for dessert and coffee and are having nice conversation when she begins to choke on her bread pudding. As she fights for a breath and reaches for her water you call 911 and remember the Heimlich Maneuver, but what is it and how do you do it?
Deneen Cooper is the business capacity development manager for Health and Safety for the Louisville Chapter of the American Red Cross and oversees the class instruction offered there. She says to first ask permission from Susan and when she nods in consent begin back blows first. “Stand beside the person placing one arm across her chest reaching toward the opposite shoulder and have them lean forward and give five back blows between the shoulder blades with the heel of your hand.”
If the object isn’t dislodged then perform the abdominal thrusts or what we commonly know as the Heimlich Maneuver. Breit describes abdominal thrusts, “You want to come up behind the person and place one hand over the other. With the knuckle of the bottom hand you place it below the sternum and thrust straight up with force” adding, “Repeat until the airway is open. If the person becomes unconscious, lie them on the floor, tilt the head forward then back, press the tongue down, and perform a finger sweep. A finger sweep is a hook like motion with your finger from one side of the mouth to the other.”
With Susan’s airway now open and clear you can both breathe a little easier, but don’t be offended when Susan doesn’t want to finish her bread pudding.
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