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Friday, July 30, 2010

A hard, flat surface and how to get the patient onto it.

CPR saves lives because chest compressions cause blood to circulate in the cardiovascular system until the heart gets re-started. Without the oxygen that the blood caries to the brain, the brain will die.

Chest compressions don't work when the patient is on a "squishy" surface. You cannot do effective CPR on a person who is in bed or on a person seated in a chair. Even if you have a CPR board handy, it's not as effective as getting the patient onto the floor.

(You cannot do effective CPR on someone who is lying face-down, either. This possibility would not have occurred to me, had I not walked into a residence on a 911 call, only to see someone trying this.)

So how do you get a really large patient onto his or her back on the floor? The first step is to get the patient onto the floor, without worrying about the "on his or her back" bit.

If you are alone and if you can't pull the patient out of bed or roll the patient onto the floor, walk around to the side of the bed you don't want the patient on the floor next to, untuck the bottom sheet and throw it over the patient. Walk back to the other side, grab the sheet, and pull it as if you were playing tug-of-war. The patient will roll out of bed and onto the floor. The bigest problem with this strategy is that many people let their fear that they will hurt the cardiac arrest victim interfere with the degree to which they really try. To them, I can only offer this: "That victim is already dead, and unless you get that victim onto his or her back on a hard, flat surface, they almost assuredly will stay dead. Don't worry about hurting the patient. Just do it."

The same holds for a victim who arrests in a chair. If you cannot pull the victim out of the chair, tip the chair over. Use the handle of a broom as a pry bar, if you need to, but get the victim onto the floor.

Victims dumped onto the floor seldom are considerate enough to land on their backs. Here's how to get them there:
  1. Straighten the limbs: it's a lot easier to roll someone whose legs are straight and in line with the torso. Ditto for the arms, either at their sides or over their head.
  2. Roll the victim unto the back, and start pumping that chest. If you are in a cramped space and there's no room to roll the patient, stand over the patient with one foot on each side of the patient, grab whatever clothing you can grab at the side - not the top - of the patient and using your knees so you don't hurt your back, pick the patient straight up and then set the patient down. You many have to do this several times.
Let me know if this isn't clear, and I'll make a video of it.