tag:blogger.com,1999:blog-24516934094880620862024-03-18T23:19:45.339-04:00Practical CPR - complements www.SLICC.orgWhen you see a cardiac arrest, your brain fights you - "No, this isn't really happening" - and the circumstances fight you - "Dang! in CPR class the manikin didn't weigh very much and wasn't sitting in a deep chair. This blog deals with practical details and presents reports of "saves." Let me have your questions and comments - they will steer the course of this blog.
This blog is brought to you by the volunteers at www.slicc.orgBob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.comBlogger353125tag:blogger.com,1999:blog-2451693409488062086.post-24333223368757554522017-10-27T09:37:00.001-04:002017-10-27T09:37:09.235-04:00Why you need an AED at home...You have until sundown on November 5th to get in on this!<br />
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Check <a href="http://www.slicc.org/AED_deal">http://www.slicc.org/AED_deal</a> and learn how having an AED in your home can quintuple your chances of surviving a sudden cardiac arrest. (Seventy percent of all cardiac arrests occur in a private residence, and the ambulance can't get there fast enough to yield more than a ten percent survival rate.)<br />
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SLICC is running its annual AED group purchase again, and the AED being offered is about 40% less expensive as the best price I've found on the web!<br />
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The older you are, the more strongly I'd urge you to participate.<br />
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BobBob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-55711446770623769272017-09-26T11:17:00.000-04:002017-09-26T11:17:04.012-04:00Feedback makes industry work well. Why not for EMS?Let's take a look at two scenarios where two individuals are performing chest compression on two SCA victims.<br />
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Both rescuers were recently trained and received their CPR cards.<br />
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Rescuer #1 got a call this morning and on arrival began chest compression while waiting for her partner to set up the AED.<br />
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Rescuer #2 got a call this morning and on arrival began chest compression while waiting for his partner to set up the AED. Rescuer #2's situation was different in that he had another instrument that watched what he was doing. The device played a sound at a rate of 105 per minute. The device warned him loudly when he left more than 1.8 pounds on the victim's sternum at the top of the "full recoil" upstroke. The device advised him for each compression when the depth was OK.<br />
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Which of the two rescuer's had a better chance of performing guideline-compliant chest compressions?<br />
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SLICC's measurement of a large number of bystanders and EMS personnel showed that this sort of feedback was necessary and that providing guidance was not effective in curing the problem over a period of two months or more.<br />
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Feedback - the process of influencing a process by reporting on quality on a current basis - is what industry relies on to control the quality of what they produce.<br />
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A applaud the AHA's recent requirement that such feedback devices must be used in CPR courses beginning in January. I wish it were able to extend that ruling to all EMS personnel.<br />
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Bob<br />
<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-3815092214542305322017-08-27T19:59:00.002-04:002017-08-27T20:01:15.777-04:00Performing CPR requires three abilities"<br />
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<ol>
<li>Compress the chest to a depth of 2 to 2.4 inches.</li>
<li>Compress it 100 to 120 times a minute.</li>
<li>Get at least all but 1.8 pounds off the chest at full recoil/</li>
</ol>
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Here's the problem:</div>
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<ol>
<li>About 0% of all households where both adults can compress their spouse's chest to two inches.</li>
<li>Most Bystanders compress at too slow a rate.</li>
<li>Most Bystanders "lean" - i.e., leave more than two pounds of force on the chest at the top of the full recoil stroke.</li>
</ol>
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The only reasonable solution is to have an AED at home. </div>
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Another problem: only 44% of the arrests are witnessed. There is a device that will call 911 + other, specified parties when you arrest. If the rescuer is in the same residence as you and you have an AED at home, your odds of survival go from zero percent to more than 50%, if you have an AED at home.</div>
Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-10573496891067970012017-07-27T20:09:00.000-04:002017-07-27T20:09:06.317-04:00This was an interesting week. I encountered several surprising things.<br />
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<ol>
<li>Earlier this week, there was a Today Show segment on CPR with Dr. Oz. It was this session that informs us that to perform Chest Compressions you have a depth choice from one to two inches. (The depth guideline became 1.5 to 2 inches in 2005. The depth guideline became 2 inches in 2010. The depth guideline became 2 to 2.4 inches in 2015.)</li>
<li>Dr. Oz showed how to apply the AED pads and got it wrong: The pad on the victim's left side is supposed to go on the left side wall, not just lower than the left nipple. (We're trying to make a "heart sandwich" out of the heart and the two pads. The AED works better that way.)</li>
<li>Dr. Oz forgot to tell the audience how to tell when someone they encounter has had a sudden cardiac arrest. (non-responsive and not breathing normally.)</li>
<li>I wasn't able to find a way to get the corrections to the Today Show.</li>
</ol>
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By the way, when the depth guideline went to 1.5 to 2 inches, a significant number of instructors weren't able to renew their certificates because they weren't able to compress to 1.5 inches on a manikin whose stiffness was significantly less than than the average adult.</div>
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Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-35822090529307040732017-04-27T20:31:00.001-04:002017-04-27T20:31:23.074-04:00Driverless cars and Sudden Cardiac Arrest...<div style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 14px; font-stretch: inherit; font-variant-numeric: inherit; line-height: inherit; margin-bottom: 1.5em; padding: 0px; vertical-align: baseline;">
Driverless cars will be actively sold before the end of this decade. They will phase in over the following 20 years.<span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span></div>
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Recent evidence shows that the accident rate with a driverless car is far less than with a human at the wheel.<span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span><span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span></div>
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One consequence is that, if the "driver" is wearing a device such as iBeat, the car can re-route and head for the closest ER when that passenger / driver is recently clinically dead.<span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span><span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span></div>
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Sure beats calling an ambulance.<span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span><span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span></div>
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Bob</div>
Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-80903506579687278142017-03-18T10:12:00.000-04:002017-03-18T10:13:20.283-04:00What are your odds of having a Cardiac Arrest within a year?Your chances of having a sudden cardiac arrest in the next year depend on a lot of factors...your health, your family history of arrests, your age...<br />
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Your age? How does your age have anything to do with it?</div>
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<ul>
<li>About 20% of all out-of-hospital cardiac arrests happen to people under 50. Ditto for people in their 50's, ditto for those in their 60's, ditto for those in their 70's, and the same for those 80 or older.</li>
<li>The total size of these population blocks gets smaller and smaller as you get older.</li>
<li>The graph below shows the percentage chance of your having an arrest in the next 365 days.</li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4D0c1b-RRkLc7uAm7uhEFd0vntgGY7HHGKdpbkPy0lS3gb97VPXKdZ5CH4ba4Yl41rNPpoxKXJGHfDlwX8HOoKS3cgJgpD5lJoOE9QGtU6B9fWivrEI_n-qaMHYYq90AeH4ZZSMppsUI/s1600/PercentChanceOfCardiacArrestWithinAYear.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="464" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4D0c1b-RRkLc7uAm7uhEFd0vntgGY7HHGKdpbkPy0lS3gb97VPXKdZ5CH4ba4Yl41rNPpoxKXJGHfDlwX8HOoKS3cgJgpD5lJoOE9QGtU6B9fWivrEI_n-qaMHYYq90AeH4ZZSMppsUI/s640/PercentChanceOfCardiacArrestWithinAYear.png" width="640" /></a></div>
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Keep in mind that these figures about age distribution are approximate. It was a lot easier to calculate and remember by using the 20% number for each age bracket. The distortion isn't major.</div>
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When you couple this info with the facts that (1) 70% of all out of hospital sudden cardiac arrests occur in the home, and (2) the ambulance is going to have a difficult time getting to the victim within ten minutes (10% survival) or within 3 to 4 minutes (50-60% survival), you really might want to consider an AED for your home.</div>
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Bob</div>
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Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-50107271520370386942017-01-28T17:14:00.000-05:002017-01-28T17:14:06.555-05:00AED vs. CPR<div style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 14px; font-stretch: inherit; line-height: 21px; margin-bottom: 1.5em; padding: 0px; vertical-align: baseline;">
<b>The difference between performing CPR and using an AED</b><span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span><span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span></div>
<ol style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 14px; font-stretch: inherit; line-height: 21px; margin: 0px 1.5em 1.5em 0px; padding: 0px 0px 0px 1.5em; vertical-align: baseline;">
<li style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">An AED is a device that examines the victim's heart rhythm and advises the rescuer as to whether to administer a shock or to resume chest compression. The AED either delivers the shock when you press the button or it delivers the shock automatically.</li>
<li style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">CPR pushes oxygen-bearing blood to the heart muscle and brain. The preservation of these two organs determine the degree you can function if resuscitated. CPR also delays the transition from a shockable rhythm to a non-shockable rhythm.</li>
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<b>Which is better?</b></div>
<ol style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 14px; font-stretch: inherit; line-height: 21px; margin: 0px 1.5em 1.5em 0px; padding: 0px 0px 0px 1.5em; vertical-align: baseline;">
<li style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Only very rarely will CPR bring a victim back without use of electricity and / or drugs. And because your probability of being brought back declines every minute after your arrest, Having an AED with you really bends the odds in your favor.</li>
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<b>It's smart to insure against catastrophic outcomes.</b><span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span><span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"></span></div>
<ol style="background-color: white; border: 0px; color: #222222; font-family: Arial, Helvetica, sans-serif; font-size: 14px; font-stretch: inherit; line-height: 21px; margin: 0px 1.5em 1.5em 0px; padding: 0px 0px 0px 1.5em; vertical-align: baseline;">
<li style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">There is fire insurance to replace your home or goods if they burn</li>
<li style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">There is life insurance to replace part of a paycheck when that person dies</li>
<li style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">There is auto insurance to help repair or replace a wrecked car.</li>
<li style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">,,,and an AED provides the best available chance of surviving a sudden cardiac arrest!</li>
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<b>Thought for the day: It's so much better to have an AED and never need it than to need it and not have it. Check out the group purchase savings at http://www.slicc.org - just click on AED_deal near the top of the left menu.</b></div>
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<b>Bob (bobt@slicc.org)</b></div>
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Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-60347213420799329532016-06-21T17:42:00.000-04:002016-06-21T17:42:34.596-04:00Why do you perform CPR?The traditional answer is that (a) good CPR helps keep the heart and brain alive until the person can be brought back, (b) good CPR delays the transition of the heart rhythm from a shockable rhythm to a non-shockable one so the person can be brought back with a defibrillator (28% survival) instead of drugs (4% survival).<br />
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I would like to suggest that a more accurate answer is "Because nobody near the victim at the time of the arrest has an AED - an Automated External Defibrillator.<br />
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The simple fact is that, if you had an AED in the home, your best bet by far would be to use it.<br />
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Think about it - most people are doing CPR to maximize the outcome for the victim when the ambulance crew gets there and uses their defibrillator!<br />
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SLICC periodically runs a <a href="http://www.slicc.org/AED_deal" target="_blank">group purchase of a really good AED</a>. Check it out.Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-12446764564714846232016-06-21T16:55:00.001-04:002016-06-21T16:55:52.391-04:00If your answer to the question in the previous post was anywhere near zero, you were pretty close.<br />
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The reason is that for most people, you need to weigh more than the victim to get two-inch compression. This means that - with a few exceptions - for both people in that home to be able to compress the other's chest two inches, they both need to be heavier than the other.<br />
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BobBob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-29257772335138717142016-06-12T08:48:00.000-04:002016-06-12T08:48:19.172-04:00What percent of two-person households are composed of two people who can perform 2" compression on each other? (no decimals, no fractions)<br />
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<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-22388806029736644022016-06-08T18:42:00.002-04:002016-06-08T18:42:36.917-04:00Why you need a personal AEDThe previous post was a variation on the "Don't worry about rearranging the deck chairs on the Titanic" phrase.<br />
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The whole presentation from which that graph was taken is at...<br />
<a href="http://www.slicc.org/FixCPR_2016.pdf">http://www.slicc.org/FixCPR_2016.pdf</a><br />
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CPR is broken.But at least it is fixable.<br />
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Bob<br />
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p.s., btw, it you and your spouse live alone together, one or two of you aren't heavy enough to perform chest compression until the ambulance gets there - get a personal AED. One way to do that is to go to www.slicc.org and click on AED deal. We don't make a profit on this group purchase.<br />
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<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-37557842215939068672016-06-08T18:35:00.001-04:002016-06-08T18:36:06.819-04:00There is one similarity and one difference between...(a) Teaching people how to save on airfare by wearing wings and flapping until they get to where they are going, and (b) teaching people how to perform manual CPR:<br />
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The similarity is that we're teaching something that most who need to cannot do. The difference is that a small number are able to perform guideline-compliant CPR.<br />
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It should be noted that the age distribution of the cohort approximated that of cardiac arrest victims.<br />
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<span style="color: red; font-weight: bold;"><span style="font-family: "arial" , "helvetica" , sans-serif;">For each of the four groups, the upper-left point
is what everybody in the group can do. </span></span><span style="color: red; font-family: "arial" , "helvetica" , sans-serif; font-weight: bold;">The
lower-right point is the best anybody in that group can do.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-weight: bold;">That's why my wife and I have a personal AED.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-weight: bold;">Bob</span></div>
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<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-63775207199191149462016-04-21T10:59:00.000-04:002016-04-21T11:54:56.207-04:00SLICC has proven that CPR is broken and has cast a plan to fix it.<br />
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Bystander CPR as presently taught is something only one in six people can perform for ten minutes on a 40th percentile manikin! Four times as many people can compress a chest for ten minutes if they use the heel of the foot. (American Journal of Emergency Medicine, October 2015)<br />
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Further, the victim chest stiffness / rescuer weight mismatch prevents many from performing even one two-inch compression on the person with whom they live. For example, the average adult chest requires 130 pounds to be compressed two inches. Using manual compression, you need to weigh at least 156 pounds to be able to compress that average chest.<br />
<br />
That's why I bought my wife a weight vest for Christmas.<br />
<br />
Actually, I didn't - I bought an AED. We keep it handy and take it with us when we travel.<br />
<br />
Things are bleak on the EMS side of the business, as well. The stiffness / weight mismatch also affects EMTs and Paramedics. If an ambulance crew is going to be able to provide two-inch compressions to 80% of adults, they both must weigh at least 216 pounds. Additionally, the 383 EMTs and Paramedics we tested tended to compress way to rapidly and tend to leave too much weight on the breast bone at the top of the supposedly full recoil stroke. This is all fixable, but it's going to take a concerted effort and mechanical chest compression devices on the ambulances.<br />
<br />
Bob<br />
<br />
<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com2tag:blogger.com,1999:blog-2451693409488062086.post-64508003744907493732016-02-26T14:52:00.001-05:002016-02-26T14:52:16.569-05:00The presentation slides I used at the ECCU - Emergency Cardiovascular Care Update - are available for download at <a href="http://www.slicc.org/ECCU_2015.pdf">http://www.slicc.org/ECCU_2015.pdf</a><br />
<br />
The download volume has been steady and satisfying. The presentation Dr. Perez and I put together was titled "Fixing CPR: What's Wrong With CPR and What Do We Need To Do To Fix It?"<br />
<br />
The comments and questions I've received from people at ECCU and from people who've accessed the slides online suggest there's a broad and growing interest in the topic and a greater understanding of what constitutes "Good CPR."<br />
<br />
The rate has to be right, the depth has to be right, the recoil has to be right, the interruptions have to be limited, and the ventilations (if you are doing ventilations) can't be too fast or too slow.<br />
<br />
And messing up on any one of those factors is enough to make sure that the victim stays dead or eventually gets discharged from the hospital in a state where the victim requires assistance to perform the activities of daily living.<br />
<br />
I encourage any of you with an interest in the topic to download the slides, and don't hesitate to send your questions to bobt@slicc.org - that's me.Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-38317266795028981542016-01-21T06:47:00.003-05:002016-01-21T06:47:52.847-05:00Let's focus on the details...<span style="font-family: "courier new" , "courier" , monospace;">Whom should we be trying to train in recognizing a cardiac arrest and whom should we train in CPR?</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">The first one is easy - everybody needs to know when they encounter a person who is non-responsive and not breathing normally, and they need to know it well enough that they reflexively call 911 when they see someone who has arrested.</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">The second question's answer is not so obvious. From the standpoint of getting the job done, we should first train those most likely to witness an arrest.</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">With about 85 percent of arrests occurring in a private residence, it makes sense to train a population whose age distribution matches that of the victims. Here are the implications of that strategy:</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">From the CARES database we know that the age distribution of out-of-hospital SCA victims is skewed. We've all known that for quite a while, but the actual numbers are interesting:</span><br />
<br />
<span style="font-family: "courier new" , "courier" , monospace;">Age SCA's</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"> 0-17 1.9% </span><br />
<span style="font-family: "courier new" , "courier" , monospace;">18-34 3.7%</span><br />
<span style="font-family: "courier new" , "courier" , monospace;">35-49 13.1%</span><br />
<span style="font-family: "courier new" , "courier" , monospace;">50-64 30.2%</span><br />
<span style="font-family: "courier new" , "courier" , monospace;">65-79 28.8%</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><span style="font-family: "courier new" , "courier" , monospace;"><span style="font-family: "courier new" , "courier" , monospace;">Older</span></span><span style="font-family: "courier new" , "courier" , monospace;"></span> 22.3%</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">We could train more than 80% of the bystanders who are most likely to witness an arrest by only training those who have reached 50!</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">This also raises the question of what's more important? Training the kids in school or training the faculty with a CPR method they can use from the time a child arrests until the ambulance crew is "hands-on"? (Hint: only one in five can perform what's taught to bystanders for ten minutes.)</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">Another common - but mistaken - belief is that all it takes to get the chest compressed by two inches is strength. This would be true if you could put one hand on the back and the other on the front of the chest, but few are that strong. Your ability to get to two inches depends upon your weight, your weight distribution, the stiffness of the chest you are trying to compress, and the compression method (hands or heel of foot) you are using.</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">The one exception is that, if you were taught to "crunch your abs" while performing compression, that boosts the depth of your compression a little bit, but I've never seen anyone be able to do that for more than a few minutes.</span><br />
<span style="font-family: "courier new" , "courier" , monospace;"><br /></span>
<span style="font-family: "courier new" , "courier" , monospace;">Another non-obvious implication is that males and females usually have different weight distributions. Weight below your hips doesn't count at all if you are performing manual compression. Weight at your shoulders really contributes to the force you can apply. Weight half way between your hips and shoulders contributes 50%. </span><span style="background-color: white; font-family: "courier new" , "courier" , monospace;">If you are performing compression with the heel of your foot, you can get more weight on the victim's chest.</span><br />
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<span style="font-family: "courier new" , "courier" , monospace;"><br /></span></div>
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<span style="font-family: "courier new" , "courier" , monospace;">Make sure the people around you watch the videos at www.slicc.org - click on "Class Video" in the left column. You'll be safer if they do.</span></div>
<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-71989332748171715462016-01-19T12:53:00.001-05:002016-01-19T12:53:57.634-05:00Some things most bystanders don’t know about CPR…and why you need an AED in your home.<br />
A heart attack is not the same thing as a cardiac arrest. Heart attack victims normally are able to talk and many are in pain. Cardiac arrest victims are non-responsive, clinically dead, and are either not breathing normally – or they might be gasping.<br />
<br />
CPR is not used on heart attack victims. CPR is only used on cardiac arrest victims<br />
<br />
CPR does not usually re-start hearts – It tries to keep the heart muscle and brain alive, and it delays the transition from a shockable rhythm to a non-shockable one. This transition drops your chance of survival seven-fold. It usually takes an AED and drugs to re-start the heart, and sooner is a lot better!<br />
<br />
Eighty-five percent of all cardiac arrests occur in a private residence. The witness, if there is one, is usually about the same age as the victim. Heel Compression quadruples the number of people who can perform guideline-compliant chest compression ("GC3’s") for ten minutes.<br />
<br />
If there is nobody in your home that weighs enough to perform 2" deep chest compression until the ambulance crew is "hands-on" you really ought to consider purchasing a personal AED for home and travel use. My wife and I have one. (SLICC will be running another AED Group Purchase this fall. Let bobt@slicc.org if you want to learn the details when the program is beginning. SLICC does not profit from this program.)<br />
<br />
Your ability to perform GC3’s for ten minutes does not depend upon your strength, it depends upon the stiffness of the victim’s chest, your weight and weight distribution, and the method of chest compression you use.<br />
<br />
The three largest flaws in how Bystander CPR is performed are:<br />
<br />
<ol>
<li>Leaning i.e., leaving too much force on the breastbone at top of the “full recoil" stroke. Leaning keeps dead people dead. </li>
<li>Very rapid chest compression - 120-150 compressions per minute was common in the nearly 400 EMS workers measured. Compressions in excess of 120 per minute reduce the probability of victims’ survival. </li>
<li>Compressions that are too shallow reduce the probability of victims’ survival.</li>
</ol>
<br />
<br />
Please watch the video at <a href="http://www.slicc.org/ClassVideo">http://www.slicc.org/ClassVideo</a><br />
<br />
Thank you.Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-36840073770299668582016-01-19T12:38:00.000-05:002016-01-19T12:38:18.416-05:00<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">
<b>What are the most serious problems with CPR?</b></div>
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<b><br /></b></div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">
<b>FROM 10,000 feet:</b></div>
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<ol>
<li style="margin-left: 15px;"><b>We're not focusing on training the people who most need to be trained. </b><b>The people most likely to need to perform CPR are about the same age as - and live alone with - the victim.</b></li>
<li style="margin-left: 15px;"><b>The technique most commonly taught is something that the vast majority cannot perform for ten minutes.</b></li>
<li style="margin-left: 15px;"><b>Many of the people who will be called upon to perform CPR weigh too little to perform 2" chest compression on a chest of average stiffness.</b></li>
<li style="margin-left: 15px;"><b>Even with free instruction, many people who need to know won't take the time to learn.</b></li>
</ol>
</div>
<div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">
<b>THE DETAILS:</b></div>
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<ol>
<li style="margin-left: 15px;"><b>We're not focusing the training on the people most likely to be presented with an opportunity to perform CPR on their spouse.</b> More than 80% of the arrests involve people over 50. Given the ratio of male vs female arrests (2/3 are males) we should be training twice as many females as males, and we should be focusing on persuading both genders over 50 to get trained.Eighty-five percent of all USA Cardiac Arrests occur in a private residence - most are in someone's home, the rest in a nursing home - and the bystander that has to call 911 and start CPR is most likely the victim's spouse. It's not always the case, but in general the spouse is about the same age as the victim. The CPR in the Schools program that we ran and that the SCA Foundation runs are valuable because it starts to sensitize young people at an early age and should eventually reduce the #4 problem.</li>
<li style="margin-left: 15px;"><b>The CPR method being taught in the vast majority of cases - manual chest compression - is something that fewer than one in six can perform for ten minutes on an adult with an average stiffness chest.</b> We have proven that the use of Heel Compression quadruples the number of people who can perform compression for ten minutes. The study was published in the American Journal of Emergency Medicine in October.</li>
<li style="margin-left: 15px;"><b>Many potential rescuers don't weigh enough to perform guideline compliant chest compressions on their spouse. </b>One's ability to perform guideline-compliant chest compressions is dependent upon the rescuer's weight, the rescuer's weight distribution, the stiffness of the victim's chest, and the method of performing compressions. An adult chest of average stiffness requires that the rescuer using manual compression weigh somewhere between 160 and 175 pounds, depending upon their weight distribution. If the rescuer were using Heel Compression, the rescuer weight needs to be between 132 and 150 pounds. It's not always the case, but the female in the relationship is generally lighter than the male.</li>
<li style="margin-left: 15px;"><b>Even if the training is available without charge (it is), not everybody who needs to learn will attend.</b> We have trained more than 10,000 in Chatham County, GA. Given that we know the age distribution of the victims, it would be reasonable to provide free, teacher-less videos (<a href="http://www.slicc.org/ClassVideo" style="color: #1155cc;" target="_blank">www.slicc.org/ClassVideo</a>) and focus the Bystander Course instructor resource on the people most likely to need to know CPR: the folks over 50.</li>
</ol>
</div>
Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-52308218874642940732015-11-04T03:23:00.000-05:002015-11-04T03:23:28.905-05:00It worked<b>The Short Version</b><br />
An elderly male suffered a cardiac arrest at a meeting. Another elderly male began to perform manual CPR but quickly tired and was unable to continue. The other person present - who had recently read an interview with one of the authors of an article in the American Journal of Emergency Medicine regarding Heel Compression CPR began to perform Heel CPR. The victim's heart was restarted before the arrival of EMS.<br />
<br />
That's the whole point of Heel CPR - when you cannot get down on the ground or you have a problem pressing hard enough on the chest to get adequate compression depth, consider an alternative: Heel CPR. Go to www.slicc.org/ClassVideo and click on the Adult CPR video.<br />
<br />
<b>Background</b><br />
Dr. Perez and I wrote a paper about the advantages of Heel Compression CPR. It was promptly published in the American Journal of Emergency Medicine. We wrote the article describing our research so that organizations such as the American Heart Association and the American Red Cross would have a peer-reviewed basis for considering the adoption of the technique in their Bystander course curricula.<br />
<br />
Because 85% of cardiac arrests occur in the home - and about half are witnessed - the witness is generally about the same age as the victim. Because of the age distribution of the victims, the witness / rescuer is likely to be unable to perform CPR in the same manner as a medical student or Intern - the typical cohort in a CPR study. Many cannot get down on the floor. Many have arthritis or other afflictions of the hands or arms that reduce their ability to perform Guideline-Compliant Chest Compressions ("GC3's"). It was for this reason that we developed Heel Compression CPR.<br />
<br />
Heel Compression CPR enables four times as many people to perform GC3's. Here's the abstract from the AJEM publication:<br />
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<b>Heel compressions quadruple the number of people who can perform chest</b></div>
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<b>compressions for ten minutes.</b></div>
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<br /></div>
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<b>Abstract:</b></div>
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<b>Objective:</b> To evaluate whether chest compressions using the heel provide a more</div>
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effective method than manual compressions for bystanders.</div>
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<span style="color: #424242;"><br /></span></div>
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<span style="color: #424242;"><b>Methods:</b> </span>This is a cross-sectional observational comparison study where each subject</div>
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acted as his or her own control. A 49-person cohort whose age distribution approximated</div>
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that of sudden cardiac arrest (“SCA”) victims, were asked to perform ten minutes of five</div>
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cm manual compressions on a CPR manikin at 100 compressions per minute. The</div>
<div style="color: #2d2d2d; font-family: Helvetica; font-size: 12px; line-height: normal;">
compression rate and the endurance of each subject were recorded. The same subject was</div>
<div style="color: #2d2d2d; font-family: Helvetica; font-size: 12px; line-height: normal;">
then asked to perform ten minutes of heel compressions at the same depth and rate.</div>
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<span style="color: #424242;"><br /></span></div>
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<span style="color: #424242;"><b>Results: </b></span>Sixteen percent of the cohort performed compliant manual compressions for ten</div>
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minutes versus sixty-five percent using heel compressions. Twenty-four percent of the</div>
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subjects were not heavy enough to get compliant depth with manual vs. two percent with</div>
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heel compressions, and six percent could not get down on the floor to attempt manual</div>
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compressions.</div>
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<b>Discussion: </b>Most cardiac arrests occur in private residences. If there is a witness, his or</div>
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her age usually approximates that of the victim. <span style="color: #2d2d2d;">Heel compressions are useful in</span></div>
<div style="color: #2d2d2d; font-family: Helvetica; font-size: 12px; line-height: normal;">
situations where a lone rescuer cannot get down on the floor, cannot compress the chest</div>
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to guideline depth because of an infirmity or lack of weight, or becomes too tired to</div>
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continue manual compressions. Heel compressions significantly increase the bystander</div>
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population’s ability to provide effective, uninterrupted compressions until EMS arrival.</div>
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Heel compressions quadruple the number of people who can perform chest</div>
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</div>
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compressions for ten minutes.</div>
Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-86541351358485568572015-10-10T06:57:00.001-04:002015-10-10T07:00:26.391-04:00It's happening...<br />
<br />
1. Dr. Perez's and my paper that proved that use of heel compression quadrupled the number of people who could perform guideline-compliant chest compression for ten minutes. What makes this even more interesting is that we didn't use the traditional cohort of fifty medical students or 50 interns. Rather, we used a mix of males and females whose age distribution approximated that of cardiac arrest victims. This paper was published online by the American Journal of Emergency Medicine within eight days of their having received it and in print within sixty days! That's pretty speedy turnaround for a peer review journal.<br />
<br />
2. The publication of this work gives the AHA what it needs to evaluate publishing the technique in their bystander classes.<br />
<br />
3. One medical first responder agency has changed their protocol to include "If a First Responder is alone with the victim and cannot achieve guideline-compliant chest compression ("GC3s") using manual chest compression, the First Responder shall use Heel Compression until someone arrives who can perform GC3s. In any event the LUCAS shall be applied as soon as possible and without any interruption of more than ten seconds."<br />
<br />
4. For a demonstration of the technique, see http://www.slicc.org/ClassVideo and click on the adult CPR link.<br />
<br />
5. The Abstract of the article in AELM is free and can be found at<br />http://www.ajemjournal.com/article/S0735-6757%2815%2900560-4/abstract<br />
<br />
<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-42029469257320683212015-08-18T11:49:00.000-04:002015-08-18T11:49:28.460-04:00"Bystander" is more an environment than a level of trainingWhen we hear "Bystander CPR" the image that comes to many minds is a person at home or at the shopping mall who isn't a medical professional but who has just seen someone have a sudden cardiac arrest. (You can thank TV for that shopping mall image - 85% of all out-of-hospital arrests occur in a private residence.)<br />
<br />
The bystander environment is usually one where the witness has to call 911 and perform hands-only CPR alone for an average of ten minutes. The ambulance environment and the hospital environment have other people there to help.<br />
<br />
When tested on a manikin exhibiting a chest stiffness at the 32nd percentile - a little less than 65% as stiff as the AVERAGE adult's chest - one-in-six of the subjects tested made it to ten minutes using their hands, but four times as many made it to ten minutes using the heel of their foot.<br />
<br />
When talking with EMTs, Paramedics, Nurses, and Doctors about heel compression CPR, the typical reaction I get is "no thanks - I'm CPR certified." The problem is that those medical professionals are certified in a manual technique that that usually cannot be performed on a real adult for ten minutes! When you are by yourself, you are a Bystander, regardless of your training.<br />
<br />
<a href="http://www.slicc.org/ClassVideo" target="_blank">Here's</a> where you can watch a demonstration of Heel Compressions. And while you're at it, why not brush up on AED use, choking emergencies, and stroke recognition - they're all in the same folder.<br />
<br />
...and to belabor the obvious, after you've watched the videos, you won't be any safer - the folks around you will be safer. So make sure those who are around you frequently watch the videos, too.Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-50771854739755600672015-08-15T11:53:00.000-04:002015-08-15T11:53:19.607-04:00Bystanders, use your Heels!A novel chest compression technique was explored in 1978 and 1980. It was good, but not necessary, because compressing an adult chest one inch wasn't all that tough for the subjects tested in CPR studies.<br />
<br />
Time marched on and in 2005 the compression depth guideline went to 1.5 inches. An alarming number of CPR instructors flunked their re-qualification trials, because they were unable to complete five cycles of 30 compressions and 2 breaths.<br />
<br />
Guess what happened when the guidelines went to 2 inches in 2010? You guessed it.<br />
<br />
As SLICC began training residents in 31411 - an older community - it noticed that many students either couldn't get down on the floor or couldn't apply much force to the manikin's chest because of problems with their hands or wrists. In those cases we instructed them to take their shoes off, stand over the victim's head facing the victim's feet, place one heel on the CPR point and use the leg / heel to compress the chest a full two inches. In a study published recently in the American Journal of Emergency Medicine Dr. Perez and I demonstrated that use of the heel quadruples the number of rescuers that can perform guideline-compliant chest compressions for ten minutes. Ready for the BIG news? The group of subjects tested had approximately the same age distribution as do cardiac arrest victims!<br />
<br />
To see the technique demonstrated, go to <a href="http://www.slicc.org/ClassVideo">www.slicc.org/ClassVideo</a> and select the Adult CPR video. (And while you are there, there are some other useful videos at that site.)<br />
<br />
After you watch the Adult CPR video, you won't be any safer - the people you live with and the people you spend a lot of time with will be safer. Hence, it's in your interest that those people watch the videos, too!<br />
<br />
Get safer! <br />
<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com1tag:blogger.com,1999:blog-2451693409488062086.post-10638536103513883152015-08-12T19:02:00.000-04:002015-08-12T19:02:46.898-04:00A way to make yourself safer in less than an hour!Eighty-five percent of Sudden Cardiac Arrests occur in the home. Fewer than half are witnessed. For the arrests that are witnessed, the witness is usually about the same age as the victim and off a different gender. The best chance of getting discharged from the hospital with major brain functions intact is immediate CPR and prompt defibrillation.<br />
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The way to make yourself safer is to make sure that the person(s) you live with watch the videos at www.slicc.org/ClassVideo/<br />
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If he or she is of the thinking type, he or she will figure out that they, too, will be safer if YOU watch the videos, as well.<br />
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...and while you're at it, think about the folks you see frequently, too.<br />
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And if you want to make the defibrillation happen faster - and that really, really helps - go to www.slicc.org and click on AED Deal in the left column.<br />
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A lot of survival depends upon what the other person does!<br />
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BobBob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-52466503608359474622015-07-27T09:29:00.000-04:002015-07-27T09:29:25.548-04:00It's been a while. My last post was just after presenting our research on the prevalence and magnitude of "leaning" at the AHA's Resuscitation Science Symposium. ("Leaning" is having too much (more than 1.5 pounds) of force on the sternum at the top of the "full recoil" up-stroke when performing chest compressions.<br />
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In the past eight months SLICC has...<br />
- Invented a Force Meter that permits the user to:<br />-- Discover the percentage of the adult population to which a person can administer compliant CPR<br />-- Measure the instantaneous rate of chest compressions<br />-- Measure leaning, the residual force on the sternum at the top of the 'full recoil' stroke.<br />- Invented a device that keeps on clicking when the leaning is within the safe limit (1.5#)<br />- Been invited to speak at ECCU about how CPR is broken and what we need to do to fix it.<br />
- Had a paper on Heel Compressions vs Manual Compressions published in the AJEM<br />
- Measured the CPR capacity, rate, and leaning of 383 Healthcare Professionals (anonymously)<br />
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Currently, we're trying to invent a BVM that cannot be operated more than 10 times per minute.<br />
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No offence, but this is so much more fun than playing golf.<br />
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...and that's why it's been eight months since I last posted.<br />
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Bob<br />
<br />Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-36706570509335751902014-11-17T13:30:00.001-05:002014-11-17T13:30:10.125-05:00SLICC presented its leaning research at the AHA Resuscitation Science Symposium on November 15th.<br />
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The Sudden Cardiac Arrest Foundation's <a href="http://www.sca-aware.org/sca-news/full-recoil-during-cpr-upstroke-elusive-for-most-bystanders-but-coaching-helps-many" target="_blank">coverage</a> of that includes the slides from the presentation at the end of their article.Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0tag:blogger.com,1999:blog-2451693409488062086.post-11817046463197010332014-11-01T06:47:00.000-04:002014-11-01T06:47:45.839-04:00Are you sure you want to vacation in Maine?<table align="left" cellpadding="10" cellspacing="1" style="width: 550px;"><tbody>
<tr><td colspan="4"><span id="divTitle" style="font-size: 14px; font-weight: bold;">Veto of Bill on CPR Training in Schools Holds</span></td>
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<span style="font-size: 1.7em; font-weight: 600; line-height: 100%;"><span style="font-family: Verdana;">The bill sought to train high <a href="http://www.mpbn.net/News/MaineCapitolConnection/tabid/1545/ctl/ViewItem/mid/3483/ItemId/28362/Default.aspx#" id="_GPLITA_1" style="text-decoration: underline;" title="Click to Continue > by CouponDropDown">school</a> students in life-saving techniques including CPR and the use of automatic external defibrillators.</span></span></div>
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<span style="font-family: verdana,sans-serif; font-size: 1.2ems; font-weight: 500; line-height: 150%;"><span style="font-family: Verdana;">AUGUSTA,
Maine (AP) _ Gov. Paul LePage's veto of a bill calling for
cardiopulmonary resuscitation training in Maine schools will stand.<br />
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A 22-13 Senate vote Thursday fell two short of the number needed to
override the governor's veto. The bill sought to train high school
students in life-saving techniques including CPR and the use of <a href="http://www.mpbn.net/News/MaineCapitolConnection/tabid/1545/ctl/ViewItem/mid/3483/ItemId/28362/Default.aspx#" id="_GPLITA_2" style="text-decoration: underline;" title="Click to Continue > by CouponDropDown">automatic external defibrillators</a>. The House had voted to override the governor's veto Wednesday.<br />
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Supporters said the bill will save lives. But Republicans supporting the
governor's veto said that while school districts should implement CPR
training, the state shouldn't order them to do so through laws.<br />
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It was the ninth veto this session lawmakers have failed to override.</span></span></div>
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<span style="font-family: Verdana;">[From the Maine Public Broadcasting Network.] </span></div>
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Bob Trenkamphttp://www.blogger.com/profile/11727082150399155823noreply@blogger.com0