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Thursday, November 18, 2010

Another save...with comments

Here is a recent story about a successful cardiac arrest save. I've added some [comments within square brackets] to point out some really pertinent points.

Bob

Edwards hero saves heart attack victim with CPR


by Staff Sgt. Angelique Smythe
95th Air Base Wing Public Affairs


11/17/2010 - LANCASTER, Calif. -- With his own heart racing, he made every effort to keep the heart of the man lying lifeless on the ground beating.

Compression after compression. Breath after breath. Still, no change. [In this case - a witnessed adult arrest - no mouth-to-mouth is indicated. The odds of not dying or of not winding up with neurological damage is higher if you skip the breaths and thus avoid the interruptions.]This was nothing like the movies when a victim would simply return to life within a few seconds of receiving cardiopulmonary resuscitation.

He tried to block out the chaotic shouting of bystanders throwing out suggestions of things to do to save this man's life and the constant questioning from terrified family members. Is he all right? How's he doing? Is he responding? [This is a very accurate description of what goes on when a crowd gathers. All of a sudden everybody is an expert, and it's very distracting to the person performing CPR. Try to get one person to control the crowd.]

Minutes were slowly passing, but time was running out. He was starting to feel tired. Another man dropped to his knees to assist with compressions.

Finally, after what seemed like an eternity, paramedics arrived. But his job was not over yet.

"Who's doing the CPR?" they asked.

"I am," he said.

"Keep doing it."

Manuel Jaramillo, 95th Air Base Wing Environmental Restoration specialist, continued working to keep the oxygen flowing into this stranger's lungs as the paramedics worked hastily around him in preparation for defibrillation.

Mr. Jaramillo was in the middle of a softball game on a field in Lancaster, Calif., Aug. 15, when the pitcher of the opposing team suffered a massive heart attack.

Ron Welsh, a 30-year employee of Lockheed Martin in Palmdale, Calif., had just pitched the ball when he suddenly fell to the ground, suffered convulsions, then lied motionless on the field. People quickly surrounded him. No one understood what was going on. Everyone was in a state of panic.

Mr. Jaramillo rushed to the scene and noticed Mr. Welsh's skin was beginning to turn blue. He then noticed Mr. Welsh's wife, who had also been standing there in shock along with her son, Daniel Welsh.

"It's kind of awkward to approach someone like that," Mr. Jaramillo said. "I'm not one to just step up to the plate and say, 'let me be the hero.' I said, 'Ma'am, I'm CPR certified, if there's anything I can do, just let me know and I'll help you out.'"

She immediately pushed him to the ground.

"I started to check for a pulse, but I couldn't find a pulse on him," Mr. Jaramillo recalled. "People were starting to yell things like, 'do this; do that; you've got to check his pulse over here.' I tried to block it all out and continued doing what I was doing. It's kind of difficult to check someone's pulse when you've got everything racing like that. The only pulse I felt was my own." [Don't bother with checking the pulse. It's a waste of time, and someone who isn't really good at checking pulses or doing CPR can feel a pulse on a rock. The turning blue around the mouth tells you all you need to know in this case - what's needed are chest compressions, at least 2" deep, 100 times a minute.]

Mr. Jaramillo performed CPR for approximately 10 minutes. It had been nearly one year since he was trained on this very important life-saving skill, and he would be due for recertification within one week.

Mr. Jaramillo, a three-year employee of Edwards Air Force Base, Calif., said, "We need to be (CPR) certified for our jobs because we go to really remote locations (to monitor water.) So, if something were to happen to any of us, all of us are CPR certified."

When Gary Booker, Mr. Jaramillo's teammate and a property manager in Lancaster, noticed Mr. Jaramillo was becoming weary, he got down to perform compressions.

"When you're doing that and somebody kneels down next to you and decides to give you a hand, it makes a big difference," Mr. Jaramillo said. "You can ask anybody who performs CPR training and they'll tell you that you're going to get tired from doing it. It's not like you're going to do it and then they're just going to automatically wake up. Chances are you're just keeping the guy alive until professional help arrives. There wasn't much I could do except keep his heart pumping and blood flowing throughout his extremities." [What really counts is keeping the blood flowing through the brain and heart muscle.]

Mr. Booker said he remembered looking over and seeing the man on the ground.

"He looked as if he was having a hard time breathing," he said. "I didn't move at first. Manny definitely was the first one there, and he was there all the way throughout the whole thing."

While assisting Mr. Jaramillo with compressions, Mr. Booker could hear people praying. He saw the wife crying and her son standing over her shoulder saying, "Come on, dad."

Mr. Booker said his girlfriend, a healthcare professional, assisted by taking out the victim's dentures to provide more space for an airway. [That's not as silly as it sounds to some folks: A lot of time victims in this situation will have a swelling tongue. You need all the airway room you can get. The compression-only CPR is relying on residual oxygen in the blood, residual are in the lungs, and a non-inconsequential movement of air into and out of the lungs as the chest is compressed and then recoils.]

"Manny was the guy," he said. "I mean, I jumped in and helped out, but Manny was really solely responsible for helping in keeping that man alive. I'm just thankful for his quick actions and persistence and for staying with that man until paramedics took over."

Mr. Booker said he, too, is CPR certified which is very much necessary for a high school basketball coach. He's coached for six years in both northern and southern California.

"With the responsibility of coaching, or being in a gym filled with kids, you have to have (CPR) certification," he said. "It's really helpful to know what to do if something happens."

The paramedics shocked Mr. Welsh several times on the baseball field, but he did not become any better. They rushed him to the hospital where he was placed under a medically induced coma for the next two weeks.

Mr. Welsh's son, Daniel, said his father suddenly awoke just as the doctors were getting ready to tell his family that he probably would not make it.

"The doctors still can't believe he's alive," Daniel said.

Mr. Welsh's blocked artery was one which doctors usually refer to as the 'widow-maker' as its blockage can cause a massive heart attack which most often immediately leads to death.

"He was gone from us for a couple hours and had to be resuscitated, shocked and defibrillated a few times," Daniel said. "As a 25-year-old man, I never thought I'd have to watch my father die, which in all reality, is really what happened."

Each doctor the family came across throughout Mr. Welsh's month-long stay at the hospital told them that if it weren't for the two gentlemen who performed CPR, he would not have made it off of the baseball field, let alone his going home to them within a few weeks.

"(Manny) is an angel; he was sent from God to watch over my father," Daniel said. "The doctors said only three percent of people who get CPR outside of the hospital even make it to the hospital because people don't always do it correctly. It so happened that Manny and (Gary) knew what they were doing. They worked perfectly in unison as a team. I owe them my deepest gratitude."

Each week, Daniel called Mr. Jaramillo to keep him updated on Mr. Welsh's status. After his release from the hospital, for the first time since the incident, Mr. Welsh and his family attended another softball game in late September. He thanked everyone for their support and expressed his appreciation to the men who saved him.

It was then Mr. Jaramillo and Mr. Welsh were finally introduced to one another.

"The really cool thing is we ended up playing (Mr. Welsh's team) a few weeks later," Mr. Booker said. "It was at the same time on the same field as the previous game. Before the game, everyone recognized he was there. Our team went over to the bleachers, shook his hand and expressed how glad they were to see him back."

Mr. Welsh said he encourages everyone to learn CPR. Although he, himself, hasn't yet had CPR training, he said this will become one of his top priorities after full recovery.

"It saved my life, and I thank Manny everyday that he took this class," he said.

On Nov. 12, the two reunited again for a photo for this article and the Welsh family continuously expressed feelings of gratitude to Mr. Jaramillo.

Wednesday, November 17, 2010

Making it real

One of the problems encountered in trying to convince people that they ought to learn CPR is that many people think it's not relevant to them.

We keep looking for new ways to help people realize that cardiac arrests are realities that happen to people they know and that they might someday be the person who has the responsibility of keeping the heart and brain alive until the medics get there.

Here's one of the more recent suggestions.

"Write down a list of your family members, your friends, and your acquaintances. Divide the number of names on that list by 7 - that's the number of people on that list that will witness at least one sudden cardiac arrest in their lifetime.

"Now, look at that list of names. The odds are high that when you witness a sudden cardiac arrest, the victim will be someone from that list. When that happens, you will need to perform CPR and there has to be an AED nearby...or you will have to live with the remembrance that you could have made a large difference, if only you had invested an hour or so."

I'd really appreciate any suggestions you might have for how we can make this real to more people. bobt@slicc.org

Monday, November 15, 2010

Cardiac arrest recovery broadcast on PA system.

Who doesn't remember the roar of a loyal crowd at a high school football game? Cheerleaders with their multi-colored pom pom's, parents with homemade signs, athletic directors having heart attacks over the PA system. Wait, what?

Erasmus Hall HS athletic director Marshall Tames was broadcasting the play-by-play on a playoff game in Brooklyn when he suffered a near-fatal heart attack yesterday afternoon [see original story in NY Post.]. Faster than you can pull off a blitz, Tames went from calling punt returns to lying on the ground with no heartbeat, having stopped breathing. Speechless spectators listened as Tames was defibrillated on the spot, with everything overheard on the loudspeaker. Chris Miccio, who was keeping time for the game and first began CPR when Tames collapsed, said the people in the stands of the 2,000-seat at Midwood High's field were relieved when he responded quickly. "Somebody asked you what you did today. 'Oh, I worked a scoreboard at a football game and saved somebody's life,' " Miccio said. It's probably the craziest PA announcement we've heard of since Kenny Powers' curse-laden high school job acceptance speech.



Sunday, November 14, 2010

Systems Approach Improves Survival

Abstract 51: Implementation of the American Heart Association Guidelines With a Systems-Based Approach Improves Survival to Hospital Discharge Following Prehospital Cardiac Arrest

Michael Dailey; Jonathan Politis; Terry A Provo

Albany Med Cntr, Albany, NY; Town of Colonie EMS Dept, Latham, NY; Advanced Circulatory Systems, Roseville, MN

Intro: A systems-based approach to out-of-hospital cardiac arrest (OHCA) involves optimizing the care continuum beginning with public recognition and bystander CPR, and continuing through specialized post-resuscitation care at Level One Cardiac Arrest Centers (L1CACs).

Hypothesis: Implementing a systems-based approach to resuscitation care that includes the most highly recommended AHA resuscitation guidelines will improve survival.

Methods: Beginning in 2006, the Town of Colonie (NY) (population 80,000) EMS system began phasing in multiple recommended therapies from the 2005 AHA CPR guidelines including: 2006) new CPR guidelines and expanded bystander CPR Anytime training; 2007) use of an impedance threshold device and emphasis on, and more rapid deployment of, mechanical CPR; 2008) improvements in dispatch to reduce response times, two minutes of CPR prior to defibrillation, and delaying advanced airway placement and IV access in favor of a period of high quality CPR;and 2009) hospital therapeutic hypothermia for comatose resuscitated arrests. EMS shift commanders respond to all cardiac arrests to assure strict protocol compliance. Resuscitated arrests are transported to L1CACs capable of continuing therapeutic hypothermia. A Standard Chi-Square analysis was performed.

Results: Since 2005 {approx}200 people/year were trained in CPR, dispatch improvements reduced response times by one minute, and three L1CACs were established. Survival following OHCAimproved from 4% (3/75; 2005 historical control) to 22% (14/64) (p=0.0013) in 2009. Survivors from 2009 were neurologically intact.

Conclusion: When OHCA patients were treated with a systems-based approach intended to improve bystander CPR rates, rapidly defibrillate, optimize circulation during CPR, and preserve vital organ function following cardiac arrest, survival rates quadrupled compared to historical controls. This approach had dramatic effects on survival in this mid-size community.

Formula

Author Disclosures: M. Dailey: None. J. Politis: None. T.A. Provo: Employment; Significant; ACSI.

From Circulation, a peer-reviewed journal of the AHA

Saturday, November 13, 2010

15-year-old Winsted girl saves choking victim

By MICHAEL MARCIANO - Editor
November, 12, 2010

WINSTED — A 15-year-old Laurel City girl has been credited with saving the life of a family friend by using CPR techniques she learned at school.

Morgan Campbell, a sophomore in the Vo-Ag program at Northwestern Regional High School, was home in the kitchen with her mother, Alicia Campbell, and a family friend, Laura Liebenow of Greenfield, Mass., when the three of them received a scare. Liebenow was choking on a piece of a brownie she had just bitten into, and she couldn’t breathe.

“It was pretty scary,” said Liebenow, 25, a nighttime drug store manager who travels to the Campbell residence regularly to participate in dog shows. “We were just laughing and joking around, eating brownies, and I started to choke on one of them. No one realized what was happening at first.”

Morgan’s mother asked Liebenow if she was okay, and Liebenow shook her head. “Alicia grabbed her phone and started to call 911. She said, ‘Stand up — we need to get to you,’ and I couldn’t stand up. Morgan came around from behind the couch and just pushed me forward, so she could get to me. We were freaking out and Morgan was the calmest out of all of us. Had she not been there, I don’t know what would have happened.”

Morgan was able to get her arms around Liebenow and use the Heimlich maneuver to force air out of her windpipe. A chunk of brownie popped out and Liebenow was able to breathe again. She told her mother that she had learned the technique during a demonstration when she was an eighth-grader at St. Anthony School.

“I don’t think she realize realizes how big a deal it was,” said Liebenow. “I didn’t know what to say afterward. This was the first time this has ever happened to me.”

Alicia Campbell, who works as Winsted’s animal control officer and as a dispatcher with the Winchester Police Department, said her daughter acted quickly and maturely.

“She’s 15 years old and she was quicker than I was,” she said. “By the time I was on the 9 she had already dislodged the obstruction.”

Campbell said the short span of time that elapsed may have contributed to her daughter’s sense that the choking episode was a minor event.

“I don’t think she really comprehends that she saved a life,” she said. “She just got up from her chair and went over and did it. It amazed me. People congratulate her and she gets embarrassed.”

Still, friends and family members have been able to see the light side of the situation, asking Campbell when they will be offered a taste of her “killer brownies.”


© Copyright 2010 by TCExtra.com

Tuesday, November 9, 2010

Coach starting second life in Hamilton

Leon Schepers says it flatly.

“I shouldn’t be alive.”

Schepers knows flat. In 2008 at the Beijing Olympics he collapsed and had no heart activity for up to five minutes.

A little more than two years later, Schepers and his family are putting down roots as he takes on the head coaching job at the National Cycling Centre Hamilton (NCCH) in Ancaster.

He just finished testing about 2,000 middle and high school students at Hamilton schools as the NCCH identifies young people to recruit for competition leading to the 2015 Pan Am Games. (See story, page SP8)

But only determined CPR and defibrillator shock over a 30-minute period brought him back from the dead Aug. 19, 2008.

The South African coach was eating a piece of watermelon in a dressing room, recalls only that conditions were “superhot,” and then remembers nothing.

“At first they thought I’d choked on a seed and that led to the heart problem,” he said.

Accounts related to him later noted that he flatlined for up to five minutes before he received CPR and electric stimulus to get his heart pumping again.

He still has difficulty believing it.

“I was in excellent shape as a triathlete and had great results in testing before the Olympics.”

Schepers required three hours of emergency treatment after he was transported to hospital, the news service china.org.cn reported. Then he spent two weeks in hospital.

After extensive testing, Chinese doctors concluded he must have contracted a vascular infection.

He lost some short-term memory from the episode but gained a new perspective on how precious life is.

“My life has changed. I view things differently.”

But he said the crisis was not the motivating factor in moving to Canada. That grew from trips to Vancouver in the past and a chance to see more of this country.

“We’re really enjoying it and the best thing is our kids love their school.”

jkernaghan@thespec.com

905-526-3422

Thursday, November 4, 2010

Teacher saves dying student with CPR


By Nikki Dowling
A Riverdale resident and former John F. Kennedy teacher and coach saved a student’s life at Lincoln High School in Yonkers, N.Y. on Oct. 27.

Charles Hill, an earth science teacher at the school who coached basketball, soccer and baseball at Kennedy until about four years ago, said he entered the gym where students were playing basketball after school to see an 11th-grade male student lying on the floor.

“I went over and checked his vitals. He continued to breathe but it was still a labored breathing and he passed out and he stopped breathing. I shook him and spoke to him and then he came back,” Mr. Hill, 51, said in a phone interview on Oct. 29.

Then, the teacher said the student stopped breathing again. And this time, he had no pulse.

Mr. Hill said he called for a defibrillator and immediately began CPR. He was able to partially revive the student but said his eyes were still unfocused and he was not fully conscious. To keep him from choking, Mr. Hill said he rolled the student onto his side.

An ambulance arrived several minutes later and it was only then that Mr. Hill said he fully grasped what had happened.

“It wasn’t until afterwards — when the ETS workers had come in and they took over — that I … got nervous. I realized I was the difference between him living and maybe dying,” Mr. Hill said.

Mr. Hill said he has been a coach since 1971, and had never dealt with a situation where someone’s heart stopped. He said there were about 40 to 50 students in the gym, plus a coach and another teacher.

“People react differently under pressure and I’m the one that responded,” he said.

When he returned to school, Mr. Hill said the administrators at the school did not thank him but teachers, as well as the boy’s girlfriend, expressed their gratitude.

“The nicest thing was today [Oct. 29] the boy’s girlfriend came up to me and grabbed me by the hand with tears in her eyes and thanked me,” Mr. Hill recalled.

Although the student was still in the hospital on Oct. 29, Mr. Hill said he was recovering and undergoing tests to determine the cause of the incident.