The Recommendation of a Book.

Thanks to Doctors Gillinov and Nissin of the Cleveland Clinic, we have a book titled Heart 411 (Three Rivers Press). It is a well-organized, comprehensive, 500+ page treasure trove of information.

The book contains an interesting chapter on how a woman's heart is different and similar to a man's.

Similarities?
The primary symptom of coronary heart disease is chest pain for both sexes. Also the principal strategies for prevention and treatment apply to both men and women: healthy lifestyle, medicine, angioplasty, and surgery.

Differences?

1. Since 1984, more women than men have died from coronary heart disease each year. Prevalence is dropping in men but rising in women.
2. For men, a heart attack is the first sign of heart disease. For women, the first sign is more commonly angina - a discomfort or fullness in the chest that generally occurs with exercise or stress and is relieved with rest.
3. About 25% of all heart attacks occur without chest pain - more commonly in women than in men. Shortness of breath is often the clue in the absence of chest pain, as are indigestion, nausea, vomiting, sweating, fatigue, and weakness.
4. Women tend to wait longer than men before seeking treatment, and they are more likely to go to their doctor's office than to the Emergency Department.
5. Eighty percent of women (vs. fifty percent of men) report having experienced early warning symptoms one month or more before a heart attack. The early warning signs for women include unusual fatigue (72%), sleep disturbance (48%), shortness of breath (42%), indigestion (39%), anxiety (36%), and chest discomfort (30%)
6. The standard exercise cardiac stress test is less reliable in women (more false positives) and fewer catheterizations for chest pain reveal blockages, thus raising the risk and lowering the benefit of these important procedures.
7. Young women - less than fifty years old - have twice the risk of dying in the hospital following admission for a heart problem than do men.
8. Men have heart attacks at an earlier age than women.

And what's all this doing in a blog usually dedicated to Cardiac Arrest and CPR? While most heart attacks are not fatal - i.e., don't trigger a cardiac arrest - some of them do.

What I didn't know about CPR

I've seen four different ways to perform CPR with your hands in the past weeks.

1. Lock your arms straight, get your shoulders over the hands, and rock from the hips. So far, no surprise.
2. Perform #1 but use your abs to accelerate your shoulders downward.
3. Perform #1 but start with your arms slightly bent and straighten them as you start the downward push.
4. Perform 1, 2, and 3 simultaneously.

For those who lack the physical training and endurance to perform alternatives 2, 3, & 4, you'll have to stick with alternative #1.

A fifth alternative - not available to those performing CPR as part of their employment - is to perform pedal compressions. It's the only way I know of where the average person at home - where two-thirds of all cardiac arrests occur - can perform chest compressions from the time they witness an arrest to the time the ambulance crew is "hands on" at the victim of a cardiac arrest. See how to perform Pedal CPR  I'm a paramedic. I've gotten a lot of CPR experience over the past decade, and I am absolutely positive that I can perform pedal compressions on someone for the ten-minute average period from the moment I see someone collapse and the time that help is "hands on." 

I hope this is something that you never need to know.

did you ever stop to think about how?

One of the recommendations one hears in CPR class sessions is "Get the victim on their back on a hard, flat surface."

Recognizing that two thirds of all arrests in the U.S.A. occur in the home, you are going to fit into one of the categories below.

1. I can physically pick up my spouse and place him or her on his or her back on a hard, flat surface, and my spouse can do the same for me.
2. I am the only adult in my home.
3. One of us can pick up the other and get him or her onto his or her back on a hard, flat surface.
4. Neither one of us can do that.

OK. Those of you who fell into group 1 or 2 can skip the rest of this. Those who are in groups 3 or 4 really need to watch www.slicc.org/2014CV_AdultCPR.mov. I can painfully testify that my 113 pound wife can get my 185 pound body out of a recliner or out of a bed and onto the floor without a problem.

If you are interested in the entire video, go to www.slicc.org and click on "For past trainees" in the left column. The Intro and the Adult CPR segments are the only 2014 videos, but the entire 2012 video is up there, as well. SLICC's instructional videos assume that you will be a "lone rescuer."

Here's a tip that can save someone's life...

How many things can you think of that you did better the first time you did them than the second?

Not a lot, right?

Here's the point: You have a rediculously high chance of seeing someone you know have a cardiac arrest, and getting it right the first time is important.

So you and your spouse need to take turns pretending that the other just had a cardiac arrest and acting out what you would do.

What would you do?

Hopefully, you would...

1. Determine that it's safe to help - there's no high voltage power line on top of the person, right?
2. Check to see that the person is truly unresponsive and not breathing normally.
3. Call 911 while walking to the door to unlock it. 
4. And don't let 911 hijack the call - and tell them (a) where you are, (b) what's wrong, (c) what you are doing about it, and (d) what you need. If you don't take charge of the call, they will keep you on the phone longer than you can afford to ignore the victim.
5. Get the victim on their back on a hard, flat surface and start chest compressions - at least two inches deep, and at least at a rate of 100 - 120 per minute.
6. Don't even think of breathing for that adult - they won't need it for the first 5-10 minutes, and interrupting the compressions, really reduces their chance of surviving.

It will be soooo much easier to get it right if you have practiced. Seriously.

See www.slicc.org if you have questions.

Best,

Bob

What is the most likely place you will see an arrest? ...and what can you do?

More than 2/3 of all cardiac arrests occur in the home.

When that happens, you might have to get the victim out of bed - or out of the recliner - onto the floor. You then need to roll the victim onto their back and begin CPR.

We need to get the American Heart Association and the American Red Cross to change their curriculum to teach what is actually needed to perform CPR on the victim of a cardiac arrest.

The most effective way to get someone out of bed is to throw the covers off the foot of the bed, untuck the bottom sheet from the far side and throw it over the victim, and pull the bottom sheet until the victim rolls out of bed. Hopefully you have placed a pillow on the floor where the head is going to hit. See www.slicc.org click on For past trainees in the left column, and watch the "Adult CPR" video.

The most effective way to get a victim out of a recliner is to reach across the victim and pull that distant arm over the body to roll them out of the recliner.  See www.slicc.org click on For past trainees in the left column, and watch the "Adult CPR" video.

There's an observation I make at the end of every Bystander CPR class that always gets a "startled look" response from the attendees. I tell them "Keep in mind that, now that you know CPR, you are no safer than you were before. It's the people you hang out with who are safer!"

Then I tell them to make a list of the people they hang out with and invite them over for a beer. When they get there, tell them you were just kidding about the beer - they are there to watch our class video and learn how to save each other, should they have a cardiac arrest or a stroke. (The class video is a free download. Go to www.slicc.org and click on "For past trainees" in the left-hand column. It's currently in transition from the 2012 complete class video to the 2014 class video, and not all the 2014 modules are up yet. Watch the 2014 modules first and then fast-forward through those sections of the 2012 video.)

Teach your friends using our materials - it will re-enforce your understanding and will get you into a safer environment.

OK, Teammates. Here's how it all sorts out:

First, if you see a person have a cardiac arrest and you are in an ambulance or in the Emergency Department, you already know what you need to do.

BUT, if you are in a situation where when you see someone arrest, you need to call for an ambulance - and I don't care whether you are a doctor, a nurse, a paramedic, or an EMT - the odds of your being able to perform Guideline-Compliant Chest Compressions ("GC3's") from the time of the arrest until the ambulance crew is "hands on" at the victim are slim-to-none.

First of all, we have studied chest compression stamina and chest compression depth, and I can assure you that you are an exception, if you are able to perform GC3's until the ambulance crew takes over, when you are using what we teach in a normal CPR class.

The things we teach in a normal certification class don't address the very real problem of getting the victim onto the hard, flat surface we talk about, and it ignores the fact that you might not be able to get down onto the floor, you might not be able to use your hands to compress the chest, the chest might just be too stiff for you to compress, or you might just already be too tired.

The solution SLICC is proposing is to use your foot, not your hands.

Check the Adult CPR portion of SLICC's 2014 Class video:
http://www.slicc.org/2014CV_AdultCPR.mov

...and make sure the people you spend a lot of time with watch it, too. You cannot pump your own chest.

Best wishes.

Bob