It
was just after 3am on the long flight to Alaska when the request
came overhead, waking up my wife, Jill.
"Is
there a doctor on board? We have a medical emergency. Please!
Is there a doctor on board?"
Jill, a pediatrician, first checked our two boys before she
quietly got up. They were three and five years old, sound
asleep and oblivious. The flight attendant led her up to first
class through the darkened cabin. Another doctor, a radiologist,
was already there, bent over holding the wrist of a middle-aged
man who appeared to be unconscious.
"I
can't get a pulse!" said the radiologist as he looked up at
my wife. "He looks pretty bad!"
"Do
we need to land the plane?" the captain asked. He and the
flight attendant traded worried glances at each other. They
were over a remote part of Alberta, Canada, and the nearest
airport was hundreds of miles away.
"Uh,
his pulse is fine," Jill finally said, as she checked his
carotids and breathing. The passenger survived, the other
doctor returned to his seat, and the plane reached its destination
on time with my wife at the passenger's side until they landed
to a waiting ambulance.
New
American Heart Association Guidelines for CPR
Studies
have shown that 35% of trained and untrained rescuers are
wrong about whether or not a victim has a pulse. For that
reason, in 2005 the American Heart Association (AHA) announced
its new guidelines for cardiopulmonary resuscitation and the
treatment of cardiovascular emergencies. Untrained bystanders
and CPR-certified lay people no longer have to check an unconscious
person's pulse before administering chest compressions. Instead
the person can "check for lifelessness" using breath, movement
and response to stimulation as indicators.
Now,
in another major change, the American Heart Association said
a month ago, that compression-only CPR works just as well
as standard CPR for sudden cardiac arrest in adults. Multiple
studies, including three last year, showed hands-only was
as good as traditional CPR. You can skip the mouth-to-mouth
breathing and just press on the chest to save a life. Compression-only
CPR calls for uninterrupted chest presses at 100 a minute
until paramedics take over or an automated external defibrillator
is available to restore a normal heart rhythm.
Of
the more than 400,000 Americans that die each year of cardiac
arrest, only about 6 percent of those survive if outside a
hospital. People who quickly get CPR before getting to a hospital
have almost triple the chance of surviving. But less than
a third of victims actually get CPR from bystanders. The new
hands-only CPR is simpler and easier to remember and removes
a big barrier for people skittish about the mouth-to-mouth
breathing. Experts hope bystanders will now be more willing
to jump in and help if they see someone suddenly collapse.
Children
are different
A
child who collapses is more likely to primarily have breathing
problems, and mouth-to-mouth breathing should be used. That
also applies to adults in distress from a lack of oxygen,
such as a near-drowning incident or carbon monoxide poisoning.
In these cases, they need mouth-to-mouth to get air into the
lungs and bloodstream.
In
adults who suddenly collapse, stop breathing and are unresponsive,
the odds are that the person is having a cardiac arrest where
the heart suddenly stops. In such a case, the victim still
has enough air in the lungs and blood for compressions to
keep blood flowing to the brain and heart.
CPR
classes are still important and highly recommended. But many
people will not have the time or money to go. By knowing the
new guidelines, and removing the "yuck" factor of mouth-to-mouth,
maybe someone reading this will someday save a life.
The
passenger from the flight had a small stroke. How he would
have been medically treated depending on whether they landed
in Canada or Alaska would be interesting to see if there was
a difference ... but that's for another article.
