CPR: Why You Should Jump on a Stranger’s Chest

We’ve all seen spectacular examples of CPR (cardio-pulmonary resuscitation), especially on TV, where it leads to equally spectacular results: the previously pulseless patient sits up and tucks into pizza while vowing undying love for his family.

CPR ventilating with bag

In real life, the story is different. Outside Casualty, Grey’s Anatomy, and other small screen dramas, CPR is far less successful. Cardiac arrest in hospital has a survival rate of around 35%. Out in the big wide world, survival is more like 8%. This UK figure is especially dismal when compared with other western countries.

I learned all this and more at a CPR refresher course this week, courtesy of the Hospital of St John and St Elizabeth in North London. Tutor Philip Howarth is a brilliant mimic as well as a gifted teacher, and he was assisted by his fellow resuscitation officer Christilene Kiewiets. I can’t actually think of a more worthwhile way to spend a rainy Wednesday afternoon.

CPR manequin

We went through various scenarios of increasing complexity, but the principles are simple and they’re things everyone should know.

In a cardiac arrest, the heart stops pumping. This deprives the body of vital oxygen.

After five minutes without treatment, this damages the most important organ in the body (that’s the brain, in case you wondered).

CPR buys time. After a cardiac arrest, it can keep life going for up to 20 minutes (possibly even longer). That means time for paramedics to get there.

But CPR needs to start as soon as possible, ideally within two minutes.

Classic CPR uses chest compression and rescue breaths (in a ratio of 30:2 for adults). But hands-only CPR is a useful alternative. (Chest compressions make the lungs move, so they deliver some ‘breaths’. And people are more likely to give CPR to strangers if they can avoid mouth-to-mouth.)

Chest compressions should be fast and deep. A rate of 100-120 compressions a minute (two per second) is better than the old advice to keep time with the BeeGees’ Stayin’ Alive. ‘Deep’ usually means to a third of the depth of the chest. It’s tiring, and it can be noisy. The sound of ribs cracking is par for the course.

AED

Defibrillators can make all the difference to the outcome. In the UK there’s an increasing number of public-access defibrillators in airports, stations, and the like. The best bit is that these automated defibrillators are very easy to use, with voice prompts that are simpler and far more reliable than sat nav.

The most important thing of all?

Have a go. If someone has a cardiac arrest and you stand idly by, that person is dead. So there’s nothing to lose.

If you’re wondering about the best place to cash in your chips, a Las Vegas casino is probably the safest location of all in which to suffer an out-of-hospital cardiac arrest. Security guards trained in CPR and the prompt use of defibrillators can achieve impressive results.

FreeImages.com/Bob Townsend

Photo credit Bob Townsend

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The free app Lifesaver is a live-action movie you play like a game. It’s a great way to learn how to save someone’s life.

The British Heart Foundation runs HeartStart training courses around the UK.

First aid courses for the public offered by other charities such as the British Red Cross also include CPR.

Some ambulance instructors also teach the public. Get in touch with the Community Defibrillator Officer or the ambulance training school nearest you for more details.

The latest Resuscitation Council UK guidelines can be found here.

Here’s an easy tweet:

CPR: Why You Should Jump on a Stranger’s Chest http://wp.me/p3uiuG-1qC via @DrCarolCooper #CPR #cardiacarrest 

Rushed off Your Paws at Christmas

You don’t need telling that it’s a busy and stressful time of year, especially if you have family to look after.

No wonder so many of us will be rushed off our feet. Or indeed our paws. 

I’m thinking of dogs like the lovely May here whose duties include opening and shutting doors, unloading the washing machine, picking up dropped items, pressing buttons and switches, and if need be getting help in an emergency.  

There’s the Christmas shopping to attend to, and that requires money. Here’s May using the ATM.

assistance dog using cash machine

photo by Canine Partners

All the food to buy.

assistance dog shopping in supermarket

photo by Canine Partners

Not to mention sorting out the Christmas post.

assistance dog with post

photo by Canine Partners

Canine Partners like May are trained to do a range of different tasks, but they’re intelligent and can adapt to the person’s lifestyle. In a survey, over a third of their humans say they rely on them to tidy toys away. Some dogs even let the cat in and out. And in and out again.

FreeImages.com/Robert Bak

And they do all this without a murmur of complaint, which can’t be said of most humans.

I don’t know about you, but I think May deserves something in her Christmas stocking.

Christmas stocking

If you don’t need an assistance dog yourself, you can still adopt one. Might even make a good last minute Christmas present for someone.

Have a merry Christmas, one and all.  

holly garland

You may like to know…

Canine Partners assists people with a range of disabilities to enjoy a greater independence and quality of life through the provision of specially trained dogs.

For example, the charity works in partnership with Help for Heroes, aiming to train dogs to meet the needs of people with even the most complex disabilities.  These life-transforming dogs also provide practical, physiological, psychological and social benefits including increased independence and confidence as well as increased motivation and self-esteem.

Canine Partners is a registered charity and receives no government funding. It depends wholly on public donations and legacies.

That’ll be you and me.

angel tree decoration

 

Easy tweet: “Christmas stress? Some busy feet barely touch the ground via @DrCarolCooper & help from @canine_partners”

Warning: A Doctor Rants

Vaccines had a bad press a few years ago, but things have changed, or so I thought. That’s why I was surprised when this week a university student refused the freshers’ dose of meningitis C vaccineFreeImages.com/Antonio Jiménez AlonsoI was even more surprised when he told me that his father, a doctor in another European country, was against vaccination.

What would you have done?  

University students are at higher risk of meningitis. One in four 15-19 year olds carries meningococcal bacteria in the back of the throat, as opposed to one in 10 of the general UK population. And, if you haven’t been a fresher for a while, imagine all that mingling with hundreds of other young people, often in crowded conditions.  

There’s lots of useful info on meningitis, and on vaccines.  Alas, I only know sites for fluent English speakers, and the lad in front of me wasn’t one of them.

I jokingly told him I wanted words with his dad. But in reality that was never going to happen. In general practice there’s barely time for a long discussion with a patient, let alone with family. Photo by Jean Scheijen FreeImages.com/Jean ScheijenConsultation rates with GPs have gone up in the last 20 years to around eight consultations per person a year. Along with that, patient expectations have risen. No bad thing in itself, but it requires more time.

Many areas are bulging with an influx of new patients. London has a particularly mobile population but it’s not the only place where there are migrants, refugees, or simply new housing. Some arrivals speak little English, so interpreters are needed, and the consultation takes twice as long as a result.

The pattern of work has shifted. As hospitals shed more care onto general practice, and send patients home sooner, GPs inevitably must do more. Around 90% of medical care now takes place in surgeries, by GPs, nurses and other members of the health team.

National Health Service logo

The structure of health care has changed with the advent of clinical commissioning groups (CCGs). In my view, that work takes a lot of good GPs away from face-to-face patient care.

Professional development makes demands too. I have to keep up to date, and these days I also have to prove it via appraisal and revalidation. People believed something had to be done post-Shipman, so now we spend time counting lots of things that don’t count. I hope that changes, but meanwhile preparing for annual appraisal takes two hours a week.

Providing good medical care is now a real struggle. GPs are retiring, and a sizeable chunk of medics are leaving the country.

Australian and UK towels on the beach

There’s nobody to replace them.

Like many GPs, I teach medical students. That time too must come out of a busy week. But here’s what really worries me about teaching.  

In the last 10 years I’ve noticed that fewer students now want to be GPs. Yet not so long ago new doctors were falling over each other to join practices.

It’s no wonder that doctors in the UK are angry and fed up. New changes imposed by government are likely to make things worse. In many areas, NHS general practice can barely provide a decent service five days a week. How can it stretch to seven days?

I’m not against change. General practice changes all the time. That’s part of its attraction as a speciality. But the developments I’ve lived through now make it almost impossible to do the job properly.

doctor's bag

You may like to read: 

Numbers of NHS doctors registering to work overseas could reach unprecedented record in the Independent, September 21, 2015

A fictional GP reflects on What They Don’t Teach at Medical School

I muse on What Happens when You Become a Doctor.

Easy tweet: What’s wrong with general practice? http://wp.me/p3uiuG-15w A #doctor rants #NHS via @DrCarolCooper

What the Dalai Lama Didn’t Say

As invitations from a financial adviser go, this one was a tad unusual. But I was looking forward to what His Holiness the Dalai Lama had to say about compassion.

We’d been to the O2 Arena before. As I passed the famous balls at the entrance, I wondered: where on the spectrum between Monty Python and Ed Sheeran would this ageing religious rock star fit in?

blue balls in O2 entrance

I’d never met His Holiness, as he is called, but I’ve been on first name terms with one of his dogs. As a teenager, I earned pin money walking Chota Peg, a Lhasa Apso given by the Dalai Lama himself to a neighbour of ours. The breed’s distinguishing feature as far as a 13-year old dog walker is concerned is that its back end looks just like its front, which may explain why I never knew which way we were going.

Now, what to wear to hear His Holiness at the O2? My son assured us that the Dalai Lama would surely be content if we rolled up in yellow sheets, but the good people in hospitality would probably expect us to be in clothes.

So, clothes it was.

Protesters formed a tidy encampment outside the venue.

protest against 'False Dalai Lama'

I can’t fault the O2, especially if you’re hungry or thirsty. We poked our heads into the VIP lounge which has a 70s vibe and possibly the best Bloody Marys in the world, though that wasn’t what we’d come for.

VIP lounge at O2

The Dalai Lama’s warm-up acts were an amazing singer and a young choir. In appreciation, His Holiness bestowed garlands and pats on the head. There’d have been suspicions had he been a Catholic priest or an iconic DJ.

The real disappointment of the day was the Dalai Lama’s address. Martin Luther King he wasn’t. And I should know

The audience was there to hear about compassion as the foundation of well-being. But the man was rambling and inaudible, and, without surtitles à la Glyndebourne, almost incomprehensible. Was the sound system at fault? We cupped our ears, straining to catch the words, trying hard to work out which way he was going.

I’ve heard that HH has spoken eloquently on many occasions. Saturday was not one of them. The unstructured address was punctuated by his trademark chuckling at his own jokes. The question and answer session at the end was even worse. If this was the poster boy for peace and harmony, no surprise the world is in such a mess.  

However the day was not a total loss. The weather was kind and we’d met some interesting people at the event. Fortified by vodka and friendship, we went on the Emirates Air Line

cable car

It’s only a ten minute journey in a cable car, during which you can see Docklands and indeed much of London clearly, including the City and the Thames Barrier. I watched the Thames flow, barges glide past, people amble, trains roll by. 

view of O2 and Docklands

We got off at Victoria Docks and visited the Oiler, a bar on a barge. Next to it, people squeezed themselves into wetsuits and tried out water-skiing.

The Oiler, Docklands

It’s a good place to sit and reflect on peace, and on where to find it.

ooOoo

Easy tweet: What the Dalai Lama Didn’t Say at the O2 http://wp.me/p3uiuG-14C @DrCarolCooper strains to hear him

You may also like:  Dalai Lama says female successor must be ‘very, very attractive’ otherwise she is ‘not much use’; in Times of India.

 

What They Don’t Teach at Medical School

Today GP Geoff gets a new group of medical students to teach. The names may change from week to week, but there’s always at least one swot from Germany or the Far East, a home-grown rugger bugger who is too big for his chair, a student in a hijab, a gay man, a babe who fiddles constantly with her iPhone, and an argumentative leftie.

HP Rapaport Sprague stethoscope, circa 1981

Geoff is a character from my novel One Night at the Jacaranda.  I made him up, but, if you know much about medicine, he seems real enough.

Education is not a vessel to be filled, Geoff muses, but a fire to be lit.  He has forgotten who said, it, but he’s pretty sure the fire should stay lit for the whole of their careers. So the students need a dose of reality.

fire in the political belly

Geoff reflects on his fifteen years of practice. The reality is that patients wangle sick notes because they don’t like their work. They get prescriptions for things they could have bought from the chemist. Well, par for the course.

They also suck you into their lives and dump their shit.  So you get involved when they tell you about their affairs that went wrong, the drugs they score on a Friday night, or how much they hate a sister or brother.

Or when they’re still driving even though they shouldn’t be.

FreeImages.com/Juan Miguel Rodriguez

Case in point: nice Mrs Thingy. Geoff is not too hot good on names, but he knows he advised her very clearly not to drive until her seizures were under control.

The snag is her three children. Geoff instantly forgets what she says her husband does, but he gets the gist. Mr Thingy has to get to Ealing Broadway station by 7am so he can’t do the school run.

“Can you walk them to school instead?” asks Geoff, ready to extol the benefits of blue skies, fresh air, exercise, autumn leaves, and the rest.

suburban street

“Doctor,” she says in a wheedling tone, “if I did that, it’d be a mile and half each way just for the boys. And Poppy is at a different school. There’s just no time. I’d run myself ragged, and that’s not good for my seizures.”

“Perhaps a neighbour can help?” suggests Geoff.

She gives a pitying look. “They’re all pensioners near us.”

“What about asking at the school? You may find a parent of a child in another class who lives near enough to you.”  Geoff is aware he’s running late now.

FreeImages.com/Vikki Hansen

“Well, I don’t know,” says Mrs Thingy.

“Why don’t you talk to the school secretary?” Geoff suggests. He may even need to involve Mr Thingy, find out if he can start work later during term-time. This is as far as one could possibly get from looking through the test results and reminding her about her smear. Geoff makes a mental note to do all this later.

Mrs T says nothing. She stares as if the GP is the baddie who makes up the laws.

Geoff continues, “If you have a seizure at the wheel… Well. It hardly bears thinking about.  Remember the Glasgow bin lorry crash last year? The driver blacked out at the wheel and killed six people.” 

“I know, I know.”  Her glance at the door shows she’d like to end the conversation as soon as possible.

Geoff leans back in the chair, which isn’t far as he has a cheaper model than his partners. “You realize, don’t you, that I’m obligated to contact the DVLA myself if you don’t.”  (For readers outside the UK, this is the Driver and Vehicle Licensing Agency.)

Her expression freezes.  “But I thought confidentiality…”

“Doesn’t extend to situations where the public is in danger.” He shakes his head slowly as he pulls a sympathetic face.

“Oh,” she says in a small voice. “Right.”

Geoff knows what he will discuss with his students today. Confidentiality.

And the knack patients have of sucking you into their lives.

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Easy tweet: “What They Don’t Teach at Medical School http://wp.me/p3uiuG-14k via @DrCarolCooper” #medicine #students

How Romantic Can August Bank Holiday Get?

The August Bank Holiday weekend is at its best when (a) it doesn’t rain and (b) you get propositioned. Three years ago, I spent a sunny day at the seaside with an old friend I hadn’t seen in a while. We were outside the Red Lion Hotel in Cromer when I rashly asked what he’d like to do next.

Red lion by Matthew Strickland

“If I tell you, you’ll slap me,” came his response.

Reader, I married him. And this Bank Holiday weekend we returned to East Anglia and the sand and the sea to revisit that day.

It was very romantic and very English.  Now I will share some of the very Englishness of the Bank Holiday with you, starting with Cromer pier

Cromier Pier, Norfolk

What’s a pier without a proper end-of-the-pier show?

Cromer end of the pier show

It starts at 4pm on Saturdays, instead of the traditional time of 2.30pm, according to two disgruntled pier show veterans who told me over their limp sandwiches how the change in schedule had spoilt their day.

Fish and chips are staple fare. Belly not bursting yet? The No 1 fish and chip shop also sells ice cream.  

No 1 Fish and Chips, Cromer

Windbreaks are de rigueur. Somewhere not far away, there’s usually a man with a knotted hankie protecting his bald pate. 

windbreak

Very few UK towns or villages have no war memorial.  This one’s in Burnham Market.

War Memorial, Burnham Market, Norfolk

A select few sport decorative village signs. There are more of these in Norfolk than in any other county, but Suffolk comes a close second.

Freckenham, Suffolk

Some have pink-washed houses (the colour’s less pretty when you realise it’s from pig’s blood). 

pink washed house, Swaffham Prior

And pubs complete with ornamental signs and wonky walls. 

Red Lion pub, Swaffham Prior

We caught a traction engine idling outside this one. 

The White Swan, Stow cum Quy

Sunset in late August comes all too soon, so it was time for one last bit of Englishness.  

chicken tikka masala, Saffron Brasserie, Cambridge

I know. Chicken tikka masala was probably invented in Glasgow. It may no longer be the UK’s favourite dish, but it’s the perfect end to a nostalgic day. 

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PS You might enjoy more quintessential Britishness on the Romaniacs blog.

Easy tweet: How English can a Bank Holiday get? http://wp.me/p3uiuG-13S a romantic look back with @DrCarolCooper 

Seven Reasons Why August Sucks

While the name ‘August’ comes from the Latin for dignity or grandeur, the reality is somewhat different.  Yes, it’s still high summer, but when you compare it to its neighbours June and July, I don’t think the month of August makes the grade. Here’s why:

1 The days are already noticeably shorter. As if that’s not bad enough, the weather thinks it’s October.

Rain by Valentina Degiorgis

2 You can’t move for tourists in London. Have you been to Marble Arch lately? It’s heaving. Luckily I know just enough Arabic to move dawdling visitors out of the way.

And in Cambridge, there are even bigger queues to get into the colleges. As here.

Clare College gardens

And here. 

queue at Kings College Chapel

Even more competitive than it is for prospective students, it seems.

Clare College gardens

3 It’s the silly season for news. That’s why the papers carry stories about donkeys rescued from seven-feet deep storm drains.

rescued donkey

And stories about Morris dancers having a punch-up with blind footballers. If you’re wondering, that one’s a spoof.

The biggest silly story of all? Must be the Labour party’s leadership contest. 

4 Kids in Scotland are already back at school. They’ve given up pretending it’s still the holidays.

5 When the August bank holiday weekend is over, that’s it. There are no more official holidays until Christmas. And any minute now, Christmas merchandise will hit the shops.

by Raquel Santos

6 It’s high season for kittens. In north-west London, the Mayhew Animal Home’s kitten cabins are overrun with furry bundles that need forever homes. Can you help? 

posed by model. photo by Roger Heykoop

7 Everyone is away (except for tourists). If you’re an adult, your inbox is full of automated away messages. If you’re a child, there’s nobody around to come to your birthday. I should know. Mine’s tomorrow. Are you going to be there? Thought not.

Roll on September.

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Easy tweet: 7 Reasons Why August Sucks http://wp.me/p3uiuG-13z according to @DrCarolCooper