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 

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How Could a Doctor Think of Going on Strike?

Best job in the world, thinks Geoff, at least when he’s not inspecting verrucas.

While Geoff is a fictional GP, he’s uncannily similar to a lot of real family doctors.

Right now he’s unwrapping a cheese sandwich and feeling grateful he’s not a hospital doctor facing life or death decisions.

Because any minute now BMA ballots will be plopping through their doors, asking whether they’d take industrial action.

Litmann type stethoscope

He’s not fond of strikes and instinct tells him doctors shouldn’t have them. If striking makes a perceptible impact, people get hurt. If it makes no impact, the strikers look stupid. Lose-lose, in Geoff’s book.

But what else can junior hospital doctors do?

By anyone’s clock, 7am to 10pm six days a week can’t be a standard working day. Geoff’s not sure how it squares with the European Working Time Directive which requires 11 hours rest a day. About 10 years ago the EWTD began to include junior hospital doctors. He recalls that opt-outs have to be voluntary. Is Jeremy Hunt aware of this?

It’s not about the money, say junior doctors. They’re not “trainee doctors”, by the way, despite the way the press describes them. They’re fully qualified members of the medical profession, ready, willing and (most of all) able, to resuscitate the dying or resect metres of gangrenous bowel as appropriate. 

Jeremy Hunt doesn’t look a bad guy.

Health Secretary Jeremy Hunt

He’s just wrong, thinks Geoff. That mortality paper in the BMJ has a lot to answer for. It showed that being admitted to hospital at weekends was linked with a significantly increased risk of in-hospital death. Lots more of them would be acutely ill, so that makes sense.

The same paper also showed that being in hospital at the weekend was associated with a reduced risk of death!

So where the fuck did people get the idea that having more doctors on duty would prevent those excess deaths? Geoff hurls his sandwich wrapper into the bin.

Being self-interested, as everyone is at heart, Geoff worries that the proposed new contract for junior hospital doctors will affect general practice too. It would imposes a drop of 40% in GP trainee salaries. Those ARE trainees, by the way. They’re doctors training to be GPs, and there aren’t enough of them as it is.

More importantly, the new contract jeopardizes patient safety because it removes the safeguards which protect doctors from working dangerously long hours.

scalpel

No wonder many people believe the proposed contract puts the future of the NHS at risk.

Does all that make striking a good game plan? Doctors last took action in 1975, well before his time as he’s only been qualified 15 years.  

Recently a whopping 95% who took part in a Guardian poll answered yes to the question: Should junior doctors strike over the government’s proposed contract?  He thinks there were 28,000 or so people polled, nearly as many people as there are junior hospital doctors. But obviously he can’t find the article now, what with the winter care plan, new advice about FGM, and an avalanche of other vital information.

It’s the baby clinic this afternoon in Geoff’s practice. Britain has one of the best immunisation programmes in the world, he likes to think. Geoff heads into the waiting room, beams at the parents, and wonders how long the NHS has left to live.

tombstone

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You may also like:

GMC advice for doctors in England considering industrial action.

The doctors’ 1975 industrial action.

 

More Certain Than Taxes, and More Painful

In a few days I’ll be at a Cambridge University event, speaking to students who look forward to careers in the media.  But today I’m looking back at a serious topic.  My piece last month in The Sun newspaper went a bit like this…

Life is complicated, but dying is even more so.

As a doctor I’ve seen many patients whose lives are utter misery.  They’ve reached a stage where nothing can relieve their suffering and make their days bearable.   Some of them beg for death.  But assisting a suicide is against the law in England and carries a sentence of up to 14 years.

If it were the beloved family pet, the answer would be clear and compassionate.

It’s heart-breaking to have a relative who longs to die, and I really feel for the families, especially as my own mother is now suffering horribly. 

My mum’s spine is deformed and broken from severe osteoporosis.  She howls in pain, and in anticipation of pain before even being touched.  She’s incapable of doing anything now.  Every single thing the devoted team of nurses do for her hurts acutely. 

Sometimes she lies in bed yelling that she’s in agony. Or else she shouts over and over “Please help me, please help me.” Mum and me crop

No longer the person she was, she weighs 35kg and stares with blank eyes.  Everything she has been through in the past two years, including a major op that she nearly didn’t survive, has left its mark.  The pain is literally causing her mind to go, but she is still aware of how bad things are.  I sit by her hospital bed and hold her hand, and she sometimes tells me she wants to die.

Increasing the painkillers makes her more confused.  Some of the drugs make her paranoid.  I’m still hoping there’s an answer because it’s so awful to watch her suffer.

Don’t get me wrong.  I was never immune to the suffering of patients in situations like this, but when it’s one of your own you can appreciate the back-story and see the whole perspective of their lives.

Medicine has a lot to answer for.  Many people wouldn’t be alive had it not been for doctors.  On the other hand, medicine isn’t a perfect science and never will be.   I’ve been a doctor long enough to know at first hand that medicine is good at prolonging life, but not so good at sustaining its quality.   

When quality of life is appalling, or treatment too awful to bear, then the balance of pros and cons may suggest that treatment doesn’t benefit the patient.  In making that decision to withhold treatment, the relatives and patient’s wishes are vital.  If the patient can’t take part in the discussion, his previously stated wishes are taken into account.

Withholding treatment is totally different from deliberately hastening death, whether or not it’s with the patient’s consent.    

But there is what’s called the doctrine of double effect.  This makes a distinction between acting with the intention to kill, and performing an act where death is an unintended effect.

For instance large doses of pain-killers can shorten life.  But doctors give them only with the intention of relieving pain. The doctrine of double effect says that’s morally right, even though the primary effect (pain relief) comes with the risk of a harmful side-effect.  Sometimes that harm can even be foreseen, but according to the doctrine it is still OK, as it achieves the main benefit, which is relieving pain.

However the double effect isn’t often the get-out clause it appears to be.  Nowadays there is a huge range of pain-relieving drugs, and dosage changes tend to be tiny, so they rarely shorten life.

Medicine has come so far now that we need an urgent way forward on that most basic event, death.  Not all doctors are agreed on the right course of action.  If assisted dying is introduced in any form, we’d need strict safeguards against abuse, greed, negligence, incompetence, and probably a few other things as well.

Some doctors are vehemently opposed.  Personally I fear that legalising assisted suicide could change the doctor-patient relationship forever.  On the other hand, there’s also the hope that it would help medics honour Hippocrates’ order: “To cure sometimes, to relieve often, to comfort always.”

Since then, my mother has died, ending our suffering, though it continues for other families.