Post accident First Aid/CPR/AED

[bigorangemd 0]

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You've got the pressures at which you can palpate various points a little turned around, but that's neither here nor there. Your point about having laypeople start CPR because the injured person may have a pulse but the BP is low and they are too inexperienced to find a pulse is illogical. They should do CPR because the person may have a heart beat but they can't find it? I do agree there is little harm in doing CPR in the field with one caveat. With a lay person there is a significant risk of body fluid contact with a traumatic arrest and I doubt if there are many protective devices readily handy at most DZ's. If bystanders feel better starting CPR, by all means do so. Even if you are unsure of how, you can't hurt dead.

You state that my saying that bystanders should start cpr because the person may have such a low BP that a pulse is not palpable is illogical, yes basically confirm what i said, saying that "it cant hurt".

if a person has such a low pulse that its not palpable, the major organs. are not being perfused, so pulse or no pulse, they are still in need of chest compressions to supplement what their heart is not doing/attempting to do.

the issue to contamination of bodily fluids, to some extent i could see that a justifible reason not to attempt resuscitation, in some situations, DZs SHOULD have at least gloves on site if they dont, theyre useful for more things other than scraping up squished people. i know some have more things available, but thats a different debate in itself

Perhaps the situation at my DZ is a little different as I have somewhat better control of the process since I am the medical director for the county EMS and county coroner so it is easier for me to make more absolute action plans at our DZ.

[mutumbo 0]

Oh, definitely. You have a large say(and in some instances THE say)of what happens from the start of the incident all the way though the ems care.


so, just to clarify, what is your stance on CPR pre-EMS arrival?

Thanatos340(on landing rounds)--
Landing procedure: Hand all the way up, Feet and Knees Together and PLF soon as you get bitch slapped by a planet.

[bigorangemd 0]

In blunt trauma (and blunt trauma only), no CPR.

[mutumbo 0]

Sorry, for some reason when i asked that i totally blanked on the fact that youd already posted your full stance, and why. Thats what i get for posting half-asleep.

Thanatos340(on landing rounds)--
Landing procedure: Hand all the way up, Feet and Knees Together and PLF soon as you get bitch slapped by a planet.

[winsor 186]

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Hate to throw cold water on the subject but; while there is a place for basic first aid for an injured skydiver, cardiac arrest from blunt trauma (hitting the ground) is not a recoverable injury. There is no chance of survival. I have recommended against CPR for injured skydivers at our DZ. Sounds harsh but it is what it is.

When Michael Vederman impacted the runway from ~80 feet up, there were no vitals when people got to him (a matter of seconds).

As luck would have it, he hit a few feet from where a Trauma Center RN was talking shop with a Trauma Center MD who worked elsewhere, and they went to work on him immediately.

Having watched the whole thing happen, I was glad that I was not the first person there, since I would have been obligated to continue CPR until someone could pronounce him dead - which was the obvious outcome.

At any rate, the ambulance left at a leisurely pace - but turned on the siren when entered the highway. We looked at each other, asked "what's the hurry?," and shrugged.

It turns out that the EMT was trying to intubate him, and Mike was thrashing. The EMT said "Sit still!" and Mike did. The EMT said "Holy shit, he's responsive! Hit it," and the driver engaged afterburner.

Thus, my sure knowledge that cardiac arrest from blunt trauma is not recoverable was disproven, and the tuition for that lesson was high, indeed - Dead Mike is still with us.


BSBD,

Winsor

P.S. Even though I like Mike a lot, and am glad he survived with a great attitude, I am still grateful that someone else beat me to CPR. They found teeth in his lungs and stomach...

[jclalor 12]

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In blunt trauma (and blunt trauma only), no CPR.

I was first on the scene of a canopy wrap. one was without a palpable pulse and one was critical, and you say I should have not performed CPR?

[mutumbo 0]

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Hate to throw cold water on the subject but; while there is a place for basic first aid for an injured skydiver, cardiac arrest from blunt trauma (hitting the ground) is not a recoverable injury. There is no chance of survival. I have recommended against CPR for injured skydivers at our DZ. Sounds harsh but it is what it is.

When Michael Vederman impacted the runway from ~80 feet up, there were no vitals when people got to him (a matter of seconds).

As luck would have it, he hit a few feet from where a Trauma Center RN was talking shop with a Trauma Center MD who worked elsewhere, and they went to work on him immediately.

Having watched the whole thing happen, I was glad that I was not the first person there, since I would have been obligated to continue CPR until someone could pronounce him dead - which was the obvious outcome.

At any rate, the ambulance left at a leisurely pace - but turned on the siren when entered the highway. We looked at each other, asked "what's the hurry?," and shrugged.

It turns out that the EMT was trying to intubate him, and Mike was thrashing. The EMT said "Sit still!" and Mike did. The EMT said "Holy shit, he's responsive! Hit it," and the driver engaged afterburner.

Thus, my sure knowledge that cardiac arrest from blunt trauma is not recoverable was disproven, and the tuition for that lesson was high, indeed - Dead Mike is still with us.


BSBD,

Winsor

P.S. Even though I like Mike a lot, and am glad he survived with a great attitude, I am still grateful that someone else beat me to CPR. They found teeth in his lungs and stomach...[/reply

hes probably the luckiest guy alive. did he make a full recovery??

Thanatos340(on landing rounds)--
Landing procedure: Hand all the way up, Feet and Knees Together and PLF soon as you get bitch slapped by a planet.

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[Anvilbrother 0]

I jumped with him at boogie a couple months ago, looked like he was back to full speed to me.

Postes r made from an iPad or iPhone. Spelling and gramhair mistakes guaranteed move along,

[mutumbo 0]

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I jumped with him at boogie a couple months ago, looked like he was back to full speed to me.

thats awesome!

Thanatos340(on landing rounds)--
Landing procedure: Hand all the way up, Feet and Knees Together and PLF soon as you get bitch slapped by a planet.

[bigorangemd 0]

Difficult to say since I was not there. Realize that every one on which you cannot find a pulse in the field is in cardiac arrest. He would likely have had the same recovery with supportive care and no CPR. Glad he made a recovery.

[DrDom 0]

Bystander CPR is covered by the Good Samaritan Law. I have dealt with this law through case review and it TRULY covers even doing the wrong thing if you did it for the right reasons. Know CPR (or CRR) but have no card and maybe did CPR on someone who didnt need it? Covered if you did it because to the best of your knowledge they needed it. Doing CPR on an person who has a pulse? We do it all the time. Especially in kids, their HR falls below 60 and they are in shock, we are taught under PALS to push. We do CPR after shocks now.

The reality as stated: traumatic arrests (blunt AND penetrating) are not survivable if vitals are lost in the field. It is usually from one of the following: aortic dissection/transection or other major vessel transection (like the vena cava); tension hemo/pneumo/or hemo-pneumo thorax (barring someone who knows how to place a chest tube); massive blood loss (cant replace that), cardiac tamponade (not easy to fix); or massive head injury. Those are simply things that short of being IN a trauma hospital you will not survive.

Advice? Try anyhow. Prove me wrong. I would happily buy the beer and tell someone "you were right and I was wrong because _________ is alive". Hell, I'll buy beers for the fact he/she is alive. If i'm there... I'll be trying to save someone even knowing what I know. I've seen some crazy things in medicine, and the worst thing to do is "nothing".

You are not the contents of your wallet.