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  1.  (10925.1)
    Questions about CPR and other emergency medical procedures? Ask them here.
    Experience as a paramedic, first aider or EMT? We'd like to hear from you.
  2.  (10925.2)
    @Mike Carey - Purple, it's possible to restart the heart. It's unlikely to take, without a defib to "set" it, but it's possible. But leave off the whacks, go straight to the compressions. The steady rhythm is your best bet at sparking the response for which you're hoping. And you're already looking at breaking a couple ribs... don't punch his ass while he's down, too.

    Fair enough. The text I'm familiar with suggested check for pulse, if there's no pulse whack the chest, check for pulse again, if there's no pulse, start compressions. But I'll happily defer to the knowledge of someone who's actually been trained to know what they're doing anytime :D
  3.  (10925.3)
    Many thanks to the right honorable Greasemonkey for the initiative.

    Perhaps, for safety sake, a disclaimer should come first... This applies to everything I posted in the Job Advice thread, as well: what I've said shouldn't be interpreted as a recommendation or endorsement, a prescription for any particular situation. If there is medical help, certified or licensed medical help, appeal or refer or defer to them. Always. The human body is a complex machine, and it's maintenance and repair should be performed by specialists whenever possible.

    It is not always possible. Most of wilderness/battlefield/gutter "medicine" is about stabilizing a situation, making transportation to proper medical facilities possible, or buying time until it is. By definition, it will almost always occur far from actual, trained, medical personnel and facilities. But it is that inability to reach those facilities and personnel that should define those moments in which this advice should be applied.

    That said, and because it should be more common knowledge, CPR, and certain facts about it, should be common knowledge. Assumed the rule, and not the rare exception. It's incredibly easy to learn, it applies to a great many common situations, and damn near everyone can do it. Beyond the proper training in CPR, everyone should know that it will break a rib or two. That should be assumed. If it's ever done to you, don't be surprised/offended/upset that you have some cracked bones. That you're alive to hate it is reason enough to forgive whoever just cracked your ribs. If you ever have to perform CPR, and I hope you don't, assume and expect to crack the poor person's ribs. This will not kill them, this will not impact your performance in any way, and is largely a trivial thing, in the scheme of things.

    Know also that it is exhausting. No one thinks it should be, no one thinks it will tire them as much as they are told it will, and everyone is surprised by how quickly they want to give it up.

    If you watched the person go down, or if you can be reasonably assured that it happened within the last two minutes, you don't need to be giving the person breaths. The adult human body, in a resting or low activity state, takes in far more oxygen than it uses. The compressions you give the chest move that oxygen to the brain and the heart, and give the person a chance for real medical people time to show up and actually save the person. If you're stuck performing CPR alone, any time you're taking to breathe into the person's body for them is time that you're taking away from moving their blood around for them. If you don't need to, don't do it.

    First and last thing to remember about CPR was said best by Vornaskotti: He's already dead; you can't make his day any worse. You might be able to make it better.
  4.  (10925.4)
    Striking the chest was once, and in some circles may still be, considered standard, but nothing I know says it will help, and my training was to disregard it. The primary goal of CPR is to keep the person alive long enough for the person to be saved. If the heart starts again due to the chest compressions, you're one of the lucky few. Roll them into the recovery position, monitor closely, and still get them professional help. Otherwise, every second that you're not forcing their body to move oxygen to their brain, the brain is dying. That's the first 3 of the Three 3s of Deprivation : three minutes without oxygen is brain-death, or close enough that it won't much matter.
    • CommentTimeDec 6th 2012
    When doing CPR, don't tilt the head back too far. You need a clear airway! But make sure to tilt the head back. And if you can take a CPR class, do it! It's not that hard, and being certified can be really useful for situations beyond medical emergencies, including getting some jobs.

    • CommentTimeDec 6th 2012 edited
    I was first aid officer at a metalworking company for ten years, saw few really gruesome accidents and probably a couple of hundred minor ones. When you're in the workplace in a major city like I was, almost all first aid involves stopping any bleeding and making the person comfortable until the ambulance gets there. My experience is industry specific (fingers lost in machines, lacerations from sheet metal and so forth) but pretty extensive.

    I never had to deal with a cardiac arrest or a broken limb, but one of our older guys severed his fingertip in the guillotine, went into shock and then slipped into a diabetic coma. We called his wife for instructions, got her on speaker, and kept him alive until the ambos arrived and administered oxygen and a glucose shot. So yeah, if you're at work and one of your co-workers has a serious medical condition, you need to know who to call.

    When someone's bleeding, TV and movie medics have it right. You apply pressure to a bleeding wound, and if it's a big wound you wad up a t-shirt and press it on with both hands. This works even on severe arterial bleeding. I've heard that in cases of severed limbs it can be necessary to grab the artery and pinch it closed, but I would apply a tourniquet higher up and then a broad compression bandage at the stump, then try slowly backing off the tourniquet and checking for leakage.

    Keep control of your damned mouth and your facial expressions. You do not say "Oooooh, fuck . . . " even when you're looking at someone's exposed intestines or burst eyeball. If you have to throw up, you step out of range and throw up, and then you step back and speak reassurringly to the injured person.

    Other than that, buy yourself a decent first aid kit with manual, and enroll in a weekend course every few years.
    • CommentAuthorRenThing
    • CommentTimeDec 6th 2012
    Few years ago I was working in a sandwich shop and we had this one-way mirror that looked out over a sink/hand-washing station onto the front counter which wasn't a problem except it had a big-ass crack running the length of the middle of it from one of the earthquakes we had. It was late at night, about an hour and a half before close, and I was washing dishes in the back when I heard the sound of breaking glass come from the office where the manager was. I figured he'd knocked over one of the extra cookie jars we kept back there and went to give him shit when I saw it wasn't a cookie jar that was broken but the glass. Apparently our coworker Al, to try and scare the manager, pounded on the glass and broke it, which wouldn't have been an issue if the guy hadn't also opened up his arm from the base of his pinky to his elbow, a fact I discovered when I turned around and saw him trying to hold his hand together as blood was pouring (but not squirting thankfully) through his fingers. While the manager lost his shit I remembered the little bit of First Aid I did from when I got my merit badge, got a couple of clean towels around his cut and had him elevate it and keep pressure on it while we tied a loose one around his arm higher up to slow bleeding. Got him some water to help calm him down, had the manager phone the emergency number and the ambulance showed up and whisked him away. Took over fifty stitches to put him back together but he thanked me for tanking care of him.
    • CommentTimeDec 6th 2012
    What RenThing said: When someone has a serious cut, elevate it above the heart. If't it's extra-serious, above the head.
      CommentAuthorPurple Wyrm
    • CommentTimeDec 6th 2012 edited
    Vaguely interesting and vaguely connected... here in Australia the standard treatment for snakebite - as taught in first aid courses and at some point during your time at primary school* - is a compression bandage. This is where you firmly wrap a long bandage all up and down the bitten limb then immobilise it to slow (but not cut off) blood and lymph flow - hence slowing down spread of the toxin to the rest of the body. Some years back I was surprised to discover that this isn't the preferred treatment anywhere else in the world.

    As it turns out this is because the venom of Australia's snakes is mostly made up of neurotoxins - so keeping it locked up in a limb away from the brain and rest of the nervous system makes sense. Snakes elsewhere in the world mostly tend to produce toxins that directly attack flesh and muscle, so keeping it all concentrated in one limb is not the smartest idea.

    * Yes, you get taught how to treat snake bites at school. We're dead 'ard :)
  5.  (10925.10)
    Purple Wyrm, I'd love to see some, or any, of this thread taught in primary schools, as is your snakebite treatment. The basis for so much of this is dead simple, and kids suck up knowledge like sponges. Even if they don't really know at the time, it bangs around in the head, maybe something tangential down the road knocks it back to the front of the mind.

    Maybe it just cuts down on some of the body squeamishness of the western world. Or poor reactions to the sight of trauma...
    • CommentTimeDec 7th 2012
    I'm safety officer in a mercyfully safe environment (worst thing I can find to make noise about is occasional ergonomics and air conditioning issues), but the metalworking stories triggered a few neurons from the training. Workplaces are usually required to keep detailed records of all chemicals in use at the facility. Goes all the way from steel-eating acids trough paint thinner to the ethanol cleaning fluid for thermal printers. It's a good idea to give them a read - or at least know who is responsible for keeping them, and how to get hold of that person in a hurry. Chemicals can do a lot of strange and disturbing things to a body, some really quickly, and sometimes the right thing to do in one case is exactly the wrong thing to do in another.
    • CommentAuthorcardo
    • CommentTimeDec 7th 2012
    Noble idea for a thread, to which I'd like to add my tuppence worth... I'm an airport firefighter (vast majority of our callouts are for medical emergencies), before that I was in the police/cops/filth and before that I was a lifeguard so I have been involved in first aid in some form for quite a few years. I'd like to share some things I've picked up along the way.

    CPR - Always call for help, whether it's shouting next door or getting to a phone. Mentioning a suspected heart attack or an unconscious/non breathing casualty tends to speed things up on the help front!
    If you are alone and are unfortunate enough to suffer a heart attack, you should try and cough as hard as you can, taking deep breaths between coughs. Do this every 2 seconds. This could save you. A person suffering a heart attack will feel faint with pain in the chest and upper left arm (though this may be both arms) and have about 10 seconds before losing consciousness. The deep breaths get oxygen into your body and coughing forces the heart to pump blood around your body. If you can, continue until the heart beat returns to a more normal rythmn or until help arrives.

    As mentioned by Mr Carey, the act of perfoming chest compressions is simple to do, and indeed, if performing CPR and bystanders are present, you can talk them through it to take over from you if you're tired, or you need to get help/perform rescue breaths.

    The last sense to go is your hearing so be careful what you say even if a casualty appears unconscious. No-one knows how they will react in a situation until it happens, but try and remain calm for both your sakes. Another thing to bear in mind is that the casualty's relatives/friends/loved ones may be present and may need to be managed as well.

    Fractures - You will be directed by the casualty on this one, I remember trying to deal with my first fracture eons ago (a double break in the forearm) and reverted to my training of immobilising and using a sling. It didn't quite work out that way as the lady in question was obviously in agony and wouldn't let me near the arm. Sometimes all you can do is try and make them comfortable, reassure them and monitor them until help arrives. Sometimes less is more.

    That will do for now, I will try to think of other (hopefully) useful tips for later.
  6.  (10925.13)
    Regarding fractures, when I started first aid training they were all about binding and splinting broken limbs, but more recently the advice has been to let the injured person continue to support the fracture themselves if they wish, since they'll tend to hold it in the least painful position. This is usually fine if it's just a matter of waiting for the ambulance.
    • CommentAuthorRenThing
    • CommentTimeDec 7th 2012
    For deep, serious punctures (as opposed to being stuck wtih a pin/needle or what not): DO NOT FUCKING PULL IT OUT. This is a very good way of getting someone killed. One, if the object isn't evenly shaped (say a branch as opposed to a smooth metal rod) you're liable to do more damage yanking it out than leaving it in. Two, you open the wound up for more infection. Three, if the stabbing bit leaves stuff inside you have a higher degree of infection. Four, like Mike said here or on the other thread in regards to getting shot, that thing that's impaling you is also plugging the hole it made; pulling it out is a good way of bleeding a whole lot.

    Depending on where the impaling has taken place you want to pack the area around the base of the bit that's sticking out with stuff to stem any bleeding that's taking place and, if you can, tape it in such a way that the bit won't move; the last thing you want when you've been stuck in the guys by a length of wood (other than being stuck in the guts by a length of wood) is that thing stirring around in your insides and turning them into minestrone stew. Keep the limb, or body, as still as possible and, if you can, eleveate it above the heart.

    If a person is impaled and the impaled bit won't come free, like if they stuck themselves on a piece of exposed rebar or tripped and fell on a metal spike, they may need to be held still, with the bit still inside them, until professionals can come and cut whatever is doing the impaling free so they can be transported to the hospital with their newest piercing. Try to keep the person from bleeding out, try to keep them calm and for fucks sake don't let them unimpail themselves which may be very difficult to do because they will probably be in a ton of pain and freaking the hell out.
  7.  (10925.15)
    • CommentTimeDec 8th 2012
    I don't have a lot to add to what the professionals above have said, but I wanted to say that if you're reading this advice and are interested, take a course - in the UK St. John's are very well represented around the country. All the advice here is very helpful to know, and actual training will help you keep calm, keep others calm, and do the right things in an emergency. You're likely to be able to do the basic level stuff and get your work to pay for it.

    St. John's Ambulance course finder.
    • CommentTimeDec 8th 2012
    From what I can see in Canada, the SJA Emergency First Aid is a subset of the Standard, comprising fewer lessons but the same options for material. Then there's Wilderness! Still don't think that's going to provide quite the nitty-gritty I'm looking for. Better to just make friends with a soldier of fortune, huh?
  8.  (10925.18)
    @Mike Carey

    Not only would I like to see this stuff being taught in primary schools, I'd like to see it being taught at all. My wife did a number of different first aid courses through work recently, and apparently they've changed dramatically since she and I did one together in the early 2000s. The focus now is on calling in professional help and not on performing actual first aid, mostly because of potential for litigation.

    Let me tell you, anyone ever sues me for trying to save their life, I'll happily turn around and un-save it pretty quick.
    • CommentAuthorMike Carey
    • CommentTimeDec 11th 2012
    Kay, if you're in the States, there are often laws to protect a person acting in good faith to save a person's life. Usually called, and in some cases actually named, something along the lines of Good Samaritan laws, they provide some basic roadblocks to criminal and civil prosecutions for life-saving efforts, regardless of training.

    Some of the more complicated issues might not be covered... State, and occasionally local laws will vary. But the simple and routine things, from the ribs you crack performing CPR, to the designer shoes you scuff removing a person from a dangerous scene (both are real attempted lawsuits against a friend), are included. For the most part, genuine efforts to save a life, to prevent further injury, are recognized and not punished, legally.

    But yeah, I'd like to see some of this stuff taught at all in routine, public education. The structure and function of the human body is too often assumed to be, or treated as, a mystery. It's a machine, and it's maintenance and care doesn't need to be the function of wizards and beeping, flashing banks of computers.

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