Re: Yobresal yeah he's a great something
Thats not right, you are at that point deciding something you /can't/ know. There have been people that come back to life and are un harmed after over 30 mins of CPR. You should always try, what if it was your kid, or your brother, or your father? Crack head or not I bet you'd still try. People with an attitude like that should NOT be anywhere near patients alive or otherwise. :tsk:
-Dustin
I would LOVE to see someone come back completely unharmed after 30 minutes. The only way that could happen is if they are young and CPR was initiated almost instantly.
CPR & ACLS fails the majority of the time. When it does work, the initial time from cardiac arrest to the beginning of resuscitation was normally long enough to cause permanent brain damage.
Even if they do get CPR in time and do not suffer any long term brain injury there is still the matter of what caused the cardiac arrest in the first place.
Spontaneous cardiac arrest is very rare. You heart has 3 back-up systems to keep itself beating. the normal SA node, atrial foci, the AV node, and then ventricular foci (in that order) So 99% of the time there is an obvious catastrophe taking place to cause the event.
most popular would be a myocardial infarction followed by necrosis of the cardiac tissue. Eventually the heart fails and goes into ventricular fibrillation and they die. Assuming they are brought back, they are still left with a heart that is half dead because they decided to ignore the chest pain they had the day before (It pisses me off when people do this. Remember, chest pain is your heart crying for oxygen. Time is muscle and cardiac muscle does not grow back.)
I'm not saying we walk in to someone who just went into v-fib or a pulseless v-tach minutes before and we go "oh, we'll let this one die." If there is a chance, even a 0.0001% chance i'll take it, because to me that just means i'll end up saving at least 1 extra person during my career if I try on all of them.
I'm saying if we walk in to find a frantic panicking family screaming over a 72 year old man they found dead when they got up that morning, we'll start CPR, even though he's obviously been dead too long to bring back. Under normal circumstances we would of put him on the cardiac monitor and after confirming asystole in 3 leads, call the coroner.
It's very popular now to keep working a code just so you can bring the family in to watch and come to terms with the fact that their family member is dead. Let them grieve for a few minutes and get them to agree to stopping CPR. It makes it a lot easier on the family.
and DLMB
Yes, we are at that point deciding and we DO know. It's the lay public who don't realize how primitive medicine is. People aren't saved by 911, they are saved by the person standing next to them who took a CPR class and knew how to operate an AED, or give mouth to mouth.
it's those first couple of minutes that are the deciding factor on if someone lives or dies, the rest is only a small influence.
If there is any chance at all that a person may be saved, i'll work it until i get them to the hospital.
Also, I still stand by my attitude that crack heads should die :crackup:. My personal opinion does not affect my work.
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