Posted Without Comment
Incident description from the call taker: “80YOF, LABOURED BREATHING. WAS UNCONS BUT HAS IMPROVED AFTER BEING GIVEN FIRST AID BY CARE HOME.”
Blue call to the hospital from the ambulance crew: “We’re bringing in a 80 year old female, a dementia patient, with severe difficulty in breathing. She was given 5 minutes of CPR by the care home. Cardiac arrest was never confirmed. Now showing sternal swelling and obvious discomfort. Pulse (normal), oxygen saturation levels (a bit low), respiratory rate (a bit fast), blood pressure (normal).”
Are you thinking what I’m thinking?
on August 17th, 2006 at 3:50 pm
Goodness me - aren;t these people meant to be trained in First Aid? Surely that includes checking for a pulse BEFORE commencing with CPR?
on August 17th, 2006 at 3:54 pm
Oh I hope not!
on August 17th, 2006 at 4:08 pm
Cardiac Tamponade? or am I just reading the wrong book?
on August 17th, 2006 at 5:56 pm
The new protocol for CPR is to star it if breathing sounds a bit dodgy. It used to be signs of life. Its been a few years since a pulse check was part of the protocol.
That being said there should be people trained beyond lay responder level at a care home
on August 17th, 2006 at 5:58 pm
My first thought was “Why isn’t this patient DNR?”
on August 17th, 2006 at 7:01 pm
That new protocol worries me. My uncle was killed by unwarranted CPR back in the 70s (back when they started it off with a good strong chest thump), administered after he collapsed briefly due to a leaking aortic aneurysm. The pressure from the CPR caused the aneurysm to burst, and he bled out.
on August 17th, 2006 at 8:59 pm
Sound like a fresh first aider that has been trained on the new protocol.
I did say to other in my division a couple of week back about my worries over admornal breathing as a point to start. looks like it was true.
on August 17th, 2006 at 9:26 pm
no, no, no
you’ve got it all wrong, the care home were performing pre-emptive CPR, no need to wait until the patient has no cardiac output at all, no that would be silly - and see it worked, patient is now alive thanks to their pre-emptive care :p
of course the patient may not have been dead at all, and they royally screwed up……. leeme see i wonder which it was
on August 17th, 2006 at 9:33 pm
My first thought was ‘bust ribs caused by CPR by someone who didn’t know what they were doing’.
on August 18th, 2006 at 12:06 am
GJ - that’s a sad case, but on the numbers game, the new protocols will mean a lot more people who need CPR get it, than people who will suffer as a result. It may be bad news for individuals like your uncle, but protocols have to be designed around the most likely scenarios.
on August 18th, 2006 at 12:36 am
It can be difficult to find a pulse though, if I believe what I read in these blogs an SHO somewhere recorded his own heartbeat as that of a dead patient.
Can’t remember if it was your blog, random reality or NHS blog doctor that I saw an automated CPR machine, (incl ECG I think). I bet they’re expensive, but if care homes don’t have trained staff…they’d be good on planes too.
Maybe I’m just wierd, and although I haven’t done a first aid course for years, really must update soon, my midwife gave me a VERY wierd look when I asked for the baby routine, knowing it to be different, but when a loved one goes down in front of you it’s nice to be able to try to help until the cavalry arrives.
on August 18th, 2006 at 12:52 am
I’m thinking “That’s the first time I’ve heard a story about a Care Home on this or any of the other similar blogs I read where any kind of medical intervention was considered worth trying before the ambulance types got there.
Surely an improvement over the ones where finding the patient long dead but suspecting a bit of CPR might have helped?
Cheers & God bless
Sam “SammyTheSnake” Penny
on August 18th, 2006 at 9:11 am
Sadly i think this kind of thing is going to become more and more regular, with the new SPR protocols, it now relys on the first aider actually knowing what Agnonal Breaths (Chayne Stoking) actually sounds like, maybe a audio clip should be played when training, so that they have an idea!!!!!
on August 18th, 2006 at 9:41 am
The first thing that sprang to my mind was “asleep”, closely followed by “broken ribs”. But maybe I’m just a cynic.
on August 18th, 2006 at 10:32 am
I’m thinking, bloody hell, a care home who bothered to try CPR on one of their inmates, erm, I mean residents. However I’m not medically trained so most of that post meant sod-all to me, sorry.
As for checking for a pulse - when I was a teenager doing my first set of first aid training at school I ran into problems because nobody could find my pulse, not my friend, not the teacher, not the St John’s person. I was upright and talking and breathing but they couldn’t find a pulse anywhere on me until they told everyone to shut up and listened to my chest. Ever since then I’ve been worried I might end up getting an unwarranted chest-thumping.
on August 18th, 2006 at 1:02 pm
There was nothing whatsoever about not checking for a pulse when I did my CPR training in April. The only things different are 30:2 and not doing a finger sweep of the mouth (incase you push something further down) Where is the protocol that you don’t even check for a pulse?
on August 18th, 2006 at 1:16 pm
I think the protocol varies depending on who teaches it. My understanding, though, was that feeling for a pulse was optional in first aid (because finding a pulse is difficult if you’re not a medical person, and doubly so if the pulse it question is weak) if you have no equipment to hand, but that in a care home someone would whip out a stethescope and verify that the patient was in cardiac arrest before starting CPR. The fact that the patient was now awake and breathing without using a defibrillator is a pretty strong indicator that she was never in cardiac arrest. It also sounds to me like all the symptoms were caused by the CPR injuring her chest.
on August 18th, 2006 at 1:45 pm
The definitive source of how to do BLS for those of us here in the UK is, in my view, the UK resuscitation council, their latest protocol clearly shows that you now start CPR if they are not breathing “normally” (http://www.resus.org.uk/pages/blsalgo.pdf).
I can see why people are worried / concerned about this ….. but I struggled on occasion myself under the previous protocol which basically led you to believe that if someone was breathing they must have a pulse.
I think its down to reputable training organisations to make sure their students understand what “breathing normally” means.
on August 18th, 2006 at 2:54 pm
Every day, people with flu, sprained ankles and cut fingers tell us they are not breathing normally, and in a way they are right - they are puffing and panting with the pain. If those guidelines catch on, anyone will be a candidate for CPR. Determining whether or not the patient is conscious or not won’t help either: a lot of people think “unconscious” is synonymous with “unable to talk” “unable to get out of bed” or even that conscious and unconscious mean the same thing. The breathing normally thing is obviously trying to get at agonal breathing, but I don’t think that’s at all clear in the guidelines. It worries me a lot.
on August 18th, 2006 at 11:08 pm
I did my adult resus training update on Weds and we were told that if the patient is not breathing, or is UNCONSCIOUS and breathing abnormally, then to begin chest compressions. One would hope that if someone was conscious and not breathing normally, nobody would start CPR… but I know I will be proved wrong…
Claire
on August 19th, 2006 at 1:49 am
but that in a care home someone would whip out a stethescope and verify that the patient was in cardiac arrest before starting CPR
Stethascope, in a care home? Yeah right, i think she was lucky anyone even attempted to do CPR, and it is possible she needed it and had her life saved!
Suprised they didnt ring NHS direct.
Oh and claire, CPR on a conscious patient? seen it done by a medical consultant in a hospital on a monitored patient, now that really is scary
on August 19th, 2006 at 2:01 pm
I don’t think this protocol goes anywhere near agonal breathing. It’s recognising that the leading cause of death can sometimes be helped by early chest compressions. Early means within minutes. If you spend vital seconds wondering whether you should or not, then you are wasting time.
The idea is that it is better to have a few more broken ribs, and a few less actual dead people.
on August 22nd, 2006 at 4:59 pm
Rosey - you haven’t checked for a pulse for a while, it’s been ’signs of life’ as Mark said, it can be very hard to find one on someone who you know is fine and well, let alone someone who could be on their last legs as far as you know. And the finger sweep hasn’t been done for a while, either.
on September 6th, 2006 at 1:40 pm
When I updated my resus a few months back we were told 2 rescue breaths followed by compressions. The most notable difference was the ratio of compressions to breaths and the speed of the compressions (115 in a minute for adults?). However, because of the risk of blood-borne diseases, new strains of TB etc., our instructor advised us to skip the breaths on strangers and only perform them on people we knew well or family members - and, even then, it would be a judgment call based on what you knew about them.