Carrying a defibrillator

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Re: Carrying a defibrillator

Postby [XAP]Bob » Mon Sep 01, 2014 10:34 am

Neilo wrote:I am not a medic, but have been First aid trained and trained to use a defib. This is what I have learned.
The best chances of surviving a heart attack are early CPR, early Defib, early clot busting drugs and early to hospital.
CPR will not restart someones heart (except in Hollywood). It will give you time to get a defib. A defib will only work if it senses the right conditions, namely that the heart is fibrilating, The electrical impulses in the heart go all screwy and the heart muscle is twitching, rather than beating. The defib defibrulates the heart, meaning that it sends an electric shock to stop the heart twitching, then it can beat properly again.
If the heart is stopped and it is not fibrilating, the machine will not do anything, the person is dead.

Whether to carry one is another matter, I guess you would have to weigh up the probabilities of it happening.
A ride with a fit and health group, with no known medical problems, probably not. A ride with the heart attack survivors cycling club, probably.

Neil


Holywood CPR is great though - Take a 3 week decayed corpse, 3 chest compressions and they'll spit out a mouthful of seawater (despite this being in the middle of the desert) and run a marathon...
A shortcut has to be a challenge, otherwise it would just be the way.
No situation is so dire that panic cannot make it worse.
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Re: Carrying a defibrillator

Postby TonyR » Mon Sep 01, 2014 10:45 am

All good stuff. Some other things to consider. You have about four minutes max from the blood stopping pumping to irreparable brain damage from oxygen starvation. You can spend that either doing CPR to keep the blood circulating or you can use it searching for a local AED. For untrained people it takes 60-90 seconds from opening the AED to first shock. Which do you think is the more productive use of time?

So you could carry a defib but how many of your group know (and have been trained) how to give effective CPR? I bet very few of them so for me first port of call if you are worried is to make sure they all get CPR training. I would far rather ride with a bunch of competent CPR practitioners than a bunch that had a vague idea about CPR and a defibrillator they didn't know how to use.
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Re: Carrying a defibrillator

Postby [XAP]Bob » Mon Sep 01, 2014 10:49 am

TonyR wrote:All good stuff. Some other things to consider. You have about four minutes max from the blood stopping pumping to irreparable brain damage from oxygen starvation. You can spend that either doing CPR to keep the blood circulating or you can use it searching for a local AED. For untrained people it takes 60-90 seconds from opening the AED to first shock. Which do you think is the more productive use of time?

So you could carry a defib but how many of your group know (and have been trained) how to give effective CPR? I bet very few of them so for me first port of call if you are worried is to make sure they all get CPR training. I would far rather ride with a bunch of competent CPR practitioners than a bunch that had a vague idea about CPR and a defibrillator they didn't know how to use.

In a group that's fine - you can work the two processes in parallel. It's if you're on your own with the patient that there is a choice to be made.
A shortcut has to be a challenge, otherwise it would just be the way.
No situation is so dire that panic cannot make it worse.
A good pun is it's own reword

Rode the WWC 2014 Raising money for Bliss. 11 hours 20 (including stops) no pushing.
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Re: Carrying a defibrillator

Postby TonyR » Mon Sep 01, 2014 10:52 am

[XAP]Bob wrote:Holywood CPR is great though - Take a 3 week decayed corpse, 3 chest compressions and they'll spit out a mouthful of seawater (despite this being in the middle of the desert) and run a marathon...


Come on, that's not true. They spend at least a minute not responding to CPR while the tension builds (or they go to an ad break or "to be continued.....). But the dogged CPRer refuses to give up despite everyone else starting to get out the body bag. Then they suddenly splutter into life, usually after an emotional kiss or chest thump of frustration, before they sit up and start the marathon. :roll:
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Re: Carrying a defibrillator

Postby TonyR » Mon Sep 01, 2014 10:54 am

[XAP]Bob wrote:In a group that's fine - you can work the two processes in parallel. It's if you're on your own with the patient that there is a choice to be made.


You can only work the two in parallel if someone knows how to do the CPR. AEDs are pretty much usable by anyone these days without any training. The same cannot be said of CPR.
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Re: Carrying a defibrillator

Postby beardy » Mon Sep 01, 2014 10:58 am

It is one of those things that so obviously should be taught in schools but isnt.

The Government is much happier to do the more expensive, high tech solution of expensive machines hanging on walls than informing the general population on what to do with their own two hands (and lungs).
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Re: Carrying a defibrillator

Postby timdownieuk » Mon Sep 01, 2014 11:08 am

Neilo wrote:I am not a medic, but have been First aid trained and trained to use a defib. This is what I have learned.
The best chances of surviving a heart attack are early CPR, early Defib, early clot busting drugs and early to hospital.
CPR will not restart someones heart (except in Hollywood). It will give you time to get a defib. A defib will only work if it senses the right conditions, namely that the heart is fibrilating, The electrical impulses in the heart go all screwy and the heart muscle is twitching, rather than beating. The defib defibrulates the heart, meaning that it sends an electric shock to stop the heart twitching, then it can beat properly again.
If the heart is stopped and it is not fibrilating, the machine will not do anything, the person is dead.

Whether to carry one is another matter, I guess you would have to weigh up the probabilities of it happening.
A ride with a fit and health group, with no known medical problems, probably not. A ride with the heart attack survivors cycling club, probably.

Neil


How many groups enquire about the health of their members? You might think that your members are all fit and healthy but in our case, we didn't know the history of our man's health. Turned out that he was on beta blockers, calcium channel blockers, statins & aspirin and had had an MI 9 years previously for which he had had stents.

I suspect that heart disease amongst members on groups rides is much more common than we think.
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Re: Carrying a defibrillator

Postby timdownieuk » Mon Sep 01, 2014 11:14 am

TonyR wrote:All good stuff. Some other things to consider. You have about four minutes max from the blood stopping pumping to irreparable brain damage from oxygen starvation. You can spend that either doing CPR to keep the blood circulating or you can use it searching for a local AED. For untrained people it takes 60-90 seconds from opening the AED to first shock. Which do you think is the more productive use of time?


Why either/or? If you're on your own clearly you go for CPR. The best way however to restore circulation after cardiac arrest is to restore rhythm, something a defibrillator does much better.

So you could carry a defib but how many of your group know (and have been trained) how to give effective CPR? I bet very few of them so for me first port of call if you are worried is to make sure they all get CPR training. I would far rather ride with a bunch of competent CPR practitioners than a bunch that had a vague idea about CPR and a defibrillator they didn't know how to use.


Again you're making assumptions to support one method being better than another. No reason why CPR training shouldn't incorporate instruction on using an automated defibrillator.

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Re: Carrying a defibrillator

Postby Flinders » Mon Sep 01, 2014 11:19 am

beardy wrote:It is one of those things that so obviously should be taught in schools but isnt.

The Government is much happier to do the more expensive, high tech solution of expensive machines hanging on walls than informing the general population on what to do with their own two hands (and lungs).


Agreed 100%, except that we do need both.

When I did teacher training around 1990, we, as students, asked if we could have St John's in to do a proper first aid course for us, so we would have some idea of what to do, and (just as important) what not to do, in an emergency. (As a side-benefit, we also thought it might make us more attractive as employees.) But the course tutors were too scared to do it. They were afraid of being blamed if anything went wrong :roll: . We were furious that they were so pathetic about it, but there was nothing we could do. :evil:

I did some first aid training even at junior school. In those days, in my town, all the kids of about 10 yrs old did 'water safety', which involved mouth-to-mouth (which was the done thing at the time though now people would be taught CPR). I think everyone ought to learn in at school, and get refreshers before they leave school. I also think all teachers should get first aid training, maybe they do these days? (I'm not a teacher any more).
I try to keep up to date by reading my brother's mountain rescue/expedition medical textbooks from time to time.
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Re: Carrying a defibrillator

Postby [XAP]Bob » Mon Sep 01, 2014 11:28 am

When I last had CPR training it was being questioned due to the damage you could do the patient (I'm not kidding)
Apparently breaking a rib was bad, and could result in being sued for deliberately causing injury....

Anyhow we did the training anyway, because the instructor could see sense. Of course he was also talking about having a tattoo on his chest:

"In case of heart failure press here:X"
A shortcut has to be a challenge, otherwise it would just be the way.
No situation is so dire that panic cannot make it worse.
A good pun is it's own reword

Rode the WWC 2014 Raising money for Bliss. 11 hours 20 (including stops) no pushing.
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Re: Carrying a defibrillator

Postby thirdcrank » Mon Sep 01, 2014 11:55 am

Here's how to avoid the need to carry one about: get it delivered -

http://www.wired.co.uk/news/archive/201 ... brillators
Gang warily.
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Re: Carrying a defibrillator

Postby profpointy » Mon Sep 01, 2014 12:46 pm

[XAP]Bob wrote:When I last had CPR training it was being questioned due to the damage you could do the patient (I'm not kidding)
Apparently breaking a rib was bad, and could result in being sued for deliberately causing injury....

Anyhow we did the training anyway, because the instructor could see sense. Of course he was also talking about having a tattoo on his chest:

"In case of heart failure press here:X"


Someone commented on the "risk of doing harm" with CPR by explaining "the patient is currently dead, how much worse can you make it"
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Re: Carrying a defibrillator

Postby TonyR » Mon Sep 01, 2014 1:31 pm

timdownieuk wrote:Why either/or? If you're on your own clearly you go for CPR. The best way however to restore circulation after cardiac arrest is to restore rhythm, something a defibrillator does much better.


Not either/or but priorities. CPR is something anyone can do with training and yet almost nobody bothers to get trained. CPR is something you need to do while someone is getting the AED ready and possibly after the shock. AEDs only work on hearts in VT or VF. CPR works on lots of other situations.

So first priority should be to avoid it happening which means telling people to own up and not soldier on under group pressure if they show symptoms. Second should be to get everyone trained in CPR. Last should be to carry an AED with you. There is probably also a danger carrying an AED of risk compensation - people struggling on or not bothering to learn basic CPR because if anything happens we've got the AED.

Again you're making assumptions to support one method being better than another. No reason why CPR training shouldn't incorporate instruction on using an automated defibrillator.


You don't really need AED training these days. Incorporating it in CPR training is not a problem. But getting people interested in doing CPR training is a big issue.
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Re: Carrying a defibrillator

Postby TonyR » Mon Sep 01, 2014 1:37 pm

profpointy wrote:Someone commented on the "risk of doing harm" with CPR by explaining "the patient is currently dead, how much worse can you make it"


There was a serious issue in the early days of AEDs. The idea was to run a trial by putting them in busy shopping malls and collect resuscitation data when people had dropped dead from sudden cardiac arrest. The regulatory authorities blocked the trial because the patient would not be able to give informed consent to participation in the trial before it was used on them.

On the other hand, most doctors in the US will not treat you in Good Samaritan mode. Too many have saved people's lives only to be subsequently sued by the person they saved.
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Re: Carrying a defibrillator

Postby Psamathe » Mon Sep 01, 2014 2:25 pm

On the CPR and doing it properly; it's many years since I was taught (on several courses) and I've never had to do it for real, but often when you see it being done on TV it's feeble and misleading. From my memory, it's meant to be done fairly hard (one course mentioned you might break a rib on your patient but better that and they live). And of course you can't do it on a person who does not need it. So when people keep seeing dainty little gentle presses (the "patient" would probably not even be aware of), I wonder if this is mis-directing the general public.

That said, it was years ago I was taught so maybe things have changed or my memory worsened (and I'm wrong).

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