Bob Trenkamp's blog

Bob Trenkamp's blog

"Bystander" is more an environment than a level of training.

When we hear "Bystander CPR" the image that comes to many minds is a person at home or at the shopping mall who isn't a medical professional but who has just seen someone have a sudden cardiac arrest. (You can thank TV for that shopping mall image - 85% of all out-of-hospital arrests occur in a private residence.)

The bystander environment is usually one where the witness has to call 911 and perform hands-only CPR alone for an average of ten minutes. The ambulance environment and the hospital environment have other people there to help.

When tested on a manikin exhibiting a chest stiffness at the 32nd percentile - a little less than 65% as stiff as the AVERAGE adult's chest - one-in-six of the subjects tested made it to ten minutes using their hands, but four times as many made it to ten minutes using the heel of their foot.

What I couldn't mention in my September 25th blog entry...

In November I made a presentation at the AHA about the incidence and magnitude of leaning. ("leaning" is what some people call "not getting to full recoil")

The short form is that in a study where the cohort's age distribution approximated that of cardiac arrest victims, sixty percent of those tested exhibited enough residual force at the top of the recoil stroke to negatively impact a victim's probability of survival.

The reason for using a cohort with the same age distribution as the victims is that more than two-thirds of all SCAs occur at home, and if there is another person present who is capable of performing CPR, that person is usually about the same age as the victim.

We're acting on the results, but we cannot share until mid-November.

In 2012 SLICC demonstrated that pedal chest compressions permitted people to last three plus times longer than people performing manual compressions also were able to provide Guideline-Compliant Chest Compressions ("GC3's") to a larger percentage of the USA adult population.
See http://www.slicc.org/ReSS_2012_359.pdf

In 2013 SLICC demonstrated that one's ability to perform chest compressions for an extended period were defined by (a) the stiffness of the victim's chest, (b) the body weight of the rescuer, and (c) the method used to compress the chest. People performing pedal compressions were able to provide GC3's to a larger percentage of the population and were able to perform compressions for more than three times longer than they could when performing manual compressions.
See http://www.slicc.org/ReSS_2013_030.pdf

If you want to better understand the magnitude of the problem...

Set up a looping function on the timer on your phone, tablet, computer, whatever. Have it beep every 88 seconds. That's the average interval between SCA's in the USA. That's right, on the average someone dies of an SCA every 88 seconds. When that beeping starts to alarm you, pause to think that we could get that interval to nearly three minutes if all of us did what Kings County, Washington (Seattle), Phoenix Arizona, or Hilton Head Island did.

And of we got a lot more bystanders trained, we could delay those beeps a lot more.

Interested in helping?

Bob

bobt [at] slicc [dot] org

Ever give much thought to the size of a risk?

Two factors determine the size of a risk:

I will unavoidably be unable to attend ECCU this year but wanted to share what SLICC has to say anyway.

Our focus at ECCU was going to be on what we can do to fix CPR.

SLICC's notes are at http://www.slicc.org/ECCU_Info.pdf

Bob

SLICC passes 10,000 trained mark!

As SLICC entered it's eighth year in April, its roster of trained bystanders had reached 10,254.

Our latest annual report is at http://www.slicc.org/AR2014

After having demonstrated at the AHA Resuscitation Science Symposium that most rescuers are not capable of delivering manual Guideline-Compliant Chest Compressions ("GC3's") for the average time from a cardiac arrest until the ambulance crew is "hands-on" at the victim, and recognizing that nearly seventy percent of all cardiac arrests occur in the home, we have advocated pedal compressions for those who cannot get down on the floor, for those who have problems with their hands / wrists / arms, for those who find they do not weigh enough to perform GC3's, and for those rescuers who are just too tired to continue with manual compressions.

Our class video runs about forty minutes and covers Bystander CPR, AED use, choking emergencies, and stroke recognition.

AEDs and water...

This is not as complex as it might initially seem.

First, the victim should not be IN the water when you use the AED - and I don't care whether that's in a swimming pool or lying on the deck surrounding the pool in an eighth of an inch of water.

Second, the skin in the area of the upper body needs to be dried off, if wet. if the skin is wet, a more-than-usual amount of electrical energy will be diverted from the normal path through the heart to a path along the skin.

Bob

What I didn't know about CPR...

I've seen four different ways to perform CPR with your hands in the past weeks.

1. Lock your arms straight, get your shoulders over the hands, and rock from the hips. So far, no surprise.
2. Perform #1 but use your abs to accelerate your shoulders downward.
3. Perform #1 but start with your arms slightly bent and straighten them as you start the downward push.
4. Perform 1, 2, and 3 simultaneously.

For those who lack the physical training and endurance to perform alternatives 2, 3, & 4, you'll have to stick with alternative #1.

The Recommendation of a Book

Thanks to Doctors Gillinov and Nissin of the Cleveland Clinic, we have a book titled Heart 411 (Three Rivers Press). It is a well-organized, comprehensive, 500+ page treasure trove of information.

The book contains an interesting chapter on how a woman's heart is different and similar to a man's.

Similarities?
The primary symptom of coronary heart disease is chest pain for both sexes. Also the principal strategies for prevention and treatment apply to both men and women: healthy lifestyle, medicine, angioplasty, and surgery.

Differences?

1. Since 1984, more women than men have died from coronary heart disease each year. Prevalence is dropping in men but rising in women.
2. For men, a heart attack is the first sign of heart disease. For women, the first sign is more commonly angina - a discomfort or fullness in the chest that generally occurs with exercise or stress and is relieved with rest.

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