Showing posts with label Value of CPR certification. Show all posts
Showing posts with label Value of CPR certification. Show all posts

Thursday, June 9, 2011

Do Children Ever Survive a Sudden Cardiac Arrest ?







The vast majority of children and teens who experience a full cardiac arrest, do die. However, they do not ALL die, if they receive competent CPR and defibrillation from an AED (Automatic Emergency Defibrillator.) It therefore makes good sense to certify all parents, all coaches, all teachers in CPR. All health care providers in most US states and Canada are required to be anyway. It also makes sense to have an AED in every school, every government building, and present at every soccer, lacrosse, baseball, basketball, practice and game, as well as at track and field events. Even when an AED is present, at say perhaps a school, the ideal time for its use is a narrow window, and depending upon the size of the facility, it may be brought to the scene too late.
Daniel had the benefit of rapid discovery and rapid CPR, and we administered epinephrine, and later an additional dose, but there was no AED in our home. There was no reason to ever buy one, or request one, although now of course, I wish we had found a way. Still, the window in which an AED is helpful is short. By the time we heard his fall, unlicked the bathroom door, pushed the door gently to move his body which was obstructing the doors opening, time was passing. Then since he was on his face, he needed to be turned over, his head tilted back and assessed for breath sounds, vomitus cleared, and breaths given, and then pulselessness detected, All these things take time, although his body should have responded to the care he received.
When an adult comes across a child in cardiac arrest, we often do not know the cause. It could be a metabolic disorder, an influenza, a respiratory arrest which led to a cardiac arrest, an anaphylactic (severe allergic reaction), or a severe asthma attack. We can't know what happened simply by looking. When a child drops to the floor with a sudden cardiac arrhythmia, we know even less. A well child who has been active that day, has dropped and is unresponsive, breathless and pulseless. According to data tabulated by the Parent Heart Watch, 100-150 children from 3-35 die of a sudden cardiac death annually. This does not include those who were successfully resuscitated and treated thereafter. The Heart Rhythm Society reported in 2004, 14,000 infants and children deaths from a sudden cardiac death or unclear causation sudden death syndrome. This is not as rare as others might have us believe.
Yes, some children survive, but not as many as we would like. I will make an effort to profile some of the survivors of Sudden Cardiac Death as well as those who we remember for passing as a result of it. There is no one state, national or world group keeping complete and comprehensive records of causes of sudden cardiac arrests in adults or in children. In fact, whether an autopsy is even done in many municipalities is a question of money available, coroner's request, and even family preference. There are simply so many more causes of death in youth for this to be a significant focus yet for public heath. I wonder how many children will die before this receives broader attention ?


Tuesday, May 10, 2011

The Precordial Thump





We found this heart-shaped stone while excavating to electrify the barn we built to care for animals. The barn was dedicated to Daniel and my father.
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Many years ago, when I was first in the process of becoming a registered nurse, we were taught something called the "precordial thump". The pre-cordial thump, in the seventies, was to be used during a witnessed cardiac arrest, prior to CPR (Cardiopulmonary resuscitation.) Pretty much, it was used only one time. (delivered to a midpoint as measured from the notch at the top of the chest to the bottom of the xiphoid process at the end of the sternum,essentially midsternally) This could be effective if the person is experiencing a rhythm which is incompatible with continuing life, but is not actually in a cardiac standstill just yet. I have done the precordial thump several times, when it was acceptable practice, and been successful a couple of times. It does not take much force to deliver correctly.
This was set aside though, sometime in the 1980s, and then, with the advent of AEDs (automatic emergency defibrillators) which are now found in more schools, government and or public buildings, we never heard it mentioned.
When we found Daniel in cardiac arrest, part of me wanted to do a precordial thump, but this was not the time to get creative. I did everything as was the standard in 2008, when his arrest occured. He did not actually meet the criteria for even a 1970s precordial thump because he was behind the door when the arrest occured,(so it is not strictly witnessed) and because he was likely in full arrest by the time we got beyond the bathroom door. Still, the mother in me rethinks whether one precordial thump would have made a difference.
Interestingly, ACLS (Advanced Cardiac Life Support) standards now permit a precordial thump in certain circumstances. Apparently, on a cardiac monitored patient, or one who who has a rhythm indicating ventricular tachycardia, it may be delivered if a defibrillator is not readily available. Since it is only effective in a very short window of time, it should not preclude CPR or defibrillation if this is available. It seems that what I did was correct in 2008, but that the precordial thump has some narrow uses once again, in the ACLS of 2010. Apparently, of patients who experience a life threatening rhythm and are about to descend into a full cardiac arrest, as many as 25% of them can be returned to a productive rhythm by the precordial thump. It should be attempted only once. There is no evidence that a precordial thump will do anything at all for a patient in a full cardiac arrest (who is pulseless).Even though I wish I had tried this on Daniel, he was in full arrest when I got beyond the bathroom door,assessed breathlessness and pulselessness and began CPR.
It's still strange that two and a half years following his passing, I still rethink those awful moments for things that could have been done differently, hopefully altering the outcome.
Of course, I recommend that every parent, every able person over about thirteen becomes certified in CPR. My eldest son Adam saved an attorney who had a full cardiac arrest at a shopping mall, a few months before Daniel's passing. Adam had been certified to do CPR at college a couple of years earlier.

This is an interesting blog entry on the use of precordial thump written by a physician.

http://paramedicine101.blogspot.com/2009/05/precordial-thump-for-asystole.html