Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.
As most of you know, Performance Medicine has a LIVE Q&A Show every Tuesday night at 7PM where I go online and answer random health questions. Recently, we had a question about CPR and emergency situations that prompted me to do a Common Sense MD podcast around the subject. Note: I LOVE podcast suggestions!
In case of an emergency, we all need to know what to do and how to do it. In this week’s Note, I will cover some practical tips on how to save a life. Most of my experience comes from being a doctor, in and out of hospitals and ER’s for so many years. I’ve had to perform CPR a couple of times outside the hospital, which made me realize the importance of everyone knowing how to respond in emergency situations.
That is the purpose of this Note. We all need to be prepared, for our family’s sake, for our neighbors’ sake, and for our own sake. Let’s get started.
According to the Bureau of Labor Statistics:
- In the United States, a car accident occurs every 13 minutes.
- Over 50% of car accidents happen within 5 miles of your home.
- There are over 6 million passenger car accidents in the U.S. every year.
- Car accidents are the leading cause of death in children under the age of 15.
All that to emphasize, DRIVE SAFELY! Do not drink or take drugs while operating a vehicle.. Always wear a seatbelt and be a responsible driver. Always approach an intersection with caution. The Federal Highway Administration found approximately 50% of fatal and non-fatal crashes happen at intersections. That is why (when approaching an intersection) you should look left and then look right, and then look to your left again. This is very important because by the time you look left and then right, a car may be approaching from the left. Remember: look to your left again!
Note: Being a longtime cyclist (and motorcyclist) you have to watch out. If you’re in an accident, it’s probably not going to be your fault. PLEASE look left, right, and then left again before you venture out into an intersection. PLEASE tell your kids about this!
Know the ABC’s when you witness a car wreck. Prior to CPR, you should:
- Ensure that the victim’s AIRWAY is clear.
- Control the BLEEDING (if any).
- Check for CIRCULATION (pulse or observation of color and temperature of hands/fingers.
STABILIZE THE HEAD AND NECK in case of a head or neck injury. Note: Always assume there’s going to be one. CALL FOR HELP (EMS). Note: Utilize others standing by to help you until EMS gets there.
According to the National Institute of Health (.gov)
- Food allergies affect an estimated 15 million persons in the United States.
- Food allergies are responsible for approximately 30,000 emergency department visits, and 50-200 deaths each year.
- Stings from bees, hornets, and wasps contribute to 220,000 annual visits to the emergency department and nearly 60 deaths per year.
It is very likely you will have an opportunity to save somebody’s life by taking care of an allergic reaction (i.e. bee sting or food allergy). Note: some people can die by simply eating shrimp. That’s why I’m a big fan of having my own medical/emergency kit. I think everybody should have one around. You don’t have to have an allergy to bees (yourself) to carry an Epipen, or something like it. Having one around can save somebody’s life. Believe me, for a guy who’s been in anaphylactic shock (many years ago), it’s a lifesaver.
The only problem with EpiPens is that they are expensive, especially if you are keeping up with the expiration date. One solution is to use a vial of epinephrine and a little insulin needle. Pull it up yourself to 0.3 (the average dose) and inject subcutaneously. You can repeat that every 5 minutes, if needed. It can save a life. Note: As for the EpiPen, if the expiration date is slightly over, you should still use it in an emergency situation.
In EVERY CASE, have somebody call EMS while you are helping the victim. Never just send them home. They need to be checked out by EMS in case of a relapse and hospitalization is needed.
I talked to somebody the other day whose son had been bitten by a snake. They came through it pretty well and learned a lot through the process. We talked about it. There’s do’s and don’ts when helping someone with a snake bite.
DO keep calm.
DO wash the bite with soap and water.
DO get them to the hospital.
DON’T put a tourniquet on it.
DON’T cut it or try to suck the venom out.
DON’T put ice on it.
There is antivenom at the hospital. Note: On the way to the hospital, call ahead and make sure the hospital has antivenom. Snake bites are fairly common around here. The two you worry about most in East Tennessee are Copperheads and Rattlesnakes. Rattlesnake bites are much worse. I’ve seen some nasty snake bites!
Bites, Fights, and Guns
You have to be careful around DOGS. My son was just recently bit by a dog. It was pretty bad. Unless it’s your dog, or you’re fairly familiar with it, I wouldn’t trust them. Especially around my face or neck. They could actually kill you, or certainly cause a lot of disfiguration and problems. If you come across someone who has been bitten by a dog (or it’s you), first CLEAN the bite with soap and water, then go see your doctor.
We live in a dangerous world. Lots of FIGHTS. Lots of homicides. You know the saying, “Nothing good happens after midnight!” Well, it’s true!! So, don’t put yourself in situations where you could get into problems. If you’re about to get into a fight, take the advice of the MMA guys and professional fighters: RUN! Avoid a fight if you can. Somebody’s going to get hurt and it’s probably going to be you.
GUN SAFETY is really important. Again, lots of homicides. Don’t be in the wrong place at the wrong time. Don’t be afraid to run from physical harm. There’s no shame in that.
Let’s go over CPR. Most likely, in your lifetime, you will come across someone in cardiac arrest. I’ve come across many. Note: It’s usually someone you know, at a ballgame or restaurant, etc. To PREPARE for that moment, you need to learn CPR. The best way to do that is taking a CPR class. You don’t need to take ACLS, just the BASIC CPR. But until then, let’s start with a few tips:
TIP 1: If somebody is in cardiac arrest, and you come upon them, the first thing you do is: YELL FOR HELP and have someone CALL EMS. Then administer CPR. Note: Defibrillators are very helpful and save lives.
TIP 2: If you’re doing CPR on an average size adult, you’re going to put the heel of your hand down (one hand on top of the other), right in their mid chest area, and then start compressions. You need to go about two inches deep (much further than you may think). Two things to remember: Push hard and push fast. Give 100-120 compressions a minute. They are now recommending that if you’re an untrained bystander, you only need to do compressions. You don’t need to breathe for them.
Professionals, on the other hand, should probably give them a breath or two. That ratio is 30 compressions to 2 breaths. Note: Unless you’re trained to do this, the patient might be better off NOT having the compressions, because when a person collapses and goes into cardiac arrest, the body is still saturated with oxygen. What YOU need to worry about is circulation. You only have about five minutes before the brain starts dying. Move the circulation. Don’t worry about breathing for them, just do the compressions. There is a little more survivability if they start breathing after a certain amount of times, so keep this in mind.
TIP 3: There are exceptions.
- If you’re not sure how long they’ve been in cardiac arrest, you could give them a couple of breaths. It may help.
- In children and infants it’s usually not cardiac arrest. It’s usually a respiratory arrest. Breathing for them is important. In infants there’s a different technique. You just have to use the two fingers and press in the precordial chest area. You only have to go about a half an inch. Again, you need to get that circulation and their respiration going.
- Another exception are drowning victims. They need breathing and then the typical CPR. You can save lives with drowning victims. If anybody is ever cold or in cold water, you don’t stop CPR until their body temperature is normal.
Learn CPR and be ready to use it. Make sure help is on the way, and don’t hesitate to put that defibrillator on them (it’s pretty easy). It’s going to read the rhythm, and if it’s right, it will defibrillate it.
Thousands of people die from choking each year. It’s more likely you will see someone choking than a cardiac arrest. Young children and the elderly are higher at risk of choking. The universal sign of choking is holding their neck. If you see someone doing this, DON’T ask them if they’re okay. THEY ARE NOT! They can’t talk. They can’t even cough. BUT, if you come across a person who says they are choking, (aka they are talking to you) don’t give them the Heimlich maneuver. Ask them to cough. If they’re in distress, plead with them to try to cough it up. If it’s not working, then you ask them “can I help you?”. Of course, they’re going to nod their head if they’re with it still.
FYI: The first thing you do is NOT the Heimlich maneuver. The first thing you do is bend them over at the waist and give them 5 very forceful pounds on their back while they’re leaned over (not in an upright position). Note: They are bent over at a 90 degree angle and you’re hitting them with the heel of your hand pretty hard between the shoulder blades. Do 5 of those. Check them after each one. If that doesn’t do it, THEN you can do the Heimlich maneuver.
The Heimlich maneuver is when you put your fist right below their diaphragm and thrust in an upward and inward motion. You are behind them. A lot of times you will be successful with this. There are some anti choking devices out there, especially for kids. One of them is called LifeVac. The other is called Dechoker. They really act as plungers. They suck the object out of the airway. In my opinion, it’s a last resort. I think you should try the back and the abdominal thrusts before you do that. They’re more proven to work (about 80% of the time) Note: If a patient is extremely obese, or pregnant, you’re probably going to have to go up higher on the chest if you do the Heimlich, but you can always do the back beat.
Cricothyrotomy is the last resort. That’s where you cut them right below their Adam’s apple and insert a large G needle, or even a straw up there. This is truly a last ditch effort. Hopefully by that time, EMS is there. But don’t give up on them. I’ve known people that have had to do this and they’ve saved lives. You can put a large 12 to 14 gauge needle right below the Adam’s apple and get air in there.
Note: I know two people who in the past year have died from choking on a piece of meat. In one case, there were three doctors around and they couldn’t save them. Tragic.
Always be prepared in case of an emergency. Have a medical/emergency kit in your house that has a good pair of strong scissors, some gauze, and a tourniquet in case of bleeding.
For someone who is having chest pains and you think is having a heart attack, have them chew up a 325mg Aspirin. Keep Benadryl around for milder allergic reactions.
Be proactive. Check out the CPR classes in your area. Know the simple ABC’s in emergency situations and above all, KEEP CALM.
Till next week.