Bloody CPR

I'd give his friend 11 out of 10 for sheer guts – he did something I wouldn’t have done in a million years.

They'd left him sitting on the sofa enjoying the afternoon sun – last night had been a heavy drinking session and he was a bit sleepy. He was fine half an hour ago, but when they next saw him he was covered in bloody vomit and he wasn't breathing.

I was working solo on the FRU car when I got the call as 'bad hangover – sleepy – not breathing'.  As I didn't know any better I was thinking about what I would say to them when I arrived to find the patient breathing, something about ambulances not being needed for hangovers…  Still – no matter, as always I drove there as quickly and safely as possible.

His friends opened the front door for me and I walked into the house – one of them, in a thick Eastern European accent, asked me to follow him.  He led me out to the garden, lying on the patio in front of me was the patient.  He wasn't breathing, he was covered in bloody vomit and he was a nasty shade of mottled purple. One friend was doing good chest compressions while on the phone to our Control.

Another friend was giving him mouth-to-mouth…

…through the bloody vomit covering the patient’s nose and mouth.

I’ve got to say that this impressed me a huge amount.  It also made me feel a little ill.

To be honest – if his friends hadn't been doing CPR I probably would have recognised death right there at the scene – as it is, if someone starts CPR then we have to continue all the way to the hospital.  I started doing my job – breathing for the patient using my ambu-bag and pounding on his chest to keep blood flowing to the essential organs.

Every time I pressed on his chest a little geyser of bloody vomit erupted from his mouth. With an airway in the patient’s mouth, that gush of fluid can travel a long way.  The floor around the patient was also covered in his vomit, so I couldn't kneel down.  I ended up doing the chest compressions standing with my feet five foot apart while bending over the patient.

My back started to twinge.

 

The ambulance took ten minutes to get there.  To be fair, they did have a long way to travel, and there were some heavy roadworks between them and myself.  We scooped him up into the ambulance and drove quickly to the hospital while I continued to do chest compressions and the ambulance attendant kept breathing for him.

 

As suspected there was nothing that we or the hospital could do – another man in his mid-forties dead.

 

I had to go back to the house to pick up the FRU car.  The patient’s friends came out to meet me, only a few of them spoke English, so I had to explain that the patient had died.  As NeeNaw mentions, the ambulance service doesn’t like to use the word ‘dead’.  Unfortunately it was the word I had to use.  I let them know that they had done everything correctly – but that the patient didn’t have much chance of surviving despite his friends best efforts.

I left them trying to phone the patient’s mother so that they, in their native tongue, could explain what happened.

20 thoughts on “Bloody CPR”

  1. “…I continued to do chest compressions and the ambulance attendant kept breathing for him.” Who are you trying to kid, “Reynolds”? Why would you work on a corpse when no-one's watching? Answer: you wouldn't.

  2. I went on a First Aid refresher recently and was told that the Resuscitation Council are introducing changes to the approved method of CPR. There will no longer be any requirement to do the mouth to mouth. The theory is that chest compressions alone will cause the lungs to deflate and by virtue of air pressure, they will fill again once the compression is complete. As much oxygen will get into the lungs, due to the fact that deoxygenated air isn't being breathed into the patient. The idea is that people who have a fear of mouth to mouth (and who could blame them if they come across a scene like the one described above?) will do chest compressions and the patient stands a greater chance of survival.The compressions are recommended when an adult patient is not breathing “normally”. They describe “normal” as between 10 and 40 breaths a minute. Any slower than 10 is agonal breathing and any faster than 40 the body is not taking in sufficient oxygen. The compressions should be done even if there is a pulse. Apparently, someone would have to do chest compressions for over 24 hours before the rhythm of the heart would be disturbed.

    Sounds a lot easier to work out whether to do CPR or not – any comments from you professionals?

  3. I just finished my first aid course today. I remember Tom talking about a change in the protocol and I met it today. I was told:If not breathing, go straight to CPR.

    Ratio of 30:2

    The rescue breaths are attempted breaths only. If no air seems to go in, carry on anyway.

    Very interesting on a dummy, but I think its very different in real life.

    Alison J- I think you have to keep up the CPR if it has been started until a doctor tells you to stop or someone else takes over.

  4. I'm not sure what you are trying to say Alison. are you saying Tom is lying and ceased all life support once the doors were shut?i hope i'm incorrect in my interpretation.

  5. yowch. That must have been harsh for his friends – to go through all that and then end up having to break it to his mum. At least they'll be able to honestly say they did all they could for him.

  6. It's interesting how it is different around the world.In NZ, if we don't get return of spontaneous circulation after 30 minutes of resuscitation we cease efforts at the scene and provide support while waiting for the police.

    We would rarely, if ever, transport a cardiac arrest patient who had no response to the resus.

  7. “Why would you work on a corpse when no-one's watching?” Correct Answer: Because we are professionals.Once CPR has been started we will continue it all the way to hospital even if we think that the patient is beyond saving, because we might just get them back. I may only have been on the road for 10 months but I strongly resent your implication that we would stop and put our feet up for the ride to hospital once the doors have been closed. Since you obviously have no knowledge of what you are talking about I suggest you keep your insulting remarks to yourself.

  8. I often say that this is the easiest job in the world – I should add a cavet to that – if you do it right.So yes, even after the doors were closed I continued to do CPR as best as possible in the back of the moving ambulance.

    A) It's what I get paid for

    B) It's what lets me sleep at night – that I do the best for everyone.

    C) I won't get into trouble for not doig my job properly

    and

    D) Most importantly It's the right thing to do.

    (I've said before that I don't do 'slow' blues)

  9. Well, we are trained in airway management and respiratory support – so we are still fully able to 'just' breathe for a patient if that is all that is needed.Having said that I haven't done the updated course yet – I'm waiting to be told it, but I do know that it is 30:2.

  10. Us lowly technicians can only 'not start' CPR, we can't stop. Paramedics can work for around 30 mins and then 'call' it.I think the difference between us is that we (in London at least) are always less than 10 minutes away from a hospital – so it'd be a bit churlish not to give them the best chance they can get.

  11. Yep – it's why I kept telling them that they had done everything right, and that they should all be proud of themselves.Anyway – I figure that the bad news will be better coming from people that she at least knows, not least those that speak the language.

  12. At least everyone tried.The UK Resus council website has some good downloads on the background to the new CPR protocol.

    'Streetwatch' a US paramedic blog also has some good observations on the changes.

    And if anyone can re-program monophasic AEDs to the new protocol it would save my voluntary aid society a shed-load of money.

  13. So come on then, tell me: how do you do effective chest compressions in the back of a moving ambulance, bearing in mind that Health and Safety regulations insist that you be strapped into a seat? Maybe my arms are just too short.

  14. You have reminded of a job I attended in 1983. It must have been one of the first suspendeds I'd done after training.I was working at the old Westminster ambulance station and we got a call to the restaurant at Victoria railway station “elderly male ?suspended.” As we arrived we were met by a portly St Johns Ambulance first-aider who puffed that his colleague was performing CPR on the patient.

    We followed him into the restaurant (isn't it strange to think of railway stations having restaurants these days?) where I saw an elderly SJA volunteer kneeling over the patient. There was a bystander doing the compressions, and as the first-aider was just bout to give a breath into the patient's mouth, she copped a fountain of vomit right into her mouth; I have to admit I very nearly threw up on the spot there and then.

    Credit where it's due, she carried on regardless, and only went to clean herself up when we were on our way to the ambulance with the patient.

  15. In emas, techs and para's can stop cpr after 20 minutes continuous asystole. With a few execptions (ie, pregnancy, drowning, hypothermia)

  16. Maybe they can reprogram the voice too. No more of that “DO NOT TOUCH THE PATIENT LOWLY HUMAN SCUM! I AM ANALYSING THE RYTHM! I AM THE SUPERIOR BEING! EXTERMINATE! EXTERMINATE! EXTERMINATE!”I'd like a nice, soft upperclass female english accent with a slight hippy twist to it. Preferably one that offers to make the tea after defibrillating…

  17. we're getting a thing over here to allow us to call the docs for advice on stopping cpr if the patient is VERY heavy or extremely difficult to move. I think its the same in a few other places cause we're a bit bass ackwards and behind everyone else…

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