Wow, that was enlightening

[DeeBye]

Have you ever sorta wondered about something and then had it laid out to you full force? I had that experience today, and it was an eye-opener.

I attended a first aid course today. I've done them in the past, but I haven't done one for a very long time. I learned everything from burn treatment to wound treatment to a slight cough treatment. My instructor, Gus, was great. When he's not teaching first aid classes he's a paramedic in Toronto.

The real meat and potatoes was the CPR portion of the class. That's the chest compressions and mouth to mouth stuff you see on Baywatch (the cool kids are hip to that now, right?).

Anyways, back when I was watching M.A.S.H. in the late 1930's, something always struck me as odd about chest compressions. I heard rumours about what I was thinking, but I've never had it laid out for me in such black and white terms until today.

Chest compressions aren't effective unless you compress the ribcage 4" (for adults). You have to get right down to where the heart is, and it's protected by all kinds of layers of junk. 4" is a lot, and you have to do this repeatedly. 60 chest compressions per minute until EMS arrives. The average EMS response time where I live is 8 minutes, so that's like, um, a BUNCH of repeated 4" chest compressions.

I think you can see where I'm going with this. If you compress a ribcage 4" multiple times, something has to give.

I asked Gus point-blank about this, and he gave a great answer.

Effective life-saving chest compressions will break ribs. If you don't break ribs, the chest compressions won't be as effective as deeper compressions that do break ribs. Gus gave me some statistics - 77% of people that did not have their ribs broken during CPR while suffering from cardiac arrest had some form of permanent brain damage; 80% of people that did have ribs broken during CPR made a complete recovery. Gus said that these figures came from a study that entailed 65,000 CPR patients (that survived, of course).

Remember some of those old medical TV shows that had a guy making a double fist over his head and slamming it into a cardiac arrest patient's chest? That wasn't meant to kick-start a heart (CPR is only 2% effective in restarting an arrested heart anyways, and isn't the point of it); it was meant to break the ribcage before effective chest compressions could be performed. They used to teach that as a part of CPR back in the old days (it is NOT recommended now).

My mind is enlightened. I take no responsibility as to the veracity of the exact figures in my post, but I have confidence in Gus.


edit: I really mucked things up but I fixed them

[--Pete]

Hi,


Just one thing to add, because it is constantly done wrong in movies and on TV. Chest compressions should NEVER be performed on anyone that has a heartbeat. They are to circulate the blood, and have nothing to do with breathing. If a person is not breathing but has a hearth beat, then all that is necessary is the mouth to mouth part of the exercise. Doing chest compressions on a person with a heartbeat will almost inevitably stop their heart and turn a dangerous situation into a deadly one.

And, yes, chest compressions take a bit of effort. In a first aid course I took years ago we had enough Andys so that we only had two people on each. The instructor told us to keep at it as long as we could up to fifteen minutes. A few couldn't go the distance, and the rest of us looked liked we'd run a marathon.

--Pete

[Griselda]

My CPR instructor out here says that if you do it correctly, there will be some nasty crunching and stuff at first as the cartilage breaks away from the ribs, but that after that you can pretty much feel where the "bottom" of your compression should be. He claims that the person will be bruised and uncomfortable, but probably won't have their ribs broken, just a lot of torn cartilage.

He says that we should break the ribs of people who are choking, though.

[LochnarITB]

Very interesting. I always assumed that that was the kind of thing that got good samaritans sued.

(BTW, Pete, this is the first time I noticed your sig. :wub: I always thought it foolish to cheat at golf because the person you are cheating always witnesses the act! ;) )

[DeeBye]

My CPR instructor out here says that if you do it correctly, there will be some nasty crunching and stuff at first as the cartilage breaks away from the ribs, but that after that you can pretty much feel where the "bottom" of your compression should be.  He claims that the person will be bruised and uncomfortable, but probably won't have their ribs broken, just a lot of torn cartilage.

He says that we should break the ribs of people who are choking, though.
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Wow, your CPR instructor completely disagrees with my CPR instructor.

Honestly though, I don't see how only cartiledge would be affected by deep CPR. I can't see how ribs cannot be broken. I subconciously knew this when I was like 5 years old, and today confirmed it.

The choking thing is just absurd. There are two ways to help a choking victim. One is to push a fist towards and up from the belly button (no ribs) and the other (performed on pregnant females and the disabled) is a short 1" chest compression which is nowhere near enough to break a rib.

I'm just going by what I was taught today (well, yesterday) by current Ontario, Canada guidelines.

[Griselda]

You push your fist up from the belly button kind of under the ribs. It's possible that you're never in any danger of breaking any ribs, but maybe he means you have to use enough force that if you do hit a rib, you'll break it.

Maybe my CPR instructor just wants us not to worry when we hear that nice happy crunching sound when we do CPR.

[DeeBye]

Maybe my CPR instructor just wants us not to worry when we hear that nice happy crunching sound when we do CPR.
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I think this is likely. My CPR instructor told us to do whatever we could to get parents away when we attempted to perform CPR on their child :(

[jahcs]

Even if you don't break ribs you will get noises that make you think you are. As Gris said, when you do a compression the cartilage makes all kinds of noise -especially the first few compressions.

A proper compression places a lot of downward force on the sternum and some the cartilage will separate where it meets the ribs. Remember the placement of your hands, give the proper amount of downward (straight down over the patient) pressure and know that you're doing your best to perform CPR correctly. If you break ribs don't worry, you're trying to save a life.

Oh, and use a face barrier when giving the rescue breaths. The alternative is something I don't want to ever see again.

[Premezilla]

I always figured that, sooner or later, somebody would TEACH me how to drive. Especially parallel parking. From when I was little I never thought about my parents driving. I mean, I would SEE them driving, but it wasn't like they were DRIVING. Do you get what I'm saying? It's like you get behind the wheel of a car for the first time and you realize you're going to be DRIVING. That it's going to be YOU directing this big hunk of carbon steel metal whatever. You never put any thought into the fact that parents had to learn how to drive to; I always assumed it was just something you acquired once you hit a certain age. I also realize that arcade racers aren't exactly practice for actual driving.

The point of my story?

I'm preparing to take my road test soon, and I can't reverse. I mean, I can, but sometimes when I swing around to look behind my sense of orientation gets skewed and I forget which way to turn the wheel. DON'T LAUGH!

I also can't parallel park as well as I'd like. Nor can I effectively reverse at an angle into a stall.

[Occhidiangela]

I always figured that, sooner or later, somebody would TEACH me how to drive. Especially parallel parking. From when I was little I never thought about my parents driving. I mean, I would SEE them driving, but it wasn't like they were DRIVING. Do you get what I'm saying?  It's like you get behind the wheel of a car for the first time and you realize you're going to be DRIVING. That it's going to be YOU directing this big hunk of carbon steel metal whatever.  You never put any thought into the fact that parents had to learn how to drive to; I always assumed it was just something you acquired once you hit a certain age.  I also realize that arcade racers aren't exactly practice for actual driving.

The point of my story?

I'm preparing to take my road test soon, and I can't reverse. I mean, I can, but sometimes when I swing around to look behind my sense of orientation gets skewed and I forget which way to turn the wheel. DON'T LAUGH!

I also can't parallel park as well as I'd like. Nor can I effectively reverse at an angle into a stall.
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So long as you lean over the seat, use one hand on the wheel, the right arm over the seat to maintain your twisted position, and remember that right is still right, and left is still left (turn the wheel right, arse end of the car goest right, turn wheel left, and arse end of car goes left) and DONT RUSH YOURSELF, you will do fine.

And

Practice, practice, practice. Early Sunday mornings in a large parking lot are a handy place to work on reps.

Occhi

[Maitre]

I also can't parallel park as well as I'd like. Nor can I effectively reverse at an angle into a stall.
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Complete thread jack, but -

When my wife was taking her road test ten years ago, she pulled up past the open parallel space and put her turn signal on and put the car in reverse, just the way you're supposed to. Another car proceeded to pull up and swipe the spot by nosing in. From what she tells me, the gentleman administering the test instructed her to put the car in park, and put the hazard flashers on while he got out and lectured the swiper about the proper parallel procedure. The other driver was unaffected and calmly walked away. My wife was given her license without completing the maneuver.

On topic -
So the Boy Scouts actually got that one right... I can remember the night we did CPR for out first aid badges and our instructor explained that correct chest compressions will lead to damage to the cartilage surrounding the sternum and broken ribs. Hard for most 14-16 yr olds to develop that kind of force, but we at least made good rescue breathers. Actually, the direct quote was "you want to press hard enough to break the person's ribs. And once you do, it gets easier."

edit - ach. spelling.

[Premezilla]

Jacking it back,

Maitre, it is now April. I just read your sig.

Explanation? :)

[Maitre]

Jacking it back,

Maitre, it is now April. I just read your sig.

Explanation?   :)
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I was hoping no one would notice that. Still witing for the evidence, but the basic answer is I've been replaced. Was planning to start a topic with photographic evidence, but sometimes that sort of thing can be hard to get without being a dead Bothan. Another week or so if you please, then all shall be revealed. Well, maybe not all, maybe just the top half.

edit: bring it back...

Back on topic, I had a similar experience to DeeBye's but in another realm. I got the same sort of feeling when I finally understood the explanation of a net-benefit acceptability curve a few days ago. I mean I've programmed these things for a while now, but I finally sat someone down to go through everything that the graph can tell you. I love graphs. I think I'm going to marry one, though my current wife may have a problem with that. :unsure: