Tag Archives: Cardiopulmonary resuscitation

Straight, No Chaser: What Will You Do If Your Baby Starts Choking?

infchokingcons

We’ve previously discussed how to address choking in adults. Today, we address the twin horrors of needing to save a baby’s life (those younger than 12 months old) from choking and how to help yourself if no one else is around to help.
In case you didn’t realize it, infants haven’t had time to accumulate enough disease and toxins to have heart attacks in the way adults do. When they are in a life-threatening situation, it’s far more likely to be from a respiratory cause, such as choking. Infants and young children are exploring their world and seemingly will place most anything near or in their mouths. Too often this leads to choking. Please keep this in mind if you’re ever faced with an infant in danger.
In discussing how to help a child in danger, let’s focus on two considerations: how to assess the situation and how to act.
It is vital to assess these situations accurately. There are important splits in treatment algorithms based on your assessment.
Simply put, the first thing you want to do is determine the infant’s level of responsiveness. For the purposes of this discussion, let’s assume we’re discussing conscious choking.
If an infant is suddenly unable to cough or cry, it’s a reasonable to assume that something may be blocking the airway.

  • When this is the case, help will be needed getting the object out.

If an infant is coughing or gagging, it’s likely that the airway may be partially blocked.

  • Coughing is actually the most effective way to dislodge an object, so you shouldn’t interfere in this setting.

If an infant is somewhat responsive in the context of a recent insect bite, bee sting or other possible allergic exposure, the throat could be closing because of an allergic reaction.

  • When this is the case, you are facing a potential life-threatening emergency. Call 911 immediately.

Infant Choking

When you’ve made your assessment, your next step (unless you’re performing CPR, calling 911 or the child is still coughing) is to try to assist in getting the object out. Think “back blows, chest thrusts, repeat unless the infant gets unconscious.” Yes, that was meant to be a jingle.

backblow

Back blows:

  • Hold the infant face up on one forearm, and hold the back of his head with the hand.
  • Stabilize the infant’s front with your opposite hand and forearm.
  • Flip the infant face down so that he’s now in the control of the other forearm. Use your thumb and fingers to stabilize the jaw while flipping. Lower your arm onto your thigh; now the baby’s head will be lower than his chest.
  • Using the heel of your hand, deliver five firm back blows between the infant’s shoulder blades in an effort to dislodge the object. Maintain head and neck support by firmly holding his jaw between your thumb and forefinger.
  • Finally, place the hand that had been delivering the back blows on the back of the baby’s head with your arm along his back. Carefully, turn him over while keeping your other hand and forearm on his front.
  • If you have dislodged the object and the infant is responsive and/or coughing, you are done. Otherwise, proceed to chest thrusts.

chestthrust

Chest thrusts

  • Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby’s head lower than the rest of his body.
  • Place the pads of two or three fingers in the center of the baby’s chest, just below an imaginary line running between his nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.
  • Do five chest thrusts. Keep your fingers in contact with the baby’s breastbone. The chest thrusts should be smooth, not jerky.

Repeat
Continue alternating five back blows and chest thrusts until the object is forced out, the infant starts to cough forcefully, cry, breathe on his own or becomes unconscious. If he’s coughing, allow him to do so.

fingersweep

If the infant becomes unconscious
If a choking infant becomes unconscious, you should proceed to modified CPR as follows:

  • Open his mouth. If you can see an object, remove it with your little finger.
  • Give two rescue breaths. If you don’t see the chest rise, tilt his head and try two rescue breaths again.

 If his chest still doesn’t rise, do 30 chest compressions.
  • Check the mouth again, looking for an object. Remove it if seen.
  • Repeat the cycle with rescue breaths and chest compressions until help arrives.

Regardless of the outcome, the infant will need prompt medical attention.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If You See Someone Choking?

choking1

So … what would you do if someone around you starting choking. Or if they choked, then lost consciousness? What would you do if you choked and no one else was around? Don’t you think you should know? Read on …
First things first. You’ve all heard of the Heimlich maneuver, even if you don’t know how to do it. My job today is to make this easy for you. My first task will be to pass on the physician’s mantra of “Do No Harm.” To that end, let’s start with things you shouldn’t do.

  • If the person is able to speak, don’t interfere.
  • If the person is coughing and still has a normal level of awareness, don’t interfere.
  • If the person is able to breathe in and out without excessive difficulty, don’t interfere.
  • If the person is conscious, don’t place anything in his/her mouth trying to extract an object.

Next, let’s review a few quick points to help you understand what could be going on.

  • Choking is occurring because something is blocking the airway (aka windpipe).
  • Choking is dangerous because complete blockage will prevent oxygen from circulating thorough the body.
  • Choking is deadly because without oxygen, permanent brain damage will likely occur in four to six minutes.

Partial blockage isn’t the same as complete blockage. The body has protective reflexes to deal with blockage. That’s what coughing is. Once blockage has become complete, you’re facing a life-threatening emergency, and the risks of doing something outweigh the risks of doing nothing.

choking

It’s not that difficult to know if someone’s choking; they’re likely grabbing their throat. You would do well to know what it looks like if someone has already choked or is choking but can’t use his/her hands. Here are some clues:

  • Coughing may be increasingly weaker.
  • They likely will exhibit difficulty breathing.
  • They may be unable to speak.
  • Their skin may have a bluish or purplish color.
  • You may hear high-pitched musical sounds while they’re breathing.
  • They may have blacked out (from the blockage).

heimlich

Here are universally accepted steps to the Heimlich maneuver (in someone not obese or pregnant):

  • Ask the person, “Are you choking?”
  • Then ask them to speak. If they can speak or are vigorously coughing, you watch and wait. If not, proceed.
  • Standing behind the person, wrap your arms around his/her waist.
  • Placing your thumb just above the belly button (navel), make a fist with one hand.
  • Grasp the fist with your other hand.
  • Thrust your fist quickly, upward and inward.
  • Repeat until the person either loses consciousness or the object is dislodged.

If the person is obese or pregnant, wrap your arms around the chest, not the abdomen. Place your fist between the nipples on the middle of the breastbone, and make firm thrusts back toward you.
If the person loses consciousness, there are four steps you must take.

  1. If you see something blocking the airway, try to remove it.
  2. Lower the person to the floor, preferably on his/her side until you start CPR or if vomiting starts.
  3. Have someone call 911.
  4. Begin CPR.

Of course, prevention is key. Take care to chew your food slowly and thoroughly.
Here are three more tips for those most at risk:

  • Children: Keep them away from small objects that can be placed in their mouths.
  • Elderly: Make sure their dentures fit appropriately.
  • Adults: Limit alcohol intake around the time of eating.

In an upcoming Straight, No Chaser, we’ll also add a post for you regarding how to handle yourself and infants (less than one year old) if choking.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Here’s How You Complete End-of-Life Planning

durable-power-of-attorney

Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions, let’s discuss some specific mechanisms by which you can ensure your wishes are honored.
Living Will: This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.
Do Not Resuscitate (DNR): A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed.  Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.
Healthcare Power of Attorney (POA): The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

  • If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
  • If you’ve made some decision and not others, the POA will fill in the gaps.
  • Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member.  Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
  • Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
  • Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to do so.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA.  If you’re able, it may be wise to engage an attorney to sort through the various documents.
I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family.  I’ve seen all too often how messy it gets when issues aren’t addressed in advance.  You really don’t want that happening to you at the end of your life.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Staying Alive – A Ridiculously Simple Approach to CPR

cpr
Hopefully, this video is the hokiest thing I’ll ever post, but modern understanding of CPR is such that every single one of you should know exactly how to respond in the event someone collapses near you. Simply put, this is how you save lives. I would think every one who reads this would do well to forward or post this message within your networks.

CPR video

In case the video doesn’t launch for you, here’s your two steps.
1) Have someone call 911.
2) Interlock your hands and fingers (one on top of the other) and use them to apply compression to the center of the affected person’s chest, right between the nipples. Push fast and hard; and yes, the correct rate (100 reps/minute) can be approximated by pump to the beat of The BeeGee’s hit “Staying Alive.” Forgive me, but this is important enough to go there.
You may have noticed the deemphasis of rescue breathing. That makes this process even easier. Combine this with my past comments regarding an AED (automated external defibrillator – click here for details), and you are really giving someone the best opportunity to have a successful outcome.
Don’t worry, in a future post, I’ll address how to get that song out of your head.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If Your Baby Starts Choking?

infchokingcons

We’ve previously discussed how to address choking in adults. Today, we address the twin horrors of needing to save a baby’s life (those younger than 12 months old) from choking and how to help yourself if no one else is around to help.
In case you didn’t realize it, infants haven’t had time to accumulate enough disease and toxins to have heart attacks in the way adults do. When they are in a life-threatening situation, it’s far more likely to be from a respiratory cause, such as choking. Infants and young children are exploring their world and seemingly will place most anything near or in their mouths. Too often this leads to choking. Please keep this in mind if you’re ever faced with an infant in danger.
In discussing how to help a child in danger, let’s focus on two considerations: how to assess the situation and how to act.
It is vital to assess these situations accurately. There are important splits in treatment algorithms based on your assessment.
Simply put, the first thing you want to do is determine the infant’s level of responsiveness. For the purposes of this discussion, let’s assume we’re discussing conscious choking.
If an infant is suddenly unable to cough or cry, it’s a reasonable to assume that something may be blocking the airway.

  • When this is the case, help will be needed getting the object out.

If an infant is coughing or gagging, it’s likely that the airway may be partially blocked.

  • Coughing is actually the most effective way to dislodge an object, so you shouldn’t interfere in this setting.

If an infant is somewhat responsive in the context of a recent insect bite, bee sting or other possible allergic exposure, the throat could be closing because of an allergic reaction.

  • When this is the case, you are facing a potential life-threatening emergency. Call 911 immediately.

Infant Choking

When you’ve made your assessment, your next step (unless you’re performing CPR, calling 911 or the child is still coughing) is to try to assist in getting the object out. Think “back blows, chest thrusts, repeat unless the infant gets unconscious.” Yes, that was meant to be a jingle.

backblow

Back blows:

  • Hold the infant face up on one forearm, and hold the back of his head with the hand.
  • Stabilize the infant’s front with your opposite hand and forearm.
  • Flip the infant face down so that he’s now in the control of the other forearm. Use your thumb and fingers to stabilize the jaw while flipping. Lower your arm onto your thigh; now the baby’s head will be lower than his chest.
  • Using the heel of your hand, deliver five firm back blows between the infant’s shoulder blades in an effort to dislodge the object. Maintain head and neck support by firmly holding his jaw between your thumb and forefinger.
  • Finally, place the hand that had been delivering the back blows on the back of the baby’s head with your arm along his back. Carefully, turn him over while keeping your other hand and forearm on his front.
  • If you have dislodged the object and the infant is responsive and/or coughing, you are done. Otherwise, proceed to chest thrusts.

chestthrust

Chest thrusts

  • Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby’s head lower than the rest of his body.
  • Place the pads of two or three fingers in the center of the baby’s chest, just below an imaginary line running between his nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.
  • Do five chest thrusts. Keep your fingers in contact with the baby’s breastbone. The chest thrusts should be smooth, not jerky.

Repeat
Continue alternating five back blows and chest thrusts until the object is forced out, the infant starts to cough forcefully, cry, breathe on his own or becomes unconscious. If he’s coughing, allow him to do so.

fingersweep

If the infant becomes unconscious
If a choking infant becomes unconscious, you should proceed to modified CPR as follows:

  • Open his mouth. If you can see an object, remove it with your little finger.
  • Give two rescue breaths. If you don’t see the chest rise, tilt his head and try two rescue breaths again.

 If his chest still doesn’t rise, do 30 chest compressions.
  • Check the mouth again, looking for an object. Remove it if seen.
  • Repeat the cycle with rescue breaths and chest compressions until help arrives.

Regardless of the outcome, the infant will need prompt medical attention.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If You See Someone Choking?

choking1

So … what would you do if someone around you starting choking. Or if they choked, then lost consciousness? What would you do if you choked and no one else was around? Don’t you think you should know? Read on …
First things first. You’ve all heard of the Heimlich maneuver, even if you don’t know how to do it. My job today is to make this easy for you. My first task will be to pass on the physician’s mantra of “Do No Harm.” To that end, let’s start with things you shouldn’t do.

  • If the person is able to speak, don’t interfere.
  • If the person is coughing and still has a normal level of awareness, don’t interfere.
  • If the person is able to breathe in and out without excessive difficulty, don’t interfere.
  • If the person is conscious, don’t place anything in his/her mouth trying to extract an object.

Next, let’s review a few quick points to help you understand what could be going on.

  • Choking is occurring because something is blocking the airway (aka windpipe).
  • Choking is dangerous because complete blockage will prevent oxygen from circulating thorough the body.
  • Choking is deadly because without oxygen, permanent brain damage will likely occur in four to six minutes.

Partial blockage isn’t the same as complete blockage. The body has protective reflexes to deal with blockage. That’s what coughing is. Once blockage has become complete, you’re facing a life-threatening emergency, and the risks of doing something outweigh the risks of doing nothing.

choking

It’s not that difficult to know if someone’s choking; they’re likely grabbing their throat. You would do well to know what it looks like if someone has already choked or is choking but can’t use his/her hands. Here are some clues:

  • Coughing may be increasingly weaker.
  • They likely will exhibit difficulty breathing.
  • They may be unable to speak.
  • Their skin may have a bluish or purplish color.
  • You may hear high-pitched musical sounds while they’re breathing.
  • They may have blacked out (from the blockage).

heimlich

Here are universally accepted steps to the Heimlich maneuver (in someone not obese or pregnant):

  • Ask the person, “Are you choking?”
  • Then ask them to speak. If they can speak or are vigorously coughing, you watch and wait. If not, proceed.
  • Standing behind the person, wrap your arms around his/her waist.
  • Placing your thumb just above the belly button (navel), make a fist with one hand.
  • Grasp the fist with your other hand.
  • Thrust your fist quickly, upward and inward.
  • Repeat until the person either loses consciousness or the object is dislodged.

If the person is obese or pregnant, wrap your arms around the chest, not the abdomen. Place your fist between the nipples on the middle of the breastbone, and make firm thrusts back toward you.
If the person loses consciousness, there are four steps you must take.

  1. If you see something blocking the airway, try to remove it.
  2. Lower the person to the floor, preferably on his/her side until you start CPR or if vomiting starts.
  3. Have someone call 911.
  4. Begin CPR.

Of course, prevention is key. Take care to chew your food slowly and thoroughly.
Here are three more tips for those most at risk:

  • Children: Keep them away from small objects that can be placed in their mouths.
  • Elderly: Make sure their dentures fit appropriately.
  • Adults: Limit alcohol intake around the time of eating.

In an upcoming Straight, No Chaser, we’ll also add a post for you regarding how to handle yourself and infants (less than one year old) if choking.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Here’s How You Complete End-of-Life Planning

durable-power-of-attorney

Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions, let’s discuss some specific mechanisms by which you can ensure your wishes are honored.
Living Will: This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.
Do Not Resuscitate (DNR): A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed.  Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.
Healthcare Power of Attorney (POA): The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

  • If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
  • If you’ve made some decision and not others, the POA will fill in the gaps.
  • Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member.  Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
  • Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
  • Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to do so.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA.  If you’re able, it may be wise to engage an attorney to sort through the various documents.
I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family.  I’ve seen all too often how messy it gets when issues aren’t addressed in advance.  You really don’t want that happening to you at the end of your life.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Staying Alive – A Ridiculously Simple Approach to CPR

cpr
Hopefully, this video is the hokiest thing I’ll ever post, but modern understanding of CPR is such that every single one of you should know exactly how to respond in the event someone collapses near you. Simply put, this is how you save lives. I would think every one who reads this would do well to forward or post this message within your networks.

CPR video

In case the video doesn’t launch for you, here’s your two steps.
1) Have someone call 911.
2) Interlock your hands and fingers (one on top of the other) and use them to apply compression to the center of the affected person’s chest, right between the nipples. Push fast and hard; and yes, the correct rate (100 reps/minute) can be approximated by pump to the beat of The BeeGee’s hit “Staying Alive.” Forgive me, but this is important enough to go there.
You may have noticed the deemphasis of rescue breathing. That makes this process even easier. Combine this with my past comments regarding an AED (automated external defibrillator – click here for details), and you are really giving someone the best opportunity to have a successful outcome.
Don’t worry, in a future post, I’ll address how to get that song out of your head.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If Your Baby Starts Choking?

infchokingcons

We’ve previously discussed how to address choking in adults. Today, we address the twin horrors of needing to save a baby’s life (those younger than 12 months old) from choking and how to help yourself if no one else is around to help.
In case you didn’t realize it, infants haven’t had time to accumulate enough disease and toxins to have heart attacks in the way adults do. When they are in a life-threatening situation, it’s far more likely to be from a respiratory cause, such as choking. Infants and young children are exploring their world and seemingly will place most anything near or in their mouths. Too often this leads to choking. Please keep this in mind if you’re ever faced with an infant in danger.
In discussing how to help a child in danger, let’s focus on two considerations: how to assess the situation and how to act.
It is vital to assess these situations accurately. There are important splits in treatment algorithms based on your assessment.
Simply put, the first thing you want to do is determine the infant’s level of responsiveness. For the purposes of this discussion, let’s assume we’re discussing conscious choking.
If an infant is suddenly unable to cough or cry, it’s a reasonable to assume that something may be blocking the airway.

  • When this is the case, help will be needed getting the object out.

If an infant is coughing or gagging, it’s likely that the airway may be partially blocked.

  • Coughing is actually the most effective way to dislodge an object, so you shouldn’t interfere in this setting.

If an infant is somewhat responsive in the context of a recent insect bite, bee sting or other possible allergic exposure, the throat could be closing because of an allergic reaction.

  • When this is the case, you are facing a potential life-threatening emergency. Call 911 immediately.

Infant Choking

When you’ve made your assessment, your next step (unless you’re performing CPR, calling 911 or the child is still coughing) is to try to assist in getting the object out. Think “back blows, chest thrusts, repeat unless the infant gets unconscious.” Yes, that was meant to be a jingle.

backblow

Back blows:

  • Hold the infant face up on one forearm, and hold the back of his head with the hand.
  • Stabilize the infant’s front with your opposite hand and forearm.
  • Flip the infant face down so that he’s now in the control of the other forearm. Use your thumb and fingers to stabilize the jaw while flipping. Lower your arm onto your thigh; now the baby’s head will be lower than his chest.
  • Using the heel of your hand, deliver five firm back blows between the infant’s shoulder blades in an effort to dislodge the object. Maintain head and neck support by firmly holding his jaw between your thumb and forefinger.
  • Finally, place the hand that had been delivering the back blows on the back of the baby’s head with your arm along his back. Carefully, turn him over while keeping your other hand and forearm on his front.
  • If you have dislodged the object and the infant is responsive and/or coughing, you are done. Otherwise, proceed to chest thrusts.

chestthrust

Chest thrusts

  • Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby’s head lower than the rest of his body.
  • Place the pads of two or three fingers in the center of the baby’s chest, just below an imaginary line running between his nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.
  • Do five chest thrusts. Keep your fingers in contact with the baby’s breastbone. The chest thrusts should be smooth, not jerky.

Repeat
Continue alternating five back blows and chest thrusts until the object is forced out, the infant starts to cough forcefully, cry, breathe on his own or becomes unconscious. If he’s coughing, allow him to do so.

fingersweep

If the infant becomes unconscious
If a choking infant becomes unconscious, you should proceed to modified CPR as follows:

  • Open his mouth. If you can see an object, remove it with your little finger.
  • Give two rescue breaths. If you don’t see the chest rise, tilt his head and try two rescue breaths again.

 If his chest still doesn’t rise, do 30 chest compressions.
  • Check the mouth again, looking for an object. Remove it if seen.
  • Repeat the cycle with rescue breaths and chest compressions until help arrives.

Regardless of the outcome, the infant will need prompt medical attention.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If You See Someone Choking?

choking1

So … what would you do if someone around you starting choking. Or if they choked, then lost consciousness? What would you do if you choked and no one else was around? Don’t you think you should know? Read on …
First things first. You’ve all heard of the Heimlich maneuver, even if you don’t know how to do it. My job today is to make this easy for you. My first task will be to pass on the physician’s mantra of “Do No Harm.” To that end, let’s start with things you shouldn’t do.

  • If the person is able to speak, don’t interfere.
  • If the person is coughing and still has a normal level of awareness, don’t interfere.
  • If the person is able to breathe in and out without excessive difficulty, don’t interfere.
  • If the person is conscious, don’t place anything in his/her mouth trying to extract an object.

Next, let’s review a few quick points to help you understand what could be going on.

  • Choking is occurring because something is blocking the airway (aka windpipe).
  • Choking is dangerous because complete blockage will prevent oxygen from circulating thorough the body.
  • Choking is deadly because without oxygen, permanent brain damage will likely occur in four to six minutes.

Partial blockage isn’t the same as complete blockage. The body has protective reflexes to deal with blockage. That’s what coughing is. Once blockage has become complete, you’re facing a life-threatening emergency, and the risks of doing something outweigh the risks of doing nothing.

choking

It’s not that difficult to know if someone’s choking; they’re likely grabbing their throat. You would do well to know what it looks like if someone has already choked or is choking but can’t use his/her hands. Here are some clues:

  • Coughing may be increasingly weaker.
  • They likely will exhibit difficulty breathing.
  • They may be unable to speak.
  • Their skin may have a bluish or purplish color.
  • You may hear high-pitched musical sounds while they’re breathing.
  • They may have blacked out (from the blockage).

heimlich

Here are universally accepted steps to the Heimlich maneuver (in someone not obese or pregnant):

  • Ask the person, “Are you choking?”
  • Then ask them to speak. If they can speak or are vigorously coughing, you watch and wait. If not, proceed.
  • Standing behind the person, wrap your arms around his/her waist.
  • Placing your thumb just above the belly button (navel), make a fist with one hand.
  • Grasp the fist with your other hand.
  • Thrust your fist quickly, upward and inward.
  • Repeat until the person either loses consciousness or the object is dislodged.

If the person is obese or pregnant, wrap your arms around the chest, not the abdomen. Place your fist between the nipples on the middle of the breastbone, and make firm thrusts back toward you.
If the person loses consciousness, there are four steps you must take.

  1. If you see something blocking the airway, try to remove it.
  2. Lower the person to the floor, preferably on his/her side until you start CPR or if vomiting starts.
  3. Have someone call 911.
  4. Begin CPR.

Of course, prevention is key. Take care to chew your food slowly and thoroughly.
Here are three more tips for those most at risk:

  • Children: Keep them away from small objects that can be placed in their mouths.
  • Elderly: Make sure their dentures fit appropriately.
  • Adults: Limit alcohol intake around the time of eating.

In an upcoming Straight, No Chaser, we’ll also add a post for you regarding how to handle yourself and infants (less than one year old) if choking.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If You See Someone Choking?

choking1

So … what would you do if someone around you starting choking. Or if they choked, then lost consciousness? What would you do if you choked and no one else was around? Don’t you think you should know? Read on …
First things first. You’ve all heard of the Heimlich maneuver, even if you don’t know how to do it. My job today is to make this easy for you. My first task will be to pass on the physician’s mantra of “Do No Harm.” To that end, let’s start with things you shouldn’t do.

  • If the person is able to speak, don’t interfere.
  • If the person is coughing and still has a normal level of awareness, don’t interfere.
  • If the person is able to breathe in and out without excessive difficulty, don’t interfere.
  • If the person is conscious, don’t place anything in his/her mouth trying to extract an object.

Next, let’s review a few quick points to help you understand what could be going on.

  • Choking is occurring because something is blocking the airway (aka windpipe).
  • Choking is dangerous because complete blockage will prevent oxygen from circulating thorough the body.
  • Choking is deadly because without oxygen, permanent brain damage will likely occur in four to six minutes.

Partial blockage isn’t the same as complete blockage. The body has protective reflexes to deal with blockage. That’s what coughing is. Once blockage has become complete, you’re facing a life-threatening emergency, and the risks of doing something outweigh the risks of doing nothing.

choking

It’s not that difficult to know if someone’s choking; they’re likely grabbing their throat. You would do well to know what it looks like if someone has already choked or is choking but can’t use his/her hands. Here are some clues:

  • Coughing may be increasingly weaker.
  • They likely will exhibit difficulty breathing.
  • They may be unable to speak.
  • Their skin may have a bluish or purplish color.
  • You may hear high-pitched musical sounds while they’re breathing.
  • They may have blacked out (from the blockage).

heimlich

Here are universally accepted steps to the Heimlich maneuver (in someone not obese or pregnant):

  • Ask the person, “Are you choking?”
  • Then ask them to speak. If they can speak or are vigorously coughing, you watch and wait. If not, proceed.
  • Standing behind the person, wrap your arms around his/her waist.
  • Placing your thumb just above the belly button (navel), make a fist with one hand.
  • Grasp the fist with your other hand.
  • Thrust your fist quickly, upward and inward.
  • Repeat until the person either loses consciousness or the object is dislodged.

If the person is obese or pregnant, wrap your arms around the chest, not the abdomen. Place your fist between the nipples on the middle of the breastbone, and make firm thrusts back toward you.
If the person loses consciousness, there are four steps you must take.

  1. If you see something blocking the airway, try to remove it.
  2. Lower the person to the floor, preferably on his/her side until you start CPR or if vomiting starts.
  3. Have someone call 911.
  4. Begin CPR.

Of course, prevention is key. Take care to chew your food slowly and thoroughly.
Here are three more tips for those most at risk:

  • Children: Keep them away from small objects that can be placed in their mouths.
  • Elderly: Make sure their dentures fit appropriately.
  • Adults: Limit alcohol intake around the time of eating.

In an upcoming Straight, No Chaser, we’ll also add a post for you regarding how to handle yourself and infants (less than one year old) if choking.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, like our Facebook page @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Here's How You Complete End-of-Life Planning

durable-power-of-attorney

Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions, let’s discuss some specific mechanisms by which you can ensure your wishes are honored.
Living Will: This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.
Do Not Resuscitate (DNR): A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed.  Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.
Healthcare Power of Attorney (POA): The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

  • If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
  • If you’ve made some decision and not others, the POA will fill in the gaps.
  • Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member.  Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
  • Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
  • Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to do so.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA.  If you’re able, it may be wise to engage an attorney to sort through the various documents.
I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family.  I’ve seen all too often how messy it gets when issues aren’t addressed in advance.  You really don’t want that happening to you at the end of your life.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offer. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If Your Baby Starts Choking?

infchokingcons

We’ve previously discussed how to address choking in adults. Today, we address the twin horrors of needing to save a baby’s life (those younger than 12 months old) from choking and how to help yourself if no one else is around to help.
In case you didn’t realize it, infants haven’t had time to accumulate enough disease and toxins to have heart attacks in the way adults do. When they are in a life-threatening situation, it’s far more likely to be from a respiratory cause, such as choking. Infants and young children are exploring their world and seemingly will place most anything near or in their mouths. Too often this leads to choking. Please keep this in mind if you’re ever faced with an infant in danger.
In discussing how to help a child in danger, let’s focus on two considerations: how to assess the situation and how to act.
It is vital to assess these situations accurately. There are important splits in treatment algorithms based on your assessment.
Simply put, the first thing you want to do is determine the infant’s level of responsiveness. For the purposes of this discussion, let’s assume we’re discussing conscious choking.
If an infant is suddenly unable to cough or cry, it’s a reasonable to assume that something may be blocking the airway.

  • When this is the case, help will be needed getting the object out.

If an infant is coughing or gagging, it’s likely that the airway may be partially blocked.

  • Coughing is actually the most effective way to dislodge an object, so you shouldn’t interfere in this setting.

If an infant is somewhat responsive in the context of a recent insect bite, bee sting or other possible allergic exposure, the throat could be closing because of an allergic reaction.

  • When this is the case, you are facing a potential life-threatening emergency. Call 911 immediately.

Infant Choking

When you’ve made your assessment, your next step (unless you’re performing CPR, calling 911 or the child is still coughing) is to try to assist in getting the object out. Think “back blows, chest thrusts, repeat unless the infant gets unconscious.” Yes, that was meant to be a jingle.

backblow

Back blows:

  • Hold the infant face up on one forearm, and hold the back of his head with the hand.
  • Stabilize the infant’s front with your opposite hand and forearm.
  • Flip the infant face down so that he’s now in the control of the other forearm. Use your thumb and fingers to stabilize the jaw while flipping. Lower your arm onto your thigh; now the baby’s head will be lower than his chest.
  • Using the heel of your hand, deliver five firm back blows between the infant’s shoulder blades in an effort to dislodge the object. Maintain head and neck support by firmly holding his jaw between your thumb and forefinger.
  • Finally, place the hand that had been delivering the back blows on the back of the baby’s head with your arm along his back. Carefully, turn him over while keeping your other hand and forearm on his front.
  • If you have dislodged the object and the infant is responsive and/or coughing, you are done. Otherwise, proceed to chest thrusts.

chestthrust

Chest thrusts

  • Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby’s head lower than the rest of his body.
  • Place the pads of two or three fingers in the center of the baby’s chest, just below an imaginary line running between his nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.
  • Do five chest thrusts. Keep your fingers in contact with the baby’s breastbone. The chest thrusts should be smooth, not jerky.

Repeat
Continue alternating five back blows and chest thrusts until the object is forced out, the infant starts to cough forcefully, cry, breathe on his own or becomes unconscious. If he’s coughing, allow him to do so.

fingersweep

If the infant becomes unconscious
If a choking infant becomes unconscious, you should proceed to modified CPR as follows:

  • Open his mouth. If you can see an object, remove it with your little finger.
  • Give two rescue breaths. If you don’t see the chest rise, tilt his head and try two rescue breaths again.

 If his chest still doesn’t rise, do 30 chest compressions.
  • Check the mouth again, looking for an object. Remove it if seen.
  • Repeat the cycle with rescue breaths and chest compressions until help arrives.

Regardless of the outcome, the infant will need prompt medical attention.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Will You Do If You See Someone Choking?

choking1

So … what would you do if someone around you starting choking. Or if they choked, then lost consciousness? What would you do if you choked and no one else was around? Don’t you think you should know? Read on …
First things first. You’ve all heard of the Heimlich maneuver, even if you don’t know how to do it. My job today is to make this easy for you. My first task will be to pass on the physician’s mantra of “Do No Harm.” To that end, let’s start with things you shouldn’t do.

  • If the person is able to speak, don’t interfere.
  • If the person is coughing and still has a normal level of awareness, don’t interfere.
  • If the person is able to breathe in and out without excessive difficulty, don’t interfere.
  • If the person is conscious, don’t place anything in his/her mouth trying to extract an object.

Next, let’s review a few quick points to help you understand what could be going on.

  • Choking is occurring because something is blocking the airway (aka windpipe).
  • Choking is dangerous because complete blockage will prevent oxygen from circulating thorough the body.
  • Choking is deadly because without oxygen, permanent brain damage will likely occur in four to six minutes.

Partial blockage isn’t the same as complete blockage. The body has protective reflexes to deal with blockage. That’s what coughing is. Once blockage has become complete, you’re facing a life-threatening emergency, and the risks of doing something outweigh the risks of doing nothing.

choking

It’s not that difficult to know if someone’s choking; they’re likely grabbing their throat. You would do well to know what it looks like if someone has already choked or is choking but can’t use his/her hands. Here are some clues:

  • Coughing may be increasingly weaker.
  • They likely will exhibit difficulty breathing.
  • They may be unable to speak.
  • Their skin may have a bluish or purplish color.
  • You may hear high-pitched musical sounds while they’re breathing.
  • They may have blacked out (from the blockage).

heimlich

Here are universally accepted steps to the Heimlich maneuver (in someone not obese or pregnant):

  • Ask the person, “Are you choking?”
  • Then ask them to speak. If they can speak or are vigorously coughing, you watch and wait. If not, proceed.
  • Standing behind the person, wrap your arms around his/her waist.
  • Placing your thumb just above the belly button (navel), make a fist with one hand.
  • Grasp the fist with your other hand.
  • Thrust your fist quickly, upward and inward.
  • Repeat until the person either loses consciousness or the object is dislodged.

If the person is obese or pregnant, wrap your arms around the chest, not the abdomen. Place your fist between the nipples on the middle of the breastbone, and make firm thrusts back toward you.
If the person loses consciousness, there are four steps you must take.

  1. If you see something blocking the airway, try to remove it.
  2. Lower the person to the floor, preferably on his/her side until you start CPR or if vomiting starts.
  3. Have someone call 911.
  4. Begin CPR.

Of course, prevention is key. Take care to chew your food slowly and thoroughly.
Here are three more tips for those most at risk:

  • Children: Keep them away from small objects that can be placed in their mouths.
  • Elderly: Make sure their dentures fit appropriately.
  • Adults: Limit alcohol intake around the time of eating.

Next is to master CPR, which we’ve made very simple for you. We’ll also add a post for you regarding how to handle yourself and infants (less than one year old) if choking.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Here's How You Complete End-of-Life Planning

durable-power-of-attorney

Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions (click here to review), let’s discuss some specific mechanisms by which you can ensure your wishes are honored.
Living Will: This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.
Do Not Resuscitate (DNR): A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed.  Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.
Healthcare Power of Attorney (POA): The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

  • If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
  • If you’ve made some decision and not others, the POA will fill in the gaps.
  • Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member.  Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
  • Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
  • Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to do so.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA.  If you’re able, it may be wise to engage an attorney to sort through the various documents.
I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family.  I’ve seen all too often how messy it gets when issues aren’t addressed in advance.  You really don’t want that happening to you at the end of your life.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Steps for End-of-Life Planning

durable-power-of-attorney
Now that you’ve had a chance to wrap your mind around the concept of needing to make end of life decisions (click here to review), let’s discuss some specific mechanisms by which you can ensure your wishes are honored.
Living Will: This document, also known as medical directives, addresses those scenarios where you are unable to communicate your near death choices. The key consideration is that a living will keeps the power and decision-making in your hands, even when you’re incapacitated or otherwise unable to state your preference. You’ll want to have a copy of this form with you or with your family.
Do Not Resuscitate (DNR): A DNR form takes the living will consideration straight to the end of life question and explicitly states your preference not to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if needed.  Your physician will retain a copy of this document in your medical record as a way of alerting other medical providers (such as in the emergency room–if and when you show up there) of your desire.
Healthcare Power of Attorney (POA): The healthcare POA is your designee to carry out your medical wishes beyond what you have explicitly stated. A healthcare POA may serve more than one function.

  • If you haven’t made DNR or living will type decisions, a POA will make those decisions for you.
  • If you’ve made some decision and not others, the POA will fill in the gaps.
  • Making a POA designation is literally putting your life in someone else’s hands. Be very careful who you choose for this role. Some people will simply designate next-of-kin or a family member.  Others will want someone objective with no other motives (e.g., financial) than fulfilling their wishes. Either choice is much better than no choice, which too often leaves family members with competing interests and potentially having to carry the burden of making decisions for you that you could have made in advance.
  • Your POA will not be able to overturn decisions you’ve designated on the DNR form or your living will.
  • Your POA will not be able to make any decisions for you while you’re still able to do so unless you ask him/her to.

It’s important to know that you can simultaneously have a living will, DNR declaration and a Healthcare POA.  If you’re able, it may be wise to engage an attorney to sort through the various documents.
I hope for your sake and the comfort of any family you may leave behind that you take the time to engage in end-of-life planning for yourself and others in your family.  I’ve seen all too often how messy it gets when issues aren’t addressed in advance.  You really don’t want that happening to you at the end of your life.

Straight, No Chaser: Quick Tips for the Drowning Victim

Drowning_safety_children_CPSC

  1. If the victim is still conscious, attempt to hand him something that can be used to pull him from the water. If you’re out of handing distance, throw either a floatable object or something he can hold onto and with which he can be pulled to safety.
  2. If the victim has fallen into solid ice, and you have enough individuals, consider forming a human rope, with each individual interconnected and at least two individuals safely connected back on firm land.
  3. The victim should be removed from the water at the earliest opportunity. Forego inclination to perform chest compressions or rescue breathing in the water.
  4. If possible, remove the victim from the water as flat (horizontal) as possible. You want to make every effort to avoid damage to the neck throughout this entire process (This actually would be additional injury to the neck; there’s a fair chance such an injury has already occurred.).
  5. Once victims are out of the water, NEVER assume death unless you’re a qualified medical professional. Begin CPR, as described in yesterday’s post (Click here to review.).
  6. If the victim has an altered mental status, check the airway for foreign material and vomitus. Use your fingers to sweep away any material visible between the mouth and throat.
  7. The Heimlich maneuver (abdominal thrusting) is not effective in removing swallowed water. Don’t waste valuable time with it.
  8. If you’ve successfully saved a drowning victim, don’t bother taking off wet clothes. It’s not worth the possible agitation to the neck, and recent medical thought suggests that cooling after certain likely types of cardiac arrest is especially beneficial in reducing brain injury and death. This consideration is much more important than any benefit to be gained from warming the patient. Sounds weird, but it’s the truth.

Regarding the lead picture, yes it’s true that one can drown in inches of water. Infant safety means keeping them at arm’s length while they’re in the water.

Straight, No Chaser: Staying Alive – A New, Ridiculously Simple Approach to CPR

cpr
Hopefully, this video is the hokiest thing I’ll ever post, but modern understanding of CPR is such that every single one of you should know exactly how to respond in the event someone collapses near you. Simply put, this is how you save lives. I would think every one who reads this would do well to forward or post this message within your networks.
http://www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/Hands-Only-CPR_UCM_440559_SubHomePage.jsp
In case the video doesn’t launch for you, here’s your two steps.
1) Have someone call 911.
2) Interlock your hands and fingers (one on top of the other), and use them to apply compressions to the center of the affected person’s chest, right between the nipples. Push fast and hard; and yes, the correct rate (200 reps/minute) can be approximated by pump to the beat of The BeeGee’s hit ‘Staying Alive’. Forgive me, but this is important enough to go there.
You may have noticed the deemphasis of rescue breathing. That makes this process even easier. Combine this with my past comments regarding an AED (automated external defibrillator – click here for details), and you are really giving someone the best opportunity to have a successful outcome.
Don’t worry, in a future post, I’ll address how to get that song out of your head.

Straight, No Chaser: Back From the Dead (aka The One Piece of Medical Equipment I Wish You Had in Your House)

Have you ever heard of an AED (automated external defibrillator)? Well, you’re about to. We’ve promoted CPR (cardiopulmonary resuscitation) a ton over the years, but recent recommendations place added emphasis on trying to literally shock patients back into consciousness. Thus, let’s start at the literal end of life, when you actually have a chance to save a life.
There are a couple of abnormal heart rhythms that suggest death is imminent. They’re called ventricular fibrillation (V-Fib) and pulseless ventricular tachycardia (V-tach). In these conditions, the heart is more or less quivering (V-Fib) or pumping too fast (V-tach) instead of giving off an optimal forceful beat. Effective beats pump blood (containing oxygen and nutrients) around the body you need to not only function, but to survive. Now, those two bad rhythms I just mentioned are unsustainable indefinitely, because without effective blood flow, vital organs such as the brain, lungs and ultimately the heart itself will give out within minutes, and that’s why you go ‘flat-line’ (aka asystole, aka dead, or soon to be). Even if you do survive, every minute these organs are starved of blood leads to damage that could be irreparable.
AEDs are designed to shock/stimulate the heart out of these deadly rhythms and back into an effective pumping state when possible (AEDs do not work for asystole, the flat-line rhythm.). The beauty of these machines is they are simple (and have been proven to be useable by untrained 6th graders), small/portable and if you pay attention, they’re all over the place. And even better: all AEDs used in the US talk to you and tell you what to do! My goal for you is simple: even if you can’t have one, know about them so you will think to use them if the opportunity presents.
Here are some frequently asked questions and answers regarding usage:
1) How do you connect it? AEDs have pads that need to be placed on the chest while staying attached to the machine. Instructions embedded on the machine will show you exactly where.
2) How does it know what to do? AEDs will detect the heart’s underlying rhythm and inform you if a shock is needed. Some machines will deliver it automatically; others will require you to press a button.
3) Are there limitations based on age? AEDs may safely be used on children and used by children. Appropriately sized pads must be used for kids.
4) Can I be sued for using this if the person dies? Users are protected by Good Samaritan Laws in case something (else) bad happens.
5) Should I own one? How expensive is it? I’d recommend one if you can easily afford it. I’d also recommend incurring the expense if you have a high-risk profile for heart disease and potentially fatal heart rhythms. This should be discussed with your physician. I paid $300 for mine, but you can pay up to $1100 for no good reason.
6) How long is it good for? You must be sure to stay up to date on the expiration dates on the components, most importantly the battery.
7) What should I do if the victim gets ‘back to normal’ after using an AED? Still call 911 and get to the Emergency Department for further investigation.
Of course the biggest question is “Do they work?” I’ll reference a study that reviewed effectiveness over two years of usage in Chicago’s Heart Start program, in which 22 individuals developed potentially fatal abnormal rhythms. 18 of these people met criteria to be treated by an AED. Of these 18, 11 survived. Of these eleven, bystanders with no prior training treated six.
I have an AED in my house and transport it in my family’s car because after all, I’m the one most likely to need it and benefit from it anyway (and I could shock myself, assuming I was still conscious). If it’s within your means, consider doing the same. It’s all about giving you the best opportunity to survive.