This Level of Stupid Drives Me CRAZY!!!

[IdaBriggs]

(Yes, it looks like a Michael Jackson thread -- but get over it and READ, please.)

http://news.yahoo.com/s/ap/us_michael_jackson Lawyer: "Jackson's doc didn't give excessive drugs"

(Blah, blah, blah -- its not my fault -- snip)

Jackson still had a faint pulse and a warm body when Murray found him in bed and not breathing Thursday afternoon, Chernoff said in the AP interview.

Chernoff said Murray was at the pop icon's rented mansion when he discovered Jackson in bed and not breathing. The doctor immediately began administering CPR, Chernoff said.(my bold)

Folks, you DO NOT ADMINISTER CPR to folks with a heartbeat. If someone is not breathing, you give RESCUE BREATHING, but NOT CPR. And doctors are supposed to know this, so either a) the lawyer is lying, ignorant, or stupid, or b) the doctor is a complete screw-up.

Let me walk you through this slowly:

The ABCs of emergency are Airway, Breathing and Circulation (with a quick scan for life threatening levels of bleeding).

A is for Airway: -- If the person isn't breathing, you tilt the head, and give two quick rescue breaths. If the air does not go in (because the chest does not rise/fall), you retilt the head. You don't go any further until the airway is not obstructed.

B is for Breathing: -- If the person isn't breathing on their own, you give the two breaths (referenced above and stop there if you can't get air to go in), and then check for a pulse. If there is a pulse, you continue rescue breathing until help arrives. This allows oxygenated blood to continue flowing through the body -- and you also periodically double check to make sure the pulse hasn't stopped while you are waiting.

NOTE: YOU DO NOT PERFORM CHEST COMPRESSIONS (aka CPR) UNLESS THERE IS NO PULSE.

C is for Circulation: -- If there is no pulse, you begin performing CPR, which is a combination of Rescue Breathing and Chest Compressions. If you have it available, you may also utilize an AED device (which is an automatic electronic defibrillator). You continue doing this until help arrives.

Let me repeat this:

NOTE: YOU DO NOT PERFORM CHEST COMPRESSIONS (aka CPR) UNLESS THERE IS NO PULSE.

The purpose of chest compressions is to force oxygenated blood through the body so it doesn't die. The rescuer provides the oxygen via the Rescue Breathing, and then forces the blood to circulate via the chest compressions. It is physically exhausting, and you *always* call for help.

So for a doctor/lawyer/newspaper to say "Jackson still had a faint pulse" and "The doctor immediately began administering CPR" is flat out WRONG. You give RESCUE BREATHING to someone who is not breathing but has a pulse, and you give CPR to someone who doesn't have a pulse.

Are we clear on this? Are there any questions?

Why am I ranting about this? Because casual misinformation like this KILLS PEOPLE; folks who haven't taken the classes but watch television think they are HELPING when they start pounding on someone's chest willy-nilly, and never realize they are causing damage (which is what giving chest compressions to someone with a heartbeat will usually do, which is why we INSIST you take the full 15 seconds to feel for a pulse in an emergency situation). This stuff matters, people. There is a difference between "rescue breathing" and "chest compressions" -- and for the record, I think everyone on the planet should be educated on basic first aid, including how to deal with the ABCs.

End Rant. :rant:

Ida Briggs
10 year Instructor for the American Red Cross (Retired Since Katrina)
Standard First Aid, CPR & AED -- Adult, Infant and Child

[cali]

1. this is a great rant, full of extremely valuable information.

[hlthe2b]

2. I share your complete frustration on this...

Not to mention that any half trained fool would know to pull the patient onto a hard surface to administer CPR, if that were actually needed...

But, I'd be willing to bet we are seeing major CYA mode from Dr. Murray and in reality, MJ may have been cold and "gone" by the time the doc found him. I'm also doubting the story that he had administered no demerol.... IF (stress IF) tox findings show high dose opiate residues, including demerol, then who did?

I think this doc was WAY out of his element and now is caught in the very uncomfortable situation of providing cover for what he didn't do and conversely what he should have done....

We'll see

[glowing]

9. Sure sounds like another Ana Nicole Smith.. Take the drugs, pass out,

Doc does CPR on the bed? Very odd... esp. if he's a cardiologist.

[Delphinus]

3. Thank you, thank you, thank you!!

I took one of those chest compression only CPR classes and this was not covered at all. Granted, those of you trained in doing this would think first, but if I were faced with this, not being a trained professional, I don't know if I would have thought to check if the breath was going or not.

Good job, Ida, and happy retirement!

[napi21]

4. This MAY explain the 911 call where the caller said "The Dr. is here

and administering CPR now." When the 911 operator askked where the patient was the caller said "On the bed." I remember many DUers screaming that you NEVER administer CPR on a soft surface like a bed, but that caller COULD have mistaken RESCUE BREATHING and called it CPR.

[cwydro]

5. Yes, I have noticed those discrepancies too.

I still think this doctor is extremely negligent, this CPR stuff aside. MJ was obviously not in good health and taking too many drugs as well.

[MADem]

6. It could be that the person who reported that "the doctor did CPR" was actually seeing rescue

breathing. Most people, if they see someone huffing air into the mouth of another, call it "CPR" even if that isn't what it is, technically.

After all, didn't the doctor disappear shortly thereafter? And only turned up, lawyered up, well after the body was in the morgue? This whole "CPR" story isn't from him. It's either from someone in the house or a first responder--and very likely it was from someone in the house.

I realize the distinction is important to you, and to anyone in the health care field, but it's not important to the average tabloid reader.

[ThirdWorldJohn]

8. That is what it is - technically. n/t

[Hello_Kitty]

7. I read that he claims he did CPR for 25 full minutes before calling EMTs

If that's true, :wtf: If you are alone with an unresponsive victim you call 911 BEFORE you begin CPR. A doctor of all people should know this.

[HillWilliam]

23. BINGO!

A sheriff's officer once told me that if you're in imminent danger or someone else is in imminent danger, call 911 and set the phone down. The keyword here is imminent, like loss of life right now, not like freepers upset over not getting the correct change at McDonalds.

911 Operators are trained to get information quickly and will understand if you're alone and need to start working right then. Seconds count when there is no pulse. It only takes a moment to relay the situation.

PS: THAT ONLY WORKS FOR LANDLINES where the operator can determine the address automatically and immediately. IT DOES NOT WORK FOR E911 or cellphones. You MUST remain on the line and relay address information. Most cellphones have speakerphone capability. You can talk to the operator whilst doing the compressions; they'll wait whilst you're giving lifebreaths.

And yeah, a doctor should know all of this. I think we're getting hoo-hah either from the numnuts media or the doctor isn't giving the whole story. Since the detectives and the ME haven't filed any charges yet, I'm thinking the media might be to blame for a lot of the misinformation. That wouldn't surprise me in the least.

[Ian David]

10. My last CPR course said you SHOULD perform compressions ALWAYS.

So that you don't waste time CHECKING for a pulse, or THINK you felt a pulse when you didn't.

[IdaBriggs]

16. May I inquire as to who taught the class? Was it Red Cross or someone else?

[Statistical]

21. Red Cross guidelines now call for CPR in non breathing situation.

I recently got Red Cross CPR and I noticed this change. The instructor was very clear that the procedures were revised recently.

It appears to much time is wasted determining a pulse vs no pulse and the first few seconds are critical. The risk/damage by doing CPR when only rescue breathing is needed is offset by the gains in starting CPR earlier and simplifying the procedures.

Per wikipedia but it matches what I was taught by Red Cross:

In 2005, new CPR guidelines<16><17> were published by the International Liaison Committee on Resuscitation (ILCOR), agreed at the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science.<18><19> The primary goal of these changes was to simplify CPR for lay rescuers and healthcare providers alike, to maximize the potential for early resuscitation. The important changes for 2005 were:<20>

* A universal compression-ventilation ratio (30:2) recommended for all single rescuers of infant (less than one year old), child (1 year old to puberty), and adult (puberty and above) victims (excluding newborns).<21> The primary difference between the age groups is that with adults the rescuer uses two hands for the chest compressions, while with children it is only one, and with infants only two fingers (index and middle fingers).<22> While this simplification has been introduced, it has not been universally accepted, and especially amongst healthcare professionals, protocols may still vary.<23>
* The removal of the emphasis on lay rescuers assessing for pulse or signs of circulation for an unresponsive adult victim, instead taking the absence of normal breathing as the key indicator for commencing CPR.
* The removal of the protocol in which lay rescuers provide rescue breathing without chest compressions for an adult victim, with all cases such as these being subject to CPR.

Research<16> has shown that lay personnel cannot accurately detect a pulse in about 40% of cases and cannot accurately discern the absence of pulse in about 10%. The pulse check step has been removed from the CPR procedure completely for lay persons and de-emphasized for healthcare professionals.

[IdaBriggs]

26. Thank you for providing this information --

and if I am wrong, it looks like I need to apologize to everyone in a BIG way. We were just updated 28 months ago, and the procedure was the same as I taught for 10+ years -- pulse check/no compressions if there is a pulse. I am going to call one of my friends from the Red Cross office (please don't think I doubt you or wikipedia, but I need to hear the explanation, as we had this POUNDED into our heads, and in turn, POUNDED it into our students heads for years!).

:) And by the way, thank you for taking the course! :)

[Statistical]

29. No problem.

I was always CPR certified as a CLS (Combat Lifesaver) in the Army. Many people are surpised the level of training non medics get in the Army. I was certified to do chest decompression and start and IV before my mother who was training to be a nurse. :)

I keep current as a civilian because I do recreational diving and CPR is often needed in water sports.

If wikipedia is wrong (or more likely correct but unclear) then update it once you find out info from Red Cross.

[Ian David]

30. Red Cross. Seven years ago. n/t

[MNDemNY]

11. Guidlines for advanced paramedics and doctors DO call for..

chest compressions with very week pulse present. The lay-care giver should NOT. However, as the 911 call shows, he was still in his bed. Chest compressions can not be delivered effectivly on a bed, unless a stiff board is also used.

[Statistical]

22. Chest compressions should be used in ALL cases since 2005. n/t

[Akoto]

12. Not to make light, but when I first heard details about his physician ...

I started to see him as the real life version of Dr. Nick from the Simpsons. He sounds like he just doesn't know what the hell he's doing, which may explain why he had a failing practice.

[peekaloo]

20. Bye Everybody (Dr Nick's last words)

no kidding. on that 911 tape when the caller is asked about the doctor being present/having witnessed the situation all you hear in the background seems to be manic gibberish.

The Simpsons did an MJ tribute (Do the BartMan) at the beginning of the show last night. (thought I'd throw that in).

[sharp_stick]

13. CPR doesn't always mean chest compressions

That's why the word pulmonary is in the acronym, the procedure includes measures to ensure adequate breathing when there is cardiac activity.

I've been avoiding all MJ related stuff because I'm sick of it but I haven't heard that chest compressions were administered by anybody while a heartbeat was present.

[IdaBriggs]

15. I pulled the quote from his lawyer on the Yahoo article.

I tried to keep my posting as basic as possible, because I don't want the average layperson to be running around giving "chest compressions" thinking they are performing "CPR" on folks, which is something we discussed in detail in the classes I used to teach.

I didn't even get into the 'don't do it on a soft surface (like a bed)'. Its hard to think of this doctor as a 'professional' when a) he did it for 25 minutes before calling for help (per another poster), when guidelines are 'call for help immediately, and then get back to administering it'; b) he did it on a bed; and c) he did it while there was a heartbeat. Medical folks may have different guidelines nowadays (my last update course was when my twins were born 28 months ago), but casual misinformation on stuff like the lawyer is spouting drives me crazy!!!

:)

[Maru Kitteh]

14. "Misinformation KILLS PEOPLE. " - Thanks for this thread Ida.

[kestrel91316]

17. I think it's entirely possible the doctor did everything right and it's the

attorney who has the CPR process all bollixed up and can't explain medical stuff properly.

[Ganja Ninja]

19. Exactly. n/t

[MiniMe]

18. The doctor is a cardologist. I don't understand why the lawyers are putting this out

:shrug: any guesses? CYA is my guess.

[Statistical]

24. I am sorry but your information is out of date.

CPR was revised by Red Cross & ILCOR in 2005.

CPR (including chest compressions) should be used in all cases in which breathing is not present.

Studies of CPR test results showed too much times is wasted determining pulse and often weak pulses are missed (false negative) or someone thinks there is a pulse when none is present (false positive).

The CPR procedures have been simplified to ease in reaction time.

I got Red Cross certified last year and was taught no breathing = immediate CPR no attempt to check pulse.
Having been certified twice in the past I was surprised and double check with the instructor.

[IdaBriggs]

27. I responded to you up-thread -- thank you!

I will be double-checking, and then possibly doing a BIG apology! :hi:

Well, won't that teach me to get my righteous rant on! LOL! :)

[Statistical]

28. No problem it is a big change not everyone is aware of it.

Also I am not sure what "de-emphasis on checking pulse" means for doctors. Should they check but not spend time? Should they do CPR if pulse is weak? or only if they find no pulse in the quick check?

I am not sure, It wasn't covered in our class being a class for "lay person".

[IdaBriggs]

31. Still waiting for a return phone call -- Not blowing this off!

:) This *matters* to me. :)

[Maraya1969]

35. You don't breath into them at all? What if there are 2 of you?

I guess my thought is it is important to get oxygen into the person.

[Statistical]

36. No breathing is PART of CPR.

The question was do you do chest compressions on someone with a pulse.

Prior to 2005 the answer was no. No need for chest compressions if the heart is beating = pulse. So you ONLY do rescue breathing.

They Red Cross studied the situation and found people waste too much valuable time trying to find a pulse. They also often miss weak pulses anyways and sometimes "find a pulse" when none exists (likely feeling their own pulse which is magnified from the adrenaline of the situation).

So Post 2005 you do CPR period however CPR does involve breathing.

I recommend EVERYONE get certified. Most CPR classes now also include instruction on use of AED since they are becoming more common.

An AED isn't the complex but you don't want the first time you see an AED to be a medical emergency.

[havocmom]

25. Great info, thanks. May save a life or twelve

I have to wonder, though, about the 'gave CPR' story.

One might wonder, in all the probable panic, if what was done was misstated as CPR by people who don't know there is a difference between that and rescue breathing.

Person on phone to 911 operator mentioned doctor doing CPR while Mr. Jackson was on the bed. Surely a doctor would know better than that? Hard surface for CPR, even I know that. Person on phone possibly didn't know the difference in CPR and breathing?

Lawyers.... well, under pressure, I could see them not noticing the difference and trying to paint client in best possible light to a mass audience, most of whom could also be confused about the two different applications? CPR sounds so much more helpful than rescue breathing to the casual listener.

Don't know. Haven't read the accounts, but just wondering if THIS particular screw up might not be a failure to communicate accurately?

[yellerpup]

32. Thank you, Ida Briggs!

This is the best, most helpful post I've read on DU for ages. You may be retired, but you are still saving lives. :kick:

[redqueen]

33. It's reached epidemic proportions.

Stuff like this always reminds me of the hospital / courtroom scenes from Idiocracy.

[Maraya1969]

34. I honest to God was thinking the same thing. They said they were "pumping" him

and I thought "was anyone breathing into him?" I didn't hear about the faint pulse until you just told me.