Having a heart attack? You're alone? Now what?

[twistedtree]

Just out of curiosity, does anyone know the differences between Wilderness First Responder training and STCW medical training? I'm heading off in a few weeks for an STCW refresher which is now required every 5 years.

 

[bnoft]

Having some training and more experience than I want, I can confirm that cardiac arrest can and usually does strike without warning. If you heart stops while alone, you're done, cooked, get the fork. March 17, 2020 I went to sleep and didn't wake up, my wife had the presence of mind, and divine guidance, to call 911 and begin CPR. 9 minutes later the squad arrived and hit me with a AED. Prior to this, my BP was within normal range, cholesterol was not a concern, I carried a few unnecessary pounds but the physical I had 3 weeks prior was as routine and brushing one's teeth. If you are "lucky" enough to go thru a similar experience, your best hope is having someone close by who knows CPR or has fast access to an AED. That will save your life. Having an AED on your boat is expensive but could prove useful.
In my case, my wife had not been trained, but Someone gave her guidance. I had run with the local fire and rescue squad, apparently it was like a family reunion that night, complete with deputies. I "slept" thru it all. In fact due to a chart mix up later that night, (I was thought to be 6'4" and 240 lbs, actually 5'6" about 190 at the time) I was administered a bit too much propafol and didn't wake up for a month. March 2020 was the onset of COVID so I can understand the ER resembling a MASH unit.

 

[Capn James Brett]

This comes from Dr. Patrick Teefy, Cardiology Head at the Nuclear Medicine Institute, University Hospital, London, Ont.

1. Let's say it's 7:25 p.m. and you're going home home, alone of course, after an unusually hard day on the job.

2. You're really tired, upset and frustrated.

3. Suddenly you start experiencing a severe pain in your chest that starts to drag out into your arm and up into your jaw. You are only a couple miles from the hospital nearest you.

4. Unfortunately you don't know if you'll be able to make it that far.

5. You have been trained in CPR but the guy that taught the course did not tell you how to perform it on yourself.

6. HOW TO SURVIVE A HEART ATTACK WHEN ALONE.
Since many people are alone when they suffer a heart attack without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.

7. However, these victims can help themselves by coughing repeatedly and very vigorously.

A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.

A breath and a cough must be repeated about every two seconds without letup until help arrives, or until the heart is felt to be beating normally again.

8. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it to regain a normal rhythm.

In this way, heart attack victims can get help or to a hospital.

9. Tell as many other people as possible about this. It could save their lives!

Also taking a baby aspirin may save your life.

 

[john-o]

I'd find the first good looking gal I could, a shot of Jim Beam and ck out with a smile.

 

[BandB]

Just out of curiosity, does anyone know the differences between Wilderness First Responder training and STCW medical training? I'm heading off in a few weeks for an STCW refresher which is now required every 5 years.

I know nothing about Wilderness.

The basic STCW refresher has been surprising as we all anticipated just covering material very lightly but at MPT it does include the fire pit and the pool. Still, just three days. Fire fighting and rescue and medical refreshers are more in depth.

We've missed regularly taking courses whether needed or not. Only taken the required since the start of the pandemic.

 

[gilbertpark]

I am a retired Intensive Care Doctor in the UK. Some of what has been said is good sense and I'm afraid some is nonsense. I am not going to get into that argument.

What I would say is that if you have someone on your boat who is ill, for whatever the reason, please can you write down the time and date with a history. I have prepared an observation chart for people who have an immersion injury (fallen overboard) along with instructions on how to do simple basic observations that may prove invaluable when they get to hospital. Please put these in a waterproof (I think the American word is fanny pack) bag strapped to the crew members waist.

Also put in the bag any drugs they are on. A mobile phone, credit card, some cash and a contacts business card is also invaluable.

If you are abroad then a passport and medical insurance certificate (or at least copies of them) are invaluable. In the US as I understand it a medical insurance certificate might also be useful (in the UK health care is free at the point of delivery).

So many times I've been faced with patients who I barely know the name of, let alone what drugs they are on and exactly what and when the event happened.

 

[BandB]

I am a retired Intensive Care Doctor in the UK. Some of what has been said is good sense and I'm afraid some is nonsense. I am not going to get into that argument.

What I would say is that if you have someone on your boat who is ill, for whatever the reason, please can you write down the time and date with a history. I have prepared an observation chart for people who have an immersion injury (fallen overboard) along with instructions on how to do simple basic observations that may prove invaluable when they get to hospital. Please put these in a waterproof (I think the American word is fanny pack) bag strapped to the crew members waist.

Also put in the bag any drugs they are on. A mobile phone, credit card, some cash and a contacts business card is also invaluable.

If you are abroad then a passport and medical insurance certificate (or at least copies of them) are invaluable. In the US as I understand it a medical insurance certificate might also be useful (in the UK health care is free at the point of delivery).

So many times I've been faced with patients who I barely know the name of, let alone what drugs they are on and exactly what and when the event happened.

Another medical professional emphasizing the need for information. I felt strange asking friends to fill out medical histories on friends and family, but in doing so it became obvious that whether on board or elsewhere, this was critical information in the event of any medical issues. We've talked about universal electronic medical charts for a long time in this country, but we're so far away still from information being available when needed. I've seen friends have a CT and wondered why no comparison to their previous. The answer was the previous was in a medical practice across the street, a practice part of the hospital chain, but labs and tests not shared. I know someone almost given contrast because no one knew his kidney problems. I had a cousin given morphine in an ER in spite a history of extremely severe reactions to it.

HIPAA is great in protecting information from employers, acquaintances, those we don't want to have it. However, we've really created a difficult situation when there is a need to know and need to access and it can't wait for information to be requested and sent.

There have been websites started by many to load one's information on and have a card or code to access, but nothing universal and nothing widely used.

 

[Portage_Bay]

Another medical professional emphasizing the need for information. I felt strange asking friends to fill out medical histories on friends and family, but in doing so it became obvious that whether on board or elsewhere, this was critical information in the event of any medical issues.

Some people don't want to give that info. My work around was to ask them to put it in a sealed envelope only to be opened in a medical emergency if they are unresponsive. The envelope to be returned to them when they disembark unopened if not needed.

Additional info to have are insurance policy numbers. Primary care physician contact. Specialists contact if relevant. Persons who have any decision authority. Learned while helping a neighbor in medical distress.

 

[n3qtrtme]

I’m a paramedic and my husband was one for 45 years. We both discussed having an AED onboard since we both know they are excellent devices and save lives and we could easily obtain one. Then we talked about how to run a code with one. With one person down and one working on the victim. Who’s steering the boat? How do we get somewhere for help? How long can effective CPR be done, even with the adrenaline boost? After all the cardiac arrests calls we have run, there was such a minimal chance of trying to make such an arrest a positive ending that carrying an AED was not helpful. I remember the days of the “thump” (whacking the arrest patient in the chest as hard as you could before starting CPR) and can see how that might still work to disrupt a dysthymia. Coughing? Nope. Use that couple of seconds to press the emergency button on the VHF and turn on your EPIRB. Call for help if you have a few more seconds.

 

[Hippocampus]

Have never gotten back talk when asking for PMH. Folks aren’t fools . They understand my focus is on their safety and the safety of the vessel. It’s a judgment call but have excluded people from crewing on that basis. In my mind there’s two types of transits. Those in helicopter range and those beyond it. No amount of medical stores possible on a small boat or prior training by a small crew belies that difference. I’m upfront about my reasons for asking and they’re not stupid so know if not supplied they won’t be chosen as crew. For me to vet crew there’s no sealed envelopes. Still the information is NOT shared except as absolutely required to provide care. I also use a form signed by crew before leaving which clearly states the risks of the voyage, their responsibilities during the voyage and my responsibilities to them. Included is my responsibility to protect their private information except as required for their benefit.

 

[SteveK]

Having some training and more experience than I want, I can confirm that cardiac arrest can and usually does strike without warning. If you heart stops while alone, you're done, cooked, get the fork. March 17, 2020 I went to sleep and didn't wake up, my wife had the presence of mind, and divine guidance, to call 911 and begin CPR. 9 minutes later the squad arrived and hit me with a AED. Prior to this, my BP was within normal range, cholesterol was not a concern, I carried a few unnecessary pounds but the physical I had 3 weeks prior was as routine and brushing one's teeth. If you are "lucky" enough to go thru a similar experience, your best hope is having someone close by who knows CPR or has fast access to an AED. That will save your life. Having an AED on your boat is expensive but could prove useful.
In my case, my wife had not been trained, but Someone gave her guidance. I had run with the local fire and rescue squad, apparently it was like a family reunion that night, complete with deputies. I "slept" thru it all. In fact due to a chart mix up later that night, (I was thought to be 6'4" and 240 lbs, actually 5'6" about 190 at the time) I was administered a bit too much propafol and didn't wake up for a month. March 2020 was the onset of COVID so I can understand the ER resembling a MASH unit.

Very sobering.

 

[CaptainDwight]

Cough CPR

“Cough CPR” really has no residual medical use. It has an interesting medical history. Efficacy requires a well trained patient with cardiac monitoring under the supervision of a trained physician or technician. It is of no use to a layman without equipment and extensive training. Recognition of cardiac arrest in the setting of a myocardial infarction (heart attack) by the victim or onlookers typically occurs only after the victim loses consciousness. An unconscious victim cannot employ “cough CPR”.

 

[Nordlys]

Note the MD disavows ‘cough therapy”

My family has a number of MD’s including an gerontologist and an emergency room physician. I had sent them all a screen shot of the posting and this proves the point of “Don’t Believe What’s on the Internet”. I will attach the two screen shots they sent me and as he said—read the note the quoted doctor put as a disclaimer-file:///var/mobile/Library/SMS/Attachments/63/03/335A91C9-AD48-4EFE-A6CD-DCF011A64741/IMG_8064.jpeg

Hmm. The actual seems to be a link—but have a look at both

file:///var/mobile/Library/SMS/Attachments/dc/12/6FF444C0-532A-473C-AF64-3E424E59F2ED/IMG_8065.jpeg

If you can’t—the gist is he is a Belarusian trained cardiologist (good so far) he denounces and reference to Cough Therapy and any connection to himself.

 

[Mark Laurnen]

Hello. NTG is CONTRAINDICATED in certain scenarios, and can make the situation worse. NTG is a powerful vaso-dilator. It can dilate the coronary arteries, especially if they are in spasm. Also it can dilate the peripheral arterial tree allowing the weaker heart to pump against less outflow resistance and possibly push more blood in it’s weakened state. This is for a left sided heart attack, the most common location, and the left side of the heart pumps the blood out to the body. BUT, a Herat attack in the right side of the heart is different. The right side of the heart pumps blood through the lungs, which then goes to the left heart to be pumped out onto the body. If the right heart is ischemic (blood starved) it may function best with a higher filling pressure which is determined by the amount of venous blood returning from the body. NTG can dilate the veins causing a significant drop in the amount, and pressure, of venous blood returning from the body to the right side of the heart. This reduced “filling pressure” may significantly further compromise the function of the ischemic right heart leading to a downward death spiral. So, while ASA (aspirin) would almost always be safe and recommended, NTG entails definite risk if the location of the blocked blood flow, right vs left, is unknown. The ASA should be chewed, not swallowed. Coughing certainly shouldn’t hurt, but it’s not likely to help. The recommendation for a “precordial thump” (blow to the sternum) to “jump start”” the heart (reset a survivable rhythm) has been largely de-bunked. If all of this said, if I had ASA and NTG and thought I were having a heart attack, I would probably play the odds and take both. One other thing I might do is lay down and elevate my legs. This position improves venous return, from the lower extremities, to the heart. This will increase right heart filling pressure improving the ability of the right heart to pum blood through the lungs and into the left side of the heart for discharge again out to the body. I apologize for this long-winded post, but as an anesthesiologist I see this physiology every day. I guess my last comment would be, when the time comes I think I’d just assume go while boating!

 

[La Mer]

My family has a number of MD’s including an gerontologist and an emergency room physician. I had sent them all a screen shot of the posting and this proves the point of “Don’t Believe What’s on the Internet”. I will attach the two screen shots they sent me and as he said—read the note the quoted doctor put as a disclaimer-file:///var/mobile/Library/SMS/Attachments/63/03/335A91C9-AD48-4EFE-A6CD-DCF011A64741/IMG_8064.jpeg

Hmm. The actual seems to be a link—but have a look at both

file:///var/mobile/Library/SMS/Attachments/dc/12/6FF444C0-532A-473C-AF64-3E424E59F2ED/IMG_8065.jpeg

If you can’t—the gist is he is a Belarusian trained cardiologist (good so far) he denounces and reference to Cough Therapy and any connection to himself.

Now Dr Patrick Teefy would be a Belarusian trained cardiologist ?? c'est de mieux en mieux, here we learn every day ; Indeed your post proves the point of “Don’t Believe What’s on the Internet”


Find below Dr Patrick Teefy's bio I received from The University Of Western Ontario (Western University), 1151 Richmond St, London, ON N6A 3K7, Canada, phone : +1 519-661-2111 :


“Dr. Patrick Teefy hails from Calgary, Alberta but eventually ventured east to undertake premedical education prior to commencing medical school at the University of Ottawa. Graduating in 1986 as a Gold Medalist in his medical class, he moved on to the University of Toronto as a medical intern and completed his Internal Medicine residency at both Wellesley and St. Michael's hospitals affiliated with the University of Toronto. He completed his trans-Canadian training in Cardiology back in his native city of Calgary, Alberta. Following General Cardiology training he stayed in Calgary for Interventional training and cardiovascular research under the directorship of Dr. Merrill Knudtson, one of the preeminent physicians in that field.

Dr. Teefy has been on staff at London Health Sciences Centre since 1993, initially at Victoria Hospital and now based out of the University campus. His main clinical focus is on percutaneous coronary intervention/stenting, as well as structural heart disease involving aortic valves. He is privileged to be a member of the transcatheter aortic valve implantation team (TAVI). In addition he maintains interest in a broad range of cardiovascular diseases. Teaching and research are also major aspects of his academic mission. Research is focused on aspects of interventional cardiology practice and aortic valve disease.

Dr. Teefy has also been fortunate to be involved with the Belarusian Canadian medical educational initiative, endorsed jointly between Western University and Belarusian State Medical University in Minsk. Over the past two decades Dr. Teefy, as well as Dr. William Kostuk, have aided in the advancement of the interventional cardiology program in the Republic of Belarus with didactic seminars and hands-on demonstrations. These techniques and skills are performed on patients throughout Belarus on a humanitarian basis. Both Drs. Teefy and Kostuk have been awarded honorary doctorates from the medical council in Belarus, a country which was heavily impacted by the Chernobyl accident and economic downturn following dissolution of the former Soviet Union.”


Once again Dr Teefy does not endorse any practice of cough CPR and any such reference on the internet is erroneously attributed to Dr. Teefy's name.

 

[Hippocampus]

There are also other situations were decreasing preload would not be advantageous.

 

[SteveK]

There are also other situations were decreasing preload would not be advantageous.

preload?

 

[Mark Laurnen]

In basic concept, the heart is comprised of four chambers, two atria (singular = atrium) and two ventricles, one of each being “right” and the other of each one being “left”, which simultaneously pump blood through two circuits. The right heart consists of the right atrium, which receives all venous blood returning from the body. The right atrium pumps blood into the larger right ventricle. The right ventricle then pumps the blood out and into the lungs where it is oxygenated. The left atrium receives the oxygenated blood coming through the lungs. The left atrium pumps the blood into the left ventricle which is the largest and strongest of the four pumping chambers. The left ventricle pumps the oxygen rich blood, at high pressure, out into the body. In the body, crucial organs like the brain, kidneys and liver, AND HEART extract the oxygen from the blood. The venous system then collects all of the blood, which has now had the oxygen extracted, and returns it to the right atrium to repeat the cycle. Failure of any one of the four pumping chambers (right atrium, right ventricle, left atrium, left ventricle) can impair delivery of oxygenated blood to the vital organs. A heart attack occurs when blood supply is interrupted, or impeded, to a portion of the heart. The left ventricle is the largest, strongest, and most critical. Most heart attacks strike the “left heart” and not surprisingly sudden death is often the first symptom. These pumping chambers are akin to the diaphragm , as opposed to centrifugal, pumps we have aboard boats. If we are trying to pressurize a closed loop system ( think fresh-water cooling) one important consideration is keeping the loop full of the substance being circulated. Muscle fibers, think cardiac muscle fibers, contract more forcefully if they are somewhat stretched before they actually contract ( think of that diaphragm bilge pump that works best when the bellows are completely full). This is up to a point at which the fibers are over-stretched and begin to fail (in congestive heart failure “CHF” fluid has backed up and the heart chambers are overstretched to the point where the heart muscle cells begin to fail). PRELOAD is the term for the pressure generated by the venous blood returning from the body to the right atrium. To a point the pump function of the right atrium increases as the filling pressure (PRELOAD) increases. This is important to insure adequate blood delivery to the right ventricle, lungs and left heart. With traumatic hemorrhage there is not enough blood return, not enough preload, to keep even a normal heart pumping adequately … the pump circuit is empty. With a right side heart attack, the struggling right atrium and right ventricle may benefit from slightly increased preload … e.g. an IV bolus of fluid, or a position (legs up) which increases the return of venous blood to the heart. Nitroglycerin (NTG) is a powerful vasodilator, it relaxes the muscle cells within the walls of arteries and veins. This can allow increased blood flow through the (coronary) arteries supplying the heart which which is beneficial during a heart attack, especially a left-sided heart attack. Alternatively, during a right-sided heart attack, NTG can dilate the veins returning blood to the right atrium, increasing their capacity and decreasing blood return (decreasing preload) which might detrimentally further impair an already struggling right heart.

 

[La Mer]

In basic concept, the heart is comprised of four chambers, two atria (singular = atrium) and two ventricles, one of each being “right” and the other of each one being “left”, which simultaneously pump blood through two circuits. The right heart consists of the right atrium, which receives all venous blood returning from the body. The right atrium pumps blood into the larger right ventricle. The right ventricle then pumps the blood out and into the lungs where it is oxygenated. The left atrium receives the oxygenated blood coming through the lungs. The left atrium pumps the blood into the left ventricle which is the largest and strongest of the four pumping chambers. The left ventricle pumps the oxygen rich blood, at high pressure, out into the body. In the body, crucial organs like the brain, kidneys and liver, AND HEART extract the oxygen from the blood. The venous system then collects all of the blood, which has now had the oxygen extracted, and returns it to the right atrium to repeat the cycle. Failure of any one of the four pumping chambers (right atrium, right ventricle, left atrium, left ventricle) can impair delivery of oxygenated blood to the vital organs. A heart attack occurs when blood supply is interrupted, or impeded, to a portion of the heart. The left ventricle is the largest, strongest, and most critical. Most heart attacks strike the “left heart” and not surprisingly sudden death is often the first symptom. These pumping chambers are akin to the diaphragm , as opposed to centrifugal, pumps we have aboard boats. If we are trying to pressurize a closed loop system ( think fresh-water cooling) one important consideration is keeping the loop full of the substance being circulated. Muscle fibers, think cardiac muscle fibers, contract more forcefully if they are somewhat stretched before they actually contract ( think of that diaphragm bilge pump that works best when the bellows are completely full). This is up to a point at which the fibers are over-stretched and begin to fail (in congestive heart failure “CHF” fluid has backed up and the heart chambers are overstretched to the point where the heart muscle cells begin to fail). PRELOAD is the term for the pressure generated by the venous blood returning from the body to the right atrium. To a point the pump function of the right atrium increases as the filling pressure (PRELOAD) increases. This is important to insure adequate blood delivery to the right ventricle, lungs and left heart. With traumatic hemorrhage there is not enough blood return, not enough preload, to keep even a normal heart pumping adequately … the pump circuit is empty. With a right side heart attack, the struggling right atrium and right ventricle may benefit from slightly increased preload … e.g. an IV bolus of fluid, or a position (legs up) which increases the return of venous blood to the heart. Nitroglycerin (NTG) is a powerful vasodilator, it relaxes the muscle cells within the walls of arteries and veins. This can allow increased blood flow through the (coronary) arteries supplying the heart which which is beneficial during a heart attack, especially a left-sided heart attack. Alternatively, during a right-sided heart attack, NTG can dilate the veins returning blood to the right atrium, increasing their capacity and decreasing blood return (decreasing preload) which might detrimentally further impair an already struggling right heart.

Outstanding explanation thank you Sir

 

[Hippocampus]

Thank you so much for explaining preload. My intention was to point out how you could violate “first do no harm”. In my mind this extends to many non cardiac events. Will offer a few examples.
On screening you try your best to exclude any functional alcoholic from crew but fail. You run a dry ship on passage except for a rare wine or shot at dinner. One crew fails to come up for watch. He’s unconscious. You know he carries nitro and has a past history of CAD (coronary artery disease) but his doc has cleared him for the trip as he had cabg (coronary artery bypass grafts) awhile ago and has been asymptomatic.
You think about putting a nitro under his tongue. But do a careful exam first. You see faint nystagmus (flickers of eyeball jerks) to the left. Assume he’s in non convulsive status epilepticus. There’s a increased incidence of epilepsy in folks with a history of substance abuse disorders including alcohol. What happened was he was withdrawing which precipitated convulsive status. He had been seizing long enough he entered non convulsive status. In this setting you can’t deliver enough oxygen to the brain as to prevent anoxic encephalopathy. You want the highest perfusion pressures you can get. You want the highest oxygen levels you can get. Giving nitro will lower preload and thereby perfusion. You will be contributing to brain cell death by slipping that nitro under his tongue.
Same guy. He hid a bunch of nips in his sea bag. He banged his head and developed a SDH (subdural hematoma). Again find him in his berth. Left fist clenched across his chest. Again decreasing preload and blood pressure which will decrease perfusion to his compressed hemisphere and related structures and increase damage.
Same guy. Now stuporous but complaining of chest pain. Unbeknownst to you is he has pending cardiac tamponade from a bleed between the covering of his heart and the outside of his heart. There’s nothing wrong with his heart but rather he has low platelets from his drinking.
Could go on and on but point being there’s lots of scenarios where you might think the problem is cardiac ischemia (heart attack) but it isn’t and giving nitro would make things worse not better. That’s why my wife and I (and B) know what we don’t know so don’t intervene without consulting with others. We have made plans so we can achieve that. Only intervene when we’re confident in our thinking or have no other choice due to the urgency of the situation.
Paddles are expensive. Ambu bags aren’t. Learn some first provider medicine.

 

[Mark Laurnen]

All excellent examples of the minefield we all tread! Don’t forget about the crew member who brings along the new girlfriend and has a little chest pain from unaccustomed strenuous activity … he might be to embarrassed to disclose the Viagra that he also brought along (remember “Terms of Endearment”)!

 

[SteveK]

Outstanding explanation thank you Sir

Agree and want to add for a non medico understandable.
Mark Thank you

 

[ssobol]

Thank you so much for explaining preload. My intention was to point out how you could violate “first do no harm”. In my mind this extends to many non cardiac events. Will offer a few examples.
On screening you try your best to exclude any functional alcoholic from crew but fail. You run a dry ship on passage except for a rare wine or shot at dinner. One crew fails to come up for watch. He’s unconscious. You know he carries nitro and has a past history of CAD (coronary artery disease) but his doc has cleared him for the trip as he had cabg (coronary artery bypass grafts) awhile ago and has been asymptomatic.
You think about putting a nitro under his tongue. But do a careful exam first. You see faint nystagmus (flickers of eyeball jerks) to the left. Assume he’s in non convulsive status epilepticus. There’s a increased incidence of epilepsy in folks with a history of substance abuse disorders including alcohol. What happened was he was withdrawing which precipitated convulsive status. He had been seizing long enough he entered non convulsive status. In this setting you can’t deliver enough oxygen to the brain as to prevent anoxic encephalopathy. You want the highest perfusion pressures you can get. You want the highest oxygen levels you can get. Giving nitro will lower preload and thereby perfusion. You will be contributing to brain cell death by slipping that nitro under his tongue.
Same guy. He hid a bunch of nips in his sea bag. He banged his head and developed a SDH (subdural hematoma). Again find him in his berth. Left fist clenched across his chest. Again decreasing preload and blood pressure which will decrease perfusion to his compressed hemisphere and related structures and increase damage.
Same guy. Now stuporous but complaining of chest pain. Unbeknownst to you is he has pending cardiac tamponade from a bleed between the covering of his heart and the outside of his heart. There’s nothing wrong with his heart but rather he has low platelets from his drinking.
Could go on and on but point being there’s lots of scenarios where you might think the problem is cardiac ischemia (heart attack) but it isn’t and giving nitro would make things worse not better. That’s why my wife and I (and B) know what we don’t know so don’t intervene without consulting with others. We have made plans so we can achieve that. Only intervene when we’re confident in our thinking or have no other choice due to the urgency of the situation.
Paddles are expensive. Ambu bags aren’t. Learn some first provider medicine.

This is all well and good. If you are an experienced ER doctor you might be tuned in and experienced with all these scenarios. However, in an actual crisis, the average boater (even with first aid training) is going to miss most of these details. If you call 911, they are unlikely to have you check for all these issues before telling you that is most likely a heart attack and what to do for first aid until the paramedics arrive.

 

[Mark Laurnen]

Over the years the multi-pronged complicated algorithm taught to physicians and EMS responders for treating a cardiac arrest (or imminent arrest) patient have been extremely simplified and contracted … because almost nothing really increased the likelihood of discharge to home after a cardiac arrest. The discouraging reality. Now it is recognized that the most important factors are early effective CPR and early defibrillation with an AED (Automatic External Defibrillator) … way more important than any medications. Everyone should learn how to render effective CPR, it is not complicated or difficult. Also, AED’s are ubiquitous … at least on shore … and they are not complicated or difficult. So back to the original thread: I’m afraid that if you have a cardiac event, while alone, significant enough to incapacitate you … well, I think your time has come.

 

[Hippocampus]

+1

 

[ssobol]

Over the years the multi-pronged complicated algorithm taught to physicians and EMS responders for treating a cardiac arrest (or imminent arrest) patient have been extremely simplified and contracted … because almost nothing really increased the likelihood of discharge to home after a cardiac arrest. The discouraging reality. Now it is recognized that the most important factors are early effective CPR and early defibrillation with an AED (Automatic External Defibrillator) … way more important than any medications. Everyone should learn how to render effective CPR, it is not complicated or difficult. Also, AED’s are ubiquitous … at least on shore … and they are not complicated or difficult. So back to the original thread: I’m afraid that if you have a cardiac event, while alone, significant enough to incapacitate you … well, I think your time has come.

If you get to the point where someone is performing CPR on you, your chance of surviving long enough to be discharged from a hospital are pretty poor. Around 10% in North America.

 

[FF]

WOW! This thread has so many opinions its like watching HOUSE on TV!

 

[BandB]

WOW! This thread has so many opinions its like watching HOUSE on TV!

Yes, and Dr. House (oh a show from the past) but Dr. House, always guessed wrong the first time.

 

[SteveK]

Yes, and Dr. House (oh a show from the past) but Dr. House, always guessed wrong the first time.

Yes do as many tests as the insurance will pay for while you are teaching the rookies how to diagnose and that is billable hours or how to fill in an hour show, I forget.

 

[Peter B]

Might I respectfully remind folk of the following great tips for posting..?

1. If it's a long'un, consider first, if it really needs to be that long - in other words, a quick re-read and edit before posting might be good..?

2. If it needs to be long to achieve the aim, please paragraph, (ie two line space) at comfy reading intervals. It actually encourages folk to actually read them.

3. For those wanting to respond/reply to such posts, please consider instead of quoting the entire post, just posting, something like, "Hi, XYZ, great post - thanks for that", or words to that effect...

or...just quote selected parts of the post being replied to, rather than the rather (? lazy) quick click on the 'quote' button. Because that highlights the specific issue one is referring to in a much better way.

Just sayin'...