Tuesday, April 01, 2008

Hands On

Man, I wish this recommendation had come out years ago.

The one & only time I've ever done mouth-to-mouth resuscitation to a real-life human being was several years ago in my first month of work in a downtown GP clinic. Security had called up to inform us that someone had fainted & they were bringing up the lady. This was at lunchtime when I was one of two doctors on duty, the other one having gone out to lunch, & we were operating on a skeleton crew of clinic assistants.

As soon as I saw the patient's condition, I knew this was not a simple case of syncope, but that she was in cardiopulmonary arrest. She was blue, no pulse, no respiration, & probably had been in this state for at least 15 minutes judging from what the security guard told us.

Adrenaline kicked in immediately as I called for one of the nurses to help me give CPR & look for the crash cart which no one could find as the assistants in charge of "taking care" of the cart had gone out to lunch...so much for being prepared.

Anyhoo, given the urgency of the situation, I had no choice but to give direct mouth-to-mouth resuscitation while the nurse did chest compressions. Fortunately, the patient had a relatively dry mouth (could have been bad - use your imagination). Unfortunately, given that she had probably been down for at least 15 minutes, despite our continued attempts at CPR, there was no response. The ambulance medics continued CPR as they brought her to the nearest hospital.

Alas, this was not a happy ending.

9 comments:

nofearSingapore said...

Hi
My experience with mouth-to-mouth was just as horrific!
I had just arrived at the golf club and the marshalls told me that a fellow golfer had collapsed on the fairway and was not on the way back to the club-house (in the buggy).
The man was already blue and without pulse or respiration. As the ambulance has not arrived, I had to do mouth-to-mouth CPR whilst quickly getting a history from his golf buddies! (Actually what I wanted to ask was that he did not have HIV/infectious disease- but did not know how to say it in nice way).
When the ambulance arrived, the medic was unhurried and took her sweet time strolling to the ambulance getting equipment! No, she says there is no intubation set! No, there is no tube for me to do mouth-to-tube too ( instead of directly on the lips).
To this day, I can still remember the taste and smell of stale secretions!
Needless to say, the man did not make it to the hospital!
That is why I always said the old Warren Golf course ( Dover Rd) is tough- it can kill!

Dr.Huang

aliendoc said...

My experience with the ambulance was just as bad. They didn't have an intubation set, & when they hooked up the defib/ECG machine, it didn't work!!! Not that it would have helped this poor lady, but still...

Anonymous said...

gosh! both of u should have thought of that (mouth to mouth resus) before submitting your applications for medical schools...

aliendoc said...

thanks for dropping in anonymous.

Applying for medical school & being a doctor is more than just mouth to mouth resuscitation. In a well-equipped clinic or hospital, intubation sets or masks are available for helping the patient breathe.

I think the noblest of doctors would be squeamish about doing mouth to mouth resuscitation when there are mucoid secretions or vomitus oozing from the mouth. But whether this squeamishness would stop the doctor from doing it in an emergency situation, well, that's the big question isn't it?

nofearSingapore said...

Hi anon:
CPR and mouth-to-mouth is not just for doctors.
Any trained CPR layman would also do it when the situation warrants.
But mouth-to-mouth may be a thing of the past as there is a news article today ( I don't know where I read it) that chest compressions uninterrupted is better than compressions and m-to-m!
They should have told me that on that fateful day years ago.
When I was faced with the need for m-to-m then, I remember I hesitated for less than one second and then just did it. I was vomiting for ten minutes after the ambulance left! ( No one saw me vomiting of course- I had to preserve doctors' stoic image! ha ha).
Doctors are from a different planet I think!

NB: If I were in Sub-Saharan Africa, I would carry a resus bag and mask with me all the time ( so no need M-to-M) HIV is more than 40% in the population.

Dr.Huang

lh said...

Hi aliendoc, does it mean we can just pump the collapsed person chest w/o m-to-m? won't it makes matters worse (considering the passerby is not trained, where to pump??)-the article says we cannot make it more worse.. and can't be that we keep doing this non-stop till the ambulance comes?

aliendoc said...

hi lh: you would still need to learn how to apply chest compresions properly. And yes u would need to do it till the ambulance arrives.

lh said...

Thanks. So does it mean that passerbys who are not trained shouldn't try to do it at all? The article seems to suggest otherwise-i.e do it rather than standby idly. I've come across readings that has similar suggestion and wondered if it's really advisable..passerbys who just "thump" the chest are not doing more harm? or they cannot do more harm already..?

aliendoc said...

Tough call. I don't expect someone who is not trained in CPR to "jump right in" & start pumping the person's chest randomly. Some questions that come to mind: Is the patient truly collapsed? I.e. no pulse, no respiration. Does the good samaritan know how to assess this properly? Someone who has been trained to perform CPR would know what to look for.

Personally, if you didn't know what you were doing & just anyhow "hantam", you may end up cracking some ribs (which is a possible complication of chest compressions anyway) or make the guy throw up if you compress the stomach.

So lesson of the day is to encourage the average citizen to learn CPR. It's not difficult - even secondary school students can learn to do it.