I'm pleased to announce that my new office is nearly ready.  There are still a few pieces of furniture to bring in, and some new equipment on order.  This is the waiting room, and that thing on the wall (left side) is a water fountain that makes a delightfully relaxing sound.  My office is the one with the light coming in on the right.  More photos to come.

You probably don’t want to think about it.  It’s gross, it’s difficult, it’s sad.  Most people who get CPR are goners.  Maybe you never want to take another class.  OK, I can accept that.  What I can’t accept is that you might not even try to do CPR, or that if you do try, your efforts could be ineffectual and wasted.  I’m writing this to encourage you to know the basics of quality CPR, even if you don’t get the certification.  You wouldn’t stand idly aside if someone were dying in front of you.  We would all do what we could.  CPR is what we can do.  So please read this and make mental notes, just in case.  Print out the steps at the end and stick them in your car or first aid kit.  If you try to help and do the best you know, you are protected from liability by the Good Samaritan Law.  Some people get CPR and live.  You could save a life.

The American Heart Association updates their teachings each five years, and the last update meeting was in 2010.  This is what they have taught since then.  The next meeting will be in October 2015 and the update will come out in April 2016.

Science has shown that it’s more important to get the blood moving right away than it is to try and push air in.  They’ve cut the beginning part short to get you doing compressions sooner, because it makes a big difference in survival.  The sooner you start moving blood, the better the victim’s chances.  There’s enough oxygen already in the blood to keep the brain alive for a while, you just have to get it there.

Before you dive into the assessment process, look around to be sure the scene is safe.  Think about it and take care of yourself.  If you have to, move them.  CPR works better if they are laying on a hard flat surface, and if you cut or lift any interfering clothing including a bra.  Don’t have a committee meeting about it, just do it.  Don’t torque the neck if there is a risk of head or neck trauma.  Look for any life threatening injuries, like heavy bleeding or a broken neck.  It doesn’t help to save a person from one threat while another one kills them.

Quickly make sure they’re not napping.  If they don’t respond to a light touch and loud voice, assess for responsiveness by rubbing a knuckle on their collarbone or breastbone, or flick the foot of a baby.  If there are no obvious signs of life and consciousness, have someone call 911.  Next check for a pulse in their neck (the carotid artery).  This is something to practice, so that you know where that pulse ought to be.  If you aren’t sure, or can’t find a heartbeat, start compressions.  If there’s a defibrillator (AED) around, send someone for it.  Likewise it’s very nice to have a face mask of some kind if it’s available. Positive pressure oxygen can also help.

They’ve stopped telling us to measure our hand position on the chest.  Just mash hard on the bottom half of the breastbone with the heel of your hand.  Using straight arms and both hands, drop your upper body weight to compress the chest at least 2 inches on adults.  The compressions should be less for small people; compress no more than 1/3 the body thickness.  Lift up in between compressions to let the chest rebound as far as it will.  This gets to be the hard part when you are tired; don’t lean on the chest.  The best quality compressions get about 30% of normal blood flow.

When you start doing CPR on an adult, you can expect for cartilage and ribs to make crunching sounds.  Don’t let it stop you.  You can expect the patient to vomit; don’t let it stop you.  You can expect to get tired.  Switch positions every 2 minutes if you have help.  If you see this going on, rotate in.  You could save a life.

The rate of compressions is at least 100/minute (max 120), same as the BeeGees song “Stayin’ Alive”.  If you know it, sing it internally and get the beat.  The ratio of compressions to breaths for adults is 30:2 for both one and two person scenarios.  The person doing compressions is supposed to count out loud. This keeps you from going too fast.  

Getting air in requires that you open the airway, pinch the nose shut, and blow in the mouth.  The head tilt chin lift is the standard way; bend the head back and pull the jaw forward with fingers under the chin.  It is possible to tilt the head too far and close the airway.  You will know if you are getting air in.  Blow in a smallish normal breath, about 200ccs of air, just enough for the chest to rise.  Don’t overventilate.  If you blow too much air in you fill the belly instead of the lungs, increase the vomiting, and decrease the freedom of the diaphragm to move.  If they vomit, roll the victim on his side and finger sweep out the vomitus before blowing more air in.

There are differences for children up to the age of puberty.  The ratio 15:2 if there are two rescuers, but the same 30:2 for one rescuer.  If you are alone and don’t know how long the kid has been down, do 2 minutes of compressions (5 sets of 30) before you even go for help.  Be extra careful not to overfill them with air; small puffs instead of breaths is all you need to make the chest rise.  Instead of compressing an infant’s chest with both hands, use two fingers.  Also, if you have two people working on a baby, the person doing the compressions can put both hands around the sides of the baby’s chest and do really good compressions with the thumbs.  The air person stays by the head and blows air into the mouth and nose, two breaths at a time with the head gently tilted back, watching for chest rise and no more.

New research shows that in a hospital setting, extended CPR increases a patient’s odds of going home by 12%.  The lesson: don’t give up too fast.  Keep going for at least 15 minutes, and for 30 minutes if you can.  It’s a workout, so help each other, take turns, take breaks.  You can stop when paramedics take over, the victim wakes up and starts breathing again, there is a danger to yourself, or you are too exhausted to continue.


CPR STEPS

1. Practice finding pulses on yourself and others; develop a feel for them.
2. PERSON DOWN!  Assess scene safety, move if needed.
3. Assess for responsiveness.
4. If no obvious signs of life, get help, call 911.
5. Check pulse in neck for adults, upper arm for babies.
6. If no pulse or uncertain, begin 30 chest compressions, at 100bpm+ and 2”+ deep on adults.
7. Ventilate with 2 gentle breaths (see chest rise) for each 30 compressions.
8. Keep going at least 15 minutes or until relieved by more trained people.
9. After it’s all over, find a way to decompress emotionally.

I've started using a lab called Ultra Lab Tests that offers deeply discounted rates on lab testing.  The only hitch is that you can't use insurance to pay for it, you just pay up front online, and show up to a local blood draw station to get it done.  It's useful for folks whose insurance has high deductibles which they aren't going to meet, and for those who are too stubborn to submit to the Obamacare mandated insurance.

Here's the lipid panel for your annual cholesterol check:
https://www.ultalabtests.com/fundamentalmedicine/Item/Item/985


The news recently has told us that the government recommendations to avoid eating fat have been reversed.  For 20 years people have been eating "low fat" foods thinking it would lower their cardiovascular disease risk, and that turns out to be false.  In fact, eating low fat is very bad for some people, like me and my family, who get fat quickly when we eat a lot of carbs.  Not everybody is the same, but it's worth paying attention to your blood sugar and lipids longterm, to make sure that you have found a good metabolic balance.

Here's a test that will tell you if you are insulin resistant (which contributes to weight gain and diabetes) or hypoglycemic:
https://www.ultalabtests.com/fundamentalmedicine/Item/Item/909


If you are not sure which tests would be most helpful for evaluating your health and risk factors, I will be happy to help.  Call 5o3-694-9six98 to make an appointment.  New patient visits are pretty long, but after I have a good idea about your current status, followups can be brief.  For folks that haven't met me yet, I'm happy to meet you in person any time it fits into my schedule for a 15 minute free consult.  It's a good way to find out if my philosophy agrees with yours.

Walking.  We figure out how to do it after crawling for a while.  We do it for decades without a second thought.  We skip and run, we carry loads and climb ladders and live life on two feet.  Walking is effortless.  

When an injury happens, suddenly walking isn't so easy.  We must learn how to walk again, step by wobbly step, using crutches, rails and the strong arm of a friend. Over the years our injuries accumulate.  It isn't many few decades after we stop crawling that we begin to stiffen up and slow down.  Arthritis brings persistent pain into our paces.  

Healing is spontaneous most of the time, and sometimes we get knees repaired or joints replaced.  When walking isn't so easy, we appreciate just how important it is.  Our ability to walk is part and parcel with our lives.

Walking speed correlates directly with life expectancy in our later years.  Fast walkers live longer.  Overall, not in every specific case.  When congestive heart failure (CHF) strikes and we are confined to our beds, walking can save us or kill us.  Research has shown that most people with CHF get better when they begin a program of walking.  A few individuals have worse outcomes, early, the rest of have better outcomes, period.

Walking is a test and if you pass, you live.