Posted by: medicblog999 | April 15, 2009

Can you do heart massage?

_618585_heart-massage150Here’s one to hopefully make you giggle a bit!!

Called to a local nursing home for a collapse? breathing.

I am working on the Rapid response car, so I set off at the speed of light to try and meet the Cat A response time of 8 mins from time of connection of the phone call to the control room.

Sure enough 5 minutes later I arrive on scene and I take a moment to imagine the control room staff standing and cheering as they congratulate my timely arrival on scene (Try and imagine a scene from NASA control when a successful launch occurs) where I am now in a position to use all of my advanced life support skills to save yet another life!

cheering

Anyway, back to reality!

I gather my kit from the back of the car, which is no mean feat in itself, and stumble my way into the home. I am shown to the farthest bedroom on the highest floor (well known ambulance fact – If you ever have to go into a home or sheltered accommodation, make sure they put you as close to the main entrance door as possible, as it is highly unlikely that you will be poorly. We always end up going to the farthest room in the building for the poorly patients) where I find an elderly man lying on the bed with no signs of life.

No evidence of rigor and no post mortem staining, so I get some help from the staff and move him onto the floor and start CPR. Whilst I am doing this, I ask for a quick history. The care staff, including the registered nurse, state that they came in to check on him and found him gasping for breath. Whilst one ran down and dialled 999, the other stayed with him to “comfort him” It transpired that shortly afterwards he stopped breathing, but they still comforted him……..No CPR though.

Following the time line of events, it looked like he had been “down” for less than 5 minutes so resuscitation was on the cards, a quick check with the paddles of the defib showed PEA (pulseless electrical activity). At the time we were still doing ventilation’s first (this was a couple of years ago) so I ensured his airway was clear, inserted a OPA (oropharyngeal airway), and delivered 2 ventilation’s. I was just about to start compressions when I asked

“Can anyone do heart massage?”

A male nurse, Michael,  stepped forward and said

“Yes, no problem, would you like me to help?”

Fantastic!, now that I have an extra pair of hands I can think about securing the airway with an ETT and then get another one of the carers to “bag the patient” whilst I get on and gain IV access and deliver the cardiac drugs.

Then all my enthusiasm for my helpers disappeared in the blink of an eye, or rather I should say, the moment of disbelief when I noticed just how effective the cardiac compressions were being delivered by my “able” assistant.

As I am at the head of the patient looking down, I see Michael with both hands flat on the either side of the patients chest, there is no downward pressure being applied to compress the heart in the thorax, instead, I kneel with open mouthed amazement as I watch this fully qualified registered nurse gently rub his hands in a circular motion around the patients nipples (imagine Daniel in the Karate Kid – “Wipe on, Wipe off!).

M999:          “You`ve got to be kidding me???”

Michael:       “What???”

M999:           ” What do you think you are doing? You said you knew cardiac massage!”

Michael:       ” Yeah, this is how we were taught it”

No time to argue, I take over both functions and decide on continuing basic life support until my back up crew arrives. As I am waiting Michael asks if he could “do the breathing for the patient”. Err, Let me think now……… NO!!

He starts delving into my kit bag looking for things to help with, he asks if I want a blood pressure reading.

IS THIS REALLY HAPPENING???

I decide to make the best treatment decision of the day, I ask him if he will go back down to the car and bring a box of gloves from the boot up for me. I didn’t need any, just wanted to get him away from me and the patient.

Shortly afterwards my back up crew arrive in the room carrying a box of gloves in with them with a quizzical look on their faces.

“What do you want these for????”

If only they knew!

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Responses

  1. It’s scary isn’t it?

    I remember going to a nursing home, it was a DIB, updated about 2 mins from scene ‘now cardiac arrest’. Arrived on scene. Rang the bell. Waited. Banged on the door. Waited. BANGED ON THE DOOR. Waited. Eventually what looks like a cleaner answers and looks at us quizically. About 5 minutes after we booked on scene we found the patient, only to be met by a nurse with a sphyg round the patients arm and the comment “He stopped breathing, so we tried the CPR, it didn’t work, and now I can’t find his Blood Pressure”

  2. Priceless! We just walk into nursing homes and they’re doing compressions on the mattress while the pt is just bouncing up and down, or they’re trying to do compressions and the patient is telling them to stop.

  3. Sadly that did make me laugh, if only the people in these home knew about the skils of the people looking after them i bet theyd think twice about going in them

  4. As vicky just said it’s scary just how unprepared for anything “outside their box” some of these people are. If I ever end up in a Home I want to sleep in the foyer, as you said the nearer the front door the better.

  5. I’d like to say I’m gobsmacked, but unfortunately it’s all too real.

    IMHO, every child over 14 (maximum) should be taught CPR at least every year until they leave. If there is not time for it, pinch it out of Religious Studies and let them find a practical way of helping their fellow humans.

    It may even be remembered by some health “profesionals” who should know better.

    Surely annual CPR training should be compulsory for all doctors and nurses. It’s not hard to learn!

  6. Good god, hope all Nursing Homes aren’t like that … we’ve got to start looking for one for my Dad. Think I’ll suggest a bed in the day room !!! …. and question the skills of the staff too ! Did make me chuckle though.

  7. Hi Mark,

    I just found your blog today.
    Very well written and just what I enjoy reading.
    I’ll be trying to find the time to read it from the start (I’ve read December and part of January so far).
    I’ve also added you to my list of blogs I read.

    Regards
    Dave

    • Hi Dave,
      Welcome to Medic999. Im glad you left a comment as I have been searching for some Australian EMS blogs, but had yet to find any.
      Looking forward to reading yours and you are added to my blog roll too!

  8. Some home health care workers aren’t trained in anything yet they are called home health. And the ones that might be CNA’s or LPN’s don’t know any vitals, don’t take any and don’t or won’t share anything they know. Some of the homes we’ve been to I’ve had to go through the worker’s files while my partner interviews the pt and the health care worker gets in the way and wonders why we need to know all this.

  9. Excellent! The description of your thoughts during this call shows how gobsmacked you were. We are always amazed that people who are paid to look after our loved ones are so incapable.

  10. Hi Mark,

    I went to an arrest at a nursing home yesterday and was remembering the things i’ve seen at this home previously (compression being performed on a consciouss pt, another time an RN using the reseviour bag from a non-rebreather to bag a pt). Imagine my surprise when I arrive on scene to see the pt on the ground with effective ECC being performed (somone was even maintaining a triple airway manourve). It was unfortunate though that this was being done by the assitants in nursing while the RN was telling me the pt had arrested a fortnight ago but ‘came good with oxygen’, i’m guessing he had a syncopal episode or something similar. Anyway, my point is the assitants did a terrific job while the RN who earns nearly double and is supposed to have a higher level of clincal knowledge was an embarresment. Unfortuantly we got a return of circulation on the old bugger, he was 98 and should have been allowed to die peacefully (my opinion only)

  11. Your story makes me laugh & cry at the same time. It’s scary how universal these issues are, across countries & states alike. At least there were some “skilled” hands around to give you some patient history, around my territory it’s like searching for Santa Claus when I need information.

    Keep up the good work!

  12. Its a bit of a late response to this blog but what the hell. This reminds me of pretty much all the nursing home calls we run on. An RN telling me a patient is in V-tach……..really? is that what the ECG machine is showing? No she isnt on an ECG machine but she is definatly in v-tach….wow. Also 3 RNs in a patients room next to the patients bed when we walk in and ask, How long has the patient not been breathing ( He was quite clearly dead) To which they replied Oh he was breathing when we last checked him….Huh your standing right next to him, im confused….


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