Saturday, July 12, 2008

r.i.p. tony snow

in case you didn't hear, tony snow died this morning after a battle with colon cancer. here's an nytimes story. in case you didn't know, he was a christian as well. here's a christianity today article he wrote. big losses in tvnews/politics lately with tim russert's recent death as well. i guess a reminder to all about the brevity of life.

Friday, July 11, 2008

thank you, thank you

i hope to surprise my SIL (sister-in-law for all you people who don't spend disturbingly large amounts of time on the internet) by thanking her for listing me in her award list for blogs she likes. odd sentence structure there. whatever, i'm too lazy to change it ... but apparently not too lazy to write another sentence about how i'm lazy. interesting. anyway, i'm also supposed to list this website which apparently started the award. here's the award pic below also. i do hope this award was legit; as anne mentions on her blog entry, there may have been a family bias to her awards. i don't want this thing to be rigged.

Thursday, July 10, 2008

viewer mail

okay, i'm gonna spend a minute discussing some important questions that came up in a viewer comment regarding the recent cpr post.

first, the aha (american heart association) advisory committee and i want to emphasize that whether you do traditional cpr with mouth-to-mouth or compressions-only cpr, the survival is similar. having said that, another way of looking at it is that, if there is any concern or hesitancy about the mouth-to-mouth part, feel assured that chest compressions only will offer similar benefit. read the aha press release here.

second, remember that this is for out-of-hospital, witnessed cardiac arrest. this is not applicable to witnessed "fainting" (or "falling out" as our hospital population calls it ... incidentally, apparently karen's side of the family had never heard this term. i hear it so often from our patients that i assumed it was common but apparently that's true only in certain populations). if someone faints, typically there is an inciting reason (stood up too fast, gross movie, etc.) and they will "come to" (is this another one of our inner city terms?) fairly quickly. if someone has cardiac arrest, they will NOT spontaneously wake back up. if you are adept at feeling pulses, they will also likely not have a pulse.

third, for the most part, this is for adults only (sort of like an r-rated cpr). most kids, younger folk, drownings, drug overdoses, etc. typically have respiratory arrest and in those cases, oxygen (via your mouth) is the most important factor for survival. so, in kids, lack of oxygen is the problem leading to heart and brain injury. in adults, it's usually the heart problems that lead to the brain and oxygen problems.

next, how long do you do compressions before you perform mouth-to-mouth? i'm not sure if there's an official answer to this but you can probably go at least 4 minutes or more before giving the rescue breaths.

do you ever stop compressions to see if they're breathing? short answer, no. assuming it's true cardiac arrest, your chest compressions will not get their heart kicking again and they will not spontaneously breath until it can get jump-started. this typically occurs via electricity, i.e., shocking someone. either that or correcting other underlying disorders which only the paramedics will be able to potentially do.

what's the best position? there is no official preference for side-by-side compressions or compressions while straddling the person. however, in my opinion, straddling the person may actually be more beneficial because the weight on the abdomen theoretically could help improve blood return to the heart by basically squeezing the blood out of the abdominal organs. not to throw anyone off, but there's even evidence and a push by some people for "abdominal" compressions instead of chest. see this interesting story.

so, in summary ...
  1. chest compressions only is an alternative to traditional cpr with compressions and rescue breaths.
  2. this method only applies to adults who have witnessed cardiac arrest. anyone with obvious airway problems needs oxygen!
  3. continue compressions until ems arrives. if it takes longer than 4 to 5 minutes, consider giving some rescue breaths.
  4. don't stop compressions for anything (except rescue breaths). if a patient miraculously starts breathing spontaneously, you will know it and can stop. in general, however, a person will not wake up from sudden cardiac death unless ems or the hospital staff intervenes (unless, of course, an aed--automated external defibrillator--is available).
  5. compressions is better than nothing.
hope this helps.

Tuesday, July 08, 2008

happy b-day kiddo!

okay, i can finally wish kate a real happy birthday, not happy 173rd day of life or happy 7 months as in the past but happy 1 year! that's right friends, one year ago today, kate made her descent down the ol' birth canal and into this world. (karen loves it when i talk this way.) i don't think the shape of her head has quite recovered from the trauma. ha! fortunately for me, being in the medical field, i have seen much more traumatic and dare i say messier stuff so the process itself didn't bother me too much.

so many highlights from the past year. look for karen's postings to come for a lot of other stories but first, here's a video of a "dueling growls" game that kate and i play. not sure how it started but kate started making this noise so i decided to do the same and now we do it back and forth to each other. sometimes i use it as a mini-gps device--if i don't know where she is i'll make this noise and listen for a response to locate her.

one of the joys of being a parent is watching the funny and quirky little things she does, especially at this age when she doesn't really know what she's doing (or so we think). i actually find most things she does funny in some way. a very brief listing of some funny memories: swinging things in front of her (with the rare bonking of the head with said object) and then at times just swinging her empty outstretched arm for no apparent reason; lowering her head when she goes into turbodrive crawling; her first balloon experience (kid went craaaazy); how her face would (and still does to a less extent) get all splotchy when she cried hard; tooting sometimes when she strains from crying also.

she loves "undoing" things these days--taking things out of boxes and purses, throwing things off of tables, pulling books off of shelves, cd's off of racks and junk out of drawers. tends to make the place very messy.

phases i'm happy to see pass: spitting her food at us (didn't last too long thankfully), not having to make as much formula or clean as many bottles (although of course this gets replaced with bowls and spoons and sippy cups ... but still better than cleaning bottles i say), 2 words--breast pump, having to burp her (which i didn't really mind but just something that has passed), sleeping exclusively on our loveseat.

okay, lots more i could add to the above but i need to get this post out before midnight so till next time. happy birthday katherine suna!