Emergency steps one should take (?)

[quietmorning]

Referring to the recent post about medical alert jewelry, it got me thinking. . . I'm at the age now where Murphy is moving into the back room and taking up residence. So, people slip on soap, have heart attacks, etc.

With the idea of practicing fire drills and getting out of the house safely . . . to be prepared, if I collapsed in the house - should someone run and get my cpap machine and hook it up to me? (Seriously) Is there an easier way of making sure my airway stays open and me able to breathe until help can arrive?

Has any one been in this situation before?

[jencat824]

Interesting thought... I've never thought about this before, but in the case of a compromised airway, it seem like it would help. I have 2 artificial joints & I have fallen multiple times (yes, I know you are never supposed to fall on them, but life happens) & if I had been short of breath, I probably would not have thought about my CPAP as an emergency tool.

Interested to see what others think.

Jen

[The Choker]

quietmorning, Some emergency responders are carrying CPAPs on their vehicles. The CPAP is used on patients with lung and heart problems irrespective of whether they are CPAPers. Of course it helps force air into the lungs and improves the survival rate and reduces damage.

[PreemieNrsTiffy]

Hey QuietMorning;

I hope I'm not being overly simplistic here but have all family members take friends and family CPR. I am aware that in the last couple of years, rescue breathing has been de-emphasized but this would be important knowledge. If anyone in your household, with or without sleep apnea is not conscious and not breathing, all should know how to administer rescue breathing. If your family member knows how to administer rescue breathing, this is much more supportive than most CPAP machines. If someone with OSA is unconscious they are more likely than others to be unable to support their airway, but emergency protocols call for rescue breathing (with mouth to mouth or ambu-bags if they are available) and not CPAP. They should certainly make the emergency personnel aware that you have OSA (or whatever condition calls for CPAP). Later at the hospital, the emergency physician and any following physicians will want more details about your medical history and what machine you use with what settings.

I've heard tragic stories of families hooking up mama (or whomever) to the CPAP machine when she's had a heart attack but it does no good if the patient is not having any spontaneous respirations. CPAP can be a great tool for the emergency workers for the correct situation. If the patient is unconscious and not breathing, CPAP may not help and emergency personnel would be ready to accelerate support beyond CPAP in that case.

Now to my personal soapbox. Make a detailed living will, with specifics, not vague generalities. Have discussions with your spouse (or designated medical power of attorney) about what you want or don't want done if there were to be a devastating diagnosis and you are not able to communicate your wishes. Too many families are left with choices that are made that more difficult by not knowing what their loved one's wishes are.

[The Choker]

Here you go.

Two years ago, I attended a meeting where several EMS medical directors were discussing the implementation of continuous positive airway pressure (CPAP) in their systems. Many were already seeing the significant benefits of CPAP. One reported his system had already reduced the number of patients requiring endotracheal (ET) intubation in the field by 79%. He felt CPAP kept many elderly patients from becoming ventilator-dependent and from “never getting off the vent.”

Another stated that nearly 50% of the patients admitted with ET tubes in one of his facilities ended up being treated for respiratory infections, particularly ventilator-associated pneumonia, and that 54% of these patients eventually died from their infections.

...

pointing out the following “contact minutes” where CPAP could be beneficial:
• Initial recognition of acute respiratory distress to the start of patient packaging (five minutes);
• Patient packaging (three minutes);
• Transfer to the ambulance
(five minutes);
• Loading and preparing the patient for transport (two minutes);
• Travel time to the hospital
(eight minutes); and
• Off loading of the patient and transferring care to the ED staff, which might not have CPAP immediately available (five minutes).

Full article http://www.jems.com/article/patient-car ... inute-time

[ems]

I hope I'm not being overly simplistic here but have all family members take friends and family CPR. I am aware that in the last couple of years, rescue breathing has been de-emphasized but this would be important knowledge. If anyone in your household, with or without sleep apnea is not conscious and not breathing, all should know how to administer rescue breathing. If your family member knows how to administer rescue breathing, this is much more supportive than most CPAP machines. If someone with OSA is unconscious they are more likely than others to be unable to support their airway, but emergency protocols call for rescue breathing (with mouth to mouth or ambu-bags if they are available) and not CPAP. They should certainly make the emergency personnel aware that you have OSA (or whatever condition calls for CPAP). Later at the hospital, the emergency physician and any following physicians will want more details about your medical history and what machine you use with what settings.

I've heard tragic stories of families hooking up mama (or whomever) to the CPAP machine when she's had a heart attack but it does no good if the patient is not having any spontaneous respirations. CPAP can be a great tool for the emergency workers for the correct situation. If the patient is unconscious and not breathing, CPAP may not help and emergency personnel would be ready to accelerate support beyond CPAP in that case.

Now to my personal soapbox. Make a detailed living will, with specifics, not vague generalities. Have discussions with your spouse (or designated medical power of attorney) about what you want or don't want done if there were to be a devastating diagnosis and you are not able to communicate your wishes. Too many families are left with choices that are made that more difficult by not knowing what their loved one's wishes are.

Excellent post and definitely worth reading.

[billbolton]

Of course it helps force air into the lungs

CPAP doesn't "force air into the lungs" - the pressures are much too low for that

CPAP is primarily for the purposes of "stinting" an airway that is blocked by muscular issues in the throat.

Many first-responder resuscitation protocols advise that a patient is physically arranged, if possible, so that they are lying on their side, to minimise the risk of airway blockages

Cheers,

Bill

[The Choker]

CPAP is primarily for the purposes of "stinting" an airway that is blocked by muscular issues in the throat.

Sounds like a "helping force" to me. But call it what you want.

BTW, it is "stenting".

[billbolton]

Sounds like a "helping force" to me.

Sounds like you don't really care much for fact

[jencat824]

Make a detailed living will, with specifics, not vague generalities. Have discussions with your spouse (or designated medical power of attorney) about what you want or don't want done if there were to be a devastating diagnosis and you are not able to communicate your wishes. Too many families are left with choices that are made that more difficult by not knowing what their loved one's wishes are.

This is a very good point - I'm big on making sure people have living wills - it gives everyone else in the situation the specifics of what you want done if you can't say so for yourself.

Jen

[Therapist]

Many first-responder resuscitation protocols advise that a patient is physically arranged, if possible, so that they are lying on their side, to minimise the risk of airway blockages

This is not true.

All Certified First Responders are taught to use a recovery position which is different from a simple "lay-them-on-their-side" approach.

[Drowsy Dancer]

Make a detailed living will, with specifics, not vague generalities. Have discussions with your spouse (or designated medical power of attorney) about what you want or don't want done if there were to be a devastating diagnosis and you are not able to communicate your wishes. Too many families are left with choices that are made that more difficult by not knowing what their loved one's wishes are.

This is a very good point - I'm big on making sure people have living wills - it gives everyone else in the situation the specifics of what you want done if you can't say so for yourself.

Jen

Some of the services listed on the medical ID thread that prompted this thread allow you to upload your living will/directive to physicians/etc. to their sites--most notably MedicAlert. Washington state used to have an upload program called the Living Will Registry. If I recall correctly they offloaded it to something called the U.S. Living Will Registry and my directive is uploaded there. I have a sticker on my driver's license to note that, but reference should go on my (future) medical ID as well.j

Also--just a usage point--the person in whose favor you have executed a medical power of attorney is not called your "medical power of attorney"--they are your "attorney-in-fact" for medical issues. A "power of attorney" is a document, not the name or status of a human being.

[billbolton]

This is not true.

Sigh...... http://vancouverfirstaidsupply.com/tag/ ... -position/

[PreemieNrsTiffy]

Also--just a usage point--the person in whose favor you have executed a medical power of attorney is not called your "medical power of attorney"--they are your "attorney-in-fact" for medical issues. A "power of attorney" is a document, not the name or status of a human being.

Yes DD, you are correct about the usage. It's one of those things where healthcare workers are always asking for "medical power of attorney" papers and we get used to using that term even though it is not a correct way to reference the actual person named.

[wardmiller]

quietmorning, Some emergency responders are carrying CPAPs on their vehicles. The CPAP is used on patients with lung and heart problems irrespective of whether they are CPAPers. Of course it helps force air into the lungs and improves the survival rate and reduces damage.

I'm a certificated Emergency Medical Technician in New York State and I've never heard of any EMTs carrying CPAPs. Could you perhaps be thinking of AEDs? (Automatic External Defibrillators)? We have them on all our ambulances, but I have never heard of anyone carrying one in their car.

I also carry a bag/valve/mask to give forced air to the patient and also an oxygen bottle that I can connect to the mask. These are standard equipment in our trauma bags.