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Old 09-15-08, 07:04 AM   #1
BSLeVan
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I think he was having a heart attack...

I was riding yesterday and came upon a group of riders off to the side of the road clustered around a man prone on his back. I stopped and learned that he collapsed, and it appears he was having a heart attack. One of the riders in the group was an EMT, and they had already called 911. So, I felt like there was nothing I could do, but asked to make sure. One man replied that none of them could do anything but wait until the ambulance got there. The EMT was busy attending to the guy. So, I pushed off and headed down the road. But as I moved away I kept wishing there was something I could do. By the time I got home I was preoccupied with three things. One, this guy was near my age. Two, it was hot and humid with the heat index at 105 degrees - not a great day to be pushing it. Three, I typically ride alone and wouldn't have anyone to call for help on my behalf. This morning, I awoke with my first thought being I hope he made it.
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Old 09-15-08, 08:15 AM   #2
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It's not a good feeling knowing there is nothing you can contribute even though someone is in dire need and your willing to help. Hopefully its not as serious as you suspect and the rider will come out all right. One of the strongest riders on my Wednesday night group ride had a major heart attack recently as he was gathering his bike and stuff to head out for our group ride. He's been in the hospital for over 1 month and it does not look as if he'll be riding with us again. At the start of our weekley rides there is always a moment when the current status of D***'s health is discussed followed by a little guilt and relief that it's not me.
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Old 09-15-08, 09:32 AM   #3
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BSL ----- strange helpless feeling that boarders on guilt? I know it well and have experienced it many times. Was there something else I could have done ----- did I miss anything? Hopefully the EMT had the ability to appropriately handle a situation as you have described.

There is something you can do. BCLS, Basic Cardiac Life Support is taught at all Red Cross locations,community colleges ect. It only requires an hour or two of your time.

Truthfully you may never experience a crisis like the one you wittnessed, but having the skill to respond appropriately can sometimes turn a negative into a positive outcome.

Just my opinion but all of us 50+ cyclist should be able to deal with a "situtation" until EMS is on the scene. Lp
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Old 09-15-08, 10:49 AM   #4
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I try to remember to take my cell phone along with me, just to give me a chance should something like this happen.

And if I can't get to it, there is no coverage, or they can't get there in time, then I've decided there are worse ways to go than to kick the bucket while on a peaceful, serene bike ride.

As to helping someone, I'm also pretty much limited to making a cell phone call in their behalf. I'm a medical dunce.
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Old 09-15-08, 01:46 PM   #5
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There is something you can do. BCLS, Basic Cardiac Life Support is taught at all Red Cross locations,community colleges ect. It only requires an hour or two of your time.
...

Just my opinion but all of us 50+ cyclist should be able to deal with a "situtation" until EMS is on the scene. Lp
Completely correct. We should all have the the requisite wisdom and judgment to get the training to jump in if needed.
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Old 09-15-08, 03:37 PM   #6
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one thing you can do AFTER CALLING 9-1-1 to help before EMS arrives is have the person chew an aspirin. This helps to immediately reduce platelet aggregation that blocks flow of blood to the heart muscle. You should always call 911 first--don't wait-- they will probably administer aspirin on the scene when they get there, but if you're out in the sticks and worried about being found by EMS quickly, this could be a real life-saver.
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Old 09-16-08, 09:11 AM   #7
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A similar thing happened several years ago while riding on the MUP. It was very hot & humid and just ahead of me a guy(maybe 65-70 years old) keels over off the bike. I was second on the scene. A gal who was a nurse showed up about a min. later. Long story short 911 was called and it was clear that he was not having a heart attack. Got some liquids in the guy and in the shade.

The most bizarre thing was that his much younger wife(mate?) was saying "there is nothing wrong with you, get on the bike!" Swear she was trying to off the guy.

Nobody could find the key to the gate blocking the trail, so the ambulance was about 150 yards away. We talked to the ambulance by phone. He refused the help of the medics and eventually got on the bike again. Rode down the trail to the ambulance and they talked him into some assistance.
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Old 09-16-08, 10:58 AM   #8
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+1 on aspirin. although, who carries aspirin on a bike ride? anyone?
I thought not.
I've never had heart issues but i take a low dose of aspirin every day. I started it when i was in my thirties and read an article about blood getting thick from living at altitude. It may not make a difference, but I do it anyway.
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Old 09-16-08, 11:39 AM   #9
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+1 on aspirin. although, who carries aspirin on a bike ride? anyone?
I thought not.
I've never had heart issues but i take a low dose of aspirin every day. I started it when i was in my thirties and read an article about blood getting thick from living at altitude. It may not make a difference, but I do it anyway.
Hmm, our office has a little box of single serving aspirin (Bayer) packets. Maybe I'll stash a couple in my Camelback.
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Old 09-16-08, 02:46 PM   #10
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+1 on the aspriin.
+1 on everybody taking BLSC.

Semi-tangential thought #1: For the first time this year I was silly enough to go mountain biking in 90+ degree weather. I lasted about 45 minutes, felt like I was getting sick, and stopped. There was a 15 y/o boy who died of heat-stroke this year in our area. I was not anxious to have that happen to me.

#2: I updated my ALSC certificate a couple of weeks ago. These days you get a computer simulation that you can take home and practice CPR and such. Setting off an AED on purpose while the nurse is taking a rectal temperature can be a source of cheap laughs It was a pretty cool program.
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Old 09-16-08, 02:54 PM   #11
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I was in Church one time, and it was during communion. A very old woman fainted in her pew...but it was right at that time when the priest was consecrating the host, so remarkably no one went to help her! I kept waiting, but finally got up and pushed into the pew to take her pulse, check her eyes and loosen her clothing. And I said "Call 911" right in the middle of all the silence. Luckily the consecration ended and then people came to help. But it really pissed me off. Worst off, the woman sitting behind her was a nurse. She apologized afterwards for not helping, but I don't know why she was apologizing to me.
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Old 09-16-08, 03:34 PM   #12
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Setting off an AED on purpose while the nurse is taking a rectal temperature can be a source of cheap laughs It was a pretty cool program.

Ouch!! Man that is one way to rock someone's world ------- it'll leave a bad taste in your mouth for sure!! Lp
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Old 09-16-08, 03:49 PM   #13
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Everyone should have CPR/First Aid training. Doesn't mean to have to use it - just in case.

There probably wasn't anything you can do - he was being cared for. At least it mattered to you. That's enough. If something happened just know he was doing what he wanted. Also just know sometimes it's foolish to do what you want (like riding in heat!). If you are out riding alone, do you wear a Road ID? You should. If you are going out always make sure you let someone know - I tend to email friends what I am doing and I check in later.
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Old 09-16-08, 05:33 PM   #14
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I carry aspirin in my bike bag. Ibuprofen too. A couple of those small sealed 2-capsule packs. They take up almost no room. I also carry a small 0.25 oz sampler tube of triple anti-biotic ointment. And a couple of bandaids. The whole lot adds very little weight and fits into little nooks & crannies around my spare tube, multi-tool, and other odds & ends.
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Old 09-16-08, 07:18 PM   #15
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A colleague once turned almost green in the office and complained of chest pains, so I dialed 911. Emergency services showed up within minutes, but I didn't think of aspirin.

In the end it wasn't a heart attack, but I still reckon I did the right thing. Security in the building was very helpful (they saw the fire truck arrive, of course), and told me that I could always ask them to call if there was a next time.

Sure, and waste another 60 seconds while I explain what's happening? I'd sooner call myself.
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Old 09-16-08, 07:22 PM   #16
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You know, anyone could potentially have a heart attack any time, even sitting watching TV, or just after walking out of the cardiologist's office after getting the all clear to exercise. You just can't dwell on it. But it's probably not a good idea to be playing Lance Armstrong wannabe in 105 deg temperatures or in the middle of a smog alert. I take easier on such days, although I have to admit, 105 deg days are pretty rare around here. Other than taking these kinds of reasonable precautions whenever necessary (and any appropriate dietary/lifestyle changes), if you're going to drop dead from a heart attach while riding, it would probably have happened anyway while doing something else.

That being said, there are probably too many guys out there who buy a racing bike and suddenly decide they are racing caliber even though they are 50-plus years old and haven't ridden even around the block in 30 years.
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Old 09-16-08, 08:32 PM   #17
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On my last century ride a rider crashed hard about 50yds in front of me, I stopped and as I saw a clump of other riders standing around not quite sure what to do my mountain rescue training kicked in and I did what I could. Someone was calling 911 while I was trying to get as much information about the guy as possible, checked him out for broken bones and back injury. Luckily a doc pulled up in a car and I was able to hand him off to her. You just never know. CPR is easy to learn and so are basic first responder skills, it's all common sense stuff. The big thing to remember though is that you are not a doctor, you don't have an ambulance at your disposal and your only job is to stabilize the person until help arrives and keep everyone around you including yourself safe so that the situation does not get worse.
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Old 09-16-08, 08:41 PM   #18
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Get CPR certified. They focus on chest compressions now, as opposed to mouth-to-mouth breathing. It takes all of 3 hours to get certified.
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Old 09-16-08, 08:46 PM   #19
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I've had the luxary of having had workplace accident/cardio basic response training and upgrades on a number of occasions so I suspect I could help out if need be. Such courses are easily available outside of work and for anyone getting on and having friends that are getting on it's a great thing to take as a group. I remember looking through a night school crafts and special intrest calender a few years back and seeing this same sort of first aid and cardio training for like $40 or $50. If you have anything like that in your area it would be a great thing to sign up for and make it a big group sort of deal. Nothing is worse than seeing someone in the beginnings of a heart attack or with a windpipe blockage and not knowing what to do.

To BSLeVan, you've got absolutely nothing to regret other than perhaps to use this event as a wakeup call to get you and some friends to attend such a basic course. The fellow had lots of folks around, 911 was on their way and there was an EMT guy checking vitals and waiting to do the next step if needed. All you would have done in that event would have been to get in the way as just another member of the crowd. You asked, which is super since they MAY have needed something, but there's no shame or guilt for just carrying on as you did.

And like you I hope he came out of it with little or no harm.
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Old 09-16-08, 08:49 PM   #20
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Get CPR certified. They focus on chest compressions now, as opposed to mouth-to-mouth breathing. It takes all of 3 hours to get certified.
Chest compressions are for a stopped heart. They still need mouth to mouth to move air in and out of the victim's lungs. unless the whole AIDS thing has made them go back to the less effective pushing on the chest or pumping the arms deal like the old lifeguards did back in the 50's.
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Old 09-16-08, 08:55 PM   #21
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Chest compressions are for a stopped heart. They still need mouth to mouth to move air in and out of the victim's lungs. unless the whole AIDS thing has made them go back to the less effective pushing on the chest or pumping the arms deal like the old lifeguards did back in the 50's.

http://www.medscape.com/viewarticle/470874



911 Dispatchers to Revise CPR Instructions

Sid Kirchheimer

March 2, 2004 Well-meaning bystanders attempting to save the life of an adult heart attack victim with cardiopulmonary resuscitation (CPR) are getting new instructions from 911 dispatchers until help arrives: Do chest compressions, and do not administer mouth-to-mouth resuscitation.

Already a trend among a growing number of 911 departments who were advising 911 callers to do chest compressions without mouth-to-mouth breathing, this new policy becomes official later this month for the National Academics of Emergency Dispatch (NAED), which provides medical instructions and is the accreditation and certifying organization for 911 operators in nearly 3,000 communities worldwide.

This means that in most cases, bystanders who try to perform CPR will be instructed by 911 dispatchers to continuously pump the patient's chest up to 400 times before they provide any mouth-to-mouth resuscitation. Under long-practiced guidelines, CPR formerly entailed clearing the airway and giving two "rescue" breaths before chest compressions began. Mouth-to-mouth ventilation was then resumed after every 15 or so compressions.

But there's mounting evidence that trying to convey telephone instructions to lay volunteers on how to perform mouth-to-mouth resuscitation during emergencies wastes valuable time and fuels their reluctance to help those suffering from sudden cardiac arrest. And some research indicates that rescue breathing does not increase a patient's chances of survival compared with doing chest compressions alone.

"Under the new procedures, rescue efforts by volunteers could be compression-only, but in instances where there's a long response time, some ventilation needs to take place," NAED spokeswoman Carlynn Page told Medscape. "But whether or not they are trained in CPR, the instructions that operators will initially give these volunteers will be compression-first."

Ms. Page said the new policy, which takes effect March 15, stems from updated recommendations by the American Heart Association and other experts on the best way for citizens to help those stricken with a heart attack until emergency personnel arrive at the scene. Within two weeks, these new instructions will be given to 911 dispatchers in at least 38 cities that serve some 10 million Americans.

"It's not that the American Heart Association or other experts are recommending that people not do mouth-to-mouth ventilation if they are properly trained, but in a limited setting where a bystander has not been trained in how to do CPR or is unsure of the procedure, it's better that they do chest compressions alone than do nothing," said John Billi, MD, chairman of the American Heart Association's emergency cardiovascular care committee.

"Chest compressions alone are much easier to teach over the telephone than the whole sequence of breathing and chest compressions," Dr. Billi told Medscape. "And we know that many people are reluctant to give mouth-to-mouth resuscitation, even though most of the time, a bystander is giving CPR to a loved one a spouse, parent, or an elderly person living in their home. What's really important is that bystanders react quickly by immediately calling 911 and doing CPR to the best of their abilities, and giving them instructions on chest compressions is more simple than trying to teach them on how to properly do mouth-to-mouth ventilation."

As a general rule, CPR must be performed within four minutes of the heart's stoppage in order to save that person's life, Dr. Billi said.

Mouth-to-mouth breathing helps provide oxygen to blood, but chest compressions may be more important for ensuring survival of adult heart attack victims because it helps move blood throughout the body, primarily to the brain, said Dr. Billi, professor of internal medicine and medical education at the University of Michigan Medical School in Ann Arbor.

"The problem is, when bystanders stop compressions to perform mouth-to-mouth ventilation, too much time may be spent checking the airway and properly positioning the mouth," Dr. Billi said. "The victim may not be getting enough compressions to better ensure survival." A study in the May 25, 2000, issue of the New England Journal of Medicine found no difference in survival rates between cardiac arrest victims on whom bystanders performed dispatcher-assisted, compressions-only CPR and those treated with dispatcher-assisted CPR using a combination of chest compressions and rescue breathing. "That study is one among an evolving group of studies showing that in some circumstances, compressions-alone was as good as also using mouth-to-mouth ventilation," said Dr. Billi.

The new NAED policy doesn't change how emergency personnel will treat heart attack patients, or how first-aid and CPR training is taught to volunteers. Both the American Heart Association and the American Red Cross will continue to teach mouth-to-mouth rescue breathing to those taking certified CPR courses.

And this new compression-first policy applies only to adult patients, not to children whose hearts have stopped beating.

"With children, we always recommend mouth-to-mouth ventilation because their heart usually stops beating because of a breathing problem, and not because of a heart attack," said Dr. Billi. "The real recommendation here is that everyone should take a CPR class. It's easy to learn, easy to perform, and easy to be trained in."

Reviewed by Gary D. Vogin, MD

Sid Kirchheimer is a freelance writer for WebMD.
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Old 09-16-08, 09:06 PM   #22
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Thanks for that writeup DnvrFox. But note that it's a stop gap intended to allow someone with no skills/never took any CPR training at all to at least do something that will help with minimal information over the phone. It's not a replacement for the better method given by a person with the proper training.

While it's likely better than nothing at all a better option is to take the proper course. In the course they'll teach you to use the proper technique for mouth to mouth and how to properly do the heart compressions without hurting the victim more.

Which, by the way, also suggests that even a minimal first aid kit should have a disposable plastic mouth barrier in it. They aren't any bigger than a larger bandaid when in the package and fold out to cover the victim's mouth in case you're worried about disease contamination. They cover these in the proper CPR course.
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Old 09-16-08, 09:19 PM   #23
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I've had all the courses so many times, I could give them in my sleep!

I started taking them when you pushed from behinf, then lifted the arms up - all without any mouth to mouth, then it was changed to mouth to mouth intermittent with the cardiac bit. They just keep changing it!
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