On January 4, a man in Wenshui Subway Station in Shanghai had a cardiac arrest, there were rescuers on the scene pressing, AED alerted the electric shock, the button flashed for 25 seconds, but no one pressed the shock button. The video is below
Are you in a hurry to press the discharge button across the screen?
So, Nighthawk posted the video on Weibo and expressed his views on the video and reminded of the importance of high-quality compressions and defibrillation. As a result, Metro gave me a rumor label on the joint media, as follows
Here's why:
Thanks to metro for complementing the full picture of the incident and allowing the information on the spot to be fully shared.
As a doctor, an emergency physician who has trained thousands of health care workers and tens of thousands of ordinary people to learn first aid and AED, Nighthawk will analyze the key nodes of the event and propose how to better respond when the local railway encounters the next similar patient. It is also a response to being labeled as a rumor:
1. When the last stop Pengpu Xincun Station reported the information, someone fell to the ground in an emergency, I hope that the staff of Wenshui Station will not wait at the door, but send someone to get the AED as soon as possible after receiving the information, and then wait at the door.
2. If you have not done the previous one, but when you see that the patient has been cardiopulmonary resuscitation, you should send someone to get the AED at the first time, do not wait for the medical staff to remind, because the subway staff is the home field, is the host.
3. I think that Cheng Yuan, who has received AED training, should understand the above two points. If the teacher doesn't teach, that's the pot that trains the teacher. If the teacher teaches and you don't do it, it's your own pot. Because you're the webmaster.
4. Under the reminder of the medical staff, Cheng Yuan got the AED, quickly ran back to the patient, and used the AED to perform the first defibrillation for the patient, which is really great, I also saw that you pay attention to the safety of the scene, everyone leaves the patient and performs an electric shock. Well done.
5. Immediately after the first electric shock, the healthcare provider starts CPR, which is good. But it's clear that the speed of compression is fast, up to 180 beats/min, while the guidelines recommend a press speed of 100-120 times/min. Of course, the tension on the scene is understandable.
6. The doctor in the text also said, "After compression, it was judged again that the carotid pulse could not be touched, and the AED did not indicate defibrillation after pausing the compression." This sentence has brought misunderstandings to many netizens.
In fact, after completing the previous shock defibrillation, AED needs to perform the next analysis about 2 minutes later, which is also recommended by international resuscitation guidelines.
At the speed of compression in the video, do 5 loops, of course, less than two minutes, at this time AED naturally will not speak prompts, because it is not yet time to start analyzing the heart rhythm.
At this moment, no great doctor can recognize with the naked eye that the patient is not ventricular fibrillation.
7. This is followed by the above video that sparked controversy. When the doctor pressed again for a while, the AED started a second round of analysis. AED development to this stage, has a good anti-interference ability, even in the process of pressing, still make a judgment of ventricular fibrillation, and complete the charging process, strongly prompt to press the discharge button, urged for 25 seconds, but no one pressed.
At that time, Cheng Station Master, I know now, you are next to you, what do you think?
The girl next to you, what do you think? I saw you wanted to reach out, but retracted.
The reason why you can't shoot may be in the following paragraph
It's a real pity that I've always thought that this passage was a mistake relayed by a reporter, so I haven't made a sound.
But when I saw the TV news, the critical care doctor still stressed that this was a distraction. I can't sit still, because if this view is accepted by the public, it will be a disaster involving countless lives.
We know that cardiac arrest is a state in which the heart stops beating, at which point the patient does not respond and does not breathe or only wheezes on the verge of death.
Cardiac arrest can be caused by a variety of diseases such as myocardial infarction, pulmonary embolism, hypokalemia or hyperkalemia and the like.
When a cardiac arrest occurs suddenly, if you give the patient ECG monitoring at this time, you will see three possible ECG patterns: ventricular fibrillation or pulseless ventricular tachycardia, no pulse electrical activity, straight line.
Only ventricular fibrillation or pulseless ventricular velocity is suitable for electric shock defibrillation, and in the hospital doctor will judge and defibrillate with a manual defibrillator.
Ordinary people need CPR after finding someone with cardiac arrest, and at the same time take the AED sticker, AED automatically analyzes, if it is ventricular fibrillation, AED automatically charges, and prompts the rescuer to press the defibrillation button to defibrillate.
If there is non-ventricular fibrillation (which may be pulseless electrical activity or ventricular fibrillation), the AED does not charge or discharge, and the rescuer needs to continue CPR.
At this time, do not remove the AED, AED will analyze the heart rhythm for about 2 minutes, it is possible that after several rounds of compression, there is a ventricular fibrillation waveform, there is an opportunity for electric shock defibrillation.
When cardiac arrest occurs, no one can tell by eye, ear, nose, tongue and hand whether the patient has an ECG pattern of ventricular fibrillation. Unless the patient has a breathing pulse, then you can say that it is definitely not ventricular fibrillation.
8. Can compressions cause interference that causes AED to mistake for ventricular fibrillation?
Not really.
If the interference is not strong enough, the AED's own anti-interference ability is enough to cancel out, and the AED can still correctly judge and complete the charging.
If the interference is strong enough, AED cannot continue to analyze, ask you to check the patch, and do not charge it yourself.
As a life-saving product that was open to the public at birth, AED has been so hard that it is impossible to charge and recommend discharging when the patient is not ventricular fibrillation. Everyone needs to trust the life-saving artifact. At the moment, it is not a waste of time.
9. Some netizens said, why do they say "there is interference when pressing, after stopping pressing, AED will no longer call the police?" ”
That's where AED comes in. It is also a blind spot in the knowledge of the rescuers on the spot.
This Mindray's AED has a feature, that is, after continuous reminders and repeated urging you for 30 seconds, if you still do not press the discharge button, the AED will release power internally. That is, I held it back.
In the above video, AED urged for 25 seconds, no one pressed down, and when the doctor stopped pressing, AED no longer reminded, what is strange!
That is to say, the reason why this AED stops calling the police is not that you stop pressing, but that it reminds you for 30 seconds, you don't stop, it is "speechless", the "fart that you want to put", hard to hold back.
10. As for whether the AED will continue to be attached to the patient until the ambulance arrives, or will it be removed and "stop using the AED"? If AED is not taken down, how did it prompt when it was analyzed for the third time? No one knows.
But in fact, some people can know, that is, to export the data of AED. Because AED has a recording function, it will record when to turn on, when to patch, what is the heart rhythm, when to defibrillate, the change of heart rhythm after defibrillation ... Full record.
11. Everyone knows the next thing anyway, the ambulance came, rehydrated, used adrenaline, no endotracheal intubation, pulled to the car, continued to rescue to the hospital, and finally died.
Therefore, if you look back at the paragraph on my Weibo, you should see that Nighthawk did not create rumors, nor did it take it out of context, but peeked at the leopard from a short video and detected the misunderstanding of the above huge rescue process.
If this misunderstanding is spread in an official and determined manner, there will be endless troubles. Some media have announced that "AED does not apply to cardiac arrest", which is too anti-intellectual.
It is recognized in the field of first aid: 80% of patients with out-of-hospital cardiac arrest present with ventricular fibrillation, and the most effective first aid method for ventricular fibrillation is defibrillation, and the success rate will drop by 7%-11% for every minute of delayed defibrillation.
As can be seen from the above events, we can also get defibrillators earlier, we can also improve the quality of our compressions, and we can also firmly carry out defibrillation to the end.
Finally, Nighthawk asks metro staff in various cities to remember:
1. When passengers have any physical discomfort, you must take the AED for backup as soon as possible. Sometimes this is even more important than calling 120 first.
2. When the patient loses the response and does not breathe or only has near-death wheezing, you only open the AED to the patient, do not touch the patient after the sticker, let the machine analyze the heart rhythm, when the machine recommends an electric shock and completes the charge, the button will flash and remind you to press down, at this time you need to firmly trust the AED and press the discharge button when you make sure that no one touches the patient.
The next time if academician Ge Junbo, a big bull in the field of cardiovascular in Shanghai, is on the scene, if he says "you don't want electric shock, this is interference", you can push the academician aside, and then pay tribute to the academician after completing defibrillation.
However, I guarantee that Academician Ge Junbo will definitely press the electric shock button faster than you, and you will not be able to grab him.
3. Rescue in the subway station, we subway staff is the main body of rescue, we must be unyielding, do not need to cower, because after effective training and teamwork, coupled with the blessing of AED, each of us ordinary people can save people who could not be saved by doctors before.
4. Don't rely too much on medical staff, because most medical staff have not seen the real AED machine, and they are half-aware of its use process. This is normal because everyone in the hospital is used to using manual defibrillators.
And we subway staff are the regular troops who rescue the subway station. Simply and calmly follow what the trainer taught.
Late at night, Sister-in-law Eagle said, you are causing trouble on the Internet again, what can you do about this?
I said, this is not trouble, this is the value of our first aid science, that is, to continuously promote the public first aid forward.
Before, everyone did not have the awareness of learning first aid, so we preached the benefits and significance of learning first aid;
In the past, everyone did not have a way to learn, so we went to open more first aid classes for them to learn;
In the past, there was no AED in public places, so we went to promote all walks of life to configure;
Now everyone will not use AED correctly, and we also need to clarify the beginning and end through this case and popularize the common sense of AED use.
All this is not to show the wisdom of an emergency doctor, but simply to hope that more lives will be saved.