Cough CPR

[chiles]

I've heard through the grapevine that people are forwarding an e-mail about "cough CPR". Apparently, the belief is that by coughing, one can delay the worsening of a myocardial infarction (aka heart attack). This is false and is not a supported intervention by the American Heart Association (please see their article on the subject at http://www.americanheart.org/presenter.jhtml?identifier=4535). So, please inform anyone who forwards you this e-mail that it's not true nor supported.

Before anyone attempt to say that cough related interventions don't exist, they do. Coughing is sometimes used to put pressure on the vagus nerve that runs in the back of the throat and regulates the pulse. The act of coughing sometimes will help slow the heart and help correct an arrhythmia. This technique is used when the patient is under the observation of a physician while a cardiac monitor is attached to them.

Similarly, grunting the word "hook" is a way that fighter pilots stave off anoxia caused by high G-forces. By grunting the word, it helps force blood into their brains.

Neither of these are what "cough CPR" are referring to. If you have any questions, feel free to PM me.

[Pylon]

That's nice.  The nurse in the clinic department at work published the procedure for "coughing" to stave off your own heart attack in our company's internal newsletter a while ago.   

Apparently even the professionals get confused by internet myths. 

[Major Lord]

Cool! Homeopathic CPR!

Maybe they should add Echinacia and St. John's Wort....that should convert your fatal arrhythmia! Don't we burn witches anymore?

Major Lord

[DrDave]

I concur.

(Although the pilot grunting is actually a "valsalva maneurver" forcing blood back to the heart from the abdominal cavity so it can be pumped to all areas like the brain.  Pulling a high G load maneuver without the mast trousers forces blood away from the heart and brain and to the extremities, leading to gray- and black-outs.)

Dr. Dave

[captrncap]

From the  American Heart Association ...

http://www.americanheart.org/presenter.jhtml?identifier=4535

[chiles]

That's in my original message:

This is false and is not a supported intervention by the American Heart Association (please see their article on the subject at http://www.americanheart.org/presenter.jhtml?identifier=4535).

[SJFedor]

Well....if you coughed hard enough to knock loose the occlusion.....


Great, more morons are going to walk (or roll) into my ER with CP x2 days, and tell us they've been coughing to try and make it go away. Forget nitro, forget baby asprin, forget plavix, just cough!

Freakin' A.

[sarmed1]

I believe it was an example of HW......ie Hollywood.  I just saw a TV show the other day (might have been House) that I remember seeing the Doc do that exact thing, encouraging the patient to cough as she was going into arrest (she was awake in asystole....you know the flat line that everyone on every TV show shocks!)

great.....another modern medical miracle

mk

[SJFedor]

I believe it was an example of HW......ie Hollywood.  I just saw a TV show the other day (might have been House) that I remember seeing the Doc do that exact thing, encouraging the patient to cough as she was going into arrest (she was awake in asystole....you know the flat line that everyone on every TV show shocks!)

great.....another modern medical miracle

mk

The show writers probably just google asystole, learn that it is the absence of electrical activity in the heart, and figure if we "shock" it, that's adding electrical activity, 200-360 joules at a time!

[sarmed1]

...its every show, I dont think I have seen one yet that they actually shock VF/VT or  if they do its still asystole on the monitor

mk

[SJFedor]

...its every show, I dont think I have seen one yet that they actually shock VF/VT or  if they do its still asystole on the monitor

mk

I saw ONE TIME on Greys Anatomy where the person actually went into VF, they called it right, and shocked it.

But their screwup was that they were using a biphasic defibrilator (one of the same ones we have in my hospital), and ordered and delivered 360j on the patient. *sigh*

[mikeylikey]

So ER and House doesn't represent what really happens in the hospital?

Man, I thought ER docs every day had to deal with explosions, deadly viral outbreaks, MRI machines eating patients, deadly potato salad, explicit sex in the medicine closet, nurses performing brain surgery, and misdiagnosis that actually find an underlying illness that was the cause of the illness that brought the patient into the hospital in the first place. 

Wow, I thought real life emulated what we see on Television.

[SJFedor]

So ER and House doesn't represent what really happens in the hospital?

Man, I thought ER docs every day had to deal with explosions, deadly viral outbreaks, MRI machines eating patients, deadly potato salad, explicit sex in the medicine closet, nurses performing brain surgery, and misdiagnosis that actually find an underlying illness that was the cause of the illness that brought the patient into the hospital in the first place. 

Wow, I thought real life emulated what we see on Television.

What goes on in the medicine closet, stays in the medicine closet.....

It's just little annoying things that us healthcare professionals notice, and it's like nails on a chalkboard. I'm sure you have your equivilant that you've seen on TV and it just makes you grind your teeth, though I dare not speculate. 

[chiles]

So ER and House doesn't represent what really happens in the hospital?

Man, I thought ER docs every day had to deal with explosions, deadly viral outbreaks, MRI machines eating patients, deadly potato salad, explicit sex in the medicine closet, nurses performing brain surgery, and misdiagnosis that actually find an underlying illness that was the cause of the illness that brought the patient into the hospital in the first place. 

Wow, I thought real life emulated what we see on Television.

As a former ER nurse, I will tell you to NEVER underestimate the deadly potato salad. They get you every time!

[mynetdude]

not everything you see on TV is 100% accurate either. However, what they portray is kind of interesting though I do like Grey's and House (sometimes, he is a smart aleck, I'd use a better word but it isn't permitted here).

Yeah I've always wondered about some of the silly things you'd see, like a surgeon stuffing a towel into someone's lungs on a previous surgery and forgot to take it out and then months later or something they come back to ER to have difficulty breathing and then they open her back up for what they think is the same reason but by a different surgeon and finds the towel holed up in this person's lungs.

One thing I DO know that DOES and HAS happened is sometimes you will be under, and then they will not realize it and you will wake up unable to move to only experience excruciating pain. I would say this is an extremely rare incident.

[SJFedor]

One thing I DO know that DOES and HAS happened is sometimes you will be under, and then they will not realize it and you will wake up unable to move to only experience excruciating pain. I would say this is an extremely rare incident.

Happens more then you know, it's just that the person usually never remembers it. Especially after RSI (rapid sequence intubation) a lot of time the etomidate or other induction agent wears off before the succinylcholine, vecuronium, or other paralytic does. So, you become "more" conscious, yet totally unable to move, speak, blink, or do anything. We usually notice this because their heart rate suddenly jumps. A bit of fentanyl and versed usually snows them enough so they go back to "sleep", and usually don't remember a thing.

It also sometimes happens in ORs where people don't react like the anesthesiologist thinks they will, and what totally snows a 250lb man might not do nearly as much to a 120lb woman, all depending on how their body reacts to the med given. Case in point: conscious sedations in the ER.  We push 100mg of diprovan on a big burly guy and he goes down like a sack of potatoes. Same dose on a small college-age girl, and she's fighting us until we load a 2nd 100mg. All depends.

[mynetdude]

One thing I DO know that DOES and HAS happened is sometimes you will be under, and then they will not realize it and you will wake up unable to move to only experience excruciating pain. I would say this is an extremely rare incident.

Happens more then you know, it's just that the person usually never remembers it. Especially after RSI (rapid sequence intubation) a lot of time the etomidate or other induction agent wears off before the succinylcholine, vecuronium, or other paralytic does. So, you become "more" conscious, yet totally unable to move, speak, blink, or do anything. We usually notice this because their heart rate suddenly jumps. A bit of fentanyl and versed usually snows them enough so they go back to "sleep", and usually don't remember a thing.

It also sometimes happens in ORs where people don't react like the anesthesiologist thinks they will, and what totally snows a 250lb man might not do nearly as much to a 120lb woman, all depending on how their body reacts to the med given. Case in point: conscious sedations in the ER.  We push 100mg of diprovan on a big burly guy and he goes down like a sack of potatoes. Same dose on a small college-age girl, and she's fighting us until we load a 2nd 100mg. All depends.

I haven't heard much about this to really say, it seems rare because nobody talks about it much.  As you said it would seem that way because if their heart rate jumps you know so you snow them in again they won't remember it which is good however I have only seen a documentary about this ONCE and they were talking about how people ACTUALLY remember the whole ordeal.  I would suppose that is also a rare incident because the anesthesiologist would keep tabs on this to make sure they are out in no time so there can't be that many people complaining about their horrible ordeals in OR.

I've had 27 major surgeries in my life, never had a problem and if I was awake they probably took care of that pronto and I didn't know it.  Plus pre-op they always weigh me anyhow... weight is incredibly important if you want to administer at least a reasonable dosage for that weight, just because you weigh xx doesn't mean you will react the same way as the next person who weighs the same thing as you do.

[jimmydeanno]

I haven't heard much about this to really say, it seems rare because nobody talks about it much.

Probably because when they sue for malpractice the 'agreement' tells them they aren't allowed too...

[davedove]

So ER and House doesn't represent what really happens in the hospital?

Man, I thought ER docs every day had to deal with explosions, deadly viral outbreaks, MRI machines eating patients, deadly potato salad, explicit sex in the medicine closet, nurses performing brain surgery, and misdiagnosis that actually find an underlying illness that was the cause of the illness that brought the patient into the hospital in the first place. 

Wow, I thought real life emulated what we see on Television.

It's like anything else on television.  In a particular ER, all those things may have happened.  But the incidents happened over say a ten year period.  Hollywood takes all the oddball cases and makes them all happen in one day.

[pixelwonk]

Pshhh...   Emergency! was real.

* tedda still flicks the caps off bic pens Johnny Gage two-thumbs stylie

</fanboy>

[chiles]

Totally off topic but I once had a friend who was a volunteer EMT-P. He did one of those "bite the needle cap off" methods. Sadly, it was filled with epi and a drop hit his tongue. He woke up a bit later and had learned a valuable lesson on the proper way to remove a needle cap.

[DrDave]

Couldn't watch the first season of "ER".  Would pace the floor in front of the TV yelling orders!  (No joke, my wife will attest.)

My favorite from "ER" was no one stabilizes the endotrachial tubes after a patient is intubated (breathing tube down the throat) -- just flings around in the breeze!

They did get one thing right -- all the female EKG techs were always hotties on the show, dressed up to meet their doctor husband ...

Dr. Dave
(Who would love to say the things Dr. House says to his patients, but can't)

[SJFedor]

Couldn't watch the first season of "ER".  Would pace the floor in front of the TV yelling orders!  (No joke, my wife will attest.)

I didn't watch ER too much, but when I did, and they were dropping a tube on someone, I never ever remember the docs ordering RSI drugs.

Every time I watch those shows, I usually end up yelling at the TV at least once. My girlfriend doesn't let me watch them anymore.

But, if you watch Trauma: Life in the ER on Discovery Health, every now and then you see my hospital 

[flyerthom]

Well....if you coughed hard enough to knock loose the occlusion.....


Great, more morons are going to walk (or roll) into my ER with CP x2 days, and tell us they've been coughing to try and make it go away. Forget nitro, forget baby asprin, forget plavix, just cough!

Freakin' A.

We get paid to cheat Darwin.