Tuesday, October 19, 2010
NFL linebackers, CPR, Goldilocks and the three bears.
These three topics are all related by the single concept of “just right”. The story of the three bears laid out the rules that too hard or too soft didn’t make the grade and neither did too hot or too cold. Goldilocks, acting as referee, decided what was just right. That has now become the standard for playing in the NFL. With the adrenalin surge of playing in a violent game, trying to hit a moving opponent, a player cannot deliver a flagrant hit. And because lack of aggression will to a missed tackle or block, each contact opportunity has to be just right. The league office plays Goldilocks but with the benefit of hindsight and replay, deciding which hit was just a little too violent.
The new CPR guidelines were meant to encourage untrained bystanders to help a patient who collapses and to avoid being paralyzed into inaction by the fear of doing something wrong. The intent was good but then the fine print got in the way.
Ideally, the sequence is pretty easy. A victim collapses unresponsive and isn’t breathing. Trying to feel a pulse fails and the good samaritan turns to other bystanders and tells them to go get help and an AED (automatic external defibrillator). Next comes CPR: start pushing on the chest hard and fast. In reality, a rescuer can’t do much harm. Death is a reasonable definition when a patient’s heart stops beating and they stop breathing. You can’t get any worse.
Adding rules about technique make it too easy to have the rescuer fear that once again they might be doing something wrong.
Put one hand in the middle of the chest and begin pushing. Not too many worries with this one. Your hands have to go somewhere and the target zone is pretty wide. Ideally, it’s in the middle of the breast bone.
Compress the chest to a depth of two inches and allow it to spring back before pressing again. This is a bit problematic since it’s hard to measure how far you can scrunch the chest. Too deep and ribs can be broken, too shallow and the heart isn’t being squeezed enough to circulate blood. As it turns out, even the most practiced paramedic or nurse will break a rib or two doing CPR. Too much adrenaline happens off the football field as well.
Push on the chest at a rate of 100 beats a minute. The teaching video recommends using the beat of the Bee Gee’s disco hit of Staying Alive. Once upon a time, CPR classes would demand that students perform chest compressions on a dummy that would spit out a recording of how well they did. Only perfect would allow a person to pass the course and become certified. The physiology was sound. Push to slowly and not enough blood gets circulated to the brain and other vital organs. Push too fast and the heart doesn’t have a chance to refill for the next beat. Lost in the process was the concept that people were trying to learn a general technique that they would likely never use. They were good Samaritans trying to be better Samaritans. No matter how well you remember disco, whatever rate you can manage is better than no rate at all.
Most victims will die. The few that live survive because they have developed ventricular fibrillation or ventricular tachycardia, heart electrical rhythms that do not allow the heart muscle to beat in a coordinated fashion. It just sits there and jiggles like a bowl of jello. The treatment that makes a difference is electricity that is delivered by a defibrillator to shock the heart back into a normal rhythm that can generate its own heartbeat. CPR is the bridge that can help those few survive until an AED or a paramedic with a defibrillator can get to the patient’s side.
Starting chest compression kindles a glimmer of hope where none existed before. Bystander CPR should be easy and the rules even easier:
Push hard and fast.
Don’t worry about just right.
Listen to Nike: Just do it.