CPR at its Finest

I recently renewed my CPR card. A few statistics I found interesting...

• If an AED is used between 0-3 minutes after asystole, or cessation of cardiac electrical activity, the survival rate is 75%
  



• Between 3-5 minutes survival rate drops to 50%
  



• Between 5-10 minutes the survival rate is as low as 2-10%

Almost make you want to carry an AED in you back pocket when your not surrounded by crash carts in the hospital?

The new CPR regulations of ABC to CAB have been some what controversial. The "B" (Breathing) portion was thrown into the back seat, with "C" (Compressions) in the front seat driving at 100 compressions per minute. For some, this makes sense, to others it doesn't. The fact of the matter is, the guidelines will change again and again and again, but the current method is proven to be most effective.

History:

At an earlier time, when anatomy and physiology knowledge was less proverbial, people noticed that the body became cold, and in an attempt to "resuscitate" the victim they would lay hot ash, wood, or coal over the body try to regain the temperature of the body. Another technique involved wiping or beating the body to stimulate the body back to life. For over three hundred centuries the use of fire bellows were used,



which is kind of a smart or more logical idea. Some less logical ideas were blowing tobacco into the rectum of the victim. Mouth-to-mouth was introduced and also used for centuries and still widely used in the current guidelines. In the late 50's and beginning of the 60's the US army implemented a modern use of CPR. It was difficult to track down but I found a free text release of the technique used by the military, printed by the official medical journal of Jama on July 9th, 1960 entitled Closed-Chest Cardiac Message (if anything, read the method portion of the article) by Dr. W.B. Kouwenhoven, Dr. Ing., James B. Rude, and G Guy Knickerbocker. The primary research and development was put out by Dr. Kouwenhoven. In 1972 the first general public training began at a conference center, in Seattle Washington the training was called "Medic 2." CPR became more popular after the inception of the American Heart Association (AHA) in 1973.

In movies or theatrics the survival rate is about 75%, in reality CPR survival rate administered out side of a hospital setting is 6%.

Supply & Demand

A few days ago CNNMoney put out an interesting article regarding the health care industry and its current standing and future outcome (See below).


NEW YORK (CNNMoney) -- As the pace of hiring slows and job opportunities dry up, one industry will remain the rare bright spot in an otherwise dismal job market: health care.

The health care field is one of the few industries that sustained steady growth, even through the recession, adding jobs every month for the last eight years. And that growth should continue. Two factors -- an aging population and health reform -- guarantee that health care jobs will be there for the taking, experts said.

"Health care jobs are driven by demand. An aging population simply needs more medical care," said Sophia Koropeckyj, managing director with Moody's Economy.com.

"The leading edge of baby boomers are now 65. They are needing more health care," she said. "But the biggest bulk of baby boomers are still 10 years behind."

That means the industry will need to ramp up fairly quickly to meet a surge in demand for health care service in the coming years, she said.

Government bleeding jobs, no end in sight Others see health care reform as another catalyst for more jobs in the field.

"The big provisions of health reform, such as the health exchanges, won't kick in until 2014. When they do, it will bring give millions more access to health care," said Nigel Gault, chief U.S. economist with IHS Global Insight.

Gault anticipates this will result in more demand for health care services and more jobs.

"There's some concern in the industry about whether there's enough qualified health care professionals to meet this demand," he said.

Still, this uncertainly bodes well for health care hiring. According to the government's June jobs report, health care hiring rose by 14,000 jobs last month while hiring in most other industries dramatically slowed to a crawl.

More bragging rights: In the past 12 months, health care has added an average of 24,000 jobs per month. But that trend goes back even further. Health care jobs have increased every month going back to July 2003, according to the government.

Since 2001, health care's workforce has grown 28% to about 17 million in 2011, according to the government.

Over the next decade, Koropeckyj expects health care will remain a fertile area for hiring and forecasts a 24% growth in health care jobs, or 4.3 million additional jobs until 2021.

Dr. Joseph Kim, founder of nonclinicaljobs.com, tracks shifts in health care jobs.

Kim said one recent trend contributing to an uptick in physician jobs are hospitals adding more physicians and specialists to their in-house staff instead of contracting with them.

He said hospitals are doing this through new hires as well as acquiring independent practices and groups practices.

Kim also expects ancillary health care jobs such as nursing assistants, medical assistants and health IT jobs to be hot growth areas as hospitals and health clinics expand into suburban areas and health providers rush to meet health reform's deadline to update technology and transition patient records to Electronic Health Records.

The government provides its own projection of fastest growing health care careers. Here are top 8 health care jobs expected to see rapid growth through 2018:

-- Bill and account collectors are forecast to increase 66%. Industry experts peg the growth to an increase in billing as more Americans get access to insurance and health care under reform.

-- Cardiovascular technologists and technicians jobs are expected to grow 52%. Kim said as boomers age, they will need more stress tests and cardio scans, which will require experienced technicians to operate the equipment.

-- Public relations specialists are forecast to rise 52%. "The interesting phenomenon happening right now is hospitals and health centers embracing social media," said Kim. As a result, he said hospitals are hiring people who are "social media" or public relations "specialists."

-- Physician assistants are expected to see a 52% increase. Kim said the current shortage of primary care physicians means many health centers in areas facing doctor shortages are using physician assistants to fill the gaps.

-- Pharmacy technicians are forecast to grow 52%. This trend may be fueled by the rapid growth of retail pharmacies and support staff needed to work with pharmacists.

-- Customer service representatives are expected to rise 52%. Kim said more hospitals are changing their models and adopting a more customer-centric approach, which includes conducting customer satisfaction surveys.

-- Massage therapists are expected to increase 52%. An aging population is boosting demand for this type of service, said Kim, as well as a slow shift away from conventional drug therapy.

-- Clinical, counseling, and school psychologists are forecast to rise 43%. Again, Kim points to the aging population and more instances of depression and anxiety as the reasons behind the projection.

-- Registered nurses are forecast to also increase 43% as health care centers boost their medical staff in anticipation of rising demand for services.

Of course, we are able to see different trends in different areas. I have observed a flooded RT market in the Las Vegas area, because of the many career oriented, private schools that have recently developed, which I presume is specifically due to these statistical numbers. There is however a shortage of paramedics in the same area, which could be due to the lack of certifying educators, schools, or perhaps the lack of adverting funds to promote the career. The recovery and development is quick in the health care setting. Like every market, health care is a roller coaster effect. In 2008, in the heat of the recession, significant spikes of enrollment into health care programs occurred. Regardless, the jobs are there and will continue to be there for at least a decade if not more.

I can't remember!

I recently read a book on memorization. The book taught about making physical imaging and connections by association. In fact, the book became pretty elaborate in the usage of association. The basic concept teaches if you can remember one image and associate that image with a number, word, object, or phrase you want to remember. Instead of having to read the entire book I will explain the tool that helped me the most and was most effective. In short, my wife put together a list of 50 activities we can do one the weekends together and I was able to memorize the list in about 6 minutes, reading the items through only once, and being able to recite the list backwards and forward. No tricks to gimmicks just by using association.

Let me give you an example... Lets take a grocery list: bagels, cheese sticks, milk, pineapple, and Alfredo sauce. It is not a long list, but it is the principle being taught here. What you do is take the list, and read it through once and only once, and associate these items in your mind with something ridiculous. The more disproportionate and more silly the better. The only challenging thing here is to be creative.

Now read the below paragraph through once:
Lets take the first two items: Bagels and cheese sticks. Remember imagine the object and make it disproportionate and/or silly. Lets say the bagel can walk and talk while eating a cheese stick. I am sure you won't forget a walking talking, large round bagel gibber jabbering and eating a cheese stick, right? Now, lets take the cheese sticks and the milk. Think of stuffing a 100 cheese sticks into a milk carton, make sure you picture the cheese going in and stuffing the carton as full as you can and closing the lid. The more detailed the easier you will remember it. Now, lets take milk and pineapple. Now maybe imagine a giant milk carton dancing with a pineapple hat. If at all possible create an action, if you create an action and visualize the action in your head it will help. Maybe the milk carton is break dancing. Last two items, pineapple and Alfredo sauce. Imagine a pineapple swimming in your bedroom full of Alfredo sauce. Make sure you visualize it!

Now try remembering the list starting with bagels. Did you do it? Make a list of your own of 25 items or more take a few minutes to read the list through once and test yourself. As time goes on you will find yourself getting quicker and quicker.

I was able to use this method on my last final. It was great! I used it on "Symptoms in patients with pulmonary embolisms" Which are:

• cough


• Dysnea


• Leg swelling


• Leg pain


• Hemoptysis


• palpitation


• wheezing


• Angina-like pain

Again, be creative with imaging and associating. This is how I remember the symptoms of PE.

I imagined a giant standing it the clouds, the clouds irritating the giant so he coughs, he coughs so much he faints and falls to the ground. Next, I imagined and visualized a person standing looking down at their legs as they rapidly started to swell and bust out of their jeans as the person saw this they fainted. And so on and so forth.

I know it is kind of silly. I found this method useful in some ways but it definitely has it limitations. If anything next time you go to the grocery store you won't need to take a list!

The Runout

Dear RT students,

Soak it up while you can... While you are a student I have learned the importance of asking questions. It is your time to ask questions and not look like an idiot. When it comes time to fly solo, guess what, your not going to have a wing-man to hold your hand. I am sure my proctor and fellow RT's at my clinical site are sick of answering questions. Don't be afraid to ask! When-in-doubt ask! Now is the time!

Along with Respiratory Therapy, rock climbing is one of my passions, and there are many things that make rock climbing exciting. As one acsends the cliff, there are many safety points, at most popular rock climbing sites, these safety points are called bolts. The distance between the protection points are called runouts or the distance between the bolts. In respiratory therapy there comes a time when you have to stop relying on the safety points (bolts) and rely on yourself.

When we are finally dubbed "Sir/Madam RT" there will come a time when we are going to be tested. I know what you are thinking... Didn't we just take tons of tests and examinations?? This test will not come from a University teacher, school board, or certifying association, this test will come from your RT director, RT co-worker, nurse, or doctor. They will test your clinical knowledge and aptitude. They will be evaluating to see if you are a good source of information. When this test comes be confident and direct. If you are unsure, fake it; Don't risk any lives or put anyone in danger, but fake it if you don't know it! Stick to your guns, even if you find out you are wrong down the road. Because if you go the other route and you are passive and you show your passivity, you are done. In their mind they will have stamped you "idiot" and move on and never give you the time of day again. Stupid right? Unfortunately, this is how it works. Confidence needs to be apart of your mentality. There is no room in a hospital setting for apprehension.

To avoid "faking it" learn all you can now so you can practice what I call "objective confidence". Objective confidence involves developing intelectually in preparation of these superfical tests. By asking questions and unceasingly building your respiratory therapy bank-of-knowledge, you will be able to use objective confindence.

One of my first RT trainers helped me to understand the importance of learning now. He was one of the most well educated RT's I have ever met. I asked him how he was able to retain so much during school? He said, "When I went to class, I took notes, when I came home from class I digitally recorded my notes, and when I went to the gym, went to the grocery store, went to the bank, I listened to my notes. And when I didn't know something, I asked."

Take ever moment to learn now, so when the runout comes you can use objective confidence, instead of ending up looking like this guy, stuck between safety points, with now where to go but down...

Delay

My sincere apologizes, I have been gone for so long. I had to change schools because of a job change. It has been a long journey but I have gone through most of my classes and I am ready to start my didactic studies. Actually, I will be starting tomorrow!!! My clinicals will be at one Las Vegas hospital. I better get to sleep, I have to report for duty at 0600 hours. Thanks for the support to everybody.

Marfan Syndrome

My final presentation for Cardiac and Renal Anatomy and Physiology. Let me know what you think!

What is COPD?

My Anatomy & Physiology final project.