Friday, March 25, 2011

Know CPR

Imagine a family member or friend collapsed in front of you and wasn't moving or breathing. Would you know what to do? Could you help save his or her life? Novato resident Stacey Beltran knew what to do when her uncle Doug Briggs crumpled to the floor this past Christmas Eve. Fred Potter of Tiburon knew what to do when his good friend Steve Sears went down in January 2008. They called for help and started CPR.
Fifty years ago, the closed-chest resuscitation technique (the cardiac component of what is commonly known as CPR) was described by William Kouwenhoven in the Journal of the American Medical Association. Kouwenhoven and colleagues at Johns Hopkins reported a success rate of 70 percent - unheard of in those days - when using the technique to treat hospital patients suffering from sudden heart attack related arrest. The implications were immediate and widespread. "The closed-chest method replaced the 'ghastly' ritual of open cardiac massage (cutting through skin and bone to access the heart). No longer would resuscitation be limited to surgeons bold enough to wield a scalpel," wrote W. Bruce Fye in American Cardiology.

This year the technique of chest compressions combined with assisted respirations celebrates its 50-year anniversary. Since its adoption, CPR has become a staple of care for patients whose hearts have stopped and has been taught to thousands of health-care providers, first responders and citizens. Multiple studies have shown that CPR, particularly

when paired with early use of an electronic defibrillator, saves lives.
Consider a study of 1,667 patients with outside-the-hospital cardiac arrest in King County, Wash. In this group of patients, if CPR and defibrillation (or other advanced life support intervention) were started immediately, the patient had a 67 percent chance of survival.

For each minute that passed without these, the chance of survival dropped by 5.5 percent. Thus, 10 minutes after cardiac arrest, if nothing had been done, the survival odds were 12 percent. In another two to three minutes they were zero.

However, if CPR alone was performed (keeping blood flowing to the brain and vital organs while awaiting help), the odds improved by 2.3 percent a minute - essentially doubling survival at 10 minutes post-arrest.

But, statistics are just part of the story. Sears, owner of Sam's Anchor Cafe in Tiburon, is alive today because Potter started CPR. It was mid-afternoon on Jan. 17, 2008, and Sears was tending to the business side of his restaurant when he collapsed. "My heart had been racing all day," Sears told me. "I remember standing in my office. After that, I don't remember anything."

Potter, a retired engineer-paramedic with Tiburon Fire, was on the deck of Sam's showing his brother the view of the bay when he heard a commotion from inside. Potter handed his cup of coffee to his brother, rushed into the office and started CPR. "The adrenaline was definitely pumping," Potter told me. "I knew what to do, but it was the first time I'd ever had to do it on a good friend."

Moments later Tiburon Fire Battalion Chief Ed Lynch arrived with an automated external defibrillator (AED) - a life-saving device that Potter describes as "easier to use than a cell phone."

Briggs is alive today because his niece knew what to do. Beltran had just taken a course in CPR from Sandy Wargo of Novato Fire. After her sister dialed 911 and got a dispatcher on the line, Beltran put her CPR skills to use.

"All of a sudden, I remembered the steps in CPR É I looked at his chest, hoping for movement, and nothing É so I put my hands together, looked for the spot on his chest and started compressions. I counted aloud just like Sandy taught me to do."

Moments later, the Novato Fire paramedics were on scene and shocked Briggs' heart rhythm back to normal.

Sears and Briggs suffered heart attacks that caused a sudden alteration in heart rhythm called ventricular fibrillation. Both required stents to open coronary arteries and both were home and mostly recovered within a few weeks. They are exactly the type of people - relatively young (under 70) and relatively healthy - who are the best candidates to survive cardiac arrest. But their survival, and that of others like them, is predicated on immediate assistance.

So, would you know what to do? Would you be able to put aside emotion and do what was needed? Or would you just stand there? If you're not sure, there are steps you can take. First, you can sign up for a basic life support course. Second, you can pay attention to where AEDs are kept - you will notice them at the gym, on campus and at the airport. And finally, on June 4 you can come to one of multiple sites in Marin and celebrate CPR's 51st birthday by receiving free (noncertified) training in hands-only CPR and AED use. The training will take less than 10 minutes, and just might help you to save someone's life.

But, don't take my word for it. "It is extremely important," said Sears. "Because without training, people freak out É they don't have the confidence to know what to do. I was fortunate to be in a circumstance where people knew what to do. I hope that my story will motivate people to get out there and get trained."

Wednesday, March 23, 2011

Sleep on it

“In the great green room there was a telephone, and a red balloon, and a picture of - the cow jumping over the moon.” So begins the final chapter of a ritual played out in bedrooms across the land…“Goodnight room, goodnight moon, goodnight cow jumping over the moon.” The soothing repetition of Goodnight Moon and similar verses is employed by millions of parents each night as they send their kids off to dreamland. For many parents, including myself, this is but the penultimate step in an extended bedtime routine. Dinner, bath, pajamas, warm milk (but not so warm to make it too hot), books on the couch, clean teeth, a wave to the stars, a march up stairs, a tuck into bed (making sure to get the pillows propped just so), Goodnight Moon and songs, and, finally, a kiss goodnight. Phew. I know I’m not alone in performing a regimen of this sort – in fact I know many moms and dads who practically obsess about the timing, ritual and quality of their children’s sleep. Why is it so important? Because, as everyone knows, sleep matters. Children whose rest routines are irregular are irritable; transforming from adorable puddle jumpers into barely bearable brats.

This parental commonsense is also backed by strong science. Rats that don’t sleep don’t just become brats, they become dead (within four to five weeks.) And the data isn’t just about rats. Studies demonstrate that sleep deprived people have delayed reactions, difficulty concentrating, and impaired cognition and judgment. This, of course, explains the rationale for sleep deprivation interrogations. Given all this, why is it that a nation so meticulous about its children’s sleep is so careless when it comes to properly resting its adults?

You may have heard about the recent Center for Disease Control and Prevention (CDC) report on sleep. Based on a telephone survey of over 70,000 adults, including some 11,000 Californians, over a third of Americans get less than 7 hours of sleep a night. This, as you may know, is less than the minimum amount recommended by the CDC, the National Sleep Foundation and The Sleep Train. An even more concerning finding in this study is that 38% of respondents reported nodding off unintentionally in the last 30 days, and 5% of these people admitted that this had occurred while driving. This suggests that data from the National Highway Traffic Safety Administration indicating that driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1,500 deaths each year may actually be an underestimation. As a shift worker, I have personal experience with this. Driving home after a night shift in the ER can be scary, sometimes it seems like my consciousness is on the verge of automatic shut down. For shift workers and parents of young children some level of sleep deprivation is virtually inevitable, but for many others, sleep deficits are preventable and should – for health, safety and sanity reasons – be prevented.

There’s no shortage of advice about sleeping to be found via Google, but to save you the time of sorting through it all, let me give a less than exhausted… I mean exhaustive, review.

So, what follows (with the help of the good people at Quoteland), is a quip-based guide to getting good with sleep.

“The sleeping fox catches no poultry.” -Benjamin Franklin

I am a big Ben Franklin fan, and while he may be technically right on this one, his advice is not applicable to most human beings. Franklin, famously, required very little sleep. And while there are certainly in-born differences between individuals in sleep requirements, there are not too many Franklinesque 30-minute-cat-nap types out there. Far more common is the burn-it-at-both-ends type who ignores her sleep need – piling onto a deficit that can only be repaid at the bedtime bank. To not settle up is to play chicken with health and longevity. If you don’t already know, figure out how much sleep you need to be at your best, and make sure you get it.

“The two best physicians of them all -- Dr. Laughter and Dr. Sleep.”-- Gregory Dean Jr.

Well, I might have to throw Dr. Feelgood into the mix too. But seriously, we are just beginning to understand the physiological functions of sleep – which include encoding memories via nerve-signal repetition; increased cellular production of proteins that are likely involved in repairing damage from stress, ultraviolet light and dietary toxins; and spikes in growth hormone release in young people. Sleep is good medicine.

“You can't stay married in a situation where you are afraid to go to sleep in case your wife might cut your throat. “ -Mike Tyson

Practical advice indeed from Mr. Tyson. How about some other suggestions for ensuring a restful night? The CDC has a list of sleep hygiene tips that include sticking to a regular sleep schedule (just like your kids!), sleeping in a dark and relaxing environment, removing all computer and other gadgets from the bedroom (but keep the white noise machine), and avoiding alcohol, caffeine and large meals within a few hours of bedtime. Another important suggestion is to just say “no” to pharmaceutical sleep aids unless you’re making a sleep transition (such as when coping with travel time changes or the disorientation of being “Sprung Forward”) and have discussed the sleep aid options with a doctor. Some over-the-counter medications may have more side effects than you expect. Instead, mindfulness exercises and yoga might be useful for the sleepless and a comfy mattress seems like a no-brainer.

“Drop, drop in our sleep, upon the heart sorrow falls, memorys pain, and to us, though against our very will, even in our own despite, comes wisdom by the awful grace of God. “

I am not sure exactly what this means, although it sure sounds pretty and I think it may be referencing the germination of inspiration. Guess I’ll try sleeping on it.