A few weeks back I got nearly scared out of my skin.

I was visiting a hindu temple outside Kuala Lumpur, which had about 500 very steep steps leading up to it. The temperature was a heady 30c, with about 90% humidity. In these conditions and being fairly fit, even I found reaching the top of the steps pretty hard going. As I finished my visit to the temple, I headed back down the steps, but soon came upon a slightly overweight man in his late 30s / early 40s who didn't look at all well. He was being tended by his wife, who was fanning him as he sat on the steps, head between knees. His skin was a pale green colour. I decided to hang about nearby for a bit, because I have some first-aid training and figured I might be useful if called upon. Pretty soon I looked across and saw the man was slumping, his head was rolling back and his eyes were doing pretty much the same. It looked awful. His wife started wailing 'HELP! HELP!', at which point I lept into action. I dashed off to try to find a phone, or someone with a phone, running up the steps past the couple as I did so. As I went past, I remember thinking that he looked pretty well gone. It was a horrible situation to be suddenly involved in – and I had this sickening feeling that any decision I made or didn't make at that point could somehow determine whether he lived or died.

After less than a minute or so I returned, still having been unable to find a phone, but then to my complete surprise I found the man was actually sitting up, still not looking well, but conscious nevertheless, and saying in broken English 'It is ok, I was just sleeping'.

I decided not to get any more involved at that point, but watched them at a distance for a few more minutes, just to ensure he hadn't deteriorated again. Eventually the couple walked off – up the steps.

Had he had a heart attack? Epileptic fit? WTF? What would've been best thing to do in this situation?

Epilepsy?

Sounds like a faint. Not a lot you can do. Nor would there have been anything much if it had been a heart attack or anything more serious.

The only thing that makes a difference to outcomes in serious collapses is how near are you to a defibrillator ( if thats what is needed) and oxygen.

Bascially if someone collapses they either get recover on their own, or they die. Only if you are within a minute or two of a fully equipped A&E does it make much difference

I'd suggest the temp / humidity / exertion may have brought on a faint, which is basically shock. The body withdraws its fluids to the core to keep those functions active and shuts down the rest as non-vital for the time being. Hence the stomach stops working which is why people in shock / faint often feel sick. The blood flow to the skin and extremities slows hence the typical pale / grey-blue pallour to the skin. In a curious mistake of engineering the blood flow also slows to the brain keeping it running on standby but shutting down conscious activities which is why people actually faint and fall down, when there isn't sufficient blood pressure being generated to pump it to head height.

I'd suggest treatment would have been to lay him down flat with legs raised so the head is then at the same level as the heart and enabling supplies to be returned. His 'collapse' seems to have had the same effect. And then treat the cause in the first place – maybe the rest would be enough, maybe dehydration, difficult to say without being there.

Doesn't sound much like either of the two conditions you speculated tbh, both have other far more remarkable symptoms that you haven't described.

[edited to correct dreadful spelling]

So why do they bother to train us first-aiders in CPR, rather than train us to use defibrillators and have those available? I think we do have a defib on site, but it could take a while for it and the trained person to make it, compared with how quickly a first-aider would get there.

A bit of a rhetorical question, as it's something I've been aware of for a while. Years ago I was a highly trained lifeguard – AFAIK CPR is still understood to be useful for drowning and similar instances, though the only time I was ever involved in pulling somebody out, the poor chap had had a heart attack in the middle of a sponsored swim and didn't make it.

The only thing that makes a difference to outcomes in serious collapses is how near are you to a defibrillator

That's completely against all the info I've had on numerous first aid courses. Are they telling porkies just to make us think we can make a difference? Do they give you a little sticker to put up in labs and offices about how to do CPR just for the fun of it?

Heat exhaustion?

I once had a fit in a metalwork class as I had the start of an illness (tonsilitis) and coupled with the heat in the room (we were smelting aluminium) I keeled over and fitted.

Went for ECGs and no epilepsy was detected.

Also I have seen a similar thing happen to a forces recruit doing an obstacle course – same thing. The body just shuts down.

Aracer – if you can get the water out of his lungs quickly then it could be lifesaving indeed. Thats not an unexplained collapse.

Coffeking – thats why I say if you have a defib nearby you might save someone – but survival rates are still low.

If there is an easily reversible cause – lungs full of water / electric shock / choke you can make a difference by removing the cause and getting the heart going again.

If they have collapsed and the heart has stopped because of a major heart attack then no you won't make any difference to outcomes.

Bascially if someone collapses they either get recover on their own, or they die. Only if you are within a minute or two of a fully equipped A&E does it make much difference

Ummm TJ – I'm walking talking proof that effective CPR can and does make a difference. I was unconscious, blue, not breathing and apparently had no detectable pulse (*) so I was not going to "recover on my own" but happened to have had my incident right next to a group of people who'd just finished a day of accident management drills.

(*) – I think detectable is the key word there – I believe it was probably just very weak.

If they have collapsed and the heart has stopped because of a major heart attack then no you won't make any difference to outcomes.

No point in CPR then?

If somebody collapses/becomes unconcious, the basic principle regardless of the cause is the A,B,C approach:
A – protect the airway. Whatever the cause, a 'collapsed' airway will kill them first. Head tilt/chin lift will suffice – this can be done on the street.
B – Breathing. Ensure there is oxygen in the lungs. This will NOT happen unless the airway is open (A). This is where mouth-to-mouth comes in. If someone IS breathing, maintain the airway.
C – Maintain a blood circulation in order to perfuse the organs with OXYGENATED blood. Blood won't be oxygenated unless tehre is Oxygen in the lungs (B) and of course there won't be oxygen in the lungs unless…….(A) – seeing the pattern! Chest compressions (in most cases) will maintain a cardiac output (adequate pulse) in order to acheive this.

TJ is partially correct – in certain situations (generally following cardiac damage/heart attack) the heart electrical activity gets so disorganised that only an electric shock will restore a normal rhythm, but decent chest compressions 'technically' should keep them alive long enough until shock is delivered.
There are many other circumstances where a person's heart stops, and only CPR will work i.e. no shock can be delivered (flatlining is a classic example – everytime you see a flatline getting a shock on TV it's plain wrong!!).

The fat guy on the stairs probably feinted given his prompt recovery. Epileptic fits are usually followed by a drowsy period of several minutes.

Next…..

DrP

My wife did this on Carn Brae. We had decided a brisk pre breakfast hike would blow the cobwebs out of our ears after a heavy nights drinking. (Ooopps)
Half way up she stopped to rest sat on a rock and just tipped forward unconscious face first into the ground.
I pulled her round so that her head was uppermost and checked her breathing etc. After a short while she came round and we managed to walk back down and drive to A+E.
They were not really worried by the feint and seemed to think that I had beaten her up (smashed glasses, cut face etc.)The more she asked to see me the more suspicious they became.

If they have collapsed and the heart has stopped because of a major heart attack then no you won't make any difference to outcomes.

I think the point is to mechanically force bloodflow until more qualified help can arrive and get it back into autopilot again, preventing/limiting brain damage, not trying to just restart someone and walk away.

I was answering the OP – In the circumstances he described then whatever he did would have had very little bearing on outcomes IMO. To oversimplify He is either fainting – recovers on his own or he has blown his heart to pieces. He dies.

In other circumstances the outcomes could be different but the major thing that has a bearing on outcomes is the availability of a defib and people experienced in CPR. Only some conditions respond to cpr and a defib.

I have done CPR in hospitals maybe 10 times. One survived for 2 months more as a cardiac cripple. The rest were dead.

His skin was a pale green colour

Racist.

Are you against Kermatism?

Dr P – if they have flatlined how can CPR correct it? yes done well you can keep oxygenated blood going round the system but there still needs to be something to reverse the cause.

Dr P – if they have flatlined how can CPR correct it? yes done well you can keep oxygenated blood going round the system but there still needs to be something to reverse the cause.

He never said it would, he said (I think, I paraphrase) keep them going until defib ability arrives. This seems like a logical course of action to minimise damage.

I'm not sure I'd like to be near you if I had heart problems, you don't seem to be too good at CPR (going by your own survival rates) and you'd probably walk away anyway 😆 Our first aid instructor told of a few negatives he'd been involved in, but many positives, including one where he had to keep CPR up for nigh-on 20 minutes with another person (must have hurt) but the person made a full recovery (ambulance arrived etc).

I was certainly told in my first aid training that cpr has a very very low success rate. I think letting people know this when learning cpr is very important in case they do have to perform cpr. False expectations of success can be damaging for people giving cpr, leading to feelings of guilt. The 999 operator wanted me to perform cpr on my friend, when i explained it was pointless (body cold, blood pooled in tissue at lowest point etc.) they asked if i could find someone who was prepared to. Talk about making someone feel guilty.

TJ – Causes of a cardiac arrest include:
Hypoxia, Hypotension (massive blood loss), Electrolyte abnormality, Toxins, Thrombotic events (PE), Ischaemia.

If someone 'flatlines', their heart has stopped it's electrical activity due to one of the above causes.
CPR maintains the 'pulse' (via chest compressions of course) whilst the above causes are identified and corrected.

Take hypoxia:
A 25 year old male is pulled from a river without a heartbeat and is 'flatlined'. Cause most likely hypoxia (i.e. he drowned and had no oxygen to his heart). Perform CPR and provide oxygen via mouth-to-mouth. There is a VERY HIGH chance he will fully recover as his heart was previously fit, and an obvious cause has been identified and corrected.

See the British Resus Council website if you want more info.

In some circumstances you cannot identify a reversible cause of cardiac arrest, in which case death is likely, but don't play down the importance of CPR please.

DrP

coffeeking – if they have flatlined a defib does not work. You have to find and reverse the cause of the flatlining. Ok I see your smiley but I can still see the faces of the people I attempted to resus. thats pretty offensive.

Dr P – thats much as I said. We are slightly at cross purposes.

TandemJeremy – Member

If there is an easily reversible cause – lungs full of water / electric shock / choke you can make a difference by removing the cause and getting the heart going again.

If they have collapsed and the heart has stopped because of a major heart attack then no you won't make any difference to outcomes.

Early CPR and defibrillation within the first 3–5 minutes after collapse, plus early advanced care can result in high (greater than 50 percent) long-term survival rates for witnessed ventricular fibrillation.

Seems to me like it's fairly important to at least give it a go, just in case it helps and things pan out well.

One thing they also say is that a lot of people don't put nearly enough force into it, requiring something like 60Kg of force to get half-decent results.

Ok I see your smiley but I can still see the faces of the people I attempted to resus. thats pretty offensive.

You obviously get fairly emotionally involved with it, as I'm sure most people would, but I'm not sure that helps. If you get hung up on stuff like that maybe you tend to become very negative and defeatist about it? I've never had to actually do it, so I can't claim that experience, but I'm fairly sure that I'd at least like to know I tried even if there was no chance. It's easier to reconcile "I tried but they were too far gone" in my head than "They might have been too far gone, I'm sure not trying was the right answer". All I'm saying is it looks like you're suggesting CPR isn't worth bothering with, if you feel like that then maybe you're in the wrong field?

Regardless of anecdotes, Out of Hospital Arrests have a survival to discharge rate of somewhere between 2 and 8%.

In other words, 92% of all OHAs will die before they are discharged.

Even in hospital arrests have a survival rate of only about 14%.

Of those who actually survive, about 10% are left with moderate or severe neurological disability.

In terms of the OP, best to look for reversible causes of unconsciousness; high ambient temperature and exercise leading to vasodilation and subsequent hypotension, or hyperventilation; Fainting…

Incidentally, it seems to be the case that the Cardiac bit of CPR is far more important than the mouth-to-mouth bit..

http://ccforum.com/content/12/2/302

In other words, 92% of all OHAs will die before they are discharged.

Or 1 in 10 people could be saved if you give it your best shot. I like those odds.

Though we are straying from the original point I think, I'm not sure I'd have suspected heart problems immediately in those conditions.

AED training now makes up part of the FAW qualification

Or 1 in 10 people could be saved if you give it your best shot. I like those odds.

Or you would have to do CPR on 100 people to see 8 survive to go home as they were. I see the ones who make it to hospital, and sometimes am surprised, but it's a grisly lottery to observe.

It's always worth having a go, but it's important to be realistic about the outcomes.

when I did my first aid training (some years back) we were warned that CPR doesn't suddenly miraculously make someone sit up and live again. The point made was that by keeping blood circulating and oxygenated you could perform the equivalent action of a functioning respiratory system and keep the brain oxygenated until help does arrive. Whether they could then do anything is their job.

Conversely – if you don't do anything then you can pretty well say that in about 3 minutes max there won't be anything to bring back even if they can.

@ ebygomm, that sounds awful and who knows how I'd feel in the same situation, but the first aid course I did basically said that a valid first aid certificate doesn't confer the permission to pronounce life and death.

I'm not going to get involved in a clinical argument, but there is some questionable medical rhetoric going on here…

Coffeeking – one reason why I moved from critical care to elderly care

I am certain I would rather people died a dignified death than with people jumping on their chests.

Of course I would CPR people but only when it was not futile.

CPR is worth it in some circumstances but not in others. Of the 2-8% crikey says get to leave hospital a significant number of them will not survive long after discharge. One of the people I resused will be recorded as surviving to leave hospital. He died 3 days after leaving hospital.

Unfortunatly on this thread my comments about a specific situation that the OP described became confused with the more general situation.

In an collapse then do CPR. However without and obvious reversible cause and in the absence of equipment then the chances of it making any difference to outcomes is very low indeed.

Sounds like he's got the bad kind of aids.

Or he's had a dodgy pint/burger etc…..

I've just done a first aid refresher course, run by a working paramedic, so a bit more practical and pragmatic than other courses I have been on.
It's interesting how the advice on CPR etc has changed over the years on the different courses I have attended. With reference to some of the earlier points:

Defibrillator: Our course instructor gave these a big thumbs up. No training required, as most of the public units will deliver spoken instructions to the user. So if you have access to a defib in a cardiac arrest situation, grab it and have a go.

CPR: The cardiac pumping is the most important bit. Our instructor made it clear it's a personal decision whether to do mouth-to-mouth, but if you decide not to, the body still has residual oxygen reserves that can help to keep the patient alive for a few minutes if you pump the heart.

@ ebygomm, that sounds awful and who knows how I'd feel in the same situation, but the first aid course I did basically said that a valid first aid certificate doesn't confer the permission to pronounce life and death.

If you find the body of someone who's been dead 16 hours, you don't need any sort of course to know that they're dead, whether you can officially pronounce it or not is irrelevant.

if you can get the water out of his lungs quickly then it could be lifesaving indeed

I'm surprised at you TJ – though I suppose you don't come across many drowning old people. Unless the advice I got was totally wrong, you don't make any attempt to get water out of the lungs and don't need to – they should still have enough left to get some air in and oxygen transfer if doing CPR.

CPR: The cardiac pumping is the most important bit. Our instructor made it clear it's a personal decision whether to do mouth-to-mouth, but if you decide not to, the body still has residual oxygen reserves that can help to keep the patient alive for a few minutes if you pump the heart.

Unless they're a drowning victim – back when I did it 25 years ago you didn't even get taught cardiac compression for Bronze Medallion (though I'm guessing that has changed now).

Ebygomm; apologies then but in the context of the discussion where someone has collapsed maybe from a faint, epilepsy, or suddenly taken by a massive heart attack I was passing on what I'd been told – namely that even if you suspect they've suffered the latter and died the correct course of action is to CPR until someone qualified arrives.

Re-reading your post and carefully thinking about what you'd written, while not clear it was a long time past there are enough clues to suggest it wasn't recent either. Apologies again for any offnce caused.

AED training now makes up part of the FAW qualification

Good – they mentioned it might come in when I last renewed. Unfortunately it's a year before I get that.

The only thing that makes a difference to outcomes in serious collapses is how near are you to a defibrillator ( if thats what is needed) and oxygen

💡 Precordial Thump

qwerty – no longer taught. – or at least at my last update a few months ago.

They were not really worried by the feint

So your wife was pretending? 😉

Feint – something misleading; a dummy
Faint – passing out.

HTH 😉

Precordial thump is only of use in a WITNESSED VT/VF arrest i.e. probably needs to be cardiac monitored in hospital….

Saying that, if i saw someone collapse and they were pulseless, I'd give 'em a whack!

DrP