What did you learn today TIL

[watcher1]

I believe I could do very well on Jeopardy, but Holzhauzer is a freaking cyborg computer from the future.  His recall on truly obscure subjects just blows me away.

A local guy and a graduate of the U of Illinois. He is on course to shatter the old total winnings by doing it in half the time. Plus he is a Cub fan.

[watcher1]

   5 – Penis is so hard it can occasionally strike sparks against flint.

I am guessing that you added #5 because of the effect MJ has on us guys....

[_priapism]

I believe I could do very well on Jeopardy, but Holzhauzer is a freaking cyborg computer from the future.  His recall on truly obscure subjects just blows me away.

A local guy and a graduate of the U of Illinois. He is on course to shatter the old total winnings by doing it in half the time. Plus he is a Cub fan.

He was a math prodigy.  He is a professional gambler.  My guess is he has a photographic memory and excellent recall, which permits him to count deep into a deck, and memorize a lot of stats for his sport betting.  He just sees and remembers things differently than most.  To him it is normal.  To the rest of us, it is completely freakish.

[RopeFiend]

I've spent the day researching Dr. Henry Heimlich and his famous maneuver.  Turns out there's not a shred of decent evidence to support it, which is partly why it's the ALTERNATE procedure in the Red Cross protocols for a choking victim.  Heimlich himself was a quack that got tossed out of the hospital he was working for, and he couldn't get malpractice insurance so he never practiced again.  He assisted with Nazi-style experiments on people in China, infecting them with Malaria to cure them of AIDS and other maladies.  Really, dude?!?  Some of his exploits are truly weird and amazing.

The term "Heimlich Maneuver" was indeed trademarked by Henry himself in 1976.  His assertion (again, with ZERO proof) that back blows might force the foreign object deeper into the lungs was at the root of his disagreement with the Red Cross (and others that followed their protocols).  That's why they removed his name from the 2006 Red Cross manual - Henry insisted, so it became "abdominal thrusts".  I haven't found a single case in my hunt today where a back blow lodged something in the lungs.  The Red Cross has some poor-quality data that suggests that the best procedure is back blows first, followed by abdominal thrusts if the blows don't clear it.  Christ on a crutch people, PRACTICE IT ON PIGS.  That's what they do for the CPR protocols - they induce V-Fib or V-Tac in pigs and then find out what's the ideal way to fix it.  If it's gonna become bacon, WHO CARES if it choked to death first?    If it saves some of the 5,000+ people that choke every year in the US, it's worth a few hundred pigs meeting their maker.  They're gonna be pork loin anyways, so they might as well help us in the process.

The number of people that die every year from choking hasn't changed a bit since the advent of the Heimlich Maneuver.  Adjusting for population growth, it's remarkably static across the years, so one method doesn't work astoundingly better than the other.  A number of prominent people have been saved by both methods.  Interestingly, just over HALF of the choking deaths are in people 75 years of age or older, which was a surprise to me.

Heimlich was such a shit that one of his sons put up a webpage debunking him.  Wow, what kind of special guy has his kids turn against him and badmouth him publicly?  That page is here: http://medfraud.info/  Check it out.

From everything I've found today, Heimlich's whole stance is based on "it's true because I say so."  People all over fell for it, including (as of today) the American Heart Association.  Their current ECC guidelines mention both blows and thrusts, although their training for the public only covers the thrusts.  From personal evidence, the blows worked just fine for a friend of mine last year.    His son lived.

https://www.youtube.com/watch?v=UVNxP7K2ATE

[MissBarbara]

I've spent the day researching Dr. Henry Heimlich and his famous maneuver.  Turns out there's not a shred of decent evidence to support it, which is partly why it's the ALTERNATE procedure in the Red Cross protocols for a choking victim....

Wow, thanks for all this excellent information!

When I took that Red Cross course, I was taught a 3-step process:

1. Check the victim's mouth, to make sure the tongue was in its proper place and there wasn't anything lodged in his mouth or upper throat.

2. Stand behind him, lean him over, and deliver the "back blow."

3. Perform the abdominal thrusts.

In the course I took, after teaching us the process, the instructor had us practice it with someone else in the class. I did it with the guy sitting next to me, who was at least 12 inches taller and 100 lbs. heavier. When I bent him over, I couldn't even reach the spot on his back where I was to deliver the back blow, and when I reached around him for the abdominal thrusts, I couldn't wrap my hands around him to put my hands in the proper place on his body.

I've never had the chance to practice my skills in real life, but I saw them perfectly executed a few years previously. I was in a dinner, and there was a commotion across the restaurant. I looked over, and a guy was choking on what I later found out was a grilled chicken sandwich. A guy eating with him bent him over and did the back blows, and then stood him up, and did three abdominal thrusts. On the third thrust, the chunk of sandwich flew out of his mouth and landed about five feet away. It works.

[psiberzerker]

I learned a lot from RF's video.  A lot of my medical training is out of date.  When I got my EMT, the Heimlich was still THE technique (The only technique, back blows were taught to do more harm than good) for a choking victim, conscious or unconscious. 

Of course, I took it, and got certified in North Carolina, which can be a little backward when it comes to Qualified instructors.  In any field.

[vinney]

One of my colleagues started choking... he was eating an apple and part of it stuck in his throat... Another colleague, an ex-army medical man, used the Heimlich Manoeuvre with great effect... the chunk of apple flying across the office. Great he survived and that someone was on hand who knew what to do. Many of the staff learned the procedure in the following weeks.

[psiberzerker]

Consider the source, but don't discredit the technique, just because it came from a Mengelesque medical sadist who used his influence to discredit his peers.  (Eddison, Tesla, and Marconi all 3 did this to each other, but we still use Light Bulbs, AC, and Radios to this day.  The Light Bulb is even symbolic of a good idea, despite the fact that he used to pubically electricute animals to prove that AC is dangerous, and helped invent the Electric Chair.)

Like the video said, it may work, but if it doesn't try something else.  If that works, try something else.  One of the reasons why CPR Chest Compressions, and Heimlich Abdominial Thrusts can break bones is because we're talking about an Emergency Situation here.  Life or Death, even trained professionals can get desperate, full of Adrenaline, and knowing the risk of Rib Fractures (One of the most common injuries) try harder to save them, even the point of trying Too Hard.

A couple of broken ribs, compared with choking to death (Which is a nightmare if you're conscious) is something you'll have to weigh, after the fact, with your respective therapists, but in an Emergency, there's only so much you can think of at once.  "Call 9-11" first.  Don't just say it out loud, point to someone with a phone.  "You, call 9-11."  Otherwise, you run the risk of Bystander Affect.

[psiberzerker]

Also, WTF is it with German (Austrian, Swiss...) Scientists?  I know the popular view is they're Brilliant, but how many is that now that have been discredited for using unethical (Sadistic) research practices?  Sigmund Freud, the (Austrian) grandfather of modern psychoanalysis basically invented medical gaslighting.  RF used the term Nazi-esque, but it didn't start with the Nazis.  They just Perfected it.

[MissBarbara]

Consider the source, but don't discredit the technique, just because it came from a Mengelesque medical sadist who used his influence to discredit his peers.  (Eddison, Tesla, and Marconi all 3 did this to each other, but we still use Light Bulbs, AC, and Radios to this day.  The Light Bulb is even symbolic of a good idea, despite the fact that he used to pubically electricute animals to prove that AC is dangerous, and helped invent the Electric Chair.)

Like the video said, it may work, but if it doesn't try something else.  If that works, try something else.  One of the reasons why CPR Chest Compressions, and Heimlich Abdominial Thrusts can break bones is because we're talking about an Emergency Situation here.  Life or Death, even trained professionals can get desperate, full of Adrenaline, and knowing the risk of Rib Fractures (One of the most common injuries) try harder to save them, even the point of trying Too Hard.

A couple of broken ribs, compared with choking to death (Which is a nightmare if you're conscious) is something you'll have to weigh, after the fact, with your respective therapists, but in an Emergency, there's only so much you can think of at once.  "Call 9-11" first.  Don't just say it out loud, point to someone with a phone.  "You, call 9-11."  Otherwise, you run the risk of Bystander Affect.

Technically, if you're performing both abdominal thrusts and chest compressions correctly, rib fractures shouldn't prove a risk at all.

The correct way to perform abdominal thrusts is to make a fist with one hand, cover it with the other hand, and place your hands just below the bottom of the rib cage.

The correct way to perform chest compressions is to place your hands on the sternum, over the heart, and compress there. And chest compressions do not need to be very forceful. You're not trying to "restart" the heart, you're essentially performing the tasks at a heart in cardiac arrest would otherwise be performing, that is, pumping the blood throughout the body and, most important, to the brain. If your compressions are hard enough to break a rib, you're not doing it correctly.

And you're right: The first thing you do is call 9-1-1 or have someone nearby call 9-1-1. And you have to be specific, as you indicate. I can't count the times in the course where I practiced saying loudly, "You! Call 9-1-1!"

[ChirpingGirl]

I learned summer vacation is going to cost more than I thought it would. 

[IdleBoast]

I can't count the times in the course where I practiced saying loudly, "You! Call 9-1-1!"

I've been a trained first-aider for nearly two decades, and despite working with various mixes of young children, corrosive chemicals and power tools, I've only twice needed to use it for more than a graze or a dizzy spell.

The secret, I find, is prevention; I've not had so much as a clipped nail to deal with since I stuck a copy of this over the power-tool rack...

[vinney]

The worst injury I had to deal with was a woman who trapped her hand and fingers in a taxi door. It was not the best feeling I had, but that was my introduction to my new first aid role where I worked. It taught me to control feeling nauseous

[psiberzerker]

Technically, if you're performing both abdominal thrusts and chest compressions correctly, rib fractures shouldn't prove a risk at all.

They teach this, but in reality, ER nurses, and paramedics still cause rib, and stermum injuries, because This Is An Emergency.  Not a dummy, a real live human being.  A conscious choking victim is going to struggle, and even kick, because they're choking.  Just like a condemned horse theif, or suicide does when hanging, even if they want to die.  There's talking about it, calmly, in the classroom, and then there's practicing it in the real world, with people.

Under ideal circumstances, if you chew, and swallow correctly, there should be no risk of choking on food.  Chewing, and swallowing is a shitload simpler, and more instinctive than practicing emergency medicine on a complete stranger.  And yet people get it wrong, often enough to have a plan for someone who critically fails their Eating roll.

[IdleBoast]

Hah, that's worse than mine, Vinney - a fingertip mashed in the hinge-side of a slammed door, and a "burst" head when somebody fell over backwards onto a hard floor.

[RopeFiend]

CHOKING:

Rib fractures aren't a worry with either back blows or abdominal thrusts; neither puts force on the ribs.  If you're hitting someone hard enough to dislocate the spine, you're hitting WAY too hard.  Try pounding the last bit of ketchup out of the bottle; that's about how hard you need to whack the back between the shoulder blades.

With infants (a year or less, or under 50 lbs) you alternate 5 back blows (with their head down) an then flip them over and use 2 fingers in the center of the chest to do 5 chest compressions (again, with the head down).  Since an infant's bones are much more pliable than an adult's, you shouldn't have to worry about breaking ribs or the sternum.  Don't attempt abdominal thrusts on an infant, or you could damage their internal organs.

CPR:

NONE of the training agencies mention it, but breaking the sternum is about a 30% risk when doing CPR on anyone.  The desired compression depth is a funky set of measurements: in reality you're shooting for compressions of roughly 1/3 of the depth, sternum-to-spine.  That means on chunky people you press DEEPER than the recommendations.  I've heard a sternum crack in real-life CPR video; it sounds like breaking a celery stalk.  IF you ever have to give CPR, DON'T WORRY ABOUT BREAKING THE STERNUM!  They'll heal from that in time.  If you do a shoddy job of the compressions because you're afraid of hurting them, they may not make it.  High quality compressions gives the person the best chance of surviving until an AED is available.  The 'rescue breaths' are of secondary importance, but they're still needed.  There's little sense circulating blood if there's no oxygen or ATP in it.  

Hands-Only CPR method is ONLY for people that aren't trained to Do It Right.  Sorry, Vinnie.

EVEN IF AN AED IS IMMEDIATELY AVAILABLE (unlikely), do 5 full sets of compressions & breaths before starting it.  You should certainly apply the pads from the other side while someone else is doing the compressions, but don't start the analysis until 5 sets (2 minutes) of compressions are completed.  The reason behind this is that the heart runs out of ATP (energy) very quickly in the case of V-Fib or V-Tac, and hitting it with a shock may not have the desired effect (flatline and re-start).  By doing 5 sets of GOOD compressions, you refresh both the ATP and oxygen in the heart muscle and valves, and the defibrillation is more likely to succeed the first time.  Doing this improves the odds that they'll survive to leave the hospital later by another 10% or so.  It's one of the parts of High Performance CPR that EMTs are trained in today, but there's no reason you can't do it as well.  Note that this is a violation of both AHA and Red Cross training: they both say to use the AED as soon as it's available.  Both groups are trying to make the process easier for lay responders (you and me), but the overall chance of survival is better if you can remember this little hint.  If you've already done 5 sets of compressions then yes, use the AED as soon as it's connected and ready.

[ObiDongKenobi]

This

"Call 9-11" first.  Don't just say it out loud, point to someone with a phone.  "You, call 9-11."  Otherwise, you run the risk of Bystander Affect.

Thanks Psi

[psiberzerker]

I didn't learn this today, but I learned it on the job:

CPR is a lot easier if there's more than 1 person that knows how to do it on site.  (It happened to be a "Senior Living Community" in Fanta Se, with an Emergency Pull in the bathroom.)  There was a Nurse/Paramedic there, that was way more qualified than a retired Industrial Engineer working as an HHA (Home Health Aide)  However, it takes a while for the Ambulance to show up, especially when the apartments are set up as apartments, and navigating the parking lot in a Wheel Chair Van is about as easy as moving a shopping cart around a bodega.  

So, you get tired, and it really helps to have someone to tag out, not to mention check the patient's vitals, and condition (After they passed out) in between doing chest compressions.  It's an Emergency, and if you could plan ahead well enough to have a Nurse Paramedic on hand to assist with the patient, you could probably avoid the emergency in the first place, but if you're lucky enough to, it really helps a lot.

Okay, I hated those Apartments, and how they set up Wheelchair Access, let alone Fire, and Ambulance access really bothered me, because it was purpose built for the purpose.  You'd thing the City Planners would plan for the eventuality of one of those old people having a myocardial infarction, slipping, and breaking a hip in the wheelchair accessible bathroom, or falling asleep with a lit cigaretee, and an oxygen tank (True story) so the Fire Department has to show up.

FFS, they had 1 Job!  I think I'm a little grumpy this morning.

Oh yeah, and the Emergency Pull didn't just light up a light by the door, and a Light in the Nurse's Office in the Senior Center.  It also automatically alerted Senior Services.  So that helped, too.  The one time I didn't have to say "You, call 9-11" before there was anyone else, who wasn't having a medical emergency.  I guess that was nice, too.  They got a DNR after that, and I couldn't work with them again, after that.  IDK if I could handle that situation again, knowing they have a DNR.  What do you do in that situation?

[ObiDongKenobi]

From Remmy's tag-line "What if the Hokey-Pokey really is what it's all about?" that outside the UK what we call the Hokey-Cokey is known as the Hokey-Pokey (I didn't even know it was used outside the UK).

One of my favourite versions being by the great musician and comedian Bill Bailey

[RopeFiend]

...  They got a DNR after that, and I couldn't work with them again, after that.  IDK if I could handle that situation again, knowing they have a DNR.  What do you do in that situation?

In that situation, you treat 'em.  You're not qualified to assess the validity of a DNR, so you do CPR until someone comes along and tells you to stop.  Lay responders don't have to respect a DNR, only medical professionals do.  I'd go for it if I got there first, on the slim chance that I could help restore a sinus rhythm.  It's a small chance, but non-zero.

Hrmmm... the Nurse Paramedic was undoubtedly qualified.  She could tell you to stop.