I've already mentioned the mandate that ER nurses notify law enforcement when we have reasonable suspicion that a crime may have been committed. As well, a reader's comment mentioned the interest of public safety in such reporting. This is never more true than in the case of wounds caused by animal bites.
Regardless of whether or not an animal bite constitutes a crime, reporting such events to law enforcement or to public health is essential to avoid the possibility that a menace to public safety is left unchecked. The menace might be a mean dog (provoked or not), a feral cat, or (and, yes, I have seen this) a vicious squirrel, etc.
The purpose of mandatory reporting of animal bites is not punitive; it is to improve public safety. Whereas cases involving pet owners (e.g., pet dog bites passing neighbor) may seem to be predicated upon sanctions--for the owner and the pet--in fact, very few responsible pet owners are prosecuted if they do the right thing by their pet and by the public (i.e., up-to-date vaccinations, payment of damages, hospital expenses, etc.) and few end up losing their pet.
Irresponsible pet owners suffer more. These are the owners who don't vaccinate their animals, don't attempt to train them, and usually don't put much stock in animal restraints. In fact, some owners of this ilk actually intend to produce vicious animals mostly for the purpose of protecting property.
Mandatory reporting does not require that I as an ER nurse investigate or understand the reasons for the incident. I leave that to law enforcement. As I told one dog bite patient who didn't want me to notify the police about the neighbor's dog that attacked him because he thought it was his (the patient's) fault: "What if you were a four year old child?"
And I've seen four year old children scarred for life in just this way. I do not pretend to know that it is somebody's fault. Many of these incidents are, in fact, accidents. Mandatory reporting intends to minimize the repetition of such "accidents" in the same way that mandatory seat belt laws intend to save lives.
The ABCs:
A -- Most animal bite victims have injuries to extremities; therefore, airway is usually not a problem.
B -- For similar reasons, breathing is usually not an issue either unless there exists some sort of co-morbidity, such as asthma, attacks of which can be exacerbated by the intensity or ferocity of the animal attack.
C -- But bleeding can be an issue. Like other bleeding injuries, animal bites require direct pressure to stop bleeding. Tourniquets are ill-advised unless used as a last resort.
Animal bites also require copious wound care. Wound irrigation. Closing the wounds either by sutures, staples, steri-strips, or occlusive dressings. And antibiotic administration (either oral or IV) to prevent further adventitious infections.
And lastly, because animal bites represent a disruption in skin integrity, tetanus vaccination status must assessed, discerned, and updated if necessary.
No one likes being bit by an animal, domestic or wild. And very few pet owners like to hear that their pet bit someone. I don't really like reporting such incidents to law enforcement, but I do because I realize it might be my child next time, and the bite might not be so very innocent.
Monday, April 21, 2008
Thursday, April 10, 2008
Deathday?
Why does our society not have a specific term that refers to recognizing the anniversary of a person's death?
Anniversary generally refers to marriage. Birthday, of course, refers to just that. But we have no term expressing our commemoration of the day a person died.
Perhaps it is because death is sad, and we don't want to acknowledge our sadness over someone's death in a public way year after year, as we would celebrate birthdays and anniversaries.
Perhaps it is because death is fearful, and recognizing the passing of others on a yearly basis in a public way reminds us too much of our own mortality. But some other cultures do. The Mexican Day of the Dead is a very good example.
Perhaps it is simply the harsh, guttural alliteration of a term like "deathday."
To be sure, it is not a festive event to memorialize the day a loved one left this world. But it is fitting and respectful.
Today is the deathday of my friend and co-worker, A.R., in 2001. I want to always remember this day and all the days before that I knew her.
Anniversary generally refers to marriage. Birthday, of course, refers to just that. But we have no term expressing our commemoration of the day a person died.
Perhaps it is because death is sad, and we don't want to acknowledge our sadness over someone's death in a public way year after year, as we would celebrate birthdays and anniversaries.
Perhaps it is because death is fearful, and recognizing the passing of others on a yearly basis in a public way reminds us too much of our own mortality. But some other cultures do. The Mexican Day of the Dead is a very good example.
Perhaps it is simply the harsh, guttural alliteration of a term like "deathday."
To be sure, it is not a festive event to memorialize the day a loved one left this world. But it is fitting and respectful.
Today is the deathday of my friend and co-worker, A.R., in 2001. I want to always remember this day and all the days before that I knew her.
Wednesday, April 9, 2008
HEC
With all the acronyms and CorporateSpeak in the health care industry these days, I sometimes wonder if any of us health care workers will ever speak in plain, unabbreviated English again. From the look of the work place project in which I am now involved, it doesn't seem so.
Our ER is preparing to change from a paper-based patient charting system to an electronic medical record (EMR). The project is called HEC (Healthcare Electronic Charting), and the program template that has been presented to us by the corporate provider (to remain nameless for obvious reasons) is filled with acronyms and some very bad grammar. The corporate representatives (I call them THEM) don't seem to be bothered by this.
Both of these facts, that the template is so poorly written AND that the corporate people don't seem to care, infuriate me. Together, THEM and a group of my co-workers and I spent two days looking at the template, THEM doing their corporate slap and tickle and me getting more and more frustrated the whole wasted time.
When I was a college professor (see entry 8/25/2007) I was sometimes confronted by students who did not think I should correct their spelling, grammar or punctuation because, after all, "this isn't an English course." Apparently, I was one of those mean, unreasonable professors who demanded students be as accountable for the accuracy of their expression as for the quality of its content.
I'm finding similar problems in the HEC project.
The most important issue I see in contemplating and preparing for a change from paper to computer charting is whether or not the electronic medium will improve charting. Two subcategories of this issue are efficiency and quality, and therefore, two questions need to be answered positively.
1) Will electronic charting increase the ease and speed with which charting is accomplished and a completed chart generated?
2) Will electronic charting improve the quality of charts in terms of accuracy and precision?
It is interesting to consider technological development in health care for a moment. Some technologies accomplish the former (efficiency) without affecting the latter (quality). Dictaphones are a good example. Doctors can dictate their charts easier via the device, but the quality of the dictation is only as good as the doctor's ability to communicate.
Other technologies can do both. Automatic sphygmomanometers (blood pressure measurement devices) enable nurses to take successive blood pressure measurements easier (i.e., remotely) and more accurately because of the elimination of subjective differences among human operators.
Will electronic charting accomplish both?
Given what I've seen of HEC, the system has tremendous potential to increase efficiency. Potential. What has to happen is THEM have to stop their corporate mucky-muck yucky-yuck and begin to examine the work methods and rhythms well-established in our ER, what THEM call "nurse work flows" (and I wonder if the mean "floes?"). So far, this has happened minimally, and when I called this to their attention, they looked at me as if I had two heads. Then, relenting a bit, responded in a shocked tone of corporate voice, "That's a good idea."
Glad I thought of it. When do I get paid?
However, also given what I've seen of HEC, I'm not certain that the program will improve the accuracy of charting. Call me anachronistic, call me a language Luddite, but I sense the electronic format THEM have provided us ruins the ability for nurses to express themselves accurately by constraining them to badly worded (and sometimes badly spelled) pre-established charting responses.
One small example.
The template allows us to indicate the Informant who provides the nurse with information about the patient. Informant. Singular. All of the response categories are also consistently singular with one peculiar exception: Parents. Why this is the only plural response category I have no idea.
Do THEM assume that when patients come in with Parent(s) that they always come in with both? In this day and age? Rampant divorce. Custody issues.
I requested that the response category be changed to singular or an S in parentheses be used, and allow the nurse to further indicate whether or not the Parent(s) is/are mother, father, or both. I even thought it might be important to indicate biological versus social parents.
I was told by THEM that the template could not be changed in this way at this time, but in the next version the change will be considered.
I cannot believe that I was they first one to raise such an objection!
Okay, it seems small, but the ramification is that we will be generating potentially inaccurate charts, charts that are considered legal documents! I can't imagine why any health care organization would willingly do this.
We'll see how things turn out. Until then, sitting in meetings with THEM, I feel like I'm really in HEC.
Our ER is preparing to change from a paper-based patient charting system to an electronic medical record (EMR). The project is called HEC (Healthcare Electronic Charting), and the program template that has been presented to us by the corporate provider (to remain nameless for obvious reasons) is filled with acronyms and some very bad grammar. The corporate representatives (I call them THEM) don't seem to be bothered by this.
Both of these facts, that the template is so poorly written AND that the corporate people don't seem to care, infuriate me. Together, THEM and a group of my co-workers and I spent two days looking at the template, THEM doing their corporate slap and tickle and me getting more and more frustrated the whole wasted time.
When I was a college professor (see entry 8/25/2007) I was sometimes confronted by students who did not think I should correct their spelling, grammar or punctuation because, after all, "this isn't an English course." Apparently, I was one of those mean, unreasonable professors who demanded students be as accountable for the accuracy of their expression as for the quality of its content.
I'm finding similar problems in the HEC project.
The most important issue I see in contemplating and preparing for a change from paper to computer charting is whether or not the electronic medium will improve charting. Two subcategories of this issue are efficiency and quality, and therefore, two questions need to be answered positively.
1) Will electronic charting increase the ease and speed with which charting is accomplished and a completed chart generated?
2) Will electronic charting improve the quality of charts in terms of accuracy and precision?
It is interesting to consider technological development in health care for a moment. Some technologies accomplish the former (efficiency) without affecting the latter (quality). Dictaphones are a good example. Doctors can dictate their charts easier via the device, but the quality of the dictation is only as good as the doctor's ability to communicate.
Other technologies can do both. Automatic sphygmomanometers (blood pressure measurement devices) enable nurses to take successive blood pressure measurements easier (i.e., remotely) and more accurately because of the elimination of subjective differences among human operators.
Will electronic charting accomplish both?
Given what I've seen of HEC, the system has tremendous potential to increase efficiency. Potential. What has to happen is THEM have to stop their corporate mucky-muck yucky-yuck and begin to examine the work methods and rhythms well-established in our ER, what THEM call "nurse work flows" (and I wonder if the mean "floes?"). So far, this has happened minimally, and when I called this to their attention, they looked at me as if I had two heads. Then, relenting a bit, responded in a shocked tone of corporate voice, "That's a good idea."
Glad I thought of it. When do I get paid?
However, also given what I've seen of HEC, I'm not certain that the program will improve the accuracy of charting. Call me anachronistic, call me a language Luddite, but I sense the electronic format THEM have provided us ruins the ability for nurses to express themselves accurately by constraining them to badly worded (and sometimes badly spelled) pre-established charting responses.
One small example.
The template allows us to indicate the Informant who provides the nurse with information about the patient. Informant. Singular. All of the response categories are also consistently singular with one peculiar exception: Parents. Why this is the only plural response category I have no idea.
Do THEM assume that when patients come in with Parent(s) that they always come in with both? In this day and age? Rampant divorce. Custody issues.
I requested that the response category be changed to singular or an S in parentheses be used, and allow the nurse to further indicate whether or not the Parent(s) is/are mother, father, or both. I even thought it might be important to indicate biological versus social parents.
I was told by THEM that the template could not be changed in this way at this time, but in the next version the change will be considered.
I cannot believe that I was they first one to raise such an objection!
Okay, it seems small, but the ramification is that we will be generating potentially inaccurate charts, charts that are considered legal documents! I can't imagine why any health care organization would willingly do this.
We'll see how things turn out. Until then, sitting in meetings with THEM, I feel like I'm really in HEC.
Tuesday, April 8, 2008
Soooo, the CAH-lege Kid says... (Part 2)
There seems to be a run of female patients being brought in by friends or ambulance for problems related to over-indulgence in alcohol. Similar to the patient I reported on recently who couldn't believe that alcohol alone would cause her to be unconscious at her sorority, many of these are college-age women...
...like the female patient who returned today to find out about culture results from a urine specimen obtained the night she was brought in by the local police, drunk, an alcohol level of 0.17. I dutifully reported the results.
The young woman asked me if I could tell her the names of the officers who were with her that night. I told her we don't usually document that, but if she told me what they looked like, maybe I would know.
"They were wearing police uniforms."
I think drinking is the least of this college student's concerns...
+++
And for all those who don't believe that obesity is a growing problem (no pun intended), check out the recent article in the NY Times that discusses the need to build different EMS equipment to accomodate large patients...gurneys and ambulances designed to lift and transport patients up to 1600 pounds.
These devices usually cost about 40% more than regular equipment built to accomodate patients within a normal range.
If only obese patients were paying for this extra service, that would be one thing. But all of us pay via the increased cost of service equipment. This means that all of us are disadvantaged by other peoples' poor health and poor eating habits.
Just like with smokers. And I don't see anyone willing to pay more for Smoking versus Non-smoking ambulances!
...like the female patient who returned today to find out about culture results from a urine specimen obtained the night she was brought in by the local police, drunk, an alcohol level of 0.17. I dutifully reported the results.
The young woman asked me if I could tell her the names of the officers who were with her that night. I told her we don't usually document that, but if she told me what they looked like, maybe I would know.
"They were wearing police uniforms."
I think drinking is the least of this college student's concerns...
+++
And for all those who don't believe that obesity is a growing problem (no pun intended), check out the recent article in the NY Times that discusses the need to build different EMS equipment to accomodate large patients...gurneys and ambulances designed to lift and transport patients up to 1600 pounds.
These devices usually cost about 40% more than regular equipment built to accomodate patients within a normal range.
If only obese patients were paying for this extra service, that would be one thing. But all of us pay via the increased cost of service equipment. This means that all of us are disadvantaged by other peoples' poor health and poor eating habits.
Just like with smokers. And I don't see anyone willing to pay more for Smoking versus Non-smoking ambulances!
Thursday, April 3, 2008
HIPAA
File this under "Don't blame the ER nurse..."
Frequently, we receive phone calls from people requesting information about patients. Usually it is someone who knows the patient--family, friend, co-worker. Other times it is someone who only has a passing interest--the good samaritan who brought the patient in, law enforcement officers, reporters from the local newspaper.
If the patient is present, awake, and able to converse, we transfer the call to the patient so they can give any information they choose. However, if this is not the case, ER nurses are bound by law to protect the privacy of the patient.
Some people don't understand this.
Once, I received a call from a person who identified herself as a patient's mother. She wanted to know why her son was in the ER, how he was doing, and if he was going to be admitted or discharged. The patient in question was drunk and unconscious, and an adult. Legally I couldn't tell the woman anything.
"But I'm his mother!"
People always say things like this, as if parentage trumps federal law. Who am I more afraid of, this woman or the feds?
ER nurses and others in the health care industry are restricted in the amount and type of information we can release about patients. The federal law that stipulates this is called the Health Information Portability and Accountability Act (HIPAA). Like most legislature "acts," HIPAA is verbose, complicated, and confusing, and has a misleading monniker. A better name would be "HIPPA: the Health Information Privacy and Protection Act".
The act does allow us to reveal the following. For a patient who is identified by name, HIPAA allows me to tell a caller whether or not the patient is in the ER, discharged, admitted to the hospital or transferred to another facility, and give a one word description of the patient's condition (e.g., critical, serious, fair, stable, poor, etc.)
That's it! It does no good to ask for more. People do, but I don't tell them. My stubborn refusal to do so angers most callers.
+++
Probably the most bizarre incident of not being able to disclose information about a patient that I've experienced occurred when a patient's wife called about 2 hours after he had been discharged. She asked the typical questions: why had he been in the ER, what did we do, and what should he do now.
Me: "We did have a patient by that name. He was discharged in stable condition."
Her: "I know. He's right here, at home. Why was he in the ER?"
"I'm sorry, ma'am. By law, because the patient is an adult, I am not allowed to disclose any other information to you without his expressed consent."
"But I'm his wife!"
"I understand that, ma'am. Allow me to suggest that you ask your husband why he was here."
"I did."
"And...?"
"He won't tell me."
"Won't tell you? And I'm suppose to?"
"Yes. I'm his wife!"
"You've already said that, ma'am. But I'm sorry. If I tell you any other information, then I will have violated your husband's right to privacy...AND a federal law."
"But I'm his wife!"
"I understand that, ma'am. What I'm asking you to understand is that that doesn't matter. I can't tell you anything else about the patient."
There was a long pause.
"But I'm his wife!"
"Yes, ma'am. Is there anything else I can do for you, ma'am?"
Frequently, we receive phone calls from people requesting information about patients. Usually it is someone who knows the patient--family, friend, co-worker. Other times it is someone who only has a passing interest--the good samaritan who brought the patient in, law enforcement officers, reporters from the local newspaper.
If the patient is present, awake, and able to converse, we transfer the call to the patient so they can give any information they choose. However, if this is not the case, ER nurses are bound by law to protect the privacy of the patient.
Some people don't understand this.
Once, I received a call from a person who identified herself as a patient's mother. She wanted to know why her son was in the ER, how he was doing, and if he was going to be admitted or discharged. The patient in question was drunk and unconscious, and an adult. Legally I couldn't tell the woman anything.
"But I'm his mother!"
People always say things like this, as if parentage trumps federal law. Who am I more afraid of, this woman or the feds?
ER nurses and others in the health care industry are restricted in the amount and type of information we can release about patients. The federal law that stipulates this is called the Health Information Portability and Accountability Act (HIPAA). Like most legislature "acts," HIPAA is verbose, complicated, and confusing, and has a misleading monniker. A better name would be "HIPPA: the Health Information Privacy and Protection Act".
The act does allow us to reveal the following. For a patient who is identified by name, HIPAA allows me to tell a caller whether or not the patient is in the ER, discharged, admitted to the hospital or transferred to another facility, and give a one word description of the patient's condition (e.g., critical, serious, fair, stable, poor, etc.)
That's it! It does no good to ask for more. People do, but I don't tell them. My stubborn refusal to do so angers most callers.
+++
Probably the most bizarre incident of not being able to disclose information about a patient that I've experienced occurred when a patient's wife called about 2 hours after he had been discharged. She asked the typical questions: why had he been in the ER, what did we do, and what should he do now.
Me: "We did have a patient by that name. He was discharged in stable condition."
Her: "I know. He's right here, at home. Why was he in the ER?"
"I'm sorry, ma'am. By law, because the patient is an adult, I am not allowed to disclose any other information to you without his expressed consent."
"But I'm his wife!"
"I understand that, ma'am. Allow me to suggest that you ask your husband why he was here."
"I did."
"And...?"
"He won't tell me."
"Won't tell you? And I'm suppose to?"
"Yes. I'm his wife!"
"You've already said that, ma'am. But I'm sorry. If I tell you any other information, then I will have violated your husband's right to privacy...AND a federal law."
"But I'm his wife!"
"I understand that, ma'am. What I'm asking you to understand is that that doesn't matter. I can't tell you anything else about the patient."
There was a long pause.
"But I'm his wife!"
"Yes, ma'am. Is there anything else I can do for you, ma'am?"
Wednesday, April 2, 2008
Soooo, the CAH-lege Kid says to the POE-lice...
Drunken university students are a dime a dozen on weekend nights in our ER. Many are unconscious, some are abusive, and others are downright funny. Most blame their inebriation on their "friends" who plied them with drinks they don't even remember consuming.
Friends?
+++
When nurses treat patients whose condition or injuries suggest that a crime may have been committed (e.g., an assault, child molestation, etc.), we are required to report our suspicion (sometimes via our supervisor) to law enforcement, despite the fact that this may place us in an awkward or even adversarial position vis-a-vis some patients, especially those who would rather their injuries not be disclosed to the police or who would rather protect others from prosecution.
However, in the case of underage drinkers (which most of our drunken college students are) when we KNOW a crime was committed (underage drinking), we are not required to report this. In fact, because the drinking age is 21 but patients are legally adults at 18 and therefore accorded certain federal rights to privacy, we are not permitted to report a patient's drunkenness to police, the university or even to the patient's parent(s) without the patient's consent.
+++
Coincidentally, many underage drunken students are covered by their parent's insurance which ends up being charged for the ER service.
+++
An underage sorority sister called the other day to find out the details of her ER experience the night before when she was brought in by ambulance after being found unconscious in her sorority house. She wanted to know what tests were done and especially whether or not a drug test had been performed.
I felt sorry for her for several reasons. First, she had no recollection of the experience. Drunk is fun (maybe); drunk and unconscious is dangerous.
Second, we conducted multiple lab tests and very expensive cervical spine xrays and head CAT scans (because in her unconscious state, injury could not be ruled out any other way). Drunk is fun (maybe); drunk, unconscious, and requiring ER treatment is expensive.
Lastly, she wanted to know if a drug test was done because she suspected that someone had slipped her a drug that would explain her unconsciousness. I had to explain to her that, although a drug test was not performed and therefore foul play could not be ruled out, I was pretty certain that her blood alcohol content (BAC) could more than account for her unconsciousness.
Her ETOH (alcohol) level was 0.3...drunk three times over by state standards!
Triply drunk and unconscious with a huge ER bill. There's no crime in that?
Friends?
+++
When nurses treat patients whose condition or injuries suggest that a crime may have been committed (e.g., an assault, child molestation, etc.), we are required to report our suspicion (sometimes via our supervisor) to law enforcement, despite the fact that this may place us in an awkward or even adversarial position vis-a-vis some patients, especially those who would rather their injuries not be disclosed to the police or who would rather protect others from prosecution.
However, in the case of underage drinkers (which most of our drunken college students are) when we KNOW a crime was committed (underage drinking), we are not required to report this. In fact, because the drinking age is 21 but patients are legally adults at 18 and therefore accorded certain federal rights to privacy, we are not permitted to report a patient's drunkenness to police, the university or even to the patient's parent(s) without the patient's consent.
+++
Coincidentally, many underage drunken students are covered by their parent's insurance which ends up being charged for the ER service.
+++
An underage sorority sister called the other day to find out the details of her ER experience the night before when she was brought in by ambulance after being found unconscious in her sorority house. She wanted to know what tests were done and especially whether or not a drug test had been performed.
I felt sorry for her for several reasons. First, she had no recollection of the experience. Drunk is fun (maybe); drunk and unconscious is dangerous.
Second, we conducted multiple lab tests and very expensive cervical spine xrays and head CAT scans (because in her unconscious state, injury could not be ruled out any other way). Drunk is fun (maybe); drunk, unconscious, and requiring ER treatment is expensive.
Lastly, she wanted to know if a drug test was done because she suspected that someone had slipped her a drug that would explain her unconsciousness. I had to explain to her that, although a drug test was not performed and therefore foul play could not be ruled out, I was pretty certain that her blood alcohol content (BAC) could more than account for her unconsciousness.
Her ETOH (alcohol) level was 0.3...drunk three times over by state standards!
Triply drunk and unconscious with a huge ER bill. There's no crime in that?
Tuesday, April 1, 2008
To Thump or Not to Thump?
In my comments on The Abyss back in September, 2007, I suggested that misconceptions people have of medical interventions for serious medical problems are often reinforced by the misrepresentation of these in movies and television.
Viewers believe what they see. Therefore, they believe things like patients in asystole (the proverbial cardiac flatline) can have their hearts "jump started" with defibrillation; that many patients spontaneously revive with just a few seconds of CPR; that long large needles pre-filled with epinephrine are often stabbed right into a patient's heart when it stops, etc.
In cases of sudden collapse with suspected cardiac arrest, one misrepresentation seems ubiquitous in movies and on TV (and occurs in a recent movie with Morgan Freeman and Greg Kinnear, entitled Feast of Love): the fist strike to the patient's chest, often accompanied by medical personnel jumping onto gurneys and straddling the patient, etc.
Otherwise known in medical circles as a precordial thump, this practice was a component of early Cardiopulmonary Resuscitation (CPR). The theory was that striking the sternum could produce a mechanical shock to the heart that would instigate a spontaneous rhythm. The practice has since been discontinued because it was found to be highly ineffective and more likely to injure a patient who was mistakenly thought to be having a heart attack.
In the movie mentioned above, a young male character collapses during a friendly football match. When he does not arouse, several people run to his aid including a female character who we know to be an emergency physician. In my willing suspension of disbelief concerning Hollywood portraying resuscitation attempts accurately, I actually thought the doctor might follow the ABCs for resuscitation. But what did she do? THUMP! THUMP! What happened? The patient regained a pulse!
Well, I won't spoil the movie and tell you what happens thereafter, but I'll point you in this direction:
http://www.nytimes.com/2008/04/01/health/research/01heart.html?nl=8hlth&emc=hltha1
If you witness someone collapse, don't be a movie star. Don't thump the patient. Just follow the ABCs. Call 911. Then...
Does the patient respond? Yes? STOP No?
Check the patient's Airway. Obstructed? Open the airway. Unobstructed?
Is the patient Breathing? Yes? STOP and wait for EMS. No?
Does the patient have Circulation (a pulse)? Yes? Reassess A and B. No? Press hard and fast on the lower portion of the patient's sternum until EMS arrives.
No Hollywood, No Heroics. Just the common sense of ABC.
Viewers believe what they see. Therefore, they believe things like patients in asystole (the proverbial cardiac flatline) can have their hearts "jump started" with defibrillation; that many patients spontaneously revive with just a few seconds of CPR; that long large needles pre-filled with epinephrine are often stabbed right into a patient's heart when it stops, etc.
In cases of sudden collapse with suspected cardiac arrest, one misrepresentation seems ubiquitous in movies and on TV (and occurs in a recent movie with Morgan Freeman and Greg Kinnear, entitled Feast of Love): the fist strike to the patient's chest, often accompanied by medical personnel jumping onto gurneys and straddling the patient, etc.
Otherwise known in medical circles as a precordial thump, this practice was a component of early Cardiopulmonary Resuscitation (CPR). The theory was that striking the sternum could produce a mechanical shock to the heart that would instigate a spontaneous rhythm. The practice has since been discontinued because it was found to be highly ineffective and more likely to injure a patient who was mistakenly thought to be having a heart attack.
In the movie mentioned above, a young male character collapses during a friendly football match. When he does not arouse, several people run to his aid including a female character who we know to be an emergency physician. In my willing suspension of disbelief concerning Hollywood portraying resuscitation attempts accurately, I actually thought the doctor might follow the ABCs for resuscitation. But what did she do? THUMP! THUMP! What happened? The patient regained a pulse!
Well, I won't spoil the movie and tell you what happens thereafter, but I'll point you in this direction:
http://www.nytimes.com/2008/04/01/health/research/01heart.html?nl=8hlth&emc=hltha1
If you witness someone collapse, don't be a movie star. Don't thump the patient. Just follow the ABCs. Call 911. Then...
Does the patient respond? Yes? STOP No?
Check the patient's Airway. Obstructed? Open the airway. Unobstructed?
Is the patient Breathing? Yes? STOP and wait for EMS. No?
Does the patient have Circulation (a pulse)? Yes? Reassess A and B. No? Press hard and fast on the lower portion of the patient's sternum until EMS arrives.
No Hollywood, No Heroics. Just the common sense of ABC.
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