# Dropping Dead - What happens ?



## kingrollo (20 Jan 2020)

Sadly a work colleague in her 50s collapsed and died at work today. I gave CPR but couldn't revive her...

She hadn't been ill had no heart conditions - I had been chatting to her litteraly seconds earlier - I turn my back and she was on the floor - obviously heart attack - but what actually happens ? Does the heart just stop beating ? - she didn't clutch her chest , there was just no warning 

I notice the colour drain from her pretty quickly heart attack / annuerism ?


----------



## Fab Foodie (20 Jan 2020)

kingrollo said:


> Sadly a work colleague in her 50s collapsed and died at work today. I gave CPR but couldn't revive her...
> 
> She hadn't been ill had no heart conditions - I had been chatting to her litteraly seconds earlier - I turn my back and she was on the floor - obviously heart attack - but what actually happens ? Does the heart just stop beating ? - she didn't clutch her chest , there was just no warning
> 
> I notice the colour drain from her pretty quickly heart attack / annuerism ?


https://en.m.wikipedia.org/wiki/Myocardial_infarction


----------



## Fab Foodie (20 Jan 2020)

Dreadful event, well done for doing your best. 50 is no age at all :-((
Condolences.


----------



## ColinJ (20 Jan 2020)

That must have been horrible for you! Well done for trying to save her though... 



Fab Foodie said:


> https://en.m.wikipedia.org/wiki/Myocardial_infarction


It sounds more like sudden cardiac arrest which is a problem with the electrical function of the heart rather than the blood supply to it.


----------



## numbnuts (20 Jan 2020)

Well done for doing CPR you did your best, I've done it twice now with 100% success rate, the first time I was chatting to him and he just fell off his chair so I felt for a pulse and started CPR.
The second time man dead in bed no pulse and had wet himself dragged on the floor and started CPR, both time the ambulance came very quickly so well pleased.
Once again well done


----------



## I like Skol (20 Jan 2020)

I'm going to be quite cold and maybe heartless now. She's not bothered what happens now, she's dead.
But this will affect you, tonight and in the next few weeks. Seek any help you can in the form of support and counseling, don't try to brush off the event or 'tough it out'.
The people left behind are the ones that suffer and you are likely to have some pretty bad feelings if inadequacy and mortality in the weeks and months ahead. To be the one present at such a sudden and unexpected ending to a life will fill you with doubts that maybe you could have done more (you couldn't) or that it might be your turn next (highly unlikely).
Accept any support that you can


----------



## MontyVeda (20 Jan 2020)

I like Skol said:


> *I'm going to be quite cold and maybe heartless now. She's not bothered what happens now, she's dead.*
> ...


i think you're missing the point by a country mile... he's not asking what happens now, he's asking what causes someone to just go so quickly. The OP is quite clear about that.


----------



## midlife (20 Jan 2020)

Well done for doing CPR, classis heart attack usually causes pain, somebody has already mentioned acute onset electrical malfunction that stops the heart beating properly and just starts shaking like a jelly. 

Do you have an automatic defibrillator at work?


----------



## classic33 (20 Jan 2020)

What @I like Skol says.

Think now of yourself, your work colleague can't be helped now. At the worst look back at what you did and remind yourself, "I tried". There's many who wouldn't have tried.


----------



## classic33 (20 Jan 2020)

MontyVeda said:


> i think you're missing the point by a country mile... he's not asking what happens now, he's asking what causes someone to just go so quickly. The OP is quite clear about that.


Me, the heart just stopped. 

The Dr. who performed the CPR was left shaken. He blamed me for not letting them know of an allergy. I never blamed anyone, it was just one of those things. He was left sweating and had to be helped off me on the floor. He accepted that help, having to take a break after he'd sorted himself out. 

That help is what I'm assuming @I like Skol is referring to.


----------



## Andy in Germany (20 Jan 2020)

Well done for doing all you could. CPR isn't a miracle cure, really it is to give people a fighting chance until the Ambulance arrives.

You gave your best for her, don't let go of that fact.

As @I like Skol and @classic33 have already said: make sure you get support over the next weeks and months: everyone is different so get the support you will need regardless of what others see as "normal".

Also you may still be in shock at the moment.


----------



## raleighnut (20 Jan 2020)




----------



## tom73 (20 Jan 2020)

Well done for tying many don’t. 
As others have said you will need to talk to someone once it hits you.
Has work offered any help ?


----------



## kingrollo (20 Jan 2020)

I am still in shock. Literally seconds earlier I was happily chatting to her. Turned my back - she was on the floor.

I don't think there was anything more I could have done - I work in hospital so plenty of others tried CPR 

Despite not saving her - I am thankful for being CPR trained - at least I had a fighting chance.


----------



## slowmotion (20 Jan 2020)

It wasn't necessarily an infarction. It could have been a stroke due to a blood clot in the brain or a haemorrhage. Also, hearts just sometimes stop due to weirdness,_ sudden cardiac arrhythmia_.
https://www.webmd.com/heart-disease/guide/sudden-cardiac-death#1 
I'm no expert, just another useless Keyboard Kildare, but well done for doing your best to save the lady.


----------



## Drago (20 Jan 2020)

Christ almighty, sorry to hear that. A few years ago I unsuccessfully gave cpr to a 13 year old kid, and when it's someone you know like that you never really get over it.

Console yourself that your did your best, and you kept your cool and did what had to he done when others would have flapped. For the love of god go talk to someone about it, don't clam up like I did. If you're like me you'll intellectually know you did all you could but something in your heart will never quite truly believe that.


----------



## Profpointy (20 Jan 2020)

MontyVeda said:


> i think you're missing the point by a country mile... he's not asking what happens now, he's asking what causes someone to just go so quickly. The OP is quite clear about that.



A bit harsh when someone is offering support


----------



## kingrollo (20 Jan 2020)

slowmotion said:


> It wasn't necessarily an infarction. It could have been a stroke due to a blood clot in the brain or a haemorrhage. Also, hearts just sometimes stop due to weirdness,_ sudden cardiac arrhythmia_.
> https://www.webmd.com/heart-disease/guide/sudden-cardiac-death#1
> I'm no expert, just another useless Keyboard Kildare, but well done for doing your best to save the lady.



I was thinking annuerism or some rupture she was fine seconds before - but after about 3 rounds of CPR - She just went grey.


----------



## MontyVeda (20 Jan 2020)

Profpointy said:


> A bit harsh when someone is offering support


his opening sentence was harsh and completely unnecessary.


----------



## slowmotion (20 Jan 2020)

It's probably not a good spot to start bitching.


----------



## delb0y (20 Jan 2020)

This happened yesterday, to a wonderful singer-songwriter. 

(From The Independent)
Singer-songwriter David Olney has died during a performance on stage.

The Americana artist, whose music was recorded by Emmylou Harris, Linda Ronstadt, Steve Young and others, died of an apparent heart attack while performing at the 30A Songwriters Festival in Santa Rosa Beach, Florida. 

According to fellow singer-songwriter Scott Miller, who was performing with Olney, the 71-year-old stopped in the middle of a song, said “I’m sorry”, and “put his chin to his chest. He never dropped his guitar or fell [off] his stool,” Miller wrote on Facebook. “It was as easy and gentle as he was.”


----------



## Levo-Lon (20 Jan 2020)

kingrollo said:


> I was thinking annuerism or some rupture she was fine seconds before - but after about 3 rounds of CPR - She just went grey.



Unfortunately that's the one you dont come back from. 
Had similar, you can only do your best, both elderly so not really traumatic but does make you very aware of your mortality. 

Much harder when the person is younger so as said be aware that this could make you feel very down.


----------



## johnnyb47 (20 Jan 2020)

Sorry to read that. It must of been an horrific experience for you. Well done you though for keeping your cool and doing everything you could. When you read things like this, it makes you realise we should live every day like its our last.
I hope you're feeling ok after it all buddy


----------



## kingrollo (20 Jan 2020)

Does anybody know the criteria for coroner to be involved ?


----------



## gbb (20 Jan 2020)

I like Skol said:


> I'm going to be quite cold and maybe heartless now. She's not bothered what happens now, she's dead.
> But this will affect you, tonight and in the next few weeks. Seek any help you can in the form of support and counseling, don't try to brush off the event or 'tough it out'.
> The people left behind are the ones that suffer and you are likely to have some pretty bad feelings if inadequacy and mortality in the weeks and months ahead. To be the one present at such a sudden and unexpected ending to a life will fill you with doubts that maybe you could have done more (you couldn't) or that it might be your turn next (highly unlikely).
> Accept any support that you can


This is so true. I gave a chap CPR at work after he suddenly collapsed, no one knew why, just very suddenly collapsed...and it turned out it was a brain bleed. He didnt respond, ambulance guys took over and eventually off to hospital. He never recovered and died a few days later.
I never slept a wink that night and maybe for a couple nights. I cant offer advise how to deal with it, but respect to you for trying, that's all you can do and be proud you did.


----------



## alicat (20 Jan 2020)

Well done for having a go. In the case of a sudden death, I would be very surprised if the coroner didn't get involved.

Hope you get a good night's sleep and are proud that you did your best to save your colleague.


----------



## vickster (20 Jan 2020)

kingrollo said:


> Does anybody know the criteria for coroner to be involved ?


I’d think there’d be a post mortem?


----------



## dan_bo (20 Jan 2020)

Well done. 

Personally I'd be halfway through a bottle of scotch by now. Look after yourself. And your family.


----------



## Pale Rider (20 Jan 2020)

kingrollo said:


> Does anybody know the criteria for coroner to be involved ?



Complicated, and I'm not sure many people - including me - fully grasp the Coroner's Rules.

Shipman also caused a shifting of the goal posts.

The coroner will certainly be informed.

In this case, I would expect him to hold an inquest, which will be open to the public.

You may be asked to make a statement, and possibly called to give evidence.


----------



## presta (20 Jan 2020)

ColinJ said:


> It sounds more like sudden cardiac arrest which is a problem with the electrical function of the heart rather than the blood supply to it.





kingrollo said:


> I was thinking annuerism or some rupture she was fine seconds before - but after about 3 rounds of CPR - She just went grey.


I agree with Colin, I think cardiac arrest fits the bill for sudden death, even then it's not as sudden as might be expected. I've had my heart stopped (deliberately) a few times, and it's a bit of a bemusing revelation to find that nothing much happens at all.


----------



## classic33 (20 Jan 2020)

kingrollo said:


> Does anybody know the criteria for coroner to be involved ?


No, but try not to think about that at present.


----------



## slowmotion (20 Jan 2020)

^^^^^^^ This.


----------



## Racing roadkill (21 Jan 2020)

M.I.s are caused by blockages in the blood vessels of the heart ( or interruptions in blood flow to the heart muscle) cardiac arrests are caused by the hearts natural rhythm being disturbed ( there can be many reasons for this, including M.I.s ironically ). M.I.s are more difficult to deal with, because the heart muscle is dying as you’re trying to get the heart pumping again, with a cardiac arrest, it’s usually the heart going into a spasm, and as long as you get the rhythm back, there’s usually little or no damage to the muscle. If it’s a complete rupture of a major blood vessel, causing the issue, there’s usually not a lot anyone can do to help.


----------



## Drago (21 Jan 2020)

kingrollo said:


> Does anybody know the criteria for coroner to be involved ?


My knowledge may well be a bit out of date, but no evidence of accident, no evidence of suspicious circumstances, and have consulted a doctor within the last month for the ailment that caused the death. That's pretty straightforward.

As it's a sudden death (stupid term, all death is sudden, alive one second, no longer the next...) I imagine the coroners officer will have been informed but once the PM results are in they'll likely lose all interest.


----------



## Pale Rider (21 Jan 2020)

Drago said:


> My knowledge may well be a bit out of date, but no evidence of accident, no evidence of suspicious circumstances, and have consulted a doctor within the last month for the ailment that caused the death. That's pretty straightforward.
> 
> As it's a sudden death (stupid term, all death is sudden, alive one second, no longer the next...) I imagine the coroners officer will have been informed but once the PM results are in they'll likely lose all interest.



The North Durham Coroner once explained the rules to me for how he decides when to call an inquest.

Death on the railway is certainly one, and most fatal road traffic collisions.

But I got the impression there is still a large element of judgment exercised by the coroner.

As you say, sudden death plays a part, by which they mean a death when there is no pre-existing medical condition.


----------



## tom73 (21 Jan 2020)

Firstly don't worry about it looking after yourself is the most important thing at the moment. 

Post Shipman things got a bit more tied up it's now for example very common now for GP's to phone the ward. Wanting to speak to the Nurse in charge of the care of someone even if expected or straight forward. when asked to counter sign a death certificate more rules on syringe drivers also got introduced.

@Drago is right from what you have said it not likely to go all the way to a formal inquest. 
A PM maybe likely as it's sudden unless she had a underlaying condition and and had seen a doctor within 2 weeks up to her death. 
Once results of PM are known if they show nothing to be of concern then the coroner will just "sign it off" 

The only other situations that results in an automatic referral to the coroner and inquest even if due to natural causes are if they have been released from within the set time limit or held in prison, police custody, detained by a police officer at the time or detained under the Mental Health Act. Together with a few others. 

Even you do get asked for a statement and they are happy with it from what you say your not likely to called to an inquest. The coroners officer will help you and support with all that anyway. Coroners court is not like a normal court yes it's formal and yes it's a court with same rules but your not on trial your a coroners witness. To help them understand what happen. In the end all they are wanting to know is the facts. What happen, when, what led up to it and can something be learned from it. On the whole MH Coroners are helpful and expect witness to be a bit worried they only really play hard ball if someone is trying to cover up, lying , talking utter rubbish or not treating them with respect. 

Just focus on yourself and remember you did all you could.


----------



## Cycleops (21 Jan 2020)

kingrollo said:


> Does anybody know the criteria for coroner to be involved ?


I'm sure the coroner will be involved. The police might even want to speak to you as it's an unexplained death at present. They spoke to me when my father died suddenly.


----------



## Drago (21 Jan 2020)

I had to give a statement when I tried to safe the girl. Having done a few in my time I chucked in a bit about everything appearing orderly in the house, no visible sign of a violent struggle.


----------



## gbb (21 Jan 2020)

Re any follow up by coroners etc kingrollo, I didn't receive another word from any authorities, that may be because he died a few days later or perhaps because there was no coroners I investigation...or a bit of both. The individual circumstances may dictate how things proceed but it's not a given you'll be involved any further.
Hope you're feeling ok.


----------



## kingrollo (22 Jan 2020)

gbb said:


> Re any follow up by coroners etc kingrollo, I didn't receive another word from any authorities, that may be because he died a few days later or perhaps because there was no coroners I investigation...or a bit of both. The individual circumstances may dictate how things proceed but it's not a given you'll be involved any further.
> Hope you're feeling ok.



I feel pretty good tbh - everyone is saying how traumatised I must be...I don't - because I knew what to do and know I did my best.
I've signed for group counseling - and will probably go for individual sessions - I do suffer with depression - so just want to make sure I'm not bottling it up.

Many thanks for the info & support.


----------



## Pale Rider (22 Jan 2020)

Something very similar happened in an office I was working in many years ago.

The incident was notable for a number of foul ups.

First problem was when the casualty collapsed, the staff found they couldn't dial 999 due to the way the telephone system operated.

Someone had to sprint through the building to the switchboard.

The ambulancemen duly arrived, but found they couldn't easily get the casualty through the open plan office on a stretcher.

No one had thought to arrange the desks in such a way as to allow access for a stretcher or trolley, so the poor man was manhandled from side to side to reach the ambulance.

Which is where the final problem occurred.

The ambulance had been directed to the nearest entrance, a staff doorway at the rear of the building.

It involved driving over a grassed area - we used to kick a ball around on the grass at lunchtime.

When the ambulance came to leave it had become stuck on the grass.

Thus more time was wasted while staff members shoved at the back of the ambulance as its wheels were spinning.

The man's family got to hear of what went on and there was talk of legal action against the company.

Not sure what happened in the end, but medical opinion seemed to be the man would have died no matter how fast help was summoned.


----------



## kingrollo (22 Jan 2020)

Pale Rider said:


> Something very similar happened in an office I was working in many years ago.
> 
> The incident was notable for a number of foul ups.
> 
> ...



That's an easy answer though. When you collapse and are uncoius - there a very good chance you aren't coming back - what shifts the odds albeit slightly - is early CPR and Early defrib - if you defribing 20minutes late odds are very much against a recovery - I hadn't got access to a defriblator - I have raised this at work - and while they are sympathetic and have promised to get one - I've heard " do you think it would have saved her" I will never know.


----------



## Nibor (22 Jan 2020)

You did your best. If your company doesn't have a AED (defibrillator) suggest that they get one.


----------



## Racing roadkill (22 Jan 2020)

kingrollo said:


> That's an easy answer though. When you collapse and are uncoius - there a very good chance you aren't coming back - what shifts the odds albeit slightly - is early CPR and Early defrib - if you defribing 20minutes late odds are very much against a recovery - I hadn't got access to a defriblator - I have raised this at work - and while they are sympathetic and have promised to get one - I've heard " do you think it would have saved her" I will never know.


Quite right. If someone collapses with a heart problem, and requires resusc, the odds are already stacked against them. Any efforts are better than none, but don’t get too bent out of shape if the efforts don’t work.


----------



## stephec (23 Jan 2020)

SCA isn't that uncommon, it happened to my lad when he was nineteen.

24/11/18 one minute he was sat next to me talking, and then all of a sudden he passed out like he'd fainted. After about thirty seconds of trying to wake him I rang for an ambulance, at 20:30 on a Saturday night, the operator kept on the phone and my wife started CPR until the ambulance arrived, and then they gave him two goes with the defibrillator to get him going again.

When you look into it it's surprising how many people it happens to each year.


----------



## Landsurfer (23 Jan 2020)

My heart stops .... and then restarts a few seconds later ....
I have an implanted "Reveal Insertable Cardiac Monitor" in my left breast ... ...
I have Long QT Syndrome .. every now and again my heart stops ... i get 20 - 30 minutes warning ... start getting sleepy .. then heart stops, reboots and we are up and running again .
Woke up once surrounded by paramedics with "the machine that goes bing" attached to me but wandered out to the ambulance under my own power ... which got some funny looks from the medics.
I can cycle as far as i want, climb every mountain, pedal as fast i want .... when my heart rate is raised all is well .... it's when i'm relaxed, 48 bpm ... 38 bpm ... 28 bpm .... 0 bpm ...... 58 bpm ... and then we're back in the room ...lol
It won't kill me but it frightens the living day lights out of folks ...
I carry a card in my wallet and ID tags on my bike frame .....
When my heart stops i get no great insight into life (Or death .. obviously )... no tunnel with light at the end of it .. no spectral voices or re-living of past life ... i just go to sleep ..... and snore ... alledgley .......... ....... .... . !

The last thing i need is a defibrillator ....


----------



## Racing roadkill (24 Jan 2020)

stephec said:


> SCA isn't that uncommon, it happened to my lad when he was nineteen.
> 
> 24/11/18 one minute he was sat next to me talking, and then all of a sudden he passed out like he'd fainted. After about thirty seconds of trying to wake him I rang for an ambulance, at 20:30 on a Saturday night, the operator kept on the phone and my wife started CPR until the ambulance arrived, and then they gave him two goes with the defibrillator to get him going again.
> 
> When you look into it it's surprising how many people it happens to each year.


It’s surprisingly prevalent in outwardly fit young people too.


----------



## kingrollo (24 Jan 2020)

What is a non shockable rhythm ? - does that mean game over ? - wouldn't you just try a shock in any case.

In the incident on Monday - In the incident on Monday - I heard the defrib saying 'shock advised' - obviously it didn't work

They then put a machine on her to continue to CPR - whilst she went to A+E Resus

What would they have done in Resus ?


----------



## mrandmrspoves (25 Jan 2020)

kingrollo said:


> What is a non shockable rhythm ? - does that mean game over ? - wouldn't you just try a shock in any case.
> 
> In the incident on Monday - In the incident on Monday - I heard the defrib saying 'shock advised' - obviously it didn't work
> 
> ...



When a cardiac arrest occurs there can be a number of different presentations and underlying causes. A defibrillator can only correct 2 causes - they are ventricular fibrillation (where instead of contracting and pumping blood the ventricles are just twitching) and fast ventricular tachycardia (where the ventricles are trying to pump so quickly that it is not geting a chance to fill with blood in between contractions)
In both these situations the defibrillator delivers a shock to stun the heart into stopping and the hope is that the heart will then start to generate the correct electrical rhythm. (It's a bit like in the olden days when a television started flickering and you gave it a good whack on the top or rebooting a computer)
The defibrillator is not a jump starter so it cannot jump the heart into beating if the electrical activity has stopped. There are also conditions where the electrical activity of the heart is still present but there is no cardiac output - so on a heart monitor you see a normal ECG but the person has no pulse. (This is called Pulseless Electrical Activity or PEA) Shocking the heart when it is in PEA won't work because it is not the electrics causing the problem. The easiest cause of PEA to understand is hypovolaemia, where the person has had a major bleed and there is no longer enough blood in the system to pump...... in that case you would need to identify and stop the source of bleeding and give intravenous (or into the bone) fluids.
If PEA is present you always need to identify the cause and treat it directly. Other causes of PEA include opiate drug overdose (reverse with Naloxone) Cardiac Tamponade (blood gathers in the protective membrane that surround the heart and compresses the heart - draw the blood of and stop cause of bleeding). Electrolyte imbalance - essential elements such as Potassium are disordered (correct electrolyte imbalance) Hypothermia (continue CPR while rewarming the patient)
Tension pneumothorax (a lung is leaking air into the chest cavity - insert a chest drain to allow chest to deflate). There are a few more causes but that gives you an idea of what may happen in resus.
On top of the above the resus team will intubate to get a secure airway, continue to monitor the electrical output because it can change so someone who presents with a non-shockable rhythm may as a result of CPR or treatment develop a shockable rhyrhm. Drugs like Adrenaline and Atropine are normally used to stimulate or regulate cardiac electrical activity so they will be administered at intervals as indicated. Bloods will be collected if possible to identify abnormalities with electrolytes and check blood sugar to ensure it isn't too low or high.
In an unexpected cardiac arrest resuscitation attempts will normally continue for at least half an hour.


----------



## ColinJ (25 Jan 2020)

A remarkably detailed reply! 



mrandmrspoves said:


> you would need to identify and stop the source of bleeding and give intravenous (or *into the bone*) fluids.


That sounds really odd! How does that work, and why is it done?


----------



## midlife (25 Jan 2020)

Bone has a good blood supply, sticking fluids into the bone cavity is almost the same as putting it into a vein. Usually done in major trauma / battlefield / can’t find a vein.


----------



## ColinJ (25 Jan 2020)

I learn something new every day!


----------



## mrandmrspoves (25 Jan 2020)

ColinJ said:


> A remarkably detailed reply!
> 
> 
> That sounds really odd! How does that work, and why is it done?



That was the abbreviated version! (I couldn't sleep anyway)

Yes where a person has collapsed their veins usually deflate as well, making it very hard to get a cannula in. (Really good CPR sometimes helps prevent this but it is often still a problem)
The intraossoeus route uses a small hollow drill piece that is driven through the skin into the bone by a small device like an electric screwdriver. The site chosen will be a place where the bone is just under the skin for example the very top of the arm or on the front of the leg just below the knee. From start to finish it takes less than a minute to inserts an IO cannula (much of that time is spent disinfecting the skin surface) once the cannula is inserted fluids can be administered pretty much in the same way as if the cannula was in a vein.


----------



## kingrollo (26 Jan 2020)

Still can't get my head around that you can be having a conversation with an apparently healthy person - 5 second s later they are dead.


----------



## mrandmrspoves (26 Jan 2020)

kingrollo said:


> Still can't get my head around that you can be having a conversation with an apparently healthy person - 5 second s later they are dead.


It is hard to come to terms with - especially when witnessed up close and even more so when the person is relatively young.
None of us know how long our clock will keep ticking and that includes seemingly fit people.


----------



## stephec (26 Jan 2020)

kingrollo said:


> Still can't get my head around that you can be having a conversation with an apparently healthy person - 5 second s later they are dead.


It happens, SCA has no warning signs, one minute I was sat next to my son talking to him and without any warning he closed his eyes and fell to the floor in front of me. I


----------



## Slick (27 Jan 2020)

Deleted as I didn't read the entire thread.


----------



## alicat (27 Jan 2020)

^^^^ Stephec says in post 45 that he and his wife managed to revive their son. Still very scary, though!


----------



## Slick (27 Jan 2020)

alicat said:


> ^^^^ Stephec says in post 45 that he and his wife managed to revive their son. Still very scary, though!


Thanks.


----------



## confusedcyclist (27 Jan 2020)

I spotted a few misconceptions in the thread, Defibrillators don't and can't restart an arrested (stopped) heart, they actually stop the heart, interrupting an abnormal rhythm, so it starts again hopefully in proper rhythm. The intention of CPR is to fill the lungs with air, and attempt to get the heart pumping again by supplying the body with oxygen once more. Automatic defibrillators won't actually work in cases of Cardiac Arrest, they only work for atrial fibrillation, you don't need to worry about that because AEDs are smart enough to know this for you. If someone collapses to the ground, and they are non-responsive, perform CPR. If they don't need CPR, they will be protesting your painful attempts. If they don't respond, just keep going. Pump 30 times, blow air, repeat until an ambulance arrives.


----------



## stephec (27 Jan 2020)

My wife kept up CPR until the ambulance arrived, half eight on a Saturday night and we still got an ambulance and two paramedic cars within ten minutes, they were top class, two of them even came up onto the ward a week later to see how he was. 

They got him going again before taking him to hospital where he spent a week in an induced coma. We were told on the second day that as he'd been without oxygen for up to twenty minutes severe brain damage was quite likely, and when he first woke up he was slow to react. 

There's obviously no way the doctors could predict what recovery he'd make, it seems some people make a full recovery whilst others are not so lucky, just pot luck. 

At first he looked similar to someone who's had a stroke, he spent from 24/11/18 to 12/07/19 in hospital, over half the time in a neuro rehab ward, and he's still having therapy now that he's home.


----------



## mrandmrspoves (27 Jan 2020)

confusedcyclist said:


> I spotted a few misconceptions in the thread, Defibrillators don't and can't restart an arrested (stopped) heart, they actually stop the heart, interrupting an abnormal rhythm, so it starts again hopefully in proper rhythm. The intention of CPR is to fill the lungs with air, and attempt to get the heart pumping again by supplying the body with oxygen once more. Automatic defibrillators won't actually work in cases of Cardiac Arrest, they only work for atrial fibrillation, you don't need to worry about that because AEDs are smart enough to know this for you. If someone collapses to the ground, and they are non-responsive, perform CPR. If they don't need CPR, they will be protesting your painful attempts. If they don't respond, just keep going. Pump 30 times, blow air, repeat until an ambulance arrives.



Much of what you have written is described in my previous post . You are incorrect on a couple of points. A defibrillator WILL work in a cardiac arrest - but only if the cause is Ventricular Fibrillation OR Fast Ventricular Tachycardia.
Cardiac arrest refers to a number of different situations all of which result in cessation of circulation but not all are caused by loss of cardiac electrical activity (asystole)or even cardiac contraction. 
CPR will not normally restart the heart and it is not its function to do so. Restarting the heart normally depends on defibrillation or administration of adrenaline or reversing the reversible causes, some of which I describe under Pulseless Electrical Activity.
CPR hopefully achieves maintenance of oxygenated blood flow to the vital organs and in doing so it helps prevent the blood clotting in the organs - which when it occurs often leads to multi organ failure and death even if the heart is initially restarted. Another important and little known effect of CPR is to decompress the heart. (When the heart stops beating, it becomes swollen and engorged with blood that makes it more difficult for it to respond to the electrical stimulation that may still be present. Hence on commencement of CPR a defibrillator may not indicate that there is a shockable rhythm but after effective CPR a shockable rhythm may then be identified.
You're absolutely correct that a public access defibrillator (AED) will detect whether a shockable rhythm is present and cannot harm the patient as it will only deliver a shock if one is needed.


----------



## Slick (27 Jan 2020)

stephec said:


> My wife kept up CPR until the ambulance arrived, half eight on a Saturday night and we still got an ambulance and two paramedic cars within ten minutes, they were top class, two of them even came up onto the ward a week later to see how he was.
> 
> They got him going again before taking him to hospital where he spent a week in an induced coma. We were told on the second day that as he'd been without oxygen for up to twenty minutes severe brain damage was quite likely, and when he first woke up he was slow to react.
> 
> ...


I didn't realise any of that. I'm delighted to hear it worked out.


----------



## stephec (28 Jan 2020)

Slick said:


> I didn't realise any of that. I'm delighted to hear it worked out.


Thanks Slick, we know he'll probably never get back to where he was before, but as we were told that 9/10 out of hospital SCAs don't survive we're more than just a bit lucky. 

In all honesty the only reason he's alive is because I couldn't find anything to watch on Netflix. My wife had already told me that he was wanting a chat with me about work, so when he came in that night and asked me I was going to suggest going to the pub the next day to talk about it, but when he came in I still hadn't started watching something so I went into his room and twenty minutes later it happened. 

If he'd have been on his own it would've been an hour before anyone found him, to say he's a bit lucky is quite an understatement.


----------



## steve292 (28 Jan 2020)

You did your best in a very stresful situation when many would have panicked or walked away. If the heart is in fibrilation as other people here have said , CPR will keeep them alive, but only the defib will shock the heart allowing it to restart.

spolier.. he does not die. its a good ending

This is a youtube video that I was shown on a first aid course. It shows both the agonal breathing reflex and how effective the defibrillator can be. The guy in the video goes from being literally at his last breath to talking to the lifeguards and knowing who and where he is.
If there is a defib available to you it should be one of the first things to get after the initial assesment, along with raising the alarm/calling for help


----------



## byegad (28 Jan 2020)

It's always going to be a shock to those left bereaved. My dad had two heart attacks. First one at 47, felt ill, came me from work, called doctor, who called ambulance. After 5 days in ITU, as it was called in those days, he made a reasonable recovery.
Second one, 16 yrs later, while waiting for a traffic light to change to allow him, Mam, my sister and brother in law to cross the road, the lights changed, 3 people started to cross, he said to Mam, hang o......

He was, according to the coroner, effectively dead before he hit the floor. A massive infarction. He hit his head as he hit the floor and his cap had virtually no blood on it at the point of contact. His heart had stopped beating during the fall/topple. We knew from the first attack that he was on borrowed time, a very heavy smoker from 14, he stopped the day of the first attack, but too late to allow him to reach a true old age.

Mam took a month to die, suffering progressive organ failure. I know how I want to go!


----------



## Slick (28 Jan 2020)

stephec said:


> Thanks Slick, we know he'll probably never get back to where he was before, but as we were told that 9/10 out of hospital SCAs don't survive we're more than just a bit lucky.
> 
> In all honesty the only reason he's alive is because I couldn't find anything to watch on Netflix. My wife had already told me that he was wanting a chat with me about work, so when he came in that night and asked me I was going to suggest going to the pub the next day to talk about it, but when he came in I still hadn't started watching something so I went into his room and twenty minutes later it happened.
> 
> If he'd have been on his own it would've been an hour before anyone found him, to say he's a bit lucky is quite an understatement.


Unbelievable, the very thin margins between being here and not.


----------



## Slick (28 Jan 2020)

byegad said:


> It's always going to be a shock to those left bereaved. My dad had two heart attacks. First one at 47, felt ill, came me from work, called doctor, who called ambulance. After 5 days in ITU, as it was called in those days, he made a reasonable recovery.
> Second one, 16 yrs later, while waiting for a traffic light to change to allow him, Mam, my sister and brother in law to cross the road, the lights changed, 3 people started to cross, he said to Mam, hang o......
> 
> He was, according to the coroner, effectively dead before he hit the floor. A massive infarction. He hit his head as he hit the floor and his cap had virtually no blood on it at the point of contact. His heart had stopped beating during the fall/topple. We knew from the first attack that he was on borrowed time, a very heavy smoker from 14, he stopped the day of the first attack, but too late to allow him to reach a true old age.
> ...


Hardly seems the right thing to like such a description that probably resonated with more than me, but that was more for your final sentence as there was a time when I thought dropping would be a nightmare, only to learn like you, the hard way that it would be a blessing to some.


----------



## presta (28 Jan 2020)

confusedcyclist said:


> Automatic defibrillators won't actually work in cases of Cardiac Arrest, they only work for atrial fibrillation


You don't need emergency defibrillation for AF, because AF doesn't stop the heart pumping. If you have AF they just take you to A&E where DCCV is just one of a number of options, and even then, there's time to shave your chest and give you a sedative first.


----------



## mrandmrspoves (28 Jan 2020)

presta said:


> You don't need emergency defibrillation for AF, because AF doesn't stop the heart pumping. If you have AF they just take you to A&E where DCCV is just one of a number of options, and even then, there's time to shave your chest and give you a sedative first.



Quite correct. Atrial fibrillation (AF) manifests as an irregular pulse and is quite common in the over 70's. In itself, AF seldom causes any symptoms but because it leads to an increased risk of blood clotting it is normally treated. 
If the AF becomes fast AF the sufferer can become quite unwell, so if there is a prolonged episode of fast af that does not respond to medication it is sometimes treated by defibrillation. In this instance the defibrillation is called cardioversion.


----------



## presta (28 Jan 2020)

mrandmrspoves said:


> Quite correct. Atrial fibrillation (AF) manifests as an irregular pulse and is quite common in the over 70's. In itself, AF seldom causes any symptoms but because it leads to an increased risk of blood clotting it is normally treated.
> If the AF becomes fast AF the sufferer can become quite unwell, so if there is a prolonged episode of fast af that does not respond to medication it is sometimes treated by defibrillation. In this instance the defibrillation is called cardioversion.


I have Fast AF. My record heart rate is 260, and at that rate you get a ticket to resus on the red telephone.  
Out of the 10 times I've been taken in, I've only been given a DCCV once, and that wasn't until the following day. For anyone who hasn't seen a DCCV, this is quite amusing (not me, but I have a recording of me hollering a bit like that, too).

View: https://www.youtube.com/watch?v=KIEFXJ8QHxw&t=5s


----------



## confusedcyclist (29 Jan 2020)

presta said:


> You don't need emergency defibrillation for AF, because AF doesn't stop the heart pumping. If you have AF they just take you to A&E where DCCV is just one of a number of options, and even then, there's time to shave your chest and give you a sedative first.



Quite right, I guess I was coming in from the angle that any lay person might experience in a place of work or in a public where an AED might be provided, rather than by the professionals in a hospital setting.


----------



## mrandmrspoves (29 Jan 2020)

confusedcyclist said:


> Quite right, I guess I was coming in from the angle that any lay person might experience in a place of work or in a public where an AED might be provided, rather than by the professionals in a hospital setting.


You had mistaken Atrial Fibrillation (not immediately life threatening and not treated with an AED, for Ventricular Fibrillation (immediately life threatening and treatable with an AED)


----------



## confusedcyclist (30 Jan 2020)

Oh yes, school boy error!


----------



## kingrollo (30 Jan 2020)

OP Here - the autopsy came back as *Ischemic heart disease - *is the SCA we were talking about earlier in the thread ?


----------



## presta (30 Jan 2020)

kingrollo said:


> OP Here - the autopsy came back as *Ischemic heart disease - *is the SCA we were talking about earlier in the thread ?


Ischaemia is blocked/constricted arteries. That sounds more like a heart attack than cardiac arrest I would have thought?


----------



## mrandmrspoves (30 Jan 2020)

presta said:


> Ischaemia is blocked/constricted arteries. That sounds more like a heart attack than cardiac arrest I would have thought?



Ischaemic Heart Disease refers to a chronic condition where the blood vessels feeding the heart muscle (primarily the coronary arteries) are damaged and blood flow is reduced. Factors that increase risk of IHD include High Blood Pressure, Obesity, Diabetes, Hereditary Factors, High Cholesterol, Sedentary lifestyle and Smoking (especially smoking and even more so when in conjunction with any of the other factors) Unless it is very advanced, a person may have a degree of Ischaemic Heart Disease and not know it. Symptoms often only occur when the person exerts themself or is stressed and cardiac demand is increased. So if a person is fairly sedate they may not experience this.
The symptoms of IHD can be vague such as fatigue and tiredness but classically include shortness of breath and chest pain (angina)
Ischaemic Heart Disease can lead to sudden disruption in the heart's electrical output (cardiac arrhythmia) causing sudden cardiac arrest. A heart attack (myocardial infarction) may result from IHD but happens when a coronorary artery becomes blocked and the heart muscle that receives blood from that artery then dies. A myocardial infarction can lead to sudden heart failure followed by cardiac arrest or sudden arrhytmia and cardiac arrest - but not all myocardial infarctions lead to cardiac arrests and not all cardiac arrests are caused by myocardial infarctions.
In this particular case - no heart attack and sudden onset of cardiac arrhythmia would result in very sudden collapse with no pre warning. If you have to go and can't choose to go in your sleep, this would be the next best choice for all of us......although it would be nice to postpone it until a ripe old age.


----------



## presta (30 Jan 2020)

mrandmrspoves said:


> sudden onset of cardiac arrhythmia would result in very sudden collapse with no pre warning.


Just how long does it take to lose consciousness when your heart stops? I can personally vouch that it's longer than 5 seconds, as I've had my heart stopped with adenosine for that long on a couple of occasions, and nothing much happened at all.


----------



## mrandmrspoves (30 Jan 2020)

I can't


presta said:


> Just how long does it take to lose consciousness when your heart stops? I can personally vouch that it's longer than 5 seconds, as I've had my heart stopped with adenosine for that long on a couple of occasions, and nothing much happened at all.



I can't give a definitive answer as there are a number of variables. If you think about syncope (fainting) which is caused by a sudden drop in blood pressure a person may feel a bit woozy for a minute or so before they drop. If they are standing and their BP is already on the low side (perhaps because they are dehydrated and sweating on a hot day) then they may only get a few seconds warning.
Syncope is caused by a drop in BP whereas sudden cardiac arrest will plummet the BP down to zero in seconds.
In your case presumably, Adenosine would have been administered while you were lying down which will help maintain BP for a few seconds and they would have made sure that your blood oxygen levels were good too.
Where I have witnessed a SCA following a large MI, I have seen a patient go from stable and pain free to clutching their chest in pain and collapsing within about 10 seconds.


----------



## ColinJ (30 Jan 2020)

mrandmrspoves said:


> If you think about syncope (fainting) which is caused by a sudden drop in blood pressure a person may feel a bit woozy for a minute or so before they drop. If they are standing and their BP is already on the low side (perhaps because they are dehydrated and sweating on a hot day) then they may only get a few seconds warning.


I suffer from syncope (I have fainted on at least 5 or 6 occasions). I sometimes got 15-20 seconds of feeling woozy, but I blacked out so fast a couple of times that I didn't even feel it coming on!


----------



## presta (1 Feb 2020)

ColinJ said:


> I suffer from syncope (I have fainted on at least 5 or 6 occasions). I sometimes got 15-20 seconds of feeling woozy, but I blacked out so fast a couple of times that I didn't even feel it coming on!


When my AF was undiagnosed and unmedicated my HR would reach 200-250, and I would feel faint when standing, but I've never actually fainted, if I feel myself going I just sit down quick. On the morning of my first ever episode I had to shower sitting in the bath. The paramedic said "no wonder you're feeling faint, you're losing most of your blood pressure". I was on the verge of passing out when they discharged me from hospital once, they'd given me betablockers on top of my antiarrhythmics when they shouldn't have.

Having my heart stopped altogether with adenosine was surprisingly uneventful though, I just felt a bit woozy and spaced out. The consultant said " this is going to make you feel lousy for a few seconds", but afterwards I said "I feel worse than that after I've been cycling".


----------



## Dave7 (2 Feb 2020)

I like Skol said:


> I'm going to be quite cold and maybe heartless now. She's not bothered what happens now, she's dead.
> But this will affect you, tonight and in the next few weeks. Seek any help you can in the form of support and counseling, don't try to brush off the event or 'tough it out'.
> The people left behind are the ones that suffer and you are likely to have some pretty bad feelings if inadequacy and mortality in the weeks and months ahead. To be the one present at such a sudden and unexpected ending to a life will fill you with doubts that maybe you could have done more (you couldn't) or that it might be your turn next (highly unlikely).
> Accept any support that you can


Could be very true that (depending on the OPs make up of course).
When I was about 10 years old a neighbour asked me to climb through their bedroom window as they couldn't open the door.
When I did I found the old man dead and hanging out of the bed.
60 years on and I still see it.
Saw my wifes dad then mum die. Saw my mum and dad die..........not a problem as it was expected.
So...... as Skol says, dont be afraid to ask for help if its needed.


----------



## presta (3 Feb 2020)

confusedcyclist said:


> Defibrillators don't and can't restart an arrested (stopped) heart, they actually stop the heart, interrupting an abnormal rhythm, so it starts again hopefully in proper rhythm.


I don't think that's correct, that's what adenosine does (or is supposed to do). Have a look at the traces below, the top one is a defibrillator, the bottom set are adenosine. It's the adenosine that stops that my heart for about 5 seconds, but the defibrillator doesn't.

During normal sinus rhythm, the sinus node (the heart's natural pacemaker) generates an electrical impulse to trigger each heartbeat. These then spread across the heart muscle a bit like a ripple across the pond when you drop a pebble in, or a Mexican wave in a stadium. During fibrillation muscle cells start contracting by themselves without a trigger from the sinus node, creating random chaotic contractions that are all out of sync with each other. I think the function of the defibrillator is to re-synchronise the cells by hitting them with a huge charge so that they're all reset into the same state simultaneously.

If you compare that with the adenosine trace, my heart stopped for a few seconds as you describe, and it was supposed to revert my heart back to normal, but as you can see, it didn't work, and my heart continued in AF when it restarted.


----------



## mrandmrspoves (3 Feb 2020)

presta said:


> I don't think that's correct, that's what adenosine does (or is supposed to do). Have a look at the traces below, the top one is a defibrillator, the bottom set are adenosine. It's the adenosine that stops that my heart for about 5 seconds, but the defibrillator doesn't.
> 
> During normal sinus rhythm, the sinus node (the heart's natural pacemaker) generates an electrical impulse to trigger each heartbeat. These then spread across the heart muscle a bit like a ripple across the pond when you drop a pebble in, or a Mexican wave in a stadium. During fibrillation muscle cells start contracting by themselves without a trigger from the sinus node, creating random chaotic contractions that are all out of sync with each other. I think the function of the defibrillator is to re-synchronise the cells by hitting them with a huge charge so that they're all reset into the same state simultaneously.
> 
> ...


In very basic terms (the ones I understand!) Adenosine causes a very short acting Atrio Ventricular Block (in effect it stops the electrical signal being transmitted from the AV node to the Ventricles for about 10 seconds) 
A defibrillator aims to stop the electrical activity for a split second.


----------

