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Moral Dilemma (Not involving a coat hanger)

Discussion in 'General Discussion' started by LessTalk MoreStab, Feb 16, 2011.

  1. LessTalk MoreStab

    LessTalk MoreStab
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    <a class="postlink" href="http://www.news.com.au/breaking-news/man-told-to-give-addict-mouth-to-mouth/story-e6frfku0-1226007551602" onclick="window.open(this.href);return false;">http://www.news.com.au/breaking-news/ma ... 6007551602</a>

    In the above article a guy was instructed by an emergency phone operator that he “had to” perform CPR on an unconscious female drug addict who wasn't breathing, she survived, but now he has to get tested for all manner of nasties.

    If it were on my watch she would’ve been fucked. I don’t much like smackies.

    FOCUS: What would you have done?

    ALT FOCUS: Moral dilemmas, share.
     
  2. DrFrylock

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    Thank God it's TERRIBLE THREAD THURSDAY because the suggestion board is badly shitted up right now and I'm out of good ideas. If you have any, please do post them in the suggestion board.

    I don't even have a good moral dilemma story to share. Most of mine are about walking that fine line between honesty and sensitivity/peacekeeping. I usually err on the side of sensitivity, but when my patience is running short (as it is today) I occasionally feel like taking a vacation to Honestonia.
     
  3. NoMames

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    If she was hot, probably played just the tip, just to see how it feels.
     
  4. StayFrosty

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    That bitch would be dead right now, my conscience would be bitching, and I wouldn't really care about either. A healthy person is supposed to put themselves at risk of disease contraction to save the life of a fucking heroin addict? Better her to die and leave some space for someone who doesn't want to waste their existence. I'm not a misanthropist but that story set me on edge. What the hell is this guy going to do if the test comes up positive? He's going to be completely screwed for life, just so a heroin junkie can keep shooting up every day until she gets a bad batch or ODs.

    As for the emergency operator, fuck him too. If I were Ambulance Victoria, and some idiot in my pay just revealed to all of Australia that we can't even give proper warning on basic protection from transmittable diseases, I would be looking for a new operator and making sure I don't have any more incompetent morons in my staff.

    To be fair, the guy who gave her mouth-to-mouth should have thought more clearly about protection, but what is the operator being paid to do? While he's on the phone with an emergency call, he's responsible for doing all he can to ensure the safety and best welfare of the people on the other end. He's limited in what he can do, obviously, but in communicating vital information to the caller, he's just as responsible as a trauma surgeon is with a patient on his table.

    On a softer note, I really hope the guy who helped ends up alright. I got the impression he felt pressured, and whether that's the case or not, no one should be fucked for saving a life.

    For the medical professionals on the board: The way I understand it, the vastly more important component of CPR is chest compression. How vital was the mouth-to-mouth to this woman's survival?
     
  5. cdite

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  6. redbullgreygoose

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    Am I to understand stds can be transmitted via kissing? I always use condoms but that's cause for concern to me. I was always under the impression stds can not be transmitted via kissing unless the person's mouth is bleeding. That's the part that jumped out to me. Am I the only one?
     
  7. Disgustipated

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    Been motherfucking up to date on CPR technique. Current best practice is to do away with the breaths and just do the chest compressions; the mechanical motion will get sufficient oxygen into the body and restoring circulation is more important. They still advocate two rescue breaths, but damn.... It is possible to do them through the nose.

    Alternatively, you should have a CPR barrier. They make that shit in keyring size now. Totally one way valve to isolate you from the nastiness.



    The big problem with CPR is the hepatitis family. You can get nasties like herpes, littlies like rhinovirus and even the slimmest of chances of HIV if you both have open cuts in or around the mouth. But, hepatitis can be transmitted through saliva. You're severely unlucky (and the person is dead skanky) if you get Hep A. Hep B is the greatest chance. Hep C is possible, but it takes blood to blood. The difference between Hep C and HIV is that Hep C is a much more robust virus and more likely to survive the distance between release and infection.
     
  8. Stealth

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    <a class="postlink" href="http://news.theage.com.au/breaking-news-world/doctor-amputates-mans-legs-with-hacksaw-20110225-1b7gm.html" onclick="window.open(this.href);return false;">http://news.theage.com.au/breaking-news ... 1b7gm.html</a>
     
  9. Frank

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    FOCUS: No fucking way would I have helped, I would have assumed it was a ploy and the BF was getting ready to jump me.

    ALT FOCUS: Last night at the liquor store I was buying three $16 bottles of wine. The guy rang me up and said I owed $32 (actual numbers have been changed since I don't feel like dealing with sales tax).

    Bad Frank: SWEET, free bottle of wine
    Good Frank: You can't do this, it's stealing, stealing is wrong
    Bad Frank: Fuck that, you've already dropped a shit ton of cash here, think of it as a 'repeat customer discount' in fact, you should steal something on the way out and piss in the owner's gas tank because they've never offered it to you before.
    Good Frank: Dude, how would you like it if you owned a liquor store and someone did it to you?

    Ultimately I corrected him, I don't consider myself a very moral person but there's something so wrong about stealing that gets under my skin.
     
  10. BL1Y

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    I probably would have helped.

    Even aware that she might have some nasty disease ready to jump on me, I don't think you can get AIDS from that little contact, and I'd imagine some immediate and thorough scrubbing would kill most anything.

    The real impediment for me would just be the pressure of trying to save someone; that might cause me to freeze, but not the risk to myself. Or, at least not this risk. It's not like I've never made out with a sketchy stranger.
     
  11. ghettoastronaut

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    STDs can also be transmitted via blood. A major source of infections among users of smoked drugs (i.e. crack, crystal meth) is that their pipes get extremely hot and burn their lips, causing burns and open sores. People also share pipes. This is practically an invitation for blood-borne diseases like hepatitis or HIV to get passed around. The difference between the two would be that hepatitis is rather easy to catch - it takes a small viral load and a relatively minor injury and the likelihood is very high. With HIV, the odds are extremely low short of direct intravenous injection or a deep muscular injury, and you can give drugs like AZT to reduce the odds further.

    This episode highlights the importance of carrying around those face masks for CPR, I would think. But also, the first rule of any decent first aid program is that you have to ensure your own safety first. If you can't safely administer first aid, then you don't. I'm not sure to what extent the emergency operator knew what the deal was, but it seems to me they're pretty vulnerable to liability if a test does come up positive.
     
  12. Harry Coolahan

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    Yes that's true, and there is actually a relatively new variation of CPR called Continuous Chest Compression CPR, in which you do away with the breaths entirely and just do chest compressions. The argument for it is twofold:

    1) First and foremost, medical professionals recognized that people don't want to do mouth-to-mouth, and a lot of people were withholding CPR treatment for this reason. This makes sense to me, I would never put my mouth against a stranger's mouth (and I don't have a moral issue with this either). So, pragmatically I think CCC CPR is a great innovation.

    2) Medically, those that developed CCC CPR claim that it is actually better than conventional CPR. The reasoning is that when you go into cardiac arrest, areas such as your legs hold large reservoirs of blood that are still oxygen-rich. Those that develop CCC CPR claim that at the time of arrest, the body will still have enough oxygen for several minutes of compressions. By skipping rescue breaths, you can give more continuous compressions. The problem I see with this is: Okay, even if that is true, anyone who goes into cardiac arrest is going to get CPR for a minimum of 30 minutes—from the time someone sees the downed patient, to the time EMS arrives on-scene, to the time the patient gets in the ER. I agree that CCC CPR is way better than doing nothing, but the argument that it's better than CPR is flimsy at best.

    What it comes down to, is: If you're giving CPR to a stranger, you should at the very least give chest compressions. If you know the patient, you should probably give rescue breaths, especially if it's a two-person CPR rescue where the time between chest compressions would be minimized.
     
  13. Disgustipated

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    This wasn't contained within the information I received. Instead, we were told that chest compressions will deflate the lungs and air pressure will reinflate them with fresh air sufficient to oxygenate the blood provided no further injury exists. This volume of air exchanged is enough to at least equate to shallow breathing which is sufficient for a prone person.

    We were also told that this is preferable to the 30/2 ratio (or 15/2 in some areas) because it promoted a constant rhythm on the chest compressions and gave a better chance of the heart resuming normal function.
     
  14. Harry Coolahan

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    Hopefully we're not getting too off-topic, but where did you learn that? Jesus, it's scary to know people are teaching that kind of thing.

    There is no way that will provide adequate breathing. If you're doing chest compressions properly, you're doing them at a rate of 100 per minute. Breathes should be administered at a rate of no more than 20 per minute, otherwise there isn't enough time for the lungs to inflate. And, the proper depth of a chest compression on an adult is 1-2 inches—this is enough to pump the heart but will do virtually nothing for the lungs. The worst part is the argument that air pressure will force an adequate amount of oxygen into the lungs—the diaphragm actively expands the chest cavity to draw air in. If you relax (e.g. if you're dead) then there is no way enough air is going to get pulled into the lungs through air pressure. That's why EMS uses a BVM (bag-valve mask) to force air into the lungs.

    (And, not to get nit-picky, but I think you mean supine, not prone.)

    This is also really wrong. The value of the chest compressions is to keep blood circulating and keep the brain alive. Chest compressions will almost never restart a heart—in theory it can, but only under certain abnormal heart rhythms, and even in those cases it's so unlikely that it's a negligible chance. You need a defibrillator to restart a heart, and even then only if it's a shockable heart rhythm (ventricular tachycardia and ventricular fibrillation).

    For a small child, I can see these arguments being made a little more (chest compressions are deeper and children are much likelier to recover from heart attacks), but it's still not medically sound advice.
     
  15. Rush-O-Matic

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    It's been 20 years since I had a class in basic CPR. (I'm taking a new one in two weeks.) But, does that mean then that the only point of CPR is to keep the blood circulating until EMS shows up with a defib device, or somebody finds an AED? How does that apply to somebody who just "drowned" when you pull them out of the pool? Is it more important to breathe for them than pump their heart? I thought that was for the C part of CPR. So confused now.
     
  16. lostalldoubt86

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    I would probably do it, but i would cut a hole in a sandwich bag and put it over her mouth first. I have no idea if that would work, but it would make me feel better. Either that, or i would just do compressions with no mouth-to-mouth contact.
     
  17. Disgustipated

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    I'm only a trained first aider and no doctor, but logic would dictate that's at least partially not correct. If I compress the chest, I flatten the lungs and force air out of them. When I release the compression, they must partially reinflate. Otherwise at 100 compressions a minute I'd eventually completely deflate the lungs. It's not breathing, but rather a lesser volume per cycle, with more cycles, thing.

    In regards to the heart, I never said that the compressions would restart it. I said "heart resuming normal function". Anyone who thinks that CPR directly restarts the heart hasn't been taught correctly. It artificially pumps the heart to stimulate circulation. It relies on getting oxygen to the brain to keep it alive, and to hopefully have it trigger the heart into restarting. Otherwise, no one would ever recover from complete cardiac arrest through CPR alone.
     
  18. tempest

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    Actually, last time I re-newed ACLS (last year) my instructor told us that the AHA was evaluating teaching CCC CPR to the general public citing the benefits of not stopping compressions and the fact that chest rebound results in micro-breaths. She expected that the technique was to be rolled out to the general public soon.
     
  19. caseykasem

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    Like others have said, I would have just done the chest compressions without the breaths. No fucking way am I going to risk my health to help someone who is overdosing unless they are my own flesh and blood. I don't carry any type of one-way valve or anything like that but after reading this I think I'll purchase one and keep it in my car just in case I'm presented with some type of crazy situation.
     
  20. gfh

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    I would have just performed chest compressions until EMS arrived.