Rebecca and the 'rescue breaths'

[K_Z]

As for CPR for someone with Max's injuries, there are important questions for lay people to ask:

1. How do you administer "rescue breaths" to a victim who is convulsing and vomiting profusely?

2. How do you perform chest compressions on a victim who is convulsing and appears to have a broken neck?

Correcting some medical misinformation.

-Patients in asystole do not convulse or experience active vomiting. People in aystole are flaccid.

-The paramedics use of the word "vomit" is a misuse of the term in their documentation-- what they should have documented is "regurgitation".

-Hypoxia/ anoxia produces relaxation of sphincter muscles-- in particular to this situation, the cardiac sphincter (which is at the gastroesophageal junction). Relaxation of that sphincter produces passive regurgitation of stomach contents, which is what plagued paramedics. This is exacerbated greatly by chest compressions. Max had eaten breakfast shortly before his accident, and had a large amount of partially digested stomach contents that regurgitated into his upper and lower airways. This is consistent with reports that he had a very severe aspiration pneumonia while in ICU. Intubation attempts by paramedics exacerbated this by "dragging" stomach contents into airways.

(Aspiration pneumonitis is a chemical "burn" of the lungs from the hydrochloric acid and stomach contents aspirated or forced into lung tissue. Produces severe swelling of airways and lung tissue, and interference with oxygen and carbon dioxide exchange.)

-As far as "convulsing", there is no documentation of this in the records that have been released. Max demonstrated decorticate posturing in the Coronado ER upon restoration of cardiac rhythm. Decorticate posturing is very, very ominous.

 

[Inparadise]

Correcting some medical misinformation.

-Patients in asystole do not convulse or experience active vomiting. People in aystole are flaccid.

-The paramedics use of the word "vomit" is a misuse of the term in their documentation-- what they should have documented is "regurgitation".

-Hypoxia/ anoxia produces relaxation of sphincter muscles-- in particular to this situation, the cardiac sphincter (which is at the gastroesophageal junction). Relaxation of that sphincter produces passive regurgitation of stomach contents, which is what plagued paramedics. This is exacerbated greatly by chest compressions. Max had eaten breakfast shortly before his accident, and had a large amount of partially digested stomach contents that regurgitated into his upper and lower airways. This is consistent with reports that he had a very severe aspiration pneumonia while in ICU. Intubation attempts by paramedics exacerbated this by "dragging" stomach contents into airways.

(Aspiration pneumonitis is a chemical "burn" of the lungs from the hydrochloric acid and stomach contents aspirated or forced into lung tissue. Produces severe swelling of airways and lung tissue, and interference with oxygen and carbon dioxide exchange.)

-As far as "convulsing", there is no documentation of this in the records that have been released. Max demonstrated decorticate posturing in the Coronado ER upon restoration of cardiac rhythm. Decorticate posturing is very, very ominous.

Thank you for your explaination. While you are correct in your thoughts, as several of my ER Doc and EMT friends regarding Max's condition, I do believe that Dina will never allow herself to go beyond blaming Rebecca for Max's death because in her mind CPR was not administered. The bottom line is that even if CPR had been administered, his injuries were such that it would not have made a difference. One cannot "replug" a detached/stretched spinal cord......and the damage to his brain was immediate.

 

[K_Z]

The paramedics, physicians and parents interest in knowing how long Max was without oxygen was very important. People do survive head injuries. Knowing exactly how long Max was without oxygen would greatly impact his prognosis. A dead brain isn't going to improve.

Correcting misinformation.

-Most of the brain damage that occurs from hypoxia and anoxia during aystole and CPR is "reperfusion" damage-- not "damage" that occurs during CPR. A thorough discussion of reperfusion damage could span an entire semester (or more). I'll spare readers, and suggest that "cerebral reperfusion damage/ management" is a good place to start a google search for more information. Reperfusion damage is a concern within just a few (2-3) min of aystole.Max clearly experienced reperfusion damage following a prolonged cardiac arrest.

- The duration of CPR/ asystole would only have been a concern in the very early process of Max's initial assessment. Beyond that, it simply didn't matter, because what matters is what the docs see RIGHT NOW on clinical assessment and diagnostics. It matters not if the cardiac arrest was 2 min or 20-- except that the 20 min arrest patient has a much less chance of neurologically intact survival. Just no one (no health care professionals) would have been wringing hands over exactly how many minutes Max was given CPR. The fact is, Max had what would have been described as a "prolonged" cardiac arrest-- and that INCLUDES time with paramedics. And quite frankly, the paramedics were fortunate to get a pulse back at all. Most patients with arrest beyond 25-30 min (who are NOT hypothermic) are not resuscitated to any cardiac rhythm.

-The fact that Max was resuscitated after 25-30 min argues VERY strongly that 911 was called VERY promptly following his discovery in cardiac arrest. If more than that time had elapsed, his heart would not have been able to have been restarted. Do your own lit review if you don't believe this-- extraordinarily few TRAUMA (NOT electrical arrest, and NOT hypothermic arrest) patients are resuscitated to any rhythm at 25- 30 min. Most literature suggests all resuscitation attempts be abandoned in trauma patients in asystole at 20 min.

In short, the argument that Max's docs were wringing their hands and unable to make decisions for Max because they did not know "exactly" how long he was in cardiac arrest is patently false, and VERY misleading (or mistaken/ misinformed). He had an "unwitnessed fall, prolonged" arrest. THAT is the pertinent piece of information docs were working with. And as soon as they had diagnostic results, they knew exactly what they were facing. They were not "puzzled" as to what caused his cardiac arrest-- it was right there in front of them. This very unfortunate child experienced traumatic cardiac arrest secondary to a fall that produced massive blunt head trauma and a very high spinal cord contusion.

 

[justice be served]

Correcting misinformation.

-Most of the brain damage that occurs from hypoxia and anoxia during aystole and CPR is "reperfusion" damage-- not "damage" that occurs during CPR. A thorough discussion of reperfusion damage could span an entire semester (or more). I'll spare readers, and suggest that "cerebral reperfusion damage/ management" is a good place to start a google search for more information. Reperfusion damage is a concern within just a few (2-3) min of aystole.Max clearly experienced reperfusion damage following a prolonged cardiac arrest.

- The duration of CPR/ asystole would only have been a concern in the very early process of Max's initial assessment. Beyond that, it simply didn't matter, because what matters is what the docs see RIGHT NOW on clinical assessment and diagnostics. It matters not if the cardiac arrest was 2 min or 20-- except that the 20 min arrest patient has a much less chance of neurologically intact survival. Just no one (no health care professionals) would have been wringing hands over exactly how many minutes Max was given CPR. The fact is, Max had what would have been described as a "prolonged" cardiac arrest-- and that INCLUDES time with paramedics. And quite frankly, the paramedics were fortunate to get a pulse back at all. Most patients with arrest beyond 25-30 min (who are NOT hypothermic) are not resuscitated to any cardiac rhythm.

-The fact that Max was resuscitated after 25-30 min argues VERY strongly that 911 was called VERY promptly following his discovery in cardiac arrest. If more than that time had elapsed, his heart would not have been able to have been restarted. Do your own lit review if you don't believe this-- extraordinarily few TRAUMA (NOT electrical arrest, and NOT hypothermic arrest) patients are resuscitated to any rhythm at 25- 30 min. Most literature suggests all resuscitation attempts be abandoned in trauma patients in asystole at 20 min.

In short, the argument that Max's docs were wringing their hands and unable to make decisions for Max because they did not know "exactly" how long he was in cardiac arrest is patently false, and VERY misleading (or mistaken/ misinformed). He had an "unwitnessed fall, prolonged" arrest. THAT is the pertinent piece of information docs were working with. And as soon as they had diagnostic results, they knew exactly what they were facing. They were not "puzzled" as to what caused his cardiac arrest-- it was right there in front of them. This very unfortunate child experienced traumatic cardiac arrest secondary to a fall that produced massive blunt head trauma and a very high spinal cord contusion.

This forum is VERY LUCKY to have a professional offer such comprehensive and detailed interpretations on Max's accident. It is greatly helpful for the lay person to receive an honest assessment of the facts. Thank you and please consider being verified as a medical professional. I continue to be impressed with your ability to take these very complex facts and grace us with understandable meanings. With this case presenting so much misinformation, your abilities are outstanding. :great:

 

[K_Z]

Here's the EMT report and it says the challenge was with advanced life support, not basic life support. Breathing and compressions were given and maintained. The question that is still unanswered is how long was Max really without oxygen? Brain death takes more than just two minutes.


http://www.maxshacknai.com/wp-content/uploads/2012/09/CFD_Report.pdf

pt was in asystole, compressions and bvm were initiated.....pt was intubated but the tube was pulled due to difficulties conforming it and bls airway was continued. JMO

BBM.

-There is an important typo in the paramedics documentation. The word they meant to type is "confirming" not "conforming". The ETT (endotracheal tube) is already "pre-formed", and most use a rigid stylette to maintain the form during intubation. It is essential to CONFIRM endotracheal intubation by several methods, and they were unable to CONFIRM that they were in the trachea with these methods. The worry is that one has "tubed the goose", or intubated the esophagus instead of the trachea. If tracheal intubation cannot be confirmed, the tube must be removed promptly.

-Paramedics were using a BVM-- which stands for "bag-valve-mask" unit (or, Ambu bag, to use the brand name of one system).

-Earlier in the EMS report, paramedics document placing a NPA (nasopharyngeal airway, or a "nasal trumpet"). This is somewhat contraindicated in facial trauma, but as they had no airway at all at that point in a patient with aysytole, it's understandable that they tried it.

- Paramedics proceeded to Coronado Sharp because they did not have a "secured" airway. (They would have almost certainly gone direct to Rady otherwise.) A BVM/ NPA airway is NOT a secured airway. They were plagued with continuous regurgitation during CPR (chest compressions exacerbate regurgitation of stomach contents into the trachea, lungs, and upper airways). In short, airway management in this patient was FAR from secure and controlled. In addition to him being in aystole until he regained a rhythm in the Coronado ED. (Reference EMS report.) All of the stomach contents interfered with delivery of oxygen, and indeed, complicated the picture by forcing vomitus into the lungs under positive pressure ventilation (PPV with the BVM). And remember that lungs in cardiac arrest do not exchange carbon dioxide OR oxygen very well at all, due to metabolic acidosis. Hemoglobin is reluctant to load oxygen, and even more reluctant to let it go at the tissue level in cardiac arrest. (Google oxyhemoglobin dissociation curve if interested in more explanation.)

- It is tempting for lay people to try to reduce cardiopulmonary arrest into something simple, but it's best to resist that temptation. It is a very complex physiologic process, during, and more importantly, AFTER.

 

[K_Z]

This forum is VERY LUCKY to have a professional offer such comprehensive and detailed interpretations on Max's accident. It is greatly helpful for the lay person to receive an honest assessment of the facts. Thank you and please consider being verified as a medical professional. I continue to be impressed with your ability to take these very complex facts and grace us with understandable meanings. With this case presenting so much misinformation, your abilities are outstanding. :great:

BBM.

Thank you for your kind words.

I am a verified health care professional. Please see the "professional posters" thread above. I have been verified on this site since approximately May of 2012.

 

[MyBelle]

Correcting misinformation.

-Most of the brain damage that occurs from hypoxia and anoxia during aystole and CPR is "reperfusion" damage-- not "damage" that occurs during CPR. A thorough discussion of reperfusion damage could span an entire semester (or more). I'll spare readers, and suggest that "cerebral reperfusion damage/ management" is a good place to start a google search for more information. Reperfusion damage is a concern within just a few (2-3) min of aystole.Max clearly experienced reperfusion damage following a prolonged cardiac arrest.

- The duration of CPR/ asystole would only have been a concern in the very early process of Max's initial assessment. Beyond that, it simply didn't matter, because what matters is what the docs see RIGHT NOW on clinical assessment and diagnostics. It matters not if the cardiac arrest was 2 min or 20-- except that the 20 min arrest patient has a much less chance of neurologically intact survival. Just no one (no health care professionals) would have been wringing hands over exactly how many minutes Max was given CPR. The fact is, Max had what would have been described as a "prolonged" cardiac arrest-- and that INCLUDES time with paramedics. And quite frankly, the paramedics were fortunate to get a pulse back at all. Most patients with arrest beyond 25-30 min (who are NOT hypothermic) are not resuscitated to any cardiac rhythm.

-The fact that Max was resuscitated after 25-30 min argues VERY strongly that 911 was called VERY promptly following his discovery in cardiac arrest. If more than that time had elapsed, his heart would not have been able to have been restarted. Do your own lit review if you don't believe this-- extraordinarily few TRAUMA (NOT electrical arrest, and NOT hypothermic arrest) patients are resuscitated to any rhythm at 25- 30 min. Most literature suggests all resuscitation attempts be abandoned in trauma patients in asystole at 20 min.

In short, the argument that Max's docs were wringing their hands and unable to make decisions for Max because they did not know "exactly" how long he was in cardiac arrest is patently false, and VERY misleading (or mistaken/ misinformed). He had an "unwitnessed fall, prolonged" arrest. THAT is the pertinent piece of information docs were working with. And as soon as they had diagnostic results, they knew exactly what they were facing. They were not "puzzled" as to what caused his cardiac arrest-- it was right there in front of them. This very unfortunate child experienced traumatic cardiac arrest secondary to a fall that produced massive blunt head trauma and a very high spinal cord contusion.

You seem confused. Here's what I said which is based on public documents produced by professionals who actually were there and attended Max or who were child abuse investigators. I chose to base my opinion on their observations.

Originally Posted by MyBelle
The paramedics, physicians and parents interest in knowing how long Max was without oxygen was very important. People do survive head injuries. Knowing exactly how long Max was without oxygen would greatly impact his prognosis. A dead brain isn't going to improve.

Nowhere have I said doctors were wringing their hands or were puzzled as to what caused the cardiac arrest. The paramedic noted that it was unknown how long Max had been in cardiac arrest and also noted they had received limited information about the incident. I will continue to hold the opinion this information was critical to the care of Max.

The concerns reported to LE by Rady personnel were that the description they received did not match the injuries. A prosecutor and child abuse investigator obtained a search warrant. These are known facts. I trust their judgment and find your attempts to discredit them rather bizarre.

JMO

 

[justice be served]

BBM.

Thank you for your kind words.

I am a verified health care professional. Please see the "professional posters" thread above. I have been verified on this site since approximately May of 2012.

I am so sorry. I reference the heading for poster's name and attached tag line. I thought registrations were identified at that place. Just blessed to have you.

 

[MyBelle]

Thank you for your explaination. While you are correct in your thoughts, as several of my ER Doc and EMT friends regarding Max's condition, I do believe that Dina will never allow herself to go beyond blaming Rebecca for Max's death because in her mind CPR was not administered. The bottom line is that even if CPR had been administered, his injuries were such that it would not have made a difference. One cannot "replug" a detached/stretched spinal cord......and the damage to his brain was immediate.

BBM. I think Dina is blaming Rebecca for Max's death because he did DIE while in her care and I can't say that I wouldn't do the same thing if I was in Dina's shoes. As far as the CPR goes, Rebecca should have at least tried and the fact that no CPR was given simply adds to the fuel that this was not an accident. She was a trained medical professional and knew rescue breaths were useless without compressions. To me, the excuse that "it wouldn't have made a difference" points to guilt. The only way Rebecca would know that is if she waited until he had no pulse to notify 911.

JMO

 

[Inparadise]

BBM. I think Dina is blaming Rebecca for Max's death because he did DIE while in her care and I can't say that I wouldn't do the same thing if I was in Dina's shoes. As far as the CPR goes, Rebecca should have at least tried and the fact that no CPR was given simply adds to the fuel that this was not an accident. She was a trained medical professional and knew rescue breaths were useless without compressions. To me, the excuse that "it wouldn't have made a difference" points to guilt. The only way Rebecca would know that is if she waited until he had no pulse to notify 911.

JMO

Max died of an accident while under the CUSTODY of his father's care....you don't know if Jonah was there or not, because you were not there. While Jonah has said that he was not there, none of us know for sure because we were not there. Even if Max had an accident while Rebecca was the only adult present, it does not mean that she is at fault......for crying out loud, kids do things that they are not supposed to when adults are around......it is called pushing the limits. And if he did something dangerous, or it was a freak accident, Rebecca certainly was not responsible. If Dina should be blaming anyone, it should be Jonah.

 

[CuriousGeorgia]

Jonah Shacknai was not there that morning when Max "fell". Marty Rudoy has said that Max, Rebecca, and XZ were there. There is not ONE shred of evidence that Jonah Shacknai was there.

The person that was IN CHARGE of Max at the time of his injuries was Rebecca Zahau. No spin or attempt to put the blame on someone else will ever change that FACT.

 

[MissJ]

K Z, you have a way of explaining the situation so precisely, thank you. My thoughts are, then...why do we have JS allegedly calling RZ the night before her death telling her there had been a change in MS' condition? It is my own opinion that there was no change in MS condition at any time during his hospitalization. There was no reason, following his initial evaluation, to believe that his situation was anything but dire.

 

[MyBelle]

Max died of an accident while under the CUSTODY of his father's care....you don't know if Jonah was there or not, because you were not there. While Jonah has said that he was not there, none of us know for sure because we were not there. Even if Max had an accident while Rebecca was the only adult present, it does not mean that she is at fault......for crying out loud, kids do things that they are not supposed to when adults are around......it is called pushing the limits. And if he did something dangerous, or it was a freak accident, Rebecca certainly was not responsible. If Dina should be blaming anyone, it should be Jonah.

Actually, I do know that Jonah was not there because I've read the official reports that have been released citing RZ and XZ as sources stating he wasn't there. Parents entrust their children to another adult's care all the time. RZ was at fault because she failed to ensure the safety of Max.

RZ was a grown woman who could have easily controlled the scooter play which was very dangerous around a balcony and stairwell. <modsnip>. I'm sure both parents wish they had a "do-over."

JMO

 

[MyBelle]

Jonah Shacknai was not there that morning when Max "fell". Marty Rudoy has said that Max, Rebecca, and XZ were there. There is not ONE shred of evidence that Jonah Shacknai was there.

The person that was IN CHARGE of Max at the time of his injuries was Rebecca Zahau. No spin or attempt to put the blame on someone else will ever change that FACT.

I agree. It is unfortunate that Rebecca took her own life and I sympathize with her family but placing blame on his parents rather than Rebecca for Max's death is very disrespectful to Max.

JMO

 

[time]

BBM. I think Dina is blaming Rebecca for Max's death because he did DIE while in her care and I can't say that I wouldn't do the same thing if I was in Dina's shoes. As far as the CPR goes, Rebecca should have at least tried and the fact that no CPR was given simply adds to the fuel that this was not an accident. She was a trained medical professional and knew rescue breaths were useless without compressions. To me, the excuse that "it wouldn't have made a difference" points to guilt. The only way Rebecca would know that is if she waited until he had no pulse to notify 911.

JMO

If she were as trained as you claim, then perhaps she knew that chest compressions would make matters worse. Plus, I think even an untrained person would realize fairly quickly that their attempts at rescue breaths were going no where. You are trying to hold Rebecca to some ridiculously impossible rescue efforts and possibly promoting she should have done more harm to him in order to prove she did CPR. My opinion based on what we now know about Max's condition thanks to K_Z.

HOWEVER, I think you are promoting the same argument that Dina may have thought at the time. No, it wouldn't have made a difference, e.g., helped Max, but I think the bigger points here are those I outlined above - there could be good reason Rebecca couldn't do more or shouldn't have. And, that has nothing to do with how quickly she started helping Max either.

 

[MyBelle]

If she were as trained as you claim, then perhaps she knew that chest compressions would make matters worse. Plus, I think even an untrained person would realize fairly quickly that their attempts at rescue breaths were going no where. You are trying to hold Rebecca to some ridiculously impossible rescue efforts and possibly promoting she should have done more harm to him in order to prove she did CPR. My opinion based on what we now know about Max's condition thanks to K_Z.

HOWEVER, I think you are promoting the same argument that Dina may have thought at the time. No, it wouldn't have made a difference, e.g., helped Max, but I think the bigger points here are those I outlined above - there could be good reason Rebecca couldn't do more or shouldn't have. And, that has nothing to do with how quickly she started helping Max either.

<modsnip>.

JMO

 

[justice be served]

K Z, you have a way of explaining the situation so precisely, thank you. My thoughts are, then...why do we have JS allegedly calling RZ the night before her death telling her there had been a change in MS' condition? It is my own opinion that there was no change in MS condition at any time during his hospitalization. There was no reason, following his initial evaluation, to believe that his situation was anything but dire.

Miss J, as much as the many case details spiral round and round incessantly, your questioning of why Jonah called Rebecca that fateful night to inform her of Max's change in condition is IMO the weakest link in the claim and ruling that Rebecca committed suicide.

With KZ's explanation of Max's dire condition from the moment of his fall, this alleged phone call stated an obviously bogus claim. And I say "alleged" because no law enforcement officer has heard the call nor anyone else for that matter.

With all the chatter on everything from CPR to scooters, it appears that poor Max had no hope for survival from the first minute when these tragedies occurred.

How can SDSO in good faith take Jonah's word on his phone call to Rebecca as the hingepin of the suicide ruling? What is really going on here? Does that sound like a fabricated motive otherwise known as a lie?

 

[time]

Miss J, as much as the many case details spiral round and round incessantly, your questioning of why Jonah called Rebecca that fateful night to inform her of Max's change in condition is IMO the weakest link in the claim and ruling that Rebecca committed suicide.

With KZ's explanation of Max's dire condition from the moment of his fall, this alleged phone call stated an obviously bogus claim. And I say "alleged" because no law enforcement officer has heard the call nor anyone else for that matter.

With all the chatter on everything from CPR to scooters, it appears that poor Max had no hope for survival from the first minute when these tragedies occurred.

How can SDSO in good faith take Jonah's word on his phone call to Rebecca as the hingepin of the suicide ruling? What is really going on here? Does that sound like a fabricated motive otherwise known as a lie?

I also think this is a key question. I'd love to read Jonah's actual police interview transcript. I think it could be enlightening and entirely possible it was either misrepresented by LE, Jonah called for some other reason, or both. Does anyone know when LE asked Jonah about this call?

 

[justice be served]

I also think this is a key question. I'd love to read Jonah's actual police interview transcript. I think it could be enlightening and entirely possible it was either misrepresented by LE, Jonah called for some other reason, or both. Does anyone know when LE asked Jonah about this call?

Time, you had posted your thoughts on the subject of Jonah's fateful phone call to Rebecca that night under #136, What One Thing? I believe your view is solid on why SDSO took Jonah's word. Here is your snipped post (hopefully you don't mind) as I believe it bears repeating:

"Makes it really laughable that during the first press conference they claimed hard science/facts told them this was a suicide for a couple of reasons - so much of it is not good science at all and every investigation looks at more than a few chosen facts to put forward for explanations - victimology, forensic psychology, MO of a perp, and so on. The later foci were almost totally excluded except for the attempt to throw a couple of things in there as to motive for a suicide. But if they were going to do that, then why wouldn't they have included Dina hatred for Rebecca and the suspicions floating around in Dina's family and with the Doctor? Because it made it look more like a murder than motive for a suicide.

No, SDSO did not want to get into the weirdness of the *advertiser censored*, bindings, Nina questioning and visiting the house that night, sightings of Dina, no alibis for many, Adam's weird 911 call, past mutual violent domestic abuse and stalking between Dina and Jonah, the death of a little boy that was misdiagnosed until autopsy and on and on."

Time, I think you are so right on.

 

[Betty P]

BBM.

-There is an important typo in the paramedics documentation. The word they meant to type is "confirming" not "conforming". The ETT (endotracheal tube) is already "pre-formed", and most use a rigid stylette to maintain the form during intubation. It is essential to CONFIRM endotracheal intubation by several methods, and they were unable to CONFIRM that they were in the trachea with these methods. The worry is that one has "tubed the goose", or intubated the esophagus instead of the trachea. If tracheal intubation cannot be confirmed, the tube must be removed promptly.

-Paramedics were using a BVM-- which stands for "bag-valve-mask" unit (or, Ambu bag, to use the brand name of one system).

-Earlier in the EMS report, paramedics document placing a NPA (nasopharyngeal airway, or a "nasal trumpet"). This is somewhat contraindicated in facial trauma, but as they had no airway at all at that point in a patient with aysytole, it's understandable that they tried it.

- Paramedics proceeded to Coronado Sharp because they did not have a "secured" airway. (They would have almost certainly gone direct to Rady otherwise.) A BVM/ NPA airway is NOT a secured airway. They were plagued with continuous regurgitation during CPR (chest compressions exacerbate regurgitation of stomach contents into the trachea, lungs, and upper airways). In short, airway management in this patient was FAR from secure and controlled. In addition to him being in aystole until he regained a rhythm in the Coronado ED. (Reference EMS report.) All of the stomach contents interfered with delivery of oxygen, and indeed, complicated the picture by forcing vomitus into the lungs under positive pressure ventilation (PPV with the BVM). And remember that lungs in cardiac arrest do not exchange carbon dioxide OR oxygen very well at all, due to metabolic acidosis. Hemoglobin is reluctant to load oxygen, and even more reluctant to let it go at the tissue level in cardiac arrest. (Google oxyhemoglobin dissociation curve if interested in more explanation.)

- It is tempting for lay people to try to reduce cardiopulmonary arrest into something simple, but it's best to resist that temptation. It is a very complex physiologic process, during, and more importantly, AFTER.

:hug: :gthanks:

Thanks K_Z for this thorough explanation of the challenges faced by RZ & EMT's trying to help MS that day.

As a lay person, I would have been terrified trying to administer CPR for the reasons you list above - fear of vomitus going into lungs, fear of harming him further with chest compressions.