Thursday, January 03, 2008
Safer in a casino than a hospital?
A headline may catch your eye today. It will read something like "You are more likely to die of a heart attack in a hospital than a casino." (Full Story). No question that sounds pretty scary, but I want to provide a little context to this story (See Study).

First off, what is really happening to your heart during a heart attack or cardiac arrest? It is typically one of two things: Either your heart is beating too fast or it is beating in some sort of abnormal rhythm. The bottom line is the same: Your heart is no longer providing the blood flow required by the rest of your body, including the heart muscle itself, and that muscle begins to die.

We also know that delivering an electric shock to the heart within a couple of minutes can make a difference, sometimes restoring a normal rate and rhythm. The longer the delay, the less likely it will work. That's the background. So what is it about casinos or airports that make you more likely to survive a cardiac arrest than in a hospital?

Well, it has to do with a couple of things. First, there are simply more people around in a casino or an airport or any public building who may actually witness a cardiac arrest and offer up treatment more quickly - in that crucial two-minute window. In a hospital, unless a patient is hooked up to a cardiac monitor or being constantly observed, a cardiac arrest may go unnoticed for more than a few minutes - maybe too long. The other factor is that patients in hospitals are often sicker in the first place, which is why they are in the hospital. They may be less able to recover from a heart attack.

As part of this blog, let me also encourage you to review the new CPR (cardiopulmonary resuscitation) practices for bystanders by clicking here. They have changed recently, and in some situations focus more on doing chest compressions rather than mouth to mouth breathing. There's even a kit available to learn CPR in just one hour at home. (Full story)

It's worth your time and may just save a life.

Have you ever witnessed someone having a heart attack? How did the people around react and what was done?
Thank you Dr Gupta for your excellent comments -- although one very important distinction should be made. CARDIAC ARREST and HEART ATTACKS are not the same thing, although this is a common source of confusion. A HEART ATTACK is when a small piece of heart muscle suffers from the lack of blood flow -- most people survive heart attacks, and most heart attacks do NOT lead to cardiac arrest. CARDIAC ARREST is when the entire body lacks blood flow, and CPR is required to save a life.

Dr Benjamin Abella
University of Pennsylvania
CPR researcher
As a casino employee, I can attest to the surprising safety of such a place. There are often First Responders employed by the casino who are able to come to a person's aid quickly.

When I passed out on the job a month ago, I was hooked up to oxygen, having my heartrate checked within minutes.
I witnessed a heart attack. I was a junior in college and just after class let out the guy walking down a crowded stairs in front of me stumbled on the steps, fell backwards, stiffened with his legs sticking out very rigid, looked miserable (grimacing), I asked him if he was ok, he didn't respond, and I noticed that although he was moving/convulsing he wasn't breathing. I had absolutely no clue what to do other than hold him and kind of prevent him from sliding down onto the floor.

The campus nurse arrived after about what seemed an eternity, 5 minutes or so, as people sort of gathered around and stopped on the halls. She had a face mask and got a volunteer who know how help do breathing. I think she had me do compressions until the ambulance came. The ambulance arrived about 5 minutes after that and they put something in his mouth with a ball that they squeezed as they wheeled him away on a gurney. They said something like "megadose him...".

I didn't know what to do; I went over to his roomates suite, told them what happened and we all went to the hospital. At the hospital they didn't work on him for more than 25 minutes, they let us go in and say goodbye to him. The nurse said "ever see someone dead? Go ahead, touch him" I touched him on the shoulder and he was room temperature and the surface of his body seemed tough, not normal.

His priest was at the hospital, talked to us, and said the Lord's Prayer. Then we all left.

He was kind of heavily built guy but not really obese; I think he had big head syndrome or whatever that is, when there is too much fluid in your head. He had some kind of shunt in his head to drain it. Apparently he had a lot of medical problems. Of course his parents flew in right away and there was a memorial service on campus.

I was told that the doctor ruled it a heart attack and that his heart had basically went haywire, a real mess, it was like a pot of noodles, all contorted.

Thanks for giving me a chance to tell my story. I am glad I could be with this young man and doubt I could have done anything more for him. There are no defribilators on that campus as far as I know.
Although I've had 4 CPR training classes in a span of 10 years, I still feel a bit inadequate to help if someone had a heart attack in front of me. It's trying enough to do it on a dummy but on a real person is a whole other story.

What is never mentioned or shown on TV/Movies is that when you perform CPR, there is a high probability that person will vomit on you. How many of us with CPR training are prepared for that? Even during the trainings I've had, only one instructor informed me of this. What else do I need to know?
this has to do with the heart,but is a little off the subject. 2 weeks ago i experiecced a miricle i have had a quintuple bypass ,i have 3 stents in my heart and have had several catherazations,the last 2 times they were unable to open the blockages and i was told there was nothing more could be done . my heart pains were severe and almost constant, with any kind of activity, espically if i had consumed anything .i had resigned myself to live day to day. then as i said a miricle happened i was accepted in a study to inject stem cells into my heart. within 2weeks my pain has stopped i don't have to wear a nitro patch over my heart and the nitro spray witch i could never be without for fear of dropping dead with out it, i have not used in days. as i said to me its a miricle and im sure that any who has had similar symptoms knows what im talking about there is a treatment for you if you are lucky enough to have access. this treatment is being done around the world and a few places in the u.s. i didn't think i would live long enough for it to be available to me but i got lucky .good luck to all my fellow damaged heart sufferers p.s. these stem cells were from my own blood and were not from embreotic stem cells so there is no possiblity of rejection and no fertilize eggs are involved. stanley in pompano beach.
It is wonderful that defibrillators are now found in public buildings and the machines can be run successfully by first-time users. The part that I didn't understand at first is that some irregular rhythms cannot be corrected with shocking.
Another issue is that the people who are in casino walking, gambling, etc are not identical to people in hospital beds.

I presume that if you are in a hospital bed, you are on average sicker than someone who is in an airport or casino. I would also suspect that hospitalized people would handle the insult of a cardiac arrest worse that those waiting for an airplane.
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