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Mouth to Mouth?

Discussion in 'Pre-Medical - MD' started by curlycity, Apr 28, 2004.

  1. curlycity

    curlycity Guest

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    So would you provide mouth-to-mouth to a stranger?

    Here's why I'm asking. I learned CPR in high school and was quite enthused about the whole idea. Then I worked at a couple of jobs where they emphasized "universal precautions," a mindset where, in handling industrial accidents, you assume everyone is positive for everything and protect yourself accordingly from blood spills and open wounds. Also I recently found out someone (family friend) who I wouldn't have thought twice about giving CPR to has a highly contagious, chronic disease, which was sort of a shocker even though we all *know* anyone could have anything. Now I'm in a state of considering whether I would endanger my family's health by performing this lifesaving service. I'm going to buy one of those one-way valve devices, but I know the situation might come up where I would have to put my mouth on a stranger and risk their saliva, blood, or vomit entering my body.

    What do you think you would do? What ethics would you apply in this situation?

    By the way, I just asked an attorney and he said (in Texas, at least) there is no affirmative duty to perform emergency care, and Good Samaritan Law protects you from criminal and civil liability if you do provide it. So it's totally up to you, legally speaking.
     
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  3. kaikai128

    kaikai128 Yes SIR. ;-)
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    I have one of those devices in a very small pouch that is caried on my key chain...can never be too prepared. :)
     
  4. curlycity

    curlycity Guest

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    Coooooooooooool. Thanks for answering my thread. I'm going to Google that device right now.
     
  5. Wahooali

    Wahooali The Real Sydney Bristow
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    You can purchase a one-way CPR mask, like you said, which is a good idea if you know how to perform CPR. I believe they also sell small, one time use masks for pretty cheap (as opposed to the nicer, more expensive pocket mask that comes in a case) that you could just stick in your purse, glove compartment, wherever so you have one around just in case. Good for you for making sure you are prepared to use the training you have. Hope you'll never need to though.
     
  6. Wahooali

    Wahooali The Real Sydney Bristow
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    ack, Kaikai128 beat me to it. Great minds think alike.
     
  7. louren

    louren Member
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    The new AHA standards for bystander CPR call for compressions only. Also, do Good Samaritan Laws apply to health care professionals in addition to laypeople?
     
  8. JohnDO

    JohnDO MS III
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    If I remember correctly, they apply to everyone (someone correct me if I'm wrong). But if you're CPR certified, definately pick up a pocket mask or something. My EMT instructor always said: "It's their emergency, don't make it yours."
     
  9. curlycity

    curlycity Guest

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    Sorry for the stoopid question, but what's AHA?

    The attorney told me (and I photocopied the law, just to be sure) that Good Samaritan Laws protect everyone from criminal and civil liability, but that professionals have to answer to their licensing boards and he didn't know about that. The law also specifically excludes people who apply care 'for or in expectation of renumeration.' And there are different rules inside a hospital. But I meant just walking down the street, you know - I'm totally sure there are a whole other set of guidelines for physicians on duty or within hospital walls.
     
  10. louren

    louren Member
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    I haven't worked as a paramedic for the past couple of years, but during medic school we were taught not to render care at accidents. The way I understand it, if you assume care as a medic then you are assuming legal responsibility under your certification. This leaves you wide open for litigation without the support of your employer and/or medical director. We were told to dispatch 911 and, if we must, approach the patient(s) under the guise of a layperson to make sure we would be covered under Good Sam laws. You can't perform patient care without equipment, anyway.

    I suppose I've hijacked this thread from the OP's original question because as a CPR provider chest compressions are the sole recommendation (in addition to notifying EMS). With regards to the face masks, I've been on a number of calls where I'm positive that a flimsy key chain one-way valve would not have provided adequate protection.
     
  11. louren

    louren Member
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    American Heart Association. www.americanheart.org

    Here's a chart showing rates of long-term survival after compressions, mouth-to-mouth, and the two combined. The combination only increased long-term survival by one percent as compared to compressions alone, although the number of people in each group (n=443 and 116, respectively) maybe isn't ideal.
    http://www.americanheart.org/presenter.jhtml?identifier=1820
     
  12. thewebthsp

    thewebthsp Shoobeedoowap
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    other than hep. b, you can't catch most bad things by mouth to mouth, unless there are copius amounts of blood...(eg HIV, HCV). I'm not sure how contagious HTLVI/II are, but they are fortunately pretty rare.

    you can get vaccinated against HBV and check anti hbv titer to see if you're immune
     
  13. EM Junkie

    EM Junkie SDN Donor
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  14. kaikai128

    kaikai128 Yes SIR. ;-)
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    True that most diseases are not that easily passed with mouth to mouth...but have someone puke one time when you are giving them CPR and you will never again think of not using a sheild of some sort.
     
  15. curlycity

    curlycity Guest

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    And a simple nosebleed from falling to the pavement, or injuries sustained from hitting the windshield, or... would produce a copious amount of blood.
     
  16. beanbean

    beanbean 1K Member
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    Good Samaritan Laws very from state to state. In some states, you are required to stop and render aid if you are able to safetly do so. However, in most states stopping to give help is voluntary. Generally, healthcare professions and lay people are protected as long as they do not exceed their level of training/certification (basic CPR cert does not allow you to intubate someone) and are not willfully negligent (willful meaning you do something to intentionally hurt them or deviate from your standard protocols knowing you could cause harm).

    It is a shame to hear that a medic class was taught not to stop and help, but perhaps your state does not offer much protection to first-responders. As a paramedic you are required to provide care to the level of your training with the supplies you have available. If you stop to help and initiate patient care you must continue with patient care until another individual of your certification or higher assumes responsibility for the patient or you could be guillty of abandonment. Paramedics can turn over care of a basic care patient to an EMT. As a physician, if you stop at an accident and give assistance you can then turn over patient care to the EMTs or paramedics. If you wish to continue to direct patient care after EMS is on scene, you must reamin with the patient until turning over care to the EM physician. So, if you are a doc and stop and decide to start telling the medic how to do their job - you are riding with them to the hospital.

    I always stop and help as long as I am not putting myself in obvious harm and I have never had a problem in 18 years.

    Anyways, that is how it works in my neck of the woods....

    Back to the original issue of CPR and infectious disease.

    1) Patients in cardiac arrest almost always puke at some point

    2) Often when someone is going into arrest it looks like they are starting to have a seizure. It usually isn't like they show in the movies when the person closes their eyes and slumps over quietly.

    3) CPR compressions often break ribs, especially on elderly people. It is a shock to you as the one doing CPR if you don't know about this and it happens.

    4) Microshield key chains are great and will hold a pair of gloves and a dsiposable face shield with a one-way valve.

    5) Treat ALL blood and body fluids as potentially contagious, but don't be afraid to touch a patient. I will admit after being an EMT for so many years and always wearing gloves, it has been a bit strange to exam patients in clinic as a med student not wearing gloves for physicals.
     
  17. No Egrets

    No Egrets Bachelorette of Science
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    I have made out with strangers in crowded bars before, so I guess it would be hypocritical to say that I wouldn't touch a stranger's mouth to my own for lifesaving purposes... Based on this precedent, however, I would be more likely to perform CPR in an inebriated state.
     
  18. SaltySqueegee

    SaltySqueegee El Rey de Salsa
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    Just put your hands/fingers :thumbup: :thumbdown: around the lips of the person when you're blowing in. Also, CPR does not require you to suck the air back out of their lungs! It's not exactly like french kissing.

    As for the bloody nose... that's a good question. That would be a diabolical ethical question to ask in an interview.
     
  19. curlycity

    curlycity Guest

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    I love your answer!

    Yeah, I'm one of *those people* who won't even drink out of someone else's cup, and I can count on my fingers the number of people my mouth's been on ... :rolleyes:

    The nice thing about making out in bars is, there's probably plenty of alcohol around to unintentionally disinfect your mouth :laugh:

    Good karma to you for making me laugh out loud in a very quiet office full of cubicles!
     
  20. Amy B

    Amy B I miss my son so much
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    Have you bought things from this site before?

    When I became certified in CPR and first aid in South Carolina, the instructor told us we were now under an obligation to stop and render aid if we could. While I haven't had to do CPR, I have stopped at a number of accidents and rendered first aid. the folks have all been thankful and have actually sent me gifts in the mail. I was surprised at that. One couple worked for the reeses company and sent us a crate filled with Fast Break Candy bars before they came out in stores.
     
  21. SailCrazy

    SailCrazy I gotta have more cowbell
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    I can't get the image of your "dog with big mouth" Avatar out of my head as I picture random drunken kissing...! :laugh: What a site that would be!
     
  22. beanbean

    beanbean 1K Member
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