Looking inside an obese body

Pandora · November 13, 2016, 2:28am

Obesity: The Post Mortem - A BBC Documentary
youtube.com/watch?v=RLu_hdlWUkI

Fascinating, I mean, just taking a peek inside a body and seeing how everything sits in there. I wish they also did one on a drug addict, an alcoholic and a chronic smoker too. Maybe look at their brains too, especially of substance abusers.

(Warning: it’s graphic)

The_Golden_Turd · November 13, 2016, 3:26am

Oh, I thought you were posting pics.

Bit misleading.

Pandora · November 13, 2016, 7:28am

You couldn’t hear the crunching sounds of the ribcage with pictures.

(So next time I do a CPR and break the ribs, I’ll have an idea what it would sound like)

The_Golden_Turd · November 13, 2016, 2:15pm

You can do CPR through the stomach, upwards compressions, rib cage won’t break. The old man I watch at night in his 90s, his whole family was in the medical profession as nurses or as pharmacists, except him. He has a bad fear of being left alone, and of death. They told me not to administer CPR or call the paramedics unless his wife upstairs insisted, and I said I wouldn’t just sit around and watch him die, but they said all that occurs when you go CPR to a old man is his ribs break, and at that age they never heal and live miserably for a few weeks more, then die.

So I found the Stomach based CPR Method. I’ll be damned if he dies when I’m around without even trying to save him.

Pandora · November 13, 2016, 8:18pm

This would be further from the heart, and there is a greater chance of aspiration if you’re pushing on the stomach. You’d also need to push harder. You might have to consider possible damage to nearby organs, like liver.

But I guess it’s better than nothing (or maybe not, it depends). broken ribs vs. vomit in lungs + bruised/damaged liver? Maybe invest into AED?

The_Golden_Turd · November 13, 2016, 10:17pm

I read it is safer, more efficient, and has a higher success rate actually.

Pandora · November 14, 2016, 1:22am

Interesting, I’ll look into it. I’m curious, if it has a higher success rate, why isn’t it widely recognized yet? AHA recently changed the breath-to-compression rate because pumping more blood had a higher success rate. If that is also true for only rhythmic abdominal compression (OAC-CPR) why is it not accepted practice yet?

The_Golden_Turd · November 14, 2016, 2:15am

Conservatism, the slow rate of the scientific process within medicine. Ranger Battalion isn’t pushing it yet.

If the military looks at a combat first aid practice, and a Ranger Medic (rarely actual Ranger Medics inventing these ideas, they just come across the concept) likes it over current practices that regular troops are trained in first aid for, they will adopt it, train the Airborne in it (they are our most elite airborne light infantry battalion). A lot of medical practices enter the US Mainstream by a couple of snotnose paramedics who are athletic enough to get in.

Another route is hospital ERs. They are allowed a higher level of experimentation given the absurdity and high risk for eminent lethality many patients face if traditional methods are used. They get some leeway.

What checks a whole hospital from going over is insurance, insurance isn’t adverse to innovation, but innovation doesn’t have a predictable statistical rate for success. Malpractice suits can be a bitch, it is safer just to let people break ribs using a process with clear acceptance in the courts.

We have studies, not a lot of studies, like normal CPR dies. I don’t believe most trainers are opposed to teaching the technique, just, CPR is still the go to standard. I wouldn’t do it to certain kinds of patients or injuries obviously.

I do believe we will change over, I encourage knowing both.

Pandora · November 16, 2016, 9:54pm

Looks like a comparative study has been made and one of the main conclusions that was reached is that OAC-CPR, in its current form, does not provide enough blood flow to the head.

[u]Comparison of CPR outcome predictors between rhythmic abdominal compression and continuous chest compression CPR techniques[/u]

Abstract
Objective Bystander cardiopulmonary resuscitation (CPR) provides treatment for out-of-hospital cardiac arrest since perfusion of vital organs is critical to resuscitation. Alternatives to standard CPR are evaluated for effectiveness based upon outcome predictive metrics and survival studies. This study focuses on evaluating the performance of rhythmic-only abdominal compression CPR (OAC-CPR) relative to chest compression (CC-CPR) using a complementary suite of mechanistically based CPR outcome predictors. Combined, these predictors provide insight on the transduction of compression-induced pressures into flow perfusing vital organs.

Methods
Intrasubject comparisons between the CPR techniques were made during multiple 2-min intervals of induced fibrillation in 17 porcine subjects. Arterial pO2, cardiac output, carotid blood flow, coronary perfusion pressure (CPP), minute alveolar ventilation (MAV), end-tidal CO2, and time from defibrillation to the return of spontaneous circulation (ROSC) were recorded. Organ damage was assessed by necropsy.

Results
Compared with CC-CPR, OAC-CPR had higher pressure and ventilation metrics with increased relative CPP (+16 mm Hg), MAV (+75/ml/min/kg) and a lower reduction in arterial pO2(−22% baseline), but suffered from lower carotid flows (−9.3 ml/min). No significant difference was found comparing cardiac outputs. Furthermore, resuscitation was qualitatively more difficult after OAC-CPR, with a longer time to ROSC (+70 s). No abdominal damage was observed over short periods of OAC-CPR.

Conclusions
Although OAC-CPR appeared superior to CC-CPR by pressure and ventilation metrics, lower carotid flow and longer delay until ROSC raise concerns about overall performance. These paradoxical observations suggest that the evaluation of efficacious alternative CPR techniques may require more direct measurements of vital organ perfusion.

emj.bmj.com/content/31/5/394

Also (same study),

[u]Comparison of the effectiveness of two CPR techniques through the use of predictive metrics and the measurement of regional blood flows
Ryan Michael Kammeyer, Purdue University[/u]

Abstract
Bystander CPR has been recognized as an important link in improving the survival rate for out-of-hospital cardiac arrest. One potential CPR technique for use by bystanders is rhythmic only abdominal compression CPR (OAC-CPR). However, little is known about its strengths and weaknesses relative to continuous chest compression CPR (CC-CPR).

In this study, intrasubject comparisons between OAC-CPR and CC-CPR were made during two minute intervals of fibrillation. Predictive metrics of survival and neurological outcome were monitored. No significant difference in the cardiac output between the two techniques was found, while OAC-CPR produced greater blood oxygenation and no abdominal damage over short periods of application.

However, OAC-CPR also produced lower carotid flow, and resulted in a greater time from a successful defibrillation until strong heartbeats were observed. End-tidal CO2 measurements suggest that this rate and force combination creates arterial hypocapnia, perhaps causing coronary and cerebral vasoconstriction.^ For a more detailed observation of the techniques, regional blood flow measurements using a microsphere deposition technique were made. This indicated that OAC-CPR produced lower coronary and cerebral blood flows.

As such, OAC-CPR is not recommended for use by bystanders in its current form. Future work will need to center on the refinement of a mathematical model of the technique that incorporates all relevant cardiovascular effects that the technique may experience. From this refined model, a more optimal form of OAC-CPR may be able to be developed and tested in-vivo. As a low risk of regurgitation and abdominal damage was observed for OAC-CPR in this study, its use as circulatory support during cardiac arrest in patients that have recently undergone open heart surgery remains promising.

docs.lib.purdue.edu/dissertations/AAI1501851/

Pandora · November 16, 2016, 10:46pm

It’s seems rather odd to me that for being so well-versed in biomedical engineering, Leslie Geddes (the proponent) did not foresee this side effect of OAC-CPR method himself. Perhaps he thought it was enough. It’s too bad he’s dead now.

youtube.com/watch?v=YIuo80XVFJ8

The_Golden_Turd · November 17, 2016, 2:37am

I’ll look it over tonight or in the morning, still have no choice by to use it, stuff I read said it was better.

Pandora · November 22, 2016, 6:53am

Here’s another CPR method (don’t worry, I have my CPR card)
youtube.com/watch?v=d45HkjY1pTI

But seriously, I was trying to find out why AOC-CPR is recommended for use only in a hospital setting, and my guess was that in a hospital setting, you can force pure oxygen, making this method more effective, I mean, if getting oxygen to the brain is the issue with this method. But the studies I’ve found are conflicting on this matter. In terms of ROSC (return of spontaneous circulation) pure oxygen and atmospheric oxygen had about the same success rates.

ncbi.nlm.nih.gov/pubmed/19520479

Moreover, there is a possibility of potential brain damage due to oxidative stress (hyperoxia in the brain) when pure oxygen is administered after CA:
kevinmd.com/blog/2010/06/sup … ation.html

The Oxygen Paradox in CPR:

[u]Oxygen Paradox[/u]
Although it is clear that restoration of oxygen is necessary for cardiac resuscitation, the re-introduction of oxygen itself causes injury. This has been termed the oxygen paradox and suggests that to optimize re-oxygenation of the ischemic tissue, initial oxygen delivery must be controlled.
Indeed a number of animal and isolated heart ischemia-reperfusion studies suggest that initial control of oxygen delivery via either controlled flow or controlled oxygenation can improve recovery of cardiac function. (10-12)

In these pre-clinical studies, strategies have included using a gradual increase in the perfusion rate and intracoronary pressure over the first few minutes of reperfusion, which has been associated with a reduction in myocardial necrosis and tissue edema. In the setting of cardiac arrest resuscitation, controlled re-oxygenation is much more difficult. As opposed to reperfusion from regional cardiac ischemia, reperfusion and re-oxygenation in cardiac arrest occurs in two stages. In the first stage, initial re-oxygenation is driven by the low flow generated by chest compressions and CPR. This is followed by increased myocardial reperfusion flow if ROSC is achieved. It is with full reperfusion, immediately after ROSC, that controlled re-oxygenation may be possible and may improve outcome.

There is good pre-clinical, and now some clinical data, in support of early controlled oxygenation to improve outcome following resuscitation from cardiac arrest. It has long been assumed that hyper-oxygenation increases reactive oxygen species (ROS) formation. Support for this concept is found in work using cultured cardiac fibroblasts. Cells cultured in a high O2 environment (hyperoxia) had higher levels of reactive oxygen species production than cells cultured in mild hypoxia. (13)

The brain seems to be particularly sensitive to hyperoxia. A series of studies utilizing a ventricular fibrillation, open-chest dog CPR model have demonstrated that hyperoxia during the first hour after ROSC impairs cerebral aerobic energy metabolism and causes more neuronal damage in the hippocampal CA1 region. (14,15) In the same cardiac arrest model, controlled post-ROSC oxygenation using a pulse oximeter to control O2 saturation to 94-96% resulted in improved neurologic outcome compared with ventilation using 100% O2. (16)

In a recent clinical review, 6326 post cardiac arrest ICU patients were divided into 3 cohorts; hyperoxia defined as partial arterial pressure of O2 (PaO2)> 300 mm Hg (18%), hypoxia defined as a PaO2 < 60 mm Hg (63%) and normoxia (63%) based on at least one arterial blood gas obtained within 24 hours of arrival to the intensive care unit (ICU). The hyperoxia group had significantly higher hospital mortality compared with the normoxia and the hypoxia groups (figure 2). (17) These clinical data add more evidence in support of controlled re-oxygenation. To date the role of post-ROSC hyperoxia on other organ function, including the heart is less defined than the central nervous system (CNS) effects.

SUMMARY
The heart is incapable of storing significant oxygen or substrates and thus is entirely dependent on a continuous delivery of flow in order to support its high metabolic state. Following cardiac arrest, myocardial tissue oxygen tension falls rapidly and aerobic production of ATP ceases. Without re-oxygenation of the ischemic myocardium, ROSC cannot be achieved. The oxygen paradox which has been described regarding other ischemia-reperfusion conditions seems to have application in cardiac arrest. It is clear that some level of oxygenation is necessary to achieve ROSC, however post ROSC there appears to be increased toxicity associated with hyperoxia. The optimal conditions for re-oxygenation in the setting of cardiac arrest remain ill defined at present.

signavitae.com/2010/09/the-r … scitation/

This really sounds like walking a fine line. To add to this confusion, what are the implications of these studies on hyperbaric therapy for heart ischemia and brain damage after CA? Something does not seem to be adding up here. Back to the drawing board.

The_Golden_Turd · November 22, 2016, 12:25pm

It isn’t back to the drawling boarg for me, I only effectively have this method to use on the elderly, the ischemic cascade or not be damned. The case of my charge being the obvious case, but I’m not gonna go about breaking elderly people’s ribcages open either. They don’t recover too well from that.

Have you ever wondered why the military doesn’t go around just blinding people, instead of killing them? We have the technology, at least since the 80s, the eyes reflect just like cameras do at set light frequencies, we can easily detect when someone is looking at our optics and burn their retinas. We don’t, because the side effects are catastrophic to a country. Instead of losing 10,000 guys in a batlle- always shockingly terrible, and then moving on with morning, remarriage, change of property and even a high portion of widows remarrying… A state that just lost a war (never a cheap burden) inherits 10,000 permanently disabled welfare cases from that one battle alone. A single war could permanently Yank a nations economy, forcing it to socialize to support the bulk of it’s otherwise healthy population, living in deep and full independence. Byzantines did this once, did not seek to do it again, realizing how bad it was.

In individual cases, I may say blinding is better. I wouldn’t force it on a whole segment of society. I wouldn’t crack the ribs open on a elderly person, statistically old enough to die anyway. That is a very long term, very painful recovery, and far too many simply don’t. We don’t ask ourselves what we are doing.

His family is medical, seen the results far too many times on elderly CPR patients. My stomach CPR is a potentially viable alternative. I will keep the oxygen issue in mind, but unless someone is insisting (his wife) that I do it otherwise, I’m instructed to just let him pass naturally. I won’t, I’ll give it a serious shot with this alternative- but dammit, the guy is 90 something now. He lives at this point pretty much to go to McDonalds each day and eat a cheeseburger (not my choice, don’t say no) and watch Hogan’s Heroes. I don’t know if he us aware at this point if they are reruns anymore. I’m not seeing the point of putting him through catastrophic hell of smashing in his rib cage just to claim I tried to save a life, if a alternative method could potentially save him and keep him reasonably healthy. Your not exactly providing me with a ethical alternative. Maybe in a guy my age, breaking ribs makes sense. I’m not doing it in someone who can’t take it and heal. That’s insane. We don’t see how many we loose to suffering hospital after hospital from bad CPR. It is worst than a battle. Why torture people that way? At their age, take the riskier yet more humane treatment, they can die with more dignity, or live with it. No need for their last days to be one of absolute torture just cause we say so.

Purely off memory, the Uschemic cascade is 17 steps, only up to step four is it reversable. Heart doesn’t always die when we go brain dead, it can beat for days after death (yes it can Kwiswest- fucking listen, it can) and we would be better off getting a chemical analysisvof the salt levels in the heart in these clinical cases of death when the heart won’t stop, and have special CPR lactated ringers with adrenaline mixed in with that formula.