Fantasy Bishoujo Juniku Ojisan to - Vol. 15 Ch. 208 - Fabiniku Ojisan And The River Sanzu

[MangaDex]

 

[Luke_chase]

You don’t get it, they need that $10,000 hifi system to write the manuscript

 

[Mah_Buddy_Keith]

You shouldn't perform compressions on a patient that still has a pulse. Only rescue breaths are needed until there's no longer a pulse.

 

[ipmanvsthemask]

Is that another hero?

 

[TheGrandMugwump]

You shouldn't perform compressions on a patient that still has a pulse. Only rescue breaths are needed until there's no longer a pulse.

Scientists are saying this isn't true now. The risk of permanent damage from reduced/stopped oxygen flow from halting chest compressions to check for a pulse is far greater than the risk of injury from doing compressions with a pulse. For lay people, if the victim is unresponsive and not breathing, then do CPR. I like the phrase "They will tell you if they don't need CPR."

 

[Mah_Buddy_Keith]

Scientists are saying this isn't true now. The risk of permanent damage from reduced/stopped oxygen flow from halting chest compressions to check for a pulse is far greater than the risk of injury from doing compressions with a pulse. For lay people, if the victim is unresponsive and not breathing, then do CPR. I like the phrase "They will tell you if they don't need CPR."

It takes ten seconds to check the carotid, which is insignificant when compared to response time, rescue scene evaluation, etc. Once you make sure the scene is safe, check responsiveness. Unresponsive to verbal and pain stimuli? Check carotid, airway, breathing. No pulse, no breathing? Start CPR. Pulse but no breathing? Breathe for them. If you start cracking ribs without checking these basic things, you end up looking like this guy:

Remember, air goes in and out; blood goes round and round. Your job as a first responder is to fix these things first.

Edit: But yeah, if they are in confirmed (big keyword right there) cardiac arrest, compressions are huge. I got dinged on my licensing for pausing compressions to help with pads, but I still managed to pass overall. Only time you shouldn't be doing compressions is during analyzing to...you guessed it! Check for a carotid pulse!

 

[TheGrandMugwump]

It takes ten seconds to check the carotid, which is insignificant when compared to response time, rescue scene evaluation, etc. Once you make sure the scene is safe, check responsiveness. Unresponsive to verbal and pain stimuli? Check carotid, airway, breathing. No pulse, no breathing? Start CPR. Pulse but no breathing? Breathe for them. If you start cracking ribs without checking these basic things, you end up looking like this guy:

Remember, air goes in and out; blood goes round and round. Your job as a first responder is to fix these things first.

Edit: But yeah, if they are in confirmed (big keyword right there) cardiac arrest, compressions are huge. I got dinged on my licensing for pausing compressions to help with pads, but I still managed to pass overall. Only time you shouldn't be doing compressions is during analyzing to...you guessed it! Check for a carotid pulse!

Pausing compressions for ten seconds to check a pulse can lead to worse organ damage from oxygen deprivation and a lower survival chance. Don't do that.

Also, a pulse isn't an indicator that blood pressure is high enough to accomplish anything. If they're not responsive and not breathing, that's already a big sign that their circulatory system isn't working right. Checking for a pulse is not only a redundant waste of precious time when doing CPR, it's detrimental to the victim's health.

 

[Dust_pile]

Thanks for the chapter!

 

[Mah_Buddy_Keith]

Pausing compressions for ten seconds to check a pulse can lead to worse organ damage from oxygen deprivation and a lower survival chance. Don't do that.

Also, a pulse isn't an indicator that blood pressure is high enough to accomplish anything. If they're not responsive and not breathing, that's already a big sign that their circulatory system isn't working right. Checking for a pulse is not only a redundant waste of precious time when doing CPR, it's detrimental to the victim's health.

A pulse is everything, for the love of God. It means that the heart is actually pumping and not a quivering ball of meat (i.e., ventricular fibrillation). A palpable pulse at the carotid but not distally, yeah there's definitely issues with perfusion due to hypotension but the heart is still pumping on its own.

Yeah, when doing CPR you want to maintain a compression fraction (the amount of time spent doing compressions) of 80% or higher. That means there's time to do other things...like rescue breaths (which take 10-12 seconds to do, assuming 5-6 seconds per breath for the typical 30:2 ratio), waiting for the AED to analyze, extrication, or other things that are needed to get the patient to definitive care.

And then we wind back to your initial argument: How have we determined that the patient is unresponsive? Alert/spontaneous eye opening? No, move to verbal. "Hello, Sir/Ma'am, I'm Keith, a first responder. Are you alright?" No response, trap squeeze or nailbed check for pain stimuli. No response. Guess they're unresponsive. AVPU probably would take like 15 seconds. Now in the unresponsive supine patient (again, assuming no spinal considerations) you check your ABCs, which involves two fingers on the carotid while checking rise and fall of the chest. Again, 10 seconds...but you're already using this time to check breathing so it isn't actually wasted because determining if they're breathing or not is gonna be done anyway.

This is all discounting all the other possible causes of respiratory depression/arrest, like opioids, foreign body airway obstructions, anaphylaxis, etc. Of course you're doing compressions for the FBAO, but knowing what happened is part of your scene survey, dude.

 

[TheGrandMugwump]

A pulse is everything, for the love of God. It means that the heart is actually pumping and not a quivering ball of meat (i.e., ventricular fibrillation). A palpable pulse at the carotid but not distally, yeah there's definitely issues with perfusion due to hypotension but the heart is still pumping on its own.

Yeah, when doing CPR you want to maintain a compression fraction (the amount of time spent doing compressions) of 80% or higher. That means there's time to do other things...like rescue breaths (which take 10-12 seconds to do, assuming 5-6 seconds per breath for the typical 30:2 ratio), waiting for the AED to analyze, extrication, or other things that are needed to get the patient to definitive care.

And then we wind back to your initial argument: How have we determined that the patient is unresponsive? Alert/spontaneous eye opening? No, move to verbal. "Hello, Sir/Ma'am, I'm Keith, a first responder. Are you alright?" No response, trap squeeze or nailbed check for pain stimuli. No response. Guess they're unresponsive. AVPU probably would take like 15 seconds. Now in the unresponsive supine patient (again, assuming no spinal considerations) you check your ABCs, which involves two fingers on the carotid while checking rise and fall of the chest. Again, 10 seconds...but you're already using this time to check breathing so it isn't actually wasted because determining if they're breathing or not is gonna be done anyway.

This is all discounting all the other possible causes of respiratory depression/arrest, like opioids, foreign body airway obstructions, anaphylaxis, etc. Of course you're doing compressions for the FBAO, but knowing what happened is part of your scene survey, dude.

As I mentioned in my first post, the advice to not check for a pulse if the patient is unresponsive and not breathing normally is for the average lay person, like the characters in the manga we're reading. They tend to spend too much time checking for a pulse and are often wrong under stress. You can check the AHA's changes in 2005 to CPR guidelines for lay people yourself, dude. https://www.ahajournals.org/doi/10.1161/circulationaha.105.166550#sec-4

And your question on how lay people determine if someone is unresponsive? Gently shake them and call out to them. If they don't respond or react to being gently shaken and called to, they're considered unresponsive. Teaching lay people to apply CPR as soon as possible to a patient potentially suffering from cardiac arrest has been deemed worth the danger of cracked ribs by the AHA.

First responders and medical professionals, who are more likely to actually find the patient's pulse or lack of it quickly, should absolutely follow their training. This advice isn't for them.

 

[Mah_Buddy_Keith]

As I mentioned in my first post, the advice to not check for a pulse if the patient is unresponsive and not breathing normally is for the average lay person, like the characters in the manga we're reading. They tend to spend too much time checking for a pulse and are often wrong under stress. You can check the AHA's changes in 2005 to CPR guidelines for lay people yourself, dude. https://www.ahajournals.org/doi/10.1161/circulationaha.105.166550#sec-4

And your question on how lay people determine if someone is unresponsive? Gently shake them and call out to them. If they don't respond or react to being gently shaken and called to, they're considered unresponsive. Teaching lay people to apply CPR as soon as possible to a patient potentially suffering from cardiac arrest has been deemed worth the danger of cracked ribs by the AHA.

First responders and medical professionals, who are more likely to actually find the patient's pulse or lack of it quickly, should absolutely follow their training. This advice isn't for them.

Oh look, a handbook provided to anyone with Standard First Aid (i.e., for Laypeople) It’s obviously less in-depth than workplace first-aid or for first responders, but the structure is still the same.

If it’s too much for you to read, it still goes over your LOC and ABCs before you jump on the chest. And it does indicate that there are allowances for you to pause compressions to allow the AED to analyze, clear the airway, and any other necessary intervention. In the end, you’re still doing your scene survey and your primary survey.

 

[TheGrandMugwump]

Oh look, a handbook provided to anyone with Standard First Aid (i.e., for Laypeople) It’s obviously less in-depth than workplace first-aid or for first responders, but the structure is still the same.

If it’s too much for you to read, it still goes over your LOC and ABCs before you jump on the chest. And it does indicate that there are allowances for you to pause compressions to allow the AED to analyze, clear the airway, and any other necessary intervention. In the end, you’re still doing your scene survey and your primary survey.

The ABC's in that manual (page 27) say nothing about checking pulse, and it says nothing about checking pulse when performing CPR (page 62). Check Airway, check Breathing, and check Circulation, meaning to check if they are bleeding out, not pulse. It also mentions that if a patient is breathing normally (agonal gasping isn't normal), then their heart is functioning, hence why lay people are encouraged to check breath instead of pulse. You should read it yourself sometime.

 

[Mah_Buddy_Keith]

The ABC's in that manual (page 27) say nothing about checking pulse, and it says nothing about checking pulse when performing CPR (page 62). Check Airway, check Breathing, and check Circulation, meaning to check if they are bleeding out, not pulse. It also mentions that if a patient is breathing normally (agonal gasping isn't normal), then their heart is functioning, hence why lay people are encouraged to check breath instead of pulse. You should read it yourself sometime.

Alright, fine. I concede. I was always trained at BLS/HCP and above, which does check pulses with circulation. However, I still stand by my statement that if the patient has a pulse (which Jinguuji did assess) but no breathing, they don't need compressions. Now we need to address the fact that CPR was stopped and Tachibana's just laying on the bed with no interventions being done whatsoever. Respiratory arrest will eventually lead to cardiac arrest, so...what now?

 

[TheGrandMugwump]

Alright, fine. I concede. I was always trained at BLS/HCP and above, which does check pulses with circulation. However, I still stand by my statement that if the patient has a pulse (which Jinguuji did assess) but no breathing, they don't need compressions. Now we need to address the fact that CPR was stopped and Tachibana's just laying on the bed with no interventions being done whatsoever. Respiratory arrest will eventually lead to cardiac arrest, so...what now?

I don't think there's an entry in our first aid manuals on how to combat fae magic that has separated a soul from a body prematurely. That probably falls under the initial assessment of life threatening issues that need to be resolved first before doing CPR, since no amount of CPR or rescue breathing is going to bring Tachibana's soul back while the fairies are interfering.

 

[Mah_Buddy_Keith]

I don't think there's an entry in our first aid manuals on how to combat fae magic that has separated a soul from a body prematurely. That probably falls under the initial assessment of life threatening issues that need to be resolved first before doing CPR, since no amount of CPR or rescue breathing is going to bring Tachibana's soul back while the fairies are interfering.

Basically, Mangaka is dumb. :c