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PostPosted: Sat Oct 03, 1998 3:11 am 
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Location: Richmond, VA
The 'ER' episode last night had a few eye opening issues in it:
-An empty first aid kit at the kid's soccer complex.
-A 13 year old karate student with heart failure from a kick to the chest and a paramedic unit without a defib machine.

As we have more and more people of various ages and sizes and skills and ability the risk of injury must be increasing. Aside from 'Bactine', Bandaids, Chemical Ice, an old EPI pen and tape (and , oh yes, some surgical gloves) I keep in my bag not much else is quickly available for dealing with an injury. What do others keep in their dojos for first aid and beyond?

Also, to you MD's, Emergency Techs and the like, other than CPR, what would be a good response to a heart stoppage due to a blow to the chest (I'll not attempt to spell the terms). With students ranging in age from 6 to 56 eventually I could be faced with an emergency situation.

Advice? Please.
Rich


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PostPosted: Sat Oct 03, 1998 7:30 pm 
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Location: Mount Dora, Florida
Very interesting discussion. One which we have been dancing around for the past 40 years. In the "old" days, only the strong survived the training and we weren't put into a position of debating the value of having a diffibrulation (sp) machine in the dojo. However, as dojo are becoming part of the mainstream physical fitness culture, and 75% of the enrollment consists of children, we must ask questions that were not important 40 years ago.

Can we train the "average" person the way we trained 20-40 years ago or on Okinawa during Uechi-ryu's golden era? Is the evolution of tournaments catering to the twice a week, one hour a class student, more realistic than trying to maintain the warrior spirit of the 50's-60's in the face of the very real statistics in our dojo?

As the martial arts grow, there will naturally be more injuries. The question will eventually be raised (probably in a court of law) as to what responsibility we teachers have towards our students? The answer lies in how we view what we teach and how the material is presented. If we allow insufficiently trained and conditioned students to perform any type of kumite or drills in the manner many of the old timers were trained, we should be asking the question as to what medical (first aid) practices we should be familiar with, if not certified in, to be found not neglegent in a law suit.

It is foolish to believe that accidents won't happen. Today, it is even more foolish to believe that someone seriously injured won't have an ambulance chasing lawyer advising him of his rights before he reaches his hospital bed! On the other hand, what should reasonably be expected of the teacher when an injury happens?


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PostPosted: Mon Oct 05, 1998 12:38 am 
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Location: Richmond, VA
Thanks J.D., Mattson sensei.

Good fortune has struck in our health club dojo. On Saturday I explained the rules and risks of 'real karate' to the new fall class. I collected the waivers and explained I would not allow much contact work until I knew the condition and abilities of all of the beginners. Also, I told them that the kicks and punches they would learn were dangerous and could result in the "ER" scenario of the previous Thursday and finished with a warning - do not use these techniques outside of the dojo unless seriously threatened.

One of the new students smiled as I asked each person to introduce themselves. It seems we now have a genuine ER Physician Assistant in the class! What could be better. We've had a US Army combat medic with us for some time but rarely on Saturdays. This is great. Now all we need is a defib machine.

Now, to George specifically. At camp, we have Chiropractors, Accupucturists, Healing Touch and Kyuso practitioners. Why not add CPR, First Aid, other sorts of training. Yes, it is available locally, but most of us will never find the time to attend classes.

While at camp, we are there to learn new things, and are committing 3 uninterrupted days to that effort. Even if at a cost (the Red Cross in Richmond charges $35 for CPR) I believe many would take advantage of the training. Perhaps 2 hours after dinner on Friday and Saturday, or in the afternoons when a break from the contact activities would be appreciated. Give it some thought. Should we start a new thread to get other opinions?

Rich


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PostPosted: Mon Oct 05, 1998 1:01 am 
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Rich: I agree we should, at a minimum, offer a course in CPR at camp. But I doubt if many will take this course when they have to forgo other martial art activities they cannot get at home. Our schedule is SOfull right now, the only way we might be able to accomodate more activities, is to add another day (thursday) to the program. Perhaps we can use this additional day for some of the suggested activities we don't have time for in our regular three day schedule.

Lets see how others feel about this. Adding the day isn't a problem for me or the Maritime Academy. But we must know early who is interested and what activities we wish to add. BTW, make sure you keep that ER student. Hopefully he will be able to attend camp!!! Image
best,
George


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PostPosted: Mon Oct 05, 1998 2:35 pm 
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Location: Richmond, VA --- Louisville, KY
Rich et al

I saw the ER episode - sat down with my post-workout Chinese dinner only to see the student being brought in on a stretcher. The rescue squad tech rattles off the vitals, and mentions that the kid was hit in the chest with a kick during a karate demonstration and his heart stopped. "Commotio cordis" I rattled off as they brought him into the room. My medicine-practicing wife gives me a 'sure, you know-it-all' look. Then Anthony Edwards yells "Commotio cordis!" I gave a smug look to my wife who looked at me dumbfounded.

We talked about this one in the past both here and on the kyusho forum.

Several points I would like to make. In the end, I will defer to the comments of the good Dr. X. However I have cardioverted dogs in the lab about a thousand times or so. I have a little bit of experience on this one.

First of all, commotio cordis is a very rare phenomenon. You have to hit the chest of someone with a thin chest wall in a time interval no larger than several milliseconds (millisecond is 1/1000 of a second).This is the period of time in the ECG where you have the rising T wave.

There are several things going on here. I will use a crew boat full of athletes as a metaphor to explain what is going on here. First of all, cardiac cells depolarize and repolarize like neurons. With depolarization comes contraction. It is a bit like the fellow in the crew boat who decides to 'stroke' (the depolarization), and then pulls the oar that moves the boat (contraction). As long as he does it in synchrony with his neighbors, the boat moves fine and it is a thing of beauty.

There are a number of things going on in this boat. There is the coxswain that yells "Stroke!". That is the equivalent of the P wave in the ECG. A pacemaker in the atrium has fired and is communicating that signal to the rest of the heart (from the SA node to the AV node). Then each person on the boat hears the word "stroke" and thinks 'I must stroke'. That is the equivalent of the electrical wave hitting the individual cardiac cells. This is the QRS in the ECG. In general each cardiac cell gets this depolarizing signal from its neighbor. Well since this signal hits all people in the boat and all the cells in the heart *nearly* simultaneously, they all 'stroke' (or contract in the case of the heart) at the same time. Then everyone in the boat needs to get their oar back into position. This is the repolarization phase in the heart, and corresponds with the T wave in the ECG.

Now each time a person in the boat 'strokes', it takes him time to get his oar back in position. This latency period is called just that in the heart. An electrical charge across a cardiac cell membrane has just reversed and it takes some fraction of a second for the ion pumps to get it back to the starting position. In both the case of the person in the boat and the cardiac cell, no 'stroking' can happen at this interval in time.

So what is commotio cordis? Imagine if you will that some people in the boat get their oar back into position a fraction of a second before everyone else. This happens in the heart too. Then in this short interval of time, some jerk on the side of the river yells "STROKE" just to screw the boat up. Well a few of the folks who have their oars ready get fooled and 'stroke'. Those that don't have the oars up can't 'stroke', and so must wait until the real coxswain gives the command. The non-fooled and non-ready then pull their own oars at the proper time. You want to know what happens? Chaos! The oars clash and everybody loses the rhythm. The only way to get things right again is for somebody to yell "HEY, EVERYBODY GET YOUR OARS UP!!!!"

Well something similar would happen if your heart got a physical blow right in the few milliseconds of the rising of the T wave. Some cardiac cells are ready to depolarize, and others are not. A few that are ready to fire will do so, and they get out of synch with the rest of the cells that are ready to depolarize a fraction of a second later. You now have ventricular fibrillation. You MIGHT be able to get the heart back in synch with a big blow to the chest. Better yet, get the defibrillator out which will depolarize every single cell it can and hopefully get them all back in synch again.

Now for the practical side of things. First of all, it was my understanding that the problem they talked about in the ER was that the RESCUE SQUAD techs and NOT the karate folks did not have the defibrillator. Sure, a lot of people could probably put the paddles up against a chest and get lucky enough to do the cardioversion properly. But they also might hurt themselves or their neighbor in the process.

It is my understanding that 1) calling 911 and 2) doing the "process" of CPR is the treatment of choice in this situation. I know there is a movement to have defibrillators in airplanes and certain public places. But you really do need to know what you are doing. If you don't, best not to put a SECOND person in cardiac arrest by fooling around with a dangerous piece of equipment.

Bill

[This message has been edited by Bill Glasheen (edited 10-05-98).]


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PostPosted: Mon Oct 05, 1998 3:50 pm 
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Location: Sacramento, CA ,USA
I am very glad that this discussion is occuring. Putting aside the fact that I think EVERYONE who is capable of learning should know CPR and Basic First Aid, those who work around the public especially those who work in athletic environments should know more.

The Red Cross offers Advanced First Aid (First Responder) class regularly. For some this might seem overkill, but in this area I feel it is worth it.

David in Sacramento


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PostPosted: Mon Oct 05, 1998 3:50 pm 
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Location: Sacramento, CA ,USA
Sorry about the double post earlier..I was getting error messages and resubmitted my comments. Apparently they got through the first time Image

[This message has been edited by David in Sacramento (edited 10-05-98).]


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