A Nurse’s Open Letter to Teachers Everywhere

/ Jordyn Redwood / 3 Comments

I probably shouldn’t write this post. It will probably be considered controversial– even though it seems like it shouldn’t. However, I am writing from a place of lessons learned and I want to share those lessons with . . . teachers everywhere.

I was happily reading some on-line celebrity news (as a destressor) when I came across this article about Anthony D’Amico. The article explains that his 2 m/o daughter went in for her regular immunizations and he experienced ” . . . an overwhelming urge to punch out the nurse . . . ” as she was delivering the infant’s shots.

Now, I’m sure, he meant this as a unifying post among parents everywhere– that none of us like to see children experience pain. I get that. As a pediatric nurse, however, I was horrified. His first instinct is not to pick up and comfort his child or say reassuring words, but to injure the nurse providing lifesaving preventative care. I’m sorry . . . that just not cool.

Would it surprise you if I told you that nurses experience the most violence of any profession . . . including police officers? Here’s just one of many articles that eludes to that fact. I first started nursing in 1993. My first job was as an adult ICU nurse. During that first year, an elderly vented patient grabbed my stethoscope that was on my neck and began to choke me with it. I could not break their grip and only when a passing respiratory therapist saw my predicament was I freed from possibly a very serious injury and/or death. Sadly, that’s not been my only incident. Getting cursed or sworn at is common— not rare. I’ve been personally threatened with unwarranted law suits just so I would bend to a family’s demand. I’ve had men raise their fists at me more than once. I’ve seen so much worse happen to other healthcare workers.

When I first started nursing those twenty-six year ago, it was an unwritten expectation that these events were tolerated and nothing happened to the perpetrators. It was, “part of the job”. These “people are sick” and “they don’t know what they’re doing.”

Well, a police officer can still charge a drunk person if that person injures them physically. For decades, a nurse was not permitted to even think this was an option.

Not only do nurses experience violence from patients and their families, but from co-workers as well. In my own state, a hospital close to where I live (I am not employed there) a nurse was nearly strangled to death by a doctor.

Now, that is SLOWLY changing. Hospitals are beginning to see and understand that patients, families, and co-workers should not be allowed to commit violence against nurses (or any healthcare worker) for any excuse or reason. It’s inspired the hashtag #silentnomore.

People should be held accountable for their actions despite being sick, tired, and or frustrated. Change is not a speedy process. Hospitals are balancing employees need for safety and the image they project. It is a complicated issue. Should a nurse be able to involve law enforcement if a mental health patient injures them during a psychotic break? Not an easy answer. And I might add, nurses are reluctant to do so knowing the underlying medical states that drive many of these situations, but they are also so very tired of the violence. This violence contributes to reduced quality of life, PTSD, moral injury, and people leaving the profession.

This is why I write this post. Not for me and my fellow nurses who know this hell that we live in with violence . . . but for the legislators and school administrators who are loosening consequences for students who are defiant, disruptive, and dangerous. I speak specifically of this new law in California that passed the Senate and is moving forward to their assembly.

Interestingly, I couldn’t find much commentary about the CA law except from conservative commentators. Here is one such example. Perhaps it’s because California lawmakers believe that there is bias in how school based punishments are merited out.

I don’t know the veracity of those claims. That’s not the point of this piece because this trend of backing off of student punishments for outrageous classroom behavior is not isolated to one state. Here’s one example from 2002 where a teacher resigned because a Kansas school board wanted her to reverse failing grades for students who had plagiarized. 

I am writing this because when disruptive classroom behavior and even violence is tolerated in schools from children or teens— they eventually become adults and then it becomes a problem for all of us. Ask any pediatric nurse when limits should be set and it starts from the beginning.

At some point we have to set firm and clear boundaries for bad behavior. When did it become reasonably sane to allow anyone to exhibit unruly and/or violent tendencies without consequences? Nurses have known all along that this was insanity and we are suffering from this, but felt powerless to do something about it because it was an expected part of our jobs. Nurses are now collectively saying we can’t live like this anymore.

Teachers . . . unruly and violent behavior should not be tolerated parts of your job. If we say to students that there is “zero tolerance” for violence and bullying then how can we allow it to happen to another one of our most trusted professions? The issue is, the behaviors before violence need to first be curbed. Kids know what boundaries are– their job is to test crossing them. Now the boundary is moving to allow more egregious behavior from students toward their teachers.

This is healthy?

So from this nurse to teachers everywhere– please fight to uphold the standards of behavior you expect in the classroom. Don’t give an inch. It could be your life that is at stake.

If anything, please learn from this nurse’s story.  Or this nurse’s story. Need another one? Or this? Maybe her story will change your mind.

Hold the line in the classroom . . . hold the line for all of us.

When a Cardiologist Becomes a Heart Patient: Dr. Paul C. Ho

/ Jordyn Redwood / Leave a comment

Today, Redwood’s Fans, I have a special guest blogger for you. Dr. Paul C. Ho is a cardiologist who suffered a heart attack which led him on a journey of self discovery. Today, he shares his thoughts here and I hope you’ll check out his book, Art on the Human Heart.

Welcome, Paul!

I’m a board-certified cardiologist and a cardiac arrest survivor—a heart doctor who became a heart patient. I believe these experiences make me somewhat of an expert storyteller from both a doctor’s and a patient’s point of view. As I reflected on playing these dichotomous roles in the health-care arena, the story of my autobiographical novel, Art on the Human Heart, came to be.

Aside from its anatomy and physiology, are there other functions or meanings to the human heart? The ancient Egyptians and the ancient Greeks considered it to be the seat of emotions. The Bible says, “In the heart dwells feelings and emotions, desires and passions. . . . The heart is the seat of the will and understanding.” For millennia, this centrally located organ has been implicated in our perception of the outside world and capable of generating a behavioral response to our feelings—the very essence of our presence, our being.

But which is the chicken or the egg? The age-old question applies here to the “emotional” aspect of the heart. When we are happy, the heart feels a sense of openness and a certain lightness. Conversely, anger can bring troubling heart palpitations and chest tightness. There is no doubt that “heart emotions” can be influenced by outside stimuli—whatever makes us happy or angry. But could the heart itself be the originator of feelings that may alter behavior and outcome? Is there then a true nature of the human heart?

As a cardiologist, my professional focus is on the physical nature of the human heart. As we all know, unhealthy life habits, such as cigarette smoking, eating fatty foods, and lack of exercise, can lead to the development of acquired heart diseases. Parallel to outside forces influencing heart emotions, external factors can also affect physical changes in the heart. What if the intrinsic nature of the heart can lead to the development of heart disease? For example, in an innately angry or unhappy heart, could the negative emotional tone trigger early heart ailments? Surely in medical literature, we are seeing an increase in reports of such associations.

When I suffered my own heart attack, I was only thirty-nine years old. I was young, living a healthy lifestyle, and did not have a predisposing genetic factor for heart disease—there was no obvious medical cause for my near-fatal condition. Why then did I almost die at thirty-nine? I questioned if the nature of my heart had something to do with it. At the time, I was extremely hard-working and had an angry, perfectionist, and type A personality. Was I subconsciously dissatisfied with my life? Was I unaware of deep-seated unhappiness? Could that have been the cause?

To better understand what happened to me, I wrote my novel to explore the true nature of the human heart through the eyes of a high-powered, high-stress cardiologist. When I became sick, my compassion turned inward toward myself for the first time in my life. Recognizing that well-being goes beyond conventional medical treatment, I dug deeper into the meaning and nature of our hearts. What truly makes us happy? What truly makes a healthy heart? To save ourselves, as I tried to do in the aftermath of my heart attack, we must understand the true nature and desires of our own hearts— nobody else can do this work for us.

I hope you will enjoy my book and learn as much as I did about our true hearts.

*******************************************************************************************
Dr. Paul C. Ho is a cardiologist and a heart attack survivor. He has published numerous medical papers and is a reviewer for several medical journals. Art on the Human Heart is inspired by his love for creativity, exploration, and self-discovery. Dr. Ho studied engineering and medicine at the University of Pennsylvania, Temple, Dartmouth, and Harvard. He was the chief of cardiology in a hospital system and was awarded several patents for his medical device inventions. Dr. Ho enjoys traveling to remote places and has worked in native communities including locations in Alaska. He lives in Hawaii with his pooch, Bear-Bear.

Author Question: Help Me Knock Out My Character!

/ Jordyn Redwood / Leave a comment

Elizabeth Asks:

I need to temporarily drug character. She will ingest it unknowingly (probably through coffee). I’m also considering having her drink one glass of wine, so the culprit could be the drug itself or the combination of the two, but I’m open to other possibilities.

It would need to be an OTC drug or something with easy access. Also, the drug would either have to wear off on its own or need be handled by an EMT without access to a hospital or medical equipment. What drug would get the job done? Would sleeping pills work and if so which kind would be best? How much would the character need to ingest? And how long before it takes effect and wears off?  Thank you!

Jordyn Says:

Hi Elizabeth!

Thanks for sending me your medical question.

You specify that the drug would need to be over-the-counter or something with “easy access”. Your two possibilities would truly be something over-the-counter or a prescription medication is stolen from someone else.

There are plenty of over-the-counter medications that cause sleepiness. The three most common would probably be diphenhydramine (Benadryl), dimenhydrinate (the active ingredient in the Dramamine that causes sleepiness), and doxylamine succinate. Several combination medications contain these active ingredients. For instance, if you look at multi symptom cough medicines, you’ll likely see one of these medications. Same with Tylenol PM or Advil PM. To a lesser degree, Melatonin and Valerian Root can also cause drowsiness.

The problem with all of these over-the-counter preparations is that they don’t have the same predictable impact. One person might take one of these medications and fall asleep in fifteen minutes. Another might take it and not be sleepy at all.

A safer bet would be to have this character steal a prescription medicine from someone. This opens up your possibilities of what drug to choose that would have a more predictable effect. Some of those drug categories would be benzodiazepines (such as Valium and Xanax), opioids (like morphine and fentanyl), and the hypnotics (like Ambien and Lunesta). Also, muscle relaxers like Soma and Flexeril have sleepiness as a side effect.

Then, of course, your character could obtain an illegal drug like Ketamine or GHB (aka the date rape drug).

The OTC medications will probably have the least disastrous side effects if given in normal doses. Your chances of injuring your character go up exponentially with these other drug classes if proper medical attention isn’t give if the character stops breathing. This would be the leading cause of medical calamity using a prescription or illegal drug.

In the end, it’s up to you to decide. I think the best thing for you to do would be pick a drug from each of these classes: over-the-counter, prescription, and illegal— and research a few to decide. If you type in the exact name of the drug and the question you want answered (like dose, onset of action, etc) you will usually find drug guides that can answer these questions for you.

Hope this helps and good luck with this story!

Child Abuse Injuries: Part 2/2

/ Jordyn Redwood / 4 Comments

April is Child Abuse Awareness Month. Last post, I covered how a given history for an injury may be a signal that an injury was intentionally inflicted. Today, I’m going to cover how the injury itself may give off clues for an abusive injury.

1. The injury is beyond the child’s developmental level. You’ll notice this is the first clue I gave concerning the history, but it also plays into the injury itself and I’m going to talk specifically about infants. Any bruising in an infant to the face, head and neck when they are not yet pulling themselves up to a standing position is concerning for abuse. To create an injury, you have to fall off of or run into something and you need to have some velocity behind it. Now, of course, injuries in this age group can have lots of accidental causes, but the story needs to match the injury.

2. The injury has a pattern. Consider typical childhood bruises. They are roundish in shape, of varying circumferences, and received from a low-velocity type injury . . . say the child running into a counter with their forehead. Anything that makes a visible pattern generally requires high-velocity force to imprint the pattern onto the skin. If I loop a belt and tap you with it, there likely won’t be any injury at all. However, if I take it and swing it at you like a pitcher throwing a baseball, it has the potential to create a loop like bruise.

3. The injury is not over a bony prominence. Again, if you have children, think back to their younger days when injuries were common. When they fell, where did they bruise? Head (scalp, forehead, nose, chin), elbows, shins, and knees. Most often, kids fall or run into something in a forward motion. Bruising to the buttocks in a diapered child is particularly concerning. Often, they will fall onto their bottoms, but they also have extra padding.

4. There are a lot of bruises. This is not definitive but can be a signal for abusive injury, particularly if the pattern is not a normal bruising pattern as in #3.

None of these items is taken in isolation as a single indictment against the caregiver. Let’s say you accidentally drop a toy onto your two-month-old’s face while cleaning up. It causes a bruise and you want it checked by the pediatrician. The pediatrician is not going to report you. Why? You have a plausible story (dropping something onto the baby’s face), it is a low velocity injury (the bruise is probably small and round) and there is only one.

Medical professionals look at the totality of the child’s case: the history, the social environment, and the injury is considered before a report to child services is made. Reports are not made lightly.

The above offers some beginning guidelines. In the comments section, give a specific injury that might be concerning for abuse.

Child Abuse Injuries: Part 1/2

/ Jordyn Redwood / 1 Comment

Nothing is more heartbreaking than to take care of a child that has been abused. April is Child Abuse Awareness Month so I thought I’d do a few posts about child abuse injuries and how medical providers pick up on the fact an injury may be intentional or inflicted.

As a pediatric nurse, I’ve been witness to child homicide at the hands of abuse. Yes, it is murder. It’s a necessary part of my job in dealing with these families, perhaps even the confessed abuser, as I care for the child abuse victim. And yes, there is a lot of conflict in these situations.

How do we as pediatric medical providers begin to suspect that an injury is abusive? During the initial evaluation of an injury, confession among abusers is rare (perhaps, they will confess later.) Often, there is a history given to account for the injury. Both parts: the history of the injury and the injury itself can give red flags for abuse. Today, let’s examine the story and how it may signal an abusive injury.

1. The story not realistic considering the child’s developmental level. This is more common than you might think. Most people cannot rattle off when a child should meet certain developmental milestones so they’ll say the child injured themselves in a manner that is beyond their developmental age. For instance, “my daughter broke her arm by rolling off the couch”. The baby is two-weeks old. Infants typically roll over starting at 3 months. Here’s a great resource for any writer/parent for developmental milestones.

2. The story changes. Just like other criminals, abusers can have a hard time keeping their story straight. Often times, the more abusers are questioned about the plausibility of the story, it will begin to change. Medical staff interviewing a potential abuser can be like a detective getting a criminal to confess. The doctor will often approach the caregiver several times to ask questions about the injury to see if the story changes. In later interviews, the doctor may say, “This injury is suggestive of abuse.”

3. The story has too much detail. This one may seem odd, but it can be a red flag for abusive injuries. If you have children, think back to their toddler/elementary school years when they seem to come home with lots of bumps, bruises, cuts and scrapes. If asked, could you come up with an explanation for each and every injury? Likely, no. Abusers will try and explain away every injury. A non-abusive parent will be truthful and likely say, “I have no idea how that happened.” and then probably feel guilty about not knowing.

What other parts of a medical history/story might give a signal for abusive injury?

Author Question: Prioritizing Medical Care

/ Jordyn Redwood / Leave a comment

Ethan Asks:

My main character was in a fight. He has a skull fracture with epidural bleed, a dislocated shoulder, and a twisted ankle. He arrives at the hospital unconscious. Would the ER try relocating the shoulder right away or wait for him to regain consciousness first? Just a common anterior shoulder dislocation. Also how? I’ve seen too many videos to know the ‘tried and true’ from a best guess. How would you do it?

Jordyn Says:

For this patient, the neurological injury would take precedence. It doesn’t matter much about his shoulder if he never wakes up. So, if he does have an epidural bleed, that would be the surgical priority. When he’s under anesthesia for the surgery and his epidural bleed has been stabilized, they could relocate the shoulder intra-operatively.

The videos you’ve seen are probably accurate— yanking and pulling a certain way to get the shoulder back in. Sometimes, if the patient is just sedated enough, the shoulder will relocate on its own, but it is more common to have to pull it back in to place.

The only thing that might make them rush with the shoulder is if they felt that the patient wasn’t getting blood flow into his hand on that side. Since he’s unconscious, he really couldn’t say if there were any numbness to that hand that would also be an indicator he might be having trouble with blood flow into the hand.

That being said, I’ve not personally seen neurovascular compromise with a “simple” shoulder dislocation (though I’m sure it does happen on occasion) so precedence would be his head injury.

Five Things This Is Us Got Right About Medical Care

/ Jordyn Redwood / Leave a comment

Usually, when I write these blog post, it’s a scathing review of something a television show or movie got wrong. However, in a recent episode of This Is Us entitled The Waiting Room, there were several things that the show got startlingly right for a change. Chrissy Metz’s character, Kate, was in preterm labor leaving the family to dwell in the waiting room. Here’s what the episode got right.

1.  People use Google all the time to question medical professionals. In the episode, one of the family members pulls up the drug Kate is on to quell her contractions and begins to question its side effects. Listen, I’m all for informed family members, but as many medical professionals know, the information on Google can be less than accurate.

It does become frustrating as a medical person to take Google’s word for a medical treatment over a trained medical professional. I’m also all for questioning a provider in a respectful way. A better way to approach this question with your provider is to ask, “What side effects are common with this medication?” and “Do you feel like those side effects are worth the benefits of the treatment?” Any provider worth their salt should easily be able to answer these questions. If not, then you may have a problem on your hands. This will tell you more than Google will be able to tell you.

2. Often times, people think that waiting equates to poor medical care. In one part of the episode, Kevin begins to question the delay in hearing any news, and openly questions if his sister should be moved to another facility, insinuating that she’s not getting proper care. The truth is, few things are fast in medicine. I think the culture and patient expectations haven’t benefited from these one hour television shows.

Nowadays, everyone wants to be seen within an hour and discharged home shortly after. In reality, especially in units where you don’t have an appointment, triage happens all the time based on how life threatening a patient’s condition is. Also, sometimes patients need to be watched for lengthy periods to see if their condition will resolve to a point where they could go home, or see if they’re appropriate for admission. If needing to be admitted, where to? Does that unit have capacity and staff to take care of the patient? Just because you’re waiting doesn’t mean anything necessarily bad is going on or that your loved one is getting bad medical care. A lot is probably happening behind the scenes that you’re not aware of.

3. Threats to staff happen a lot more than you might think. Maybe a better term for this would be microaggressions. Threatening to leave. Threatening to transfer. Threatening to call the patient care representative to file a complaint. Threatening to sue.  Using profanity directed at the medical staff and not just expressing frustration at the situation. Unfortunately, medical professionals hear variations of these every day and often without merit. They are designed, generally, to force medical care to happen more quickly. Using threats or aggression to speed up medical care is not necessarily wise for a variety of reasons. The largest reason is that stressed out healthcare workers tend to make more mistakes— the one thing you don’t want to have happen.

4. Waiting rooms are pressure cookers. It’s not unusual for arguments and fights to happen in waiting rooms. The waiting room becomes a voluntary prison and all people can do is watch the clock ticking. The more time that goes by— the more frustration builds. We are all more likely to take out frustration on our loved ones most— probably after the staff. That frustration will bleed over into other people and families.

5. Healthcare workers respond to kind and courteous over anger a lot better. In the episode, Kevin and Randall both approach the nurses’ station asking for information. Randall does it with more kindness and respect and gets more of what he’s asking. We are normal humans and it’s true what they say about honey.

This Is Us used truth and reality to make a very effective episode. Well done.

Author Question: Polar Bear versus Shoulder

/ Jordyn Redwood / Leave a comment

Laurie Asks:

I’m a debut Christian romantic suspense author and I wondered if you could help me with a medical question.

My hero is mauled by a polar bear. He’s suffered a dislocated right shoulder, tearing of the ligaments, rotator cuff, and whatever tendons are in the shoulder and across his scapula. He’s got bite punctures on his upper arm, his right ear was bitten and repaired via plastic surgery. He’s got a scalp laceration with twenty-eight staples to reattach it.

My hero is an RCMP cop and he needs to get back to work.

Can you tell me what he’d have done surgically to repair the rotator cuff and ligaments? How long would he realistically be off work and need physical therapy?

Jordyn Says:

I reached out to Tim Bernacki, an awesome physical therapist, who rehabbed by own shoulder after I dislocated it. If you live near Castle Rock, Colorado check out clinic called Front Range Therapies. I highly recommend him.

Tim Says:

A massive rotator cuff tear (RTC) along with ligament tears and dislocation would lead to quite a surgery. One of a kind. The massive tears I’ve seen used multiple anchors (versus one or two for the “common” repairs).

Some of the massive tears also used either synthetic or pig skin patches because of the tear size. The ligaments would also need to be repaired with more anchors. This person would be in a sling with an abduction pillow at the side for probably eight to ten weeks (versus six weeks for the smaller tears).

Therapy could start earlier than when the sling comes off but would entail only passive range of motion (provided by the therapist). The tricky thing here is that if one portion of the RTC is torn, the protocol would incorporate stretching of that repair last in the sequence of stretches. Likewise, strengthening would incorporate moving in that one direction later than others.

With this person, all directions of movement would need to be respected. This person will need a truly great therapist, or I would expect them to get about eighty percent of their range/use/strength in the end. If all goes well, I would anticipate full range around four months post-op.

Strengthening would begin around three to four months post-op and could go on for at least three to four months itself. For full duty police work, minimum time from date of surgery to return to work I’d guess is eight months, but more likely around ten months. Most police officers return to working on restricted/light duty (if the injury was work related). Light duty is typically communications and/or desk work, working cold cases, helping with investigations, but not leaving the station.

Author Question: Rehabilitation after Gunshot Wound Injuries

/ Jordyn Redwood / Leave a comment

Sean Asks:

Hi Jordyn!

Looking for a little bit of help with some 9mm gunshot wounds. I was going for non-lethal aside from possible bleeding out and injuries that would have long recovery time.

I have a character get shot at point blank range in the lower right abdomen from the front. Then in the right shoulder/clavicle, also from the front, about five to ten feet away, breaking the clavicle. Finally, in the left calf from behind from ten to fifteen feet away, breaking the tibia which is made worse when the shooter grinds his foot into it.

I’m guessing the shoulder/clavicle and calf/tibia would require a sling or cast and a serious amount of PT. The abdomen wound I’m guessing would require some reconstructive surgery depending on if and how much the bullet bounced around?
I figured it would take her almost a year to walk without assistance from those.  Am I close in that assessment? Thanks in advance for ANY help!
_______________________________________________________________________________________________

Jordyn Says:

 

Since this is largely a rehab question I reached out to Tim Bernacki, a great physical therapist, who I highly recommend from personal experience. If you live near Castle Rock, CO look up his clinic, Front Range Therapies.

Tim Says:

Generally, time frame of healing is 6-8 weeks for most things, especially soft tissue. All these injuries would require surgery. The clavicle fracture would require an open reduction/internal fixation (ORIF)—this means that there is an incision made and hardware placed to stabilize the fracture.

I wouldn’t know what is done if the clavicle is “shattered” and is in a multitude of pieces. The wound would have to be a glancing hit that results in a fracture. Anything more severe in the area could result in ruptured arteries, as well, and the person cannot die from this wound.

The tibia fracture also would require an ORIF—either plate, screws, or rod with locking screws. The difficult thing in all this would be that due to the leg recovery, the person will be using an assistive device, but probably cannot use crutches due to the clavicle pain. Perhaps a walker could be used. Depends on how conditioned the person is, how young, etc . . .

The leg injury would require limited weight bearing for 6 weeks I would guess. If all heals as expected according to x-rays, then they would transition into weight bearing as tolerated (WBAT). Probably would have a limp for several weeks after that. Likely wouldn’t run until four months following surgery if all goes well. The clavicle would probably have a sling for maybe 2-4 weeks (if no repairs to muscle or rotator cuff were done). After that, overhead reach would be most affected and for several months.

As for the abdominal injury, other than not bearing down with pressure for a short time, I wouldn’t think there are other issues to consider.

I’ve seen some gunshot wounds (GSW) where the bullet enters, hits a long bone, changes course and travels along the bone. This assumes the round is a practice round (full metal jacket) and not a hollow point. Hollow point bullets or defensive rounds open up when they hit something, resulting in a much-enlarged object/wound. I’ve seen rounds left in place because taking them out was unnecessary and I’ve seen rounds removed because of the location. Sometimes there are exit wounds and sometimes there aren’t depending on what stops the round. Sounds like there wouldn’t be an exit wound with the clavicle and leg but could be with the abdominal (perhaps in the low back).

Hope this helps and good luck with your story!

Author Beware: Good Example of BAD CPR

/ Jordyn Redwood / Leave a comment

Sometimes, blog posts are very easy to write. I was tagged on this CPR video by a respiratory therapist friend of mine. It comes from a FB page called Enfermagen. Since I don’t speak the language, I’m not sure if they’re using this as a good or bad example of giving a patient CPR, but I’m here to confirm this is bad CPR and here’s why.

1. The patient has purposeful movement. As you can see, several times in the video the patient reaches up and attempts to move the mask from his face. Any time a patient crosses their midline, it’s purposeful movement. It definitely appears that he is sick, but he has enough of a perfusing blood pressure (and therefore pulse) for his brain to be getting blood flow in order to make these movements. Therefore, he does not need CPR.

2. The compression rate should be 30 compressions to 2 breaths. The compression depth is two inches. When the patient does not have a breathing tube in his throat (called intubation), the compressor should pause in order for the person to be able to deliver breaths. This compressor doesn’t really pause in order for the rescue breaths to be delivered. Luckily, for this gentleman, his compressor gives relatively shallow compressions and not the two inches they should be.

3. No one checks a pulse. What might help these rescuers is that when the patient starts moving, is to check his pulse. This might confirm for them that he has one and they can stop compressions.

4. Patients should not need to be restrained for CPR. CPR is for unconscious patients without a pulse. If you’re retraining the patient, they likely don’t need CPR.

I’m not sure the medical nature of this gentleman’s illness. Clearly, it looks like he does need some sort of medical assistance. It’s just not CPR.

Can you see anything else wrong with the way this team is delivering CPR?