This column may save your life in a poker room

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How many people in America play live poker every day? I figure 30 cardrooms in Florida alone with 15 or more tables per room and nine players per table. Add in the big poker states such as California and Nevada and all the Indian and riverboat casinos everywhere else. Now double that number for bar leagues, home games and casual family gatherings. I don’t know what the final number is but it’s pretty big, probably more than 100,000 every day. Maybe twice that.

Some will die at the table. Gather 100,000 people every day to perform any activity and it’s inevitable some hearts will unexpectedly stop beating. If this happens in your poker room, you could be the one who makes the life-or-death difference. That’s what happened to one of my ER co-workers.

He found himself the only one in the room knowledgeable enough and willing to interrupt his play to resuscitate a fellow player who collapsed at his table. The casino had a defibrillator handy and it worked beautifully so it was a clean save. It was lucky my friend didn’t have to pound on the poor guy’s chest for long because the new version of bystander cardiac compression, while cleaner and simpler than ever before, requires a level of physical stamina that most of us would find pretty demanding. I’ll explain.

The old version of CPR was a complicated mishmash of compressions, ventilations and pauses for pulse checks that changed depending upon the number of rescuers. The precision and coordination required put synchronized swimmers to shame. Plus it had that messy mouth-to-mouth business. Geez, who wants to do that?

It turns out, a whole lot of people didn’t, so most cardiac arrest victims never got the pulmonary part of bystander CPR. Years later, after a lot of research, we’re a bit smarter. We’ve come to the realization that maybe it’s really OK not to give Grandpa the “kiss of life.”

The latest studies seem to show it’s the compressions that make the difference, not the ventilations. Use faster forceful compressions to keep the blood pressure up. If you can provide good blood flow to the brain and heart, a single rescuer can skip the mouth-to-mouth part.

“How can that be? Oxygen, we have to have it, right?” True, but there’s a fair amount of residual oxygen still floating around in the victim’s blood. The old compression rate of 60 per minute coupled with all the interruptions for ventilations and pulse checks didn’t produce enough pressure head to get that residual oxygen into the brain and heart muscle.

Enter Continuous Chest Compression CPR. Find someone down. Check a pulse or try to arouse him for about 10 seconds just to make sure he’s not sleeping or something. Then launch into compressions. Don’t bother to check for breathing; don’t give two quick breaths; don’t watch for the chest to rise; just yell for help and start the compressions. No need to count or remember ratios, just pump.

The details are fairly simple. Kneel beside the victim. Put the heel of one hand in the middle of the guy’s breastbone and your second hand on top of your first. Lock your elbows and using the weight of your upper body, compress about two inches then repeat until help comes. Use plenty of force and don’t worry about a few broken ribs. He’s dead! If you don’t keep his brain alive until a defibrillator arrives, he’s still going to be dead. Pump hard.

Here’s the only difficult part. You’ve got to speed it up. The old rate of 60 compressions per minute just doesn’t cut it. Bump it to 100 and the pressure head stays high enough for blood flow to get to the brain and heart.

So how do you estimate 100 compressions a minute? Easy, think John Travolta dressed in white. Stayin’ Alive, the old Saturday Night Fever disco earworm, clips on at just about 100 beats per minute. Plus it’s got that uplifting theme of keeping someone alive. I never liked the Bee Gees and I’m a cynical cuss so I prefer Another One Bites the Dust by Queen. Same tempo and it seems strangely more accurate somehow. If you are too young to remember those songs, try Somebody to Love by that hairy heartthrob Justin Bieber. It works, too.

And don’t forget the “calling for help” part. One hundred chest compressions per minute can get tiring in a hurry, even for young buff Internet whiz kids. It may be tiring but keep in mind that CCC is not technically difficult. You can do it — really.

You may never win a major tournament, but you might have the opportunity to be a real hero. All you have to do is fold your baby suited connectors, start pumping and sing, “Ah, ah, ah, ah, stayin’ alive!”

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical
director for Red Bamboo Medi Spa in Clearwater, Fla. Email your poker-health
questions to ftoscano@redbamboomedispa.com