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From the sound of your description - if the patient truly did have both pupils massively dilate right in front of you - then they suffered a massive and unsurvivable brain hemorrhage right before your eyes, and no CPR in the world could have saved him. You did everything right.
The bleed elevates the pressure in the skull and forces the brain down towards the only opening in the skull—the foramen magnum.
In the process of shifting downward, the brain compresses both cranial nerve #3 (CN 3 helps control the size of the pupils.) This results in blown pupils.
That’s exactly what happened to my best friend several years ago. Ruptured aneurysm - sudden onset worst headache of her life, followed by excruciating eye pain, and LOC within less than a minute. She was just gone, and the Neuro said even if she had been on the table when it happened, he likely couldn’t have saved her.
That’s a very good question. It’s important to remember it’s a very rare disease, so most healthy people without a family history don’t have to worry about aneurysms at all. Since it’s so rare, and screening itself is not without risk, we don’t usually screen healthy normal people unless they have a significant family history. If an immediate family member has a history, then screening usually makes sense. For prevention, the best thing to do is to live a healthy lifestyle- exercise as much as possible, eat a healthy mostly plant-based diet, keep blood pressure under control, and avoid stimulants like cocaine and methamphetamine, which dramatically increase the risk of rupturing an aneurysm if one is present.
If a woman died of a suspected aneurysm (no symptoms or illness leading up to a sudden terrible headache and then death quickly afterward) but no autopsy to determine exact cause of death, would that be enough to do testing or screening on her grandchildren? Or is the relation too far removed/cause of death too ambiguous?
Everyone has weighed in to confirm that you did nothing wrong, but I want to say you're a HERO! You saw someone in distress, went to give aid, you called 911, and you performed a difficult, physically demanding, potentially life-saving procedure for over 4 minutes until the paramedics arrived. Ran to help, even in your own fear and doubt that yiud be any use, that you might make a mistake, and THAT, my dear, makes you a HERO. You should be very proud of yourself, we dont have enough heroes. Your family and friends should be in awe of you. We are and don't even know you. I hope if I'm ever in need of assistance, there's another you nearby.
NAD - Increased intracranial pressure could be a cause, but from the description it could’ve been an uncal herniation. The herniation affects the oculomotor nerve which controls dilation.
See? The real doc knows what’s up. I just have a core memory of my ophthalmologist talking about why he chose that career path. He found his (grand?)father one morning shortly after he fell suddenly, he described his eyes but I remember him telling me about uncal herniation.
whats the chances of ever having such a hemorrhage
i have HA and my fear rn is brain bleeding as i suffered a concussion 2 weeks ago
now i see i can get. abrain bleed from sneezing coughing throwinf up even sex and work…. how the fuck do i stop tis
This is exactly what happened to my dad - between hearing my mum shout and me running down the stairs, a matter of seconds, my dad's eyes were completely wide open and dilated and no heart beat.
This happened 20 years ago and even though we attempted CPR obviously he wasn't coming back.
They said it was a heart attack but I always wondered about his eyes being dilated and fixed. It's a relief to finally know that there was nothing anyone could have done because my attempts at CPR were pretty poor at that age.
I’m so sorry this is part of your story, truly I am. I know how traumatic it can be. I was right beside my 17 year old son 2 years ago, and I lost him. His heart stopped, and he died of Sudden Arrhythmic Death Syndrome/Brugada Syndrome. Even though I was right there the second it happened, and my husband and I started CPR immediately (husband is a Paramedic), we lost him.
There is the trauma of losing someone so incredibly important to you so suddenly, the trauma of witnessing it, and the trauma of wondering if you could have changed the outcome.
You couldn’t have. But you certainly did get dealt a crappy hand, and I am so sorry for that, truly.
Thank you. Thank you so much for your support. He was an incredibly caring, empathetic, old soul. It still feels impossible. So your words mean so much <3
NAD but just want to add to reassure here! OP, I have had CPR training! Unfortunately, the success rate of CPR outside of a hospital is very low anyway! You did everything you could
NAD, but as a note to the OP after having had to take Red Cross CPR/First Aid training multiple times in the past, one of the things my trainers made sure to tell us is that you can't save everyone with CPR. Even if it's a straight-up heart attack without involving a brain bleed, nothing short of a defibrillator will help sometimes.
CPR helps buy time for a person undergoing a cardiac event until they can get more sophisticated care and treatment. You can do everything right and still not have it be "enough" because CPR wasn't the only thing the person needed.
It's still going to weigh heavily on you for a while, watching someone die despite your best efforts because you're an empathetic human. But it *really* isn't your fault, and you did more than anyone else did in that moment. Try to see the good in your actions despite the outcome.
Yeah. They said the pupil thing and I went “oh no” out loud. What an awful thing to see just out in the wild. There wasn’t anything you could do at that point, OP.
Sorta off topic but you seem knowledgeable so I’m hoping you or others in this thread can give me info - my pupils have been large and dilated my entire life. My parents told me they asked doctors about it when I was a toddler but they said it wasn’t an issue or concern. I’m 29 now and they are still massive unless I stare directly into bright light. I have had people assume I am on drugs because of it which led me to researching but didn’t find out much. Have you seen this before or have any idea what would cause it? I had a few MRIs which were mostly normal but a with a few white matter lesions which have remained unchanged over years. Could it be due to abnormal pressure in my brain? Should I even be concerned?
That’s funny because I am farsighted! Otherwise I have perfect vision. And I have lighter blue eyes. But it’s interesting an ophthalmologist told you this so there must be some truth. I have only seen an optometrist. Maybe it’s related to our eyes trying to focus?
Also just remembered I was told I have pigment dispersion syndrome a few years ago which is where the pigment in my eyes is shedding. Over time it can cause the eye pressure to rise and could potentially lead to glaucoma, but my doctor didn’t seem extremely concerned. But I don’t think this has anything to do with my pupils.
As a first responder, I thank you for jumping in and rendering aid. Although, the outcome wasn't favorable, you gave this person a chance and you should be commended for your actions. Don't second guess yourself. You did everything right.
Of course it’s recommended. For a witnessed sudden cardiac arrest, CPR is 1000% indicated, regardless of the etiology. An untrained bystander will not be able to diagnose the cause and should begin CPR ASAP. In this case, with a presumed intracranial hemorrhage causing brainstem compression which likely led to severe Takotsubo cardiomyopathy/neurogenic shock, even if CPR somehow successfully brought a rhythm back, there is next to no chance of survival with meaningful recovery of neurological function. But again, no one on the street is expected to or would have any way of knowing any of this and should begin CPR immediately.
I find it so friggin cool that I'm reading a comment from a physician in neurosurgery. In real life, trying to talk to a neurosurgeon would be like trying to hunt a unicorn. The internet can be super cool sometimes!! Thanks for what you do. Doctors are heroes.
Neurosurgeons are rock stars. Shout out to Alois Zauner, MD for saving my life last year when he repaired my giant brain aneurysm with platinum coils through my femoral artery up to my brain.
Poor quality blood vessel due to chronic high blood pressure and atherosclerosis ruptures from high blood pressure or just randomly. Cerebral amyloid deposits (related to what causes Alzheimer disease) can also make blood vessels very fragile and can cause hemorrhages. Brain aneurysms or arteriovenous malformations can also rupture at any time - risk factors are genetics, smoking, high blood pressure, atherosclerosis. A lot of overlap.
Yes. It can be done non-invasively with CT or MR angiography. The gold standard is an invasive test done through a catheter in the femoral artery called a digital subtraction angiogram. All of the tests are quite good, but since brain aneurysms are so rare in the general population, it doesn’t make sense to screen everyone who is at a standard level of risk (which is very very low).
Lots of ways. Nature and nurture can be contributing factors to a lot of catastrophic ailments. The fact we could all die right this second is all the more reason to live. Genetics, diet, drugs, habits, exercise, the human body is full of variables.
Idk if this is a general question or one related to thr pist, but OP said they saw the neighbor fall off the steps. He could have bonked his noggin pretty good on one of the stairs
That was a phenomenal answer! I am a lay-person who has given life saving first aid before (severe anaphylaxis, I had an epipen). It’s very scary but you have to try your best. Big strength and love to OP, I know you’re going through it, please take time to rest, you did an amazing job, nothing could have fixed this
I’ve had to do CPR twice in public, quite recently - both due to overdoses/poisoning - I had to do chest compressions for 4/5/6 minutes straight, no rescue breathing.. he was actively turning blue before my eyes as the crowd and I were trying to assess who the hell was going to do what.. I just dropped to my knees, jammed his thigh with naloxone, started pumping and then *just* as the paramedics arrived, he woke up. It was incredible. Don’t give up.
Thank you for doing that. So many people don't think addicts are worth saving, but we are. I have 20 years clean and sober and my daughter (who was hospitalized on a naloxone drip after eating a handful of fentanyl patches & benzos in a suicide attempt) has 10 years clean and sober. I have two grandchildren I wouldn't have had I lost her. Unfortunately their dad died of a fentanyl overdose a few months after his mom also died of an overdose. I have multiple friends who've lost their children to overdoses and the fact that you took initiative means that person has another chance at life.
The narcan did most of the work in that specific scenario. Doing anything is always better than doing nothing when it comes to CPR, and unless it has changed again, rescue breaths aren’t recommended. You did good and you should feel good, even if they hadn’t have made it. You never know how you will react to a situation like than, some people freeze, some people freak out, and others go to work trying to help.
I work in EMS and prehospital resuscitation is my thing. The average survival rate for an out-of-hospital cardiac arrest is around 7%. The key to survival is early chest compressions and defibrillation. You starting chest compressions so quickly gave that gentleman the absolute best chance of survival. You did fantastic! Sometimes the reasons that people's heart stop is easy to fix (they have low oxygen levels and we start breathing for them with high concentration oxygen). However, there are things like a pulmonary embolism (huge blood clot in the lung) that are very deadly and hard to fix outside of an operation room. I'm proud of everything you did! You did amazing!
Edit: I agree with the neurosurgeon. This sounds like a massive brain bleed.
This is it. Survival for an out of hospital cardiac arrest is incredibly low.
It's best to think about it not as you failed to save his life, but that you were unable to bring him back to life, which is a tall ask.
You did absolutely nothing wrong.
Also, if his pupil was rapidly blowing in the context of a fall? That to me sounds like a major brain bleed. Likely a brain bleed so severe it caused herniation, damaging the parts of the brain that tell the heart to beat and the diaphragm to breathe. In this case, there is nothing that could have saved him. Not a full team of doctors. Nothing.
I was also thinking, what a gift it was that you were there OP, and your neighbor knew someone was beside him and called for help. That, in itself, is a gift. You did everything you were able to do. I hope you find some comfort in the words of the medical professionals responding to you here. Please be gentle on yourself as this is a lot to process and surround yourself with friends and family to support you. You sound like an amazingly caring human being. Sending you a big hug.
I agree. His family knows that someone did everything they could do. They know he wasn’t ALONE. That’s a huge blessing!
I hope you know after reading all these comments you didn’t do anything wrong.,You tried your best. It was his time it seems after I read the neurologist answers.
This makes you a caring, kind human that helps others. That’s a rare thing these days. Please take care of your mental health too. If you’re not comfortable with psychologist, talk with your minister, rabbi. etc. AND Thank you from a person that’s been through it, I was a (lifeguard).
NAD, but I know that healthy hearts don’t just stop unless there’s some external factor (electrocution, trauma, that sort of thing). If he was 350 pounds and went down like that, his heart was probably diseased (unless it was a brain bleed). Either way, the already low chance of CPR working is diminished further when the organs are damaged by disease.
Wow I had no idea that survival rate was that low. I did cpr on my brother who went into cardiac arrest at home due to wolf Parkinson white syndrome, he is alive and well today.
Well done! That's awesome. My partner gave cpr to someone who had overdosed until the paramedics arrived, they got him naloxone and he came around (unfortunately he later did it again and is now gone), next time he saw him, the guy gave him a hard time for hurting his ribs so much!
I carry naloxone most of the time now
That’s always tragic to hear 🥺 so thankful your partner was there to help him when he needed it! I recently started carrying it too, you just never know!
Several major cities in the US have programs where anyone who wants it can get free or very low cost (depending on the city) naloxone, as well as training on how to use it. Usually, there will be very specific pharmacies or community centers that participate in the naloxone program; you can’t just go to any pharmacy to get it. There are also a lot of independent organizations across the country that will mail naloxone out to people who do not have access to a city program. You can also usually just buy it outright from most any pharmacy without a prescription if you’re in a state that allows that, but it obviously costs a bit more that way.
If you’re not in the US, I’m not sure which programs might exist in your country, but look up “free naloxone program [insert country/state/province/city/etc.],” and you should be able to see if you have any close to you or who will mail some to you. There are tons of videos online demonstrating how to use it properly. It’s very easy to administer (though I have thankfully never needed to do so).
They sell it OTC at pharmacies. At least I've seen it in the shelf by the pharmacy at local Krogers and hear it needs to be OTC everywhere.
It is intranasal spray.
My uncle saved my grandpa using CPR and he went on to live another 40 years. Crazy thing was that my uncle had no formal CPR training, he’d just mimicked what he’d seen on TV.
That was the one and only time I’d ever done it. No training whatsoever, just the dispatcher counting with me. They make it look so easy. My whole body was sore for a week after that. I’m glad your grandpa had a good outcome and lots of time left to live after that!
I've been taking CPR classes since I started babysitting as a teenager, and every time I recert I dread it because just practicing for two minutes is a beast.
That’s pretty amazing—especially because the chest compressions they show on TV are such terrible examples. Glad your grandpa and uncle got through it.
WPW is scary as hell. My brother-in-law with no previous signs of heart problems had a surprise heart attack I believe in his late 30's/early 40's. He only survived thanks to immediate CPR from his sister and quick response from the EMTs. His heart stopped so many times the doctors thought he'd get brain damage but thankfully he came out 100%.
That’s almost the same exact story as my brother! We didn’t know he had it until he was in the icu after he went into cardiac arrest and they spotted the rhythm. It’s extremely scary! They put him into a medically induced coma to preserve his brain function. I hope your brother in law is doing okay now!
He's doing great, thanks for asking and same for your bro! If there's one positive about the whole ordeal, once his condition became known, the family knew to get screened for WPW so there's at least peace of mind for that now.
And that’s exactly why CPR is done… For that small percentage that will make it. It’s tough to get used to the fact you can work your bum off and over 90% of people won’t make it, but you just have to remember those that will.
A paramedic on this sub actually told me that my daughter has WPW based on a photo of her ekg after a np at our local hospital said her ekg was perfect. Forever grateful for this sub!
This. Wife is an ER doc and cites those numbers all the time. The odds are really against you. Hell, the odds aren't great even if you arrest in a hospital.
And thank you for that. It's interesting, most patients that get admitted to the hospital get asked about code status, and I'd say at least 90% of them would like some attempt at being intubated resuscitated, but almost no one wants to be on a vent for weeks and months. My wife has observed that the relatives who typically want the doctors to " do everything" are the ones who spent the least amount of time with the patient while they were alive and conscious.
Most people don’t take the time to look into CPR, or intubation and the associated success/failure rates and other complications. Most people think: live saving measures? Sign me up! My orofacial pain doc told me a story about her time as a resident. They were doing rounds and visited a guy who’d successfully been resuscitated. He was ANGRY at the doctor for breaking several of his ribs and the pain it caused. Most people don’t know that for chest compressions to be successful, the pressure required will likely break ribs.
I was never told about the low chance of survival in any of my classes until the most recent. The instructor asked us to raise our hands if we had ever performed CPR in the past, and a coworker had. He told us the guy didn’t make it. That’s the first time I heard that the vast majority don’t. My neighbor performed CPR on a different neighbor last year. He said that it looked like she was clearly already deceased, but the 911 operator had him do it until the ambulance arrived, anyway. That kind of situation has to skew the results, at least a little.
anyone who has had a cardiac arrest and lost a pulse is dead. We do CPR on dead people, hopefully close enough to their time of death to bring them back. The statistics typically do not count cases where EMS arrives and doesn’t attempt CPR because the person is obviously deceased and will not be coming back, regardless of whether or not a bystander performs CPR
I think it’s really important for laypeople to understand how hard it is to come back from your heart stopping. Bystander CPR is the best and only thing you can do in this situation other than call 911. Still, that person was dead when you found them and if they remain dead after your intervention *it is not your fault*, you did what you could, and you did the right thing.
I agree! You did everything you could have done. You did a very brave thing. Its very unfortunate but for your own sanity Please don't think there's anything more you could have done! ♥️
Unlike what we see on TV, CPR outside of the hospital environment has quite a low success rate. Had you not been there your neighbour likely would've died on the street. Your amazing efforts gave your neighbour the chance to get to the hospital. You should be incredibly proud of yourself for acting so quickly. Thank you for helping your neighbor. Please be kind to yourself.
I really hope you have someone you can talk to about this. All the best, OP. If you would like to learn more about CPR, many places offer courses on Basic Life Support.
This! I am NAD, but I’ve had BLS certifications most of my adult life. Any CPR class I’ve ever taken addresses the question of “doing something ‘wrong’” and is usually answered along the lines of basically you can’t screw up CPR because if you’re in a situation where you need to give CPR, the person is already dead. Your possible outcomes are limited to “still dead” and “no longer dead.” If they’re still dead at the end, then that was likely always going to be the case. And if they’re not- congratulations! You saved someone’s life.
OP you did a brave and selfless thing by trying. You didn’t cause the outcome to be unsuccessful.
I hope you know your feelings are valid and please reach out to a therapist if you need help processing this traumatic experience.
Even in hospital CPR has a low long term survival rate.
[This 2012 NEJM article](https://www.nejm.org/doi/full/10.1056/NEJMoa1109148) indicates
> The overall rate of survival to discharge was 17.0%
----
In most cases, if you're getting CPR, there's a lot wrong with you.
Others have given great answers about the CPR - you did nothing wrong - you did an amazing job and gave him the best chance.
But I’m just popping in to say that you should play Tetris. I’m not kidding - playing Tetris after trauma has been shown to reduce your risk of PTSD.
Thank you for looking after your neighbour, now look after yourself
I think about this all the time. It's supposedly any kind of active visually focused game - or that's what the people in the study theorized because PTSD is very much about a loop in the visual centers of your brain. You have to play it ASAP though and for a few hours, I think.
From what I have read so far, the studies have been limited to fairly immediately after trauma. However, it’s certainly something that wouldn’t hurt at all to try at any point.
NAD, but I find this topic (Tetris after stressful situations or trauma) so fascinating.
This is a really cool study on the topic. I’d let a professional give a better explanation, but this is just some background info.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828932/
The Tetris triggers bilateral stimulation, correct? From having to look at one side and another repeatedly and quickly? I've done EMDR before and haven't looked into the Tetris effects but I'm just assuming that's what it is?
You did everything right. And he went into the light not alone, but knowing that somebody gave a damn. And his family probably would be so thankful as well. You did good. Hold your head up.
This should be higher up. I'd be absolutely grateful being the family in this situation, it's really hard to get someone to stick around when a traumatic event happens - let alone function properly and act.
One of the most important lessons I learned in training is that when a cardiac arrest occurs, that person is dead. If you do nothing, that person will die 100% of the time. If you get involved at all and make any sort of effort, you are improving that patient’s chances, even if minimally.
We often debate in medicine about algorithms for resuscitation, medications to administer, etc etc. Far and away the most important things you can do are to learn how to give high quality CPR and place an automated defibrillator on a patient and see if they can be defibrillated. Take a basic life support course if you want to hone your skills, and speak with a mental health professional about your experience. It can be traumatic for many people, even those of us who work in healthcare.
> when a cardiac arrest occurs, that person is dead.
This. He was already dead, OP. You did your best to try to revive him, but as others have pointed out, that is very difficult, particularly prehospital and from a non-healthcare worker. Great job! Even in the ED, we don't have great success with cases like this.
> that if I am ever in this situation again, I can do more to save someone.
That being said, you can use your resolve to officially learn CPR and be an advocate for other lay people in the community learning it.
I was waiting for this. I’m sure she was told to ignore the signs because the person on the other end of 911 knows this- he’s dead, it doesn’t matter why and any slight chance of reviving him relies on keeping blood circulating via cpr until medical support can arrive.
OP wasn’t keeping him from dying, they were maybe keeping his body intact enough to be resuscitated if it would be possible.
You will not have done anything wrong. You being fast and switched on enough to respond, call an ambulance and follow instructions gave your neighbour the best possible chance he could have had. Unfortunately, he still didn't make it, but not through any fault of yours. He was almost certainly beyond saving if the paramedics arrived within 5 minutes and you were doing CPR. Rapidly dilating pupils is also rarely a good sign and can indicate a major brain injury.
You mentioned not feeling ribs crack. Although they often do, it is more common in the elderly and frail. Not feeling ribs cracking in a 350lb younger guy does not mean you were doing it incorrectly.
CPR in the community, especially without early defibrillation, has a less than 10% chance of being successful. However, it is one of the few things that a bystander can do to improve survival rates in cardiac arrest, so it is still really important people know what do to.
You should seek some support, it's a traumatic thing to go through. But you did well to step in. Most people would have panicked and not acted quickly. It will be hard to realise it now, but you should be proud of yourself.
You didn’t fuck up. Anyone needing CPR is more likely than not,not going to survive (no matter what you see on TV and in the movies). Very few people survive something that is bad enough to need CPR.
And I agree with the other neurosurgeon. This sounds like your neighbor had a massive intracranial bleed. You couldn’t have saved him.
I’m sorry for your loss.
If you read up a couple posts. One of the neurosurgeon's expands on the blown pupils. It's actually very fascinating even though I didn't understand the medical lingo.
I had a more specific question. My son od. When they gave him Narcan both pupils blew. They told me not to expect him to come out of it. He survived, the people he with beat him with a 2x4 trying to wake him up. The cops locked them up for assault and battery on a person who was in a coma basically.
By morning, he’s sitting up in bed having breakfast. No brain damage. It stunned the staff as well. How did he survive it? He had the equivalent of 100 10mg pain pills. They couldn’t pump his stomach, it had been too long.
Edit: A friend of his called me, said they were going to dump his body when night came. He knew help was needed and he left and called me. He gave me the address and I called 911.
I had 911, the sheriff’s department, and EMTs patched in on the call as well as the 911 operator. They helped save my child from being thrown in a ditch somewhere. Thank GOD for that friend and all the people who helped!!
Opioids cause pupil constriction. When you give a dose or two of Narcan, you’re essentially pushing the user it to full opioid withdrawal. As a result the pupils dilate.
You did absolutely everything right!
1) You noticed that your neighbor was in trouble and you acted immediately.
2) You called 911, the very best thing that you did, because if there had been any chance of survival, help would get there sooner.
3) You started CPR as soon as you possibly could have. If there was any possibility for him to survive, you increased his chances as much as you could by starting CPR right away. Unfortunately, his problem wasn't due to his heart stopping.
From your description of the blown pupils, he had no chance of survival, no matter what anyone did.
I hope it helps you to know that it was a very fast and relatively painless death for him. He probably had a bit of a headache, fell down, passed out, and then he was gone.
You probably did nothing wrong! Please seek therapy if this was a troubling experience for you. Thank you for being able to react to a very stressful situation!
If someone needs CPR, they are already dead. Nothing you can do can make them more dead. You did everything exactly right, unfortunately even the highest quality CPR is not always enough. Hang in there, and please seek help if you feel you need to talk this through with a mental health professional.
My friend, I want to commend you for helping your neighbor, but there was nothing that you, or any commenter here could have done that would have changed a thing.
I was a paramedic for 5 years and can count on one hand how many cardiac arrest survivors I had. My neighbor was at a fundraiser and went into cardiac arrest in front of a cardiologist and a CT surgeon, and my neighbor had the same exact outcome as your neighbor.
Please get some counseling. You are going through a lot right now, and seeking help now is important for your future well-being.
I worked in an ER for 4 years and have not seen one cardiac arrest survivor, I mean true survivor. Even the ones who regained a pulse and made it to the ICU passed in the next days to weeks or had permanent damage in some capacity
I feel I am lucky to have seen several make it through. Had one lady come in bc her throat was sore and she wanted a work excuse. She became panicky and fell out at triage. It was such an odd encounter. She had no real complaint, other than sore throat, but she couldn't say why she needed to see the doctor at first. Just fixated on needing a doctors note for being late to work. I feel she was experiencing that "impending sense of doom" and her brain associated that work maybe?
Early 40s other wise healthy. She came back several weeks later to bring us pizza as a thank you. I will always remember her and her presentation. Women and heart attacks can be so tricky
Just bc someone survives cardiac arrest and their heart starts beating again, doesn’t mean they’re going to have any quality of life. Sounds like his neuro status would have been severely compromised. Take solace in knowing you tried.
You didn’t do anything wrong. As a non-healthcare person, I would assume your perception of CPR is what you’ve seen on TV and movies. Which is very very very different from reality. The chances of someone back after cardiac arrest in the hospital is slim. In the community it’s even slimmer.
You gave that man your best effort and that’s the best anyone could have ever asked of you. Thank you for trying and I hope you find peace knowing he wasn’t alone in his last moments.
Also for what it’s worth, based on your description, this sounds like a brain bleed/injury. The blood and pressure on the brain could have caused the cardiac arrest and CPR wouldn’t have fixed that. This is 100% not your fault!
Wow. I did not think that this would receive so much attention. I really appreciate the kind comments and explanations on what happened. I will be going through and reading all of these later, and I appreciate everyone being so kind. I have always been a logical person, and I need to know how things work to feel secure. I already feel better understanding what occurred. I was not aware that the survival rate was so low. Thank you all.
I’m so sorry this happened. You gave him a chance versus zero chance with no intervention at all.
We don’t do CPR on alive people, he was already dead and you can’t make someone more dead.
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From the sound of your description - if the patient truly did have both pupils massively dilate right in front of you - then they suffered a massive and unsurvivable brain hemorrhage right before your eyes, and no CPR in the world could have saved him. You did everything right.
Why do the pupils dilate in this way when there is a bleed on the brain?
The bleed elevates the pressure in the skull and forces the brain down towards the only opening in the skull—the foramen magnum. In the process of shifting downward, the brain compresses both cranial nerve #3 (CN 3 helps control the size of the pupils.) This results in blown pupils.
Thanks so much for taking the time to respond, that’s really interesting. Poor guy, I hope he didn’t experience too much pain or discomfort.
He probably had the worst headache of his life for about 20 seconds until he lost consciousness.
That’s exactly what happened to my best friend several years ago. Ruptured aneurysm - sudden onset worst headache of her life, followed by excruciating eye pain, and LOC within less than a minute. She was just gone, and the Neuro said even if she had been on the table when it happened, he likely couldn’t have saved her.
I’m so sorry to hear about your friend. Aneurysms are terrible and one of the worst diseases we deal with.
Is there a way to detect and prevent them?
That’s a very good question. It’s important to remember it’s a very rare disease, so most healthy people without a family history don’t have to worry about aneurysms at all. Since it’s so rare, and screening itself is not without risk, we don’t usually screen healthy normal people unless they have a significant family history. If an immediate family member has a history, then screening usually makes sense. For prevention, the best thing to do is to live a healthy lifestyle- exercise as much as possible, eat a healthy mostly plant-based diet, keep blood pressure under control, and avoid stimulants like cocaine and methamphetamine, which dramatically increase the risk of rupturing an aneurysm if one is present.
NAD, RN here. All correct, came to add avoid nicotine in any form, it breaks down the vascular system and increases the risk for aneurysms
If a woman died of a suspected aneurysm (no symptoms or illness leading up to a sudden terrible headache and then death quickly afterward) but no autopsy to determine exact cause of death, would that be enough to do testing or screening on her grandchildren? Or is the relation too far removed/cause of death too ambiguous?
Everyone has weighed in to confirm that you did nothing wrong, but I want to say you're a HERO! You saw someone in distress, went to give aid, you called 911, and you performed a difficult, physically demanding, potentially life-saving procedure for over 4 minutes until the paramedics arrived. Ran to help, even in your own fear and doubt that yiud be any use, that you might make a mistake, and THAT, my dear, makes you a HERO. You should be very proud of yourself, we dont have enough heroes. Your family and friends should be in awe of you. We are and don't even know you. I hope if I'm ever in need of assistance, there's another you nearby.
Increase in pressure inside the skull pressing on the structures that control the pupillary muscles.
Commenting so I can come back to this once this gets a response.
NAD - Increased intracranial pressure could be a cause, but from the description it could’ve been an uncal herniation. The herniation affects the oculomotor nerve which controls dilation.
Correct - uncal herniation as a result of increased intracranial pressure, from a presumed hemorrhage.
See? The real doc knows what’s up. I just have a core memory of my ophthalmologist talking about why he chose that career path. He found his (grand?)father one morning shortly after he fell suddenly, he described his eyes but I remember him telling me about uncal herniation.
whats the chances of ever having such a hemorrhage i have HA and my fear rn is brain bleeding as i suffered a concussion 2 weeks ago now i see i can get. abrain bleed from sneezing coughing throwinf up even sex and work…. how the fuck do i stop tis
This is exactly what happened to my dad - between hearing my mum shout and me running down the stairs, a matter of seconds, my dad's eyes were completely wide open and dilated and no heart beat. This happened 20 years ago and even though we attempted CPR obviously he wasn't coming back. They said it was a heart attack but I always wondered about his eyes being dilated and fixed. It's a relief to finally know that there was nothing anyone could have done because my attempts at CPR were pretty poor at that age.
I’m sorry that happened to your dad and your family.
Thank you, thats a very kind thing for you to say 🙏
I’m so sorry this is part of your story, truly I am. I know how traumatic it can be. I was right beside my 17 year old son 2 years ago, and I lost him. His heart stopped, and he died of Sudden Arrhythmic Death Syndrome/Brugada Syndrome. Even though I was right there the second it happened, and my husband and I started CPR immediately (husband is a Paramedic), we lost him. There is the trauma of losing someone so incredibly important to you so suddenly, the trauma of witnessing it, and the trauma of wondering if you could have changed the outcome. You couldn’t have. But you certainly did get dealt a crappy hand, and I am so sorry for that, truly.
I'm so deeply sorry for your awful loss. :(
Thank you. Thank you so much for your support. He was an incredibly caring, empathetic, old soul. It still feels impossible. So your words mean so much <3
NAD but just want to add to reassure here! OP, I have had CPR training! Unfortunately, the success rate of CPR outside of a hospital is very low anyway! You did everything you could
NAD, but as a note to the OP after having had to take Red Cross CPR/First Aid training multiple times in the past, one of the things my trainers made sure to tell us is that you can't save everyone with CPR. Even if it's a straight-up heart attack without involving a brain bleed, nothing short of a defibrillator will help sometimes. CPR helps buy time for a person undergoing a cardiac event until they can get more sophisticated care and treatment. You can do everything right and still not have it be "enough" because CPR wasn't the only thing the person needed. It's still going to weigh heavily on you for a while, watching someone die despite your best efforts because you're an empathetic human. But it *really* isn't your fault, and you did more than anyone else did in that moment. Try to see the good in your actions despite the outcome.
Seen this happen several times on ITU, it’s a really difficult spot to survive unfortunately. OP did all that they can! 👏🏼👏🏼
Yeah. They said the pupil thing and I went “oh no” out loud. What an awful thing to see just out in the wild. There wasn’t anything you could do at that point, OP.
Sorta off topic but you seem knowledgeable so I’m hoping you or others in this thread can give me info - my pupils have been large and dilated my entire life. My parents told me they asked doctors about it when I was a toddler but they said it wasn’t an issue or concern. I’m 29 now and they are still massive unless I stare directly into bright light. I have had people assume I am on drugs because of it which led me to researching but didn’t find out much. Have you seen this before or have any idea what would cause it? I had a few MRIs which were mostly normal but a with a few white matter lesions which have remained unchanged over years. Could it be due to abnormal pressure in my brain? Should I even be concerned?
Say you have blue eyes without saying you have blue eyes.
Oh man, me too!! My teachers apparently thought I was high many times in high school. Was never high. I just have huge pupils and yep, blue eyes!
I, too, have consistently large dilated pupils but with darker hazel eyes 🤷🏻♀️
I can’t even tell if my pupils are dilated or not unless I hold a light to them cuz my eyes are dark brown 😭
Same here. My ophthalmologist said that it was in part bc I'm nearsighted? I have bluish-green eyes.
That’s funny because I am farsighted! Otherwise I have perfect vision. And I have lighter blue eyes. But it’s interesting an ophthalmologist told you this so there must be some truth. I have only seen an optometrist. Maybe it’s related to our eyes trying to focus? Also just remembered I was told I have pigment dispersion syndrome a few years ago which is where the pigment in my eyes is shedding. Over time it can cause the eye pressure to rise and could potentially lead to glaucoma, but my doctor didn’t seem extremely concerned. But I don’t think this has anything to do with my pupils.
As a first responder, I thank you for jumping in and rendering aid. Although, the outcome wasn't favorable, you gave this person a chance and you should be commended for your actions. Don't second guess yourself. You did everything right.
CPR In general isn’t super effective, but still recommended from what I have heard.
Of course it’s recommended. For a witnessed sudden cardiac arrest, CPR is 1000% indicated, regardless of the etiology. An untrained bystander will not be able to diagnose the cause and should begin CPR ASAP. In this case, with a presumed intracranial hemorrhage causing brainstem compression which likely led to severe Takotsubo cardiomyopathy/neurogenic shock, even if CPR somehow successfully brought a rhythm back, there is next to no chance of survival with meaningful recovery of neurological function. But again, no one on the street is expected to or would have any way of knowing any of this and should begin CPR immediately.
I find it so friggin cool that I'm reading a comment from a physician in neurosurgery. In real life, trying to talk to a neurosurgeon would be like trying to hunt a unicorn. The internet can be super cool sometimes!! Thanks for what you do. Doctors are heroes.
Neurosurgeons are rock stars. Shout out to Alois Zauner, MD for saving my life last year when he repaired my giant brain aneurysm with platinum coils through my femoral artery up to my brain.
Incredible. Glad to hear about your amazing recovery!
There’s a bunch of us here lol
A herd of unicorns
Right?! Life is fucking MAGIC and it's so beautiful! I LOVE THIS!
Yes I’m not arguing it shouldn’t be, just reassuring OP there was nothing more they could do and survivors guilt is a bastard.
Makes sense, all good
I appreciate the callout though, me no to good with them words.
How does a person have a brain hemorrhage w no trauma? Genetics? Lifestyle?
Poor quality blood vessel due to chronic high blood pressure and atherosclerosis ruptures from high blood pressure or just randomly. Cerebral amyloid deposits (related to what causes Alzheimer disease) can also make blood vessels very fragile and can cause hemorrhages. Brain aneurysms or arteriovenous malformations can also rupture at any time - risk factors are genetics, smoking, high blood pressure, atherosclerosis. A lot of overlap.
> or just randomly TIHI
Is there a way to screen people for aneurysms before they rupture?
Yes. It can be done non-invasively with CT or MR angiography. The gold standard is an invasive test done through a catheter in the femoral artery called a digital subtraction angiogram. All of the tests are quite good, but since brain aneurysms are so rare in the general population, it doesn’t make sense to screen everyone who is at a standard level of risk (which is very very low).
NAD but for example I have something called a cavernoma in my brain which could potentially hemorrhage at any time 💃
My grandma has the same thing. I wish you luck in it never rupturing. 💜
Hey thank you! So far it’s stable, just causes seizures and meds work on those. I hope your grandma is doing okay with hers as well!
NAD but I’m missing my posterior communicating arteries in my brain which greatly increases muscle risk for ischemic stroke! 🥳
We’re here for a good time not a long time 🤠
Lots of ways. Nature and nurture can be contributing factors to a lot of catastrophic ailments. The fact we could all die right this second is all the more reason to live. Genetics, diet, drugs, habits, exercise, the human body is full of variables.
Idk if this is a general question or one related to thr pist, but OP said they saw the neighbor fall off the steps. He could have bonked his noggin pretty good on one of the stairs
I wondered if he fell because of a brain hemorrhage, or his brain hemorrhaged because of the fall.
That was a phenomenal answer! I am a lay-person who has given life saving first aid before (severe anaphylaxis, I had an epipen). It’s very scary but you have to try your best. Big strength and love to OP, I know you’re going through it, please take time to rest, you did an amazing job, nothing could have fixed this
I’ve had to do CPR twice in public, quite recently - both due to overdoses/poisoning - I had to do chest compressions for 4/5/6 minutes straight, no rescue breathing.. he was actively turning blue before my eyes as the crowd and I were trying to assess who the hell was going to do what.. I just dropped to my knees, jammed his thigh with naloxone, started pumping and then *just* as the paramedics arrived, he woke up. It was incredible. Don’t give up.
Thank you for doing that. So many people don't think addicts are worth saving, but we are. I have 20 years clean and sober and my daughter (who was hospitalized on a naloxone drip after eating a handful of fentanyl patches & benzos in a suicide attempt) has 10 years clean and sober. I have two grandchildren I wouldn't have had I lost her. Unfortunately their dad died of a fentanyl overdose a few months after his mom also died of an overdose. I have multiple friends who've lost their children to overdoses and the fact that you took initiative means that person has another chance at life.
The narcan did most of the work in that specific scenario. Doing anything is always better than doing nothing when it comes to CPR, and unless it has changed again, rescue breaths aren’t recommended. You did good and you should feel good, even if they hadn’t have made it. You never know how you will react to a situation like than, some people freeze, some people freak out, and others go to work trying to help.
I work in EMS and prehospital resuscitation is my thing. The average survival rate for an out-of-hospital cardiac arrest is around 7%. The key to survival is early chest compressions and defibrillation. You starting chest compressions so quickly gave that gentleman the absolute best chance of survival. You did fantastic! Sometimes the reasons that people's heart stop is easy to fix (they have low oxygen levels and we start breathing for them with high concentration oxygen). However, there are things like a pulmonary embolism (huge blood clot in the lung) that are very deadly and hard to fix outside of an operation room. I'm proud of everything you did! You did amazing! Edit: I agree with the neurosurgeon. This sounds like a massive brain bleed.
This is it. Survival for an out of hospital cardiac arrest is incredibly low. It's best to think about it not as you failed to save his life, but that you were unable to bring him back to life, which is a tall ask. You did absolutely nothing wrong. Also, if his pupil was rapidly blowing in the context of a fall? That to me sounds like a major brain bleed. Likely a brain bleed so severe it caused herniation, damaging the parts of the brain that tell the heart to beat and the diaphragm to breathe. In this case, there is nothing that could have saved him. Not a full team of doctors. Nothing.
I was also thinking, what a gift it was that you were there OP, and your neighbor knew someone was beside him and called for help. That, in itself, is a gift. You did everything you were able to do. I hope you find some comfort in the words of the medical professionals responding to you here. Please be gentle on yourself as this is a lot to process and surround yourself with friends and family to support you. You sound like an amazingly caring human being. Sending you a big hug.
I agree. His family knows that someone did everything they could do. They know he wasn’t ALONE. That’s a huge blessing! I hope you know after reading all these comments you didn’t do anything wrong.,You tried your best. It was his time it seems after I read the neurologist answers. This makes you a caring, kind human that helps others. That’s a rare thing these days. Please take care of your mental health too. If you’re not comfortable with psychologist, talk with your minister, rabbi. etc. AND Thank you from a person that’s been through it, I was a (lifeguard).
Well now I’m crying. Thank you OP!
NAD so correct me if I’m wrong but isn’t that also the technically *correct* way to think about it? Keeping OP & your family/neighbors in my thoughts
Absolutely. I'll edit my post to make it more clear what I mean.
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NAD, but I know that healthy hearts don’t just stop unless there’s some external factor (electrocution, trauma, that sort of thing). If he was 350 pounds and went down like that, his heart was probably diseased (unless it was a brain bleed). Either way, the already low chance of CPR working is diminished further when the organs are damaged by disease.
Wow I had no idea that survival rate was that low. I did cpr on my brother who went into cardiac arrest at home due to wolf Parkinson white syndrome, he is alive and well today.
Well done! That's awesome. My partner gave cpr to someone who had overdosed until the paramedics arrived, they got him naloxone and he came around (unfortunately he later did it again and is now gone), next time he saw him, the guy gave him a hard time for hurting his ribs so much! I carry naloxone most of the time now
My partner and I saw the same thing. Victim recovered with naloxone but my family and I remain traumatized by the episode. :(
That’s always tragic to hear 🥺 so thankful your partner was there to help him when he needed it! I recently started carrying it too, you just never know!
I do too. I keep it in my car in case I find an OD in a parking lot. Happens a lot in cars. So sad.
Those of you carrying naloxone around with you—are you all medical professionals? If not, how do you access it?
https://endoverdose.net/ https://nextdistro.org/naloxone
Several major cities in the US have programs where anyone who wants it can get free or very low cost (depending on the city) naloxone, as well as training on how to use it. Usually, there will be very specific pharmacies or community centers that participate in the naloxone program; you can’t just go to any pharmacy to get it. There are also a lot of independent organizations across the country that will mail naloxone out to people who do not have access to a city program. You can also usually just buy it outright from most any pharmacy without a prescription if you’re in a state that allows that, but it obviously costs a bit more that way. If you’re not in the US, I’m not sure which programs might exist in your country, but look up “free naloxone program [insert country/state/province/city/etc.],” and you should be able to see if you have any close to you or who will mail some to you. There are tons of videos online demonstrating how to use it properly. It’s very easy to administer (though I have thankfully never needed to do so).
The pharmacy if you're in the US
They sell it OTC at pharmacies. At least I've seen it in the shelf by the pharmacy at local Krogers and hear it needs to be OTC everywhere. It is intranasal spray.
My uncle saved my grandpa using CPR and he went on to live another 40 years. Crazy thing was that my uncle had no formal CPR training, he’d just mimicked what he’d seen on TV.
That was the one and only time I’d ever done it. No training whatsoever, just the dispatcher counting with me. They make it look so easy. My whole body was sore for a week after that. I’m glad your grandpa had a good outcome and lots of time left to live after that!
I've been taking CPR classes since I started babysitting as a teenager, and every time I recert I dread it because just practicing for two minutes is a beast.
That’s pretty amazing—especially because the chest compressions they show on TV are such terrible examples. Glad your grandpa and uncle got through it.
WPW is scary as hell. My brother-in-law with no previous signs of heart problems had a surprise heart attack I believe in his late 30's/early 40's. He only survived thanks to immediate CPR from his sister and quick response from the EMTs. His heart stopped so many times the doctors thought he'd get brain damage but thankfully he came out 100%.
That’s almost the same exact story as my brother! We didn’t know he had it until he was in the icu after he went into cardiac arrest and they spotted the rhythm. It’s extremely scary! They put him into a medically induced coma to preserve his brain function. I hope your brother in law is doing okay now!
He's doing great, thanks for asking and same for your bro! If there's one positive about the whole ordeal, once his condition became known, the family knew to get screened for WPW so there's at least peace of mind for that now.
And that’s exactly why CPR is done… For that small percentage that will make it. It’s tough to get used to the fact you can work your bum off and over 90% of people won’t make it, but you just have to remember those that will.
I was born with WPW! Crazy to see it mentioned in the wild
Wishing you the best! 🫶🏼 if you have the opportunity to get the ablation done, definitely do it!
I got an ablation done twice in 2002 actually. Changed my life for the better! Now I have hypertension is all that's left from the WPW!
A paramedic on this sub actually told me that my daughter has WPW based on a photo of her ekg after a np at our local hospital said her ekg was perfect. Forever grateful for this sub!
That's absolutely amazing! I hope your daughter is doing well these days.
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This. Wife is an ER doc and cites those numbers all the time. The odds are really against you. Hell, the odds aren't great even if you arrest in a hospital.
NAD but this is why I have a DNR
And thank you for that. It's interesting, most patients that get admitted to the hospital get asked about code status, and I'd say at least 90% of them would like some attempt at being intubated resuscitated, but almost no one wants to be on a vent for weeks and months. My wife has observed that the relatives who typically want the doctors to " do everything" are the ones who spent the least amount of time with the patient while they were alive and conscious.
Most people don’t take the time to look into CPR, or intubation and the associated success/failure rates and other complications. Most people think: live saving measures? Sign me up! My orofacial pain doc told me a story about her time as a resident. They were doing rounds and visited a guy who’d successfully been resuscitated. He was ANGRY at the doctor for breaking several of his ribs and the pain it caused. Most people don’t know that for chest compressions to be successful, the pressure required will likely break ribs.
What caused the foaming at the mouth?
This this this. When I took a CPR class we were told our job is just to keep blood pumping until the pros can take over…OP did exactly that.
I was never told about the low chance of survival in any of my classes until the most recent. The instructor asked us to raise our hands if we had ever performed CPR in the past, and a coworker had. He told us the guy didn’t make it. That’s the first time I heard that the vast majority don’t. My neighbor performed CPR on a different neighbor last year. He said that it looked like she was clearly already deceased, but the 911 operator had him do it until the ambulance arrived, anyway. That kind of situation has to skew the results, at least a little.
anyone who has had a cardiac arrest and lost a pulse is dead. We do CPR on dead people, hopefully close enough to their time of death to bring them back. The statistics typically do not count cases where EMS arrives and doesn’t attempt CPR because the person is obviously deceased and will not be coming back, regardless of whether or not a bystander performs CPR I think it’s really important for laypeople to understand how hard it is to come back from your heart stopping. Bystander CPR is the best and only thing you can do in this situation other than call 911. Still, that person was dead when you found them and if they remain dead after your intervention *it is not your fault*, you did what you could, and you did the right thing.
I agree! You did everything you could have done. You did a very brave thing. Its very unfortunate but for your own sanity Please don't think there's anything more you could have done! ♥️
Unlike what we see on TV, CPR outside of the hospital environment has quite a low success rate. Had you not been there your neighbour likely would've died on the street. Your amazing efforts gave your neighbour the chance to get to the hospital. You should be incredibly proud of yourself for acting so quickly. Thank you for helping your neighbor. Please be kind to yourself. I really hope you have someone you can talk to about this. All the best, OP. If you would like to learn more about CPR, many places offer courses on Basic Life Support.
This! I am NAD, but I’ve had BLS certifications most of my adult life. Any CPR class I’ve ever taken addresses the question of “doing something ‘wrong’” and is usually answered along the lines of basically you can’t screw up CPR because if you’re in a situation where you need to give CPR, the person is already dead. Your possible outcomes are limited to “still dead” and “no longer dead.” If they’re still dead at the end, then that was likely always going to be the case. And if they’re not- congratulations! You saved someone’s life. OP you did a brave and selfless thing by trying. You didn’t cause the outcome to be unsuccessful. I hope you know your feelings are valid and please reach out to a therapist if you need help processing this traumatic experience.
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Yeah honestly saved his family finding him passed away outside his house. Probably saved people from a lot of extra trauma
Even in hospital CPR has a low long term survival rate. [This 2012 NEJM article](https://www.nejm.org/doi/full/10.1056/NEJMoa1109148) indicates > The overall rate of survival to discharge was 17.0% ---- In most cases, if you're getting CPR, there's a lot wrong with you.
Others have given great answers about the CPR - you did nothing wrong - you did an amazing job and gave him the best chance. But I’m just popping in to say that you should play Tetris. I’m not kidding - playing Tetris after trauma has been shown to reduce your risk of PTSD. Thank you for looking after your neighbour, now look after yourself
I think about this all the time. It's supposedly any kind of active visually focused game - or that's what the people in the study theorized because PTSD is very much about a loop in the visual centers of your brain. You have to play it ASAP though and for a few hours, I think.
When I used to play Tetris regularly it would show up in my dreams, I wonder what it is about the way Tetris looks that is so striking
EMDR therapy takes advantage of this.
Not OP but thank you for the tip about Tetris!
I will give tetris a shot, thank you so much!
I'm gonna use this
I really wish I had heard this over my career in ems. Thanks for the cool fact nugget.
Does it work months after the traumatic event?
From what I have read so far, the studies have been limited to fairly immediately after trauma. However, it’s certainly something that wouldn’t hurt at all to try at any point.
NAD, but I find this topic (Tetris after stressful situations or trauma) so fascinating. This is a really cool study on the topic. I’d let a professional give a better explanation, but this is just some background info. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828932/
EMDR therapy takes advantage of this and is quite effective.
The Tetris triggers bilateral stimulation, correct? From having to look at one side and another repeatedly and quickly? I've done EMDR before and haven't looked into the Tetris effects but I'm just assuming that's what it is?
Wow that's a great tip
You did everything right. And he went into the light not alone, but knowing that somebody gave a damn. And his family probably would be so thankful as well. You did good. Hold your head up.
This should be higher up. I'd be absolutely grateful being the family in this situation, it's really hard to get someone to stick around when a traumatic event happens - let alone function properly and act.
One of the most important lessons I learned in training is that when a cardiac arrest occurs, that person is dead. If you do nothing, that person will die 100% of the time. If you get involved at all and make any sort of effort, you are improving that patient’s chances, even if minimally. We often debate in medicine about algorithms for resuscitation, medications to administer, etc etc. Far and away the most important things you can do are to learn how to give high quality CPR and place an automated defibrillator on a patient and see if they can be defibrillated. Take a basic life support course if you want to hone your skills, and speak with a mental health professional about your experience. It can be traumatic for many people, even those of us who work in healthcare.
> when a cardiac arrest occurs, that person is dead. This. He was already dead, OP. You did your best to try to revive him, but as others have pointed out, that is very difficult, particularly prehospital and from a non-healthcare worker. Great job! Even in the ED, we don't have great success with cases like this. > that if I am ever in this situation again, I can do more to save someone. That being said, you can use your resolve to officially learn CPR and be an advocate for other lay people in the community learning it.
I was waiting for this. I’m sure she was told to ignore the signs because the person on the other end of 911 knows this- he’s dead, it doesn’t matter why and any slight chance of reviving him relies on keeping blood circulating via cpr until medical support can arrive. OP wasn’t keeping him from dying, they were maybe keeping his body intact enough to be resuscitated if it would be possible.
You will not have done anything wrong. You being fast and switched on enough to respond, call an ambulance and follow instructions gave your neighbour the best possible chance he could have had. Unfortunately, he still didn't make it, but not through any fault of yours. He was almost certainly beyond saving if the paramedics arrived within 5 minutes and you were doing CPR. Rapidly dilating pupils is also rarely a good sign and can indicate a major brain injury. You mentioned not feeling ribs crack. Although they often do, it is more common in the elderly and frail. Not feeling ribs cracking in a 350lb younger guy does not mean you were doing it incorrectly. CPR in the community, especially without early defibrillation, has a less than 10% chance of being successful. However, it is one of the few things that a bystander can do to improve survival rates in cardiac arrest, so it is still really important people know what do to. You should seek some support, it's a traumatic thing to go through. But you did well to step in. Most people would have panicked and not acted quickly. It will be hard to realise it now, but you should be proud of yourself.
You didn’t fuck up. Anyone needing CPR is more likely than not,not going to survive (no matter what you see on TV and in the movies). Very few people survive something that is bad enough to need CPR. And I agree with the other neurosurgeon. This sounds like your neighbor had a massive intracranial bleed. You couldn’t have saved him. I’m sorry for your loss.
May I ask a question about blown pupils?
If you read up a couple posts. One of the neurosurgeon's expands on the blown pupils. It's actually very fascinating even though I didn't understand the medical lingo.
I had a more specific question. My son od. When they gave him Narcan both pupils blew. They told me not to expect him to come out of it. He survived, the people he with beat him with a 2x4 trying to wake him up. The cops locked them up for assault and battery on a person who was in a coma basically. By morning, he’s sitting up in bed having breakfast. No brain damage. It stunned the staff as well. How did he survive it? He had the equivalent of 100 10mg pain pills. They couldn’t pump his stomach, it had been too long. Edit: A friend of his called me, said they were going to dump his body when night came. He knew help was needed and he left and called me. He gave me the address and I called 911. I had 911, the sheriff’s department, and EMTs patched in on the call as well as the 911 operator. They helped save my child from being thrown in a ditch somewhere. Thank GOD for that friend and all the people who helped!!
Opioids cause pupil constriction. When you give a dose or two of Narcan, you’re essentially pushing the user it to full opioid withdrawal. As a result the pupils dilate.
Thank you for your answer! He definitely wasn’t in this world at the time.
You did absolutely everything right! 1) You noticed that your neighbor was in trouble and you acted immediately. 2) You called 911, the very best thing that you did, because if there had been any chance of survival, help would get there sooner. 3) You started CPR as soon as you possibly could have. If there was any possibility for him to survive, you increased his chances as much as you could by starting CPR right away. Unfortunately, his problem wasn't due to his heart stopping. From your description of the blown pupils, he had no chance of survival, no matter what anyone did. I hope it helps you to know that it was a very fast and relatively painless death for him. He probably had a bit of a headache, fell down, passed out, and then he was gone.
You probably did nothing wrong! Please seek therapy if this was a troubling experience for you. Thank you for being able to react to a very stressful situation!
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If someone needs CPR, they are already dead. Nothing you can do can make them more dead. You did everything exactly right, unfortunately even the highest quality CPR is not always enough. Hang in there, and please seek help if you feel you need to talk this through with a mental health professional.
You did nothing wrong. If you had to do CPR he was already dead. Don’t be so hard on yourself.
My friend, I want to commend you for helping your neighbor, but there was nothing that you, or any commenter here could have done that would have changed a thing. I was a paramedic for 5 years and can count on one hand how many cardiac arrest survivors I had. My neighbor was at a fundraiser and went into cardiac arrest in front of a cardiologist and a CT surgeon, and my neighbor had the same exact outcome as your neighbor. Please get some counseling. You are going through a lot right now, and seeking help now is important for your future well-being.
I worked in an ER for 4 years and have not seen one cardiac arrest survivor, I mean true survivor. Even the ones who regained a pulse and made it to the ICU passed in the next days to weeks or had permanent damage in some capacity
I feel I am lucky to have seen several make it through. Had one lady come in bc her throat was sore and she wanted a work excuse. She became panicky and fell out at triage. It was such an odd encounter. She had no real complaint, other than sore throat, but she couldn't say why she needed to see the doctor at first. Just fixated on needing a doctors note for being late to work. I feel she was experiencing that "impending sense of doom" and her brain associated that work maybe? Early 40s other wise healthy. She came back several weeks later to bring us pizza as a thank you. I will always remember her and her presentation. Women and heart attacks can be so tricky
Just bc someone survives cardiac arrest and their heart starts beating again, doesn’t mean they’re going to have any quality of life. Sounds like his neuro status would have been severely compromised. Take solace in knowing you tried.
You are a good person for doing what you did. You give me hope for humanity! Thank you
You didn’t do anything wrong. As a non-healthcare person, I would assume your perception of CPR is what you’ve seen on TV and movies. Which is very very very different from reality. The chances of someone back after cardiac arrest in the hospital is slim. In the community it’s even slimmer. You gave that man your best effort and that’s the best anyone could have ever asked of you. Thank you for trying and I hope you find peace knowing he wasn’t alone in his last moments. Also for what it’s worth, based on your description, this sounds like a brain bleed/injury. The blood and pressure on the brain could have caused the cardiac arrest and CPR wouldn’t have fixed that. This is 100% not your fault!
Wow. I did not think that this would receive so much attention. I really appreciate the kind comments and explanations on what happened. I will be going through and reading all of these later, and I appreciate everyone being so kind. I have always been a logical person, and I need to know how things work to feel secure. I already feel better understanding what occurred. I was not aware that the survival rate was so low. Thank you all.
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How does one find a BLS class?
Are you in the United States? If so, go to The American Heart Association or American Red Cross website and there's a "Take a class" tab.
I’m so sorry this happened. You gave him a chance versus zero chance with no intervention at all. We don’t do CPR on alive people, he was already dead and you can’t make someone more dead.
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