For Want of a Nail - Misha Route (Updated 11/1/19)

[ArmedLiberal]

“Wahahahahahaha~! That was fun! Is everyone okay~?”

I want to respond, to move, but no luck.

My heart.

“Hicchan?”

I can't say for sure, but I think it was Shizune’s head. It hit me square in the chest.

“Hicchan~!”

I can see the terror in her eyes as she realises what's happening. In the same instant, she seems to become a different person.

“Shicchan, get the nurse!”

Shizune nods, picking herself up and quickly disappearing down the stairs.

“Emi, get the AED!”

“The what?”

“It's by the stairs on the second floor! It's a red box with a heart, a lightning bolt, and the letters ‘AED.’”

Emi hesitates for a moment, then shoots down the stairs in her trademark blur.

Misha lays me out on the landing while Rin watches. Hands on my chest, she starts pushing down. CPR. It's a nice gesture, but we both know the odds aren't in my favor.

I feel like I'm looking down over myself, like I'm not the person on the ground there dying. Emi comes with the red box, and Shizune comes back a little later with the nurse. All sorts of things are happening around me, but I don't care. I know I'm dying.

At least I'm not dying a virgin.

That's the spirit, Hicchan~!
Seriously, that was awesome and (at least, inasmuch as it can be) unexpected. It's usually interesting when a totally different persona emerges in stressful situations. It's also surprisingly common. In any given daily situation, I can be quite indecisive. But when the fecal matter hits the rotating impeller, decisions are very quick and easy for me. I can triage, render aid, return fire, or whatever is necessary. Ask me for what I want for lunch, and I might not have an answer after a half-hour.

[minimike96]

Was half expecting another April Fools scene, really grad it wasn't.
Great work as usual Prof.

[Ommadawn]

Woohoo! I really enjoyed the update as well, thanks ProfAllister!

[Mirage_GSM]

Important note to all prospective first-aid-givers:
If a patient is still conscious their condition is not bad enough to warrant CPR by far!

With that out of the way, welcome back, good to see you again and all that

Long hiatus. Might be a record - so far...

[ArmedLiberal]

Important note to all prospective first-aid-givers:
If a patient is still conscious their condition is not bad enough to warrant CPR by far!

With that out of the way, welcome back, good to see you again and all that

Long hiatus. Might be a record - so far...

That's true in most instances... but not all. I have a paramedic friend who related a story about a guy who had to be defibrillated while still conscious (and if a paramedic is doing it, it's emergent). He was like, it's really cool that you're still conscious and all, but this is going to suck.

[Mirage_GSM]

Defibrillation is indicated for ventricular fibrillation or ventricular tachycardia. The vast majority of patients will be unconscious, but some might not be.
If a paramedic diagnoses one of those conditions after looking at an Electrocardiagraphy of a conscious patient (or they know the patient's medical history) that is okay.

I really doubt your paramedic friend would have given CPR to a conscious patient, though. CPR is a last ditch measure to supply oxygen to body cells when a patient is not breathing and their heart has stopped beating, i.e. when they are functionally dead already and literally can't get any worse. CPR will do nothing for a patient like Hisao. It won't restart his heart or anything - it just buys time until you can get a defibrillator or a doctor with medication. (You can forget about any Baywatch episodes where someone wakes up, coughs a few times and walks away after getting CPR.)

As long as a patient is conscious, they are also breathing, so there is no need to take such extreme measures - in fact you can make things a lot worse.

[HoneyBakedHam]

I took it as him being out of it when I read the CPR. Must've assumed he was unconscious soon as I read the CPR part because it was sounding like he was having a near death experience where he's watching his death (which means Hisao is dead and that's our end, right?).

[BlackWaltzTheThird]

I'm no doctor, but I would expect that you don't just immediately fall unconscious when your heart stops beating (see heart attacks). You can easily argue that Hisao is on his way out of consciousness. In that case CPR is probably still premature but given that Misha is also not a doctor I don't expect her to know that. In a weird roundabout way it's actually kind of logical. Wrong, but understandably so.

Also, I see you left that last line intact, Prof. I shall observe what people make of it.

[HoneyBakedHam]

(sees what Waltz meant)

...He's not really getting CPR, is he?

[brythain]

(sees what Waltz meant)

...He's not really getting CPR, is he?

He's not dying a virgin...

[HoneyBakedHam]

I totally forgot about the erotic chapter from long ago, so I retract my nercophilia comment and go back to him just being dead.

[Mirage_GSM]

In that case CPR is probably still premature but given that Misha is also not a doctor I don't expect her to know that. In a weird roundabout way it's actually kind of logical. Wrong, but understandably so.

Of course, Misha is no doctor and can be mistaken about what kind of measure is appropriate.
I just wanted to be sure nobody takes home dangerous, false medical knowledge from a fanfiction.
You don't do CPR on someone who is just "out of it".

[ProfAllister]

In that case CPR is probably still premature but given that Misha is also not a doctor I don't expect her to know that. In a weird roundabout way it's actually kind of logical. Wrong, but understandably so.

Of course, Misha is no doctor and can be mistaken about what kind of measure is appropriate.
I just wanted to be sure nobody takes home dangerous, false medical knowledge from a fanfiction.
You don't do CPR on someone who is just "out of it".

While this is true, I am disappoint that you assume I didn't do my homework.

You'll recall the Nurse's dire warning about a blow to the chest, yes? He was referring to commotio cordis. Hisao has Long QT syndrome, placing him at elevated risk for commotio cordis. Commotio cordis is a type of sudden cardiac arrest. Treatment recommendations for sudden cardiac arrest include immediate application of an AED, and CPR until the AED is deployed (also relevant). I could go on, because (unsurprisingly) there's a wealth of resources regarding CPR and heart health.

The key takeaway, however, is that a layman can't easily determine if a (potential) cardiac arrest victim is unconscious, and any delay could be fatal. Performing CPR on a healthy conscious person is a terrible idea. Performing CPR on someone who's been diagnosed with a serious heart condition who just had a traumatic event and isn't responding is a significantly less terrible idea. In fact, the rule of thumb, based on that whole "seconds matter" concept, is that if you're in doubt as to whether you should apply CPR, you should err on the side of performing unnecessary CPR - CPR when it isn't needed can cause all kinds of nastiness, but withholding CPR when it is needed dramatically increases lethality of the event.

And yeah, I guess I could continue on that point in a lot more detail, too.

TL;DR - CPR on a healthy conscious person = bad; CPR on an unhealthy/questionable person who seems to be having heart problems and isn't responsive = good.

Also, getting medical recommendations from cripple porn fanfiction = WTF is wrong with you?

[HoneyBakedHam]

Also, getting medical recommendations from cripple porn fanfiction = WTF is wrong with you?

Eh, all this is kinda like House MD for me: Come in, enjoy the writing, and learn a bit of medical knowledge while I'm going through my-

Ahem...should probably stop there.

[Mirage_GSM]

You'll recall the Nurse's dire warning about a blow to the chest, yes? He was referring to commotio cordis. Hisao has Long QT syndrome, placing him at elevated risk for commotio cordis. Commotio cordis is a type of sudden cardiac arrest. Treatment recommendations for sudden cardiac arrest include immediate application of an AED, and CPR until the AED is deployed (also relevant). I could go on, because (unsurprisingly) there's a wealth of resources regarding CPR and heart health.

All this is correct.
The problem is that Hisao is your narrator, and since he is able to narrate all the stuff about Misha giving him CPR that means that he is conscious at the time. Sure, Misha could have mistaken him for being unconscious, but he seems to at least have his eyes open and be following events around him.
(He also stays concious during CPR until Shizune comes back with the nurse which actually had me laughing out loud when I read it the first time. I'm not sure giving the kiss of life to a conscious person would even work. They'd probably breathe against your breathing just by reflex.)

Again: It doesn't matter what Hisao's condition is - as long as he is conscious, he is breathing, and his heart is beating, thus there is no reason to perform CPR.
CPR is quite likely to stop whatever spontaneous pulse and breathing the patient still has going, replacing it with the artificial version - and breaking a few ribs in the process*

If Hisao had blacked out before Misha started CPR and been told about it after he woke up again, everything would have been fine.

*In first aid courses, currently the procedure we teach is to start CPR after ascertaining the patient is unconscious and not breathing. Checking for pulse is no longer recommended for lay helpers, because it can be difficult to correctly find a pulse if it is weak and you're not doing it regularly and also because if there is no respiration there's a high likelihood** of there not being any pulse either.
I'd still take the few seconds to ascertain the patient really has no pulse left before starting a measure that might mess up whatever pulse there might still be.

**not sure how high right now...