CPR Revisited: Hands Only, AED, Etc.
November 20, 2008 by dr. lam · Leave a Comment
I had to take my ACLS (Advanced Cardiac Life Support) renewal this past weekend, as a requirement for maintaining my surgery center’s credentialing. I have always been bored out of my skull during these courses but not this time. Robert Twite, RN, brilliantly created a session that allowed me to sense his passion and his “why” (see Tuesday’s blog). His mission in life was to help others truly save others’ lives. I assume his vision for myself and as part of his crusade (see Wednesday’s blog), I posted a video on how to do good CPR and why to do it. My teaching skills for CPR pale in comparison to his so forgive me Robert for my feeble attempt but I need to get this message out to my readers and followers of this website.
What I found very interesting were a few things. First, he mentioned the idea of “hands only CPR” that has come into vogue recently was very very intriguing. He argued that many advocates have shown that just doing chest compressions without mouth-to-mouth can have very similar or same outcomes in survival. There are a few reasons for this. First, the air that is recycled from your lungs and breathed into the individual is filled with CO2. Second, if you breathe too often and too much (which is the natural tendency to do), you can make chest compressions less viable owing to a rise in pressure inside the chest wall. Rapid, early, and hard chest compressions can save a life.
Second, he talked about how we believe in the past that we better check a pulse before starting CPR. Well, yes, that is not a bad idea but not at the expense of starting early CPR. What he argued is that without chest compressions in someone who does not have a pulse will lead to a quick death. If you perform chest compressions in someone who has a pulse, the only negative outcome is a sore chest. Even if you find a weak pulse, additional CPR can oftentimes supplement the cardiac output of blood and lead to a better outcome. He offered the example that in children who even have a pulse but a slow one like at 60 beats per minute (that is slow for a child), the advice is to actually do CPR to improve blood flow. So if you check a pulse, then I check a pulse, and we both don’t know if there is a pulse, we are wasting precious time for no reason. Forget all that and start high quality CPR. Crappy chest compressions do nothing. High quality chest compressions only offer 25 to 30% of a normal amount of blood to flow out of the heart. Also, remember that you must lift off the chest, i.e., let the chest completely recoil back to an inflated position because you need the blood to return to the heart as well.
Finally, if your business does not have an AED (automatic extrenal defibrillator), you need to get one. Early shocks from this device will lead to a life saved. Without one, even chest compressions might not be enough. These devices will actually guide you when to shock and when not to. Basically today, the goal is 2 minutes of sustained high quality CPR with chest compression to breaths of 30:2 followed by the AED announcing when 2 minutes are up to determine if you need to be shocked or not. Even after a shock or not shock, continue CPR until told to stop. The AED however should interrupt CPR at the earliest time possible since the earlier you get an AED on someone the higher chance of survival for that person in many cases if the rhythm is shockable like ventricular fibrillation, which is a common cause of cardiac arrest.
This blog is not intended to replace formal basic life support training but to encourage you to get certified. In the meantime, if you haven’t yet and the occasion arises where you need to save a life remember early and hard chest compressions with recoil time and get an AED fast and furiously then continue until help arrives. Don’t err on the side of checking pulses, checking pulses, then looking at each other. Most likely CPR and an AED will save a life more than whatever the ambulance or physician can do. Outcome studies have shown that only 2 things matter for survival: good quality and early CPR and an AED early, not fancy drugs or airways. Two things in conclusion: get CPR certified and make sure that your workplace has an AED on site. Thanks Robert for the brilliant education. I hope I can spread your message out there to all who can hear.
The Vision Thing Part 3 of 3: Take My Vision
November 19, 2008 by dr. lam · Leave a Comment
Simon Sinek talked about Apple’s success. The reason that Apple succeeds is not because they make good looking computers. They succeed because they have inspired their customers to aspire to be what they are all about, i.e., making good looking computers (among other things…that work well). I myself aspire to be an Apple aficionado because I cherish their values: great design, simple to use, and passion not to compromise that aesthetic vision. Do you think the reason that someone wears a Harley-Davidson tattoo is that they want to promote a Harley so that their stocks will rise? Well, that is a lot of dedication if it is the case. No, in fact the reason that someone has a Harley-Davidson tattoo is that the individual has taken that vision unto themselves as their own. They have assumed that vision and internalized it and made it theirs. Sinek said the reason that people marched on Washington D.C. in the 60s was not for Martin Luther King. It was for themselves because they assumed Reverend King’s vision for themselves.
One of my proudest moments this year (you might chuckle) was when a newscaster here in Dallas whom I do Botox, fillers etc. for told me she had walked into a room of 20 women where one woman was talking about not doing browlifts but to focus on balancing the anterior cheek, etc. Afterward, my patient went up to the lady and said, “Are you Dr. Lam’s patient?” She said, “Yes, how did you know?” Of course, my patient said, “Because you sound just like him.”
I hope that my vision for changing this world from an overlifted bizarre looking alien race to a natural beautiful ethnically sensitive balanced result will challenge you to assume my vision and make it yours. If you are not there yet, I hope you will be. I know that is sounding arrogant but I am not intending it to be. I hope you can be my agent of change and to renounce the status quo that noses need to be over-elevated in Asians, over-reduced in Middle Easterns, and individuals need brows in the middle of their forehead. That is why I was angry sounding this weekend in response to a forum posting because I would hope my patients not allow others to be subjected to antiquated surgery and what I view as an untenable philosophy.
BTW, THE WEB TUTORIALS ARE ALSO NOW LIVE!
The Vision Thing Part 2 of 3: Getting to Why?
November 18, 2008 by dr. lam · Leave a Comment
Many of our businesses are predicated on the what and the how. What are we producing? What is it that the consumer wants? How do we improve things? How do we make the consumer happier? Let’s take a look at the real core issue: Why. I was listening to Simon Sinek last year at an EO event who talked about getting to why (more about that tomorrow as well). The why is why we are doing what we are doing.
I had a spa event a few weeks ago where a lady said what really bothered her were a few fine lines on her upper lip. No one in the room could see what she was talking about, and she asked me, “Dr. Lam, would you mind if I just came to you to fill these lines and nothing else?” I said, “No, that is fine. However if you continue to do that over the next 3 years, you are wasting my talent and I am wasting your money.” That being said, MOST women come to me solely to fill those fine lines because that is what they are programmed to think ages them. Obviously, if I have done what it takes to get you where I think you should be then we can fill those lines. That is fine with me to see you and to educate you but I do not roll out of bed to fill a line. I get out of bed for an entirely other reason…
What is my why? It is in a nutshell “to take care of people and to transform lives”. Audacious? perhaps but it is something that is driven into my staff’s brains. The why is not just the reason that I get out of bed, it is the reason that all my staff get out of bed too. Yes, they come for a paycheck no doubt. However, they come because of the difference they know we are making every day.
If any of them look at what I do as trivial, then they will not stay with me oftentimes not because I am going to fire them but because they are going to fire themselves. They can’t survive in a culture that is dedicated to relentlessly addressing our core why. Stephanie, who works as my MA, left her last job because they had no why. Their why was to gouge and steal from the customer. She has seen what our why is every day. She sees that I turn away as many customers’ desires as I accept. I fundamentally cannot and will not waste your money. I really love what I do until I bleed. However, my staff does too. We are here every day impassioned by YOU.
Remember that as much as you choose me as a surgeon, I choose you as a patient. This is a marriage of sorts. If you are principally negative and micro-managing. If you are here to do something that fundamentally is a waste of your money, you should not be my patient and I should not be your physician. Am I taking risks with this website? Absolutely, I am NOT all things to all people. I have defined my vision and my patients who are attracted to it come and stay. Those who are not, do not. They leave or don’t stay and I am more than happy about that. Same with my staff. Those who cannot share my vision at a fundamental level don’t last. Are they wrong? Am I wrong? No. No one is wrong. The fit is just not right.
Do you know what your why is? Why do you get of bed every day? Why do you go to work every day? Is it just for a paycheck? Is it to punch in the time clock and leave so that you can party with friends? Fundamentally beyond the what and the how lies the why. That is the core of any vision.
BTW: THE UPDATES SECTION IS NOW LIVE. ENJOY!
The Vision Thing Part 1 of 3: Vision & Action
November 17, 2008 by dr. lam · Leave a Comment
My favorite quote of all time is as follows:
“Vision without action is only a dream.
Action without vision is only passing time.
Vision with action will change the world.”
I have used these words to close many of my lectures on leadership. It is the core of my belief system. It is the core of this website. I had a blog entry (you will see that many blog entries relate to one another, partly because I have a finite brain but also because I have deep abiding passions that are focused in nature) that talks about “walking the talk.” I have dealt with a lot of dreamers who have seen the glorious building I have built and who want to be part of the vision. My tagline which has become a bit of an inside joke is “Join the vision now”, which is what I used when I was first recruiting physicians for my building. I found that physicians (pardon me) can be divided into one of two types: the lone maverick whose ethical decision making is circumspect to say the least or the risk-adverse individual who is ensconced in his or her own fears. The first type is a big dreamer but I do not like their actions. The second type is neither a dreamer not a doer, leading ultimately to failure at getting the bigger slice. I infrequently encounter a medical professional in whom I have the rare respect of having both the right vision and the right action. In any case, I have not compromised my vision for anyone (not even for my patients. We’ll get to that on Wednesday.)
A huge reason that I joined Entrepreneur’s Organization (EO) is that these are gentlemen and ladies who have a big vision for changing the world and who have put all their risk behind that vision. I slavishly defend my brethren in that organization and have rarely if ever missed a meeting. I missed only September’s this year for our learning event because I was in Montreal at the hair restoration meeting. I have missed no forum meetings this year because I make that a priority. We are all given one miss. I take that to mean zero if at all possible.
Reading this weekend entries from a young gentleman from the UK in my forum postings, I like what he said, “a mentor/friend of mine said that you become the top 5 people you surround yourself with. it led me to change my entire social circle, create a mastermind, and my life has changed so drastically over the last year, and continues to every single day. It’s really hard to get rid of negative influences in your life, especially when you bonded and create some level of co-dependency. So I absolutely agree with thoughts in this post!” Thanks Vince for your wonderful entries. He also offered his apologies for talking about irrelevant subjects on this website. I have made it a point that there is no such things by opening a section called “Tell me about your passions”. This website aspires to be much more than a website on facial cosmetic surgery. It is about a community inspired to change the thinking of the world. Okay, once again I get ahead of myself. Read Wednesday’s blog.
Wait Times Best in Texas!
November 14, 2008 by dr. lam · Leave a Comment
Jan May, our Botox business development rep, just gave us the good news: we have the best wait times in Texas based on a uniform customer satisfaction survey provided nationally. Remember these are only the top practices across the U.S. that even get these services so these are the busiest practices that at least reach platinum status with Allergan (300+ bottles of Botox a year, which we are way over). Obviously, for a slow practice with 10 patients a day, you would expect the wait times to be great. However, we are the best of the busiest and that says a lot.
I am obsessed with quality customer service and so is my staff so I am extremely proud that despite our very busy practice that we can garner this distinction. In addition, I always make it a point to make sure that my patient knows that I am running behind if I am, and I do so personally myself rather than delegate that responsibility to my staff. Further, my staff tries to ensure that every waiting patient is attended to with appropriate amenities to make their time more enjoyable and perceptually less prolonged. In short, I am really happy with our results, and I am glad that my patients overall are satisfied with our expeditious service!