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Annie...Annie...Are You Okay?

Summary:

Some new equipment, changes in protocols, combined with Chet and Johnny end up having consequences for poor Annie.

Work Text:

"Annie…Annie…Are You Okay?"

By: The Delirium Threemen

January 2013


"Annie…Annie…Are you okay?" John Gage asked the prone figure lying in front of him while doing a sternal rub.

She remained unresponsive. Using his index and middle finger he traced over to the side of her neck and pressed down firmly just under her jaw near the mid-point between her chin and earlobe.

"No pulse."

Her chest wasn't moving indicating that she wasn't breathing. He bent over and placed his ear near her nose and heard nothing nor did he felt the expulsion of air from her mouth. He tilted her head back and inserted a finger into her mouth and swept it around. Finding no obstruction in her airway, he lifted her chin, pinched her nose, and then used his mouth to form a seal over hers as he administered a rescue breath. He lifted his head slightly and took in a second breath, bent his head down, recreated a good seal and blew deeply into her mouth a second time and watched her chest rise.

"Begin compressions Chet." Johnny ordered.

"Try not to slip her the tongue Gage. I know she's of a similar construction to most of your regular dates…except this gal doesn't require a bicycle pump to get ready for for you." Chet smirked as he locked his fingers together, with his knuckles facing upward, before placing them on the sternum of the mannequin.

"Ha-ha. Bet this is the closest you've been to ANY woman's chest in a dog's age. Real or otherwise," Johnny shot back.

The sofa in the rec room squeaked as Captain Stanley leaned forward drawing his eyebrows downwards in a Grinch-like manner. He scratched the ears of the hound dog's head resting on his lap and whispered to Roy. "Can't those two ever be serious?"

Roy shrugged his shoulders and muttered, "Only in a real emergency."

Henry lifted his head from Hank's lap, yawned as he looked over at the two men in front of the couch. Finding them uninteresting he placed his head back onto the Captain's lap and closed his eyes.

"Ahh, ahh, ahh, ahh, stayin' alive, stayin' alive. Ahh, ahh, ahh, ahh, stayin' alive, stayin' alive." Chet sung to himself as he pushed hard on the doll's sternum.

Johnny shook his head. "It's not 15 to 2 anymore. Remember, its 30 compressions to 2 breaths. Start over again and quite the caterwauling."

"It helps me keep count." Chet retorted as he started another round of compressions.

"Feel the city breakin' and everybody shakin', And we're stayin' alive, stayin' alive. Ahh, ahh, ahh, ahh, stayin' alive, stayin' alive. Ahh, ahh, ahh, ahh, stayin' alive, stayin' alive."

Johnny performed two ventilations on the patient and Chet started another round of compressions.

"Feel the city breakin' and everybody shakin', And we're stayin' alive, stayin' alive. Ahh, ahh, ahh, ahh, stayin' alive, stayin' alive. Ahh, ahh, ahh, ahh, stayin' alive, stayin' alive."

Sitting cross-legged on the floor, Roy was studying the manual on the new rescue mannequin. On the couch behind him sat Captain Stanley with a sedentary Henry sprawled out across the empty cushion beside him with his head nestled on the Captain's lap and his tail draped over Marco's leg. Marco leaned forward from his spot on the far end of the couch and tapped Roy on the shoulder.

"Why did they change from 15:2 to 30:2?"

"Because the 5 second pause between chest compressions can reduce the coronary perfusion pressure by 50%. It can take between 5 to 10 compressions to rebuild it. If you're performing CPR by yourself that 5 seconds ends up being 15-16 seconds."

"Is he allowed to sing during CPR?" Captain Stanley asked.

"Sure…why not? Seems to help him with pacing and keeping track of his chest compressions."

"Yeah, but Roy don't you think it could come off as unprofessional out in the field?" Captain Stanley stated.

"Maybe…" Roy pondered the question a moment as he recalled some of the times he ran into someone who Johnny and he had taught in a CPR class months earlier and hearing that person comment on how much he or she had forgotten about performing it.

"Many people take CPR courses and have trouble remembering a lot of things. Another problem, not just with civilians, but professionals as well, is they don't thrust down hard enough or at the right pace. When that's the case, the blood doesn't circulate properly in the body."

The sound of a kitchen chair scraped across the floor as Mike moved in closer to join the conversation. "I suppose the tempo of a song like that could help someone remember how fast to do the compressions."

"A catchy song sticks in someone's mind," Marco added from the other end of the couch.

"That's a good point; it would be easy to remember a couple of verses of a song with the correct counts." Captain Stanley ran his hand across his chin. "But what about the problem of not pushing down hard enough?"

"The heavy beat of the song might inspire people to push more aggressively," Roy answered.

"So how does this new rescue dummy let you know if they're doing CPR right?" Marco inquired.

"It gives a printout like an EKG strip that shows whether your timing, depth of compressions, and sequence of events were all done properly."

"What's that metronome over there beside the doll supposed to measure?" Mike asked.

"Umm…yeah. The lights are supposed to let you know if you're doing the compression rates properly." Roy looked down at the pod-like device that should have been connected to the body of the mannequin. His eyebrows furrowed in puzzlement as the indicator lights on the electronic metronome failed to light up.

"Check the obvious Roy. Did they plug it in?" Mike smiled slyly.

Roy crawled over to the pod and gave it a slight tug revealing two thinner cords with round connectors hanging out of the end of the armored cable. "Figures, they didn't attach the sensors when they assembled the doll."

"What are those extra parts still in the box?" Marco inquired.

Roy picked up the booklet he had been reading earlier and flipped through the pages until he found the answer. "Apparently...you can attach the tubing and inflatable bulbs to the dummy and you can use one to simulate a carotid pulse and the other for dilating the pupils."

"Well neither one bothered to read the manual when they were setting her up," Captain Stanley pointed out. "Instead they decided to en-ter-tain us with a half hour of squabbling over what part when where."

"That's because 'real' men don't need to follow instructions," Marco dryly stated as crossed his hands over his chest.

Johnny moved in behind Chet. "Switch."

Chet moved sideways towards the head and changed positions seamlessly with Johnny. He checked the position of the head, pinched the nose, and gave two quick breaths before Johnny started his first round of compressions.

"Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh..."

Chet bent down and gave the rescue doll two breaths. Johnny bent slightly as he began his next round of compressions. Suddenly, he saw a flash of stars and his eyes began to automatically water.

"Dammit, Chet, ooo cracked me in duh 'ose," he complained as he gingerly palpated his nose.

"Well wait until I'm outta the way, man."

Johnny rolled his eyes and resumed his compressions.

"Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh..."

"Jeez, Gage, is that what you sound like on the extremely rare occasions you get lucky with a girl? No wonder you don't get any repeat business!" Chet uttered loud enough for everyone in the room to hear.

Chet performed two rescue breaths on the 'patient' as soon as Johnny finished his set of compressions.

"Dammit …will you quit bobbing hard-as-rock head up and down like a jack-in-the-box." Johnny yelped after having his teeth connect with the back of Chet's head. He raised his hand to his face and ran a finger across his teeth to make sure none of them had become embedded in Chet's skull.

"Make sure I'm outta the way first," Chet growled as he rubbed the back of his head.

"You don't need to be lifting your fat head up so high after your rescue breaths."

"Whatever." Chet rolled his eyes.

Captain Stanley looked down at the men practicing two-man CPR. "Twits," he muttered, shaking his head as Henry slinked off of his lap and moved towards Marco at the other end of the couch.

"Dammit, Gage!" Chet snarled as he pulled on the head of Rescusi Annie towards him.

Johnny glared at Chet. "How the hell am I supposed to do chest compressions on her stomach?"

"How the hell am I supposed to practice mouth-to-mouth when you keep knocking me in the head?" Chet's nostrils flared in anger.

Johnny gave Chet an indignant glare. He opened his mouth and closed it, then opened it again as he puffed out his scrawny chest like a banty rooster. He pointed an accusing finger towards Chet. "You're the one who keeps bangin' into me."

Johnny grasped the dummy's shoulders and dragged it back towards him. Chet placed his hands around the head and tugged it roughly back in his direction. Not to be outdone, Johnny gave a hard jerk to bring the doll back closer to him.

The two men stubbornly glared at ear other.

Johnny's eyes narrowed into a viper-like stare.

Chet jutted his jaw out stubbornly.

Grabbing the head of the doll, Chet ended up turning it completely sideways as it he jerked it towards him. At the same time, Johnny grabbed her shoulders gave a hard yank to pull the body in his direction.

"POP!"

"Now look what you've done," Johnny snarled.

"Don't blame me. You're the one who did it." Chet barked back.

"Fine." Johnny began doing chest compressions on the now headless Annie.

"Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh... Uhhh...Uhhh...Uhhh..."

Chet scrunched up his face, letting his tongue peeking out slightly from between his lips. He turned away from Johnny, bent down over the head, and performed two deep breaths into the mouth of the detached head. Johnny's lips curled into a sneer as he locked his fingers together, with his knuckles facing up and resumed his compressions on the doll's body.

"At least they're not fighting anymore." Roy snorted as he tried to suppress his laughter.

Marco chuckled. "Yeah, but they really can't go decapitating real patients in the field."

"I'm just glad the spirit of King Solomon stepped in before the two of them killed each other. That or Chet knocking Johnny out cold with his thick skull." Mike crossed his arms and leaned back in the chair he was sitting in.

"Damn twits. Brand, spanking-new, state-of-the-art equipment and THEY manage to bust it. How the hell am I going to explain this to headquarters?" An exasperated Captain Stanley looked up towards the ceiling and threw his hands up in a 'why me' gesture.

"Don't worry 'bout it Cap," Roy chortled. "They probably didn't have her head attached properly."

Captain Stanley looked over at Roy as a sense of relief filled his body. "You mean the dummy is idiot proof?"

"Not exactly." Roy opened the case beside him.

Hank leaned in closer as Roy pointed to the last column of instructions.

"She has several parts that have to be removed for cleaning. Over here are the instructions for removing her head," Roy explained. "They probably didn't button the chest cover which is why it came off so easily."

Captain Stanley studied the instructions. "I can't believe all the pieces that need to be cleaned for the upper and lower airways."

"Oh yeah, plus you still have to remove the chest wall to clean out the plastic lungs and soak everything in disinfectant."

Mike let out a low whistle. "Cleaning her makes latrine duty desirable."

The four men watching exchanged a few sly smiles and a couple of raised eyebrows with each other. A devious smile spread across Hank Stanley's face.


Author's Notes:

There are some 'historical factoids' that are off and I knowingly put them in this story. More or less, as a comparison of the 'old' and 'new.'

The idea to use the song "Stayin' Alive" by Chet to pace his compressions IS NOT mine. The use of the song "Stayin' Alive" while doing compressions was inspired by stumbling across a YouTube video by the British Heart Foundation for Hands-only CPR featuring Vinnie Jones. The tempo of the song (103 beats/min) almost matches the rate for performing hands-only CPR at 100 compressions/minute (no mouth-to-mouth). The person that the American Heart Association credits with the idea is Dr. Alson Inaba who is a pediatrician and professor at the University of Hawaii for coming up with the idea in 2005.

The change in compressions to ventilation rate would not have occurred during the time period Emergency! aired. The American Heart Association CPR protocol from 1974 to 2005 for 1 and 2 rescuer CPR was 15:2. In 2005 it was changed to 30:2. (Journal of American Academy of Physician Assistants, Nov 16, 2009).

Coronary Perfusion Pressure: The difference between aortic diastolic and right atrial diastolic pressure. CPP is a part of normal blood pressure that is specifically responsible for coronary blood flow.

The Recordable Resusci Annie manufactured by Leardal is the basis of the model used in the story. When the those models were first actually developed has been hard to pinpoint, so it is likely it came out after the 70s and sometime in the 80s. Some of the models used in the 70s, the face and upper airway were a single piece of plastic that had to be removed after each class and thoroughly cleaned and disinfected. Later versions of this doll would not have synthetic hair and included individual mouth/lips for each person to use, along with replaceable lungs that no longer required cleansing as infection control became a greater concern with the advent of HIV/AIDS.