Rebecca and the 'rescue breaths'

Discussion in 'Rebecca Zahau Nalepa' started by Ausgirl, Oct 23, 2012.

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  1. Ausgirl

    Ausgirl Enough Is Enough!

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    I looked for a thread on this topic and couldn't find one. Sorry if it's a repeat. Mainly, it's a place to discuss this:

    From what I have read, XZ told the 911 operator that Rebecca was attempting to revive Max during the call. I must admit to having no clear idea where XZ was at the time, and whether she could see what was happening or had to be told.. in any case, that's what she told 911.

    Rebecca is herself known to have made various claims and denials as to what she actually did for Max as far as those attempts went (if anyone can help me with the timeline for those, I'd be grateful.. Not being lazy, I'm in migraine mode and too much screen-hopping sets me off, sorry ><) but the EMS report is quite clear that Max did NOT receive CPR, and there's also no mention of any 'rescue breaths' or any other attempts prior to their arrival to revive him at all in that report, is there?

    Then we have the fact that Max was quite severely oxygen deprived. Four minutes elapsed between the time of dispatch (close to the time of Max having breath enough to whisper the dog's name to Rebecca), to when the ambulance arrived to find Max's heart had stopped and he was very blue.

    Would Max have been so severely oxygen deprived, had he actually received any 'rescue breaths' at all? I understand that his airways were compromised due to his injuries, but if he was breathing shortly before the call (as that whisper Rebecca said he made implies) and there were attempts to revive him during the call, and the ambulance arrived scant minutes later -- would he have been less blue (to use layman's plainspeak) than he was?

    I'm inclined to believe, due to Rebecca's changing story and lack of clarity on details given the medics (why not 'I tried to revive him for about X minutes' rather than being cagey about it, when it was obviously a vitally important detail..), that Max may not have received 'rescue breaths' from Rebecca after all.

    Interesting take on the message, Zinn - it was my immediate 'read' on it, even prior to knowing there was doubt about the help offered to Max by Rebecca. Not just a 'feeling' - but a take on the structure of the exact phrasing itself, when viewed in conjunction with the peculiar staging of Rebecca's body, which says to me 'sarcasm', and therefore an accusatory tone.

    I do believe her death was murder, and the crime scene heavily and carefully staged. So the message fits rather neatly with that, and with possible perceptions of doubt on behalf of her killer, as to whether Rebecca was wholly truthful regarding the circumstances of Max's death.


    Apologies if this is a bit rambly, my head is really thumping... ><
     
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  3. Inparadise

    Inparadise Verified Insider - Rebecca Zahau Case

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    Airway, Breathing & Circulation work in a cascade; if the patient's airway is blocked, breathing will not be possible, and oxygen cannot reach the lungs and be transported around the body in the blood, which will result in hypoxia and cardiac arrest. Ensuring a clear airway is therefore the first step in treating any patient; once it is established that a patient's airway is clear, rescuers must evaluate a patient's breathing, as many other things besides a blockage of the airway could lead to an absence of breathing
     
  4. K_Z

    K_Z Verified Anesthetist

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    I understand the temptation to reduce a cardiac arrest to something simple, as in “air is good”. It’s important to remember that Max did not suffer cardiac arrest as a result of oxygen deprivation. He suffered complete asystole secondary to blunt force cranial trauma that produced a very serious central nervous system insult at the highest point in the spinal cord, where it joins the brain stem. His cardiac arrest was about 30 min in length, and he ultimately died as a result of the brain swelling following his resuscitation.

    If you go to the EMS report thread, there are a number of studies I posted that document the outcomes of children who sustain cardiac arrest in the field secondary to blunt force trauma. Some of the retrospective studies were done in San Diego, with hundreds of patients, in the same place Max was. The overall survival rate hovers around 1%-- and of those 1%, none were even close to neurologically intact (only one had any level of consciousness), and the rest were in a persistent vegetative state. Cardiac arrest in children secondary to blunt force trauma is better than 99% fatal, no matter what kind of out of hospital care they received. One study suggested that health care professionals should acknowledge that prolonged resuscitative efforts are often successful only as to maintaining a potential organ donor.

    It’s also important to understand that cardiac arrest physiology is not the same as “living” physiology. No matter how much oxygen you “pump” in, there is seriously altered chemistry at the cellular level. Even with some circulation from very high quality chest compressions, the ability to load and unload oxygen at the cellular and tissue level is severely altered—and gets worse as time goes on. All cellular metabiolism is severely deranged. Meaning, red cells don’t carry oxygen like they normally do, and what little oxygen they do have is not easily released at the tissue level. (This is a greatly simplified summary-- entire textbooks are written on this.)

    Max was in a full cardiac arrest at the scene—asystole. Rescue breaths would be "nice", but wouldn’t make a bit of difference in the big picture of what his injuries were. The persistent focus on “rescue breaths” and “CPR or no CPR” is a complete distraction from acknowledging that Max’s injuries were devastating, and virtually assured he would not survive to discharge from the hospital. He had a healthy 6 year old heart, which paramedics were finally able to restart.

    I seriously doubt any of his physicians held out any hope for him to live, let alone recover any meaningful neurological function. I’m confident Max’s hospital records document how dismal his prognosis was on arrival at Rady—and certainly after the first MRI (within minutes to hours) this would have been confirmed. I understand that Dina has said things to the contrary that indicate she either did not understand what the docs were telling her, or she was in a state of denial due to shock. She has not released any of the documentation in Max's medical records to support her claims and accusations. I personally do not believe there is anything in Max's records to support what she has said about her knowledge of his prognosis in the first couple days.

    The EMS thread has some good conversation on this, Ausgirl.
     
  5. Zinn

    Zinn New Member

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    Thank you, Ausgirl! This helps me understand that there may be some who believe Max did not receive CPR or rescue breaths based on his worsening condition at the scene. This had not occurred to me given the time and effort required by EMS to get his body to respond.

    Can you please link to the evidence that Rebecca gave conflicting reports about what she did for Max? I haven't seen that.

    Also, I don't remember the origin of "rescue breaths" in this case. Can someone remind me? I hear the 911 snippet in which XZ said "resuscitating" and I heard NR's interview that focused greatly on a claim of CPR. I also saw SDSO's presentation that said "CPR in progress" in reference to the 911 call (don't know if that was an interpretation of "resuscitating" or if XZ actually said "CPR" at another point in the call), but I haven't seen the EMS report as I will not visit the site at which it is hosted. Based on comments here, I thought the EMS report said no CPR was given prior to arrival, but did it actually say "rescue breaths"? Or did Rebecca tell EMS "rescue breaths"?
     
  6. time

    time New Member

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    Thanks for another excellent explanation. I hope this link back to page 3 of "Max Shacknai EMS Report" works. It seems to be where a lot of the discussion about 'rescue breaths' occurs, most recently.

    http://websleuths.com/forums/showthread.php?p=8396564&highlight='rescue+breaths'#post8396564
     
  7. JBean

    JBean Retired WS Administrator

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    This has been a controversial topic that has resurfaced over and over. So much so that it has not been open for discussion.

    Let's give this thread a try and see if it can be discussed here.

    But it absolutely MUST stay off the other threads. No exceptions. If it still creeps into the other threads,gets hostile or hard to manage- we will have to make adjustments.

    If this topic is resolved in your mind and do not feel additional discussion is required then I urge you to not click on this thread.

    Thanks.
     
  8. Zinn

    Zinn New Member

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    BBM

    K_Z, I always appreciate your posts and have learned so much from you. However, I must respectfully disagree that the topic of "CPR or no CPR" is merely a distraction. I personally feel understanding the origin of this belief could help us understand a potential motive for murdering Rebecca. And I'm still not clear on the genesis of this belief. I was wondering what piece of evidence might lead someone to believe Rebecca lied about this.

    Additionally, I may be in the minority in that I suspect the message on the door was written for the audience of one person, JS, suggesting the author felt he was complicit in this alleged lie about CPR. So I am trying to breakdown the events leading up to Rebecca's death to get a sense of when and why a murderer might have been convinced that Rebecca and JS lied about this.

    All of the above is just my opinion.
     
  9. MyBelle

    MyBelle Well-Known Member

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    According to the AR, Rebecca told the first responder that she gave a few rescue breaths. However, rescue breaths without also doing chest compressions isn't effective and I think that's why the Paramedic reported no CPR was done. Both the brain and the heart need the circulated blood. This article explains it:

    Many experts said some inexperienced rescuers who try to perform mouth-to-mouth breathing may take valuable time away from urgently needed continuous chest compressions.

    "If I'm laying here and we're waiting for the defibrillator to arrive, I don't need oxygen [right away], I need circulation of the air I have to my vital organs," said Page. "As you push hard and fast, you are moving air."



    http://abcnews.go.com/Health/HeartH...ns-effective-rescue-breaths/story?id=11272055
     
  10. Zinn

    Zinn New Member

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    Thanks, MyBelle. So was the AR the first indication that there may be been different terms used by Rebecca ("rescue breaths") and JS ("CPR")? Or is there a belief that JS purposely changed the wording from "rescue breaths" to "CPR" when reporting what he knew of the incident? Or is the belief that Rebecca told first responders "rescue breaths" and then told JS "CPR"? I am still trying to pin down when and why the perception of a lie came about.
     
  11. Betty P

    Betty P Well-Known Member

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    Thanks, K_Z for bringing some evidence based medicine into the discussion. I also agree that members of Max's family were probably in denial about his condition in the first days after the accident. Let's hope that those who remain in denial eventually accept the truth. It will make their lives and the grieving process much easier.
     
  12. Zinn

    Zinn New Member

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    Thank you, JBean.

    To be clear, my goal is to explore the origin of the belief that Rebecca falsely claimed to provide CPR. My goal is not to rehash whether she performed CPR or rescue breaths or neither, though it is certainly a related topic. Maybe my exploration of this would make more sense attached to the thread about the message on the door as I find it thematically similar to claims that Rebecca did not provide CPR. If so, feel free to move my comments to the thread about the message on the door.
     
  13. Inparadise

    Inparadise Verified Insider - Rebecca Zahau Case

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    I would suggest that Max's family was well aware of his grave condition within hours of his arrival at Rady, because someone from the family obviously communcated that information to the daughter of Dina's boyfriend, who posted the following on "Witty Profiles" around 8 pm on Monday evening:

    #3262032

    PLEASE READ.
    My Dad's girlfriend's son is in a coma.
    He fell off a balcony at his dads house this morning. He might not live. He's basically my little brother and I love him so much. They don't know if he'll live. He hasn't woken up since the fall. He doesn't have any brain activity going on. I'm worried sick. I can't stop crying. I can't go see him, my dad won't let me go. He's six. That's too ******ing young to die.
    I'll I'm asking for is for you to pray. Pray for Maxfield Shacknai. Please.
    I love you Max.
     
  14. Betty P

    Betty P Well-Known Member

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    Just to help with the discussion, I'm posting the latest timeline for that morning's events. Hope this helps.

    July 11th –

    Early AM – Max and Jonah drive Max’s two older half-siblings (Jonah’s older kids by Kimberly) to the airport for their prearranged scheduled flight to meet up with their mother in Phoenix.

    Mid-morning –

    – Jonah walks/runs to the gym for a workout.

    10:00 AM – Rebecca and Max wake XZ. XZ was to shower and Max clean his room. They had plans to go to the beach. According to Attorney Rudoy.

    – Dina scheduled to pick up Max from Jonah, according to Dina's recent press
    conference.

    10:00 AM approx – Max’s fall from the 2nd floor to the foyer happens. Rebecca was in one bathroom. XZ had gone upstairs to take a shower. Rebecca screams for XZ to call 911.

    10:10 AM – XZ Calls 911. Rebecca attempts CPR.

    10:12 AM – Coronado PD arrive. Rebecca claims that Max whispered “Ocean” the name of the dog in the house and then became unresponsive. The documents say that first responders found Max on his back, a razor scooter resting on his right shin, a soccer ball in the foyer and Ocean sitting on the landing. A broken chandelier laid shattered near Max’s left shoulder.

    10:24 AM – Rebecca calls Jonah at the gym to tell him about Max’s fall and he runs home in time to see Max being loaded into the ambulance. Jonah follows ambulance to Sharp Coronado ER.

    10:36 AM – Max arrives at Sharp Coronado ER. He is later transferred from Sharp Coronado ER to Rady Children’s pediatric intensive care unit.

    – Police attempt to locate Dina Shacknai.

    – XZ apparently cuts herself trying to help clean up the shattered glass from
    the chandelier. A police officer drives XZ and Rebecca to a local urgent care
    to have 4 stitches in her leg.
     
  15. Zinn

    Zinn New Member

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    Betty P - Regarding one of your above timeline points, I missed DS's comment about picking up Max. Did she say when she was due to pick him up?
     
  16. K_Z

    K_Z Verified Anesthetist

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    Respectfully snipped.

    My apologies, Zinn! I'm sorry for the misunderstanding, and for my curt use of the word "distracting". My thoughts were about a discussion of the medical efficacy of CPR in this situation.

    I also want to emphasize that I hope no one will misinterpret my words and think that no one should start CPR in a head injured child-- clearly, CPR should be attempted whenever practical, and when trained bystanders are emotionally and physically able to do so. CPR is not always possible, for a multitude of reasons. The discussion about the efficacy of CPR as predictive of outcome in cranial trauma and cardiac arrest is where my thoughts were. That is the part that I think is distracting.

    I do think that discussion of CPR and/ or rescue breaths as the basis for the beginning of a murder motive is worth having. I do understand (and strongly agree!) that this "CPR/ No CPR" has been grasped onto by Dina as though CPR would have equalled neurologically intact survival. She has inferred that she perceives and believes that Rebecca intentionally withheld CPR so as to cause Max to die, and couples this with her imagined "assault" on Max by Rebecca and/ or XZ. Combined with her vast misunderstanding or denial of Max's condition in the ICU, and Dr. Peterson's apparent and very unfortunate use of the word "suffocation" in some explanation/s, I do believe that these 3 things together provide a very plausible motive for Rebecca's murder. Certainly a more plausible motive than the poorly supported suicide conclusion that many people are incredulous about.

    Added thought:

    Please also remember that Max had a full stomach and quite a lot of passive regurgitation on arrival of the paramedics. They struggled to achieve even basic ventilation, and had to abandon intubation attempts. That also makes me question why anyone would think a layperson would have any BETTER chance at rescue breaths/ airway management than the paramedics did, with all of their advanced equipment, ambu bags, O2 sources, suction, basic and advanced airways, etc.

    The EMS report clearly indicates they had significant airway management challenges at the scene. The whole reason they went to the Coronado Sharp hospital FIRST, instead of directly to Rady, is because they did not have a secured airway for the longer trip. They needed help stabilizing him and achieving an airway, AND a pulse, before continuing to Rady. The EMS report indicates Max did not regain a pulse or electrical rhythm until he was in the Coronado ED.
     
  17. MyBelle

    MyBelle Well-Known Member

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    The AR is quoting the report filed by the first responding officer who said RZ told him she did the rescue breathing prior to his arrival. He made no mention of JS even being there at that point. The paramedics arrived within a couple of minutes of the call and initiated CPR right away.

    I think his attending doctors felt Max should have survived within that timeframe and his brain death is an indication he was deprived of oxygen far longer than the few minutes it took for help to arrive.

    JMO
     
  18. *Lash*

    *Lash* Justice 4 Rebecca

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    Another poster mentioned awhile ago that the CPR story almost sounds like the telephone game. I have to agree. Once Nina received the story that RZ had given CPR within 2 minutes, the story had been passed down by multiple people. I personally need more facts to understand why RZ is being accused of changing her story. I have not heard one fact to support this statement.

    Maybe more exists in the 911 call? Maybe more exists in the voicemail and email from RZ to Det. Adkins? What we do know is XZ told the dispatcher RZ was resuscitating Max. We do know the EMS report states no CPR administered prior to arrival. We do know according to Nina, Jonah stated RZ gave Max CPR within two minutes. In my opinion, it is important to note that this was not a first hand conversation between RZ and Nina. CPR was not mentioned when RZ picked Nina up from the airport. We do not know what RZ said! It is highly possible what RZ said has been misinterpreted by many, including the 911 dispatcher. When A dispatcher is typing an initial report, they are in speed mode to get out as much info as possible. The dispatcher could have changed the word resuscitate to CPR. RZ may have told the responders she attempted CPR but was not successful. She may have said she attempted rescue breaths but was not successful. How it is reported by the EMS responders is entirely up to them. Semantics? Maybe the EMS responders kept to the most pertinent details, which was CPR was not given prior to arrival and did not elaborate on any further details. Maybe Jonah changed RZ's words when repeating info he was told? Maybe RZ wanted Jonah to believe she did everything she could for Max? There are too many maybe's and not enough facts.

    In my opinion, the fact the EMS responders knew from the very beginning that CPR was not given prior to arrival is the most important and telling fact we have. The most important people at the time had the facts. This info would have been properly relayed to the hospital staff that would be receiving and caring for Max. The EMS responders knew CPR was not administered. How did the EMS responders know this, because of what RZ told either them or other officers.

    How it was relayed later by RZ, Jonah, Nina or whoever was not (imo) significant to Max's care or outcome. Only what was in the EMS report. This was a traumatic event for everyone involved. A tragedy that can cause PTSD. Words are said, images can be blocked and time almost stops for the families involved. The family is in crisis mode. I would not expect anyone in the first 24hrs of Max's accident to be in a normal state of mind. BUT, the EMS responders had the correct information. In my opinion, that is all that mattered for the hospital to properly care for Max.
     
  19. Betty P

    Betty P Well-Known Member

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    In one of her interviews, Dina mentioned she was planning to pick up Max that morning. I'm searching...

    The timeline comes from one that Lash has compiled and kept updated.
     
  20. Zinn

    Zinn New Member

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    So am I understanding correctly that there is not a perception that Rebecca lied? Rebecca gave rescue breaths and described them accurately as rescue breaths, but others later determined Max would have survived if he had received CPR instead of rescue breaths?
     
  21. Inparadise

    Inparadise Verified Insider - Rebecca Zahau Case

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    IIRC, it was noon.
     
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