Time management involved with CPR.
June 21, 2011 7:43 AM Subscribe
The enclosed article link scared the heck out of me today as I am the wife of a man who has already had a very serious heart attack and the idea of his having another one is never completely out of my mind.
I have timed out the necessary steps I will need to do if he should ever have another one and I don't know how I can possibly do what I have to do in terms of starting CPR, contacting the paramedics and setting the house up for their arrival, etc.
Problem:
I have to immediately spring into action if the "worst" happens - run to the phone, call 911, explain the situation to them, give them the address and tell them how to get to our place which is situated in the back of a big complex with security doors, prop our front door open with something, catch the dog, put him in the bathroom as he will be going insane, then run back upstairs and begin CPR. As you can see this will take several minutes no matter how fast I go.
Can anyone think of a better way for me to do things?
I lie awake at night and try to imagine how I can shave off some time but according to this article, even a few seconds not performing CPR can cause a critical difference in survival.
I have timed out the necessary steps I will need to do if he should ever have another one and I don't know how I can possibly do what I have to do in terms of starting CPR, contacting the paramedics and setting the house up for their arrival, etc.
Problem:
I have to immediately spring into action if the "worst" happens - run to the phone, call 911, explain the situation to them, give them the address and tell them how to get to our place which is situated in the back of a big complex with security doors, prop our front door open with something, catch the dog, put him in the bathroom as he will be going insane, then run back upstairs and begin CPR. As you can see this will take several minutes no matter how fast I go.
Can anyone think of a better way for me to do things?
I lie awake at night and try to imagine how I can shave off some time but according to this article, even a few seconds not performing CPR can cause a critical difference in survival.
If this kind of thing is causing you so much stress that you're the one who might have a heart attack next, you might want to consider a modified security system or LifeAlert. You can register the stuff like the exact directions to your home and instructions to break down the security door, etc. Just push a button, they'll call 911 for you and relay the information on how to get in and get to you.
posted by juniperesque at 7:51 AM on June 21, 2011 [2 favorites]
posted by juniperesque at 7:51 AM on June 21, 2011 [2 favorites]
Tully -- have you ever taken a CPR class? I'm not asking you that because I'm thinking "what are you doing trying to give CPR if you never have done that before," I'm asking because I think that part of your anxiety may be coming from you feeling overwhelmed by what CPR would involve. And the best way to deal with that is, information and training.
I would try taking a CPR or first-aid class, just for peace of mind. First-aid classes can not just prepare you for what to do in the case of an emergency (and knowing that you KNOW what to do in case of emergency is very reassuring emotionally, to boot), they can help you sort through which of those steps you can maybe overlook. (Like, the dog -- I have a feeling that securing the dog in the bathroom may be a step you can skip.) But a good first aid class can help prepare you for this, and also help you sort through the feelings of "there are so many things I have to do how am I going to do them all".
posted by EmpressCallipygos at 7:52 AM on June 21, 2011
I would try taking a CPR or first-aid class, just for peace of mind. First-aid classes can not just prepare you for what to do in the case of an emergency (and knowing that you KNOW what to do in case of emergency is very reassuring emotionally, to boot), they can help you sort through which of those steps you can maybe overlook. (Like, the dog -- I have a feeling that securing the dog in the bathroom may be a step you can skip.) But a good first aid class can help prepare you for this, and also help you sort through the feelings of "there are so many things I have to do how am I going to do them all".
posted by EmpressCallipygos at 7:52 AM on June 21, 2011
Isn't this article about the time between stopping CPR and when the paramedics do their thing? And it's about cardiac arrest, which isn't precisely the same as a heart attack. I don't think these two things mean that you have ten seconds to start CPR after a heart attack.
Is there any way for you to consult with your husband's doctor about the best way to plan for this (even though you hope it will never ever happen)? Can you carry a cell phone?
posted by Frowner at 7:53 AM on June 21, 2011
Is there any way for you to consult with your husband's doctor about the best way to plan for this (even though you hope it will never ever happen)? Can you carry a cell phone?
posted by Frowner at 7:53 AM on June 21, 2011
Lock the dog up. Call 911 on speakerphone. While the phone is ringing through, start CPR. (1-2 min)
The first responders will find their way to you. You can assist on the phone but to assume that they won't be able to find you and get in just because the door is locked is not the case.
posted by rdurbin at 7:53 AM on June 21, 2011 [1 favorite]
The first responders will find their way to you. You can assist on the phone but to assume that they won't be able to find you and get in just because the door is locked is not the case.
posted by rdurbin at 7:53 AM on June 21, 2011 [1 favorite]
I'd consider purchasing a home defibrillator. (Ask your husband's doctors first.)
posted by apartment dweller at 8:00 AM on June 21, 2011 [3 favorites]
posted by apartment dweller at 8:00 AM on June 21, 2011 [3 favorites]
It's always so frightening when a loved one has a serious health scare, and it's understandable that you're thinking this over. Was the heart attack recent? Have you had a chance to process your fear around that? Talking to a therapist might help you manage some of the anxiety that is clearly overwhelming.
Have you and your husband spoken to his physician about this? It would help to get a good and realistic assessment of what his health risks are and what you can do together to minimize those risks. Is he at risk for another cardiac episode? What can he do to treat that? In many cases, a heart attack does not immediately stop the heart and respirations, so quick action in other ways would be needed (e.g., should he take aspirin? What signs should you be looking out for as early signs of heart trouble, if any?). You can make sure that you're prepared for these things so it doesn't come to having to perform CPR.
Take a refresher CPR course. They run you through just these scenarios so that your response is automatic and you don't have to trouble shoot in a crisis. Ask for help coming up with a plan for if there is a health emergency with anyone anywhere and you are alone. Practice that routine until it's automatic. You should also know that emergency responders will be able to access security gates. You don't have to worry about that step.
Finally, it is possible to get an automatic external defibrulator (AED) device that you can store at home. This device takes care of monitoring heart activity and delivering a shock if needed and will also run you through the steps of CPR if needed. They are available in most public spaces these days. A medic alert button or something simlar might also give you some peace of mind, but these are more drastic steps, and I would talk to his doctor about what is truly warranted in your husband's case.
Take good care of yourself, so you can keep taking care of him.
posted by goggie at 8:01 AM on June 21, 2011
Have you and your husband spoken to his physician about this? It would help to get a good and realistic assessment of what his health risks are and what you can do together to minimize those risks. Is he at risk for another cardiac episode? What can he do to treat that? In many cases, a heart attack does not immediately stop the heart and respirations, so quick action in other ways would be needed (e.g., should he take aspirin? What signs should you be looking out for as early signs of heart trouble, if any?). You can make sure that you're prepared for these things so it doesn't come to having to perform CPR.
Take a refresher CPR course. They run you through just these scenarios so that your response is automatic and you don't have to trouble shoot in a crisis. Ask for help coming up with a plan for if there is a health emergency with anyone anywhere and you are alone. Practice that routine until it's automatic. You should also know that emergency responders will be able to access security gates. You don't have to worry about that step.
Finally, it is possible to get an automatic external defibrulator (AED) device that you can store at home. This device takes care of monitoring heart activity and delivering a shock if needed and will also run you through the steps of CPR if needed. They are available in most public spaces these days. A medic alert button or something simlar might also give you some peace of mind, but these are more drastic steps, and I would talk to his doctor about what is truly warranted in your husband's case.
Take good care of yourself, so you can keep taking care of him.
posted by goggie at 8:01 AM on June 21, 2011
Oh my heart is breaking for you - I know how hard it is to stop worrying and planning but it sounds like it has reached a nasty point for you. I have a feeling that your worry and stress over logisitics is really just a distraction from deeper concerns.
My mother trained to be a 911 operator (before she realized that she did not have the fortitutde for the job) and let me tell you it won't happen the way you have imagined. The first thing the 911 operator will instruct you to do is begin CPR if you know how (and I would urge you to get trained if you haven't already). Forget about the dog unless he will pose a danger to paramedics - you can deal with him when the paramedics arrive. Forget about propping open the door - they will either get it open or the 911 operator will instruct you to stop CPR and let them in.
Also, you have a lot longer than 10 seconds after a heart attack to start CPR - I was instructed that we should try and start within minutes. Cardiac arrest is a different (but related?) thing.
posted by muddgirl at 8:01 AM on June 21, 2011
My mother trained to be a 911 operator (before she realized that she did not have the fortitutde for the job) and let me tell you it won't happen the way you have imagined. The first thing the 911 operator will instruct you to do is begin CPR if you know how (and I would urge you to get trained if you haven't already). Forget about the dog unless he will pose a danger to paramedics - you can deal with him when the paramedics arrive. Forget about propping open the door - they will either get it open or the 911 operator will instruct you to stop CPR and let them in.
Also, you have a lot longer than 10 seconds after a heart attack to start CPR - I was instructed that we should try and start within minutes. Cardiac arrest is a different (but related?) thing.
posted by muddgirl at 8:01 AM on June 21, 2011
Call the fire department and ask if they can come do a site survey of your house / housing development. I _think_ (IANAFF) the fire department can put notes into the 911 system that are associated with your address. That way, if you call 911, they know what to expect from your development / house.
posted by tayknight at 8:04 AM on June 21, 2011 [2 favorites]
posted by tayknight at 8:04 AM on June 21, 2011 [2 favorites]
Call your local Red Cross chapter and ask if they have a preparedness class for home medical emergencies, in addition to their CPR class. Then take them. Make your plan for responding (writing it down helps) and practice responding. That creates a habit which allows for better reactions in the event of an emergency. You may find that it's impractical to deal with the dog immediately. Once when my mom drove my dad to the hospital during a cardiac event (it was faster than waiting for the ambulance and my parents had already discussed best courses with dad's doctor), she left one of the dogs hysterical in the yard for several hours. I imagine that your concern is the dog getting in the way when help arrives or barking over your conversation with 911, but you may find it's more practical to deal with the dog after help arrives, rather than before.
I recommend this book all the time, but if you think your anxiety levels can take it, read The Unthinkable: Who Survives When Disasters Strike and Why. Basically, the book shows that measure, controlled, calm response makes an extraordinary difference in crisis and it is a learned response for nearly everybody. Disaster planning and physically practicing the motions you will go through, help your brain over-ride both panic and inertia in a crisis. So, what you are doing (rehearsing the worst-case) is actually helpful. You'll probably feel a little silly running "heart attack drills" but there is good evidence that it's useful to do. (That's basically the take away from The Unthinkable, so I guess there's no reason for you to read it, except that it's an interesting book).
posted by crush-onastick at 8:18 AM on June 21, 2011 [2 favorites]
I recommend this book all the time, but if you think your anxiety levels can take it, read The Unthinkable: Who Survives When Disasters Strike and Why. Basically, the book shows that measure, controlled, calm response makes an extraordinary difference in crisis and it is a learned response for nearly everybody. Disaster planning and physically practicing the motions you will go through, help your brain over-ride both panic and inertia in a crisis. So, what you are doing (rehearsing the worst-case) is actually helpful. You'll probably feel a little silly running "heart attack drills" but there is good evidence that it's useful to do. (That's basically the take away from The Unthinkable, so I guess there's no reason for you to read it, except that it's an interesting book).
posted by crush-onastick at 8:18 AM on June 21, 2011 [2 favorites]
I feel for you, as I have been/am in the same situation. I agree totally with everything above, especially staying calm and practicing (even if just mentally) to remain calm.
Generally, there are "clues" to oncoming heart attacks (and heart attacks do not necessarily cause cardiac arrest immediately). 911 should be called at the first signs of potential heart attack. (Pain in chest, upper arms; squeezing feeling; irregular heartbeat-- you and hubby should study all signs and symptoms so you can recognize them earlier rather than later).
Talk to your local first responders, they will be quite happy to talk with you, make an appointment if you need to, and they likely may be able to calm some of your fears.
Do look into home security as mentioned above, or is there a neighbor you could rely on to step in and help you? Maybe a neighbor is in a similar situation and you can work out an agreement to help each other.
Memail me if you want.
posted by batikrose at 8:51 AM on June 21, 2011
Generally, there are "clues" to oncoming heart attacks (and heart attacks do not necessarily cause cardiac arrest immediately). 911 should be called at the first signs of potential heart attack. (Pain in chest, upper arms; squeezing feeling; irregular heartbeat-- you and hubby should study all signs and symptoms so you can recognize them earlier rather than later).
Talk to your local first responders, they will be quite happy to talk with you, make an appointment if you need to, and they likely may be able to calm some of your fears.
Do look into home security as mentioned above, or is there a neighbor you could rely on to step in and help you? Maybe a neighbor is in a similar situation and you can work out an agreement to help each other.
Memail me if you want.
posted by batikrose at 8:51 AM on June 21, 2011
This defibrillator will not only detect if the heart rhythm needs to be shocked or not, but it will also tell you if your CPR compressions are too shallow or too deep, and too fast or too slow. It has a handy little bar graph and metronome. Defibrillator companies in general these days are taking articles like this one to heart and making the devices more CPR-friendly.
posted by Melismata at 9:03 AM on June 21, 2011
posted by Melismata at 9:03 AM on June 21, 2011
Response by poster: Thanks for the great and kind advice.
I took a CPR class years ago and I keep up with the latest techniques (hand over hand, using the heels, press 2" deep into the chest on the breastbone to the beat of "Stayin' Alive")
BTW, this linked article has the latest info re: seconds matter.
Background: He had a "widowmaker" heart attack 15 years ago and had a lot of heart damage as he lay around in the local ER on Thanksgiving Day night when they had short staff. We just drove over there as we didn't know what was wrong with him (throwing up and chest pain.)
He is on a combination of the Ornish diet with a little more fat added via the Mediterranean Diet. He runs every day (age 68) is tall and thin and never had high cholesterol (!) He meditates and, in fact, became a Buddhist after his h.a. His cardiologist is the dept head at the University of Chicago and that's the best we can get!
Yes, I am a very anxious person and I always feel I have to be on guard and prepared for anything that might come up.
Oh, the dog would definitely interfere with the paramedics as he is so protective. I still would have to have the front door propped open so they can get in.
I really need to explore that home unit for those paddles (sorry I can't think of the proper term) and get trained on them that way I could have it with me when we travel, etc.
Thanks so much for your kind advice.
posted by Tullyogallaghan at 9:13 AM on June 21, 2011
I took a CPR class years ago and I keep up with the latest techniques (hand over hand, using the heels, press 2" deep into the chest on the breastbone to the beat of "Stayin' Alive")
BTW, this linked article has the latest info re: seconds matter.
Background: He had a "widowmaker" heart attack 15 years ago and had a lot of heart damage as he lay around in the local ER on Thanksgiving Day night when they had short staff. We just drove over there as we didn't know what was wrong with him (throwing up and chest pain.)
He is on a combination of the Ornish diet with a little more fat added via the Mediterranean Diet. He runs every day (age 68) is tall and thin and never had high cholesterol (!) He meditates and, in fact, became a Buddhist after his h.a. His cardiologist is the dept head at the University of Chicago and that's the best we can get!
Yes, I am a very anxious person and I always feel I have to be on guard and prepared for anything that might come up.
Oh, the dog would definitely interfere with the paramedics as he is so protective. I still would have to have the front door propped open so they can get in.
I really need to explore that home unit for those paddles (sorry I can't think of the proper term) and get trained on them that way I could have it with me when we travel, etc.
Thanks so much for your kind advice.
posted by Tullyogallaghan at 9:13 AM on June 21, 2011
Maybe this is a good time to teach your dog "come" and a command ("shelter"?) to go into a specific spot. If you don't have to catch the dog but just have to shut the door behind him then that will save a lot of time. A rock solid "come" is probably the most useful thing you can teach your dog, ever.
posted by anaelith at 9:15 AM on June 21, 2011 [1 favorite]
posted by anaelith at 9:15 AM on June 21, 2011 [1 favorite]
Oh, the dog would definitely interfere with the paramedics as he is so protective.
At the point at which the paramedics arrive, you can deal with the dog. If he is a real danger to first responders, then maybe positive-reinforcement obedience training would be a worthwhile use of time.
We just drove over there as we didn't know what was wrong with him (throwing up and chest pain.)
I think this is actually the most important thing you can plan to do - be vigilant for symptoms and encourage him to seek help even if they seem relatively minor.
posted by muddgirl at 9:22 AM on June 21, 2011
At the point at which the paramedics arrive, you can deal with the dog. If he is a real danger to first responders, then maybe positive-reinforcement obedience training would be a worthwhile use of time.
We just drove over there as we didn't know what was wrong with him (throwing up and chest pain.)
I think this is actually the most important thing you can plan to do - be vigilant for symptoms and encourage him to seek help even if they seem relatively minor.
posted by muddgirl at 9:22 AM on June 21, 2011
Tully - there is a lot of confusion on this thread so please be cautious when listening to this advice as I can see that many people are confused about the difference between a heart attack and a cardiac arrest.
For those reading, a heart attack occurs when part of your heart is not getting enough oxygen, usually due to a blockage in a blood vessel of the heart. This typically results in chest pain, nausea, shortness of breath, sweating, or some combination of these symptoms. It does not require CPR on its own. When having symptoms of a heart attack, the best thing to do is call 911 for an ambulance so that the person having the heart attack can get medical care as quickly and safely as possible.
Sometimes, bad heart attacks can result in a cardiac arrest, which means that the heart actually stops beating, and the person has no pulse. When a person collapses or is unresponsive, the first thing to do is to check the pulse and whether they are breathing -> if not, start CPR. If the person is talking, they nearly always have a pulse and are breathing!
Tully, my advice to you is that if your husband collapses and is unresponsive, you must immediately call for help. If anyone is within hearing distance, have them do the phone call to 911 while you initiate chest compressions. You will not need to give detailed directions - they have GPS and maps! Just give your address and say you need an ambulance because your husband has collapsed. It should only take about 30 seconds to 1 minute to make the call. If no one is within hearing distance, then you must call 911 as quickly as possible, then go back and start chest compressions.
After you have done several cycles of chest compressions and rescue breaths (remember, the new guidelines do allow "Hands Only CPR" if you are not trained - this is chest compressions only with no breaths and it is easier for most people to perform), THEN go to prop the locked door open, and immediately return to do chest compressions and continue until the arrival of EMS.
So I would alter your sequence in this way:
Instead of
1. Call 911
2. Prop door open
3. Chase dog and put it away
4. Perform CPR
Change your sequence to:
1. Call 911
2. Perform CPR
3. Prop door open
Are you seriously going to stop CPR to put the dog away, when it means time that your husband is not getting oxygen to his brain and other vital organs? Unless the dog is physically putting itself between you and your husband and not allowing you to perform compressions, just ignore him.
Remember, the article you linked to is about time to DEFIBIRLLATION, which cannot happen until the EMS arrive. The way you ensure that the EMS arrive as quickly as possible is to call 911 immediately. After that, your first responsibility is to perform bystander CPR to ensure that your husband is getting some oxygen to his brain and other vital organs, which will maximize his chances of surviving a cardiac arrest.
Click here for the link to the AHA 2010 guidelines, which describe all the significant changes including the recommendation for Hands Only CPR.
posted by treehorn+bunny at 11:10 AM on June 21, 2011 [3 favorites]
For those reading, a heart attack occurs when part of your heart is not getting enough oxygen, usually due to a blockage in a blood vessel of the heart. This typically results in chest pain, nausea, shortness of breath, sweating, or some combination of these symptoms. It does not require CPR on its own. When having symptoms of a heart attack, the best thing to do is call 911 for an ambulance so that the person having the heart attack can get medical care as quickly and safely as possible.
Sometimes, bad heart attacks can result in a cardiac arrest, which means that the heart actually stops beating, and the person has no pulse. When a person collapses or is unresponsive, the first thing to do is to check the pulse and whether they are breathing -> if not, start CPR. If the person is talking, they nearly always have a pulse and are breathing!
Tully, my advice to you is that if your husband collapses and is unresponsive, you must immediately call for help. If anyone is within hearing distance, have them do the phone call to 911 while you initiate chest compressions. You will not need to give detailed directions - they have GPS and maps! Just give your address and say you need an ambulance because your husband has collapsed. It should only take about 30 seconds to 1 minute to make the call. If no one is within hearing distance, then you must call 911 as quickly as possible, then go back and start chest compressions.
After you have done several cycles of chest compressions and rescue breaths (remember, the new guidelines do allow "Hands Only CPR" if you are not trained - this is chest compressions only with no breaths and it is easier for most people to perform), THEN go to prop the locked door open, and immediately return to do chest compressions and continue until the arrival of EMS.
So I would alter your sequence in this way:
Instead of
1. Call 911
2. Prop door open
3. Chase dog and put it away
4. Perform CPR
Change your sequence to:
1. Call 911
2. Perform CPR
3. Prop door open
Are you seriously going to stop CPR to put the dog away, when it means time that your husband is not getting oxygen to his brain and other vital organs? Unless the dog is physically putting itself between you and your husband and not allowing you to perform compressions, just ignore him.
Remember, the article you linked to is about time to DEFIBIRLLATION, which cannot happen until the EMS arrive. The way you ensure that the EMS arrive as quickly as possible is to call 911 immediately. After that, your first responsibility is to perform bystander CPR to ensure that your husband is getting some oxygen to his brain and other vital organs, which will maximize his chances of surviving a cardiac arrest.
Click here for the link to the AHA 2010 guidelines, which describe all the significant changes including the recommendation for Hands Only CPR.
posted by treehorn+bunny at 11:10 AM on June 21, 2011 [3 favorites]
Don't plan on taking time to deal with the dog when you're the only one in the house with your husband. Wait to take the time to deal with the dog until after the first responders get there. Your husband will do better with one-half of a distracted paramedic team than he will with nobody at all, and since the paramedics frequently come in pairs, one of them can give your husband his full attention while you and the other one deal with the dog.
As for the door -- you don't need to prop it. Call your building's manager and tell him or her to do it; this is part of their job. This is what I would recommend for your plan:
0. Call your building manager now, today, and explain the situation. Agree on a plan. I would have the plan be for the manager to meet the paramedics at the entrance to the building and bring them back to your unit. Again, this is part of the manager's job.
1. Call 911 from your cell phone. Start CPR while you talk to the good people at 911. Give your apartment number and explain that the manager will meet them. If you have the slightest hesitancy about the manager's reliability, ask the 911 operators to also call the police to deal with the security doors.
2. Call the manager and give the go signal.
3. When the paramedics and the manager arrive, hand your husband off to the paramedics, and you and the manager deal with the dog.
The key to success in your situation is to delegate. As you've correctly noted, it's very hard for one person to do everything that needs to be done to support the best outcome. The building manager is your ally here!
Once you've come up with your plan, practice it. Have your husband occasionally sing out "Heart attack drill!" and then go through all the steps: pretend to call 911, mock CPR, pretend to call the manager. Use the actual words you'll use; focus on speaking loudly, clearly, and slowly. You can't control the if or the when, but you CAN prepare for the how.
posted by KathrynT at 11:16 AM on June 21, 2011 [1 favorite]
As for the door -- you don't need to prop it. Call your building's manager and tell him or her to do it; this is part of their job. This is what I would recommend for your plan:
0. Call your building manager now, today, and explain the situation. Agree on a plan. I would have the plan be for the manager to meet the paramedics at the entrance to the building and bring them back to your unit. Again, this is part of the manager's job.
1. Call 911 from your cell phone. Start CPR while you talk to the good people at 911. Give your apartment number and explain that the manager will meet them. If you have the slightest hesitancy about the manager's reliability, ask the 911 operators to also call the police to deal with the security doors.
2. Call the manager and give the go signal.
3. When the paramedics and the manager arrive, hand your husband off to the paramedics, and you and the manager deal with the dog.
The key to success in your situation is to delegate. As you've correctly noted, it's very hard for one person to do everything that needs to be done to support the best outcome. The building manager is your ally here!
Once you've come up with your plan, practice it. Have your husband occasionally sing out "Heart attack drill!" and then go through all the steps: pretend to call 911, mock CPR, pretend to call the manager. Use the actual words you'll use; focus on speaking loudly, clearly, and slowly. You can't control the if or the when, but you CAN prepare for the how.
posted by KathrynT at 11:16 AM on June 21, 2011 [1 favorite]
run to the phone, call 911, explain the situation to them, give them the address and tell them how to get to our place which is situated in the back of a big complex with security doors
A couple of suggestions: if your cell phone is small enough, keep it in your pocket at all times, even when you're home. That takes care of any phone delay. Also, write down clear and simple directions to your place (and your address!) and keep that in your pocket, so you won't have to try to figure out what to say when you're flustered.
posted by bentley at 9:01 PM on June 21, 2011
A couple of suggestions: if your cell phone is small enough, keep it in your pocket at all times, even when you're home. That takes care of any phone delay. Also, write down clear and simple directions to your place (and your address!) and keep that in your pocket, so you won't have to try to figure out what to say when you're flustered.
posted by bentley at 9:01 PM on June 21, 2011
This thread is closed to new comments.
posted by Oktober at 7:51 AM on June 21, 2011 [1 favorite]