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CPR discussion

Discussion in 'First Aid Station' started by filjos, Jul 19, 2012.

  1. filjos

    filjos Loaded Pockets

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    In another thread started by Matt Colman, titled "My 'Back of the Car' Rescue/Trauma Management Kit", (found here: http://edcforums.com/threads/my-back-of-the-car-rescue-trauma-management-kit.96534/#post-1251515) questions were raised about CPR, working outside the scope of your training, and what the current American Heart Association guidelines state about hands-only CPR, especially as it relates to lay rescuers. In an attempt to not thread jack that thread I am posting what I learned today at my BLS for Healthcare providers refresher course regarding CPR and the necessity of breaths. This information should not be construed in any way to be me giving anyone advice on how to conduct CPR and should not replace quality instruction. This is only a discussion of the methods I learned and the opinions of the instructors I dealt with.

    So the issue seemed to be whether or not breaths were needed for CPR and what was currently being taught. As of the 2010 AHA guidelines for CPR, non-Healthcare providers do not use rescue breaths. It was the opinion of the instructors that when AHA revises their guidelines for 2015 (as they release new ones every five years on schedule) rescue breaths will no longer be a part of the protocols for individual Healthcare Providers. That is, healthcare providers acting alone. When done in a team setting with a bag valve mask, they will possibly still be a part of the equation, but may be out as well. The reasons given were that whenever you stop giving compressions in order to give breaths, it takes the first 10-12 compressions of the next cycle to get back to the level of profusion achieved with your last set. Also, air is being moved with compressions anyway. The final reason is that giving breaths, via mouth to mouth, mask, or BVM, can create its own set of problems; generally, pushing air into the stomach, causing the victim to vomit, which can occlude the airway and/or get vomitus everywhere, including on you, which is a biohazard.

    But that is for adults. For infants and children, breaths will likely be a part of the equation for some time, as children do not generally suffer from cardiac arrest, and when they go down, it is because they are not getting air. The emphasis for infants and children was on providing breaths, to the point that if you come on a child/infant victim, we were taught to begin CPR right away and do a full five cycles, or two minutes of compressions AND breaths, before even calling for help.

    That's what I remember for now. Feel free to ask any other questions and I'll check my brain and notes to see if I can answer them.
     
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  2. Halligan

    Halligan Loaded Pockets

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    Pretty much in line with my last recert as well. The last time I did CPR the medic had just gone through some new ACLS protocols and had us doing 100+ compressions to a ventilation. They are also doing some far more advanced monitoring of oxygen levels as well.
     
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  3. whoozle

    whoozle Loaded Pockets

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    *Watching thread*

    This should be a good one since I'm planning on getting certified in basic CPR and first aid in September. :)
     
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  4. Dok J

    Dok J Loaded Pockets

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    In the other thread, VinnyP shared the current ERC guidelines, soon to be updated, as this year they're holding the congress at Viena in October.
    AHA, on the other hand advise against rescue ventilations.
    In my last refresher course, we were told to do hands-only CPR if we were alone or doing basic support with EMS closer than 5 minutes. If there's two or more rescuers, help is far or there's an isolated airway (tracheal tube) ventilations are recommended.
    Usually, ERC recommendations are two to five years behind AHA's, so for this year's congress ventilations are expected to be dropped out off the ERC guidelines.
    Law says that "on-duty" professionals have to act as their service's protocols state. "Off-duty" or if no barrier protective methods are available, the professional chooses whether or not give mouth to mouth ventilations.

    My two cents: In my FAK there's a "face shield" and in my car's FAK there's a hard mask, similar to this one.
    If I've got my FAK and unless I'm in the city (under five minutes for ambulance arrival), I'm doing 30:2 CPR.
    If I get sued, I could get by if I did everything I could.
    I won't go into ethics, as those are personal.

    Cool thread Filjos!
     
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  5. Prætorian ®

    Prætorian ® Loaded Pockets

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    Interesting share. In my last recert, one of the participants was a bit iffy on rescue breaths. The instructors reply was pretty straight forward. As long as airway is not obstructed, better to continue with compressions and no breaths, than nothing at all.

    Personally, I have face shield in my mini, and a pocket resuscitator (similar to Dok J's)in bag if needed.
     
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  6. filjos

    filjos Loaded Pockets

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    I've got the pocket mask in my FAK and hard mask in my car kit as well. I should say also that even though the focus was on compressions, they did state, and we were tested on, the scenario that Dok mentioned: specifically, that if an advanced airway was present and you had multiple rescuers, you should continue to do rescue breaths. But that was only because by having two rescuers, you could limit the downtime between breaths and compressions. As it was stated in the other thread, the problem with breaths is stopping compressions, placing the mask, repositioning them ask for better fit, trying to get air in and hoping you're not filling their belly, then finally going back to compressions and having to start all over to prime the pump again. It's a lot of wasted time. The instructors in my class stressed that when you are using rescue breaths, even in the presence of an advanced airway with two rescuers, you dont't actually give two breaths: you make two ATTEMPTS, then get right back to compressions.

    They also stressed that compressions were the focus, to the point that you don't stop compressions to attach an AED. The idea being that if an AED is there, you would probably have a second rescuer who brought it, so you keep doing compressions and let them work around you to get the pads on, and you only stop compressions when the AED and the person running it tell you to clear so that it can analyze for a rhythm and shock. Then after it shocks, you don't check for a pulse, you just go right back to compressions, hard and fast.
     
  7. Fabregas485
    • In Omnia Paratus

    Fabregas485 Loaded Pockets

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    Over in the UK, even if your not trained, they tell you to go hard and fast compressions only. If trained, only do breaths if your comfortable with it.
     
  8. filjos

    filjos Loaded Pockets

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    Oh yeah, another point. The old "ABC" thing of focusing on Airway, Breathing, Circulation, is now taught as CAB, because they believe so strongly in the importance of compressions for circulation.
     
  9. Halligan

    Halligan Loaded Pockets

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    That CAB thing also has to do with overly focusing on airway and breathing while someone bleeds out. In most unconscious person assessments you are positioning the airway, checking breathing and pulse at once.
     
  10. Alistair Hammond

    Alistair Hammond Loaded Pockets

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    I live in the UK, and I've done RLSS lifesaving training the last few years, which includes CPR/Life support. We got updated on the new 'methods' (5-6cm depth, 30-2 @ 120bpm for adults, etc), but we have never been told just to do compressions if you're on your own/ambulance is near etc. We've been taught to not do breaths only if it's dangerous (suspected poisoning for example) or we're uncomfortable doing it, e.g. blood/vomit around mouth etc. In those situations we'd still attempt breaths using a mask if available.

    On a slight sidenote, to those of you who just do Red Cross CPR courses or similar, do you know when or when not to give 5 initial rescue breathes, including drowning victims?
     
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  11. bnoland

    bnoland Loaded Pockets

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    In my 2011 BLS (basic life support) training for the police department before I left, breath was part of the training. 30 compressions 2 breaths. An adult can go 2-3 min without breathing which allows for time to get a defibrillator if one is accessible or get more help. With a child breathing must start immediately to avoid brain damage or death.
     
  12. JPHing

    JPHing Loaded Pockets

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    I'm curious.
    In th FA course I did, I was taught 15 compressions, 5 breathes.
    But reading other sources, they all gave different amounts.

    What's the correct amount of compressions and breathes one should give?
     
  13. defuse kit

    defuse kit Loaded Pockets

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    I'm a BLS instructor and a nursing student, so ask me anything you want till Flight ER Doc steps in. All of my answers will be according to AHA guidelines, but are no substitution for taking the course yourself.

    Ratio depends on the situation. If you're by yourself, the compression to ventilation ratio is always 30:2. On an infant or child with another healthcare professional, it's 15:2.

    Hands only CPR is fine most of the time, but it is contraindicated in a few situations. You must give breaths to victims of drowning, overdose, and to infants and children. I would also attempt to give breaths to anyone who became unresponsive after choking. The theory behind hands only CPR is that there's still oxygenated blood in the system, it just needs to be circulated. But in situations where the oxygen has been used up, you should be giving breaths.
     
  14. JPHing

    JPHing Loaded Pockets

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    Ah I see. Thanks for clearing that :)
     
  15. Dok J

    Dok J Loaded Pockets

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    Ratio depends on which protocols or recomendations you're following, so please Defuse don't take me wrong.

    Last ERC recomendations and my last refresher courses stated ratio is 30:2, always.

    That's because ventilation is proving very little advantages and big disadvantages (like vomits being aspirated to lungs, biohazard for first aid provider if doing mouth-to-mouth ventilations...). One of the instructors told us that it seems next recomendations ventilation will be ditched from the CPR protocol unless airway isolation can be achieved (tracheal intubation).
     
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  16. Alistair Hammond

    Alistair Hammond Loaded Pockets

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    Definitely not what I've been taught, according to the most recent guidelines. It's 30:2 @120bpm for everyone. What changes is the number of hands/fingers and depth of compressions.
    Adult: 2 Hands, 5-6cm
    Child ~1-8yrs old: 1 Hand, 1/3 of chest depth.
    Baby <1 yr old: 2 fingers, same depth as child.
     
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  17. Flight-ER-Doc

    Flight-ER-Doc Loaded Pockets

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    For single-person CPR, it's 30:2 (or just compressions, done deep and fast.....the Disco tune 'Staying Alive' is a good timing device, as is 'Another one bites the dust'). Depends on what kind of mood I'm in....
     
  18. filjos

    filjos Loaded Pockets

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    Since we are all coming from different areas with different standards, perhaps before we post what we have been taught or what we believe to be the standard, we could just throw up a line stating where in the world we are. I know that it is in everyone's profile, but for ease of discussion, I think if you state, "Well, I was taught to do X compressions with Y breaths", you should also state, "And that was in Bumfart, Minnesota, United States."

    I suppose since I started this discussion, I should be the first to state that my recent experiences are limited to training provided by North Memorial EMS Education in Minneapolis, MN, United States, and that they were teaching the American Heart Association standard for Healthcare Provider BLS.

    I just think that sometimes these discussions can get confused because two professional EMS workers will have very different standards, and if any lay person is reading along, they may wonder why. And although no one should take anything written here to replace proper medical training, a casual reader from California may end up at a car wreck doing 18 compressions and 12 breaths because an EMR from Thailand said that was how they did it on edcforums.com. :eek:
     
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  19. JPHing

    JPHing Loaded Pockets

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    I'm from Johannesburg South Africa.
    Did First aid level 1 with St John's ambulance which covered cpr.
     
    Last edited by Djjonny, Jul 29, 2012
  20. Dok J

    Dok J Loaded Pockets

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    True that.
    I work in Madrid, Spain. I'm trained under the ERC recomendations for basic and advanced CPR.
    30:2 until recovery or certified dead.