Nah--everyone's afraid to dive with her!
(That's an inside joke--I couldn't find the old thread for a link.)
45 Minutes of CPR...
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Nah--everyone's afraid to dive with her!
(That's an inside joke--I couldn't find the old thread for a link.)
2 Big 2 Fail
Contributor
It would, in fact, be hard to think of a more appropriate place for an AED than a dive operation. I can't think of anywhere else more prone to encounter the ideal (if we can call it that) situation. A respiratory arrest from mechanical cause, likely sufficient duration of respiratory arrest to result in a cardiac dysrhythmia, a likely otherwise healthy and relatively young patient, oxygen adjuncts available, likely CPR-trained people on board, the AED close at hand, and an almost certain delayed response by EMS or other paramedics.
As to thinking about stopping CPR, the rescuers could not know if the situation was irretrievably grim or if the victim was suffering an arrhythmia that was not wholly non-circulating but pulseless to manual palpation or if they were being so effective that a convertible v-fib or v-tach rhythm was maintained throughout. They couldn't know if it was a drowning or a cardiac disease event.
That's why the standard is to go until exhaustion. I've worked a lot of CPR advanced life support field calls over 30 years, and my expectation of a successful resuscitation after 45 minutes of just CPR in that situation would be pretty close to zero, but here, the victim survived, because they kept going. Had they stopped, he essentially would have had no chance at all.
As to thinking about stopping CPR, the rescuers could not know if the situation was irretrievably grim or if the victim was suffering an arrhythmia that was not wholly non-circulating but pulseless to manual palpation or if they were being so effective that a convertible v-fib or v-tach rhythm was maintained throughout. They couldn't know if it was a drowning or a cardiac disease event.
That's why the standard is to go until exhaustion. I've worked a lot of CPR advanced life support field calls over 30 years, and my expectation of a successful resuscitation after 45 minutes of just CPR in that situation would be pretty close to zero, but here, the victim survived, because they kept going. Had they stopped, he essentially would have had no chance at all.
Remember that it doesn't matter what the cause is for going into full cardiac arrest. The treatment is the same. Be it from trauma, asphyxia, or a cardiac event....high quality chest compressions and time to shock are the two factors that influence outcome the most. Of course the scenario changes with obstructed airway...in which case you also do abdominal thrusts for adults.
AleG
Contributor
Thanks all for the clarifications.
I always assumed that vigorous chest compressions should get some air in and out of the lungs, of course rescue breaths are much better, but whatever little air flow from the pumping wouldn't hurt.
I always assumed that vigorous chest compressions should get some air in and out of the lungs, of course rescue breaths are much better, but whatever little air flow from the pumping wouldn't hurt.
Bogie
Contributor
Wow! Great Job!
2 Big 2 Fail
Contributor
Note that AHA and other CPR standards organizations move very slowly. The advantages of uninterrupted compressions has been demonstrated in studies for many years. This is not to say AHA, et al., are too slow. It's quite a major thing to change standards, and the fundamental problem is not one of differences in technique but encouraging some kind of effective CPR at all, trying to get the numbers up for initiation of CPR by the public. If you sit there and take the tiniest breaths, probably less air than would be moving from chest compressions, you find that you can sustain yourself nicely. What the studies found was that deep, rapid chest compressions could generate a useful blood pressure, but it dropped drastically during any pause in compressions. Rescue breaths are beneficial, but maintaining the rate and depth of compressions is essential.
Keep in mind, too, that CPR recommendations do not always reflect more or less medical benefit from one or another technique. Laypersons are commonly not experienced at detecting pulses and may assume cardiac arrest where only respiratory arrest is present. (In accounts of people actually being revived by CPR, the rescuer likely just missed the pulse.) So, recommending classical compressions with rescue breaths in drownings and other respiratory arrests addresses the problem of doing unneeded compressions and omitting critically needed breaths as much as any benefit from rescue breaths in cardiac arrest secondary to respiratory arrest.
I feel a need to discuss one aspect of this topic--cold water near drowning. Why? Because it has not even been mentioned here so far. I live in an area (Oregon) which has cold water. You who are blessed with 80+ degree F water can tune out a bit, as this discussion pertains to cold water (say below about 65 degrees F).
Last summer, we had a fellow drown in the Clackamas River. His body was recovered after 15+ minutes underwater. CPR was initiated, but then stopped when it was determined that he was dead by authorities. The problem? Well, years ago I took a course from Dr. Cameron Bangs, a well-known expert on hypothermia. He was very emphatic that someone is never "dead" until they are "warm and dead!" He said that in most hypothermia situations, the signs of death do not apply. The person will be cold to the touch; have fixed, dialated pupils; no breathing; and no perceptable pulse*; but this person if in a hypothermic or cold-water near drowning situation could still be viable (resuscitated). The problem I have with the above drowning is that there was no emergency transport to the hospital for rewarming while the victim was (according to my training) potentially viable.
We are divers, and so are around cold water a lot, at least in my local. Because of that, we need to understand the implications of cold-water near drowning. Here is an interesting publication by the State of Alaska, Cold Injuries & Cold Water Near Drowning Guidelines (Rev 01/96):
Be aware, as divers, that even in relatively warm lakes it is possible to have thermoclines which would allow this cold-water effect to take place. Also, there are ways of dealing with cold water that will help in the survival of people who are in the water. One thing we found out in Pararescue in the 1970s, after loosing a person to hypothermia, is that any IV given to a hypothermic person should be warmed first. The link shows a commercially-available product, but we simply put an IV bag into a helicopter helmet bag, along with a heating pad.
SeaRat
*Pulse rates of 3-4 per minute have been recorded for hypothermia victims, which are beyond the ability of any rescuer to determine with tactile methods.
Last summer, we had a fellow drown in the Clackamas River. His body was recovered after 15+ minutes underwater. CPR was initiated, but then stopped when it was determined that he was dead by authorities. The problem? Well, years ago I took a course from Dr. Cameron Bangs, a well-known expert on hypothermia. He was very emphatic that someone is never "dead" until they are "warm and dead!" He said that in most hypothermia situations, the signs of death do not apply. The person will be cold to the touch; have fixed, dialated pupils; no breathing; and no perceptable pulse*; but this person if in a hypothermic or cold-water near drowning situation could still be viable (resuscitated). The problem I have with the above drowning is that there was no emergency transport to the hospital for rewarming while the victim was (according to my training) potentially viable.
We are divers, and so are around cold water a lot, at least in my local. Because of that, we need to understand the implications of cold-water near drowning. Here is an interesting publication by the State of Alaska, Cold Injuries & Cold Water Near Drowning Guidelines (Rev 01/96):
Be aware, as divers, that even in relatively warm lakes it is possible to have thermoclines which would allow this cold-water effect to take place. Also, there are ways of dealing with cold water that will help in the survival of people who are in the water. One thing we found out in Pararescue in the 1970s, after loosing a person to hypothermia, is that any IV given to a hypothermic person should be warmed first. The link shows a commercially-available product, but we simply put an IV bag into a helicopter helmet bag, along with a heating pad.
SeaRat
*Pulse rates of 3-4 per minute have been recorded for hypothermia victims, which are beyond the ability of any rescuer to determine with tactile methods.
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As I understand it, one of the reasons it moves slowly is that the different organizations that teach CPR try to be consistent with one another. Usually one organization will not change standards until there is a consensus to make that change among all organizations.
alijtaylor
Contributor
I agree, I had always assumed that if you got no reaction after a few minutes you were probably just continuing until the experts arrived to 'call it' but this has made me think differently.
Alison
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