CPR so you think you are doing it right !

[Dive-aholic]

Just read through the posts. Without going into too many details...

First thing that comes to mind - Univ. of Chicago did the study, but it seems the study was done outside the US. I'm not knocking other countries, but different cultures bring different practices. Where are the US results?

Second - Doctors doing CPR? In 15 yrs, I think I can count the number of docs I've seen get hands on involved other than intubation on one hand (doing actual compressions). And I've worked the 3 person codes - RT does compressions, RN administers meds, MD handles airway. No offense intended against the docs. But this does bring us back to the question of the location of the study.

Third - Femoral v carotid, I agree carotid does provide pulse for lower pressure, but there's usually too much going on around the head to get in and find it, besides, if you're not getting a femoral pulse, your not perfusing the brain enough. I know the carotid leads to the brain, but you still need good pressure to perfuse the brain.

Fourth - Residents, some of them are good, most are still learning. The RNs actually run the code (suggestions to the residents). It's a matter of experience and the residents just don't have it yet. Not their fault, just the way things are. Oh, and don't trust them to palp the pulse...again experience.

Fifth - Doing compressions, yes you do need to be in good shape to do them for a long time. That's why you switch off with someone else every few minutes. I won't do them for more than 4-5 minutes because it does get tiring.

That's all I can think of right now. Probably enough. Just remember, even though it's supposed to be the same everywhere, it's not...

 

[archman]

I'll merely say that most folks doing CPR are going to be pretty dang shy about cracking ribs. Yeah yeah we're always told to "not be nice", but being told something and application are two different beasts.

More realistic practice dummies, that's the only solution I see. That, or a really dramatic on-topic episode of ER. One of the key characters would have to be killed off due to inadequate chest compressions. Hmmm... wonder who should get the axe... maybe that rock star resident. What a twerp.

 

[miketsp]

Part of the issue here is when we refresh every year the health and safety execetive appears to have changed the recommended numbers of compressions/breaths and/or ratio from one year to the next !

I remember reading a magazine article that many people die for lack of CPR even though someone standing nearby has been trained.
The same person that would try to save a friend or family member does nothing. This is due to a natural reluctance to do direct mouth to mouth with an unknown person, especially if he/she is dirty or bloody.
The article stated that in many cases the breaths do not actually make a significant contribution and just doing the compressions correctly would save many lives.
So the article's conclusion was that by just teaching correct compression technique there would actually be a net gain in lives saved as many more attempts would be made.

 

[theskull]

Some people spend there lives helping people they don't even know, and then there is you. All bow to the "rescue diver"....Im so glad you "agree". What exactly do you agree with and what background do you have to say anything?

Shaka quoted what he agreed with! That to have a basic idea of what to do and DOING IT is the most important thing to a diver (person) in the field when tragedy strikes. It only takes a properly trained Rescue Diver to do that.

The minutiae being discussed here may be of interest to those with an intense medical background, but this is a divers' forum. The details being provided are interesting as trivia for teaching an EFR class but will not be of much use to someone without serious medical equipment with an emergency in the real world.

theskull

p.s. Not criticizing those of you who are medics, just defending Shaka against an unnecessary attack. BTW - I could spell CPR before it was called CPR.

 

[ReneeC]

Just to add my little say so... (sorry got longer winded than I planned)

I agree that the only bad CPR (by lay people) is no CPR.
I also feel that it is back to the old "good vs bad" instructor as to whether CPR students learn good or bad skills.

Back to the original post - I'm sure many of us old time instructors or CPR students remember the Annies with the monitors on them. They were great for teaching people who where going on to become instructors or professionals but overwhelmingly intimidating to the average Joe. I'd hate to see those come back.

I still use Annie for my mannikin for the reason that if you are getting good depth there is a lovely pop and crack sound. I do explain that this is normal and might be the sound of breaking ribs or rib separation-but I don't spend much tme on that.

In a real emergency a well taught Lay student is going to forget alot but hopefully remember enough to be "helpful". If the Doctors and Nurses that I certified (and then had to recertify) are any example, I'll take the guy who says "I took a CPR Class" over a doctor anyday. Doctors are always my biggest PIA - they don't want to be there, don't pay attention and do as little as possible to complete the skills and pass the test. And with AHA being the primary training organization - after two years they have forgotten everything they did learn.

However, Thanks for the post! I like to stay up on developments (specially since I end up having to retrain all the instructors down here when they make these kind of changes)

 

[pete340]

Not PADI bashing here but related, does the rescue diver course include cpr, AV and mouth-nose as well as -mouth techniques or is that reserved for another course?

PADI Rescue Diver assumes you're familiar with CPR. But you need to modify the techniques when you're in the water (in particular, you can't do the C part, so you stick to rescue breathing). In order of preference: mouth-to-pocket-mask, mouth-to-mouth (or nose), mouth-to-snorkel.

 

[pete340]

The same person that would try to save a friend or family member does nothing. This is due to a natural reluctance to do direct mouth to mouth with an unknown person, especially if he/she is dirty or bloody.

PADI has a new video for their Emergency First Responder course. Amazing how all the "ordinary people" in it carry gloves and barriers.

 

[hvulin]

In Croatia (I know it's far away, but...) I have never seen a doctor even try CPR without gloves or any other kind of protection (I was told that they were taught not to do it without protection)... And, btw. I only had to do CPR once for real (it didin't work) and the guy was FAT and stinking of alcohol! Sorry but I never practiced on fat and stinking doll... (I had CPR as part of my DIVECON training, and were shown how to do it in school many years before) - but I still tried it and I can tell you that it was a nightmare to even try to check his pulse (since he was so fat) and even worse to do mouth to mouth....

PS after medics arrived I jumped in the water to clean myself up, and the medic comented: "Look at him, he is just swimming around while we try to save life" (I just told him to go himself, since this was after 30min of CPR (two of us did it...)

 

[skeet]

what did i miss reading this, were did the femoral artery concern come in. most everybody in this thread is right. like someone said before the only wrong cpr is one not administered, but you can get a bp back after cracking a few ribs, ain't that right skeet!

Thats right, do a few deep adequate compressions and get the veins up to get IV access.

 

[jonnythan]

One of the first things they told me in my first CPR class was that a lot of professionals do it wrong and don't know it.

It's really not that complicated, but the compression/breath ratio as well as the deepness of the compressions themselves are not very intuitive, and people in authority positions in life-and-death situations tend to do what they *feel* is correct rather than rely on what they read in a book.