CPR so you think you are doing it right !

[Tom Smedley]

There is a lot to take into consideration here. Everytime that you begin compressions on anyone the first few result in loud ligament cavitations. Much like several folks popping their knuckles all at once. This scares heck out of a newby. Broken ribs are a moot point and sometimes make the compressions easier. Ribs can be fixed.

The age of the person and whether or not they have prior vascular disease makes a difference. Young folks with healthy hearts have not developed collateral circulation that might make an older person with some vascular history survive.

If the plug hits the left main - Oh well!

Where citizen CPR comes in most handy is stuff like Ventricular Tachycardia where the person can go in and out of NSR and really has a chance to survive. We have a case where one of our divemasters saved his best friend's life when the friend went into V-tach during Ivan. His CPR kept the friend oxygenated until the paramedic got there with some 400 Joule therapy. The friend had a Intra-Cardiac Defibrillator (ICD) installed and was back at work within a week. The lifesaver admits that he was scared beyond belief and he credits ingrained step-by-step responses learned in a first aid and CPR class for saving his friend's life.

Like I said - first call for help - then do what you can remember - but don't forget to call for help. BTW you don't have to tell me you're medically trained.

 

[Dive-aholic]

Femoral pulse is great and all, but we are really concerned with oxygenating the brain -- not the legs. It is a simple matter for a rescuer performing an inverse jaw thrust to reach down with one finger and verify a pulse. Not only does a natural pulse feel different, it's really obvious when it occurs between compressions.

If a person has a femoral pulse, then the brain is being oxygenated. It takes more pressure to get a femoral than a carotid pulse. Unless there's blockage in the carotid, you won't have a femoral pulse without a carotid.

 

[Wildcard]

There is a lot to take into consideration here. Everytime that you begin compressions on anyone the first few result in loud ligament cavitations. Much like several folks popping their knuckles all at once. This scares heck out of a newby. Broken ribs are a moot point and sometimes make the compressions easier. Ribs can be fixed.

The age of the person and whether or not they have prior vascular disease makes a difference. Young folks with healthy hearts have not developed collateral circulation that might make an older person with some vascular history survive.

If the plug hits the left main - Oh well!

Where citizen CPR comes in most handy is stuff like Ventricular Tachycardia where the person can go in and out of NSR and really has a chance to survive. We have a case where one of our divemasters saved his best friend's life when the friend went into V-tach during Ivan. His CPR kept the friend oxygenated until the paramedic got there with some 400 Joule therapy. The friend had a Intra-Cardiac Defibrillator (ICD) installed and was back at work within a week. The lifesaver admits that he was scared beyond belief and he credits ingrained step-by-step responses learned in a first aid and CPR class for saving his friend's life.

Like I said - first call for help - then do what you can remember - but don't forget to call for help. BTW you don't have to tell me you're medically trained.

Two small points here. Collateral circulation dosen't happen untill after an infarct and the max for defib is 360 joules.

 

[Wildcard]

I guess EMTs must be doing it OK

Let me tell you about Marc the magic EMT. Drowning call.Gal walked into teh waterto kill her self. It worked. Dive rescue shows up and pulls the gal out. I slaped the monitor on and it's flat as can be. MArc starts doing compressions. He sdoes two and I told him to stop. She was back in NSR with pulses and pressure! :11: Brain dead but had a pulse.

 

[Dive-aholic]

Just the other night a patient coded in the ICU, CPR was done for about 45 minutes (yeah 45 minutes!) and the doc finally called the code. Everyone left the room and a few minutes later the patient is alive. The patient is now doing better than before the "code". No explanation for this.

 

[Aquadoc68]

Pulse with compressions? Yes. Stop compressions, pulse? No? Resume compressions. Thats how it's done. Over all depth may or may not have anything to do with effectiveness of compressions.....Guide lines are just that, guide lines. MAny of these studies are done by MDs who want there name on something. Take it wait a grain of salt.

BTW chest compressions don't "restart" the heart as is stated in the article.....Early defib followed by early ACLS is the key to survival.

I am AHA and Military BLS, ACLS, PHTLS instructor. Got a radial pulse when you or ur partner compresses?? if Yes good compresions, if No better go deeper. Also Bump the Electricity in V Fib and unstable Vtach, other than that Drugs to treat underlying reason such as Epi and atropine for PEA. Anyway...

 

[Aquadoc68]

Two small points here. Collateral circulation dosen't happen untill after an infarct and the max for defib is 360 joules.

Another point: Despite your best efforts your pt will do his best to die on you.

It does help that the army bought us the $300K SIM-MAN A "pt" That will give you feedback on just about every diagnostic save Labs, and it will prompt those. Things like end title CO2, ABG's, and compression and breath feed back, and of course the whole gambit of disrythmias.

 

[Wildcard]

SIM MAN is only 30K. They are an intresting toy but don't make up for real world experence.
Expecting a radial pulse from chest compressions is a little unrealistic. It may happen from time to time but is not a "standard" place to evaluate the effectivness of compressions.

 

[cornfed]

These things come and go several times before dying a slow death. How many times have MAST pants been pulled only to be replaced 6 months later? Thus the "Practice" of medicine.

Good point! Let's bring back the thumper!

 

[Aquadoc68]

SIM MAN is only 30K. They are an intresting toy but don't make up for real world experence.
Expecting a radial pulse from chest compressions is a little unrealistic. It may happen from time to time but is not a "standard" place to evaluate the effectivness of compressions.

FFS Fat finger syndrom 30K actually 37K all told. Of course not = to real world, and we can banter over 100 dif reasons one would not feel a pulse here or there. For what its worth while hauling a$$ in an FLA from the front line to the BAS I am gonna feel for the carot. Thats if I could afford to take a breathless, pulseless PT to the BAS just the reality of MY job.