CPR test?

[Wildcard]

I just saw this and thought Id share with everyone, just in case you missed it. I have to admit, I find there survival rates to be a bit high.
http://www.cnn.com/2006/HEALTH/08/02/cpr.futile.ap/index.html

 

[Fotoz4FX]

I have a question with regard to CPR... as applied to what is called a cold-water near drowning victim.
Essentially there may be a pulse but it is so weak that it may not be palpable and may even be missed by a monitor...

Should someone who has drowned in fresh water be resusitated on scene or first transported to a hospital?

What might a rescuer consider when dealing with such an incident with regard to the victim's potential for survivability?

What do you think should be considered before initiating a Pulmonary or Cardiopulmonary effort?

What factors precipitate the viability of a cold-water drowning and what may cause the termination of a victim that responds to CPR at the scene or hospital?

I want to bring up this discussion because I would like feedback from CPR-trained Dive Professionals as well as medical personnel at both the emergency level and clinical levels.

Any thoughts or observations (and opinions on a personal level) would be appreciated.

Thanks in advance (be forewarned... this isn't as simple a question as it may look).

 

[tnfireman]

I have a question with regard to CPR... as applied to what is called a cold-water near drowning victim.
Essentially there may be a pulse but it is so weak that it may not be palpable and may even be missed by a monitor...

Should someone who has drowned in fresh water be resusitated on scene or first transported to a hospital?

What might a rescuer consider when dealing with such an incident with regard to the victim's potential for survivability?

What do you think should be considered before initiating a Pulmonary or Cardiopulmonary effort?

What factors precipitate the viability of a cold-water drowning and what may cause the termination of a victim that responds to CPR at the scene or hospital?

I want to bring up this discussion because I would like feedback from CPR-trained Dive Professionals as well as medical personnel at both the emergency level and clinical levels.

Any thoughts or observations (and opinions on a personal level) would be appreciated.

Thanks in advance (be forewarned... this isn't as simple a question as it may look).

As a first responder our protocal here is to begin CPR and admin. O2 .
We have no specific guidelines on cold water drowning or near drowning, But the Med Director can and does sometimes dictate otherwize.
I really hope somebody with more familarity with these type of situation can answer you better

 

[ItsBruce]

My recollection is that one should do CPR only if the victim has no pulse. If there is a pulse, no matter how weak, CPR will only cause harm. If there is no pulse, then start CPR and continue as long as possible, until there is a pulse or until someone more knowledgble says to stop.

In most instances the real purpose of CPR is to maintain the organs for transplant, not really so much to save the victim.

 

[Wildcard]

I am so sorry I started this... It was intended for people in the field. Cardiac monitors will pick up any electrical activity and show it as such. CPR should be done on any but the most obviously dead people you might see, liberals excluded. ...What they are looking at is who we as providers, should be working on. It truly is old stuff but it just came up.... If you are not a medical provider, do CPR untill someone says stop.

 

[tnfireman]

Wildcard
A first responder in the state of Tennessee is a medical provider, roughly equivilant to the old classification of EMT-B. That being said, I agree with you on the Cardiac monitors and not stopping CPR.
In the area that I live we have 2 EMS units and they get overwhelmed with medical calls very easily (usually at the far side of the county) ,So many calls get dispatched to the Fire Dept. First Responders .We ,at the FD are all volinteers and have put together our own med kits which are usually sufficant But do not contain monitors or even AED's(the county did provide AED's but they got recalled and heve never been replaced).
WE do what we can with what we have......
Ray

 

[Fotoz4FX]

I'm really interested in responses to the questions as best as you know based on your training level and what your protocol may suggest as I'm trying to get a feel of what the general (and personal/professional) consensus is.

I've done a lot of research into this and it does get argumentative with medical professionals (including environmentally educated emergency professionals and dive docs)

 

[divindoc]

The general approach is: "You're not dead until you're warm and dead". In other words, rescuscitation should begin immediately and continued until the victims' core temperature approximates normal or until obvious that further efforts are futile.

Really impossible to make a judgement call as to which victim should/should not be rescuscitated so CPR should begin in the field and continue until arrival @ a medical facility, or determination by a medical prof. with experience in these things that further attempts at rescus. are futile, or until the rescuers are too physically exhausted to continue or are endangering their own lives in the attempt.

General guideline - Carotid pulse (neck) = B/P of 60 systolic, Femoral pulse (groin) = 70, Radial pulse (wrist) = 80.

Realize when initiating CPR that you are essentially treating a dead or soon to be dead person, so you don't have anything to lose by trying to rescusitate the victim.

 

[divindoc]

WildCard, just read the CNN article. Sounds like common sense to me. Most victims of cardiac arrest are older and not in the best of health to start with.

Drowning victims tend to be younger and healthier, and their cardiac arrest is usually not a primary event, ie their heart stopped because their breathing stopped first. Usually dealing with a basically healthy heart in this situation, so rescus. from that standpoint easier. In addition, cold water drowning is a whole different proposition, and again these people need aggressive early rescus., realizing that a hypothermic heart is irritable, and the fewer drugs/cardioversion given generally the better.

Couldn't agree more with the futility of CPR as outlined in the population in the Canadian study. Have seen a lot of these cases after 24 years of full-time emergency medicine practice in a 80,000 + visit ER. Sometimes it is better to say "Stop".

 

[Wildcard]

I have been involved since 1979 and have seen CPR grow and morph from code EVERYONE to only work viable pts like we do now. In days of old, if anyone had started CPR, we had to continue it to the hospital. One memorable pt that had CPR innitated by a fire dept was so dead he had maggots crawling out his mouth but we had our protocals. These days in the field, at least where Im at, it is my discression as to who gets run and who dosn't. Also we are allowed to start the code then terminate it quickly if the person is not responding. One intresting note in the article pointed out that survival from full arrest was almost below zero unless you happened to code infront of someone who could provide ACLS. I think AEDs are changing this a lot. We provided AEDs for schools, police cars and the local gym. The gym has used theres 3 times in 3 years, 2 of those people are still walking around! Just a reminder to those who may be reading this that are not providers, AEDs are just one step, you still need paramedics there ASAP to continue the care.