Doctor sparks debate over CPR

[Wildcard]

Isn't this the reason we were all taught to tip the head back, and then tip it back some more?

Finally I'd just like to rant a moment! I do not want to train to work as a paramedic, but I see nothing wrong with learning all I can - hell I took my stress and rescue course for a reason! In the UK I was able to take a full weeks course on first aid (including CPR) which covered a lot of stuff, I expected to be able to find this course in the US (since it was run by the Red Cross) and follow up courses...but apparently the Red Cross doesn't do courses like that. When I took my most recent CPR class in the US and tried to find out where I could go next I found out...Nowhere! Unless I want to spend the time and money training to be a paramedic. What is up with that?

Sure you can. Try looking at the local community college. Advanced First Aid then first responder, then EMT basic, then various levels of "inbetween" EMT and Medic.

Wasen't trying to flame but after many years in the field I can smell BS a long way off. Im not sure where the assumption that no airway applies to us to came from as I didn't read the whole article since I followed along on this a couple of months ago here too. CCC builds up the IT pressure which increases circulation and thus perfusion. A break of even a couple of seconds takes up to 15 seconds to recover the pressure. This can be done while intubation and meds are being done....Has anyone every realy done real mouth to mouth? It's pretty much impossable to maintain an airway and blow at the same time and I would venture to say it IS impossable for a lay person to do. CPR as it's done and taught now seldome works and I think this change is a great thing!

 

[ParamedicDiver1]

Has anyone every realy done real mouth to mouth? It's pretty much impossable to maintain an airway and blow at the same time and I would venture to say it IS impossable for a lay person to do. CPR as it's done and taught now seldome works and I think this change is a great thing!

Yep, been there done that, was much too young and thought I had to save the world. (It was also about a month after I first got certified as a Basic) Long story short, he vomited in my mouth. And I agree, it is very hard to maintain an airway while doing it. And now, with the encouragement of doing mouth-to-mask, I think it is even harder to maintain a proper airway and ventilate a patient.

 

[CBulla]

I think the original article left out the fact that if your pumping 100 compressions a minute and are on a two man an ambu mask and bag are used for respirations so that the person doing compressions can do so uninterrupted. When you have that set up you can also add an O2 line and up the qualitiy of respiration and compressions with the higher oxygen percentage being absorbed by the body. The ambu mask also has the vomit valve to keep you from getting a mouthful of the victims lunch and pills.

Duno if that was brought up already... I sorta skipped from the first to the last page since there were so many in between.

 

[redrover]

Has anyone every realy done real mouth to mouth? It's pretty much impossable to maintain an airway and blow at the same time and I would venture to say it IS impossable for a lay person to do.

Hi you guys,
I thought what I was taught was how to maintain an airway. Did have a lot of trouble with fractured tracheas and jelly necks were a challenge.
I thought excellent perfusion (nail bed and pupil constriction) was an indicator of an open airway. (Yes by the way, up close and real personal.)
Please don’t go into flame out.

 

[babar]

Yep, been there done that, was much too young and thought I had to save the world. (It was also about a month after I first got certified as a Basic) Long story short, he vomited in my mouth. And I agree, it is very hard to maintain an airway while doing it. And now, with the encouragement of doing mouth-to-mask, I think it is even harder to maintain a proper airway and ventilate a patient.

yup, mask ventilation and maintaining an open airway are the toughest, and most valuable skills to learn. Even more so than intubating. I was told this repeatedly by instructors back in BCLS and then in ACLS, and didn't believe them at the time. I can tell you that it's true. I stress this when teaching and now the students probobly don't believe me...I think that most student even under ideal classroom conditions have trouble ventilating a manican properly. I dont think that the average layperson, even with CPR training, can do it effectivly.

Babar

 

[Wildcard]

Long before AHA and ARC started pointing out that you would get a mouthfull of there lunch, I taught that. Scoop it out and keep going. In retrospect, blowing stomach acid into the lungs couldn't have been a good thing. I had one get me twice, through the tube! Thats when ( I was a baby medic ) I learned to keep my mouth shut and point the end of the tube away from me.

So we are in agreement, well most of us, that mouth to mouth is pointless? CCC is the future of CPR, coming soon to a recert class near you!

 

[PairofMedics]

Long before AHA and ARC started pointing out that you would get a mouthfull of there lunch, I taught that. Scoop it out and keep going. In retrospect, blowing stomach acid into the lungs couldn't have been a good thing. I had one get me twice, through the tube! Thats when ( I was a baby medic ) I learned to keep my mouth shut and point the end of the tube away from me.

So we are in agreement, well most of us, that mouth to mouth is pointless? CCC is the future of CPR, coming soon to a recert class near you!

Always remember to point the nasty end of whatever you're doing at your EMT!!!

 

[PairofMedics]

I think the original article left out the fact that if your pumping 100 compressions a minute and are on a two man an ambu mask and bag are used for respirations so that the person doing compressions can do so uninterrupted. When you have that set up you can also add an O2 line and up the qualitiy of respiration and compressions with the higher oxygen percentage being absorbed by the body. The ambu mask also has the vomit valve to keep you from getting a mouthful of the victims lunch and pills.

Duno if that was brought up already... I sorta skipped from the first to the last page since there were so many in between.

Yep...but the big problem with that is the guy compressing is reducing your lung capacity by at least 1/3 and as he's pushing down he's increasing the pressure within the lungs, causing an outward flow of air/gas. Even with an intubated patient on a ventilator you can create problems.

 

[PairofMedics]

Yep, been there done that, was much too young and thought I had to save the world. (It was also about a month after I first got certified as a Basic) Long story short, he vomited in my mouth. And I agree, it is very hard to maintain an airway while doing it. And now, with the encouragement of doing mouth-to-mask, I think it is even harder to maintain a proper airway and ventilate a patient.

My first mouth to mouth was a baby just born, still attached by the umbilical cord in the backseat of a car in front of the ER. He was purple, apneic and had a faint brachial pulse around 40. Once I got him clamped, cut, suctioned and free from Mom I went to it without even thinking. I'll never forget the looks on people's faces as I walked past them pushing and blowing on this baby. He survived and thrived. Felt good but tasted terrible. Afterward I thought about the risk and in a perfect world it wouldn't matter. But I'd still do it again...and that's my personal choice. I'd never expect anyone else to do it or ridicule them if they didn't. Mom and Dad said thankyou....that was more than enough for me.

 

[aa777888]

Wow, this is a heck of a thread.

It was touched on in a couple of posts, but have we considered that the entire issue is ALMOST moot?

I can quote NH statistics from a few years ago (from my 8 year stint on a municipal EMS service): only approx. 10% of pre-hospital cardiac arrests are resuscitated and only 10% of those (an aggregate 1%) ever leave the hospital again. My service was an ACLS provider only 10 minutes from our receiving hospitals. We had the best rate in the state one year, 12%. 99% of these were secondary to cardiac disease. The trauma-arrest resuscitation rate is close to zero.

An interesting book was written on all this, "Sudden Death and the Myth of CPR" by Stefan Timmermans.

Cardiac arrest secondary to respiratory arrest caused by simple mechanical means, say because of drowning, has better statistics, but I don't know what they are.

It seems likely that the difference between the worst CPR and the best CPR is probably worth fractions of a percentage point in survivability. Let's face it, cardiac arrest is almost always a very late sign of a really damaged system.

Anyway, I say "almost moot" because, like anyone else, if and when it's time I want my 1% chance. But please don't argue too much while you're doing it, just give it your best try. At worst you'll have provided what now amounts to the first important part of the modern-day American death ritual.

aa