Locating midway in CPR

[GoBlue!]

Firediver once bubbled...
Standing around watching never saved anybody. Dr Paul Thomas I agree with what you said as just go and help and don't worry about finess.. I just say stay off the xyphiod..

Doing CPR over the xiphoid would be darn near impossible, and I think that anyone who found their hands there would realize immediately that "gosh this doesn't feel like it's doing anything worthwhile!" So for those of you worried about hand position, if you just aim for the center of the chest in the heat of the moment, you'll probably be right on. If it feels "squishy," just move up a little!

I've participated in far more cardiac arrests than I can count, all of which were in a hospital setting, many of whom were saved but it wasn't likely the CPR....it was the short time to defibrillation. I hope that more & more dive boats are being equipped w/ AEDs & oxygen.

Jim

 

[crazed_dolphin]

Hi,

I'm in the navy and we're required to have a current CPR qualification at all times. On my most recent class less than 1 yr ago we were taught to use the nipple line. I'm qualified by the American Heart so I don't know what the American Red Cross recommends.

 

[Jambi]

The problem with the nipple line is that it cannot be counted on to be in the same spot for different people. For example, a large breasted woman, fat person, mastectomy or some other form of trauma to the chest, be it new or old. The process of finding the Sternum is such a no brainier is shouldn’t be a problem. And as always cut clothes or environmental protection off. If your heart has stopped the last thing you will be worried about is the condition of your gear or clothing. The link divemed6 says it all.

Jambi

 

[Firediver]

I have pt agree with Jambi on the use of the nipple line. I am an EMT-B and a First Aid instructor for the Canadian Red Cross. The best way to land mark is to walk your fingers up the edge of the ribs until you reach a knotch in the middle of the chest. From their place two fingers above the knotch and place the heal of your hand above those two fingers. You should be on the middle of the Sternum. The only time you would use the nipple line is on an infant. because their chests are so small. You'd PLace either your ring finger on your left hand on the nipple line and lift your middle and index so your finger tips are in the middle of the chest, Or with your right hand place your index finger on the nipple line and lift your middle and right ring finger<I don't know what it's called > so the tips of your fingers are on the middle of the brest bone. Lift your finger that was on the nipple line and straighten the two fingers on the middle of the breast bone and push straight down 1/2" to 1" .

When it comes to universal percautions.. if you have them use them if you don't improvise.. ie a piece of plastic with a hole in it to use as a face peice.. If you know the person and you don't have anything go ahead... I know as an EMT I would do CPR outside the job if I never had anything for universal percautions, I would do compressions without the breaths unless I knew the person ie my dive buddy or people I am diving with, friends & family. Other wise just compressions and no breaths until EMS arrived. Most of the time CPR on an Adult won't bring a person around without the use of an Automated External defibulator(AED), and meds which Paramedics can give.. But I hear AED's are widely found in public places in the US. Here in Canada only EMS personelle carry them.

Hope this helps.. I know I have babbled a bit here.

 

[sharpenu]

I have done CPR more times than I care to count. I can say that using the nipple line as a rule of thumb will frequently land you in the wrong place. There are so many differences in anatomy that the nipples are frequently poorly placed.

Just "doing something" without ensuring that you are doing it correctly usually means you are making it worse. If you have problems finding your landmarks, or are unsure of what to do, the CPR course is not that long and is usually pretty cheap ($20 or so) Just like diving, it requires training and retraining.

My own experience with CPR is poor. In over 200 cases (guessing here) I have had numerous patients regain a pulse and blood pressure, but only 3 of them survived long enough to be discharged from the hospital. Early defibrillation and access to ACLS/ALS is the key. Your odds diminish rapidly after the first couple of minutes. In addition, trauma patients who "code" are much less likely to survive, as it takes multiple system trauma/ shutdown to cause arrest and this is frequently not survivable.

 

[The Iceni]

sharpenu once bubbled...
Just "doing something" without ensuring that you are doing it correctly usually means you are making it worse. . . My own experience with CPR is poor. In over 200 cases (guessing here) I have had numerous patients regain a pulse and blood pressure, but only 3 of them survived long enough to be discharged from the hospital.

Hi Sharpenu,

Not one of us can really state with any conviction that we have the evidence to justify the statements we have made on this thread. I doubt the usual success rate of 1% could be submitted for analysis and a conclusion reached that any particular failure was due to "poor performance" in chest compression - if only because of this abysmal success rate.

I do agree that it is possible to make matters worse but, clearly, it is also quite impossible to do any meaningful statistical analysis to prove that this is in fact the case.

Hence my feelings that every rescuer must do what he can.;- Early basic life support followed by early defibrillation is of proven worth in the public first-aid situation, where ventricular fibrillation secondary to an ischaemic event (or trauma) is the most likely diagnosis.

My impression;- Whether this can be extrapolated to the majority of diving accidents is open to debate and well beyond the remit of this forum.

What is of proven worth in diving injuries is early and continued use of 100% oxygen.

 

[sharpenu]

No, I agree with the statistical part. When I talked of my success, I was answering your earlier post that asked about personal success with CPR. Sorry, should have been more clear. The overall point of my post was that CPR training and retraining was important.

As far as AED's on dive boats, I think it is a good idea, but I am not sure how effective it would be. The one time I did CPR on a dive boat, it took us almost 45 minutes to get to shore. Even with an AED, that is much too long of a down time. Your patient is likely to be acidotic by then, even with good CPR.

Early BLS, followed by early Defib is good, but it must be backed by early access to ALS. Here in the US, the ideal is BLS within 2 minutes, Defib within 4 and ALS within 8 minutes. I am not familiar with Europe or any other locations, is it the same everywhere?

 

[divemed06]

A bit off topic...but isn't it amazing how many scuba divers learn CPR for the purpose of dealing with a diving related problem when in fact, the most likely place to encounter a VSA is in your own home, with your family. Most divers (and I'm assuming) would not have taken a CPR course if they had not become divers. I wish that everyone (divers and non divers alike) would take a CPR course at least once in their lifetime....it's fun, it's rewarding, it doesn't take up that much time and it might help you save someone you love....

 

[The Iceni]

sharpenu once bubbled...
No, I agree with the statistical part. When I talked of my success, I was answering your earlier post that asked about personal success with CPR. Sorry, should have been more clear. The overall point of my post was that CPR training and retraining was important.

Hi Sharpenu,

I think we are in violent agreement!:doctor:

kind regards,