Rescue Breathing on the surface

[tracydr]

Haven't I read somewhere lately that the NEW procedure for reanimation is not 12 chest compressions and then 1 breath , but 20 compressions and then 1 breath because the most important is to have the blood circulated to the brain, not air in the lungs ?

*** Did not have to use the new technique yet, but it should be a work out for the responder !!

Keep in mind, most CPR research is done with cardiac arrest due to v-fib. You are also in a dry situation and able to check pulse. The difference in a drowning victim is substantial. There is a good chance that resp. arrest has not yet caused cardiac arrest. (although it will shortly) Therefore, a few rescue breaths in the water may very well get a non-breathing or weakly breathing victim back quickly.

 

[tracydr]

Regardless of what is taught or by whom, it is not practical for the average weekend recreational diver to both tow a diver and continue rescue breathing for any extended period of time. The tow will go very slowly and the average rescue diver will wear themselves out before they reach the shore. Now you have two divers in trouble. If you can stay put and call a boat or other divers over for help that is a different situation.

Just took rescue diver last month. Recommendation for rescue breathing is different if the tow is long or short. For a long tow you give two rescue breaths and then begin towing. For a shorter two you breath the entire time.
Don't have my book sitting right here so I'm not going to try to quote the actual length/time of the tows.
I would go by what is taught and try to keep up with current guidelines as well.
Just took my Advanced Cardiac Life support for about the 20th time. Used to be an instructor but went back to complete residency and wasn't able to teach for two years. Anyway, the 30:2 ratio is correct. Not doing rescue breaths is only for lay persons "if they are reluctant to do them due to possible disease transmission".
I consider rescue breathing very important (and far more effective if you use your mask/get a good seal) because a non-breathing or shallow breathing victim may still have a pulse. The physiology behind why they are down is so much different from a cardiac victim. (unless of course they had a heart attack in water, then all bets are off) I think of them more like a neonatal or pediatric patient because the primary problem is lack of oxygen rather then heart attack.
JMHO along with some valuable ER experience of my own.
By the way, you may actually use this stuff in real life so learn it well. I saved a toddler next door one time. He had been in the pool probably 10-15 minutes and was pulseless/not breathing and blue. When I arrived the BLS EMT guys were attempting to provide O2 with a non-rebreather and not providing chest compressions. I started proper CPR and got a bag/valve mask going to provide positive pressure breaths (instead of O2 flowing past his face doing him no good) and then intubated as quickly as possible.
Kiddo's temp was 86 degrees when he arrived to the nearest ER. (EMTs were going to take him into town, a 20 min drive when the army hospital was 5 min away!!!)
Parents brought the kid by my house a week later and he looked great. Talk about a gratifying experience. Much better than 99% of the codes I've run in the hospital with poor outcomes.
Point is, drowning victims stand a much better chance of survival then other types of arrests and positive pressure breathing can save their lives.

 

[scjoe]

Or stay put and call a boat or other divers over for help WHILE you are performing the rescue breaths?..Ever did CPR. Its difficult to perform CPR on land for an extended amount of time by yourself also. It is just very difficult, physically.

I never said that you can perform CPR in the water?

Northern Diver,

Your first quote seems to equate breathing in water with CPR which is why I drew the distinction.

 

[northen diver]

Northern Diver,

Your first quote seems to equate breathing in water with CPR which is why I drew the distinction.

Or stay put and call a boat or other divers over for help WHILE you are performing the rescue breaths?..Ever did CPR. Its difficult to perform CPR on land for an extended amount of time by yourself also. It is just very difficult, physically.

 

[derwoodwithasherwood]

PLEASE STOP advocating that rescue breathing is a waste of time. You ARE NOT a doctor are you? All of these agencies are teaching this skill for a reason. Stick to your training. If you disagree with it, so be it, but dont spout off like you KNOW its a waste of time unless you have some real proof.

I am a small cog in the study that supports his statements. That multi-year, multi-phase North American wide study is part of what led to the change in CPR standards to 30:2.

There are always exceptions of course, but there is very strong statistical evidence that compressions are, above all else, the most critical need after the heart stops and should be given precidence over and above breaths. There is usable O2 in the blood stream for some time after circulation stops, even though the levels will be somewhat depleted. We are currently engaged in the next phase of the study which statistically compares 1 minute of initial uninterupted compressions to 3 minutes of initial uninterupted compressions at a rate of at least 100bpm.

So, assume for a moment that the Px has some sort of a pulse but has stopped breathing. What you are facing is a typically degrading situation and can be assured the heart will soon cease to move blood. You have only a very few minutes after that until brain cells start to die -- one figure often bandied about is 6 minutes.

Let us say that the heart stops moving blood efficiently precisely at the moment you make your decision. If you are 5 minutes from shore or a boat, you have 1 minute to get the Px out of the water and start CPR. Good luck with that, but stranger things have happened. If you do 3 minutes of in-water rescue breathing first, you are now 2 minutes overdue when you hit the shore. Now the odds are that much worse.

But let us say that you started rescue breathing immediately on loss of conciousness -- well before the heart stopped moving blood. And let us further suppose that you are skilled, able to maintain a good airway, don't fill the Px with water, do everything perfectly and keep the heart and brain sufficiently oxygenated. What have you accomplished? You are still 5 minutes from shore and 6 minutes from brain death. You are also now getting tired from your efforts.

In My Humble Opinion, considering the above: If you *know* that help is responding promptly to your location, then it makes sense to attempt rescue breathing. Otherwise, you are probably best to get the Px out of the water as soon as possible so you can treat them effectively.

Just my 2¢

 

[Satori]

For the apneic diver at the surface, ABC's should be initially checked. Airway patency should always be assured (if you don't have an airway, you dont have a patient) The diver may only need a patent airway to ventilat on his own. If diver isn't ventilating on his own, 2 rescue breaths need to be given. Lets assume this is post dive surface breathing... the etiology of altered level of consciousness needs to be questioned. Is this a bad fill? Did the diver get bent/oxygen toxicity? Did the diver have a medical incident such as a spontaneous pneumothorax at depth? Did the diver begin to drown or have a mechanical ostruction? Assuring airway patency and delivering breaths can help you to decide what kind of interventions may be needed, in addition to providing essential ventilation of the unresponsive diver. Compressions can't really be performed effectively in water so I wouldn't even waste time in assessing circulation before reaching a stable surface.

 

[stevewirl]

hi guys . im a m1 instructor with cmas im also a paramedic . the new compression rate from last year is 30:2 .
as for the rescue breaths it is generaly understood that survival rate decreases between 7-10% for every min the heart is not beating . after 3 mins the o2 starved brain starts to die . my opinion would be to get the victim to the shore and recieve advanced care asap .
BUT.............. as with everything if it in the book its the bible so thats the stance