Resuscitation question...

[DeepSeaDan]

I've actually seen patients with arterial lines and Swan Ganz catheters in place when they have been undergoing CPR. Effective CPR can generate a surprisingly high mean arterial pressure and a significant cardiac output. Although I have not seen a patient breathing in Vfib arrest, I can easily imagine it possible, with a slender patient and well-performed CPR.

There is currently a strong movement toward compression-only CPR, as outcomes have been shown to be essentially equivalent to compression/ventilation resuscitation, and people are reluctant to do mouth-to-mouth resuscitation these days.

...to see the diversity of what folks have read/heard on this subject. I have read that outcomes using compressions-only "CCR" have resulted in significantly improved outcomes by EMS services practicing the philosophy. I've also read of Japanese research where they are recommending standard "CPR" be used for children, due to their comparative inavailability of circulating O2 post-arrest, & their higher metabolic rates. My local base hospital moved to a "circulation first" modus operandi
a few years back - it still jars me to see airway management take a relative backseat to circulation on code calls.

DSD

 

[StreetDoctor]

In the state of chicago giving ventilations are further and further down the list of importance. 30:2 right now, I wouldn't be suprised to see that go to 50:2 in the future. Lots of studies have been done locally that show everyone over oxygenates the pt which increases the intrathoracic pressure which makes compressions less effective.... or something like that. We're also getting further away from ET tubes and using King LT airways instead as they can be placed without ceasing compressions.

 

[carrielsal]

When I took cpr last year, I was told that the procedure had changed to compressions only, no breaths.

 

[DandyDon]

When I took cpr last year, I was told that the procedure had changed to compressions only, no breaths.

Unless it's a child under 8, right...?

 

[carrielsal]

Unless it's a child under 8, right...?

I don't remember.

 

[DandyDon]

I don't remember.

Well, this may vary with whom one quotes as much is being studied with some changes, and the differences become bigger with a baby. The under 8 differences have more to do with how to compress, so maybe I misspoke there. From Cardiopulmonary resuscitation (CPR): First aid - MayoClinic.com

To perform CPR on a baby
Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If you know the baby has an airway obstruction, perform first aid for choking. If you don't know why the baby isn't breathing, perform CPR.

To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don't shake the baby.

If there's no response, follow the ABC procedures below and time the call for help as follows:

If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number.​

If another person is available, have that person call for help immediately while you attend to the baby.
Airway: Clear the airway

Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.

Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.

In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.​

If the infant isn't breathing, begin mouth-to-mouth rescue breathing immediately. Compressions-only CPR doesn't work for infants.

continued at link

 

[StreetDoctor]

When I took cpr last year, I was told that the procedure had changed to compressions only, no breaths.

for the lay person they're teaching breaths are not necessary if you aren't comfortable with it. I think this stems from people not wanting to do mouth to mouth, so if you just want to beat on the chest that's completely acceptable.

 

[knotical]

Won't chest compressions alone cause some air to be expelled from the lungs? Wouldn't this cause some air exchange? Granted, not as much as efficient rescue breaths, but …

 

[DandyDon]

Won't chest compressions alone cause some air to be expelled from the lungs? Wouldn't this cause some air exchange? Granted, not as much as efficient rescue breaths, but …

I think much of that would be simple fluctuations of the dead air space between the lungs and mouth/nose, much like dead space in a dive snorkel.

 

[carrielsal]

We were told that there is enough O2 in the blood already and it was more important to have it circulating and not stopping compressions for the rescue breath.