Squeeze Chest, Breathless: New CPR Protocol.

[Bubblesong]

Slightly off topic question about CO2 and CPR for @Kevrumbo and @TONY CHANEY : i am taking my 4th CPR class and the fireman teaching us says it is changing to “not expect public to give breaths”, but just focus on compressions, because there is enough O2 in blood to keep brain alive. 1) He doesn’t mention that after the Krebs Cycle metabolizes O2 into CO2 and water, that there will be a build up of CO2 in the blood, that won’t be eliminated through respiratory system without me giving breaths. 2) If compressions are only strong enough to thoroughly perfuse Willis Circle of organs, leaving extremities with even less oxygen, so that when heart restarts, brain getting a wash of CO2 laden blood to cause an even stronger Hypercapnic Response, and greater difficulty reviving breathing. I’m thinking of re-taking CPR elsewhere, unless you can tell me how this truly is the path to Best Results.

EDIT=> “Please Read This: After careful consideration of circumstance, plus the advice of Dr.Mitchell, I have decided that landlubbers having a heart attack might not get breaths, but anyone whose trouble started with choking, drowning, hypoxia or other Oxygen deprivation circumstances most certainly DO need breaths and I will continue to supply full CPR as best I can”

 

[JohnnyC]

I have to take first aid/CPR/AED/O2 refresh every year for work. Last year the guy said rescue breaths were no longer required. His explanation was that by providing chest compressions, you were sufficiently ventilating the lungs through the mechanical action of compressing the chest. I don’t know if this is true, but it was the reason that was given.

I don’t have any evidence as to whether this is either true or false.

 

[Schwob]

I have to take first aid/CPR/AED/O2 refresh every year for work. Last year the guy said rescue breaths were no longer required. His explanation was that by providing chest compressions, you were sufficiently ventilating the lungs through the mechanical action of compressing the chest. I don’t know if this is true, but it was the reason that was given.

I don’t have any evidence as to whether this is either true or false.

We were told the same, also no idea how much of it is rooted in medical truth and how much in other truth (legal?).

 

[northernone]

I have to take first aid/CPR/AED/O2 refresh every year for work. Last year the guy said rescue breaths were no longer required. His explanation was that by providing chest compressions, you were sufficiently ventilating the lungs through the mechanical action of compressing the chest. I don’t know if this is true, but it was the reason that was given.

I don’t have any evidence as to whether this is either true or false.

This is the best source I know on the subject:

http://www.nejm.org/doi/full/10.1056/NEJMoa0908993#t=article

Or search the web for:

CPR with Chest Compression Alone or with Rescue Breathing

• Thomas D. Rea, M.D.,
• Carol Fahrenbruch, M.S.P.H.,
• Linda Culley, B.A.,
• Rachael T. Donohoe, Ph.D.,

 

[KevinNM]

Slightly off topic question about CO2 and CPR for @Kevrumbo and @TONY CHANEY : i am taking my 4th CPR class and the fireman teaching us says it is changing to “not expect public to give breaths”, but just focus on compressions, because there is enough O2 in blood to keep brain alive. 1) He doesn’t mention that after the Krebs Cycle metabolizes O2 into CO2 and water, that there will be a build up of CO2 in the blood, that won’t be eliminated through respiratory system without me giving breaths. 2) If compressions are only strong enough to thoroughly perfuse Willis Circle of organs, leaving extremities with even less oxygen, so that when heart restarts, brain getting a wash of CO2 laden blood to cause an even stronger Hypercapnic Response, and greater difficulty reviving breathing. I’m thinking of re-taking CPR elsewhere, unless you can tell me how this truly is the path to Best Results.

Non-professional CPR is expected to be fairly short term. Then EMS arrives and takes over using a BVM with 100% oxygen. The objective is to have a viable patient when EMS gets there in minutes.

 

[GJC]

The general public is just not that good at doing ventilations and interupting compressions for more than a couple seconds is really bad for the victim.

Ventilations with CPR is still taught to professional rescuers (EMTs and paramedics) and all medical personnel.

 

[tursiops]

That "hands only" CPR is caveated as not valid after drownings. See the note at the bottom of this link from the AHA. For scuba, in water, we assume drowning.

 

[tursiops]

That "hands only" CPR is caveated as not valid after drownings. See the note at the bottom of this link from the AHA. For scuba, in water, we assume drowning.

There is a lot of confusion between workplace CPR and scuba CPR.

 

[Jonny Wishbone]

In the LE agency I work for we just re-certified and the new changes for me are that we were trained on using a hand squeeze ventilator to replace the actual mouth to mouth even though we had been using a pocket mask with a valve in it in the event the patient vomited. Now we just use the hand ventilator and compressions.

 

[rsingler]

That "hands only" CPR is caveated as not valid after drownings. See the note at the bottom of this link from the AHA. For scuba, in water, we assume drowning.

Just to clarify, the rationale for compressions only CPR on the street is that the most likely cause of collapse is cardiac, and maintaining circulation is key (plus bystander interruption of compressions to deliver rescue breaths was shown to have a poorer maintenance of effective circulation).
In scuba, by contrast, the primary cause of collapse is more likely to be respiratory, and there may well be continued heartbeat and circulation that you can't assess while the victim is in neoprene and in the water. Rescue breaths answer the need for oxygen for an otherwise effective circulation (plus, you obviously can't do CPR while towing). Of course, if you DO have a primary cardiac cause of collapse (e.g., heart attack) while underwater, your situation is grim. But then the success rate of bystander CPR without early defibrillation by EMT's or an AED is equally grim.
Bottom line, scuba rescue = Rescue Breaths until you have the victim on a hard surface. Once you are on the boat, my recommendation would be to continue traditional CPR with breaths until you have an ECG diagnosis of the rhythm. Until then, the cause of the problem for a scuba victim should be assumed to be respiratory.

Diving Doc