Squeeze Chest, Breathless: New CPR Protocol.

[GJC]

For all of us scuba people, look for a Healthcare Provider CPR course not the lay person CPR course.

Ventilations are still taught in the Healthcare Provider CPR course. You should not have any problem enrolling in the Healthcare Provider course if you are not a healthcare provider.

 

[Kevrumbo]

Concur on Rescue Breaths:

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

. . .This reflects a very common misunderstanding about the differences between community cardiac arrest and what happens in drowning.

The reason we would not recommend compression only CPR in water is nothing to do with an inability to offer cardiac support in the water. Even if we could do effective cardiac support / chest compressions in water we would not recommend compression only CPR where asphyxia is the likely cause of respiratory / cardiac arrest.

Compression only CPR is effective in community cardiac arrest because the cardiac arrhythmia / arrest is the cause of cessation of breathing. At the point of ceasing breathing the patient is oxygenated and importantly there is oxygen in the lungs. Compression only CPR works because it will circulate blood, and some oxygenation of that blood will occur as it passes through the lungs.

In asphyxia / drowning the patient becomes hypoxic before the cardiac arrest; indeed, hypoxia is the eventual cause of the cardiac arrest. That is, as hypoxia worsens, breathing efforts cease and eventually, if the hypoxia is not corrected, there will also be a cardiac arrest. Compression only CPR will not work in this setting because there is effectively no oxygen to circulate. It is even worse than that though. As implied, there is a period between respiratory and cardiac arrest. If hypoxia can be corrected during this period then cardiac arrest may be prevented which, in reality, is the only thing likely to save a life out in the ocean. In a diving rescue it is not possible to tell if the victim is in respiratory but not cardiac arrest, but if that is the situation (and we would hope it is), then the only realistic chance of saving the victim is to stop them going into cardiac arrest in the first place. Thus, rescue breaths (breaths as early as it is physically possible to administer them) may be the key life saving intervention in drowning. . .

 

[tursiops]

The DAN and PADI/EFR classes still teach rescue breaths, as of course do the healthcare provider courses.
it is only the workplace CPR classes that teach hands-only, and even then they should be giving the appropriate caveats.

 

[Bubblesong]

I am dropping that class to re-take at a Local Dive Shop, that speaks to dive situations and locations.

 

[tursiops]

I am dropping that class to re-take at a Local Dive Shop, that speaks to dive situations and locations.

Try and get the DAN 1st Aid for Professional Divers course. it is awesome.

 

[Dr Simon Mitchell]

Hello,

This issue is very explicitly dealt with in the paper I have uploaded here. The paper represents a consensus of diving medicine experts and is a diving equivalent of the European Resuscitation Council Guidelines, but tailored to issues in diving. It strongly reflects the perspective shared by rsingler and the earlier commentary of mine that Kev re-posted.

Simon M

 

[Bubblesong]

Hello,

This issue is very explicitly dealt with in the paper I have uploaded here. The paper represents a consensus of diving medicine experts and is a diving equivalent of the European Resuscitation Council Guidelines, but tailored to issues in diving. It strongly reflects the perspective shared by rsingler and the earlier commentary of mine that Kev re-posted.

Simon M

Thank you! This is why I can’t rely on town sponsored CPR, but need to get the Scuba version that takes into account very different situation and CPR needs. Luckily our LDS has a combined CPR, First Aid and O2.

 

[KathyV]

I was recently trained in CPR and first aid and they gave each of us a face shield like the one at the link below. It is small and easy to carry. I keep mine in my wallet but I will have to think of a good place to carry it on a dive boat!

https://tinyurl.com/y9v6c3m4

 

[Rred]

"and the fireman teaching us says it is changing to “not expect public to give breaths”,"
Changed about four years ago IIRC. I recertify every 2-ish years as required, and around 4 years ago, maybe 5, we were being taught CPR with breathing--but told the new standards had already been written and would be making the breathing unnecessary. Which can be problematic because you have to do as you've been taught, for liability reasons, so if you are classed as "professional" or have been trained with breathing...you have to keep doing it that way. If you haven't been trained that way, then you SHOULDN'T be doing it that way.

Apparently if someone is not conscious, simply circulating the blood will oxygenate the brain "enough". Statistically? There's a 10-minute window for CPR. If started immediately, there's about a 100% chance or restarting the patient. That goes down by 10% per minute, so if you don't reach them and start CPR within five minutes, they are down to a 50% chance of being revived, with or without breathing. After ten minutes, the odds are they will need a miracle. Either way.

On the one hand, yes, I would like to know and do what is best. On the other hand, if you don't follow your certification training, you become very open to liability suits. Nice, isn't it?

 

[Bubblesong]

Actually, since I dive with family, My kids can’t sue me or I won’t pay for their college!
But if I get trained through town, not to give breaths, then also trained through dive shop that I should give breaths in a dive situation, then I am likely covered either way! Boo-Yah!