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CPR Technique Updated - 10/18/2010 6:57:52 AM   
poise


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RE: CPR Technique Updated - 10/21/2010 7:22:58 AM   
afkarr


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Status: offline 		The latest rage is CCP- continious cardio perfusion, or "hands only" CPR. Compressions with no breaths. It's been shown to actualy result in less neurological impairment when used pre hospital than traditional CPR.

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RE: CPR Technique Updated - 10/21/2010 7:40:16 AM   
angelikaJ


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quote:

ORIGINAL: afkarr

The latest rage is CCP- continious cardio perfusion, or "hands only" CPR. Compressions with no breaths. It's been shown to actualy result in less neurological impairment when used pre hospital than traditional CPR.


CCP was the previous American Heart Association revision. They came up with that one when research was showing that many people were afraid of the mouth-to-mouth part because of their worries over disease transmission and so people weren't giving CPR at all.

Now the AHA has rethought their position on it and have decided that people were not getting enough oxygen with just compressions.

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RE: CPR Technique Updated - 10/21/2010 11:39:16 AM   
Louve00


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Status: offline 		Well, if I'm recalling right, room air before you inhale it is 21% oxygen.  After its inhaled and used by the body, I don't know how much oxygen is left in an exhaled breath.  But taking it all into consideration, it would be more important to circulate that blood and let the body use whatever oxygen it has left until first responders arrive, then to waste time stopping compressions to give a stale breath of air, with very little oxygen to begin with.  In fact, thinking on it as I type, you may be administering no more oxygen to them in one of your own breaths, than circulating the blood which may have about the same oxygen as the breath you breathe into them.  Just a thought.

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RE: CPR Technique Updated - 10/21/2010 5:16:57 PM   
hausboy


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Status: offline 		They have been studying this for quite awhile....and the debate in the medical community goes back and forth.  Sometimes, I swear they just change the guidance so that instructors and students have to buy new textbooks....

But here was the latest thinking on it:

two prong.
Yes--the layperson was reluctant (and rightfully so) to perform ventilations-- mouth to mouth-- on a stranger.  And the first thought was better compressions than nothing at all.  Which is true.

But there's more to it:

The latest AHA funded research determined that the oxygenation level in the blood was sufficient for at least the first few cycles of compressions, and that it was more important that adequate perfusion to the brain and subsequent organs was sustained through constant compressions.  Especially for the public, most took entirely too long between compressions and ventilations, and there was inadequate perfusion.  Constant compressions allowed for momentum, for lack of a better term, to build up, and it enabled sufficient perfusion long enough until EMS could arrive. Even healthcare provider CPR guidance was changed about 2 years ago, adding longer compression ratios so that the blood "momentum" could be sustained without breaking to ventilate the patient.

That said--the real denominator for successful CPR has much more to do with access to early defibrillation--how quickly EMS arrives...and then a cardiac receiving team at a hospital (cath lab)...receive the patient.  Compression-only CPR is only one small link in the chain of survival, and if you live in a location where the arrival of a medic crew will be delayed (especially true in rural communities) compression only CPR will not ensure survivability.  Ozygenated blood will only go so far.  Of course, neither will perfectly performed CPR with ventilations-- approximately 5% of all cardiac arrest patients survive and return to a good quality of life. And in some places where EMS has long transports, it is much less than 5%.

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RE: CPR Technique Updated - 10/21/2010 7:56:47 PM   
WyldHrt


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quote:

Well, if I'm recalling right, room air before you inhale it is 21% oxygen.  After its inhaled and used by the body, I don't know how much oxygen is left in an exhaled breath.  But taking it all into consideration, it would be more important to circulate that blood and let the body use whatever oxygen it has left until first responders arrive, then to waste time stopping compressions to give a stale breath of air, with very little oxygen to begin with.  In fact, thinking on it as I type, you may be administering no more oxygen to them in one of your own breaths, than circulating the blood which may have about the same oxygen as the breath you breathe into them.  Just a thought.

The human body uses about 20% of the available oxygen taken per breath. An exhaled breath is 14-16% oxygen, down from the ambient 21%, enough for the purposes of CPR. It really does depend on how long it takes for EMS to get there, and the availability of defibrillators (many places like gyms and such now have them). If EMS will be on scene quickly, rescue breathing isn't all that important; but if it is going to be awhile, compressions alone aren't going to cut it.

I once did CPR compressions on a woman for over 45 minutes while we transported her from her house in BFE into town. Even with another EMT spelling me, I was exhausted by the time we got her heart going. It wasn't a 'good' save, but at least her family got to say goodbye before she passed again.


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RE: CPR Technique Updated - 10/21/2010 7:59:04 PM   
thatsub


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Status: offline 		Forget what you learned on TV as well - up to 30% of cardiac arrest victims have broken ribs as a result of correctly done CPR.

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RE: CPR Technique Updated - 10/21/2010 10:12:34 PM   
tazzygirl


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RE: CPR Technique Updated - 10/22/2010 8:49:16 AM   
Louve00


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quote:

ORIGINAL: WyldHrt


The human body uses about 20% of the available oxygen taken per breath. An exhaled breath is 14-16% oxygen, down from the ambient 21%, enough for the purposes of CPR. It really does depend on how long it takes for EMS to get there, and the availability of defibrillators (many places like gyms and such now have them). If EMS will be on scene quickly, rescue breathing isn't all that important; but if it is going to be awhile, compressions alone aren't going to cut it.

I once did CPR compressions on a woman for over 45 minutes while we transported her from her house in BFE into town. Even with another EMT spelling me, I was exhausted by the time we got her heart going. It wasn't a 'good' save, but at least her family got to say goodbye before she passed again.



Point taken and noted.....and damn, WyldHrt...doing CPR on someone for 45 minutes!!!  You must have muscles that just don't quit and I'd hate to get into a tussle with you! 


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RE: CPR Technique Updated - 10/22/2010 9:25:12 AM   
DomImus


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Status: offline 		For the record the Red Cross still recommends rescue breaths as of Wednesday. I completed an adult CPR class just a few days ago.

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RE: CPR Technique Updated - 10/22/2010 3:06:59 PM   
WyldHrt


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quote:

...and damn, WyldHrt...doing CPR on someone for 45 minutes!!!  You must have muscles that just don't quit and I'd hate to get into a tussle with you! 
It was more like adrenaline that wouldn't quit, because it was my first time doing CPR on a real person. Even though I was 22 at the time, I was sore as hell the next day!


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RE: CPR Technique Updated - 10/22/2010 5:31:24 PM   
hausboy


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Status: offline 		WyldHrt-
absolutely agree with you.  I've lived in places where the EMS response times (rural) could be up to 30 minutes to almost an hour before anyone arrived....and other metropolitan locations where EMS (or at least, an engine with EMTs/AED) is on scene in about 4 minutes.  CPR is just one part of the chain of survival--most folks don't understand that.

The longest I think I ever had to perform CPR was probably about 20 minutes--and that was plenty exhausting!



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RE: CPR Technique Updated - 10/27/2010 7:21:58 PM   
MercTech


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Status: offline 		I scared the crap out of my girl the other day when I screamed at the TV... they showed the CSI (guess which program) jumping to do chest comressions without ever even checking for a pulse.
IF THE PATIENT HAS A PULSE AND YOU START CHEST COMPRESSIONS YOU WILL GIVE THEM A HEART ATTACK.

And, if you don't clear the airway, they CAN NOT BREATH on the back with the head tilted forward. No one can breath in that position with the tongue relaxed to the back of the throat.

Clear the airway,
Check for pulse,
Check for breathing.

THEN start rescue breathing and/or chest compressions if warranted.

If they have a pulse and are breathing and no overt breaks or wounds, the proper position would be on the side with one leg bent at the knee to keep them there so the unconcious person can breath easily on their own and not aspirate if they vomit.

The first time I took American Red Cross Advanced First Aid, the course was from a 400 page manual and took two hours 3 times a week for eight weeks. The last time I took the Red Cross Advanced First Aid course for recert, it was taught from a 32 page booklet and took two hours total. The bar has been lowered waaayyyyy too low I think.

Ok... soap box put away.

Stefan

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RE: CPR Technique Updated - 10/27/2010 7:25:45 PM   
Lordandmaster


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Status: offline 		Yeah, in the old days, before you commenced CPR, you had to lean over the person and say "Are you OK?  Are you OK?"  Now, with the updated procedures, you're required to say "Is you OK?  Is you OK?"

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RE: CPR Technique Updated - 10/28/2010 6:31:42 AM   
angelikaJ


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quote:

ORIGINAL: MercTech

I scared the crap out of my girl the other day when I screamed at the TV... they showed the CSI (guess which program) jumping to do chest comressions without ever even checking for a pulse.
IF THE PATIENT HAS A PULSE AND YOU START CHEST COMPRESSIONS YOU WILL GIVE THEM A HEART ATTACK.

And, if you don't clear the airway, they CAN NOT BREATH on the back with the head tilted forward. No one can breath in that position with the tongue relaxed to the back of the throat.

Clear the airway,
Check for pulse,
Check for breathing.

THEN start rescue breathing and/or chest compressions if warranted.

If they have a pulse and are breathing and no overt breaks or wounds, the proper position would be on the side with one leg bent at the knee to keep them there so the unconcious person can breath easily on their own and not aspirate if they vomit.

The first time I took American Red Cross Advanced First Aid, the course was from a 400 page manual and took two hours 3 times a week for eight weeks. The last time I took the Red Cross Advanced First Aid course for recert, it was taught from a 32 page booklet and took two hours total. The bar has been lowered waaayyyyy too low I think.

Ok... soap box put away.

Stefan


Stefan, believe it or not, but both of the American Red Cross and the American Heart Association did away with checking for a pulse quite some time ago, for laypeople at least.
Their research had shown them that too many times people would check for pulses and feel them when they weren't actually present because what they were feeling was their adrenaline fueled own pulse. They would feel that and not do chest compressions, when in fact they were needed.

So, yes, airway is very important, but instead of checking for a pulse, we now look for "signs of life": body movement.


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RE: CPR Technique Updated - 10/29/2010 5:48:51 PM   
MercTech


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Status: offline 		Ok.. back to the comment about lowering the bar.

Stefan

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RE: CPR Technique Updated - 10/31/2010 9:12:52 AM   
angelikaJ


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quote:

ORIGINAL: MercTech

Ok.. back to the comment about lowering the bar.

Stefan


I think the point is, even if you do have to lower the bar on technique, it doesn't really matter as long as lives are saved.
They are trying to make AED's more available and train more people in the use of them.
Meanwhile, if more people do the minimal basics until someone shows up with an AED, the person has a good shot at survival and recovery.

AEDs really changed how things are done.

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RE: CPR Technique Updated - 11/3/2010 8:08:16 AM   
NovelApproach


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quote:

ORIGINAL: angelikaJ

I think the point is, even if you do have to lower the bar on technique, it doesn't really matter as long as lives are saved.
They are trying to make AED's more available and train more people in the use of them.
Meanwhile, if more people do the minimal basics until someone shows up with an AED, the person has a good shot at survival and recovery.

AEDs really changed how things are done.


Availability and training are really starting to take off.  I was actually taught AED the last time I went to re-certify in CPR.  The machines are cropping up all over the place now too - at the mall near my house, there's an AED located next to every fire alarm/extinguisher in one of those emergency break-the-glass boxes. 


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RE: CPR Technique Updated - 11/3/2010 2:26:58 PM   
kiwisub12


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Status: offline 		I tend to think CPR outside of the hospital is a waste of time. I worked in an ER for 10 years , and in all that time, we had exactly ONE save - and he had leukemia. That is one person who actually walked out of the hospital after his arrest.

If you factor in the time and effort and money to save that one person, well, let me just say, i would rather the money went to vaccinating kids or providing discounted dental care for school aged kids.
Now, AED's are a great idea, hopefully they will help save more people than CPR ever did.



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RE: CPR Technique Updated - 11/7/2010 2:18:49 PM   
Aswad


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quote:

ORIGINAL: MercTech

Ok.. back to the comment about lowering the bar.


It doesn't matter if you lower the bar.
You are not actually saving any lives with CPR.
You're extending the timeframe in which it might be saved.

Loss of respiration will cause cardiac arrest, so ignore the presence of a pulse unless you are an ER nurse or doctor, or the patient starts breathing again. Try to clear the airway if you have reason to suspect it may be obstructed. Make sure to call 911 right away, which gets the EMTs on site as fast as possible. They are the ones who will try to save the patient's life.

After cessation of spontaneous breathing, the body can go without ventilation for 4 minutes without risk of brain damage, and heavy brain damage or fatal loss of cardiac function is unlikely before 6 minutes have passed. This means you should not spend more time than what it takes to administer one test breath (to check the airway), unless drowning is involved, or the 911 operator tells you the EMTs will take more than 4 minutes to get to the scene. They will have bag ventilators or oxygen tanks, both of which are superior to the partial pressure of oxygen provided by rebreathing. The less time you waste, the more time they will have to use those ventilators.

After cessation of circulation, loss of consciousness occurs after 15 seconds, give or take.
Time to permanent brain damage is measured in seconds, although it's like 2-3 digits.
Death is assured in minutes, and that is presently an irreversible condition.

So, yeah. Please keep the bar low. You really want rapid response.

Long term or high quality CPR makes very little difference.
Rapid response and good perfusion are the keys.
That, and getting EMTs on site quickly.

Health,
al-Aswad.

P.S.: The accuracy of non-ER nurses trying to determine the presence or absence of a pulse in an emergency is on-par with a coin flip. This has been verified on nurses in a thorough study up here, done in connection with quality assurance on the national guidelines for emergency medical care and civilian life saving courses (including basic CPR courses, of course). The course surveyed nurses in many locations, iirc, including my local hospital (about 50K people).

P.P.S.: Some exceptions apply with hypothermia. Sometimes.



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