New research With regard to CPR

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Seatonstomb -> New research With regard to CPR (3/22/2007 3:14:13 PM)
New research suggests that compressions more important than breaths

sweetnurseBBW -> RE: New research With regard to CPR (3/22/2007 7:02:26 PM)
Its not that breaths are less important. The same amount of breaths are being done just more compressions. Research found out that more time during cardiac arrest was spent with hands off the chest. Compressions help circulate drugs and O2 being administered during CPR. End result to improve outcome. [:)] http://circ.ahajournals.org/cgi/content/full/112/9/1259

hereyesruponyou -> RE: New research With regard to CPR (3/23/2007 4:58:49 AM)
And also, many people chose to do nothing if they were uncomfortable with giving rescue breaths. One of main plugs now is to get people to at least do the compressions. ~ American Red Cross Instructor (makes the subs feel safer too!)

sweetnurseBBW -> RE: New research With regard to CPR (3/23/2007 6:12:37 AM)
I work in cardiac intensive care so we just ambu bag or intubate. More of a problem on floors and out of hopsital arrests. [:D]

NightWindWhisper -> RE: New research With regard to CPR (3/24/2007 12:20:59 PM)
Pumping deoxygenatied blood will do nothing for the heart so both are important. Indeed, more compressions are the norm now, but the breaths are too. Ultimately though success is measured almost always directly related to the availibility (in most cases) of an AED (Automatic External Defibrillator) after (I think) four minutes the success rates, even with very good CPR plummets.

calicowgirl -> RE: New research With regard to CPR (3/24/2007 12:29:18 PM)
From what I was just told at a recent CE class the US is one of the only countries left worrying about giving breaths at all during bystander CPR. It is believed that in approx 4 yrs when they do another round of inevitable turn overs as far as upgrading CPR based on case studies that layman CPR will be taught without giving breaths at all. cali

tasha_tart -> RE: New research With regard to CPR (3/24/2007 8:08:14 PM)
In Canada, the new protocol is just beginning to be taught. The rationale for more compressions is that it takes time to re-establish circulation after stopping compressions. Also, the heavy-duty chest compressions do result in some air exchange in/out of the lungs (anyone remember Holger-Nielsen or revised Sylvester?) They (St John Ambulance in particular) have also totally dropped all the landmarking and cadence requirements. Lock the hands, centre of the breastbone, compress pretty much as fast as you can...the theory being bad CPR is better than no CPR. Less emphasis on pulse checks too, since many lay people cannot reliably find one...and if there's no breathing, no pulse is going to follow pretty damned soon. Can't say I miss the days of having to produce a perfect tape from the mannequin...and the five 8 hour days the course used to take. Tasha

bettie1959 -> RE: New research With regard to CPR (3/25/2007 1:19:06 PM)
30 compressions for every 2 breaths for those non medical folk that maybe reading this topic.

Termyn8or -> RE: New research With regard to CPR (3/25/2007 2:30:09 PM)
The engineer's perspective. I think when I was a kid they taught like five compressions to one breath. Remember I am not a doctor, but fluid dynamics and aerodynamics apply here. First of all in the case of cardiac arrest, what I have been told is that it is a muscle spasm, a severe one, that is bad enough to cause part of the heart muscle to go into anoxia. Since the heart's pumping action is based on check (one way) valves any form of effective compression and decompression will result in pumping action. With cardiac arrest, that is no longer happening, but the person actually was breathing right before, so there is probably some O2 left in the blood. Now I understand flow, supply and demand and a few other things I will render an opinion. I AM NOT a doctor, I AM NOT an expert, but I want to know what you think about this. I am applying engineering principles here, here goes. I walk in, he's laying on the floor, she doesn't kniow what to do, as I start the compressions I ask "How long has he been laying here ?", now it depends on the answer. I realize that in a real situation this answer might not be available, but say it is. If the answer is a few seconds I would say to adminster more compressions, there is likely to be some O2 left in the blood, but with the lack of an answer, I would have to assume the worst. Perhaps in that situation five compressions would be optimal, followed by two breaths. In fact if I could manage it I would try to retain the seal, and breath in another breath through my nose to sort of inflate the patient's lungs, This should provide more area for O2 absorption. Basically two breaths in one, then back to the compressions. If possible, somehow it would be good to have the lungs inflated during the compressions, this is problematic for one person to do, I think it could be done if one can learn to deliver the compressions with one hand. The idea is to get the good blood out of the lungs and where it needs to be. The other problem is that you are giving them air that has already been breathed, and I think that would make this more important. If they are not in the greatest of health (people who need CPR rarely are), they probably don't absorb O2 all that well in the first place. The main question is, how long does the good blood stay good ? How many compressions until it hits the destination, the brain ? In such a case, every cell in the body is starving for O2, I don't think the blood stays good all that long. So that lends creedence to the new theory, more compressions, get it there faster. That's my 1 cent worth, if I were a doctor you would be paying the full price. Today only, 50% off ! lol T

DommeChains -> RE: New research With regard to CPR (3/25/2007 9:15:25 PM)
With the new CPR guidelines you still start the whole cycle with 2 breaths before starting the chest compressions. The most optimum layperson scenerio also includes access to an AED &, hopefully, EMS with full ACLS personnel within 3-8 minutes. The amount of dissolved O2 in the recycled air from the rescuer to the victim is not terribly high but still better than nothing by far. Also, if the chest compressions are of sufficient speed and depth you do have a bellows-like effect which will draw in some additional air. Overall success rate with CPR even in optimum settings is not high but still better than doing nothing at all. I have been in a fair number of arrest codes in both hospital/clinical settings and in non medical settings. Sometimes you get amazed at who survives.

calicowgirl -> RE: New research With regard to CPR (3/26/2007 9:21:34 AM)
Another thing they are teaching is that faster compressions are not better. The 30 to 2 ratio now being taught is for everyone infant through adult... for 1 person CRP and equals about 100 per minute. The reason being is that when fast compressions are given most do not allow the chest to completely expand between compressions, whioch actually decreses the refill of the heart by nearly 50%.. From studies over the last couple of years( here in So Cal, we were taught the new 30 to 2 last year and when another class was given last week I took it again and some of the new numbers they were releasing based on the new guidlines were staggering), using the new methods the rate of in the field saves has greatly increased and if the patient either has a witnessed down and and AED is used within three minutes, the conversion rate for vfib is very close to 90%. And yes as tasha_tart said, no more searching for landmarks... lock hands over sternum and go to town or using the nipple as a guide on children/infants. They have also changed the age guidlines... no longer going based on a number age except for the infants(under 1 year), for children they are using puberty changes, breast development, underarm hair etc as the guidline. Another big change is with the Heimlich Manuever... it can all be difficult to keep up with for this creature of habit and especially given the fact that it changes every few years but the new statistics/studies on this are pretty exciting to me. cali

hereyesruponyou -> RE: New research With regard to CPR (3/26/2007 9:39:07 AM)
Happy to report that after 4 years of haranging, harrassing, begging, pleading, and quoting statistic after statistic, i was finally about to put an AED into service in our building at work! Yea! We live in a semi-rural area and it takes a minimum of 20 min for fire/ambulance to arrive, now at least we can feel like we did all we could

calicowgirl -> RE: New research With regard to CPR (3/26/2007 9:55:24 AM)
WoooHooo, wonderful news!! I live in a very rural area and the fire dept I have been on for the last 10 years waits a minimum of 15 min for an ambulance. I have actually worked on patients for 2+ hours waiting for an ambulance on a busy weekend. It is frustrating as hell. Good for you. Glad all the hard work has finally paid off. cali

VeryMercurial -> RE: New research With regard to CPR (3/26/2007 6:32:33 PM)
quote: ORIGINAL: sweetnurseBBW Its not that breaths are less important. The same amount of breaths are being done just more compressions. Research found out that more time during cardiac arrest was spent with hands off the chest. Compressions help circulate drugs and O2 being administered during CPR. End result to improve outcome. [:)] http://circ.ahajournals.org/cgi/content/full/112/9/1259 Thanks sweetnurse, I have heard this also. Thanks for making sense of it to me.

Aswad -> RE: New research With regard to CPR (4/6/2007 10:52:21 AM)
The basic idea is fairly simple. First off, you want to make people actually try CPR, and many are reluctant to try mouth-to-mouth. Second, there will be about 6 minutes worth of oxygen in the blood, and circulating this is the most important thing. Third, if the same person is performing the mouth-to-mouth as the compressions, which is what this study applies to, there is a significant risk of fainting from the combination of the deep breathing and the exertion from the compressions. Fourth, the use of mouth-to-mouth doesn't bring in as much oxygen as you would usually be getting. In any case, the likelyhood of CPR succeding is minimal, unless the response time of the ambulance is such that it can be there in 6 minutes or less. For anyone serious about CPR, investing in a chest compression unit and a manual ventilator, and learning to use these, will be the only realistic option. Putting it in the back of the car, along with the first aid kit, and moving it indoors when engaging in play (just in case) is the most sensible option.

wrestlergrl03 -> RE: New research With regard to CPR (4/6/2007 7:20:09 PM)
Fun fact: In my medical class we learned to give 100 compressions a minute, and if you compress to the beat of 'another one bites the dust', you'll give exactly 100

Aswad -> RE: New research With regard to CPR (4/7/2007 12:09:56 AM)
quote: ORIGINAL: wrestlergrl03 Fun fact: In my medical class we learned to give 100 compressions a minute, and if you compress to the beat of 'another one bites the dust', you'll give exactly 100 That's kind of funny, yes, and probably good advice. Although I can't say that I'd find it very easy to keep that tune going in my head while applying that much force more than once a second... my dislike for the melody itself notwithstanding. It's also appropriately ironic, and possibly a bit morbid, since the patient (?) will most likely "bite the dust" anyway. Too few first aid courses emphasise this last point: you should still try it, because a life is worth the effort of trying to save, even in the face of poor odds, but you shouldn't blame yourself if it doesn't work, because it very rarely does. People end up getting an impression off TV that CPR works in most cases, while in reality the success rate is <10%, and in most of these cases, brain damage and/or other complications will still tend to be the result. Going into it with everything one has got is a good thing, but going into it with the expectation that the person will make it is not, as one will most likely be setting oneself up for a traumatic experience. Yes, it doubles or triples the odds of survival, but the odds are still bad. Of course, I'm not saying everyone gets this impression from TV, but it is kind of funny to note how even people who normally discern very well between TV and the real world may let small things like this slip through the cracks. An OT but relevant example of this is the case where there was a cop that shot a guy that was advancing on him with a knife, where people subsequently commented that it was "unfair" for someone with a gun to take out an attacker that "only" had a knife. I was like "wtf?" over that sentiment, but it kind of dawned on me that a lot of these people had unconsciously internalized some ideas about violence that have no relation to the real world.

NightWindWhisper -> RE: New research With regard to CPR (4/7/2007 3:21:49 PM)
quote: ORIGINAL: Aswad Too few first aid courses emphasise this last point: you should still try it, because a life is worth the effort of trying to save, even in the face of poor odds, but you shouldn't blame yourself if it doesn't work, because it very rarely does. People end up getting an impression off TV that CPR works in most cases, while in reality the success rate is <10%, and in most of these cases, brain damage and/or other complications will still tend to be the result. An OT but relevant example of this is the case where there was a cop that shot a guy that was advancing on him with a knife, where people subsequently commented that it was "unfair" for someone with a gun to take out an attacker that "only" had a knife. I was like "wtf?" over that sentiment, but it kind of dawned on me that a lot of these people had unconsciously internalized some ideas about violence that have no relation to the real world. In cases where the heart stops but there is not massive heart damage, and an external automatic defibrillator is used in less than four minutes the success rate is much higher and brain damage does not occur within this window. Calicogirl, even the smallest FD should have an AED and Oxygen. There are usually grants. A few years ago in a small city near me a man brandished a knife, and was shot to death by, I think, a dozen bullets. He did not advance, but rather brandished it. It must have been a very fearsome penknife, for that is what he had. Edited to correct spelling error.

Aswad -> RE: New research With regard to CPR (4/7/2007 11:25:59 PM)
quote: ORIGINAL: NightWindWhisper In cases where the heart stops but there is not massive heart damage, and an external automatic defibrillator is used in less than four minutes the success rate is much higher and brain damage does not occur within this window. Yes, that's true. But how often do you have access to a defibrillator inside four minutes? And in the cases where the defibrillator doesn't work, you still need compressions, as some arrythmias need other kinds of intervention, IIRC. A chest compression unit will keep the blood pumping without cracking any ribs, even in the case of extensive heart damage or non-responsive arrythmias. quote: A few years ago in a small city near me a man brandished a knife, and was shot to death by, I think, a dozen bullets. He did not advance, but rather brandished it. It must have been a very fearsome penknife, for that is what he had. If he was at such a distance that he couldn't possibly have closed the distance in the space of time it takes to take good aim and fire the usual two shots to the torso and one to the head, then I would say that it was clearly wrong to shoot him. However, if he was sufficiently close that he could have attacked them before they had a chance to completely incapacitate him, I would say that they were justified. That is not to say that it wouldn't be better if they didn't, though. Here in Norway, the police will only rarely fire shots unless you're actively advancing on them. Bear in mind, though, that a knife, even a penknife, is a *lethal* weapon. People who know how to use one can, in the space of a heartbeat, inflict cuts that are such that there would be no way to save the victim even if they were on an operating table in a fully equipped emergency surgery room with O-neg standing by at the time. That's how deadly a knife is. And if someone gets within range of you with the intent to harm you, they will succeed in doing so, although they may not always succeed in killing you. As one army combatives instructor nicely put it: "You will be cut." If someone is sufficiently unbalanced to grab a lethal weapon, you have no assurance that they will not use it. I think the Sayoc Kali people have some demonstration videos on the net that illustrate this point (no, I do not train in that art). As I recall from their instructional DVDs, the first attack you start working on is a cut that severs the carotids, jugulars and either the axillary or subclavian on the left hand side, as well as bisecting both kidneys. This is one smooth movement that takes far less than a second with a little bit of practice, and even if you defend in any one area, you will sustain lethal injuries elsewhere. Worst case, it's instant death, best case it will take 10-20 minutes to bleed out. Really, the main advantage of a gun is its range, and in most cases, the police are using this advantage to protect themselves and others as well as they can.

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