Hands only CPR

[Bowlander]

Lots of media coverage and a great Vinny Jones advert about this at the moment.

http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr.aspx

Does this replace first aid training on giving mouth to mouth and chest compressions or is it just basic advice for all who would normally be afraid to do anything?

 

[Chambers]

From what I saw its basic advice for people who would not otherwise know what to do or may be daunted at the thought of full CPR. There was the worry that people may not do deep enough compressions whilst trying to stay in time with the Begees.

Personally I think if it came to it anything has got to be generally better than nothing!

 

[Buckshot]

The idea is that a small amount of air is forced out and back in when the chest is compressed. Plus there's a lot of oxygen in the blood stream already so you might as well pump that round the system to start with.
Basically breathing CPR is better than compression only but compressions only is better than none as Chambers says

Mark

 

[Bowlander]

Thanks for the info. I won't ditch my carry card from the course with the reminders on then!

 

[santaman2000]

It seems to be becoming the accepted protocol here now I believe. It's what was taught the last time some of my friends were certified. I'm not sure though as I haven't been through a certification course since I retired last January.

 

[mikeybear]

It was mentioned on the last first aid course I did.
I think one of the points was that people may wish not to have mouth to mouth contact and hence would do nothing .
Much better to do just chest compression so it is given as an option to prevent people from doing nothing.

MB

 

[santaman2000]

I'm sure you're right about the reasoning for the shift in thinking. Although I was also always taught to use an inexpensive protective mask for the respirations (for that matter the law here requiring professionals to "stop and render aid even when off duty" is voided if they don't have said PPE)

 

[mikeybear]

We are normally given a protective mask on each course ( every 3 years here) but I don't carry it except when I have my FAK.
I'm first aid trained for a specific reason ( so I can teach a Martial art ) , if any of my friends needed CPR I suspect not having a mask wouldn't stop me from administering it.

MB

 

[The Big Lebowski]

This has been an ongoing subject for some time.... And something they really need to clear up for all FAAW's (or trained First Aid Personnel)

It was originally chest compressions followed by rescue breaths, then went straight to compressions (which through medical feedback had a higher revival/survival rate) and now its at the discretion of the person trying to do the best for the casualty presented in-front of them....

I've had an ale or three tonight, but this is something that's narked me for a while. If you are going to train an individual on how to save someones life, the last thing they need in the moment is unclear or even worse, optional advice.


Just my HO.

 

[kiltedpict]

From my perspective as a former first aider and current intensive care specialist (with various certs) the Casualties lungs will already contain 21%O2 (pretty much), so breathing into them will replace that with about 18%O2- ie nae much improvement !

In adults, the primary cause of cardiac arrest is often heart attack (MI). This disrupts the normal electrical activity and causes an abnormal rhythm (often but not always Ventricular Fibrilation). Shocking the heart (defibrillation) actually STOPS the heart, allowing the natural pacemaker to regain control of the natural rhythm, and this is the GOLD STANDARD! Breathing into a casualties chest initially will not add anything to the equation, and thus is counter productive, delaying the more important defibrillation.(hence the recommended go for help then start CPR).

The is different in children as the major cause of cardiac arrest in kids is hypoxia (low oxygen levels)- thus the recommendation of 1 min CPR to try and restart things before going for help.

Obviously, if there is more than one of you, then common sense dictates that someone goes for help, and the other resuscitates regardless of the situation (personal safety excluded).

As an ever-learning practitioner, I'm more than happy to be corrected on any aspect of the above!

ATB

KP

 

[Martyn]

Bottom line, your chances of a successful resus are pretty minimal to start with, unless you can correct the cause of the arrest, which in reality is way beyond the remit of most peoples first aid skills (unless it's something like a glaringly obvious airway obstruction). In such a situation, anything is better than nothing and far too many people stand down because they are unsure or the correct procedure, or frightened to have a go, or think they may do harm, or are grossed out by vomit, or maybe the cas seems unclean or whatever. The BLS algorithm has been all about simplification for some years now, with each new change being about a simple and more accessible protocol. The hands only thing is for use primarily by the untrained, the unwilling or the grossed out and both airway and cardiac management remain the standard for those who have received training.

Here's what the resus council say....

It is important that those who may be present at the scene of a cardiac arrest,
particularly lay bystanders, should have learnt the appropriate resuscitation skills and be
able to put them into practice. Simplification of the BLS sequence continues to be a
feature of these guidelines, but, in addition, there is now advice on who should be
taught what skills, particularly chest-compression-only or chest compression and
ventilation. Within this advice, allowance has been made for the rescuer who is unable
or unwilling to perform rescue breathing, and for those who are untrained and receive
telephone advice from the ambulance service.

and...

It is well documented that interruptions in chest compression are common and are
associated with a reduced chance of survival. The ‘perfect’ solution is to deliver
continuous compressions whilst giving ventilations independently. This is possible when
the victim has an advanced airway in place, and is discussed in the adult advanced life
support (ALS) chapter. Compression-only CPR is another way to increase the number
of compressions given and will, by definition, eliminate pauses. It is effective for a
limited period only (probably less than 5 min) and is not recommended as the
standard management of out-of-hospital cardiac arrest.

My bold.

Current protocol (can always be found at this link)...
http://www.resus.org.uk/pages/bls.pdf

 

[Martyn]

In adults, the primary cause of cardiac arrest is often heart attack (MI). This disrupts the normal electrical activity and causes an abnormal rhythm (often but not always Ventricular Fibrilation). Shocking the heart (defibrillation) actually STOPS the heart, allowing the natural pacemaker to regain control of the natural rhythm, and this is the GOLD STANDARD! Breathing into a casualties chest initially will not add anything to the equation, and thus is counter productive, delaying the more important defibrillation.(hence the recommended go for help then start CPR).

I think that's only true for VF and pulseless VT, in other words where the heart is fibrillating or tachy but no output, otherwise airway management most certainly does add to the equation.

 

[BoonDoc]

As a paramedic, the hands only protocol is used when the casualty had a witnessed collapse.

Breathing is still very important. Usually, by the time we get the casualty intubated and get a CO2 reading, the CO2 levels are twice normal. The brain will be damaged with such a high level.

Push and ventilate until the drugs can be administered.


The original point about the Vinnie video is that for the lay person just pushing for the first few minutes works just fine.

 

[Biker]

The original point about the Vinnie video is that for the lay person just pushing for the first few minutes works just fine.

So the compressor and the garden hosepipe's a no no then?


Like has been said doing something is better than nothing. S

aw the advert for the first time lon TV last night and thought it funny but also slightly disturbing. Growing up in the east end of London and seeing such thugs like Vinnie's character is has left a mental scar I suppose.

 

[silentman]

I did a first aid refresher the other week and was told this came from America, in so much as people didn't want to place their lips on others. Personally I've had to study first aid for 20 years and in a stress situation I would automatically do the two breaths and compressions . Do no harm is what I have been taught.

 

[Buckshot]

Absolutely
It is a good technique to be aware of though for when you can't/ it's unsafe to kiss someone - If they have a facial injury or chemical burns etc.

 

[Martyn]

I did a first aid refresher the other week and was told this came from America, in so much as people didn't want to place their lips on others. Personally I've had to study first aid for 20 years and in a stress situation I would automatically do the two breaths and compressions . Do no harm is what I have been taught.

You have to be realistic though. Not everybody carries a pocket mask. If the cas looks like Kate Winslett you probably wouldn't have any problems doing mouth to mouth, but if the cas is a filthy looking, 60 something vagrant, with a minging beard, rotting teeth and reeking of alcohol and vomit, would you be so eager to get in there? The cas is much more likely to be the latter than the former and the human mouth - even the cleanest - is a pit full of disease. Would you really lay blame on someone for refusing? Unless you have been in that situation and have been faced with that choice, I dont think anyone can sit in judgement. You cant force people to do mouth to mouth, though I would hope people would man up, you have to accept that a very unsavoury looking cas will put many (..if not most) people off. The whole issue of mouth to mouth with a stranger, even a clean looking one, creates revulsion in a lot of people and causes them to back away from doing anything at all. Hands only is an attempt to tackle this.

 

[John Fenna]

I have done CPR twice - both times with the snogging - 1st time, the guy was pronounced dead on the site, second time I managed to get the guy (who had fitted) to give spontaneous output (from flat line) but the paramedics had to shock him back twice on the way to hospital and he was dead after a week in hospital ... too much damage from the initial collapse.
Unless you get the paramedics and all their kit on site FAST the cas has only a slim chance of survival anyway.
Both the casualties I dealt with were folk I knew so I had no probs giving mouth to mouth, both guys had vomit in their mouths, both times the adrenaline kicked in to overcome the disgust, both times the disgust and revultion took over once the adrenline wore off.
I think that using chest only would not have affected the eventual outcomes and it would have saved me some issues....

 

[Martyn]

I have done CPR twice - both times with the snogging - 1st time, the guy was pronounced dead on the site, second time I managed to get the guy (who had fitted) to give spontaneous output (from flat line) but the paramedics had to shock him back twice on the way to hospital and he was dead after a week in hospital ... too much damage from the initial collapse.
Unless you get the paramedics and all their kit on site FAST the cas has only a slim chance of survival anyway.
Both the casualties I dealt with were folk I knew so I had no probs giving mouth to mouth, both guys had vomit in their mouths, both times the adrenaline kicked in to overcome the disgust, both times the disgust and revultion took over once the adrenline wore off.
I think that using chest only would not have affected the eventual outcomes and it would have saved me some issues....

Very true John. I think it's something like 5% of people who receive CPR actually survive the event and a large percentage of those go on to die of complications later. It can be very effective on some groups though, drowning victims for example - if you get to em quick enough your chances of a positive outcome are very good - mainly due to the fact they are probably otherwise healthy, with no underlying cardiac or pulmonary problems. But examples like that are rare. More often than not, you are resussing someone with an extensive history of problems and their body is "trying to die". You are often fighting a losing battle.

 

[santaman2000]

I just looked the current protocols here (Red Cross protocols & the AHA protocols) they do both still call for full CPR (breaths and compressions) for certification.