Hands only CPR

[santaman2000]

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...

Again having just looked up the protocols (here) it is always taught to call 911 before begining 1st Aid of any kind on anyone (adult or child)

 

[Martyn]

Again having just looked up the protocols (here) it is always taught to call 911 before begining 1st Aid of any kind on anyone (adult or child)

...as it is everywhere I would think - it certainly is here too. There is no point at all starting CPR unless you know you have help coming. Eventually you will tire and will give up. If help isn't on the way, what's the point? Always get help first, or get someone else to get help and then come back and tell you they have done so.

 

[santaman2000]

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

When working in the prison we always had FAKs with masks strategically located around the compound. That said ALL certification courses I've ever taken (or taught) always had in the protocols that you NEVER, NEVER, NEVER even touched a patient without PPE. It (the protocol for PPE) really has nothing to do with a feeling of disgust about an unclean patient or vomit; it has everything to do with Hepatitus, AIDS, Herpes, and other common communicable diseases.


When I was a certified instructor we always knew (and never really worried about) the fact that a large majority of our students were not professionals. They were elderly grandmothers or grandfathers who were worried about what to do if suddenly they were confronted with an emergency with their spouse of 40-50 years. It was patently obvious that they would not worry about PPE and it really didn't matter in their case nor did it matter in the case of my military students as they generally would not be on active duty with any of said diseases.

 

[EdS]

and its still 2 rescue breath FIRST in the case of drowning. As no resisdual O2 in the lungs.

 

[santaman2000]

...as it is everywhere I would think - it certainly is here too. There is no point at all starting CPR unless you know you have help coming. Eventually you will tire and will give up. If help isn't on the way, what's the point? Always get help first, or get someone else to get help and then come back and tell you they have done so.

Yes. And the 1st act of aid is always "Survey the scene....determine that it is safe for you to render aid..."

 

[John Fenna]

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.

Aye - I guess that is fair comment on both the attempts I made - the first had massive alcjhohol abuse issues, was morbidly obese and had other issues as well. The second was a realy nice guy who had cardiac issues from birth, learning disability (minor) and had a history of abuse from a violent father and learning disability affected mother and had recent health issues as well - their bodies certainly seemed "trying to die".
But you have to give it a shot ... don't you?

 

[BoonDoc]

...as it is everywhere I would think - it certainly is here too. There is no point at all starting CPR unless you know you have help coming. Eventually you will tire and will give up. If help isn't on the way, what's the point? Always get help first, or get someone else to get help and then come back and tell you they have done so.

Good point Martyn,
When teaching Wilderness First Aid, there are five protocols that we get to do in the remote areas that we can't do in the city. One of them is stopping CPR after 30 minutes. It is just not worth risking the lives of the rescuers by keeping CPR going for hours and hours.

 

[Martyn]

Aye - I guess that is fair comment on both the attempts I made - the first had massive alcjhohol abuse issues, was morbidly obese and had other issues as well. The second was a realy nice guy who had cardiac issues from birth, learning disability (minor) and had a history of abuse from a violent father and learning disability affected mother and had recent health issues as well - their bodies certainly seemed "trying to die".
But you have to give it a shot ... don't you?

Oh of course. Your best shot at that, it's life and death after all. But it's the fact that you have to give it a shot even when the cas is way beyond mortal help, that accounts for the poor success rate. It's just not possible for anyone to make that kind of decision at the time. But one thing we can all be absolutely certain about, no matter how fit and healthy, we are all going to die. No amount of CPR will keep someone alive indefinitely. All you can take away from it, is to not beat yourself up if you fail, the cards are usually stacked heavily against you from the start.

 

[Martyn]

Good point Martyn,
When teaching Wilderness First Aid, there are five protocols that we get to do in the remote areas that we can't do in the city. One of them is stopping CPR after 30 minutes. It is just not worth risking the lives of the rescuers by keeping CPR going for hours and hours.

That's interesting, I didnt know that, but it makes sense. My personal record was over an hour, but on a tubed patient and taking it in turns between 4 of us to do compressions. But I'm sure you'll agree, keeping 100/min going, even with regular swaps is absolutely exhausting. I thought I was going to have an MI myself. If there is just 2 of you, you'd be battered in 10 mins or less.

 

[kiltedpict]

Again having just looked up the protocols (here) it is always taught to call 911 before begining 1st Aid of any kind on anyone (adult or child)

Of course, apologies for not adding that. It was late and was just back from a wee shindig so in hindsight nae the best time to post!!

 

[Nemesis]

Whilst discussing first aid in general, I've been meaning to post for a while to say that one of the things I think should be in everyones, pocket and/or FAK and/or EDC is a hands free kit for their mobile.
It's cheap, tiny and will allow an individual to call for that much needed help (and potentially, take more detailed instruction from the operator/medic on the other end whilst waiting for help to arrive) whilst leaving both hands free to administer compressions/keep pressure on a bleed etc. etc.

It's one thing I never see mentioned in FAK listings and rarely in EDC but to my mind is a big help in many situations.

 

[user24]

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.

Yeah I agree, when was a SJAB cadet they were constantly changing the CPR and recovery position, which is fine if it's getting drilled into you every week, but ten years later I had no idea what the CPR protocol was until I did a refresher course. I thought it was 2 breaths to 8 compressions! (it's actually 2:30).

 

[mrcharly]

Whilst discussing first aid in general, I've been meaning to post for a while to say that one of the things I think should be in everyones, pocket and/or FAK and/or EDC is a hands free kit for their mobile.
It's cheap, tiny and will allow an individual to call for that much needed help (and potentially, take more detailed instruction from the operator/medic on the other end whilst waiting for help to arrive) whilst leaving both hands free to administer compressions/keep pressure on a bleed etc. etc.

It's one thing I never see mentioned in FAK listings and rarely in EDC but to my mind is a big help in many situations.

Most phones can be put on speakerphone - that would work just as well (in fact, it could be better - I wouldn't fancy trying to do cpr while I had a bluetooth headset on or wires dangling around).

 

[cbkernow]

IN THE UK - some clarification on the current protocols for getting help etc before/after starting CPR...

Skipping the D.R.A.B section - lets assume its safe and casualty is unconcious and not breathing.

Ideally send someone to get help (and tell them to come back to tell you they were succesful) or call from a mobile "on scene" and start CPR immediately

Where rescue breathes are not possible (facial injury, drugs/poison or general squemishness) CPR should be carried out with continuous chest compressions (like what Vinnie says!).

Adult witnessed or unwitnessed collapse NOT DROWNING

In the case of adults, for 99.9999999999999999% of the time, CPR from a first aider will not bring someone "back to life" - they need a defibrilator so getting a defib and trained person to the causalty is the priority.
So in the worst case scenario, you are on your own with no phone, you must get help immediately. NOW.
Only when the ambulance etc is on its way do you start CPR, straight into compressions, 30 compressions then 2 rescue breathes.

Adults Drowning

Check D.R.A.B (eg its safe and casualty is not breathing)
Start off by giving 5 rescue breathes
then 1 minute of CPR (30 compressions to 2 breathes after the initial 5 breathes)
Leave the casualty to get help
Return and continue CPR (30:2)


Children (all cases including drowning)

Children have a chance of starting to breathe on their own. So continuing the worse case situation, on your own no phone...

Check D.R.A.B (eg its safe and casualty is not breathing)
Start off by giving 5 rescue breathes
then 1 minute of CPR (30 compressions to 2 breathes after the initial 5 breathes)
Leave the casualty to get help
Return and continue CPR (30:2)



Seems a little strange to have a specific time to "give up", it all depends on the speed with which help can arrive, who is present, eg, lots of people can take turns and keep going for a lot longer. Of course, the "D" for danger in the DRABCDE protocol is the most important part, no use risking your own safety by giving CPR longer than you are able.


Don't stop until
a) help arrives and a paramedic etc takes over
b) casualty shows signs of recovery (breathing,coughing)
c) it is no longer safe to do so -eg you are too exhausted to carry on

if more than one person present, take it in turns for 2 minute "shifts" (approx 6 cycle sof 30:2)




Full disclosure: I'm a Scout leader with a 4 day HSE "full" qualification which qualifies me to teach the very basic "First response" course to other Scouters







My best advice is to get some training, call the local St Johns/St Andrews/Red Cross they often do community courses. (or become a Scout Leader, we teach you for free/cheap!)

 

[werewolf won]

People are people, I know a European heart is no different from an American’s, or an Asian’s heart, yet the protocols here in the States are quite different than the UK’s. Not saying one is better than the other just an observation. But wouldn’t you think there would be a worldwide standard.


Wolf

 

[cbkernow]

Different protocols are down to national organisations providing guidelines

just done a bit of googling and it seems there are international guidelines (well the International Red Cross have guidelines)

http://www.ifrc.org/PageFiles/53459...irst aid and resuscitation guideline 2011.pdf (about page 75) and they seem to agree with that which I've posted:

Adults (except drowning)
Get help immediately - if needs be leave the casualty to get help
CPR 30 compression to 2 breathes

Children and Adults after drowning
Send for help if not alone
2-5 Rescue breathes
1 minute 30:2 CPR
if alone leave casualty to get help
continue 30:2 CPR


Can't see any references on the net to USA protocols being different to UK (though not looked especially hard)

 

[werewolf won]

Thanks!

We have the American Heart Association and the Red Cross here and both teach CPR; there are subtle differences between them. CPR does seem to have settled out a bit. At one time every time you got recertified it was so different from the time before you started to wonder if any of it would work. It is also been watered down a lot over the years. I’m not a lay person so I certify at different standards; truth be told I’m not sure today what a basic rescuer is taught anymore.

Wolf

 

[Martyn]

People are people, I know a European heart is no different from an American’s, or an Asian’s heart, yet the protocols here in the States are quite different than the UK’s. Not saying one is better than the other just an observation. But wouldn’t you think there would be a worldwide standard.


Wolf

Yeah, it's all about expediency, rather than the best technical protocol. I guess each country has it's own idea about where the right balance between expedience and technical proficiency lies.

 

[fast but dim]

i think the new ad, and the hands free protocol is superb.
most of the people i know would be unwilling / reluctant to perform 'mouth to mouth' cpr.
There no real excuse for not wanting to give chest compressions. It's not rocket science, plus the ad's caught people's attention across the board.

great sensible first aid thread too, which is rare.

 

[cbkernow]

my problem with the advret is that it doesn't make it clear that if you know how to do CPR, DO IT! But I'm just being picky. Anything that gets people thinking about it is good.