Hands only CPR

[Miyagi]

I think for the untrained this new campaign is a good idea.

For those of us with first aid training we have more options, but have had the options drilled into us.

I study an old style of Jujutsu/Kenjutsu and the "Kuatsu" (resuscitation techniques) are quite simple. The airway is kept open by the positioning of the head, but there's no attempt at mouth to mouth and mostly involves various forms of chest compression.

The old fella that first taught me these said they were very similar to the old methods of "over a barrel" resuscitation used by old sea dogs.

As far as I know similar methods to ours were being taught in Judo in the 50's and 60's but I'm sure they've been replaced.

Liam

 

[Graveworm]

Some of the most significant recent changes are surrounding the depth and speed of compressions which have had the biggest impact on the efficacy of CPR after inclusion of AED use as part of the protocols.

 

[Martyn]

Watch out for the little old ladies with osteoporosis - it's horrible when you feel the ribs break and it's surprisingly easy.

 

[Miyagi]

At one time, I honestly thought that "bone glue" was a euphemism for population paste...


Liam

 

[rik_uk3]

Watch out for the little old ladies with osteoporosis - it's horrible when you feel the ribs break and it's surprisingly easy.

Like a Wishbone on a chicken:yikes: Not a nice sound I'm out of date these days Martyn so whats the thoughts on a precordial wallop now? Another technique that came and went and came and went over the years.

 

[Martyn]

Like a Wishbone on a chicken:yikes: Not a nice sound I'm out of date these days Martyn so whats the thoughts on a precordial wallop now? Another technique that came and went and came and went over the years.

From memory, it's still current if the arrest it witnessed, but I'd have to check mate. It's one thing I've never done, I've seen a few go in front of me, but I always forgot and got stuck in with CPR.

It's one of those thing a lot of folks seem leery of doing anyway as it seems so much like ...well a big wallop.

 

[mrcharly]

My wife has just started a nursing degree and covered CPR. No wallop, just straight in with compressions.

 

[Beardy]

Had to do a day on first aid as part of a refresher course for a job overseas this summer. I was impressed that they had incorporated AED use into the basic course alongside CPR. You always see AEDs in public places but I have never been taught it prior to this, which doesn't seem to make much sense. Anyway, it grates a little that we seem to be anticipating (expecting?) people to do less than before (that advert does not mention to Joe Bloggs that 'chest compressions only' is one sub-optimal option available to them, and not the new overall standard), whereas other schools of thought are scaling up their courses to teach their people more capabilities (ones that significantly improve the odds).

That said, one of the instructors did say word for word 'you will always get some people who will not want to do mouth to mouth in case of HIV and such', and they did mention a recent case where a girl had collapsed and although was surrounded by people, no one had got involved, so I suppose that these are the sorts of situations which 'chest compressions only' is aimed at. Perhaps those CPR masks that are folded in a sachet that could fit in your wallet (Laerdal?) are an answer. I know someone who has a mask in a boat's FAK but it's more like the big rubber facepiece from a BVM and too big that you could keep it on you everyday.

Regarding the wallop, I've never been taught it, but we have a nurse in the family who says that whilst it might not be taught there is still a chance it can restart things. I'm not sure if it's actually in any of their procedures though since in their setting they are far more likely to have a proper defibrillator, so it may just be the way some people were first taught before it was dropped?

 

[rik_uk3]

From memory, it's still current if the arrest it witnessed, but I'd have to check mate. It's one thing I've never done, I've seen a few go in front of me, but I always forgot and got stuck in with CPR.

It's one of those thing a lot of folks seem leery of doing anyway as it seems so much like ...well a big wallop.

That was the protocol the last time I trained, if they go in front of you, strike. Not done it myself but have seen it done.

 

[Martyn]

Just checked and the precordial thump is still in the ALS protocol, though it's role has been de-emphasised....

Precordial thump
A single precordial thump has a very low success rate for cardioversion of a shockable
rhythm93-95 and is only likely to succeed if given within the first few seconds of the onset
of a shockable rhythm.96 There is more success with pulseless VT than with VF.
Delivery of a precordial thump must not delay calling for help or accessing a defibrillator.
It is therefore appropriate therapy only when several clinicians are present at a
witnessed, monitored arrest, and when a defibrillator is not immediately to hand. In
practice, this is likely to be in a monitored environment such as the emergency
department resuscitation room, ICU, CCU, cardiac catheter laboratory or pacemaker
room.
A precordial thump should be undertaken immediately after confirmation of cardiac
arrest and only by healthcare professionals trained in the technique. Using the ulnar
edge of a tightly clenched fist, deliver a sharp impact to the lower half of the sternum
from a height of about 20 cm, then retract the fist immediately to create an impulse-like
stimulus. There are a very few reports of a precordial thump converting a perfusing
rhythm to a non-perfusing rhythm.131

http://www.resus.org.uk/pages/als.pdf

It's not part of the BLS protocol, so it wont be taught to students or on BLS courses.

The key point is that you need to confirm VF or pulseless VT before doing it which means the patient needs to be connected to a cardiac monitor at the time of the arrest, as it also needs to be delivered within the first few seconds of the arrest.

 

[winst0nsmith]

Very interesting discussion, I qualified a few years ago as a first aider (ie my certification has run out) thanks for the updated ideas, besides water in the lungs, how do you identify how someone is in need of breath?

Is this the insurance industry covering themselves against transmitable deseases? The police never gave a care about seatbelts until it counted to insurance premiums; call me a cynic, but if it's on the TV, a banker who wants to control you is paying at the end of the day, and they are interested in their bottom line, not your welfare.

 

[EdS]

if you are trained still do breathing.

The new hands only CPR is to get more of the general public to do it rather than just stand there saying I don't know what to do. It is also to get them over the "uurggh I don't know where they have been / what will I catch" fear.

 

[BoonDoc]

Just checked and the precordial thump is still in the ALS protocol, though it's role has been de-emphasised....

The precordial thump was quite common when I first started as a first aider in the mid eighties..... How things have changed.

The science behind the precordial thump is this:

Precordial Thump = 70 joules of electricity
AED/LifePak 12 = 200 joules, up to 360 joules.

You do the math. What is the chance that 70 joules will work?

It has happened and it is a useful skill to have but it is rare enough when we get someone back using the LifePak 12. Let alone using just punching the guy.

 

[rik_uk3]

The precordial thump was quite common when I first started as a first aider in the mid eighties..... How things have changed.

The science behind the precordial thump is this:

Precordial Thump = 70 joules of electricity
AED/LifePak 12 = 200 joules, up to 360 joules.

You do the math. What is the chance that 70 joules will work?

It has happened and it is a useful skill to have but it is rare enough when we get someone back using the LifePak 12. Let alone using just punching the guy.

How often does CPR work? Not often.

 

[kiltedpict]

The precordial thump was quite common when I first started as a first aider in the mid eighties..... How things have changed.

The science behind the precordial thump is this:

Precordial Thump = 70 joules of electricity
AED/LifePak 12 = 200 joules, up to 360 joules.

You do the math. What is the chance that 70 joules will work?

It has happened and it is a useful skill to have but it is rare enough when we get someone back using the LifePak 12. Let alone using just punching the guy.

70 joules can be enough if given immediately ( hence the advice to be used only when the collapse is witnessed). The longer the delay, the more energy needed ( to a point )

I personally have done the thump on 2 occasions where it has worked, but both times I was at the bedside and saw the heart rhythm change. It won't work even if you delay by a few seconds.

I remember being told a story as a newly qualified nurse by a mentor about a case in the cardiac catheter lab, one patient was put into VF by the catheter tickling the heart, and the patient was told to cough and that was enough to put them back into normal rhythm before they even lost consciousness- might have been an urban legend as I didn't see it...

 

[Martyn]

70 joules can be enough if given immediately ( hence the advice to be used only when the collapse is witnessed). The longer the delay, the more energy needed ( to a point )

I personally have done the thump on 2 occasions where it has worked, but both times I was at the bedside and saw the heart rhythm change. It won't work even if you delay by a few seconds.

I remember being told a story as a newly qualified nurse by a mentor about a case in the cardiac catheter lab, one patient was put into VF by the catheter tickling the heart, and the patient was told to cough and that was enough to put them back into normal rhythm before they even lost consciousness- might have been an urban legend as I didn't see it...

I haven't done a thump, but I've seen it done successfully a couple of times. In one case I was covering a shift in cardiac ITU and the fella kept flipping into VF. The charge nurse just kept legging it to the guy and thumping him. The difference there though, is the pt had a known, extensive and complex cardiac history.

 

[jonajuna]

How often does CPR work? Not often.

it works a lot more if attempted than if not

if you see me on the floor without a pulse please bounce on my chest until you hear ribs crack

 

[Bushwhacker]

How many people (Joe public) have been put in that situation and acted upon it?

 

[jonajuna]

Me, in the street, was driving, wife noticed the chap collapse, I attended, another stopped and called ambulance while I did the deed.

Was less than 50m from local general hospital, had no assistance.

He didn't come back, but was very elderly and in the minute took me to stop, dash cross dual carriageway, assess and start cpr/mouth to mouth... He was fixed pupil, zero response to verbal or pain stimuli so pretty dead

I carried on just in case

Two odd things.... Knew he was probs gone, knew I had done all I possibly could.... Still done the "what ifs"

Second, I could taste him for weeks.... ALWAYS carry a facemask now.

 

[BoonDoc]

I remember being told a story as a newly qualified nurse by a mentor about a case in the cardiac catheter lab, one patient was put into VF by the catheter tickling the heart, and the patient was told to cough and that was enough to put them back into normal rhythm before they even lost consciousness- might have been an urban legend as I didn't see it...

It is amazing what does work. While working in the A&E I saw countless times where someone would present with SVT (fast heartbeat) and we were able to change their rhythm with having them hold their breath or maybe by putting their face in ice water.

One time we had someone who didn't speak english. The doc had to demonstrate how to put her face into ice water. The casualty laughed so hard at the doctor that it changed her heart rhythm back to normal.

Strange things indeed......