Hands only CPR

[tim_n]

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

and children. In the case of drowned children who have fallen into water and immediately stopped breathing can be suffering from mamillian diving reflex which gives the appearance of death. CPR is still appropriate. Even if the child has fallen in a pond and has been in for some time, MDR can preserve the brain for extraordinary lengths of time, so don't give up till the paramedics have (and sometimes even after that)

*ahem*CPR is to extend the period of time available until the professionals arrive

Also, blood stream already has O2 in it. When you're pumping on the chest, the chest will exhale and inhale fresh air, but it won't go as deep into the airsacks. Always confirm help is on the way before starting, 30 compressions, 2 rescue breaths to be repeated ad nauseum until you collapse, help arrives or you give up.

Most inexperienced people who have done a 1-4 day course in first aid forget to open the airway correctly, inflating the stomach and creating a juice box effect. (boo, there's no puking smilies)

You can't shock someone who isn't in fibrillation. If they're in asystole (flatlining) then you're not doing anything by shocking them as a shock is meant to stop the heart not to start it. The idea is by stopping it, it'll stop fibrillating and will restart "normally"

Yes, if CPR is done at the right depth breaking ribs is possible and likely. On the two times I've had to do CPR it's been pretty much spot on (the AEDs measure all sorts and record so they can gather data). Both guys had broken ribs by the time the four of us had had a go and the paramedics had arrived!

 

[jonajuna]

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.

You were in professional instructor who taught you can catch hiv, hbv, hcv and herpes (well ok yes, you could get coldsores which is one strain of the herpes virus, but you don't get it on your genitals from mouth to mouth contact)?

You CANNOT get hiv, hbv or hcv from mouth to mouth contact unless you both have open wounds

And anyways, wouldn't all prison staff have hbv vaccination? (yes they would, no need to answer)

Sorry to be so 'correcting' but it's this sort of misinformation that causes the walk by attitude of so many people

The likely worst you would get from mouth to mouth contact is a cold or dose of squits

I would happily contract coldsores in exchange for saving someone's life

 

[BoonDoc]

I would happily contract coldsores in exchange for saving someone's life

Would you be happy to get cold sores for a 1/500 chance of saving someone's life?

The other question is this: would you be happy to swallow their vomit? I have yet to do CPR on someone who did not empty their stomach contents unless we already had them entubated.

 

[jonajuna]

It's a 40% chance of return of spontaneous circulation and 4% chance of survival in bystander attended cpr.

Yes I have given mouth to mouth without a faceshield (though I always carry one now)

No vomit wouldn't stop me, sure it stinks and tastes rank, but... Not trying all you could to save a life, no matter how remote, because of some carrot chunks, just doesn't sit with me

 

[cbr6fs]

Quick question guys please.

As never having done CPR on a person i'm worried about applying the right amount of pressure, is there some easily available real world substitute that is about the resistance as a human chest?

I realise it would be different on say kids, but as i only have the use of 1 arm i'm concerned that i won't be able to apply enough force on say a grown bottom adult.

 

[jonajuna]

My friend has one arm, he is stronger than I with 2, have faith in your abilities

You don't use arm muscle to compress, lock your arm(s) and push down with your body weight.

Trying to use arms alone will likely not achieve enough compression and you'll tire rapidly.

You are looking to achieve an inch or so of chest compression

Trying might work in saving someone , not trying definitely won't

 

[nigeltm]

You are looking to achieve an inch or so of chest compression

The Resus council recommend 5cm or 6cm (2 inches). Guidelines seem to change every 5 minutes

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

1 inch or 2 inch? As long as your doing something it is better than nothing.

Even better than compressions is a an automated external defibrillator. If available it is much more effective than compressions. An AED will restart the heart while compressions are unlikely to get it going but will keep the blood flowing, increasing the chances of a recovery. The increase in AEDs in public spaces is a real improvement.

 

[Martyn]

Quick question guys please.

As never having done CPR on a person i'm worried about applying the right amount of pressure, is there some easily available real world substitute that is about the resistance as a human chest?

I realise it would be different on say kids, but as i only have the use of 1 arm i'm concerned that i won't be able to apply enough force on say a grown bottom adult.

As mentioned earlier, you dont use you arms, you cant really get enough depth on the compressions and you fatigue way too quickly. You keep your arms locked and motion comes from the hips and shoulders. How much force is difficult to say, because it varies from person to person. I've done CPR maybe somewhere between 50-100 times over the last decade or so and it's always a bit different. I've done it on a big strapping lad and it was hard work getting the depth, on a skinny lady, it's easier, but old people are often "stiffer" and brittle. You just have to go by feel, but you do need quite a bit of force. I would say as a rough approximation, try putting the cushion off your sofa on the floor. If it's a medium stiffness cushion and about 4 inches thick, then enough force to bottom out through the cushion would probably be about right for a normal adult. You'll probably be compressing about 3 inches, which is more travel than you would normally, a human chest is a lot stiffer than a cushion, but the overall resistance would probably be something like. But that is obviously very generalised. An important point, you will have a much easier time if you get the cas onto a flat, solid surface. Doing CPR on a matress for example, is a nightmare. You have to use a lot more energy because of the bounce of the bed. A solid surface offers a much better platform, requires much less effort and you get much more feedback through your arms so you can judge the depth much better. The actual compressions are better as well, resulting in a taller, sharper trace on the ECG which means a better ejection from the ventricle.

 

[cbr6fs]

Very helpful thanks guys

 

[Satyr]

Hands only CPR is for people who are not first aid trained. It is supposed to encourage untrained people to give some form of assistance.


CPR without O2 and an AED is not likely to be successful but it is gives a better chances than doing nothing - incidentaly the HSE now allows the use of AED without formal training (they are very self explanitory provided they are in a language you understand)

I carry a face shield on my keyring, some these days fold down really small and can be added no problem to a FAK or kept in the pocket.

 

[Martyn]

incidentaly the HSE now allows the use of AED without formal training (they are very self explanitory provided they are in a language you understand)

I assume that is for the use of defibs that are AED only and not machines where AED is an optional mode?

 

[Nemesis]

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).

Though that's presuming theres no background noise (traffic/bystanders etc.) of course. Think I would stick with the hands free kit.

 

[santaman2000]

...incidentaly the HSE now allows the use of AED without formal training (they are very self explanitory provided they are in a language you understand)...

Over here we were generally taught that the AEDs were invented for people without (or with very limited) formal training.

 

[Minotaur]

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

The current standard used by all is British, I think. They tested it on pigs and found what worked. We use the same stuff for almost everything, the big changes are to do with education.

How often does CPR work? Not often.

This is the problem about the tone of what people are saying. If someone needs cpr in a city, do it, because all of these protocals expect an ambulance to turn up in eight minutes. You are not re-starting a heart, you are keeping the brain alive until the heart can be shocked, or drugs given.This is why defibs are everywhere all of a sudden, they really save peoples lifes.

 

[jonajuna]

+ 1 for that post

 

[Martyn]

Over here we were generally taught that the AEDs were invented for people without (or with very limited) formal training.

I was originally trained on the old manual monophasic defibrillators, remember the 200/300/360 joule cycle? I think a lot of us felt a bit put out with the introduction of biphasic AED's taking away our decision making and wondered if we could "trust" them and a bit sceptical of this new reduced energy biphasic system. In reality, they dont get stressed, they dont get in a flap, they dont panic, they keep time perfectly and they follow the protocols with an accuracy that few professionals could ever match. All defibrillators in the UK are AED's now (I'm surprised the same isn't true in the states?), but the professional machines have an additional mode that allow the operator to manually cardiovert. They are a great invention, a complete no-brainer to use and allow you to concentrate on other things like airway management, IV access, drug admin and correcting the causes of a PEA arrest. With the old defibs it was it was a nightmare trying to keep track of where you were in the algorithm with everything else going on. I doubt any professional who has used AED's, would wish the old manual monophasics back into use, aside from the massive benfits to staff in shopping centres and so on. Even staff trained to use the old defibs, sometimes lacked confidence through lack of practice and there were problems, particularly with rhythm recognition - is it VF or fine VT etc. AED's are a great invention and a big help to professionals and the untrained alike. I remember the first time I used one, they had only just been introduced and I was leading the resus and naturally a bit apprehensive of this new machine, but it was the slickest resus I'd ever done ...and we got ROSC with one shock - it saved a life first use out of the box - it proved to us that 100 joules biphasic really did work.

 

[rik_uk3]

The current standard used by all is British, I think. They tested it on pigs and found what worked. We use the same stuff for almost everything, the big changes are to do with education.

This is the problem about the tone of what people are saying. If someone needs cpr in a city, do it, because all of these protocals expect an ambulance to turn up in eight minutes. You are not re-starting a heart, you are keeping the brain alive until the heart can be shocked, or drugs given.This is why defibs are everywhere all of a sudden, they really save peoples lifes.

Please don't think or suggest that I'm saying don't try CPR...please do try, its vital that you try however the success rate is very low; if memory serves me correctly success rate is or was a little under 5% on the 'street' and maybe 25 or 30% in a hospital (any up to date data Martyn?) I used CPR on an old chap who collapsed on the street, no idea of the outcome as the paramedics and police arrived, took my details and history of the event and took the old guy off; when nursing I was involved many more times (can't remember to be honest). I just don't want someone trying, failing and feeling any sort of guilt.

Always try, do the best you can, after all, you won't kill them trying.

 

[Martyn]

Please don't think or suggest that I'm saying don't try CPR...please do try, its vital that you try however the success rate is very low; if memory serves me correctly success rate is or was a little under 5% on the 'street' and maybe 25 or 30% in a hospital (any up to date data Martyn?) I used CPR on an old chap who collapsed on the street, no idea of the outcome as the paramedics and police arrived, took my details and history of the event and took the old guy off; when nursing I was involved many more times (can't remember to be honest). I just don't want someone trying, failing and feeling any sort of guilt.

I dont know the exact data Rik, but I thought it was 5-10% across the board - it might be a little higher with AED's now. Obviously that's 1 in 10 human lives get saved. That's pretty darned worthwhile, I'll take those odds. But as you say, it's worth pointing out that the cards are stacked against success, so people dont feel guilty if it doesn't work. Sometimes people think it was because they were doing something wrong or missed something, but in 9 out of 10 cases, it's just not going to work no matter what/who or where.

Always try, do the best you can, after all, you won't kill them trying.

Absolutely. If a person has no pulse, they will be dead in a couple of minutes unless you do something to give them a chance, so give it to them.