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CPR Not as Effective as Chest Compressions Alone
patiwat writes "A Japanese study detailed in the New York Times has found that people suffering from cardiac arrest were more likely to recover without brain damage if rescuers focused on chest compressions rather than on rescue breaths. Some experts advised dropping the mouth-to-mouth part of CPR altogether. Interrupting chest compression to perform mouth-to-mouth ventilation might do more harm than good if blood flow to the heart was not properly re-established, a researcher from Tokyo's Surugadai Nihon University Hospital said. According to the article, 'More than 300,000 Americans die from cardiac arrest each year. Roughly 9 out of 10 cardiac arrest victims die before they get to a hospital — partly because they do not get CPR.'"
Sarver Heart Center
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Linux, you magnificent bastard, I read the fucking manual!
Good! There's soooo many more lives that I'd save, without the mouth part!
"Speaking the Truth in times of universal deceit is a revolutionary act." -- George Orwell
If that person is in the state that they require CPR and their heart has failed then they are probably not breathing. You might want to consider reading the article again because it's pointing out that if one has to give CPR to a person with heart failure, it will be more effective if they concentrate on doing the chest compressions rather then also having to get air to person at the same time. (This makes sense after all.)
Yeah. That was my first thought, too. Great way to get herpes or something. Gross.
This year the Red Cross changed their standard from 2 rescue breaths every 15 compressions to 2 rescue breaths every 30 compressions (or that is what my yearly training reflected). They also removed abdominal thrusts for unconscious choking victims and basically made the care the same as for a heart attack (minus the AED). I had thought they were dumbing the program down (in the case of choking)so the average person who takes first aid/CPR wouldn't have too many things to remember. Now I see that rescue breaths are generally without merit. I wonder if my training next year will reflect this particular study.
I read about this back in November, and it was known even in 2005. How many people's lives were affected in the interim due to slow news sources?
The mouth-to-mouth ventilation part was always the tricky bit. To be effective you had to blow a large volume of air into the patient with a frequency that made you dizzy and tired quickly. But you also had to be careful not to blow too hard and get air into the stomach which would then blow out all the food out. Often members of the public were reluctant to engage in CPR because of the ventilation part (because of hygiene and sensitivity consideration) and many victims didn't get any CPR because of this. In many countries, including here in Finland, the directives for teaching non-professionals CPR have been changed years ago to teach only the compression part. But I see no reason here why the ventilation part would make CPR less effective when done properly and by professionals. Perhaps this study just shows the lack of skill in doing it properly. After all, what's the point of circulation, if there's no oxygen going in?
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No, it is true even if they have stopped breathing. Basically, it does no good to get more oxygen into the blood if it isn't being circulated, and it takes a lot of chest compressions to get it circulated properly. This is an issue that has been slowly unfolding over the last several years. The Red Cross already decreased the recommended number of breaths to chest compressions a couple years ago, and people are debating whether to get rid of the breathing altogether. One additional argument in favor of the breaths is that it allows the person giving CPR a small break, which is important if they are the only one around to provide CPR.
So if the person is still breathing but their heart has stopped, rescue breaths provide no benefit. DUH!
It's not that much of a 'duh'. The idea originally behind CPR is that you manually perform the action of the heart through the chest compressions, and that the chest compressions don't do much good without some fresh O2 in there. As such, one could ask what good CPR is without the breathing part?
The research basically just shows that circulating the remaining O2 in the blood and stimulating the heart muscle is much more valuable than stopping occasionally to ensure the air is fresh, but that's not a determination you could make with no education, experience, or actually performing the research.
If you're going to call 'duh', you're asserting thay you know more about medicine than the medical professionals who created it and have practiced it all these years. I don't think that's the case, and as is usually the case, the facts are more complicated than it seems to laypeople.
If you really want to survive in emergency situations, just be wide enough to float.
Don't disappoint your bird dog. Go to the range.
What if one person gave chest compressions while another gave mouth to mouth.
Libertarian Leaning Political Discussion Forum.
IIRC, last time I had a CPR refresher, where they told us to increase compressions from 15 to 30, one of the things they mentioned is that the chest compressions themselves help to bring in a minimal amount of air, provided the air cavity is not blocked. Right now, it isn't a sure thing that the breathing should be gotten rid of entirely, but it definitely isn't as important as we once thought it was.
There's soooo many more lives that I'd save...
Scenario: Darl McBride on the ground clutching his chest in pain.
Well? Your move. No lip locking required.
He forgot to also mention its rare (if EVER!) that someone is breathing and their heart has stopped. Definately a not duh.
God spoke to me.
a recent refresher course has really stressed chest compressions over air as well. 30 compressions per two breaths.
MORTAR COMBAT!
Kicking him while he's down is allowed, right?
I still have more fans than freaks. WTF is wrong with you people?
A key caveat here is that the average joe will have great difficulty recognizing if a victim is suffering from cardiac arrest or respiratory failure: in this case, a combo is the safe approach that covers the most bases.
After each 1 minute of pumping someone's chest, i like to teabag the victim for about 30 seconds.
As emphasized by someone in the article, which I read when they published it (and I'm also a swim instructor, lifeguard, and first responder) it's VERY important to note that using only compressions is best and useful in the event of a dryland cardiac event. If someone has just been pulled from the water for instance and is not drowning, you need to give them AIR. Rehashing from the article: most people suffering from heart problems and fibrilliation have plenty of oxygen in their blood and it will remain that way for about 8 minutes. They are not generally in danger of losing oxygenated blood flow to their brain and dying that way. Thus, the exec that collapses in the stairmaster you can probably do just fine with giving compressions: and if you're the ONLY one there who can do that, you had probably better do that. Having actually given CPR for more than 2 minutes, it can literally cause you to pass out if you're the only one there: you have to combine forceful compressions (of breaking THROUGH the ribcage to the heart to get it going) with breathing into a person...and then there are people who might know CPR but, as the article points out, are afraid of catching something. In summary: don't forget to breath into the victim if they aren't breathing. Especially if they were drowning.
"As two-person CPR requires a degree of synchronized technique, it is usually more effective for first aid providers to perform individual CPR, and change operators after ten minutes or so." - http://www.fortunecity.com/campus/springbank/973/f irstaid/cpr.htm
Could this be the end of being able to trick hot teenage lifeguards into making out with you?
This study refers to CPR in case of cardiac arrest only! You should still apply the 30:2 rule to patients that drowned, have airway obstructions or drug overdoses.
In any case, when you approach a patient, most of the time you will not know what the cause of collapse is, unless it is witnessed (someone choking in a lunch room, someone grabbing their chest in case of heart attack). So in this case you have to check for a good airway, by listening and feeling and sometimes by giving a breath mouth-to-mouth to see if the chest rises)
In any case, for people with first aid training i suggest carrying some kind of barrier device like a pocket mask to perform CPR. Some of the smaller device are really cheap and small (fit on your key ring).
I always carry my pocket mask and gloves with me, but then I am also obligated by law to help people because of my first aid ticket, and i want to play it safe.
Also, when i was tought in first aid class, we were specifically instructed never to give mouth-to-mouth unprotected, because the first rule in first aid is to watch out for your own safety!
Thomas Schmid athschmid@gmail.com Skype: athschmid
ianaEMT but I volunteer at our local ambulance service as the network admin. I heard about this study and others like it back in December. Due to the emphasis and effectivity of chest compressions, and the risk to the patient during the lapse of compressions when you are breathing, we looked at buying two of these units
:(
You strap the patient to the board and it will do regular chest compressions for you. It is nothing short of amazing and the medics tell me that it is very effective. You can't do either breathing OR compressions when you are hauling a gurney down 3 flights of stairs.
I wish I'd known this before Zoll stock went from 24 to 80
An easy way to remember the timing was shown to me by a paramedic and diving instructor.
30 compressions is the chorus of "Nellie The Elephant"
NELLie the ELephant PACKed her TRUNK and SAID goodBYE to the CIR - CUS,
OFF she WENT with a TRUMPety TRUMP, TRUMP, TRUMP TRUMP.
NELLie the ELephant PACKed her TRUNK and TRUNdled OFF to the JUN - GLE
OFF she WENT with a TRUMPety TRUMP, TRUMP, TRUMP TRUMP.
If you sing the Toy Dolls version
http://www.youtube.com/watch?v=otBWbVdvxLk
you'll even get the 100bpm about right.
Kicking him while he's down is allowed, right?
Hell yeah! But since it's St Patrick's day, you have to get drunk first.
Cheers!
Even the best CPR circulates only a fraction of oxygenated blood to the brain. This study was performed under the old guidelines of 15 compressions to 2 ventilations. A theory proposed by the researchers who did the study is that the delay in properly positioning the patient's airway to provide ventilation actually decreased the effectiveness of the compressions. By the time the rescuer got blood flow going, it was time to stop and ventilate again. Perhaps with the current 30 compressions to 2 ventilations as now taught would change the outcome of the study. In any event, everyone who experiences cardiac arrest who is not successfully resuscitated dies of the same thing, anoxia, or lack of oxygen to the brain. Many people in cardiac arrest vomit, sometimes profusely. Layperson CPR really does not allow such a person to be properly ventilated, as the ventilations would most likely cause aspiration (the vomit entering the lungs). By doing adequate and continuous chest compressions, life saving oxygenated blood is delivered to the brain. This can keep the patient viable until professional rescuers arrive on the scene and are able to provide advanced life support such as defibrillation, intubation and cardiac drugs. Studies have repeatedly shown that early access to CPR and defibrillation provide the best chance for surviving cardiac arrest. Also note thought that this study involved adult patients who usually experience cardiac arrest due to cardiac related events such as heart attacks or lethal disrhythmias. Children usually experience cardiac arrest due to airway problems such as choking. So it is vital that ventilation attempts be made on children to determine whether or not they have a patent airway. If not the Heimlich maneuver should be initiated immediately, as the child's best chance of survival is restoration of a patent airway.
A friend of mine works as a 911 operator. I remember her saying years ago that they were testing out new CPR directions to give to folks calling in. They were supposed to tell people to do 400 heart compressions to every breath, but they were losing count. (Panic situations, donchya know.) So they ended up telling them to do 100 compressions and then ask for what to do next. They'd just say, "keep going...."
As far as I know they adopted the new guidelines. It's just hard to spread the word that mouth to mouth isn't all that effective.
In my own humble experience, a person with heart failure will gasp and breathe as soon as blood flow is established.
With a drowning victim it is the other way around - their hearts are OK, but their lungs are full of water, so getting them to breathe/cough/drain is more important - their hearts will beat OK.
So, some intelligence is required. You have to analyze the situation, not just start full resussitation if you don't know what/why you are doing it.
Excuse me, but please get off my Pennisetum Clandestinum, eh!
and change operators after ten minutes or so
I take my hat off to anyone who can do effective chest compressions for 10 minutes. If you have the manpower you want to be swapping much sooner than that.
Seven puppies were harmed during the making of this post.
More than 300,000 Americans die from cardiac arrest each year. Roughly 9 out of 10 cardiac arrest victims die before they get to a hospital -- partly because they do not get CPR
;)
With roughly 3% of CPR actions actually doing anything useful, it's no wonder most cardiac arrest victims die. Even with CPR you're only going to save a tiny fraction of them.
Every once in while, CPR makes me think of all the half-hearted measures we introduce into our legal system - on the premise of "well, if it saves ONE life it's worth it". We spend an awful lot of time and money teaching CPR to people, and it almost never does any good. Thanks to TV and the movies, the average person actually thinks CPR is a fairly successful procedure - they get (sometimes violently) angry when you tell them the actual success rate.
Ah well, anything that improves it is a plus, I guess. Now only 8.88889 out of 10 cardiac arrest victims will die
Endless arguments over trivial contradictions in books written by ignorant savages to explain thunder in the dark.
'More than 300,000 Americans die from cardiac arrest each year. Roughly 9 out of 10 cardiac arrest victims die before they get to a hospital -- partly because they do not get CPR.'"
One less asshole: one more job opening.
Just wanted to point out that if your heart has stopped beating it is impossible to breathe...so anyway what you said was kind of idiotic.
"So if the person is still breathing but their heart has stopped, rescue breaths provide no benefit. DUH!"
RTFA ... if they are NOT breathing, and had a cardiac arrest, DON'T WASTE TIME WITH THE RESCUE BREATHING! Just call for help and do the chest compressions. In an urban emergency, you can keep them going until the EMT's get there with the defib and O2.
I didn't see any of the other comments mention this yet, but a number of researchers believe that adequate chest compressions will cause air to exit the lungs, and the moment of relaxation between compressions will allow some (adequate?) air entry.
Also, if not done by very well trained individuals, the time spent giving a breath to these individuals means time not engaged in chest compression, meaning the effective heart rate will decrease.
Help! I'm a slashdot refugee.
Just to be pedantic, as a paramedic, I watched a few people who were breathing while in cardiac arrest. It's not common, but it can happen. The thing is, they won't breathe for long while in cardiac arrest. One guy in a witnessed arrest for 5 minutes, no pulse, not breathing, v-fib on the monitor, grabbed me and screamed "NO!" when I tried to defibrillate him. I almost shocked both of us. After I got his hands pried off my collar, I sparked him and got him back into a decent rhythm. When he woke up a couple hours later, he didn't know why he screamed "NO!" I've always wondered what was going on in his mind.... The ability to move blood decreases dramatically with time when blood isn't flowing. This result may indicate that stopping compressions for anything short of a return of cardiac activity isn't worth it. In the field and in the hospital, it's not uncommon for the person doing chest compressions to stop occasionally to perform an intervention. This result may change how CPR is done by the medical professionals as well. On the other hand, if rescue breathing is being done poorly in the field, perhaps it's complications like air in the stomach that results in vomiting and thus aspiration pneumonia that's causing the problem. More work will definitely need to be done on this question.
This sig seemed like a good idea at the time....
Wouldn't the act of compressing the chest, also compress the lungs, causing a bit of fresh air flow in and out of them?
Love many, trust a few, do harm to none.
Um. I think you misunderstand the meaning of Cardiac Arrest, and I can tell you didn't RTFA. When an individual is in respiratory arrest such as when they are suffering from anaphylactic shock, they have stopped breathing, but their heart is still pumping. If they are in cardiac arrest then they have both stopped breathing and their heart is in an unsustainable rhythm, e.g. asystole (flatline), or ventricular fibrillation.
There is no such thing as cardiac arrest with continued respirations.
The study discusses many different reasons why lay persons should focus on chest compressions alone if a victim is in cardiac arrest. One of the most important reasons is that lay people avoid providing chest compressions (felt to be the most important part of CPR for the first few minutes) because they don't want to give rescue breaths.
The protocol for lay people has already been changed to reduce the number of rescue breaths given, and the duration at which they are given.
There are also contraindications to full rescue breaths for emergency responders, such as asthma-induced respiratory (and then later cardiac) arrest, COPD, etc. It was also noted by the study that "saves" (conversions, survivors, whatever you want to call them) tend to suffer from less brain damage if they are not given rescue breaths, but the mechanism for such a claim is unclear to me.
For the time being, professional rescuers will continue to follow the newest protocols for CPR, which involves chest compressions, rescue breaths via BVM or advanced airways (ET tubes), and AED application ASAP.
I'm not sure why this is even much of a topic for discussion anyway. AED is the tool that actually saves lives. CPR is generally not effective except in witnessed arrests, and even then the probability of a save is frequently low. Speaking from personal experience, I've performed CPR 20+ times, and have yet to get a save. Even though I get recertified every year, you should expect your experience to be about the same. You need paramedics with drug bags, and defibrillation, and you need them yesterday. The rest of us are just trying to buy time.
Friends help you move. Real friends help you move bodies.
Never forget: 2 + 2 = 5 for extremely large values of 2.
I teach CPR instructors for the layperson as well as for professionals. Yes, I do work in emergency medicine. Here is my take on the findings and from my experience.
First responders (people first on the scene, not medical professionals) historically tend to do a very poor job of ventilating a patient. Often times this renders the rescue breathing almost useless. This has been known about and debated for many years. The "something is better than nothing" attitude as prevailed through the years, even though the majority of the time "nothing" is exactly what the patient gets in terms of oxygen. They often also tend to perform very poor quality CPR compressions (not deep enough, not fast enough).
You are breathing 21% oxygen now. When you exhale into an individual, they are not receiving 21% for part of it was used by the rescuer. The patient is only receiving 16% oxygen. This is a drastic reduction, but it is far better than nothing.
When any patient is determined to not be breathing, there are 3 things a rescuer must remember:
ABC
Airway
It the airway is not clear and straight, no oxygen can get into the lungs.
Breathing
If a person is not breathing, you MUST breath for them or their heart will stop due to lack of oxygen.
Circulation
If a pulse is not detected, you must do proper CPR to circulate oxygenated blood.
These must be maintained in the order ABC. Maintaining circulation when there is no breathing or oxygen is bad.
CPR buys time until properly trained medical personnel arrive. It will not get the heart starting to beat again. You are simply trying to circulate oxygenated blood since the body is not capable of doing that on its own. When there is no pulse in the early stage of a heart attack you see, generally the heart is in an abnormal, but regular rhythm most of the time, but not always. It is basically beating so fast that it cannot circulate blood, and the rhythm at some point becomes very irregular. Defibrillation and cardiac drugs are needed for the heart to return to a normal rhythm. If there is electrical activity still in the heart there is a significantly greater chance of resuscitation. When the heart is in asystole, there is no electrical signal and it is game over. Circulating oxygen is key to survival.
It is also a known fact that most people who take a CPR class forget more than half of what they were taught the day before. As more time elapses, even more is forgotten. If I were having a heart attack, I would prefer that someone tried to give me rescue breaths, even though there is a chance they will do it wrong. It is better to have oxygenated blood circulated than deoxygenated blood. This is just my opinion.
"This is America... where the will of the few outweigh the outrage of the many..." - Unknown
Actually if you've had Red cross training, you'd know that cardiac arrest does NOT necessarily mean respiratory failure.
The Old way
1, check pulse.
2 check breathing
3 perform appropriate parts of CPR
New way
1 Check pulse
2. perform chest compressions
Food not Bombs is a nice platitude but it breaks down when you notice that the Bombees are usually well fed
You're touching the crux of the problem there - people won't perform first aid on others, especially here in the US, where, if the person dies or doesn't recover 100% without a medical bill, you'll get sued, because there's a slim possibility that your actions caused more harm than good, and that the person potentially could have recovered on his own. By helping others, you become liable.
Heck, even doctors and nurses walk away here out of fear of litigation, unless they're on duty or their assistance have been requested by someone else.
Teaching people about CPR here in the US should be followed by laws like they have other places, where it's a felony to not assist a fellow in life threatening situations, and where you can not get sued for results of actions obviously intended to assist someone in dire need. Unless the laws are changed, CPR will almost exclusively be performed by ambulance personnel, hospital staff, and very close family.
Kick 'em when they're up
Kick 'em when they're down
Kick 'em when they're up
Kick 'em all 'round
Dirty little secrets
Dirty little lies
We've got our fingers in everybody's pies
We love to cut you down to size
We love dirty laundry!
While I was working at that medical facility, I took the opportunity to recertify with the office. We covered AEDs in addition to the normal compression/breathing routine. Someone mentioned only medical professionals get this training, and my card DOES say "Healthcare Professional" on it as well as specifically mentioning AEDs. Is the AED training available to the public yet, or will I lose my certification at some point? Anyone?
Don't tell me to get a life. I'm a gamer; I have LOTS of lives!
My employers sent me on a CPR course. A while ago, but I remember it well.
Two things in particular that stuck with me:
1. Since you have your hands full, you must nominate somebody to call for help: YOU!!! Call an ambulance! Don't ask for volunteers.
2. Don't be afraid to lean in to it. Nobody ever died of cracked ribs.
I've never had to use what I learned. I hope I never do.
...laura
This isn't true is many instances. While I don't know if it applies at a national level, I know that many states have "good samaritan" laws that provide a legal shield against being sued for rendering assistance in good faith. Such laws are there precisely due to the concern you detail: that no-one would render assistance for fear of litigation.
As far as doctors and nurses walking away, they'd better hope that no-one sees them do so. I recall from my Maryland EMT training that trained professionals (i.e. from EMTs all the way up to doctors) have a duty to render assistance in such situations. Indeed, I think it's far more reasonable to hold a doctor negligible for not rendering assistance since a duty of care exists by virtue of his profession. Of course, talk to me once I'm done with medical school and perhaps I'll have a somewhat less idealistic view, but I sure hope not.
P.P.S. I'm doing Science and I'm still alive.
As a physician who deals with in-hospital cardiac arrests on a regular basis, and whom has RTFA, there are couple important points. First, this study really only looked at bystander-provided CPR. The paramedics/other trained professionals who arrived still intubated and ventilated these patients - as this is standard of care. The authors of the study say that the likely explanation for their finding is likely that bystanders interrupted chest compressions to give rescue breaths. So, we may need to change the training for the lay public regarding CPR, but professional responders will still need to give ventilations, and once an airway is secured simultaneous compression and ventilation can be given. If you don't breath - you don't live. Second, while this is likely one of the better studies that can be done on a topic like this, it was not randomized, it was not controlled, nor was it even comprehensive/population-based. There are multiple types of errors that can creep in and cause erroneous results in these types of studies. Finally, we need to keep results in perspective. While any improvement is important - and should be pursued - the overall statistics they report for outcomes are still pretty dismal. The overall survival rate for out of hospital arrest was 8-9%, and the number of people with only moderate/mild disability afterward (ie able to walk, talk, etc) was ~6% if you only got chest compressions, ~4% if you got compressions and rescue breaths. So, even with the "chest compressions only" strategy, the absolute difference is relatively small.
No, It's the other way around. Here are the old steps for Adult CPR:
1. Check Scene Safety
2. Obtain Concent/Check for Consciousness
3. Send someone to call 911, apply protection
4. Check for Breathing if not breathing continue else goto 16
5. Open airway and give Rescue Breath if success goto 8
6. Readjust airway and give Rescue Breath if success goto 8
7. Five Stomach Pumps, Sweep Throat with Index Finger, goto 5
8. Check for Pulse, if no pulse continue, else goto 12
9. Fifteen chest compressions
10. Open airway and give two breaths, goto 6 on failure
11. Repeat step 9 and 10 for about one minute, then goto 8
12. Give a slow breath
13. Count to five
14. Repeat steps 12 and 13 for about one minute
15. Check for breathing, if not breathing goto 8
16. Continue to monitor for changes, treat other issues, if not breathing goto 5
Changes:
Step 9 is now Thirty chest compressions
Steps 4-8 optional for untrained persons
Disclamer: IANAD (I am not a doctor or CPR trainer) this is not medical advice.
But the bottom line, if it comes down to doing CPR, the person's most likely going to die anyway. If you do see someone that looks like they're in cardiac arrest, you're first instinct should be to look for the automatic defibrillator device if one's available. CPR should be a last resort after that.
Thank you for RTFA and commenting from a professional point of view.
You may want to check your facts on HIV. The chances of spreading the virus via saliva alone are extremely slim.
True. But do you think most Americans know that? Most Americans can't even find Iraq on a globe! If you read my post again, you'll see I said they just feared catching HIV from it.
You can be sued for anything in this country. But thanks to Good Samaritan laws in every state (and in D.C.), you cannot be successfully sued for providing first aid, provided that you act as a volunteer (don't accept any compensation), act in a reasonable and prudent manner (don't do stuff you know you're not supposed to), and don't abandon the victim once you start.
So please - don't be afraid to help. You have the law on your side.
When it comes to CPR, you're doing it on someone with no pulse. The person is dead. You can't make them any worse off than that.
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
AED training is available to the general public, indeed that's the whole idea: put them everywhere and make them idiot-proof. (Though they still need to work on that.)
The "medical professional" training I think varies a little bit between the Red Cross and American Heart Association standards, but covers the two-rescuer protocol, plus maybe the use of a ambu bag, and maybe cricoid pressure if that's still in there (wasn't covered in my last training). But it's not like anyone checks your documents if you sign up for the "medical professional" level class.
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
Given the people in my area, I'd be more than happy to skip the mouth-to-mouth thing. :|
One of the most important CPR facts is that it is only effective 5%-10% of the time! Many people who are trained in CPR and have actually had to perform it do not know this, and they suffer psychologically because they feel they performed it wrong and let/caused someone to die, when they probably did it right. Know this.
--<Mike>--
Disclaimer: IANAL. Get a CPR card if you want to practice CPR. Mine is out of date; work gave maintenance the CPR training, while I got the mandatory "confined spaces" training instead--it consisted entirely of looking at pictures of every last manhole around the plant, while being told "don't go in them." I wish I was making that up.
Back on topic, many places have "Good Samaritan" laws which protect people who try to help you from malpractice suits in situations like that. Might be worth looking up what, if any, such laws your state has if you're worried about that.
In America they will probably sue you for NOT helping too. Your dammed if you do and dammed if you dont. And anyway, why cant it be called "bob" instead of Sue?
http://www.rense.com/general79/wdx1.htm
No, it's not allowed, it's obligatory.
Birds are not dinosaur descendants;birds are dinosaurs, for all useful meanings of "birds", "are" and "dinosaurs"
What a ridiculously backwards representation of the point the articles on this topic actually make. The title of this entry should be: Chest Compressions Alone Nearly Always as Effective as Full CPR
I read the script, and I think it would help my character's motivation if he was on fire. -Bender
I'm not implying that people shouldn't bother helping someone, of course they should, but I think too much hope is placed in the exercise, and too many hospital dramas make it look like a quick push against someone's chest will wake them up right away.
Except for those wacky places that go by brain activity. What are they thinking? Everyone knows your soul is in your heart. By the way, they should change the name to "CR".
"Clinically dead" is a type of dead, though it is a type that's sometimes reversible.
Presumably, rescue breathing - "mouth-to-mouth" - will still be used for people in respiratory arrest but who still have a pulse.
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
I know when I took a first aid course, we were always supposed to ask the person if they needed help. Good Samaritan laws only kicked in if the person couldn't answer. In the majority of CPR cases, this would be true, however it's kind of an odd rule. And I live in Canada. If you saw someone with a gash to the head, and they were still conscious, then you were supposed to ask them if they needed help before applying pressure with a clean cloth. And if they refuse, you're supposed to just not do anything. Possibly wait for them to pass out and then help them. What a screwed up world we live in.
Anthropic principle: We see the universe the way it is because if it were different we would not be here to see it.
The subset of people who actually know CPR are probably going to be a little more knowledgeable about HIV than the general population.
Me, I'd be more concerned about catching a cold.
AED is for anyone. The AED attempts to determine cardiac rhythm by monitoring electrical activity on the pt. That's why you are told "Stand clear, analyzing rhythm", because if the pt. is jostled during this time, the AED can get a bad read, and follow the wrong algorithm.
IANAL, but I am reasonably sure that regardless of what you do or don't do you can be sued. However, if your pt. is in cardiac arrest, they are already dead, so if you at least attempt to do SOMETHING for the pt., and that something isn't stupid, I believe that precedent is on your side. However, if an AED is available and you don't use it, you open yourself to criticism and/or challenges unless you have a good reason. You should check with the practice that you work for to ensure that you are personally insured for your actions at work, including negligence in treating dead people.
I can't speak for all AEDs, but the ones we carry on our rigs have voice recording on them, so if you follow the voice instructions, chances are the recording will back you up. In any case, at least in my state, unless you are an EMT, Medic, PHRN, or MD/DO etc., once one of those show up they're in charge (that's right, you RN's, the EMT's rule when they show up), so if you follow their instructions (unless they seem to be counter to your training), I believe your liability concern should be reduced.
Friends help you move. Real friends help you move bodies.
Never forget: 2 + 2 = 5 for extremely large values of 2.
Stanmann, I know you think you're right, but the mistake you're making is a common one. This is an important detail because for patients in respiratory arrest you actually can make the situation worse as performing CPR on victims with a pulse can induce arythmias or arrest.
e althatoz.com/healthatoz/Atoz/common/standard/trans form.jsp?requestURI=/healthatoz/Atoz/ency/cardiopu lmonary_resuscitation_cpr.jsp
Here's the easy way to determine which goes first - the respirations or the pulse. If you have a victim who has full airway obstruction due to choking - can they breathe? No. Is their heart still beating? Yes - they're probably still conscious, and are standing up giving the universal choking sign - and they might even be running full speed in a panic. Right? OK, then.
If you still don't believe it, google "CPR Procedure". Here are a couple of sites I just pulled up quickly. The fist one lists the new protocol for lay people.
http://globalcrisis.info/cpr.html
http://www.h
PLEASE before you hose it and make matters worse, contact an instructor or get recertified. If your certification is current, you might be able to get your recert expedited. Try contacting the BLS/ALS dispatchers in your area as they will probably know of a class coming up shortly, or they might even have a class with you by yourself by appointment.
Really.
Friends help you move. Real friends help you move bodies.
Never forget: 2 + 2 = 5 for extremely large values of 2.
As a recently certified EMT, I find this both encouraging and disturbing.
The switch from 2 breaths/15 compressions to the 2/30 ratio made sense; the idea is to circulate oxygenated blood to the brain and heart. Oxygen in the lungs is useless if there is no circulation, ergo circulation is far more critical, even if blood oxygen saturation is relatively low.
This study disturbs me because it will cause me to doubt the efficacy of my patient care in the field. If working alone, should I forego rescue breaths and concentrate on chest compressions? Or should I follow the AHA recommendation of 2/30? Whichever route I choose, is it the best care for the patient?
I will no doubt take the CYA route and follow protocol, which is 2/30. Still, if a patient does not survive, I will wonder if perhaps they might have survived had I violated protocol.
Most unpleasant.
Ignorance is curable, stupid is forever.
Ok, but what if you've got a small sore in your mouth somewhere? (lips, inside of cheeks, gums, etc). The probability is small, but if it happens, you've just gained HIV from helping someone. (I'm assuming here that it's a 100% chance of the victim having a sore somewhere in the mouth, as that has been the case with almost every drug addict OD'ing I've found so far).
Good point. Yes, asking permission to render aid was a part of my training too. As I recall, if the person is unable to answer or is a child, then aid can be rendered in good faith and is protected by the Good Samaritan laws. Interestingly, however, only laymen are protected. IIRC, trained individuals are expected to have a standard of care exceeding that of laymen and thus are not protected by the law. I suppose this is the trade-off for being able to do so much more. I am originally from the U.K., so I sometimes find it interesting to muse on the differences between the U.S. and U.K. systems.
P.P.S. I'm doing Science and I'm still alive.
Would that it was so. Unfortunately, it isn't, at least in the state where I live. Yes, there's a Good Samaritan law, but it only protects qualified medical personnel, and not laymen without certified training. If you fall over, I'm the only one around, and I find no pulse and give you CPR, and you get back to life, you can then sue me for your broken ribs, hospitalization, malpractice, assault, and, of course, "pain and suffering".
Also, the Good Samaritan law here is limited to cardio-pneumonary situations. If you slash open the aorta in your leg, anyone who puts a torniquet around your thigh to stop you from bleeding to death is then fair game for malpractice and assault lawsuits.
I'd still take my chances and help you, but don't count on many people doing that.
...the lack of people trained up on basic emergency life support (ELS) techniques. I'm an instructor for the HeartStart scheme (run by the BHF) in the UK, where general knowledge of ELS is pretty poor, hence the initiative I guess. Over in Canada things are so much more different to the USA, as most people are pretty clued up on the basics. Given the Western decline in healthy eating standards (especially over here, where things have really gone down the pan) this should be the sorta stuff we're teaching kids today. Doing something is better than doing nothing at all, which is a point a lot of people seem to miss.
Given a victim with an unobstructed airway (a case of cardiac arrest, for example), do chest compressions move any air into and out of the lungs as a side effect?
Have gnu, will travel.
Where's that?
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
There's also "brain dead", "biologically dead", and "legally dead", which are generally the same thing. You can be all of these without being "clinically dead". Which proves that clinicians don't know squat.
See http://www.cprinstructor.com/legal.htm (and weep).
It doesn't matter where I am - less than half the states have Good Samaritan laws that apply to everyone; in most cases you have to have an American Red Cross certification, be a nurse or a doctor to avoid liability.
Some of the so-called "Good Samaritan" laws even go further the other way, where groups that one would think should be required to give common sense emergency assistance are explicitly exempt from having to do so. In some states, if your kid's teacher watches your kid choke or drown and doesn't even try to save him, the Good Samaritan law prevents the teacher and school from being sued over it.
I prefer the system found in some European countries, where it's a felony to not assist people in dire need until someone better qualified arrives. The first person at the scene of an accident is obligated to assist, and both can and will be put in jail if ignoring a life-threatening accident. If you don't know anything that may help, it's then your obligation to with utmost urgency get hold of someone who can. Calling an emergency number isn't enough - you have to flag down others who may be able to assist where you can't. And honestly, I don't think that's too much to expect. Next time it may be you who need that help.
In the paramedic course I did some years ago they told us, if someone doesn't know how to do the breathing just do the compression.
First of all the breathing is difficult to do right, especially in a stress situation. Also someone who doesn't breath will have heart problems soon and vice versa. There's also enough oxygen still in the blood for the next 10 minutes. And after 10 minutes the ambulance should arrive anyway.
Of course that's now what a paramedic on duty should do. But with an anesthesia bag it's also much easier. The rule is more for your typical first aider or if you don't have anything with you to avoid getting in direct contact with the sick person. Call 112 or 911 on concentrate on the compression.
I think what people are missing here is that if the brain and/or heart muscle die, there's no point in saving the rest of you. Heart and brain are both better off getting SOME circulation with SOME residual oxygen, than NO circulation, which by definition will bring no oxygen either. So the priorities are circulation first, input of fresh oxygen second.
~REZ~ #43301. Who'd fake being me anyway?
It is my understanding that in some circumstances after being struck by lightning it is possible for a person to continue breathing after their heart has stopped. Not that it has much bearing on this discussion, because no amount of CPR or treatment is going to save them by then! It's kind of fascinating though.
I like my coffee the way I like my women - roasted and ground up into little tiny pieces.