CPR best practices and barriers?

[BuckarooMedic]

Yup, the new CPR (just chest compressions) is meant to just keep the blood circulating until the patient can be shocked. There is a significant amount of residual oxygen left in the lungs after exhalation and only electricity is going to get the heart going again (OK, electricity and some specific cardiac Rx too). Studies found that stopping to check for pulses and give rescue breaths just waisted time. Plus, many "lay rescuers" were too squeamish to give proper rescue breaths and were getting confused on what to do. Basically wasting time. I've only had two patients survive (that I know of) death, CPR, ALS, etc, etc. That doesn't mean that I wouldn't start CPR if I came across someone who I thought needed it though. EMS is really changing when it comes to CPR in the field these days. The last couple of unwitnessed arrests I ran, were field pronouncements. In the "old days" both of these patients would have had CPR, advanced airway, IV access with first line Rx, several defib attempts, then we would have loaded and hauled ass to the nearest ED and they still wouldn't have survived.

My favorite rescue breathing barrier device is the Laerdal Pocket Mask with the one-way valve. It's a little on the big side, but they really work when you need them to.

[medicjim]

I have always disliked programs that focus on the dimwitted subset of the population, so here is some common sense context that requires the ability to think... if you are a dimwit, this will prove useless. If you have a working brain, I hope this helps.

-In near three decades of continuous operation as an ALS trained first responder... I have seen exactly 0 people recover from trauma arrest. CPR is useless in this context. My best guess would be >3000 attempts witnessed.

- It makes perfect sense in my mind to focus on circulation and defib for the first couple minutes of a cardiac arrest. The heart was circulating oxygenated blood moments ago, so you probably have some time before that blood O2 is depleted, focus on the actions that are most likely to recover the system.

-once defib and continuous compressions fail for a minute or so, filling the lungs with air seems real important to me....just pushing on the chest for 10 minutes seems highly unlikely to produce effective circulation that far in, but then, I'm not an adminstrator working in a teaching hospital... I just use the technique and observe the outcomes first person <G>

-A $20 disposible BVM (bag valve mask) is what I define as the minimum useful tool...I've come to dislike pocket masks.

-A $3 OP airway and the skills to insert it seem like worthwhile if you carry a BVM.. five minutes with just about any US EMT would be adequate training.

[firecog]

I have always disliked programs that focus on the dimwitted subset of the population...

Even though it seems like the newer guidleines are simply making it easier for un/undertrained rescuers, it is my understanding that it is based more on the most recent science and backed up by field trials.

...In near three decades ...>3000 attempts witnessed.

Sounds like you're running your tail off, that's one or two trauma PNB's a day!!

[medicjim]

Even though it seems like the newer guidleines are simply making it easier for un/undertrained rescuers, it is my understanding that it is based more on the most recent science and backed up by field trials.

The concept of delayed oxygenation makes sense....but delivery of the message is "dumbed down".

Sounds like you're running your tail off, that's one or two trauma PNB's a day!!

30 years x 365 days is over 10K days...

But your point is valid, my number is too high....

[BuckarooMedic]

medicjim,

I totally see your point. I too hate programs that teach to the "lowest common denominator" (LCD), but it's a fact that we have to follow the standards and our protocols. Let's face it, most protocols are geared towards the LCD and are based on nationally accepted standards set by such distinguished organizations such as the AHA, NAEMT, NREMT (shudder), etc. that gear everything to the LCD. It's a vicious circle isn't it?

[firecog]

30 years x 365 days is over 10K days...

Sorry, my bad. Apparently my son didn't get his mathematical apptitude from me.

[David in OR]

So what's the next step for a well-meaning LCD-type guy, after the Red Cross first aid/CPR/AED class? I'm talking weekend-level commitment.

[medicjim]

http://www.citizencorps.gov/cert/

Volunteer firefighter

State, County or Municipal Office of Emergency Management

Wilderness EMT class

Federal "Red Card" training (wildland firefighting)

[medicjim]

one more

http://www.oregon.gov/OMD/OEM/tech_resp/sar.shtml

[David in OR]

Wilderness first aid is the sort of thing I'm thinking about. Maybe the 20- or 40-hour NOLS WFA/WAFA courses before jumping right into Wilderness EMT.