CPR best practices and barriers?

[David in OR]

So what're the current best practices around compressions + rescue breaths vs. just compressions? (For "basic first aid"-type people.) I know the Red Cross is teaching 30 compressions + 2 rescue breaths. That's what I got, but I also got told in a different course that it was okay to just do compressions.

If there's evidence that it's good to incorporate rescue breaths, what's the most packable barrier that works okay?

TIA

[jhayes6405]

Compressions only CPR is good for the non medically inclined. Pulse checks were taken out as well be because almost all Americans are terrible at them.
As far as barriers, there are little one way valves out there with plastic skirting on them. They make them in key chain size, but is big for a key chain IMO.
I think a google search will turn up some results for you pretty easily.

On a side note, not one person I have ever done CPR on is alive today and I was doing really good compressions every time. CPR is a last ditch effort. Don't beat your self up if you wind up in that position and things don't go like they do in the movies. Breaking ribs is normal and to be expected with good compressions.

[jhayes6405]

David,
Was working on an upcoming medical class and found this for you.
http://blog.remotemedical.com/2012/0...cpr-guidlines/

[15FunCo]

Bystander CPR is now compressions only until rescuers arrive. The idea behind this is that the problem isn't a lack of oxygenation but a lack of circulation. People who go down as a "witnessed" arrest have just stopped breathing and do not need to be re oxygenated but they do need that blood circulated. So now it is recommended that you push hard and fast (100 times a minute and break ribs) until paramedics arrive and establish an advanced airway.


If you want to do rescue breaths still then you can purchase a pocket make with a one way valve at most medical supply stores

[David in OR]

David,
Was working on an upcoming medical class and found this for you.
http://blog.remotemedical.com/2012/0...cpr-guidlines/

Interesting, thank you. "Compressions and breaths are still preferred for those trained in CPR." This is more or less what I was told by the Red Cross. I think, then, for me, it would come down to whether I had a mask of some sort. Unless it was family, in which case I'd risk it. Thanks, too, for the perspective.

Thanks also 15FunCo.

[one-eyed Bob]

Apparently you must pump for a while to build up pressure in the chest. Stopping to breathe for the patient allows the pressure to subside. Try to treat what you see; if a person stops breathing or chokes, fix that; if they suddenly collapse, do chest compressions and call for help. Eventually the patient will need ventilation so hope that help arrives. I have a colleague who collapsed at home. His wife did CPR for 30 minutes until help arrived. He was on a ventilator for 3 days and presumed brain dead. Then he awakened and is normal (mostly). Don't worry about the barrier stuff since you won't have it with you anyway. You could throw an ambu bag in the trunk to use if you come upon a wreck.

[firecog]

"Best practice' is always up for debate.

It appears that the studies and field experince are leaning towards CCR (cardio cerbral rescucitation, but sometimes referred to as continuous compression rescucitation). AHA and ARC are starting to come around and incorporate many of the CCR principles that have already been discussed, but it will probably be a few years before they get to full CCR. As jhayes noted, things like rescue breathing and pulse checks have tended to cause problems for lay responders. When implementing full CCR however, even for ALS responders, it is compression only for the first couple minutes, O2 via non-rebreather, and no pulse check after the first defib-just more compressions. Then you start considering things like an advanced airway or ACLS meds.

Regardless, even though CCR is helping to improve the outcomes, it is still a low-percentage game. Given his background, I suspect jhayes' experience is primarily due to dealing with patients who are PNB secondary to trauma, in which case the outcome is always the same. There is zero chance of rescuscusitating a traumatic PNB. In a wilderness/backwoods setting that is something to consider before using valuable energy and/or resources in a rescusitation attempt.

When in doubt, start pumping....

[jhayes6405]

"
There is zero chance of rescuscusitating a traumatic PNB. In a wilderness/backwoods setting that is something to consider before using valuable energy and/or resources in a rescusitation attempt.
..

Exactly why we were taught not to try CPR on the battlefield.

[one-eyed Bob]

I think you can breathe for someone who has been underwater,etc, and also do cpr. You can pump someone who has an MI and then, hopefully, use an automated defibrillator. It is very difficult to do much for the person who vomits and aspirates, and that is where hands only cpr is probably the only thing you can get bystanders to do, anyway (been there). I mentioned my friend so that you can be assured that cpr can work in the right circumstance, particularly arrhythmias. We had a retirement party for this guy! It was better than a funeral. This is not something to feel bad about if you can't resuscitate an elderly person with many problems.

[David in OR]

Regardless, even though CCR is helping to improve the outcomes, it is still a low-percentage game. Given his background, I suspect jhayes' experience is primarily due to dealing with patients who are PNB secondary to trauma, in which case the outcome is always the same.

From http://flightforlife.org/FlightForLi...ightRounds.pdf

"Shimazu et. al., reported a series of 267 patients who sustained blunt or penetrating trauma who were PNB at the time of hospital arrival. All patients had resuscitation efforts continued in the hospital. Six of 267 patients survived, 2 with severe neurologic impairment. The resulting functional survival rate in this series was 1.5%."

"The information provided above is not, by any means, meant to discourage a continued aggressive approach to resuscitation of the critically injured patient. Rather, the intent is to give insight to the prognosis of this group of patients so that EMS personnel will not impose unrealistic expectations upon themselves.
The patient should always be given the benefit of the doubt should any exist, but realize no matter how talented the EMS provider and no matter how excellent
and advanced the care delivered, as a group, trauma patients who become pulseless non-breathers have a grave prognosis at best."

Good to know.