CPR best practices and barriers?

[one-eyed Bob]

My post was mainly to point out that I have a friend who is alive and normal because his wife did CPR for 30 minutes! You never know what might happen. I also wish to point out that ventilating a person covered in vomit is unlikely to produce a good result, so don't beat up on yourself if you defer or do "hands only".

[David in OR]

^ Yes, and I appreciate this and the other posts in this thread very much. It's always good when people here get turned loose on a topic. Always a lot to learn, no matter what's being discussed.

I think I've gotten good perspectives, here and elsewhere, on what can be hoped for from CPR--and why one might decide to give it one's best effort even if one is realistic about the odds. One thing I did not know before this thread, because it never came up in my dumbed-down-for-the-masses classes, was the practical hopelessness of doing CPR in the case of a traumatic PNB. That is good to know, if only for my own emotional consequences in such a case.

[BuckarooMedic]

@David in OR,

I would highly recommend the WMI/NOLS Wilderness First Responder course. I took their WEMT course, in Lander WY, a couple of years ago and it was top notch. About half the students had previously taken the WMI WFR course, at many different locations around the country, and they were all very well prepared and knowledgeable. It seems that WMI does a real good job in standardizing their courses and instructors. The great thing about these courses is that it's about 40/60% classroom/hands-on. I liked the experience so much, I would really like to go back as an instructor for them (this is something I said that I would never do again after seven years of instructing).

Take care,

Take care,

[Sawtooth]

Just finished my professional rescuer CPR/AED class yesterday. Scheduled for my WFA course in late May. Great info here on the thread guys. Thanks for posting. I'll keep checking back.

[Doc]

< One thing I did not know before this thread, because it never came up in my dumbed-down-for-the-masses classes, was the practical hopelessness of doing CPR in the case of a traumatic PNB. That is good to know, if only for my own emotional consequences in such a case. >

The latest study I've seen here in OZ suggests that < 3% of PNB will survive regardless of the type of CPR applied. That figure included all the witnessed arrests that occurred in hospitals during the timeframe of the study.

This study suggests that number is optimistic.
"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%."

Perhaps they did not include the numbers that occurred within the hospital environment and possibly had a better chance of successful intervention overall?

[BuckarooMedic]

Perhaps they did not include the numbers that occurred within the hospital environment and possibly had a better chance of successful intervention overall?

I didn't see much better survival rates in the emergency department either. The ER staff responded to all full-arrests in the hospital. Usually, the pt died. I can only remember one or two pt that arrived in full arrest that actually survived.

[Doc]

I didn't see much better survival rates in the emergency department either. The ER staff responded to all full-arrests in the hospital. Usually, the pt died. I can only remember one or two pt that arrived in full arrest that actually survived.

Same same here. I can only remember a few who made it.

[Take-a-knee]

CPR has a pretty good chance of restoring life and health to lightning/electrocution victims and those who've taken a blow to the head, IE, auto crash victims. Both tend to stop breathing long enough to endanger neural tissues before they start breathing again. IIRC, this is better described in the PHTLS manual.

[BoulderTroll]

I agree with what has been said here, especially about CPR effectiveness (or complete lack of) in trauma scenarios. I've probably done CPR somewhere between 100-150 times over that last 15 years (far less than Medicjim), and I've only ever seen pulses come back a handful of times, and those were after meds and defib. For masks, I agree with Buckaroomedic...the Laerdal pocket mask is far in a way my favorite. A BVM is better, but I don't carry one in my car, a Laerdal takes up much less space.

The problem with teaching the lay person compressions only, is that airway management and rescue breaths are even more effective and usefull than CPR, at least in my experience. Twice now in my life I've been lucky enough (through no skill of my own, simply being in the right place at the right time) to save someone who was in respiratory arrest; simply by opening the airway and providing rescue breaths until they began breathing spontaneously again (the most recent one was in the newspaper last week). One was on a grown adult and the other an infant. As an interesting side note, in neither incident did I use a pocket mask or any type of PPE/ BSI...although normally I'd recommend it if at all possible. With teaching the lay person compressions only, you may be teaching them a "better than nothing" method of helping someone in cardiac arrest and respiratory arrest, but you're ignoring training for respiratory arrest emergencies.

PS- I didn't mean to make it sound like I was ragging on those who teach compressions only. Until recently I was an AHA CPR instructor and that's they way we were starting to teach as well. I just wasn't personally in favor of it.