Hands only CPR

[cedd]

I made my instructor chuckle last time I did my defibrillator course. I trained and worked as a pool lifeguard for a few years when I was in sixth form. Back then it was 15 to 2 which meant you could do compressions to the tune of Nelly The Elephant. He'd not heard that one before! Now I've got to sing it twice though to get the right number of compressions!

 

I've got to second the words on AED's. Excellent pieces of kit. We've got a lot at work (as you'd expect at an international airport) and they've so far managed to save 3 people. We're a bit of an oddity as we have 3 or 4 million passengers passing through our doors each year, not counting friends and family. One of their great features is after an incident they can download the log files from them. It means particularly if you've not been successful in getting somebody back, they can look and provide reassurance that you did everything right. The graph they show you about survival chances versus time till defibrillation is pretty convincing. They're also dead simple to use!

 

First aid's a funny one, my dad (ex police officer - dealt with more than his fair share of serious and fatal accidents) got quite cross on his most recent first aid course (he's now a music teacher) when they were told that the old way of doing things "didn't work". He had to interject and point out that he could give the names of at least 10 people for whom it had! The point is, it's not that the old way "didn't work", just that they're working out better and sometimes easier ways of doing it. It was the same on my last FAW when we got told we should never ever use a tourniquet. I witnessed and dealt with a serious accident many years ago now where a cyclist ended up with a pretty hefty bleed to his leg. Nothing would stop the bleed so it was time for my belt! The instructor leveled with me later that he'd probably still go for one in the case of a serious bleed, but that the official line was not to use them. Point was that at the side of that road, with nobody to help and an ambulance a long way away, it was all I had and it ultimately worked!

[Andrew C]

I did my FaW a couple of years back and the instructors told us that the move to 30/2 was due to a Japanese surgeon loosing someone on the table, and doing an experiment. At 15/1, oxygenated blood was just reaching the brain when you stop to do the next breath. Thus the blood was giving up oxygen in the plumbing, not where it was needed. 30/1 was shown to give good levels of oxygen at the brain where it is needed.

 

The move to compression only stems from the fact that if you are pressing hard enough to move the blood around, you will also be pumping the lungs sufficiently to exchange the CO² and air. Easier to teach, and administer in a real incident too.

[kerry davies]

Lots of answers to be found here; http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr-faqs.aspx

 

The public AED scheme appears to have been quietly dropped and I can find no mention in the current NHS web pages. The British Heart Foundation placed 200 in post then the last government added another 700. What happens next is anyone's guess.

 

CPR has come a long way since my Boy Scout 'artificial respiration' days and changes are the only constant. In the early days of ABC and mouth-to-mouth we used to use a Guedel airway but less proficient first aiders did more harm than good with them.

 

The recovery stats have very little to do with CPR which is why this latest initiative has been launched. Preventive drugs and stents have made an enormous difference but CPR can save many more lives than it does at present and wider use of AED even more. Could do better.

[ramdram]

Amazing how things have changed! Judging by the past posts my training would have been as likely to kill a patient.

 

I did a couple of St John courses over four decades ago. On the last one (at school in the fifth form)I think we used a "torso" dummy thing called a "Resusi Andi(sp?) or Annie"; actual physical treatment ref the breathing into other people being not quite the thing, neither was a demo of compression of the femoral artery, but the brachial was OK. Scalds/burns were to be covered with clean dressing or hankie(?). The notion of holding a scald wound under the cold tap had not been recognised.

 

The recovery position had just been invented or perhaps realised and training was given on how to turn a victim over so as not to break anything else...or constrict the blood supply further. The other practice which was strongly encouraged was to keep talking to the victim to "take their mind off the accident".

 

First action if you noticed a lack of breathing was to open the mouth and check the tongue was where it should be...not blocking the airway. We were advised you could use a safety pin to pin the tongue to the cheek!

 

We were told that it was entirely possible that the victim had vomited and you would have to clear that out of the mouth first with two fingers. However it could be that the jaw had been smashed and you could not get the mouth open anyway. So it would be mouth to nose. Sometimes it might be there was blockage further down the airway and to get the necessary pressure with mouth to mouth you had to pinch the nose shut. In the case of babies it might be that you could cover both nose and mouth together and blow very gently in case you ruptured a lung. I recall the breathing thing had to be much faster too.

 

It may be IIRC we were taught the technique, rpt technique (for obvious reasons, ** laughs out loud **), of doing a tracheotomy with a handy knife and a biro tube. I think you were supposed to make a sideways cut an inch below the "Adams's Apple" and insert the biro tube. Again, IIRC, sucking wounds and collapsed lungs were covered and something about a handy flexible plastic tube and a part water filled jamjar. Although how you would actually recognise that sort of thing and have the kit handy was never actually mentioned.

 

If you suspected broken rib injuries then compression was out anyway and it was mouth to mouth or mouth to nose (if the jaw had been smashed). Aids had not been invented then so there was not that concern...although I suppose there may have been issues with hepatitis and gum boils/open ulcers sort of thing.

 

Tourniquets were also "allowed" but you had to keep a note of the time the tourniquet had been applied...even to the extent of writing the time on your patient's skin in biro and timing with your watch. It was preferable to use a compression pad on a wound and bind as tightly as possible with constricting the blood supply to other parts.

 

In the case of a drowning you could start the mouth to mouth as soon as their head was clear of the water...tho' how you would actually keep yourself and victim afloat...

 

Fortunately, for potential victims, all staff at our venue are doing a course later this year...should be a very interesting experience. Don't know if we will do the defibrillator exercise. I suppose these days the accent is in keeping the victim breathing and stop them bleeding to death...and just hope the paramedics get there fast enough.

[the kid]

The other thing with compression 1st is that its a cleaning method. The head in the right position, and a good swift few compressions will clear water/ vomit etc or allow you to be aware if there is something else there.

[OllieDuff]

The other thing with compression 1st is that its a cleaning method. The head in the right position, and a good swift few compressions will clear water/ vomit etc or allow you to be aware if there is something else there.

 

Good point - there's an argument to be made that you should do rescue breaths if a) you know how and b) you have a CPR mask. AFAIK those who know how to perform CPR should do compressions and breaths as usual, the Vinnie Jones ad is really more so that Joe Public won't shirk from administering CPR because they're afraid of infection/messing up/don't want to give another guy mouth to mouth.

 

As for discussions about tourniquets etc, it's really situational: I did my FA training with the Royal Yachting Association and the course instructor suggested that a FA kit afloat should include the following on top of the usual:

 

- Nappies: easy to apply dressing, and can be used to mop up blood (I'm a bit sceptical - an absorbant pad seems like it might draw blood out of the body but I guess for a gushing wound it might be helpful)

- Gaffer tape: for securing the above to the casualty

- Cordless drill and a sharp 6mm drill bit: for trepanning to relieve pressure from a compression injury (intracranial bleed)

 

None of these things are exactly recommended when you're ashore, but if you're a day's helo flight from the nearest land it might be a good idea.

[bigclive]

I've just watched the Vinny advert on Youtube:-

 

Youtube CPR advert.

 

It's very good. Nice, simple and humorous enough to get the message to people.

 

AED's... I wonder how many in use are actually being maintained. Their batteries don't last forever and need changed from time to time, and are often expensive proprietary packs.

 

The history of AEDs is fascinating. They were first developed with funding by the American power industry because it was losing so many crew to electrocution. (Typically one American lineman still dies every week because most work is done live!) The first machines were just a high voltage transformer on a trolley. While testing the first machines on a dog (sorry dog-lovers) it was noticed that when the electrodes were pressed onto the dogs chest it's blood pressure rose and that was how CPR was discovered.

 

Modern machines activate when opened and talk you through electrode placement and use. They actively analyse the electrical activity in the heart, make an educated decision to apply a shock if needed and then time it to the exact point where it will achieve best results. There's a lot of science going on in those little boxes.

 

AEDs will not attempt to defibrillate a flat-lined heart or one that is beating acceptably.

[timd]

And if you wanted to know exactly what's inside an AED:

 

[cfmonk]

The gold standard in resuscitation is the BVM & Compression route but the idea behind hands only is that it is simpler and better than doing nothing.

 

The body can survive without breathing for a lot longer than it can survive without circulation.

 

Confusion happens because different training providers take different lengths of time to adopt recommendations. The accepted basis of training for resus in the UK is the Resuscitation Council (UK) which in turn take advice from the European Resuscitation Council but then it's up to providers to decide what they are currently going to teach (it's the same with oxygen therapy and many other things).

 

The current SJA standard is:

 

If less than two breaths heard during the 10 second breathing check then do 30 chest compressions, followed by 2 rescue breaths, 30 compressions and so on. The compressions should be done at the rate of 100 to 120 per minute.

 

The only exception to this is the case of children (defined as not reached puberty but "it is neither necessary nor appropriate to check whether a child has reached puberty" love that line) and drowning where the cycle is preceded by 5 rescue breaths.

 

If you are unwilling or unable to do rescue breaths then just do compressions. The chances of catching anything from most people from mouth to mouth I would say are pretty slim, especially if you've had your Hep vaccinations!

[Tris]

- Cordless drill and a sharp 6mm drill bit: for trepanning to relieve pressure from a compression injury (intracranial bleed)

 

None of these things are exactly recommended when you're ashore, but if you're a day's helo flight from the nearest land it might be a good idea.

 

Hmmm. I think your instructor needs a dose of reality. That is never going to be a good idea

 

Quite apart from the difficulty in diagnosing such a condition you would never do this on a boat, of the type he is instructing for. Even in the calmest of conditions offshore the swell is going to make that idea lethal.

 

As ever, these training scenarios, are an ideal scenario for CPR. How many times do you actually find a casualty in a nice clear, well-lit, flat space for instance?

[dbuckley]

- Cordless drill and a sharp 6mm drill bit: for trepanning to relieve pressure from a compression injury (intracranial bleed)

 

None of these things are exactly recommended when you're ashore, but if you're a day's helo flight from the nearest land it might be a good idea.

 

Hmmm. I think your instructor needs a dose of reality. That is never going to be a good idea

 

Australian GP saves boy's life using household drill

 

Dr Carson found a De Walt wood drill in the hospital's maintenance room and rang Melbourne neurosurgeon David Wallace for help. Mr Wallace guided him through a procedure that could have turned disastrously wrong had the drill been pushed too far or too hard.

 

"Mr Wallace told me that to do this with a household drill was unbelievable," Mr Rossi [the boy's dad] said.

 

Dr Carson drilled into the skull below the bruising, where bleeding had formed a clot that was putting lethal pressure on Nicholas's brain, and released the clot.

[Tris]

- Cordless drill and a sharp 6mm drill bit: for trepanning to relieve pressure from a compression injury (intracranial bleed)

 

None of these things are exactly recommended when you're ashore, but if you're a day's helo flight from the nearest land it might be a good idea.

 

Hmmm. I think your instructor needs a dose of reality. That is never going to be a good idea

 

Australian GP saves boy's life using household drill

 

Dr Carson found a De Walt wood drill in the hospital's maintenance room and rang Melbourne neurosurgeon David Wallace for help. Mr Wallace guided him through a procedure that could have turned disastrously wrong had the drill been pushed too far or too hard.

 

"Mr Wallace told me that to do this with a household drill was unbelievable," Mr Rossi [the boy's dad] said.

 

Dr Carson drilled into the skull below the bruising, where bleeding had formed a clot that was putting lethal pressure on Nicholas's brain, and released the clot.

 

You missed my point. A trained doctor drilling into someone's head - fine. They are trained, on land and is essentially what they do in a theatre - just less precise and sterile

 

That is entirely different to layman on a moving boat

[azlan]

I attended an emergency first aid at work course on Saturday, and our instructor said that the 'hands only CPR' is meant to try and encourage people with no training to attempt CPR as it is still better than nothing at all in an emergency, but that CPR & breaths at a ratio of 30:2 should still be used if possible, and ideally using a face-shield

[cfmonk]

I attended an emergency first aid at work course on Saturday, and our instructor said that the 'hands only CPR' is meant to try and encourage people with no training to attempt CPR as it is still better than nothing at all in an emergency, but that CPR & breaths at a ratio of 30:2 should still be used if possible, and ideally using a face-shield

 

This is entirely correct. I always tell the people I train that if they remember nothing else then remember:

 

Blow in the top, bounce on the middle.

 

That could save somebody's life!

[kalmatthew]

if any one is really intrested in the research and all its background the Resuscitation Council (UK) is the place to look, they are the medical body that SJA, the Red Cross etc all take their lead from. They work with other resuscitation councils round the world to do the research that is used to write the guidelines.