View Full Version : New update in CPR procedure, just do the hands part
hopefulhiker
03-31-2008, 20:11
Anyone heard about this?
http://www.breitbart.com/article.php?id=2008-03-31_D8VONA8O0&show_article=1&cat=breaking
Appalachian Tater
03-31-2008, 20:13
If you are doing adequate chest compressions, you're squeezing air in and out of the lungs, anyway.
I read that today. 100 chest compressions/minute?
If you keel over, I'll try to give you 40.
Bear in mind, that is just for lay rescuers. It doesn't change anything for healthcare professionals, who are trained for a compression to breath ratio of 30:2. It's a good recommendation, if you ask me if EMS arrives quickly, otherwise you're just circulating unoxygenated blood.
Frolicking Dinosaurs
03-31-2008, 20:20
100 compressions per minute!!! I hope others are around to help as it would be hard to keep up that rate alone for very long.
Mouth to mouth is still recommended for incidents related to drowning, drug-overdose or carbon monoxide poisoning and also for all CPR with children and infants.
100 compressions per minute!!! I hope others are around to help as it would be hard to keep up that rate alone for very long.
Mouth to mouth is still recommended for incidents related to drowning, drug-overdose or carbon monoxide poisoning and also for all CPR with children and infants.Speaking as someone who performs CPR on a regular basis, that rate is very difficult to keep up for more than a few minutes at a time. When we run codes at work, we rotate the nurse doing chest compressions pretty frequently, no more than 5 minutes at a time or so.
I think this makes about four changes since my first intro to CPR.
Why I have 15/4 still burned into my brain, I don't know.
Toolshed
03-31-2008, 20:30
Speaking as someone who performs CPR on a regular basis, that rate is very difficult to keep up for more than a few minutes at a time. When we run codes at work, we rotate the nurse doing chest compressions pretty frequently, no more than 5 minutes at a time or so.
I used to be on an ambulance squad and I had to give CPR for about 11 minutes once when I was younger and stronger. I thought I was gong to die. Soaked with sweat, shaking from exhaustion. Took me at least 3-4 hours to recover.
I think this makes about four changes since my first intro to CPR.
Why I have 15/4 still burned into my brain, I don't know.I'm with ya. Since I first learned CRP in the Marines in 1987, there have been so many changes that it can be hard to keep straight. But in all honesty, I'm glad that there is research that continues to make CPR not only easier, but more effective. After all, increasing CPR's efficacy and saving more lives is what it's all about.
I used to be on an ambulance squad and I had to give CPR for about 11 minutes once when I was younger and stronger. I thought I was gong to die. Soaked with sweat, shaking from exhaustion. Took me at least 3-4 hours to recover.I have plenty of paramedic friends who have to do CPR "cowboy style" too. I feel fortunate to be be in an environment where there is plenty of help.
If you are doing adequate chest compressions, you're squeezing air in and out of the lungs, anyway.And you base this on what clinical evaluation and research? Even if you're doing chest compressions at the recommended depth and rate, you're still doing nothing to give the patient oxygen. No matter how hard you push the chest, you have to provide positive pressure to the lungs for them to inflate. This is done by way of the mouth-to-mouth or bag-valve mask, and preferably an external oxygen source which provides 100% oxygen, since exhaled breath is only about 16% oxygen.
Jim Adams
03-31-2008, 20:44
Talk about changes.....when i started they had us doing mouth to mouth but instead of compressions, you did back pressure arm lifts!
CPR changes about every 2 1/2 years...sometimes for the better, sometimes for the worse.
The new system of no ventilations has been proven effective because of the air exchange in the lungs from the compressions. Research has shown (supposedly) that the O2 sats are higher w/o ventilations because the compressions are not interupted and the constant air exchange is taking place with the compressions. I find that hard to believe but the stats on it are from research.
geek
Appalachian Tater
03-31-2008, 20:46
And you base this on what clinical evaluation and research? Even if you're doing chest compressions at the recommended depth and rate, you're still doing nothing to give the patient oxygen. No matter how hard you push the chest, you have to provide positive pressure to the lungs for them to inflate. This is done by way of the mouth-to-mouth or bag-valve mask, and preferably an external oxygen source which provides 100% oxygen, since exhaled breath is only about 16% oxygen.
No, no research, just experience, from experimenting on each other in school, even though we were told not to. Not only does it push air in and out of your lungs, it hurts even if you don't crack ribs. Get one of your co-workers to give you a few chest compressions and see for yourself.
Frolicking Dinosaurs
03-31-2008, 20:49
I've only had to do adult CPR three time, but have done infant CPR about a dozen times and child CPR more times than I can remember. I agree with Hooch - the compressions do not inflate the lungs. I believe I would use the good ol' 20 / 2 variety. That's the one I learned first and the one I've used since and it has work well for those that could be saved. I just do it faster for children and infants.
No, no research, just experience, from experimenting on each other in school, even though we were told not to. Not only does it push air in and out of your lungs, it hurts even if you don't crack ribs.Not enough air, and hence gasses, are exchanged to provide even a minute change in blood oxygenation. Air pushes in and out of people with spontaneous ventilation because of atmospheric pressure and the action of the diphragm relaxing and contracting. The same is not so for a person who is in respiratory and/or cardiac arrest. By simply doing chest compressions, particularly at the rate at which they are now done, you won't provide oxygenation to the patient at all.
Jim Adams
03-31-2008, 20:56
No, no research, just experience, from experimenting on each other in school, even though we were told not to. Not only does it push air in and out of your lungs, it hurts even if you don't crack ribs. Get one of your co-workers to give you a few chest compressions and see for yourself.
Yeah, supposedly the tidal volume isn't very high but the positive pressure from the compressions is enough to force the molecular exchange through the cell wall and the rate compensates for the lower tidal volume. O2 is administered via non-rebreather mask at high flow. I have seen save rates ( in the stats from University of Pittsburgh Hospital, Childrens Hospital of Pittsburgh and Allegheny General Trauma Center) increase by 20% due to this new procedure.:-?
geek
Appalachian Tater
03-31-2008, 21:02
Not enough air, and hence gasses, are exchanged to provide even a minute change in blood oxygenation. Air pushes in and out of people with spontaneous ventilation because of atmospheric pressure and the action of the diphragm relaxing and contracting. The same is not so for a person who is in respiratory and/or cardiac arrest. By simply doing chest compressions, particularly at the rate at which they are now done, you won't provide oxygenation to the patient at all.Then the new protocols for street CPR will prove ineffective and will be revised again. Supposedly the new method is as effective as the old. That may say more about the ineffectiveness of the old protocols than the effectiveness of the new.
Oh, yeah, and chest compressions aren't very effective even for circulation if you don't deflate the mattress!
Then the new protocols for street CPR will prove ineffective and will be revised again. Supposedly the new method is as effective as the old. That may say more about the ineffectiveness of the old protocols than the effectiveness of the new.Like I said, that's fine for lay rescuers. But when it comes to use for healthcare professionals, we're still working at a 30:2 ratio. Trust me, doing CPR on a dying patient is a lot different than doing a few compressions on your buddy because you wre told not to.
Lost My Mind
03-31-2008, 21:19
Another reason for the change is that most lay people do not properly open the airway to give adequate ventilations. If EMS is accessed immediately, the patient has a better change of recovery if the oxygen already in the system is circulated thru compressions.
A lot or research goes into AHA to determine what will produce the best response. It's all based on research and fact. In medicine, things change everyday. We continue to learn new procedures. Thank goodness!
Yea, 100 per minute can be tiring. Heck: 60 per minute is tiring if you do it long enough :rolleyes:
From what I understand the reason for the change: the idea is it takes quite a few compressions just to get the blood flowing again after stopping to give the breaths. So, to keep the blood flowing better, you keep the compressions going. I don't know if it works any better, havn't had the chance to try it yet. But I'm sure to get the chance soon enough :(
As a provider, It's often 2 people doing CPR, but more times than not I'm "flying solo" so,,,,,
No Idea how many times I''ve done it for real, stopped counting at over 100, 20 years ago.
Yea, 100 per minute can be tiring. Heck: 60 per minute is tiring if you do it long enough :rolleyes:
From what I understand the reason for the change: the idea is it takes quite a few compressions just to get the blood flowing again after stopping to give the breaths. So, to keep the blood flowing better, you keep the compressions going. I don't know if it works any better, havn't had the chance to try it yet. But I'm sure to get the chance soon enough :(
As a provider, It's often 2 people doing CPR, but more times than not I'm "flying solo" so,,,,,
No Idea how many times I''ve done it for real, stopped counting at over 100, 20 years ago.I never started counting. :rolleyes: I've done CPR more times than I could even consider counting. I'm sure most healthcare providers have done CPR more times in a year than any 20 people will in a lifetime.
Appalachian Tater
03-31-2008, 21:51
I never started counting. :rolleyes: I've done CPR more times than I could even consider counting. I'm sure most healthcare providers have done CPR more times in a year than any 20 people will in a lifetime.It depends on where you work. My first year out of nursing school, I called physicians to come up urgently several times, bagged a patient all the way to the unit once, but never had to actually call a code.
After that, I always had residents and staff nurses, respiratory therapists, etc. to actually perform the CPR. I mostly would pass meds and help keep count, kick bystanders out of the room, page particular personnel, get extra drugs or equipment, calm roomates and family members, etc.
Unfortunately, in my experience, most "real" codes aren't successful, but it sometimes takes some convincing to end them.
It depends on where you work. My first year out of nursing school, I called physicians to come up urgently several times, bagged a patient all the way to the unit once, but never had to actually call a code.
After that, I always had residents and staff nurses, respiratory therapists, etc. to actually perform the CPR. I mostly would pass meds and help keep count, kick bystanders out of the room, page particular personnel, get extra drugs or equipment, calm roomates and family members, etc.
Unfortunately, in my experience, most "real" codes aren't successful, but it sometimes takes some convincing to end them.As an RN and respiratory therapist working in a level 1 trauma ICU, I can most certainly agree with you on that one Tater. The odds of a true code being successful are pretty low, even in-hospital. We have all kinds of resources immediately with us, but the bottom line is that when a patient's number is up, it's up, no matter what. IMO, the idea is to keep the code from happening in the first place. Not always possible in a pre-hospital setting, but when you have the advantage of a monitored patient in a hospital environment, it helps.
Frolicking Dinosaurs
03-31-2008, 22:02
I imagine CPR in a hospital setting is rarely successful. Doing it in the field tends to have better results as you aren't starting with a medically stabilzed patient
I imagine CPR in a hospital setting is rarely successful. Doing it in the field tends to have better results.
CPR done in-hospital actually has a higher success rate than CPR done in the pre-hospital setting does. You don't have to wait for advanced care to arrive and transport time is eliminated, among other factors. When a patient is in cardiac arrest or any other pulseless cardiac rhythm, such at V-Fib, narrow complex V-tach, Toursades, etc, CPR does nothing to correct that problem. It is early defibrillation that does. That's why there is so much talk about the AED and people being trained to use it.
HikerRanky
03-31-2008, 22:15
I've heard about that study.... As a CPR and AED Instructor, we hear about such as this quite often.... The thinking is that one of the reasons people don't want to do the respiration part is fear of contracting some disease because the lay person doesn't have a barrier handy..... It is NOT meant to replace the 30:2 at a rate of 100 compressions/minute.
Once the heart has stopped, the ONLY thing that will start it again is the use of fibrillation by using an AED.
Jim Adams
03-31-2008, 22:27
I've heard about that study.... As a CPR and AED Instructor, we hear about such as this quite often.... The thinking is that one of the reasons people don't want to do the respiration part is fear of contracting some disease because the lay person doesn't have a barrier handy..... It is NOT meant to replace the 30:2 at a rate of 100 compressions/minute.
Once the heart has stopped, the ONLY thing that will start it again is the use of fibrillation by using an AED.
I'm back.....we are using the new system in EMS in Pa. all hospitals in Pittsburgh are definitely following the AHA's new standards.
A defibrilator will not start a stopped heart...it attempts to shock a heart in fibrilation into a sinus rhythm by stopping all of the ectopic foci from firing.
Hooch...the MVA was a wash!;)
geek
tx.katie.finch
03-31-2008, 23:30
We do it pretty frequently at work (ambulance) and we squeeze in breathes between compressions without a set ratio.
Something else.... I've NEVER done adult CPR WITHOUT breaking ribs. At least 2 per patient... usually closer to 5-8.
We also do rodeo style... one hand holding onto the oh **** handle above us and one 'pumping chest.'
Generally during the new refresher courses we smile and nod until we get our cards and continue on how we've always done it. If it ain't broke..
tx.katie.finch
03-31-2008, 23:33
Random comment... I have to disagree with the comment that ONLY defibrillation restarts a heart. I've had 2 come back with CPR alone. Granted, CPR was performed for less than 3 minutes and we witnessed the code in the back of the truck, but they still came back without defib. 1 was asystole and 1 was PEA.
take-a-knee
03-31-2008, 23:37
As an RN and respiratory therapist working in a level 1 trauma ICU, I can most certainly agree with you on that one Tater. The odds of a true code being successful are pretty low, even in-hospital. We have all kinds of resources immediately with us, but the bottom line is that when a patient's number is up, it's up, no matter what. IMO, the idea is to keep the code from happening in the first place. Not always possible in a pre-hospital setting, but when you have the advantage of a monitored patient in a hospital environment, it helps.
Head trauma and electrocutions often produce a prolonged enough period of apnea (no breathing) to do serious neurological harm, with little actual physical damage, CPR is often very successful in these cases.
take-a-knee
03-31-2008, 23:39
I'm back.....we are using the new system in EMS in Pa. all hospitals in Pittsburgh are definitely following the AHA's new standards.
A defibrilator will not start a stopped heart...it attempts to shock a heart in fibrilation into a sinus rhythm by stopping all of the ectopic foci from firing.
Hooch...the MVA was a wash!;)
geek
That's why you call it fine V-fib before you shock'em.
I'm afraid, if it's left up to me, you're all going to die. :( Don't worry though, your gear will be put to good use. :p
I'm afraid, if it's left up to me, you're all going to die. :( Don't worry though, your gear will be put to good use. :pYou know, as much as I hate to say it, that's kind of reassuring. :rolleyes:
Jim Adams
04-01-2008, 08:39
That's why you call it fine V-fib before you shock'em.
...or coarse v-fib, v-tach, SVT, etc., etc.
a precordial thump attempts and at times succeeds in doing the same thing.
geek
BTW, everytime I try doing 1 handed CPR, the lettuce from my hoagie in the free hand keeps falling onto the pt's chest...makes it too slippery!:D
...or coarse v-fib, v-tach, SVT, etc., etc.
a precordial thump attempts and at times succeeds in doing the same thing.
geek
BTW, everytime I try doing 1 handed CPR, the lettuce from my hoagie in the free hand keeps falling onto the pt's chest...makes it too slippery!:DSwitch to Romaine, it's not as bad. :eek::p
superman
04-01-2008, 09:34
I'm afraid, if it's left up to me, you're all going to die. :( Don't worry though, your gear will be put to good use. :p
When I was a scout back in the 50s the new way is the same old thing they taught us way back then. There was nothing wrong with the old way except for an occasional broken rib or two. People stopped giving mouth to mouth to strangers because of all the potential diseases people are knowingly or un-knowingly walking around with today.