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#55101 - 12/01/05 11:49 PM New CPR guidelines issued
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
This news is a couple days old, but the International Liaison Committee on Resuscitation's new CPR guidelines are out. Various groups like the American Heart Association should start teaching the new guidelines in the near future. Probably in the spring.

The new guidelines are simpler, to aid in memory retention and to improve real world success. No more ABC check, and chest compressions to ventilation ratio is now 30:2, from infants through adults. If someone is unconcious, not moving, and not breathing (ignoring occasional agonal gasps), then start CPR. Actually, these changes have been in the works for quite a while, but now they're official.

Some experts argue that the guidelines should be simplified even more to just compression-only CPR, and there is evidence to support that technique, but I think that's too radical a change for the scientific/medical community to make all at once, since there is also evidence that shows that ventilation is also important.

Anyway, for those you who haven't gotten a CPR refresher in a long time (me included) you should consider doing it sometime early next year when the new guidelines are being taught.

If you'd like to check out the new CPR guidelines in all its scientific, medical journal glory, you can view it for free here , along with a ton of other new ILOR recommendations on issues like advanced life support, stroke treatment, etc. based on the best evidence available today.

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#55102 - 12/02/05 12:40 AM Re: New CPR guidelines issued
Susan Offline
Geezer

Registered: 01/21/04
Posts: 5163
Loc: W. WA
Thanks, Arney, for pointing this out. I had not seen it.

WARNING: SARCASM AHEAD!

There seem to be many people (I work with some) who know CPR, but say they would hesitate to use it on a stranger. And the term "stranger" is defined by someone who doesn't have a dated-today HIV/AIDS blood test result pinned to his/her chest.

And this comes from people who would French-kiss everone of the opposite sex in a large, crowded nightclub if they were given the opportunity.

One guy who said this has recently fathered two children in casual relationships, so he is obviously not using any form of protection for anything. But he wouldn't give a dry-mouth kiss-of-life to any other stranger unless she was young, pretty, blond and had big boobs.

So, if you hesitate to give CPR to someone, stop and think who you're willing to kiss NOW. <img src="/images/graemlins/smirk.gif" alt="" />

Okay, finished.

Sue

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#55103 - 12/02/05 01:43 AM Re: New CPR guidelines issued
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Actually, the whole mouth-to-mouth issue is one of the big advantages that proponents of compression-only CPR put forth. We can't force people to be Good Samaritans, but if we can make it easier or more palatable by, say, making CPR simpler or teaching that just doing chest compressions is OK, then that's a worthwhile change to consider. Again, I say this in the context that there is evidence that compression-only CPR does have evidence backing it up but it's not conclusive yet.

Actually, there are places in the country that teach compression-only CPR. I have read that the University of Arizona and some places in Wisconsin teach it to the public. I have read that an important article on compression-only CPR will be published early next year.

I would say that if you have any hesitation about doing mouth-to-mouth on someone (and assuming the unconcious, not moving, not breathing conditions), then you'll still be doing the person a service by doing compression-only CPR. But I'm not a doctor (nor a lawyer!) and this is just my personal opinion.

Experts say most real world CPR is done incorrectly anyway, so simply pressing hard on that sternum steadily at 100 reptitions per minute until EMS arrives will do this person a world of good compared to wasting 20 seconds making "Do I have to?" faces before giving each puff of breath while doing regular CPR. Or worse, doing nothing at all, while the person dies. <img src="/images/graemlins/frown.gif" alt="" />

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#55104 - 12/02/05 05:19 AM Re: New CPR guidelines issued
Craig_phx Offline
Old Hand

Registered: 04/05/05
Posts: 715
Loc: Phoenix, AZ
You also have to keep in mind that someone who requires CPR may have just vomited. I don't want to put my mouth on that, do you?
_________________________
Thermo-regulate, hydrate and communicate.

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#55105 - 12/02/05 05:52 AM Re: New CPR guidelines issued
Polak187 Offline
Veteran

Registered: 05/23/02
Posts: 1403
Loc: Brooklyn, New York
Well that's what I was about to point out... By inncorect head positioning you pump stomach full of air and than eventually all the stuff comes up... About 90% of my cardiac arrests are messy. My latest one which was a save happened to be a gentelman with stomach ultcer bleeding for days. When fireman pressed on his chest there was a fountain of half digested blood that went about 2-3 feet in the air. I dont know how hard core you are but I wouldnt recommend putting your mouth on that.

HIV doesnt worry me as much as Hep B. Well I had a shot for it but that's not somethign that typical bystander will have.

I'm all for making cpr simple for a layman. But medical professional should be thought differently.
_________________________
Matt
http://brunerdog.tripod.com/survival/index.html

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#55106 - 12/02/05 05:22 PM Re: New CPR guidelines issued
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Ugh, I was just about to have breakfast...and I just read your "...fountain of half digested blood that went about 2-3 feet in the air..." comment. <gulp> I think I'll pass on breakfast for a while. <img src="/images/graemlins/tongue.gif" alt="" />

But, having never been around anyone ever needing CPR, it's good to hear some feedback from people with experience about what we lay people may face. For a few years now, since first reading scientific evidence that shows the effectiveness of compression-only CPR, I decided that I would stick with compression-only CPR. That's around when I moved back to San Francisco for a few years and got a job downtown, where you see tons of homeless, drug addicts, and mentally ill people all the time. (Interestingly, I had just moved from Manhattan, where you see only see a fraction of what you see in SF) Most people wouldn't touch them with a ten-foot pole, and maybe when crunch time came, I wouldn't either, but hey, they're human beings, too, and I tried to mentally prepare myself to not waste time deciding and just get to doing compression-only CPR and hope EMS gets there quickly. That kind of situation is a tough call and one we can only make for ourselves.

Anyway, figured I should mentally rehearse one way for everybody instead of facing the prospect of doing nothing at all because I didn't want to do mouth-to-mouth. It shouldn't make a difference if the lady on the ground is young, pretty, blond, and has big boobs...it shouldn't...it--boy, she's a looker, aint' she?... <clunk!> Another one upside the head for Arney, perhaps from Susan. <img src="/images/graemlins/wink.gif" alt="" /> <img src="/images/graemlins/grin.gif" alt="" />

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#55107 - 12/02/05 05:25 PM Re: New CPR guidelines issued
bmisf Offline
Member

Registered: 03/19/03
Posts: 185
Carry a pocket CPR shield. There are even keychain-sized ones now.

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#55108 - 12/02/05 06:12 PM Re: New CPR guidelines issued
fugitive Offline
Member

Registered: 08/26/05
Posts: 183
Loc: The Great Pacific Northwest
QUOTE: "all the stuff comes up... About 90% of my cardiac arrests are messy."

This is the dirty little secret about CPR. I have had an interest in first-aid since being a Boy Scout. I was fortunate enough to have some "reality" discussions with a few Paramedics many years ago. Back in those days the pocket shields didn't exist to my knowledge. They said plan on getting a mouth full of vomit. They said this was especially common when the person goes “brain dead”. Later I have heard this was due to air in the stomach.

I have taken numerous CPR courses over the years and not a single time has this problem been mentioned. My wife also has taken many CPR courses with the same failure to prepare a student for a real CPR situation.

My guess is they don't want to discourage trained bystanders from helping with CPR situations. If I hadn't been warned about this vomiting issue I may have freaked out or panicked if it had surprised me during a resuscitation. I’ll take honesty over deception anytime. I feel leaving out critical information like this is doing a great disservice to the CPR student.

I appreciate Polak187’s frank discussion about this topic.

This brings up additional questions needing an experienced “hands-on” user to reply:

I am sure the pocket shields are better than nothing, but how effective are they “really” at preventing contamination of the CPR responder?

Are there any brands or models that should be avoided?

Are there any brands or models that are recommended?

Is it also common for CPR patients that have gone “brain dead” to relieve other bodily functions? (I thought I had better keep it clean for any other breakfast eaters).

Sometimes I feel that Polak187 is a bit jaded, but I respect his no holds barred candor on sensitive subjects like this.

Thank you, TR

(Going compression only for the near future).

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#55109 - 12/02/05 06:26 PM Re: New CPR guidelines issued
bmisf Offline
Member

Registered: 03/19/03
Posts: 185
I have one from MDI that has a one-way valve and an inflatable cushion to allow for a better fit against a face (and to adjust for altitude). It comes in a pouch that also holds gloves and a biohazard pouch. I got it from WMI when I did my WFR training for $15 or so.

The pocket/keychain ones are generally pretty minimal and often don't have the valve, but are better than nothing; I keep one in my pack/small first aid kit at all times.

(PS - whichever you use, it's still going to be messy.)

- Steve

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#55110 - 12/02/05 06:31 PM Re: New CPR guidelines issued
Anonymous
Unregistered


It makes sense to add to your kit some latex gloves(not just for first aid but I use them for my bike and other dirty jobs) and a faceshield of some discription. The best type look like oxygen masks but the plastic sheet ones work as well. I have heard some stuff that says they actually improve your CPR.

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