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I think the next big thing in CPR with be abdominal comressions. A second rescuer with perform upward compressions over the belly button opposite the person doing chest compressions. It would be a see-saw type pattern to flush blood out of the abdomen into the chest and also to "pump" the aorta and vena cava just like the heart.
Heres a pre hospital example of the hypothermic therapy.
http://pressherald.mainetoday.com/st...39021&ac=PHnws
While we are on this topic, can someone please make it illegal for "rescuers" on TV and in movies to find someone unconscious, breathless and pulseless, give them a rescue breath or two and a handful of fake compressions and have them wake right up and thank them for saving their life? That shit pisses me off to no end.
what's interesting about the 2005 guidelines is that they recommend stopping ventilations for bvm but not tube airways.Quote:
Originally Posted by mtnmedic
http://circ.ahajournals.org/cgi/cont...24_suppl/IV-19
I can't say I'm around alot of bagged arrests, but I've never seen that in practice.
incidentally that same paper also says "This 30:2 ratio is based on a consensus of experts rather than clear evidence."
the only evidence are two pig experiments and a mathematical model.
also interesting is they mention cric pressure. I think that's new
I've been told that once they're tubed, the risk of gastic inflation is lower, so you don't need to stop compressions. Obviously you can still bag them too hard with a tube in place and cause bad things to happen.
Cric pressure helps keep the esophagus closed during ventilations, in addition to helping visualize the airway during intubation. I've read studies on this, but have noticed it myself in the field.
huh interesting. what's the mechanism?Quote:
Originally Posted by grrrr
pretty sure the starling curve argues otherwise. increased intrathoracic pressure decreases venous return and cardiac output
and a little light reading for emtnate
http://content.nejm.org/cgi/reprint/346/8/549.pdf
http://content.nejm.org/cgi/reprint/346/8/557.pdf
http://circ.ahajournals.org/cgi/reprint/108/1/118
I'm not aware any Denver systems start it in the field
That is interesting, you may be right. I do seem to recall reading some studies that the new protocols were based on though. I will have to do some digging at work and see if I can't find them.Quote:
Originally Posted by spicy cha cha
The reason we use constant compressions at work is my patients are intubated and I can do any other procedures around the compressions. Its just easier to say "go and don't stop", and the benefit of constant compressions is obvious.
One area of concern with CPR and avy victims is where the victim has severe hypothermia. After speaking to some of the patrollers involved in the Snowbird incident earlier this year I started to wonder whether CPR is always helpful. I found a couple of papers (which are at home, so I can't cite them here) which suggest that you should wait at least a minute to check for a pulse before starting CPR on a hypothermic victim, because they could have a pulse as slow as 2-3 beats per minute, and CPR could send them into defibrulation (sp.?). If there is a pulse, even one as weak and slow as this, no CPR is indicated.
I am not sure how this works in the field, where conditions may not be condusive to finding a pulse as slow as 2-3 beats a minute. Fortunately, I have not been in that position.
On the topic of getting CPR training, the standard first aid/cpr course should be taken by everyone. For me WFR was a real eye-opener. My wife and I took it after both of our kids did it. My motivation was off-shore sailboat racing, but it has given me confidence in shoreside settings, as well.
I did my paramedic clinicals in Phoenix. When I was there in Jan/Feb 06 they were doing 200 compressions check for pulse and then another 200 compressions. No breathing was done and all they did was put in an OPA. The other medics there told me they were getting a lot better results with this than they did before.Quote:
Originally Posted by mtnmedic
All skiers and outdoors folks should take as much first aid as they can...knowledge you can use! Props to all the voly ems and patrolers and the paid pros too! Saving your bacon in times of need!
Thanks for the links to those articles. I actually got to ski today, so I'll read them when I'm less tired.
So they are doing compressions minus ventilations in Phoenix. My medical director told me this will be the standard within the next few years. Just using an OPA does not surprises me either. The last ACLS class I took was in October, and they are teaching to use a BVM with OPA / NPA as long as you are getting good ventilations. Then drop an King LT or Combitube. They want an ETT to be a last resort to secure the airway.