Another Notch In The Belt

[Mike Wilson]

Any Heathers out there in need of lifesaving care?:



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One more for the portfolio!

 

[EddieS'04]

 

[CountyMounty]

I just did that same training about 2 months ago. Upgraded from the basic CPR and First Aid. Almost got an AED save a couple weeks back but the lifeguard at the pool got to the guy with hers just as I was coming in. It was a save too and the guy actually started to come around right then which is rare.



Have you been following the push to change the CPR procedures yet again, everytime I recertify it changes. 15 and 2, 30 and 2, etc. etc. cant keep it straight. Now they are saying maybe no breaths at all just compressions, that might be good for the city where an ambulance gets there in 5 minutes but here it takes a lot longer and a person just cant possibly survive that long with no breaths there is not enough residual oxygen in the system. Do you have your own AED to carry with you, they are such a great little machine everyone should have one.

 

[Mike Dziubina]

nice job TracnBlack congrats...i have the same cert...



EMT/CPR/AED...and now as of this week Firefighter...so now im a true FF/EMT



Firedog...congrats on your save...i have never got to use the A.E.D. yet...(guess its a good thing)...however this past weekend was busy...saved 2 20 year olds that O.D'd on heroine... both came back...one on sat night, the other on sunday...the Trac first responded to both! (she did nice on the road...people moved right out of the way with the lights on!) Narcan is a miracle drug!



I have also heard they might move to just chest compressions...when i first certed it was also 15-2, now i hear its 30-2...i have not heard of no rescue breaths though...i agree with you on the response time and survival with no breaths. even though rescue breaths only supply the patient with 30% oxygen, it is better than nothing



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[Mike Wilson]

Here's the gist I got:

Atmosphere is basically 21% oxygen, 79% nitrogen and other trace gasses.

The human cardiopulmonary system can only uptake or infuse 5 to 6% of

the oxygen in any given breath, so exhaled breath still contains 15 to 16%

of the unused oxygen and carbon dioxide and water vapor. Pump perfusion,

which is what we are trying to achieve with chest compressions, is more im-

portant than breaths in the overall survival rate in the <6 minute time frame.

The first 6 to 8 chest compressions are 'priming the pump" (heart) with minimal

blood circulation. This is the main reason for the change from 15 to 30 com-

pressions, to minimize pump downtime, or hands off time, and keep the circulation

at the optimum rate.

As far as the no breaths go, our instructor said that that was a situational call.

If for some reason a person was not comfortable giving mouth-to-mouth, they

could perform chest compressions only till help arrived. This is mainly for the

lay person, as I could not imagine a well prepared and professional EMT/Responder

not being prepared with at least the basic BSI protective equipment and lifesaving

gear, even off duty!

My jump kits accompany me everywhere, and in the rare instance the wife and

I take her Mariner when we go somewhere, the jump kits go with!

 

[Rodger Tellefson]

 

[Mike Wilson]

Well,



'Night, all. Classes again in the A.M.!

 

[CountyMounty]

I agree with the reason for the change from the 15-2 to the 30-2 because as studies showed people were dying because there were not enough compression to keep the blood circulating well, there was too much down time, and repriming of the pump. The "no breaths" approach was all over the news for a couple days here a month or so ago. It was based on studies overseas somewhere I do not recall, but basically the reasoning behind it was that chest compression were more important and that it is very easy for the lay person to just do compression not to mention they are more willing to do so. The news I saw indicated some doctors in the US were pushing to have the procedures of basic CPR changed to only compressions. While I agree that just compressions is better than nothing and the compression are more important at first I cant see eliminating breaths all together, and obviously that would not be the case for EMT's/first responders.



Mike I did not have a save myself but it was a save so that is what matters, we have a couple officers here who have had saves since we got the AED's last year.



The problem is they keep changing things and it is confusing to remember, right now its 30-2 but if its 2 person CPR it is still 15-2. Most people unless very recently certified still know it as 15-2. Also I am a certified EMD as well and the CPR instructions there are different from the BLS teachings. They involve taking it a step further and trying to determine the cause of the arrest and therefore deciding whether to start with compressions of ventilations first. So much to remember, for someone who is primarily law enforcement and not medical.

 

[Mike Dziubina]

good information from all! this is good!



Firedog...i know what you mean, but i look at it as a team effort...and you were part of that team! its the effort that counts!

 

[Mike Wilson]

That is where good practice and professionalism come into play. Common sense

and good judgement are as critical a part of Emergency Medecine as the equipment

itsself, on many occasions. If you know an older person was jogging when the

event occured. it may be safe to assume a cardiac event. If same person was in a

restaurant setting, may be safe to assume foriegn body airway obstruction. End

resuld for both could be CPR, but your initial diagnosis and findings could alter your

treatment methods for the two situations. Most arrest situations start with the two

rescue breaths, but if you have a FBAO, you need to check for and try to clear the

obstruction first.

Well, gotta go to class. See you all later this P.M.!

 

[CountyMounty]

Tracnblack just thought I would list out what the EMD instructions say just to try to clear up what I mean and because I thought you might appreciate it since is does differ then what we are all taught in CPR which it always breaths first. Atleast I believe that everyoen from the school teacher to the paramedic is taught to always start CPR ventilations first so I find it strange that an EMD is to instruct a layperson based slightly differently. It adds another step which takes time and I have seen one of our EMD's basically lock up at this step for a few seconds trying to figure out what to instruct, the person was found unresponsive and the caller did not know what the problem was but thought they might have overdosed but really had no specific reason to think this other they had no other explanation and the person was young. Anyway it was that EMD'd first CPR call and after the fact they knew that next time they would be prepared and just go to compressions rather than waste time thinking about it. FYI choking is handled under a whole other protocol.



Ventilations 1st CPR done if any of the following conditions apply:

-any patient under 18yo, -allergic reaction, -drowning, -hanging, -lightning strike,

-overdose/poisoning, -severe trauma, -suffocation, -toxic inhalation, -chocking & unconscious



Compression 1st CPR for any other problem



See what I mean, it takes it to a different level from the field CPR.

 

[CountyMounty]

I forgot to add that if they are doing compressions first CPR then after the frist 30 pumps then 2 breaths we instruct the caller to do 100pumps then 2 breaths over and over. If this is the best way to do it then why are medical responders not instructed to do it this way. Or am I wrong, are you (they) instructed to do it this way, I am only trained at a first responder level are EMT's, EMT-I, EMT-P trained to do it this way?