Friday, July 30, 2010

The Newer CPR: no more lip locks?

Two years ago, the American Heart Association gave the OK for people to stop using "rescue breathing" as a part of Cardio Pulmonary Resuscitation (CPR). This came from a relatively recently study, relative to the 50 years that CPR has been taught, that showed that increasing the chest compressions did more good than the breathing. The compressions, after all, does allow for some breathing to happen automatically due to the mechanical operation of the chest cavity.

What they found was more important, was that the blood get to the brain immediately and for along and as much as possible prior to paramedics getting on the scene. This lead to the current situation which seems to be paying off pretty well. According to the article, 1 in 3 people get prompt CPR attention.

Another issue, not usually preferred to even discuss, is the mouth on mouth method of giving the "breath of life". Many people are quite reticent to do this to a stranger, or even a loved one in many cases depending on the situation.

I've spoken to paramedics myself over the years about this issue and I've gotten a variety of responses. A few have said, they would never put their mouth on patient unless it was absolutely necessary, that they have a device to allow for that, they put it in the patient's mouth, then they breath into them through that.

That may sound against the unspoken rules of being a paramedic, or even of being a "good Samaritan", but consider this: several paramedics had told me they had patients actually vomit into their own mouth while they were attempting to give CPR. One said, it only takes that to happen once, with a stranger, or anyone, to make you shy to give mouth to mouth again.

I asked a fireman/paramedic friend once, about this. Understand, this was a guy who was once a "special operator" in the military going behind enemy lines. He and a partner would parachute in, using Low Opening techniques, literally popping their chute just above the tops of trees, then taking out indicated enemy targets, literally by hand, or more typically, by knife. This was a guy, scared of nothing, a devoted paramedic now; he had said that he sees so many accident victims, so many patients over time, that he (all paramedics) really needs to be careful about doing things like direct mouth to mouth contact. He said he'd do it in a heartbeat if he had to, but not if he had his device available, and he always had it available. He said that device also gives him a moments warning if the patient does start to expel more than air.

I was originally taught to give three breaths into the person, then fifteen chest compressions, then cycle around again until help arrives. Now they are saying that it is more important to give 30 chest compressions before mouth to mouth, or reycle and give 30 more compressions. This, being more important in situation where heart ailments may be at issue, unlike children or non-cardiac type breath cessation has occurred.

From the NPR article:
"Dr. Thomas Rea, medical director of Seattle-King County's Emergency Medical Services, who led one of the studies, says their real importance is the endorsement the studies give to the new-style CPR. "We saw that bystanders were more likely to get CPR started when the instructions were just chest compressions as opposed to chest compressions plus rescue breathing," Rea reports. Many people are uncomfortable with mouth-to-mouth resuscitation, so they don't attempt CPR at all. And when they do, they interrupt chest compressions too long to do rescue breathing. Scientists now think that chest compressions are more crucial, because immediately after the heart stops, the blood contains residual oxygen for a few minutes. Circulating this blood — until the EMTs arrive and can begin more effective oxygen supplementation — is probably more important."

See the full NPR article:
During CPR, Locking Lips May Not Be Necessary - NPR

Hey, everybody! Have a great weekend!

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