UKC

I am not a medic, but have done first aider training (I need to do a refresher course as it was some time ago)

According to this article in the NY times, http://tinyurl.com/yplhf9
chest compressions are more important than mouth to mouth. So instead of 15 compressions to 2 breaths it is now recommended 30 to 2.

I was taught 15 to 2 and I imagine that others would have been as well.

There is a good discussion with input from some medical and non medical people here:
http://science.slashdot.org/science/07/03/17/2114237.shtml

Would any of the ukc medical types like to add anything that may be of use in this situation?

In reply to dread-i:
Vaguely remember somebody telling em at the weekend about something in The Lancet. About how stopping the chest compressions briefly to perform rescue breaths is detrimental/useless compared to just continuing compressions @ 100/min.

The British Resus. Council published new guidleines for CPR a little while ago, indicating 30 compressions, 2 breaths, 30 compressions. So now instead of singing 'Nelly the Elephant' once i have to sing it twice. Terrible.

In reply to shingsowa:
P.S. i am not a medical type. I may have made the above up, i can't remember.

In reply to dread-i:

Not up to date, but I think people get far too anal about how many compressions to breaths. Chances are that if someone needed CPR in a room full of first aiders they'd be stuffed, as the first aiders would all start arguing about who knew the right number to do, and that my mountain first-aid beats your first-aid at work certificate...
As I understand it, when you do compressions you also force air into and out of the lungs at the same time as you maintain circulation, therefore the more chest compressions the merrier.

In reply to dread-i: I did a first aid course two weeks ago and it has been reset 30:2. this is because there is no use getting the oxygen in there if its not going to get around the body. Also small ammounts of oxygen remain in the bloodstream so the compressions are more important

In reply to dread-i: Read a recent article, I think based on a japanese study, suggesting scrap mouth to mouth as it puts people of helping and the chest compressions are what matters. However some British organisations were quoting arguing against this view point.

In reply to Ridge:
>I think people get far too anal about how many compressions to breaths
Are you sure that you are blowing into the right end

I mentioned it only so that people can give the best care to the victim, as when I read it, it was news to me.

In reply to dread-i: when you do chest compressions, its a bit like squessing a sponge under water, when u push down, the air is forced out of the lungs, when u release, and the chest moves up, air is pulled into the lungs. (water sucked into the sponge....) It was therefore decided that due to the fact that chest compressions get air into your lungs anyway (given, not as much as "rescue breaths" that they should be more of a priority. So we now have 30:2 The breaths ensure there is enough air going in, but there doesnt need to be as many of them.

In reply to dread-i: this is now the official way 30 compressions to 2 ventilations 30:2.must start with comps" first,I know cos i am a member of st.andrews ambulance association,amongst the first to impliment the new methods in uk,first orginisation to train all members, world wide.
i have used it for real it works,not very nice, no reason for not taking up a first aid class it is worth it.

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In reply to chriz: how does this relate to initial assessment of a casualty? I could be wrong but I remember being taught to always check airways first - ABC. If no breathing then give breaths and then check circulation. Has this changed too if compressions are now given first?

In reply to jamieled:
No, you still need to establish need for CPR and this can only be done through your primary survey. The sign that CPR should commence now is an unresponsive patient that is not breathing, in other words at the lay level of emergency care don't bother trying to find a pulse as without being practiced there is a low likelihood of finding one.

Rob

In reply to Plumb-bob:
Actually you don't do a C for circulation anymore - if there's no breathing then you start the chest compressions anyway - so ABC is now Airway, Breathing, Chest Compressions.

It's easy getting used to 30/2 however I have seen some people with less stamina struggling to maintain the rate after 15.

In reply to dread-i: if you are interested:

http://www.resus.org.uk/pages/bls.pdf

there is a much better consensus about resus now than there has been in the past and the new guidelines are nice and simple. Some of the ALS stuff remains a bit contentious

In reply to dread-i:

As others have said, 30:2 is the new ratio. However, compression-only CPR is also a valid and acceptable alternative if:
you don't have a face shield/mask
your casualty has facial injuries or has ingested poison
you don't want to put your mouth to theirs.

If you need to do a refresher course, please check out my profile and contact me.

C

In reply to Allan Thomson:
I don't wish to get into an overly pedantic discussion on this but saying that you don't do a C for Circulation anymore is ignoring the purpose behind performing a Primary survey, that is to identify life threatening conditions.

If as you say you get to B and find the patient not breathing then yes you look at the C being compressions but to say that there is no C for circulation anymore is akin to saying without looking at the patient that they need CPR.

Rob

In reply to Plumb-bob:
Fair enough, as you know, whereas in the past you would have checked breathing, then given two rescue breaths, then checked circulation, the procedures as you've stated have been revised so that the C becomes Chest compressions - however if breathing is established, then C would be looking at the circulation to ensure there are no other conditions to affect it - eg severe bloodloss, etc.

We both know what we mean anyway, I suspect it's probably confusing to others when you go too closely as it's simple enough when left to the basics really!!

In reply to Allan Thomson:
True....

In reply to dread-i:
The whole purpose of mouth to mouth is to give oxygen so that the heart can pump it around the body - if there is no circulation there is no point giving mouth to mouth.

i recently did my Mountain first aid and the ratio we were told was 15:2.

In reply to dread-i: I heard a rumour from an ambo crew that the chances of keeping someone alive with CPR are extremely low indeed, and at that stage, if there is no pulse or oxygen getting in, they need a lot more gizmo's.
Having had the pleasure of doing chest compressions while my mate did mouth to mouth, i would tend to agree that you're onto a losing battle. Needless to say the guy died. I have no negative feelings as we did the best we could, but can without doubt say that doing chest compressions and hearing and feeling all the ribs break under the pressure is pretty grim.
Would agree with the comments that there are many different figures you can be taught, but as long as you get the basic ratio right, just do the best you can.

In reply to dread-i:

If you witness a collapse (could be a fall etc) the casualty will have a few minutes of O2 in their bloodstream/ lungs already. Giving rescue breaths has been deemed pointless, hence the emphasis on chest compressions. What will cause irreparable damage is lack of circulation of the vital O2. (Also, most people's chest compressions are fairly ineffective).
30:2 has been around for a couple of years.
At the end of the day you do what you can, but a lot of cardiac arrests result in death.

Davie

In reply to JACKASS:
The point of CPR isn't to revive someone per say but to keep the brain oxygenated, so what the Ambos' were referring to is that it is very unlikely that you will have a patient regaining consciousness due to your efforts... but it is likely you will increase their survival as long as they get advanced cardiac care quickly.

With unconscious and unresponsive children on the other hand, due to it being very unlikely that they have suffered a heart attack, 1 round of 30:2 with initial breaths before getting help is advised. (as opposed to immediately getting help without CPR being commenced for an adult).

Rob

In reply to dread-i: When I was taught (for lifeguarding a while back) I vaguely remember it's different if the casualty is dragged from cold water. I think there were more breaths and less compressions (10-2 maybe?). Also we were taught a method of doing it as a pair where you sped up the cycle by doing it as 10-1 rather than 15-2, 20-2 or whatever we were taught. When I did this the stanards used to change (without any exageration) every six months or so, it was crazy, it has basically left me not really knowing how many I'm supposed to do. Still, anything is better than nothing; just because you don't know what this seasons favoured recovery position and compression/breath ratio are doesn't mean your knowledge is useless.

Most important thing I remember is that you have to lock elbows and press pretty damned hard, none of the pussy-footing around you see on TV. The guy who taught us told us that if we didn't break the casulties ribs then we probably weren't doing it hard enough.

In reply:

Wow! Some amazing bollocks on this thread isn't there?

1. CPR alone is not going to cause an adult casualty's heart to restart. Defibrillation or defibrillation and medication may, depending on the cause of arrest, duration, cardiac damage.

2. CPR may restore respiratory function in a non-breathing adult drowning victim if repiratory arrest (not cardiac arrest, which wll occur soon anyway) has only just occurred. Hence for drowning victims give 5 breaths first.

3. The ratio of 30 compressions to 2 breaths reflects the need to maintain a longer period of artificial circulation (than previously thought necessary) whilst still ventilating the casualty.

4. Chest only CPR (i.e. compressions only) are to be used in situations when Expired Air Ventilation (EAV/mouth to mouth) is considered unsafe and no bag-valve-mask (BVM) or airway adjunct is available. e.g. inhalation of poisonous/corrosive fumes (BVM as a minimum to be used) or biological hazards, e.g. active herpes simplex virus (face-shield as a minimum)

5. When breathing ceases, if the casualty was fully oxygenated to begin with the oxygen present on the haemaglobin remains there for around 4 - 5 minutes before disattachment. this gives a window of 4-5 minutes where chest only CPR has some effect. Compressions alone (like the old Holger-Neilson method) will not ventilate the casualty. Why do you think EAV was refined?

Hope that clears up some of the confusion, let's hope we never have to use it. It's not fun.

DJ

In reply to steve456:

The feeling of cracking and crunching underneath isn't very nice.

In reply to dread-i: did my Breathing Apparatus rescue ticket earlier this year and it was 30-2