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Old 04-01-2008, 05:23 AM   #1 (permalink)
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Revised CPR method: for those afraid of cooties

Somewhat big in the news today is the release of a revised CPR method that requires only chest compression, approximately 100 compressions per minute.

Original Article

Quote:
Originally Posted by AP
NEW YORK (March 31) - You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

"You only have to do two things. Call 911 and push hard and fast on the middle of the person's chest," said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

Hands-only CPR calls for uninterrupted chest presses - 100 a minute - until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.

This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. The odds are that the person is having cardiac arrest - the heart suddenly stops - which can occur after a heart attack or be caused by other heart problems. In such a case, the victim still has ample air in the lungs and blood and compressions keep blood flowing to the brain, heart and other organs.

A child who collapses is more likely to primarily have breathing problems - and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.

But in either case, "Something is better than nothing," Sayre said.

The CPR guidelines had been inching toward compression-only. The last update, in 2005, put more emphasis on chest pushes by alternating 30 presses with two quick breaths; those "unable or unwilling" to do the breaths could do presses alone.

Now the heart association has given equal standing to hands-only CPR. Those who have been trained in traditional cardiopulmonary resuscitation can still opt to use it.

Sayre said the association took the unusual step of making the changes now - the next update wasn't due until 2010 - because three studies last year showed hands-only was as good as traditional CPR. Hands-only will be added to CPR training.

An estimated 310,000 Americans die each year of cardiac arrest. Only about 6 percent of those who are stricken outside a hospital survive, although rates vary by location. People who quickly get CPR while awaiting medical treatment have double or triple the chance of surviving. But less than a third of victims get this essential help.

Dr. Gordon Ewy, who's been pushing for hands-only CPR for 15 years, said he was "dancing in the streets" over the heart association's change even though he doesn't think it goes far enough. Ewy (pronounced AY-vee) is director of the University of Arizona Sarver Heart Center in Tucson, where the compression-only technique was pioneered.

Ewy said there's no point to giving early breaths in the case of sudden cardiac arrest, and it takes too long to stop compressions to give two breaths - 16 seconds for the average person. He noted that victims often gasp periodically anyway, drawing in a little air on their own.

Anonymous surveys show that people are reluctant to do mouth-to-mouth, Ewy said, partly because of fear of infections.

"When people are honest, they're not going to do it," he said. "It's not only the yuck factor."

In recent years, emergency service dispatchers have been coaching callers in hands-only CPR rather than telling them how to alternate breaths and compressions.

"They love it. It's less complicated and the outcomes are better," said Dallas emergency medical services chief Dr. Paul Pepe, who also chairs emergency medicine at the University of Texas Southwestern Medical Center.

One person who's been spreading the word about hands-only CPR is Temecula, Calif., chiropractor Jared Hjelmstad, who helped save the life of a fellow health club member in Southern California

Hjelmstad, 40, had read about it in a medical journal and used it on Garth Goodall, who collapsed while working out at their gym in February. Hjelmstad's 15-year-old son Josh called 911 in the meantime.

Hjelmstad said he pumped on Goodall's chest for more than 12 minutes - encouraged by Goodall's intermittent gasps - until paramedics arrived. He was thrilled to find out the next day that Goodall had survived.

On Sunday, he visited Goodall in the hospital where he is recovering from triple bypass surgery.

"After this whole thing happened, I was on cloud nine," said Hjelmstad. "I was just fortunate enough to be there."

Goodall, a 49-year-old construction contractor, said he had been healthy and fit before the collapse, and there'd been no hint that he had clogged heart arteries.

"I was lucky," he said. Had the situation been reversed, "I wouldn't have known what to do."

"It's a second lease on life," he added.
For those of you trained in and comfortable practicing traditional CPR, will you change your technique to eliminate mouth-to-mouth? Have you ever had to perform CPR other than on a dummy for your training? For those of you untrained in CPR, were you comfortable with the idea of performing mouth-to-mouth? Will you be more likely to offer assistance with chest compression-only CPR?

I have had training in CPR, rescue breathing, and general first aid from the Red Cross when I worked at a YMCA camp for the summer. Though I was trained in CPR technique, I (luckily) have never had the chance to perform it in "real life." There's not much of a "yuck" factor for me regarding rescue breathing, but I will say that I am more comfortable with the idea of performing compression-only CPR than combining chest compressions and mouth-to-mouth. I always had trouble remembering the time intervals and number of compressions or breaths for infant/child/adult CPR and would mix them up occasionally, so remembering a single number (compressions/minute) for each category strikes me as much easier.
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Old 04-01-2008, 06:38 AM   #2 (permalink)
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As an RN, paramedic, CPR instructor and business owner providing instruction.

It is great, but, the AHA makes MONEY by changing their theories every 5 years so people and organizations need to purchase access to the science.
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Old 04-01-2008, 02:33 PM   #3 (permalink)
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I'm glad they updated it before I have to get recertified this summer. As a childcare worker, I keep my infant/child and adult CPR/First Aid certifications up-to-date. I have not yet had to use CPR in my workplace or otherwise, and for that I am thankful. The change in method is not as pertinent to me as it is to other responders, given that I largely work with children,and the method is unchanged for them.
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Old 04-01-2008, 09:46 PM   #4 (permalink)
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Quote:
Originally Posted by whatever1
As an RN, paramedic, CPR instructor and business owner providing instruction.

It is great, but, the AHA makes MONEY by changing their theories every 5 years so people and organizations need to purchase access to the science.
I just got recertified on my ACLS and they told us of the new studies. They told us no more of the 2 fingers up from the xyphoid, just somewhere on the sternum near the nipple line. Curious to see what the new studies will show in 4 years time.
Doesn't matter what the protocols are. Its one of those "better than nothing" procedures.
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Old 04-01-2008, 09:52 PM   #5 (permalink)
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I think it's a bit odd to think that there are people who worry about these things.

'Gee, that guy collapsed and I could use my training to save his life, but he might have germs!'

My cert has actually lapsed as of last year. I don't need it for anything work related and it's expensive, so I haven't bothered to recertify yet. On the other hand, if I should find myself in a situation where such assistance is necessary I hardly intend to let the paperwork get in the way.
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Old 04-04-2008, 03:04 PM   #6 (permalink)
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It's never bothered me much. Originally I learnt mouth-to-mouth in a swimming context - we were all fairly young, and it was essentially a temporary measure, we'd have masks+oxygen in near reach.

For a long time though - I carried a mini-mask in my wallet and a larger one in my car. I should probably restock these anyways.
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Old 04-07-2008, 04:50 AM   #7 (permalink)
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From the AHA website : http://handsonlycpr.eisenberginc.com/faqs.html#b

Quote:
Originally Posted by AHA
Q: Who should receive Hands-Only CPR?
A: Hands-Only CPR is recommended for use on adults who suddenly collapse. The American Heart Association (AHA) recommends conventional CPR (that is, CPR with a combination of breaths and compressions) for all infants and children, for adult victims who are found already unconscious and not breathing normally, and for any victims of drowning or collapse due to breathing problems.
This 'new' method is only used when you actually see the person go down. I just took a CPR class on Saturday and the instructor made a point of explaining this to us. We also covered this in Physio lab, the oxygen level in the blood is sufficiently high for 2-3 minutes if a person stops breathing, provided the heart continues to beat. Not really revolutionary, but I can see the use in pointing it out to half the world.
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Old 04-07-2008, 05:23 AM   #8 (permalink)
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Quote:
Originally Posted by Hektore
From the AHA website : http://handsonlycpr.eisenberginc.com/faqs.html#b



This 'new' method is only used when you actually see the person go down. I just took a CPR class on Saturday and the instructor made a point of explaining this to us. We also covered this in Physio lab, the oxygen level in the blood is sufficiently high for 2-3 minutes if a person stops breathing, provided the heart continues to beat. Not really revolutionary, but I can see the use in pointing it out to half the world.
On the other hand, if I recall correctly it takes about 5-7 minutes for brain damage to begin.

I wonder how long it will be before somebody gets sued for failing to perform rescue breathing?
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Old 04-12-2008, 05:30 AM   #9 (permalink)
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Ta for that.

Yeah I did notice, but thanks for pointing that out.

What bothers me more about the whole resus. thing (EAR/CPR) is the relative number of victims who emerge with serious brain damage. I did read an article on that once and it made me question my entire view on the topic.

I really should go check for some stats on that.

But yeah. The various associations push resuscitation quite hard. But is that always warranted, particularly when the first on-scene has effectively got a choice?
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Old 04-12-2008, 01:40 PM   #10 (permalink)
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i went through cpr course a couple of weeks ago and we were taught the new breathe-optional method. in response to the last question i recal the instructor saying something along the lines that cpr won´t kill someone so if in doubt give it. apparently the statistic he gave was that 10% of people who need cpr don´t get it and the aim is to reverse that to 10% of all poeple who don´t need cpr get it
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Old 04-12-2008, 02:35 PM   #11 (permalink)
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Quote:
Originally Posted by lotsofmagnets
i went through cpr course a couple of weeks ago and we were taught the new breathe-optional method. in response to the last question i recal the instructor saying something along the lines that cpr won´t kill someone so if in doubt give it. apparently the statistic he gave was that 10% of people who need cpr don´t get it and the aim is to reverse that to 10% of all poeple who don´t need cpr get it
Granted it's been a few years, but I seem to recall my instructor during my last refresh saying that unnecessary CPR can in fact be dangerous, as it has the potential to cause damge - of particular concern is the xiphoid process, which is sharp and easily broken, resulting in the first responder essentially stabbing the victim. For this reason, I was taught, it's very important to understand when CPR is and is not appropriate and how to administer it properly.
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Old 04-12-2008, 02:58 PM   #12 (permalink)
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And miss my opportunity to get to first base with a complete stranger? No way, Jose.

Besides, as long as you know what you're doing (like not putting air into their stomach) the mouth way seems to work just fine.
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