Tag Archives: ProCPR

Posted in Roy on Rescue • Training Questions • Airway • CPR for Providers • Respiratory

Isn’t “Not Breathing Normally” Still Breathing? Maybe Not.

Comments:1 Comment

ConfusedHello Everyone,

I had a great comment come through the student comment section this week and thought it might help others if I shared my response.

So, the student asked,
” Some questions on your test seemed to give incomplete or misleading information, in my opinion. Such as the one referring to a man who is unresponsive and not breathing normally. The answer to pass was to give them 30 chest compressions yet if someone is not breathing NORMALLY it leads me to believe that they are breathing and the first thing I would want to do is try and figure out why the breathing is not normal. Not give them chest compressions. Have I checked for a heartbeat? I wouldn’t give chest compressions unless I couldn’t detect a pulse.”
-ProFirstAid.com Student

Here was my response. I hope it helps.

Dear “Student”,

There were a couple of changes in this 2010 ECC/ILCOR and American Heart Association release from the guidelines of 2005. One was that if the person is unresponsive and not breathing “normally” we begin chest compressions. Pretty aggressive I know but this is what the guidelines suggest as best practice. Secondly, basic first aid providers no longer check for pulses in the unresponsive victim. Now, when a lay-rescuer comes upon a person who is unconscious, not breathing or not breathing “normally”, they are to activate EMS(call 911) and begin chest compressions at a rate of at least 100 per minute and at least 2 inches deep. This is to continue for 30 compressions only interrupted long enough to give two full breaths after the head tilt chin lift and then back to the chest compressions. The rescuer is not to stop this process unless the patient begins to respond and become conscious, begins breathing normally again, an AED is available, or if EMS arrives and takes over. CPR is to be provided fast and hard with as few interruptions as possible. So there you have it as stated by the new and latest ECC/ILCOR guidelines.

Now, for my subjective slant on the whole deal. I say, don’t feel bad if you’re a little frustrated. As a licensed paramedic, instructor trainer for CPR, First Aid, ACLS and PALS, it still a bit hard for me to watch the latest recommendations and guidelines put forth by the International Liaison Committee On Resuscitation”. It was hard to watch them throw the proverbial “baby out with the bath water” if you will. I for one believe that people can learn how to perform effective and more advanced assessment if given the correct learning mechanisms by which to learn and retain the information in order to use it well during a real rescue situation. I believe that people are more than capable of providing optimal CPR and First Aid which would include pulse checks. I think that there can be times, though maybe rare, where checking for pulses would be helpful in determining the correct next steps especially when dealing with patients suffering from low blood sugar, or a hard hit to the head which temporarily knocks them unconscious and they stop breathing for some time. I also wonder about the person who has been in cardiac arrest for some time. The person is certainly permanently dead and any resuscitation efforts will not change the patients status because they’ve been dead for more than half an hour or longer. Does the rescuer still perform CPR and Rescue Breathing because the person is not moving, not breathing or not breathing normally? Very difficult for me to believe that a rescuer would have to perform CPR on a person with rigor mortis while waiting for the EMS providers to arrive and confirm time of death.

But, the ECC/ILCOR recommendations were based on some evidence, though from my findings I admit not much, that more people would benefit from these simplified procedures than would suffer any ill consequence. So they made the change.

What helps me to deal with the changes when I don’t agree with them, is that the changes were made by the ILCOR group to “simplify” the procedures of CPR and to hopefully encourage more people trained or not, to get involved and hopefully make a difference in saving more lives. If this is indeed the case and we’ll know in a few years, than I guess it’s worth the bit of frustration that some of us must suffer.

I hope this helped. Please let me know if you have any further questions.

Best Wishes,

Roy
royonrescue@gmail.com

Posted in Roy on Rescue • CPR for Instructors • CPR for Providers

Professional Rescuers and The Good Samaritan Law

Comments:

In this episode of RoyOnRescue, a newly licensed Medical First Responder asked if they might be at a higher risk when they try to help a citizen now that they are licensed.  Though this can be a scary and ever present problem in the world of professional medicine, it’s very rare for anyone to get sued or especially lose a lawsuit when it comes to helping people who have medical needs.  In this episode, Roy sheds some light on how most Good Samaritan Laws work and how any rescuer regardless of their level of training and license can help others while staying well within the guidelines of the Good Samaritan Law.

Best Wishes and a Blessed New Year From Roy and The Whole RoyOnRescue Team!

Minnesota Good Samaritan Law

Posted in Roy on Rescue • Training Questions • CPR for Instructors • CPR for Providers • Respiratory

RoyOnRescue Answers Question About Assessing Breathing

Comments:3 Comments

In this post, I answer a question from a professional who has been training lay rescuers and wants to update their students to the new 2010 suggested guidelines.

The following excerpt is taken from the original email.
Greetings from India,


“We teach first aid and CPR (to the layperson/non medical person)in New Delhi, India and are reading the new guidelines so that they can be incorporated in the new year.  I know the handbooks will be out in the first quarter but would like to start adding the 2010 guidelines sooner.
A couple of questions- your input would be appreciated.
1. Do we carry on with AVPU
2. As checking for breathing is being de-emphasized – how are first aiders to tell if breathing is present or not. From what i can figure out- look, listen feel is not to be used now.”


Merry Christmas and Happy New year.

Kind Regards,

New Delhi

The following is my response:

Hello Student,

Thank you for reaching out as I hope to be of assistance.  Regarding the new updates for 2010 and how it relates to training the lay public.

1.  Q:  “Do we carry on with AVPU?”
A:  Yes and No.  Yes in so much as we are always kind of asking ourselves, “Is this person awake? Are they Verbal? Do they respond to pain(not that we should be causing any pain)? Are they unresponsive?  But I have to say no, because we are checking to see if the person appears to be breathing or breathing normally?  This does not fit in the AVPU scale for a level of consciousness.  We must also remember that AVPU is an advanced medical training and the ECC/ILCOR recommendations do not teach lay rescuers to use AVPU anywhere in the curriculum.

2.  Q: With assessment for breathing being de-emphasized and the elimination of the “Look, Listen, and Feel” part of assessment, what is the best way to train lay rescuers to assess for breathing?
A:  This is a great question.  Under the new guidelines, assessment for breathing is performed by looking for the following:  Is the persons chest moving like in breathing?  Does the person appear to be breathing normally?   If the person is not breathing normally, and the chest is not rising and falling, the rescuer will initial emergency medical services and begin CPR starting with 30 chest compressions at least 2 inches deep and at a rate of at least 100 per minute.

The simplification of assessment for breathing was brought by confusion of agonal respirations vs. regular gas exchanging breathing.  The hope is that if a rescuer notices that the person is not breathing normally, help will be called and initiation of CPR will not be delayed.

For those of us who worry that too many victims will receive CPR when it is not necessary and thereby suffer unnecessary injuries, one must be aware of the scientific studies that show that “only two percent of people receiving CPR suffered any injury at all from CPR when it was not needed.  But the advantages of early initiation of CPR without delay, has been shown to improve survival with minimal risk of injury but with great increase of benefit.( http://circ.ahajournals.org/cgi/content/short/121/1/91)

Please note that all update training is available for free at:  http://www.profirstaid.com

Thank you for your email and please let me know if you need any further assistance.

Best Wishes and Merry Christmas!

Roy Shaw, EMT-Paramedic
roy.shaw@procpr.org
royonrescue@gmail.com

Posted in Roy on Rescue • Training Questions • Child Emergencies • CPR for Instructors • CPR for Providers

How Can A Child Do CPR?

Comments:1 Comment

In this episode of RoyOnRescue, Roy get’s asked the best way to have a child do CPR on a person who is larger then them.  Other than a bit of bad videography while Roy’s on the fly…I think it will help answer a question many people have about the best way that a small person can help someone in cardiac arrest.
Best Wishes,
The RoyOnRescue Team

Posted in Roy on Rescue • CPR for Instructors • CPR for Providers • Special CPR Conditions

Life and Death With Dignity…and Privacy

Comments:

just received a question from a student who asked:

Dear RoyOnRescue,

“In thinking about the use of an AED, what if the person is a woman and we have to “bare the chest”.   Should we place the AED pads under the shirt, or do we have to actually bare the chest for proper use of an AED?”

-CH

This is a good question and one that is uncomfortable for some to think about.  Whenever a rescuer is working on a patient, male or female,  a rule of ethics applies.  We as rescuers should be thinking about the dignity and respect of the patients privacy and confidentiality at all times.  This includes times where we may have to “Bare” the chest of the victim in order for us to defibrillate or treat them.  We should seek to be discrete as long as we are able to get the job of rescue accomplished without delay.   If the person is able to be defibrillated without full removal of the clothing that’s great.  If the person needs to have shirt or underclothing cut or removed in order to defibrillate properly than that will need to be done.  If there are bystanders, those bystanders could turn their backs to the patient and try to make a human curtain around the patient in order to protect the patients privacy and dignity.  Think about if this is in a public workplace or location where the person is known.  They may survive if everything goes the way it should and if they do, they will probably return to this workplace.  We must make sure that as far as we can control, we protected their dignity and helped them as much as possible without complicating or slowing down the rescue process.

I hope this helps.

Best Wishes,

Roy

www.royonrescue.com
royonresccue@gmail.com

Posted in Roy on Rescue

CPR on Airbeds and Shocking a PaceMaker

Comments:2 Comments

We had a student write in about different situations that can make it really difficult to do CPR and use an AED on someone.  I thought I’d include the scenarios and then give a little help on some ways to make it all go as well as possible.
royonrescue@gmail.com

The person writes: I have patients in oversized  beds, usually air beds.  I am a nurse in a nursing home and have this discussion frequently with my CNA staff so they know what to do.  You’d be surprised how many licensed staff attempt CPR in a bed.  Question, can an AED be used on a person with a pacemaker or indwelling defibrillator?

-Help?

Well, these two different situations do throw a small curve ball but nothing that we can’t work through together.   First, let’s talk about the airbeds.  In the medical field, we are constantly finding ways to decrease bed sores and pneumatic air beds are one of them.  When a patient needs CPR compressions there is a golden rule that shoulds be followed.   Chest compressions work best on a hard flat surfaces.  This does not mean that the patient must be moved to a different surface everytime, but it does mean that the surface must be hard/stiff and flat in order to maximize the depth and consistency of the chest compressions.

With airbeds, we usually see them built with a deflate or CPR button?  Or a way to deflate them quickly.  Even the air/sand beds have this feature so make yourself familiar with it and you will instantly have that hard flat surface we are talking about.  If it is a normal hospital or patient bed and the person is not able to be moved safely to the floor, we should have quick access to a CPR board or a back board which will usually stiffen the surface enough for good compression depth.  It’s always a good idea to practice all of these steps to make sure you know just what you are going to do if the emergency arises.

Secondly,  Defibrillators of every type are able to be used with internal pacemakers and internal defibrillators.  When we place the pads of a defibrillator on  a person’s chest, the placement is usually upper right pectoralis region and left lower mid axillary chest.  This will be below the left pectoralis muscle  or breast and mid line with the left armpit.  See http://www.ProCPR.org under AED video training for a demonstration.  If the Pads or paddles are placed in these locations, they will clearly miss the most popular location for an internal defibrillator or pace maker.  Even if for some strange reason the pacemaker is in an abnormal location and you will have to place the pad over the device.  Be sure to seal it to the chest well and follow the AED training procedures.  We would want to move necklaces from the path of electricity and we will wipe off any nitro paste or other medicine patches from the area’s we place the electrode pads.

If you work in a hospital setting, be sure to ask your educators what the hospital or facility procedure or protocol is if you have any doubt on this advice.

I hope this was helpful and keep the good questions coming.  I’ll be looking forward to your emails.

Best Wishes,

Roy

Roy W. Shaw, EMT-Paramedic

RoyOnRescue.com

Posted in Roy on Rescue • Training Questions • Special CPR Conditions • Trauma

Person Falls Face Down, Unresponsive!

Comments:1 Comment

On this episode of RoyOnRescue we take a closer look at a questions a person had about what to do if a person falls, has a potential neck injury, is face down and is unresponsive.  This can be a complicated scenario when it comes to assessing the person for airway,  breathing and circulation. Watch this episode to hear one way to respond to a person in this situation, treat them without causing further harm and maybe save a life.

Posted in Roy on Rescue • CPR for Instructors • CPR for Providers • Special CPR Conditions

But The Family Said…DO NOT RESUSCITATE!

Comments:1 Comment

A student emailed in a great question and one in which can be a very tough one to answer!      It’s challenging enough to get bystanders to begin CPR.  But when we complicate the scenario with a person yelling; “They have a DNR, don’t do CPR or you’ll get sued!”   This can really complicate matters.  What do you do?   Stop CPR and hope that the withholding of potentially life saving CPR is legitimate?  Don’t stop CPR and continue to upset the people that are yelling stop in the first place?   Whoa! Tough spot to be in.

In this episode I’m going to do my best to explain the very complicated issue surrounding Do Not Resuscitate orders(DNR) when CPR is already in progress or about to begin.

Sample of Proposed DNR Guidelines From BENO-Ethics

Posted in Roy on Rescue • Sports Related • Concussions • Head Injuries

How to Hit Your Head on Pavement at 17MPH and Survive!

Comments:2 Comments

Imagine riding your road bike and as you near a curve in the bike trail hitting speeds of around 17 miles per hour your front tire instantly goes flat.  Now you’re trying to corner on a metal rim sliding across the pavement which has as much traction as an ice skating rink.   This is exactly what happened to Tom Monett, cycling enthusiast, big mountain skier, hiker and mountain climber.  As Tom’s bike slid out from underneath him, he didn’t have enough time to catch himself let alone think about what was about to happen.  As his head hit the pavement, and his ribs began to break, his wisdom to ride with personal protective equipment most likely made the difference between life and death.  Watch this episode of royonrescue to see the full interview and hear his story about surviving a high speed cycling crash.

Concussion

Warning!  Video contains graphic pictures of injuries and accidents.

Video Gallery of Actual Bike Accidents

Posted in Roy on Rescue • Weather Related • Environmental • Heat Related

Staying Safe In The Heat

Comments:

QUESTION:

“It’s so hot where we live and it seems that we have elderly people who suffer most when it gets hot and humid.  Is there anything I can do to stay cool myself and maybe even help someone who is having a heat related health problem?”

Signed,

Melting in Florida

Dear Melting,

Benjamin Franklin once said “An ounce of prevention is worth a pound of cure.” This saying applies to many different health care related scenarios, heat related emergencies certainly not the least of them.

When staying safe and healthy in hot and humid weather it is important to understand what types of environments will put one at risk.

To get started, let’s take a look at how a heat index works.

A heat index combines air temperature with relative humidity as a way of determining how hot a person feels.  A person feels hotter in more humid climates because the moisture in the air does not allow one’s perspiration to carry the heat generated by the body away and evaporate as easily.  When the body cannot cool itself by perspiration and evaporation, the body’s temperature rises and one may feel less comfortable or may even lead to more serious heat related problem.

An example of what could take place in certain heat indexes are as follows:

  1. 80–90 °F  Caution — fatigue is possible with prolonged exposure and activity. Prolonged activity could result in heat cramps.
  2. 90-105 °F  Extreme Caution — heat cramps, and heat exhaustion are possible.  Prolonged exposure and activity could result in heat stroke.
  3. 105-130 °F  Danger — heat cramps, and heat exhaustion are likely; heat stroke is probable with continued activity.
  4. Over 130 °F Extreme danger — heat stroke is imminent.                                                                                                                                                                                               (Please note that these are shade values.  Exposure to direct full sunshine could increase these heat values by more than 10 degrees.) Closely paraphrased from the public domain article Heat Index on the website of the Pueblo, CO United States National Weather Service.

Most individuals can indeed acclimatize to heat which will help the body tolerate hotter conditions with less stress to the body.  This process for normal healthy individuals usually takes about 5 -7 days.  This should be done gradually and with a person maintaining good hydration.  A person is capable of sweating up to 2-3 gallons of water per day in hot conditions and cannot rely on the thirst drive in order to know when to drink.  During heavy sweating, a person should be drinking approximately 5-7 ounces every 15 minutes 20-30 ounces per hour in order to replenish lost fluids.  Valuable electrolytes such as sodium, calcium and potassium may be lost during heavy perspiration and should be replaced with proper nutrition and diet. http://www.cdc.gov/niosh/hotenvt.html

Those who are most vulnerable to these heat indexes include:

  • infants,
  • the elderly (often with associated heart diseases, lung diseases, kidney diseases, or who are taking medications that make them vulnerable to heat strokes),
  • athletes, and
  • outdoor workers physically exerting themselves under the sun.

or

Those who do not have means for escaping the heat.  Some examples of how to escape the heat include:

  1. Circulation of air by fan or ventilation,
  2. Accessing lakes, ponds or pools
  3. Air conditioning or subterranean cooling like a vegetable cellar or cool basement.
  4. In certain cases, placing ice bags under arm pits or around the neck or over other arteries like the wrists, ankles, top of head which may help in cooling core body temperatures.
  5. Cool or tepid bath water or a cool shower

If an individual does not have means of cooling and succumbs to the heat they may be suffering from heat fatigue, heat exhaustion or heat stroke.  Let’s take a look at each of these and how to treat each problem.

Definition Heat Fatigue: The signs and symptoms of heat fatigue may include heavy sweating, muscle weakness, tiredness, and impaired performance of skilled sensorimotor jobs.

Treatment:  Remove from heat, encourage water intake and good healthy nutrition and allow person to rest.  Allow person to acclimatize longer to increased heat environment.

Definition Heat Exhaustion: The signs and symptoms of heat exhaustion may include all of the above with the addition of heat cramps in legs, abdomen, back, calves and arms, headache, nausea, vomiting, dizziness, confusion and lethargy.

Treatment:  Remove from heat, encourage fluid intake, loosen clothing, poor water over persons body to soak clothing and begin cooling persons body. Monitor person for unresponsiveness, difficulty breathing or cardiac arrest.  If person is not improving with treatment or symptoms worsen, activate EMS or 911.  Heat exhaustion can become heat stroke if body temperature is not reduced.

Definition of Heat Stroke:   All of the above for heat exhaustion but usually progress to the following:

  • high body temperature
  • the absence of sweating, with hot red or flushed dry skin
  • rapid pulse
  • difficulty breathing
  • strange behavior
  • hallucinations
  • confusion
  • agitation
  • disorientation
  • seizure
  • coma

Treatment: Remove person from source of heat, loosen clothing, begin cooling the person’s body safely as soon as possible in order to lower body temperature.  Nothing should be given by mouth once the person cannot drink safely on their own.  Activate EMS/911 and support with CPR and First Aid for life saving measures. http://www.medicinenet.com/heat_stroke/article.htm

So, next time you’re planning a trip out into hot conditions, take a moment to check the heat index and formulate a plan for protecting, preventing and treating yourself and others who might fall to heat related emergencies.  Oh, and if you know someone who may be vulnerable to hot weather, see if you have an extra fan, or maybe even give them some tips on how to cool down right in their own home.  You could just find that you have some rescue hero in you too.