thanks for this
I posted it to my local paddlers listserv. It’s a typical scenario for a subset of us less skilled but dedicated paddlers who push the limits looking for rolling and rescue scenarios.
The benefit of having a group leader has come up in the past and is always left hanging. I’m not sure the incident under discussion would have a changed outcome with a predetermined trip leader.
Lyn
I’m not sure the scenerio was 'typical’
This was a group of skilled and experienced paddlers that knew each other (reference: page 17-18 “Appendix 2 - The Participants”). My take, based on their comments, is that they were a little to casual and complacent in their approach to this rescue skills day trip. They indicated that the thought process and decision-making would have been different if they had selected/named a formal trip leader.
In retrospect they certainly met their goal of conducting rescue practice. They obviously got that in spades.
I wonder about that.
– Last Updated: Oct-22-10 3:34 PM EST –
First of all, people over-use that term "dead" to describe a person who's heart and breathing have stopped. They are NOT dead, but they will be soon if if blood flow and respiration are not assisted in some way and soon re-started. Second, the body's use of oxygen does NOT stop when a person is in this condition. Metabolism within the tissues continues (because the tissues are very much alive) and thus the need for oxygen persists. Without oxygen, the road toward being "really dead" is a lot shorter, so yes, reoxygenating the blood is as important as keeping the blood moving. I suspect that the ratio of time spent on compression versus mouth-to-mouth is more a function of the fact that a person can get by on much lower levels of oxygen than "normal", not due to any reduced demand for oxygen when their heart is not beating. Then, since manual compression can only create a small amount of blood flow, this part of the process becomes a limiting factor.
In any case, the idea that oxygen is not being used by the body but it is still important to keep the blood moving are two contradictory notions. After all, what need would there be to keep the blood moving if there's no need to deliver oxygen? Supplying oxygen to the body is THE reason for keeping the blood moving (in this case, supplying oxygen to the brain is the main goal - all other tissues can survive without oxygen for much longer periods of time than the brain, and once the brain is dead, the person is dead - "for real" this time).
More on this "dead" thing: Even in a healthy, conscious, living person, any tissue that dies STAYS that way. There is no coming back from true death, for individual tissues, or for the whole person.
I'm only applying basic biology principles here, so it would be great to hear from someone with a deep understanding of what goes on during CPR. I wanted to chime-in though because this idea that people in need of CPR are already "dead" is totally wrong, and that type of thinking can lead to other erroneous ideas (like the idea that there's not much potential for using up oxygen during that time).
A complex problem
There is more and more EBM that compressions are so much more important than breaths that to stop compressions and do breaths is not wise in most cases.
I would like to apologize now for the length of this and for my poor abilities to convey in a clear manner what I want to say. Also keep in mind that any cpr or compressions are better than non but as my medical control says, “If you find me down f*** the breaths and just push and get the defib going”.
A closer look
True death is brain death. No coming back
If the heart is beating and the person is not breathing it is better to give rescue breaths than to do cpr. There are exceptions to this such as if the heart is beating very very slowly. So slowly that blood is circulating at an insufficient pace. Also so slowly that most citizens will not check for long enough to tell there is a heart beat. For simplification lets leave out hypothermia and cpr and electrocution and cpr.
If there is no heart beat there is not breathing going on. Rescue breaths alone will not do anything.
I have not been in a WEMT class for years but it used to be, possibly still is, cpr in a wilderness setting is usually not used. And if used is for a short duration. CPR alone seldom works. I do not know off hand what the success rate is of cpr without defib but it is incredibly small. I think in most settings it is considered that cpr is used to keep the person viable until a defib unit is used. The longer without a defib unit the less chance of a save.
One of the things that happens during compression is a buildup of pressure in the chest. In care in an ambulance, in advanced systems, there are mechanical units that provide positive pressure, (positive pressure ventilators). They are used under certain circumstances to increase pressure. This can be more important than most people realize. When you jog and you find yourself pursing your lips on your exhale so that you have to push the air out, on the exhale, you are helping to increase pressure. Your body wants an increase of pressure so it causes you to have resistance on the exhale so pressure will build up. When doing compressions you are building up pressure. When you stop doing compressions you have lost the benefit of that pressure. This build up of pressure has proven to be important.
If you find yourself in a situation that you might be giving cpr keep in mind that every min that goes by without a defib means less and less chance of a save when the defib arrives. I guess if you find yourself in a situation where cpr might have to be done for extended amounts of time one should consider giving breaths. But also keep in mind that the chance of a save with extended cpr is so very unusual.
I work in an area that has forward thinking protocol. Our continuing education medical director, medical control (who we consult during a run) also lives in the area and regularly rides on the ambulance as a volunteer. We are one of the few areas of the country where we put a heart attack patient in hypothermia, if we can, during the call. We also send them only to a hospital that can keep them in hypo if we have done this procedure. This is done because after the heart stops the brain goes into a self protection mode if and when heart beat and oxy is restored. This is not the same as the cell death that occurs from lack of oxy. It is a process that occurs after function has been restored. The cooling of the brain helps to cut down on the brain deficits that occur after a heart attack. Again, this is not the cell death of lack of oxy.
Because of the research that has been done we not longer do cpr, at the scene, as we get ready to intubate and are setting up the defib. We do compressions. The compressions continue until the defib is in use and the compressions are used until the intubation is in. No breaks for breaths.
When I say never, or we do this, or always, this is not to be taken literally. Very seldom is something always or never. there are often times the situation can change what happens. Drugs, hypothermia, electrocution. punctured lungs, chest trauma, facial trauma, neck trauma…
It is felt by some that in several years it will only be compressions in most circumstances. The AHA has a history of being several years behind the curve of what actual results show. Hell on the ambulance we are as much concerned with the makeup of the exhale as we are with the amount of oxygen we are delivering. To the point that we sometimes turn the amount of oxygen down so that we can build up the byproducts we want in the lungs.
CPR is aa complicated process that is not a simple as it appears.
If you add time to this (cpr with no defib) the chances of survival decrees dramatically.