CPR supplies, and CPR discussion

[snoboy]

I recently did my CPR C ticket.

 

I was interested to learn that the rates of survival for younger/healthier people are higher (no suprise there) but more interesting was that this was also true in cases where trauma is involved.

 

This leads me to the conclusion that the chance of CPR being a useful skill is actually much higher with the people I tend to be around.

 

I have a mask like Iain's pic in my climbing FA kit, and a simple barrier device in my wallet. I don't even think about it, but I am always carrying one these days.

 

Places like Moore Medical and CPR-Pro are good sources for these items. Even MEC carries them for us Canadians. They are not expensive.

[Figger_Eight]

[jon]

I'm going to ask around about the actual risks of performing mouth to mouth to someone who has severe bleeding. Being in public hearth and studying pathogens I would be pretty hesitant to perform mouth to mouth on someone without a mask. While I'm not using the most recent case, I think you have to weigh the risk of contracting something versus the likelyhood of them surviving in a case with extreme amounts of body fluid. That said I have a mask and gloves in my car with my first aid kit and typically have some gloves in whatever bag I have with me.

[iain]

The Canadian Pacific Railway faced great difficulties laying tracks through the treacherous mountains to join the Pacific Coast with Eastern Canada. Thanks to the surveying work of Major A.B. Rogers, a pass was discovered near the headwaters of the Illecillwaet River.

[iain]

A pocket mask and gloves are nice in the glove box of your car, and the keychain keeps protection available other times. If you are getting advanced CPR training, you are the most likely candidate for having to act in an emergency. It would really suck to have to worry about disease if someone collapses at a mall in front of you.

[catbirdseat]

The Canadian Pacific Railway faced great difficulties laying tracks through the treacherous mountains to join the Pacific Coast with Eastern Canada. Thanks to the surveying work of Major A.B. Rogers, a pass was discovered near the headwaters of the Illecillwaet River.

How's that for something "completely different"?

[Ursa_Eagle]

It's a CPR discussion, as per the initial subject!

[rbw1966]

The chances of reviving someone with CPR who has coded are very slim. All you are doing is keeping oxygenated blood moving to the vital organs until more advanced life-saving measures can be administered. Thats not to say that its a waste of time or effort but something you should consider when deciding whether its appropriate or not. You and your buddy are skiing Goat Rocks when he slams into a tree and suffers massive head trauma and has stopped breathing. Is CPR appropriate in this scenario? Its just you and him miles from anywhere.

 

Another thing to keep in mind in addition to What Jon said about potential disease transmittal is the chance of injuring the person further by administering CPR. A friend of mine witnessed a child being hit by a car in a residential neighborhood. The kid had stopped breathing and there was no pulse so my buddy started CPR. The kid survived and was a paraplegic. The parents sued my friends alleging that he compromised the kids spinal cord. Although protected by good samaritan laws, it was a pain in the ass.

[fleblebleb]

I called CPR-Pro at 1-866-208-5324 and ordered four small masks to stash in different places. The total came to US $21 with shipping. This took 5 minutes total. I had no idea what the different models are but just asked the guy on the phone. They don't take credit card orders over the web so calling is a good option.

[kurthicks]

you can also get some supplies at www.boundtree.com they've got some good stuff on there too.

 

one more thing about CPR--when I took my WFR course they said that it is about 30% efficient, which is why you can stop after 30 minutes unless care is on the way.

[Doug]

For the record, in my lightweight 1st aid kit, I do carry a CPR mask & latex gloves. Of course, after being around cc.com, a biohazard suit may be the next addition.

 

Did you know there is an increasing prevalance of people who have an anaphylactic (sp)reaction to latex & other rubber products (no joke).

 

There are some new synthetic gloves on the market that take care of that risk.

Edited March 9, 2004 by Doug

[jon]

The keychain mask is available at the UW Bookstore by the medical center for $7, not large enough for gloves though.

[iain]

Just making it clear that the pathogen vs saving life comment I made in the other thread is simply to illustrate how rarely CPR works, rather than to say how frequently you will catch a disease. I would not hesitate to initiate CPR if it was warranted, but I would do some thinking if a mask and gloves are not available.

 

Also, I think it is inappropriate for people to be describing the injuries this fellow received in unnecessary (and perhaps even unauthorized) detail.

[Farrgo]

I always carry a cpr mask with me. I have a full on mask in my climbing first aid kit, than I carry a barrier in my wallet. when i took my wfr, my instructor indicated that if someone stops breathing and has no pulse than the chances of recovery (without a aed) are slim to none. apparently all chest compresions can do is bring you into venticular fibrulation. however, rescue breathing can go on for hours and is effective. a decent cpr mask will definately make this situation easier. so if you were in the goat rocks and your buddy stopped breathing and you expected that somebody might come by in a reasonable amount of time, start rescue breathing.

[icegirl]

topically (as in laying your hands on a person with latex sensitivity) I have not heard of anaphylactic reaction (that does not mean it is not possible). I have seen one such reaction when latex gloves were used inside a known latex sensetive person during surgery.

 

Almost all hospitals have gone to latex free/poweder free exam gloves, not only for the patient but the healthcare provider. We still use some latex gloves in the Operating Room because the surgeons insist that they have better "feel".

[ChrisT]

I have a mask like Iain's pic in my climbing FA kit, and a simple barrier device in my wallet. I don't even think about it, but I am always carrying one these days.

 

Places like Moore Medical and CPR-Pro are good sources for these items. Even MEC carries them for us Canadians. They are not expensive.

 

You can get the keychain mask at the Red Cross as well.

[mneagle]

This is a recent position statement on the cessation of CPR in trauma patients intended for rescue workers.

 

Journal of the American College of Surgeons

Volume 196 • Number 1 • January 2003

Copyright © 2003 American College of Surgeons

 

Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: joint position statement of the national association of EMS physicians and the american college of surgeons committee on trauma

 

 

Position statement

The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) support out-of-hospital withholding or termination of resuscitation for adult traumatic cardiopulmonary arrest (TCPA) patients who meet specific criteria.

 

1. Resuscitation efforts may be withheld in any blunt trauma patient who, based on out-of-hospital personnel’s thorough primary patient assessment, is found apneic, pulseless, and without organized ECG activity upon the arrival of EMS at the scene.

2. Victims of penetrating trauma found apneic and pulseless by EMS, based on their patient assessment, should be rapidly assessed for the presence of other signs of life, such as pupillary reflexes, spontaneous movement, or organized ECG activity. If any of these signs are present, the patient should have resuscitation performed and be transported to the nearest emergency department or trauma center. If these signs of life are absent, resuscitation efforts may be withheld.

3. Resuscitation efforts should be withheld in victims of penetrating or blunt trauma with injuries obviously incompatible with life, such as decapitation or hemicorporectomy.

4. Resuscitation efforts should be withheld in victims of penetrating or blunt trauma with evidence of a significance time lapse since pulselessness, including dependent lividity, rigor mortis, and decomposition.

5. Cardiopulmonary arrest patients in whom the mechanism of injury does not correlate with clinical condition, suggesting a nontraumatic cause of the arrest, should have standard resuscitation initiated

6. Termination of resuscitation efforts should be considered in trauma patients with EMS-witnessed cardiopulmonary arrest and 15 minutes of unsuccessful resuscitation and cardiopulmonary resuscitation (CPR).

7. Traumatic cardiopulmonary arrest patients with a transport time to an emergency department or trauma center of more than 15 minutes after the arrest is identified may be considered nonsalvageable, and termination of resuscitation should be considered.

8. Guidelines and protocols for TCPA patients who should be transported must be individualized for each EMS system. Consideration should be given to factors such as the average transport time within the system, the scope of practice of the various EMS providers within the system, and the definitive care capabilities (that is, trauma centers) within the system. Airway management and intravenous (IV) line placement should be accomplished during transport when possible.

9. Special consideration must be given to victims of drowning and lightning strike and in situations where significant hypothermia may alter the prognosis.

10. EMS providers should be thoroughly familiar with the guidelines and protocols affecting the decision to withhold or terminate resuscitative efforts.

11. All termination protocols should be developed and implemented under the guidance of the system EMS medical director. On-line medical control may be necessary to determine the appropriateness of termination of resuscitation.

12. Policies and protocols for termination of resuscitation efforts must include notification of the appropriate law enforcement agencies and notification of the medical examiner or coroner for final disposition of the body.

13. Families of the deceased should have access to resources, including clergy, social workers, and other counseling personnel, as needed. EMS providers should have access to resources for debriefing and counseling as needed.

14. Adherence to policies and protocols governing termination of resuscitation should be monitored through a quality review system.

 

 

 

 

It is very important to understand the difference between trauma patients and cardiac arrests. A cardiac arrest patient has otherwise functioning organs and intact anatomy (namely intact vascular system). A trauma patient may have internal injuries or obvious injuries that result in blood loss and no matter how hard you compress, there will not be effective circulation. Hence the saying, "Fill the pump before you flog the horse".

 

I have done a lot of CPR on cardiac and trauma patients. I have also been sprayed in the face with Hepatitis C positive blood and been stuck with large hallow gauge needles during codes on patients with an unknown status. To anyone out there who says they would do CPR on someone without barrier protection, I guarantee they have never had to go through the hell of blood testing every few months to see if you have contracted a potentially fatal disease. (Fortunately, I'm clean.) I wouldn't even consider doing CPR on a stranger without gloves and airway barrier.

 

Assuming the right equipment is present, I'd try to revive an avalanche or drowning victim but a full on major head injury in the wilderness just isn't going to get better.

[Farrgo]

Latex gloves are completely inappropriate in a wilderness medical setting. Chances are if you come on somebody and you need to do body substance isolation, your gonna have to keep your gloves on for a long time. Try it, latex gloves get ripped to hell really quickly. Most first aid kits are coming with these nitrite (sp?) gloves now. There extremely durable and you don't have to worry about latex allergies.

[snoboy]

topically (as in laying your hands on a person with latex sensitivity) I have not heard of anaphylactic reaction (that does not mean it is not possible). I have seen one such reaction when latex gloves were used inside a known latex sensetive person during surgery.

 

I have heard of people experiencing anaphylactic shock due to latex gloves being used in the same room (I think they were powdered)!!

 

Here's some info:

 

link to ski patroller's viewpoint, and a personal story.

 

Tons of links on Latex allergy

[Dru]

FWIW when I did a wilderness first aid course several yrs ago the instructor pointed out if you start CPR you are going to have to keep it up until help arrives. If the nearest help is, say, 8 hrs away, you aren't going to be able to keep it going that long. So the response time provides one good way of figuring out if it is worth it to begin CPR. Discuss.

[jordop]

Latex gloves are completely inappropriate in a wilderness medical setting. Chances are if you come on somebody and you need to do body substance isolation, your gonna have to keep your gloves on for a long time. Try it, latex gloves get ripped to hell really quickly. Most first aid kits are coming with these nitrite (sp?) gloves now. There extremely durable and you don't have to worry about latex allergies.

My WFA course years ago spoke of the benefits of yellow dishwashing gloves for this purpose

[mattp]

I was taught the same thing, Dru.

 

However, while it sounds to me as if MtnEagle is probably right in suggesting there is little chance of reviving your victim whose heart has stopped due to rapid blood loss or blunt trauma -- especially if there is not going to be an ambulance on the scene within a few minutes -- what can you do? Do you want to be the guy at Vantage who essentially "pronounces" the person dead?

 

I don't know what to think about all the posts concerning the possibilities for becoming infected but, within the constraints of however we resolve that question, I think most of us will want to try to do what we can.

[Dru]

in all my first aid courses they indicate that no one is OBLIGATED to provide first aid except professionals like EMT's. i would have no problem being the one to say "don't waste your time" giving cpr to a guy with a massive head trauma or whatever. i appreciate that people want to help and will do some rather extreme things rather than admit someone is dead, but the "what if I could have saved him" factor does not really bother me - at least from my abstract position of never having had to tend to a serious injury or a fatality. i hope to keep it that way.

[David Yount]

Latex gloves are completely inappropriate in a wilderness medical setting. Chances are if you come on somebody and you need to do body substance isolation, your gonna have to keep your gloves on for a long time. Try it, latex gloves get ripped to hell really quickly. Most first aid kits are coming with these nitrite (sp?) gloves now. There extremely durable and you don't have to worry about latex allergies.

 

Nitrile Gloves. My favorite. Been using them for hazardous field work (superfund sites, nasty chemicals) for many years. You can purchase your exact hand size, they are super tough, and they don't degrade like latex does after months of storage.

 

"Latex products contain two types of compounds that may cause an allergic reaction - natural proteins (the biggest culprit) and added chemicals such as antioxidants. Synthetic rubber, such as vinyl, neoprene, and NITRILE, does not contain these allergens. "

[thelawgoddess]

in all my first aid courses they indicate that no one is OBLIGATED to provide first aid except professionals like EMT's.

you obviously don't live in the us. in some states you kind of are "obligated" if you have any training.