CPR supplies, and CPR discussion

[lummox]

a friend of mine is a paramedic. his station is participating in a study about cpr. they have learned that 'perfusion' drops when chest compressions are halted for the mouth to mouth shizzle. it seems to be more effective to just pump the fukers chest. there is some air flow in the lungs just from the compressions.

i say hang out with people who wont need it.

[mneagle]

As of 2-3 years ago when I last certified, Vermont was the only state that had an obligation to perform CPR law. Nearly every other state has a Good Samaritan law which protects those from performing CPR from lawsuits.

 

I should add that BLS (basic life support) is what most people are taught. MD's, EMT's, RN's are mostly taught ACLS (advanced cardiac life support). ATLS (advanced trauma life support) is usually only taught to medics, ER doctors and surgeons. It is quite a bit more complicated and requires loads of medical gear to do right. If medics can arrive soon to a trauma, then start BLS but with one change. Step 1 (airway) is different in ATLS than BLS as traumatic C-spine injuries are common. To do it right without a C-collar, have a second person lay on the ground and place their hands on either side of the head. Whatever happens, that person cannot allow the head to move. Under no circumstances should you thrust the forehead down to put a victim in the sniffing position like often instructed in BLS.

[chris]

This is a great thread that proves the need to go out and take WFR or WEMT courses. The Wilderness components address issues like remote care and when it is appropriate to stop providing care.

 

FYI: The Wilderness Medicine Society Practice Guidelines For Wilderness Emergency Care, edited by William W. Forgey, M.D., states that CPR does not need to be initiated when

 

1) vital signs are detected

2) there is a danger for rescuers

3) dependent lividity is present (that's the pooling of fluids in the body, typically 4 after death and lasting 12-24 hours)

4) rigor mortis

5) obvious lethal injury (decapitation, significant bleeding, massive trauma, etc.)

6) a well-defined DNR status (your partner tells you he has a DNR form in his medical record and his wife knows it too)

7) a patient with a frozen chest (CPR is ineffective without adequate chest movement)

 

If you do start CPR, the WMS states you can stop when:

1) resuscitation is successful (now go get a beer)

2) RESCUERS ARE EXHAUSTED (emphasis is mine)

3) RESCUERS ARE PLACED IN DANGER

4) patient is turned over to more definitive care (typically, someone with more training who is willing to take responisibility)

5) PATIENT DOES NOT RESPOND TO PROLONGED - APPROMIXIMATELY THIRTY MINUTES - OF RESCUSCITATIVE EFFORTS

 

This is an excellent book for the definitive standards in wilderness - not urban - medicine. Copies can be purchased through the Wilderness Medicine Institute of NOLS online.

 

Negligence can occur if and only if all four issues are proven:

1) A Duty to Act existed - when the injured and the care-giver have established a relationship where the care-giver was responsible for the safet and mideical care of the injured

2) Breach of Duty - the care-giver then does something, either by action or omission, outside of the existing stadard of care (defined as the care one would expect to be given in similar circumstances by similarly trained individuals)

3) Physical or Physchological Injury - a definable injury then occurs

4) Cause - the care-giver's breach of duy directly caused the injury

 

Obligation to create a Duty to Act is different from State to State. Typically, those of us with at least an EMT - Basic or higher training do have an obligation. Also, if you are leading a group on a trip, you have already created a duty to act. While every state I'm aware of has Good Samaritan laws protecting layman (and that typically covers those with First Aid training but not operating in a professional or leadership capability as well), I believe Vermont actually has a "Good Neighbor" law, in which the first person at the scene of an accident or medical incident is required to stop and give aid, even if it is just comfort, until professional assistance arrives.

 

Don't "Geek out" on the legal issues too much - to date, there has never been a negligence suit attempted against someone in a wilderness setting.

[foraker]

As I recall during my Wilderness FA class (taken in Sydney Australia) was that even if you revive someone with CPR, unless they are within quick access of advanced cardiac care, then their chances of ultimately surviving are very very slim.

They weren't saying that this so that you wouldn't try to save someone's life, more so that you wouldn't beat yourself up afterwords over whether or not you'd 'done enough, soon enough or done the right things'.

 

That said, for those who say 'just read a book', I have to say that that is simply not sufficient. A well-run wilderness first aid class immerses you in this stuff for at least a week and includes running numerous scenarios. The course I took, they created accident scenes and basically dumped you into the middle of them. It took pretty much everyone at least two days of this to stop freaking out and freezing up when coming upon an accident scene. I don't think you learn such things from books. For example, our last scenario was for 3 people who'd fallen off a cliff. It was basically a night extraction scenario. They cut it short and we were still out there for 7 hours. Learn that from a book...:

[Farrgo]

The entire problem of when or when not to do cpr really boils down to whether or not you are putting yourself in danger by performing it. This includes the fact that if you are deep in the backcountry and there is basically no chance that anyone will come by, then you simply cannot keep doing cpr indefinately. Although, does that mean that you don't start doing cpr and continue to do so up until you need to stop for your own safety? I agree that there are some injuries where if someone needs chest compressions, they are not going to be revived (i.e, a huge fall), but there are circumstances where cpr is completely appropriate (lightning).

 

Just based off the training I've had I'm always going to give cpr for as long as I can just on the off chance that something miraculous happens.

[Blakej]

It seems that most of you carry some sort of protection on a regular basis but even if your stuck with out it can you really see just standing there and watching someone die while you potentally can prevent that. The percentage of people in the US with potentially life threatining diseases that you may contract from cpr is relatively low and as for if the guy is a victum of trauma or not if he's already dead what can it hurt. unless your a well trained medical professional who knows what hes looking at better to err on the side of caution.

[SmokeShow]

I've been told that it isn't uncommon for CPR to cause vommiting in certain situations and the shield helps block any upheaval of nastiness.

[Kevin_Ristau]

In a wilderness setting, if you are prepared to start CPR, then you should be prepared to stop it as well. Most people are taught to perform CPR until help arrives, which may not be feasible for the kind of scenarios we are talking about.

 

The vomitting usually occurs as a result of successful CPR where the patient's heart starts beating on its own again. There is usually a lot of vomit. Protection is a good idea.

If the patient recovers a pulse, this does not mean that they are out of the woods. They must be constantly monitored, and even if they do recover a pulse they probably won't be breathing on their own.

 

If you do decide to start CPR, remember that you are primarily providing an oxygenated blood flow to the brain in order to prevent loss of brain cells, which begins to occur after five minutes without blood flow.

 

CPR is hard work, physically and emotionally. I have been lucky enough to get a pulse back in a couple of patients, and my crew was involved in a case a year ago whereby one lucky lady made a 100% recovery. It is a very gratifying feeling to be a part of something like that. We lose at least as often as we win, probably more, and most of the time the recovery is not complete.

 

Take a course, learn the skills - not just CPR.

Read Medicine for Mountaineering.

Be safe.