Follow Up Comment to Chest Injuries and CPR

I received a question from a person who after watching the “Chest Injuries and CPR” video blog asked:

Dear Roy,
Reading your letter, I would agree if the injury is just soft tissue injury. However if a # is suspected, It would be dangerous to do CPR as the # might or will puncture the lungs and cause immediate death, if immediate intervention is not available.
Kindly comment.

Bent Steering Wheel From Drivers Body

Here is my response:

Hello,

Regarding your question about Chest Injuries and CPR. It’s important to make a distinguishing point whenever we talk about CPR. When a person is in need of CPR, it means that the person is in cardiac arrest. This is to say that they are unconscious, not moving, not breathing normally. If this is the case, they are presumably in cardiac arrest or in a state that justifies Cardio Pulmonary Resuscitation.

If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death otherwise known as biological death(permanent).

This is why, regardless of the chest injury, if the person is “dead” or in need of CPR, compressions are to be given per the American Heart Association guidelines even if the complications could include those of punctured lungs, lacerated organs, or bruised/punctured heart muscle. This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.
If however, the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and complicate the victims injuries. As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services would be contacted and CPR would be initiated regardless of the injuries of the patient.

I appreciate the question and hope that this clarifies any confusion caused by the article. Please don’t hesitate to email me again if you would like to continue dialogue on this subject.

Best Wishes,

Roy Shaw, RoyOnRescue.com
royonrescue@gmail.com

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

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

RoyOnRescue Answers Question About Assessing Breathing

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

How Can A Child Do CPR?

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

2010 CPR Guidelines Update – Activation of EMS or Calling a Code

In this episode of RoyOnRescue, Roy Shaw visits the new 2010 CPR guideline update regarding activation of Emergency Medical Services and calling a code. Be sure to watch this episode to get the latest guideline release covering this subject.

2010 CPR Updates -Compression Only CPR

Hello Everyone,

I’ve been debating on trying to post this before the weekend and now I’m sure I should. It’s not going to be short but I will try and get too the point.
There is a lot of talk going on about Compression Only CPR and how it rivals traditional CPR. I’m going to shed some light on the technique and try to sneak in a bit of synthesized science to help understand what it is and what it’s not. Hold on to your seat…hear we go!

2010 CPR Update Series – 911 and Dispatcher Changes

This 2010 CPR update training, I take a look at the 911 and Dispatch Changes.  The biggest takeaway from this change is a simplification for the rescuer who is calling 911.  The dispatcher is going to ask a series of questions to determine if the victim is breathing or “Not”.  Not, can mean not breathing at all, or could mean not breathing normally(Agonal or gasping).  Upon this finding as well as deciding if this victim is in cardiac arrest due to asphyxia or medical condition like cardiac disease will change the directives the dispatcher will give to the rescuer.

Watch this RoyOnRescue video to help understand the difference between 2005 and 2010 and why the change was made.

2010 Latest CPR Guidelines Released!

Roy Shaw, EMT-Paramedic and Instructor Trainer for ProTrainings.com has embarked on a quest to cover all of the important updates and topics related to the new 2010 ECC/ILCOR and American Heart Association updates which are in the process of being released and communicated via email, news, TV, blogs, twitter, Facebook and any other means of communication you can think of. Only one problem, many CPR instructors haven’t been told how to handle them yet! So after many emails, phone calls and questions, Roy Shaw has decided to work through the updates topic by topic and give the old and new standards, his take on them and then open them up for converstaion. So if you’re looking for some insight on how to handle the 2010 CPR changes, look no further.

Person Falls Face Down, Unresponsive!

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.

Why are there questions on the ProCPR Test that aren’t on the Videos?

For those of you who have wondered why ProCPR has test questions that aren’t covered on the video trainings, here is your answer.  Roy Shaw, Paramedic and Instructor for ProCPR.org explains the answer to this question and has some good news at the end!