[Closed] CPR and basic life support

Zips ties, sounds like a good idea, the only alternative I carry that would be remotely useful is shoe laces in my shoes.

CPR, I'm all ears.

If you're carrying Asprin then Ventolin too? I've had a trip with the pompiers that would have been avoided had anyone had Ventolin to hand.

Did my 1 dayer EFAAW a few weeks ago and we were still taught DRABC and 30:2

The number of changes to the count for compressions and breaths since I was first taught is huge!  I was originally taught 4:1

I think  but I am sure Drac will correct me) that if you do not pause the chest compressions to do the breath the breath will not fill the lungs properly but its been shown the critical thing is the chest compressions as they also cause a bit of air movement in and out of the lungs - so outcomes are not much different if you do breaths or not.

edit - the other thing is lay folk like you and me will hopefully only be doing this for a few minutes until the pros arrive

Can one person do compressions while one does ventilation/breaths? I'd have thought the violence of the compressions would make it impossible to do a breath?

My First Aid at Work course booked for January, my license expired at the beginning of Covid. Already warned my boss that I have my own DNR list....

Did my full course in October as went out of date pre covid. 30:2 but feel free to not do breaths if too mashed up or risk of contamination (covid etc). As above I would suggest breaths while compressing would be very difficult. If in doubt stick to compressions only.
As for carrying pills, that was a big no. If for people you know then not as bad as you have more confidence in their history. I would never give it to Joe public. Call 999 and find the nearest defibrillator.
Tourniquets was a reintroduction for me. Trained on the them back in the day but then they got removed from our course 10 years ago.
None of this was employer specific as the course was clearly delivered and written for the rest of the world.

As above I would suggest breaths while compressing would be very difficult.

aye, that could be it then, hadnt thought of that.

As for carrying pills, that was a big no. If for people you know then not as bad as you have more confidence in their history. I would never give it to Joe public.

obviously theyd still be conscious at this point, so would you be in any bother if you gave it to them to take themselves and something went wrong?

If you’re carrying Asprin then Ventolin too?

isnt this an inhaler, and only prescribed to those that need it? so youre not likely to be able to include one in a first aid pack?

cheers

I carry aspirin in my emergency kit. I know I shouldn't really, but If they want it they can take it themselves.

Aspirin is a non prescription medicine.  Its legal to carry for emergency use

Ventolin is a prescription only medicine.  Its not legal to carry it for this or give it to anyone else unless you have prescribing rights

having said that I carry prescription only meds ( serious painkillers) and I would give them to someone who needed them on a " this is a serious painkiller, take it if yo want" and I would then have to face the consequences of doing so if anything went wrong

never had to do it yet and hopefully never will

IIRC the 300mg aspirin for a suspected heart attack is now considered part of normal first aid but not sure on the legality of giving it to somone else.  But again I would and face the consequences later.

On the tourniquet, I'd be hesitant to use zip ties other than a last resort on the basis that they'd be very difficult to release or cut when done right enough.

I'm not sure what the current guidance is but I've always been told that a tourniquet needs to be released periodically.

So many other things can be improvised like belts, shoe laces, rucksack straps, spare inner tubes. Pretty much anything you can make a strong loop out of.

Resus council is a good place to while away a few hours:

https://www.resus.org.uk/library/2021-resuscitation-guidelines

I’m not sure what the current guidance is but I’ve always been told that a tourniquet needs to be released periodically.

I believe that the advice on tourniquets has been changed - but I learnt that on here

I do however know that I have never been trained in the use of them and thus I would not use one.  I was trained to control bleeding with pressure on the wound including if needed using a strap twisted to increase the pressure on the wound site / pad you put over the wound so i would only do what I was trained to do

training in first aid is the critical thing.  I am only trained in basic first aid - I am not even a "first aider" under the various safety at work acts despite being a registered nurse

Going beyond that which you have been trained to do is problematic but as long as you can show you acted in accordance with the norm for a person with your knowledge you are OK legally

I would be held to a higher standard than a lay person but Drac would be held to a higher standard than me.  to establish if I acted appropriately the standard would be " did I have the knowledge / use the techniques expected of a retired nurse" Drac would be held to the standard of a highly trained paramedic

We are taught tourniquets go on and stay on until removed by a medical practitioner, no releasing pressure

What type of training Kilo?  What is your role?

Reasonably timely post. Unfortunately we (unsuccessful) had to perform CPR on my girlfriend's grandma a fortnight ago. Literally just dropped down dead aged 78. My girlfriend was raised by her grandparents, and we live with them on the family farm.

Any ideas/info on the long term effects unsuccessful CPR on a family member may lead to? I'm fairly concerned about what effect it will have on her. I had a dream a couple of nights ago where I was performing CPR on a corpse which was fairly grim 😒

I was told that one of the main drivers for the changes to breaths is just that it's pretty likely that it won't work- you need to get the airways right and do it right, and with everything else the actual success rate is apparently pretty poor so if that's the case, you're just missing compressions.

What type of training Kilo? What is your role?

It’s called Operational first aid, so (in theory)first response to traumas - catastrophic bleeds, shooting stabbing stuff. I am a minor civil servant

CPR - main reason for change is adults dont arrest from lack of oxygen very often, and if they do you're not likely to get them back with mouth to mouth. Also, as said, breaths often arent effective. Mouth to mouth doenst generate much pressure so wouldn't work with chest compressions going.

Sorry to hear that @Tom-B, must be horrible to do on family. I would say try find some professional counselling if it becomes longer term issue - maybe through work? , though being able to console yourselves that you did all you could might help, and time is genuinely a great healer.
With regards to cpr, think rationale is that giving breaths just break up the effectiveness of giving a blood pressure - I've done compression on people with arterial lines and can see the bp live, every time you change person can see it drop off and take up to 30 seconds to recover - think the impact that has versus a constant bp from continuing compression.
Impossible to give breath effectively while someone else jumping up and down on chest. Also, most people just don't give effective breaths as it's actually quite tricky to deliver, especially in random Non-Clinical environments.
Tourniquet not sure, but inability to release a cable tie might be an issue?

Over 30 years of workplace training and they keep changing the methods and amounts, such that I can never remember the numbers. The new trainers make it seem like the previous methods would have failed.

I guess it's expected that, during this period where people are waiting far too long for an ambulance to turn up, you're going to need more than one person to keep going for the long periods wait to give the patient a fighting chance.

My dad is part of a small group trained to use special CPR equipment in his village. It is passed around the members and they are "on call" volunteers that will rush out with the kit and use it until an ambulance turns up. That kit, and the volunteers, makes a real difference in an ageing population village.

As someone who has had to do CPR on someone very young and very close to me, I was very glad that I was well trained in CPR due to my work. The CPR was unsuccessful, but I know I did my best and at least that hasn't added to the grief/processing. I was trained and willing to do breaths and did initially but when the 999 call handler was put on speaker they told me just to keep going with the chest compressions and actually counted out loud to keep me at the right place.

Bottom line is anything you can do is better than nothing, but it is important to do proper chest compressions and not TV drama style ones.

Don't second guess yourself, but have an outline plan in your head and follow through with it, and keep going until the paramedics or equivalent are ready to take over.

@Tom-B re the effects of unsuccessful CPR, I would say just be careful about triggers. CPR is depicted surprisingly often in the media and sometimes quite lightly and is almost always depicted as miraculously successful. Either that or very traumatic. I find it quite hard to watch and it can set me off a bit. It's got better over time. The first time I had to go back to CPR training at work was hard too, and recently they updated the training with videos which were a bit more confronting (agonal breathing etc) which I found hard again.

The fact that you did CPR at all is a good thing so don't get tied up about minute details of what you did or didn't do, and worry that it might not have been perfectly efficient.

CPR - you will not be able to do the breaths when someone is compressing the chest by 1/3 and as you are supposed to achieve 60 compressions in a minute you have no chance of getting a breath in before they are doing another compression.

Tourniquet - I would suggest only using it if you have a means of releasing it, I could see a zip tie cutting in and you not being able to cut it off, assuming you have a means of cutting it off with you.

We are taught tourniquets go on and stay on until removed by a medical practitioner, no releasing pressure

thats what we were told last week too. i can see the thought process as to why periodically loosening may be a good idea (maybe prevent toxic shock syndrome by releasing a bit, then tighten again) but thats obviously not the case.

Also sorry to hear that Tom-B and meikle, you did your best.

we were told its difficult to actually make the situation worse, its always better to do something than nothing at all. even if its not the most effective method, itll still be better than doing nothing.

The Ventoline thing is odd. There are 900 deaths a year in France from acute asthma attacks. Our MTB club shares a hall with the football club. There's a defibrillator with instructions for anyone to use if someone has a heart attack but no ventoline for an asthma attack, and you're saying I couldn't give mine to anyone else in the UK (here I could - I'd be breaking the law if I didn't help someone I could).

I know there are risks associated with giving any medication. If someone is haemoraging and you give them asprin it's not a good thing. Ventoline isn't great if someone has a heart issue. But if someone is having serious difficulty breathing it could save their life. Soluped (spelling? ) too.

The last CPR advice I had was TJ's approach: don't worry about the air, they'll get enough, keep up the heart massage.

Edit: as I've explained on another thread I'm another CPR failure and it quite upset me. It's sometimes not as easy as depicted. Our victim probably weighed over 100kg. I'm about 65kg and the nurse with me was no more than 50kg. The victim was face down in the bottom of a ditch, we couldn't turn him over, wasted time trying to find a pulse or signs of beathing, eventually dragged him out feet first and all this time the clock was ticking... .

Tom-B, first of all well done for attempting CPR and condolences on your loss. By performing CPR you gave her the best chance of survival, however sadly sometimes it will not be successful. Survival rates in out of hospital cardiac arrest are low but without CPR there is no chance. Try not to think of it as unsuccessful CPR, you’ll have performed it well enough it’s just that the event was unsurvivable.

‘It's normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these improve naturally over a few weeks. You should visit your GP if you or your child are still having problems about 4 weeks after the traumatic experience, or the symptoms are particularly troublesome.’ from NHS website.

I’m sure one of the reasons compression only CPR was introduced was due to lack of bystanders not wanting to give inflations and so not performing any form of CPR.

As already linked above Resus Council will have good information. CPR is not hard to do and is a massively important part of trying to save someone’s life. Early defibrillation (if appropriate) is also very
important. Again it is easy, public AEDs will literally tell you what to do. There are many worthy schemes/charities to increase the number of public AEDs, it’s also not a bad idea to know where the nearest to your home is.

@Edukator - if someone is having an asthma attack serious enough to lead to a poor outcome, I would find it unlikely they could take in enough salbutamol via an inhaler to do anything helpful. The dose is tiny and relies on taking it effectively, nebulisers from ambulance / hospital has massive dose comparatively and is easier to take in.
Obviously, in crap situations anything is better than nothing but I genuinely cannot see it making a blind bit of difference unless exceptionally early on, and then it's not really an 'asthma attack' in my books.
Technically I couldn't give you mine I carry with me or I might lose my registration as I am a nurse and not a prescriber, so if anyone complained I'm outside my scope - I would however let you take it and support you administered it. Not sure if has been tested in law but think it's all based in preventing litigation 🙄

Any ideas/info on the long term effects unsuccessful CPR on a family member may lead to

I would strongly advise counseling.  Doing CPR is traumatic enough without it being on someone you love and couldn't save.  I can still remember breaking someones ribs and having to carry on for 25 mins hearing "crunch crunch crunch" and that was 35 years ago and as a nurse in ITU.  I changed career paths s a result of that and stopped working in the acute sector.

I do not know if there are people who specialise in this sort of trauma

Tourniquet for stopping flow to a limb with a belt or strap or to apply constant direct pressure to an open bleeding wound
I think the first was battle feild last chance situation only where blood losses were high and non stop. The preference was to apply a pad of some sort and compress the wound tightly to stem the bleeding if possible
It has been a few years since i did a first aid course so things may well have changed
Tom B. Its tough. I can still picture clearly the lady on the roadside a year ago going xmas shopping with her bright red lipstick and i didn't know her at all.

@Tom-B there is some useful info on this page about having performed CPR and suggestions of where can seek help:

https://www.bhf.org.uk/informationsupport/support/support-if-youve-given-cpr

It's strange isn't it @tjagain - I remember by 1st arrest, working as bank HCA while training as a nurse it was 26th December 1998 - likewise broke ribs but told carry on until arrest time arrived, it was unsuccessful. I then qualified and worked in ITU for 12 years, but still remember the 1st one, and many other subsequent ones both successful and otherwise

I'll feel less guilty about leaving my ventoline at home now, northshoreniall. 😉 I'm one of those naughty asthmatics who undermedicates. I only take the Becotide when I feel the need which may be every day or not for weeks. I can run, swim, bike, ski and be fine but sometimes not. Last attack I was posting on STW and thought "oh **** here I go". I thought I'd make it to the local pool about 100m away but put myself in the recovery position just outside the garden gate and waited for help.

I like the way you use "poor outcome" for death. 🙂

Any ideas/info on the long term effects unsuccessful CPR on a family member may lead to?

Sympathy to you all for that. Our first aid training told us that only 1 in 3 attempts at CPR are successful. At least you know you tried your best.

Daughter is a Young Leader with Rainbows (aged 5-7) and they had a first aid session last week, just teaching them how to get help if they find someone ill, as too small to do much at that age. I think a lot of cuddly toys had bandages and plasters applied. Important that first aid is a normal thing for everyone.

The preference was to apply a pad of some sort and compress the wound tightly to stem the bleeding if possible

A compress is obligatory in the first kit for ski-mountaineering races. If that doesn't work, tourniquet.

@Edukator - I am more of a do as I say not as I do asthmatic - often forget to take mine until chest goes tight them remember I'm asthmatic 🙂 I take Seretide daily if remembered then ventolin as needed (or when told to by wife) I would say recovery position not best choice if you cant breathe though - sitting upright to allow easier breathing would be optimal during an attack, but I'm likely telling you what you know already so will shut up.
I'm subtle like that, though was called Beverley (as in Beverley Allitt) by some biking mates for some reason.....

MoreCashThanDash sadly your trainer is being a bit optimistic:

Fewer than 1 in 10 people survive an out of hospital cardiac arrest.
Around 7–8% of people in whom resuscitation is attempted survive to hospital discharge.
Immediate initiation of CPR can double or quadruple survival from out hospital cardiac arrest.
Only 40% of people receive bystander CPR in the UK.
Defibrillation within 3–5 minutes of collapse can produce survival rates up to 50–70%.
Each minute of delay reduces the probability of survival to hospital discharge by 10%.
Fewer than 2% of people have an automated external defibrillator
(AED) deployed before the ambulance arrives.

Let’s use this thread to encourage anyone thinking about training to get it or thinking about a worthwhile charity cause to consider raising money for an AED. Actually what about that? I bet if someone could arrange a collection page we could probably collect enough to have a sponsored Singletrackworld AED by the end of the weekend? Sorry for suggesting this and not arranging it but I should really be getting some sleep after work last night, what is really encouraging to see is the discussion taking place and so many people clearly interested in wanting to help others, well done all 👍

sitting upright to allow easier breathing

I agree, I lie down at the point I think I'm going to pass out. I've only got to that point three/four times in my life. One day I'll work out what combination of alergens and pollution affect me so badly. It's always in the Spring.

Hedgehopper - it also depends on your definition of survival - I know two people who "survived" according to "were discharged"  Both died within a week of discharge  I wonder what the number reaching 5 years post resuss is.

Defibrillation within 3–5 minutes of collapse can produce survival rates up to 50–70%.

surely that should have the caveat " and were in a shockable rhythm" ?

tjagain you’re absolutely right, survival to discharge (and indeed survival to discharge with no lasting effects e.g. neurological) is a more valid statistic. Sadly the numbers will be worse than survive to hospital.

Again, correct about shockable rhythm (though the AED will determine that for you), those stats were from NICE and I think they were using data from the last Resus Council guidelines so hopefully there has been an improvement 🤞.

Tourniquet – I would suggest only using it if you have a means of releasing it, I could see a zip tie cutting in and you not being able to cut it off, assuming you have a means of cutting it off with you.

you wont be the one cutting it off tho, so no need to worry overly about that. we're told once on it stays on until taken off by a professional, so once in hospital theyd have the tools for that.
youre right about it cutting in tho, spose theres a chance itd be a bit toooo thin?

A tourniquet should be 4cm wide to reduce the risk of nerve damage. Tourniquets are only for used when direct pressure fails to stop the flow or there is serious blood loss eg arterial bleeding. If you do put a tourniquet on note the time it was applied

Sprootlet where have you heard that 4cm claim? I have a professional interest and I've never heard that before?? Nor have I ever seen a 4cm wide tourniquet...and I've seen LOTS. Also no one should be applying tourniquets unless life threatening exsanguination is present, so nerve damage perhaps not that high up the list of priorities?
Genuinely intrigued.

The ones in trauma kits are narrower than 4cm eg

https://www.steroplast.co.uk/stat-tourniquet-stat-orange.html

I do wonder if on the tourniquets we are at cross purposes

A tourniquet is applied closer to the heart than the  wound over a point where the main artery runs over a bone to close the arte

I was trained to use a strap over a wound pad on the actual wound and even to twist it up to get the pressure but that does not close off arteries.  In that case I would be using a tourniquet but not as a tourniquet.  does that make sense?

footflaps - that one is 3.5 cm wide

There’s a lot of bollocks spoken by some 1st aid tutors.
Tourniquets- in 12 years as a full time ambulance paramedic I never used one- the type of injury in which they are useful is vanishingly rare in civilian prehospital care, (although city centre stab injuries are a subset I wasn’t particularly exposed to) but they may be life saving if applied in the right circumstances- US soldiers in Afghanistan had them pre applied to limbs to self/buddy care in the event of IED blast injury. Almost all bleeding is controllable with sufficient direct pressure. Please don’t use a cable tie- at the tension needed it would likely be through the skin before hospital arrival and would be very hard to get a tool under to cut. If you must, a loop of fabric tightened with a stick or similar in a windlass fashion provides pressure and is releasable.

CPR- don’t worry about ratios, continuous compressions at 100/min 1/3 depth of chest and allow recoil between each compression. Get a defib, follow the instructions, you can’t harm the patient.

I think the only group I’d consider mouth to mouth would be children who tend to have hypoxia arrests, and drowning victims.

Tom (paramedic/advanced clinical practitioner in emergency medicine)

Oh, and for a MTB specific example of excellent 1st aid find Cedric Gracia’s femoral artery injury in YouTube!

Had my forestry first aid refresher recently that focuses heavily on extreme bleeds and crush injuries.

The time for applying a tourniquet has reduced since my last course and is only really for crush injuries to mitigate toxic shock. Once applied, it's for professionals to remove. Trainer also showed the importance of not buying cheap, the copies snap before they stop anything.

Big bleeds can be dealt with several ways through use of Celox type products in a few minutes. This ideally negates the need for a tourniquet and it's issues.

CPR wise, anything is better than nothing and our industry is pretty remote.

I used to volunteer for the Forestry Commission and had the chance to do their first aid course "focusing on severe bleeding and amputations" was how I think it was referred to.

Couldn't go on the course, but luckily the ranger did, as I needed stitches after an unfortunate billhook/thumb interface!

Chest compressions move a small amount of air in and out of the chest, if the heart isn't beating then oxygen requirements are actually fairly minimal. With rescue breaths some of the air will also enter the stomach, continuous rescue breaths would increase the risk of the patient vomiting (no bueno). ALS (advanced life support) involves continuous breaths however this only 'begins' once an airway has been inserted that ensures air will only enter the lungs