# There's a New CPR



## Yrys (18 Jul 2007)

Did the CF change it's CPR ?

http://www.msnbc.msn.com/id/19762047/site/newsweek/



> July 23, 2007 issue - The good news: millions of Americans know how to perform CPR. The bad news: when confronted with an apparent victim of cardiac arrest, most bystanders won't do it because it includes mouth-to-mouth breathing.
> 
> Now Dr. Gordon Ewy, director of the University of Arizona's Sarver Heart Center, is championing a new form of CPR called cardio-cerebral resuscitation, or CCR, which focuses on rapid, forceful chest compressions, about 100 per minute, minus the mouth to mouth. "Mouth to mouth inflates the lungs, but it's not the lungs that need oxygen, it's the heart and the brain," says Ewy. "Chest compressions alone will help save those organs."
> 
> ...


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## Bzzliteyr (18 Jul 2007)

well we just did the first aid course and the compressions did change from what I learned a few years ago..it is now 30 compressions to 2 breaths..


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## PMedMoe (19 Jul 2007)

Yep, 30 hard and fast compressions and two breaths of one second each (changed from two seconds).  Not a lot of time to see if the chest expands, eh?  Another change is not checking the pulse if you are not trained to do so.


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## Civvymedic (19 Jul 2007)

It was found that CPR providers were over ventilating and under compressing. The focus is now very strong on Compressions for better overall circulation and "priming" the heart to facilitate Defibrillation. In the Civvy world where I work the emphasis is so strong on proper compressions that we have devices that lay over the chest to monitor compression rate and depth and a computer graph as a visual guide on the cardiac monitor with sometimes annoying voice prompts. "Harder"  "Faster" Deeper" etc.  : It makes for some interesting discussion and glances from the public but it actually works very well.


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## PMedMoe (19 Jul 2007)

Civvymedic said:
			
		

> "Harder"  "Faster" Deeper" etc.  : It makes for some interesting discussion and glances from the public but it actually works very well.



  I bet you get some comments/glances!!


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## Civvymedic (19 Jul 2007)

Oh yes. We have actually been able to turn our voice prompts off and just use the visual graph. The Fire Dept.'s in our area have kept theres though. It can get quite comical at a most inappropriate time, and for whatever reason it's programed very loud.


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## PMedMoe (19 Jul 2007)

Civvymedic said:
			
		

> and for whatever reason it's programed very loud.



Probably if it's very noisy and chaotic on scene.  Otherwise, you might not be able to hear it.


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## Civvymedic (19 Jul 2007)

True. Thats what we figured but it could be a wee bit more discreet. I mean it belts out the statements. Actually some systems have an earpiece for the compressor to use so only that person hears it. Probbably the best way to go.


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## Bzzliteyr (19 Jul 2007)

We were informed in Quebec that we aren't allowed to use an automatic defibrillator if we are not trained on them.. kind of funny how this province is...


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## HItorMiss (19 Jul 2007)

Last update I had on CPRit was mentioned that we were no longer to do AR in a cariac arrest situation with a single rescuer. I was a bit taken a back by that but when I did some research on my own I know understand.


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## Armymedic (19 Jul 2007)

The recommendations came out in 2004 by American Heart and Stroke, but were adopted by Red Cross for FA in 2006.

15,2 vs 30,2...Really, does it matter? Not a whole bunch... as long as air is going in, and blood is going round and round.


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## X Royal (19 Jul 2007)

As a St. John Ambulance F/A & CPR Instructor we teach the 30 to 2 compressions to ventilation ratio. For those who are uncomfortable with the "mouth to mouth" portion the no ventilation method is an accepted alternative. Compressions without ventilations is still better than no CPR. Many people will be uncomfortable giving "mouth to mouth" to unknown people or people they suspect may not be healthy without barrier devices (pocket masks ect.). Compressions & ventilations are still the best, but self protection is important. Barrier devices are a simple safety measure.

Best Wishes: Rick


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## Yrys (19 Jul 2007)

Bzzliteyr said:
			
		

> kind of funny how this province is...



It may be coming from the laws that we have here, French ones, instead of English ones.

From Wiki :



> Quebec law is unique in Canada because Quebec is the only province in Canada to have a civil law system.


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## Northern Ranger (19 Jul 2007)

Here in NWT we must be trained on a automatic defibrillator, once trained we must be certified by a MD.


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## ArmyGuy99 (30 Jul 2007)

Back in Ontario anyone can use the AED's now, thanks to superb stupid proofing of these devices.  The ont gov't changed the legislation a few years back, and now there is an AED at every school, pool, museum, places of work etc........ Of course unless you know how to do CPR as well, not much is going to happen. Since there are only a few shockable rythyms, and asystole or no heart beat is not one of them. You'd better know how to do Compressions.

as for not doing AR as well.  I agree that the protection of the First Aider is important, and so is getting oxygen to the brain.  I like that the protocol is now up to the first aider IF THEY want to take that risk.  I for one won't, but then again I keep a mask in my F/A Kit.


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## medaid (30 Jul 2007)

ArmyGuy99 there's only 1 rhythm an AED is programmed to recognize and shock and that's V Fib.

Also, first-aiders always had a choice when it came to vents. To do vents and CPR or NOT to give care. The option has always been there. Also, that's only a St.John's thing with regards to no vents straight compressions. Red Cross doesn't have that at all.


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## Armymedic (30 Jul 2007)

MedTech said:
			
		

> there's only 1 rhythm an AED is programmed to recognize and shock and that's V Fib.



Interesting. As I do not play AEDs, I did not look into the theory of use for them that much, I did not know that. 

Not V Tac?


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## kratz (30 Jul 2007)

I know the MP's are deploying the Zoll AED Plus  in their patrol cars and the CF Fire Trucks are carrying Medtronic's Lifepak 500. I know that AED is now allowed to be used without training in 8/10 Canadian provinces, though yearly recertification is encouraged. The CF policy on AED use has not been updated yet, so retraining an being signed off by a designated MO is still required.


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## medaid (30 Jul 2007)

St. Micheals Medical Team said:
			
		

> Interesting. As I do not play AEDs, I did not look into the theory of use for them that much, I did not know that.
> 
> Not V Tac?



Ya apparently it's the only rhythm that it shocks, and it's the one that more closest and I guess easiest to being achieved after compressions. Hence... I guess that's why laymens get a defib for only 1 rhythm. 

That's what's been taught to me  maybe not the laymen's parts... and that's what I've been teaching my students.


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## medic45 (30 Jul 2007)

An aed will also recognize and shock ventricular tachycardia.  In theory if you applied to a person in VT who was still perfusing it could and would recognize and shock VT in a pt with a pulse.  That is why aed's are only indicated for pulseless patient's.


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## medic45 (30 Jul 2007)

For the purposes of ACLS ventricular fibrillation and pulseless ventricular tachycardia are treated the same.


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## MedicStudent (3 Aug 2007)

MedTech said:
			
		

> Ya apparently it's the only rhythm that it shocks, and it's the one that more closest and I guess easiest to being achieved after compressions. Hence... I guess that's why laymens get a defib for only 1 rhythm.
> 
> That's what's been taught to me  maybe not the laymen's parts... and that's what I've been teaching my students.



medic45 is correct on the fact that AEDs will recognize V-fib and V-tach. The use of an AED is indicated in a patient who is unconscious and not breathing "normally" when used by a lay responder now though so it's not just for pulseless anymore technically (although we sure hope that they are). 

Since the AED will recognize V-tach it is extremely important to pay attention to the prompts on your machine so that you don't miss when it tells you to stop CPR as it begins the analysis. Much like being in a moving vehicle can look like V-fib, having compressions done create artifact that looks like V-tach.


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## ArmyGuy99 (7 Aug 2007)

MedTech,

You were right, I misread my notes, the AED's for Civi and most other uses only shocks V-Fib, but V-fib is not the only shockable rythym, just that the others are for ALS and Doctors to take care of.  Either way, I'm glad it's in our tool box to use.


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## medaid (7 Aug 2007)

ArmyGuy99 said:
			
		

> MedTech,
> 
> You were right, I misread my notes, the AED's for Civi and most other uses only shocks V-Fib, but V-fib is not the only shockable rythym, just that the others are for ALS and Doctors to take care of.  Either way, I'm glad it's in our tool box to use.




Hahaha I'm glad I wasn't completely out to lunch, if I was I would've handed my cert. back in disgrace...


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## MedicStudent (7 Aug 2007)

ArmyGuy99 said:
			
		

> MedTech,
> 
> You were right, I misread my notes, the AED's for Civi and most other uses only shocks V-Fib, but V-fib is not the only shockable rythym, just that the others are for ALS and Doctors to take care of.  Either way, I'm glad it's in our tool box to use.



I can't speak in regards to the AEDs that you were taught on, but current AEDs will shock both V-fib and V-tach. A popular model for use by the public is the Zoll AED Plus (http://www.zoll.com/product.aspx?id=75). From their technical sheet on the device (http://www.zoll.com/uploadedFiles/Products/AED_Plus/9656-0158_0706AEDPlusTA.pdf):


> Defibrillation Advisory:
> Evaluates electrode connection and patient ECG to determine
> if defibrillation is required. Shockable Rhythms: Ventricular
> fibrillation with average amplitude >100 microvolts and
> ...


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## X Royal (12 Aug 2007)

ArmyGuy99 said:
			
		

> Back in Ontario anyone can use the AED's now, thanks to superb stupid proofing of these devices.  The ont gov't changed the legislation a few years back, and now there is an AED at every school, pool, museum, places of work etc........



 In Ontario the use of an AED is still a delegated medical act requiring a doctors authority for the user. There has been talk of deregulating the use of the AED in Ontario but it still has not happened. Currently now if your authority to use an AED is for your workplace you are not covered to take the AED off the company property to help some across the road.
 As for AED's being at every school, pool, museum, place of work ect.. , thats still a long way off. Although some places of work do now have them, far many more do not. As for schools and recreational places it is up to the local authorities if they wish to spend the money on the equipment and training. Unless AED's are mandated by law they will never be in all the listed places. Some places will install them, while others will not or can not afford the cost.


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## MedicStudent (12 Aug 2007)

X Royal said:
			
		

> In Ontario the use of an AED is still a delegated medical act requiring a doctors authority for the user. There has been talk of deregulating the use of the AED in Ontario but it still has not happened. Currently now if your authority to use an AED is for your workplace you are not covered to take the AED off the company property to help some across the road.
> As for AED's being at every school, pool, museum, place of work ect.. , thats still a long way off. Although some places of work do now have them, far many more do not. As for schools and recreational places it is up to the local authorities if they wish to spend the money on the equipment and training. Unless AED's are mandated by law they will never be in all the listed places. Some places will install them, while others will not or can not afford the cost.



In regards to AEDs being a controlled act in Ontario, it depends on how you interpret the current legislation. From my interpretation, it is quite clear that when used as first aid in an emergency situation (i.e. someone who is in cardiac arrest), it is not a controlled act. The Heart and Stroke Foundation is also of the opinion that it is not a controlled act. 

If it were then who would be allowed to use the public access defibs that are in places like airports?


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## X Royal (16 Aug 2007)

MedicStudent said:
			
		

> In regards to AEDs being a controlled act in Ontario, it depends on how you interpret the current legislation. From my interpretation, it is quite clear that when used as first aid in an emergency situation (i.e. someone who is in cardiac arrest), it is not a controlled act. The Heart and Stroke Foundation is also of the opinion that it is not a controlled act.
> 
> If it were then who would be allowed to use the public access defibs that are in places like airports?



The Chase McEachern Act (Ont.) was passed on 04 Jun 07, but to the best of my knowledge it is yet to receive Royal Ascent. This act in Ontario will protect those from liability who attempt to use an AED during a life threating situation while in a place with a public accessible AED. It will also protect the provider of the AED as long as the AED has been properly looked after.
It is generally thought that AED's without training are of little use(see studies published on the Ont. Ministry of Health web site).
This protection is not guaranteed within the private workplace or for someone to buy their own AED & carry it around. Proper training is & med. authority are still needed. The Ont. Ministry of Health web site is a good resource for info for Ontario. Every place that I'm aware of that have AED's available have also taken the time & expense to train the people most likely to use them.


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## sonardork (16 Aug 2007)

I just finished my First Aid and CPR today in Victoria. According to BC laws, AEDs are not to be used by untrained/uncertified people. We had a demo, and from what I understand it is not designed for "starting" a heart rather to "stop" it from abnormal rhythms followed by chest compressions when prompted allowing you to "prime the pump" for starting on it's own. Our instructor said a 2 hr SJA course will certify you to use it (in BC) however the CF Surgeon General has yet to sign off on any policy for the CF. From the demo (and SJA video) it seems like a dead simple piece of kit to use [no pun intended]. Those SJA videos, and CF ones for that matter, always make me laugh though....such great acting


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