Using resuscitation mask in water

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Im opting for mouth to nose in water. Masks can be a complete pita to seal.

(obviously this depends on distance to shore or boat - better option maybe to just tow to land if its not far)

 

[Charlie59]

How many people carry a rescue mask on every dive? I don't. Guess that would leave mouth to mouth.

Recent study did show better survival without artificial respirations, but in that case chest compressions were being performed. Chest compressions do not exist in the water.

We do not exhale enough CO2 in our breathing to be of significant consequence during mouth to mouth ventilation.

 

[ScubaFreak]

rumor or not the bellows effect brings in O2 where our breaths bring in CO2 ... enough said?

not really relevant.
The body uses 4% oxygen with every breathe, We exhale 17% oxygen, the Co2 is not a big deal here.

I agree with trtldvr in towing the diver from above, using 2 hands on the mask ensuring a good airway opening.

for the record i do carry a mask on every dive in my BC pocket...

 

[logos]

I have heard that rescue breathing may actually be on the way out altogether.

I understand that an experimental protocol in one metro area EMS has tried continuous fast compressions (100+ per minute) with no breathing, and patient survival rate increased. The thought here is that the chest compressions are also causing a bellows effect on the lungs resulting in adequate air exchange.

This might be an unfounded rumor, anyone else hear anything along this line.

Not a rumor at all. The study you refer to was the reason the new AHA CPR recommendations were instituted ("new", guess its been a couple of years now). Its becoming pretty clear that the old "ABC" was way off and should have maybe been "CAB". That is, outcomes with compressions alone are probably about as "good" as with breaths and compressions. The current guidelines still call for breaths, however, they specifically say that compressions are #1 and should not be held if at all possible, even if it delays things like securing the airway. Compressions are no longer held for breaths either if the airway has been secured.

 

[mavdog]

For Cardiac Arrest (CPR) Defibrilation is number one, Circulation Two, Breathing three. They got to be out of the water to get zapped. Rescue Breathing is something different the Heart is still beating. The kicker is one does not do CPR on people that are still alive. So its better to do anything than nothing at all.

 

[Oddsnends]

I am an EMT who is currently taking the PADI rescue course. I must say I nearly fell off my sofa when I saw the DVD demonstrate in water rescue breathing with a pocket mask. Maintaining a good seal with a BVM under ideal conditions requires a good deal of attention. If we have enough manpower the preference is to have 2 people managing airway and breathing; even then, the preference is to insert devices to prevent airway obstruction and achieve intubation ASAP.

It seems the main advantage (beyond barrier protection) to using the pocket mask is preventing the entry of water into the mouth and nose; correct me if I am wrong.

Concerning compressions vs respirations, here are a few reasons why continuous compressions are being suggested.

1) Studies have shown one reason people hesitate to render aid is because mouth-to-mouth puts them at risk. I read one study that said only 15% would be willing to do mouth-to-mouth. Meanwhile heart and brain tissue are going hypoxic.

2) People who don't do it every day have a helluva time finding a pulse or determining if it is absent. This wastes time, adds confusion as to how to proceed, leads to stress and errors. Meanwhile heart and brain tissue are going hypoxic.

3) A common public mis-perception is each time you compress the heart, blood circulates. This is not quite correct. The heart pumps at 60 or so bpm for a reason. It is struggling to maintain a pressure gradient. The signs and symtoms we call "shock" are the results of the body's attempt to maintain this pressure gradient. When the heart stops this pressure gradient falls to nothing. When we do compressions we need to build this gradient back up. The more proper compressions you make in a row, the higher this "perfusion pressure" gets. Every time you stop (rescue breaths, etc) the perfusion pressure plummets. You need to get into the high teens of a compression series before you are getting modest perfusion to the brain. This is assuming you are doing everything right, which you won't, because you will be scared out of your mind.

 

[deepblueme]

Not to start a dust up but...

In water chest compressions used to be taught years ago. Way back in 1981 when I was a little diver I took the YMCA SLAM class and we had to show that we could do them along with rescue breathing.
It is done the much the same way as the Himelich(sp) just higher up on the chest.

Now I am not TELLING anyone to try this I just see alot of people saying you cant do it.
It works much better on a hard surface.

I taught my students mouth to mouth over a mask after I found a mask in its case floatin in the middle of the lake, wasn't doing the owner much good out there.
I do like the mask for use once you have reached shore.
How many have an O2 bottle and defib machine when they dive?
You need to learn to live with what you have and be ready to deal with it not working even if you do have it.
Any idea just how long that o2 first aid bottle lasts?

Alot of it does have to do with how many peeps you have on hand to help and how far do you have to tow to shore.


All I have left to say is hope I never have to do it again.
Paniced divers are hard enough.

 

[Al Mialkovsky]

How effective are rescue breaths alone, even on dry land?

If I'm not mistaken many countries have done away with rescue breathing already.

 

[String]

The rationale for the new (BLS 2005) recommendations are it was found that with compressions they only started to become effective after about 10-12 cycles so the old 15:2 ratio meant only 3 effective ones before starting all over hence 30:2

In water reason for not doing compressions was given that the blood probably has enough oxygen in it to last a while anyway and compressions are useless in water and more effective on land so the priority now is to get the casualty out of the water without wasting too much time rescue breathing - if they have no pulse its not going to do anything anyway and if they do have a pulse there is enough residual oxygen dissolved to last a while. Breaths generally recommended if its more than a few minutes to shore or boat.

Also worth noting that for sudden cardiac incidents defib is the only real fix and getting that ASAP is priority. However, drowning/near drowning are one of the few incidences where compressions can actually fix the problem so its worth trying.

Nobody now recommends to look for a pulse - too hard to find especially in a cold person. You treat as if none until proven otherwise.

I don't know of anyone that gets rid of artificial ventillation totally. All the last recommendations did was combine CPR and AV and invent a name for it (rescue breathing).

 

[Bob Vincent]

I've did AR 2 times for real. One the 1st time without a mask. The 2nd with a mask. I trained with the mask and had no problem when having to use it for real. I did like alot less water intrusion with the mask. I also like the nasty thing that happens not entering my mouth. A mask is easy to flush instead of me sitting there and ... I think you know. Plus not loosing time trying to compose myself.

I think it would be better to haul the victim in faster. But until the Red Cross changes the official way we do things we are stuck doing it the official way. Remember we are under watchful eyes and depending on your Cert you might think about what happens when the dust settles. I know I'm going to "catch it here" but it's true. Your like I have to do this right the life of that person is in my hands. Then on the flip of the coin your screaming 1 - 1000 ... to make sure your doing it by the numbers so everything is right. I want everyone hearing me in case there's ever any questions. I hate to say it but as a diving professional you still have to cover ones own butt.