Rescue Breath

[DomaNitrogen]

Before i start the post i would like to emphases that I am interested in the theory i dont intend to practice this method if an emergency occurred. And secondly I am not sure if this is the right area to post

I was reviewing my rescue book and I stopped at unconscious diver at the surface who is not breathing. at that point you have to give rescue breath every 5 sec either mouth to mouth, snorkel or using a pocket. Each method has it's advantages.

What if at that point rather then give a breath use the regulator either yours or the victim and every five seconds give a short purge.

In theory this would make the tow much faster and less complex and will work as splash guard.
Also in theory this could cause an issue if the regulator free flows or you give to much gas.
Also if the regulator is not sealed in the victim mouth the air might escape.

I would like to hear about your thoughts ?
is this practice implemented in any agency?

 

[S. starfish]

I'm pretty sure that using the reg would be less effective as a lot of the air would just go out the exhaust. Maintaining an open airway, making sure the unconscious divers lips are properly sealed around the mouth piece and hitting the purge seems like it would be a onverly complicated process as well.

 

[bmcsteve]

not to mention the risk of overpressurizing the lungs which could cause a pneumothorax, inflating the stomach and eventually wearing / swimming in what ever the victim had for breakfast.:looking_a

 

[TSandM]

The biggest problem is that the pressure needed to open the exhaust valve is lower than the pressure needed to inflate the chest. Therefore, gas will preferentially exit the regulator into the air, rather than ventilate the diver.

We could get into the utility of continued rescue breaths, but that's been discussed before, and fairly recently. But a regulator is not a ventilator, and cannot effectively be used as one.

 

[Thalassamania]

If your concern is speed of transport, mouth-to-snorkel permits very rapid progress through the water.

 

[Gene_Hobbs]

This is an interesting question and similar to one that is getting some attention currently because of the recent changes to the AHA CPR and ACLS guidelines. Below are some of the references I put together for the UHMS Diving Committee when questions related to these changes first came to us. We drafted our thoughts and returned them to the agency that requested them (there should be more from this soon).

It is also worth note that the AAUS will be hosting a "Dive Rescue Workshop" in 2008. This should lead to further interesting discussion on this and similar topics.

For the OP, the Poulton et. al. article below will be of interest. Lynne, I added the LMA abstract for you. :blinking:

Feasibility study of CPR in the water.
March and Matthews. Undersea Biomed Res. 1980 Jun;7(2):141-8.
RRR ID: 2878

In-water resuscitation.
Letters to the Editor. Undersea Biomed Res. 1981 Mar;8(1):63-6.
RRR ID: 2648

Modification of scuba regulator for IPPV.
Poulton, Littleton, and Raudenbush. Undersea Biomed Res. 1985 Jun;12(2):215-9.
RRR ID: 3033

UHMS ASM Abstracts (not complete search of all years):

MODIFICATION OF THE CLOSED CIRCUIT UNDERWATER BREATHING APPARATUS LAR V MAKES IT SUITABLE FOR CARDIOPULMONARY RESUSCITATION (CPR).
Mutzbauer and Neubauer. 1997 UHMS Abstract
RRR ID: 311

NEW METHODS FOR ARTIFICIAL VENTILATION DURING CARDOPULMONARY RESUSCITATION FOR DIVERS ON CLOSED CIRCUIT REBREATHERS.
Mutzbauer, Tetzlaff, Mueller, and Neubauer. 1998 UHMS Abstract
RRR ID: 706

MOUTH TO LARYNGEAL MASK AIRWAY RESCUE BREATHING DURING TOW OF THE UNCONSCIOUS NON-BREATHING DIVER.
Mutzbauer, Neubauer, Tetzlaff, Mueller, and Lamp. 1998 UHMS Abstract
RRR ID: 673

UHMS Workshops.

Lanphier EH (ed). Unconscious Diver: Respiratory Control and Other Contributing Factors. 25th Undersea and Hyperbaric Medical Society Workshop. UHMS Publication Number 52WS(RC)1-25-82. Bethesda: Undersea and Hyperbaric Medical Society; 1982; 160 pages.
RRR ID: 4278

Butler, Jr FK, Smith DJ (eds). Tactical Management of Diving Casualties in Special Operations. 46th Undersea and Hyperbaric Medical Society Workshop. UHMS Publication Number USSOCOM 3-93. Bethesda: Undersea and Hyperbaric Medical Society; 1997; 72 pages.
RRR ID: 4512

 

[AbyssalPlains]

Research on CPR has shown that the standard protocol of two mouth-to-mouth breaths of 5 seconds is impossible to accomplish. The average person needs 16 seconds, and even highly trained paramedics can't do it in less than 14. Add to that the difficulties of performing mtm in the water and it appears to make more sense to get the victim on the boat asap and then do proper CPR. The most important thing to remember is that if the person has no pulse, you can breathe into their lungs all day long but the oxygen doesn't go anywhere. That's why chest compressions are more important than "rescue" breathing, to get that blood moving around.

 

[boulderjohn]

That's why chest compressions are more important than "rescue" breathing, to get that blood moving around.

Everything I have heard agrees with this emphatically. In fact, the most recent protocols are for chest compressions only, without taking time for the occasional rescue breaths.

So why bother with in water rescue breaths?

I asked that question, and basically it came down to "hope."

1. In some near drowning situations, a few rescue breaths result in the victim vomiting and resuming breathing on his or her own. You hope this happens.

2. You cannot tell if the patient has a pulse, but you hope there is one.

If you have any chance of getting the victim to a place where chest compressions can be given in a reasonable amount of time, that is your best option. If I have someone in that situation, I will instead be doing the fastest tow I can possibly do.

 

[tceylan]

Originally Posted by pteranodo:
"Research on CPR has shown that the standard protocol of two mouth-to-mouth breaths of 5 seconds is impossible to accomplish. "

The standard protocol (for PADI Rescue) for unresponsive diver on the surface is 1 rescue breath every 5 secs. You give 1 breath and then count to 5. When you get in the rhythm, it is doable, but not easy.

If the land/boat is more than 5 mins away, then this protocol changes. If the diver responds to the rescue breaths, continue with them. If not, tow to the land/boat as fast as possible for CPR.

 

[Colliam7]

You asked a very interesting question, and received some insightful responses. The bottom line is that a regulator is a less reliable method of ventilation than rescue breathing, however imperfect the rescue breathing may be.

The biggest problem is that the pressure needed to open the exhaust valve is lower than the pressure needed to inflate the chest. Therefore, gas will preferentially exit the regulator into the air, rather than ventilate the diver. … But a regulator is not a ventilator, and cannot effectively be used as one.

not to mention the risk of overpressurizing the lungs which could cause a pneumothorax, inflating the stomach and eventually wearing / swimming in what ever the victim had for breakfast