Using regulator to ventilate apneic diver?

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bamamedic

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I haven't taken the rescue class yet, but this was touched upon in a recent class...

Something about using a regulator to ventilate an apneic diver at the surface. Is this common practice? Does it work?

Seems that it would be a lot easier than trying to provide rescue breaths and protect the airway from water at the same time.

I'd be worried about causing an overexpansion injury, though, with all that high pressure air. Seems you'd have to be really careful not to press the purge for too long, though. An overzealous rescuer could overventilate really easily. Plus, if you weren't really, really careful about holding the airway open, you could easily get one heck of a lot of air into the stomach, which would cause vomiting, which could cause an airway obstruction.

Anyways, what do y'all think?
 
For all practical purposes it does not really work, the exhaust valve cracks and vents before you can "push" gas into the lungs.

After a couple rescue breaths to try and stimulate breathing just beat feet for shore or the boat. Ventilation is actually 2ndary to a heartbeat and you can't do compressions in-water.
 
Yes, the only way to develop enough pressure to ventilate someone (particularly in the water) would be to block the exhaust valve in some fashion. Chest wall resistance is greater than the pressure needed to open the exhaust, as Richard said.

Although it is not what is taught in Rescue curricula, it is my firm belief that, if you give a couple of rescue breaths to clear the airway and reduce the CO2, and you get no respiratory effort from the diver at all, it is highly likely that they are in arrest, and your highest priority should be to get them to somewhere you can do compressions. Recent research in resuscitation has shown that you are far better off doing compressions without ventilation, than compromising compressions to attempt more frequent or more thorough ventilation.
 
Yes, the only way to develop enough pressure to ventilate someone (particularly in the water) would be to block the exhaust valve in some fashion. Chest wall resistance is greater than the pressure needed to open the exhaust, as Richard said.

Although it is not what is taught in Rescue curricula, it is my firm belief that, if you give a couple of rescue breaths to clear the airway and reduce the CO2, and you get no respiratory effort from the diver at all, it is highly likely that they are in arrest, and your highest priority should be to get them to somewhere you can do compressions. Recent research in resuscitation has shown that you are far better off doing compressions without ventilation, than compromising compressions to attempt more frequent or more thorough ventilation.

right on! If i was faced with this situation, i wouldnt mess with using the regulator. if you were lucky enough to get a heart beat back (assuming it was a full arrest) and I was diving nitrox, i would try to give them some blow by....whatelse could you really do without any ALS equip? Best thing would be to get them to a hard surface to work them though

has anyone noticed most bystander CPR is inadequate, while the effort is there the correct form isnt. I hate cracking ribs!

brett
 
I ran a call once, where very vigorous bystander CPR was being performed...unfortunately, the patient was still lying in bed. At least it didn't crack any ribs, though :)

Cool...that's what I kind of suspected concerning using the regulator as a ventilator. I'd probably keep the regulator in their mouth, just in case I misdiagnosed apnea, and the diver is still breathing shallowly (and to protect their airway from water), but I'd just get to shore (or boat, or dock) as quickly as possible.
 
I ran a call once, where very vigorous bystander CPR was being performed...unfortunately, the patient was still lying in bed. At least it didn't crack any ribs, though :)

awesome! I know exactly what your talking about! Kinda like doing chest compressions on someone with a pulse:shocked2: or rescue breaths for someone that has extensive pooling...:shakehead:

brett
 
As I understand the CURRENT "official PADI" rule is IF you believe you would be more than 5 minutes from help, two rescue breaths and then tow -- but IF you are within 5 minutes of help, then two rescue breaths with a 5 second breath thereafter. As a test in a recent Rescue class, it took the student almost 5 minutes to bring me from one side of the pool to the other (regular competition sized pool) doing the 5 second breaths. The moral of the story is, do the two breaths and then haul the victim to shore!
 
As others have said, ventilation without circulation is worthless. In general, we are now taught to assume that a non-breathing adult is not circulating. Exceptions to this are for children and for drowning victims. This exception leaves us with the hope that your non-breathing diver might be circulating. (You really can't tell easily in the water, so don't waste time checking.)

Thus, if you are reasonably near a firm surface, give your two breaths (drowning victims often revive quickly with these) and get there as fast as you can to begin CPR.

If you are a long way away, you have a problem. If the diver is not circulating, there is essentially no hope, but you don't know if this is true or not. Therefore, you give the breaths in the hope that he or she is circulating or that those breaths will cause the breathing to begin again.
 
Cool! Thanks y'all :) I'm actually finding myself looking forward to the Rescue course (hopefully coming up in the next few months).
 
Have fun! LOVED my rescue course...

Here is an older thread with a few publications you might find interesting while waiting to take your course.

That thread includes this paper of interest to the current thread:

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

Poulton et. al. abstract:
Attention is appropriately being focused on the performance of adequate cardiopulmonary resuscitation in aquatic situations. We modified the second stage (mouthpiece) of a standard scuba regulator to permit intermittent positive pressure ventilation using either a mask or an esophageal obturator airway. Tests demonstrated the inexpensive modification to function adequately for emergency ventilation.



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