Rescue Breathing from a Regulator

[mempilot]

This question is posted to doctors, medics, emt's, etc...

First, I'm trained in CPR and rescue techniques. I was taught surface rescue breaths.

My question is about inwater and surface rescue of an unconscience diver using higher than 17% O2 from a back gas, stage, or deco bottle via the regulator's 2nd stage. In your professional opinions (no armchair quarterbacks please for obvious reasons), does this technique have merrit?

I was reading today about this technique. According to the text, it has advantages and disadvantages. The advantage being the ability to deliver greater than 17% O2(our exhaled breath), and the disadvantage being the possibility of overexpansion injury due to high delivery pressure.

I'm guessing it would be used when 1. there will be an extended inwater surface time before getting the victim onto the boat where elevated O2 % would be helpful in restoring breathing, or 2. surface conditions are rough enough to make mouth to mouth dificult if not impossible.

I ask this based on scenarios where dive profiles make nitrox or O2 mixes available to the rescuer, and 100% O2 will be available once the victim is stabalized on the boat.

 

[Wildcard]

20 year Paramedic here. Just get em to the surface and do it right. Screwing around underwater is not helpfull. BUT, if you can't get em up, keep them face down so water does not get into the airway ( or not as much anyway) and do mouth to mouth from the bottom.
Many moons ago I was on a call that was later re enacted for the pilot for Rescue 911. Two docs from Sweden I think ( it was long ago) were gold mining on the American river in Cali. A boulder rolled down the hill and traped one just under the surface. Doc 2 does underwater mouth to mouth while the dredge was used to suck the gravel out from unsder him to free him. He made it...So it can work but your best bet is to get them to the surface.

 

[mempilot]

I agree with getting them to the surface immediately. I guess I should clarify inwater and not underwater. Once on the surface, this text talked about possible advantage of the higher O2 content of a regulator purge over the 17% O2 exhaled from the rescuer to the victim. The other mention was the regulator keeping water out of the airway.

Just out of curiosity, how do you perform rescue breathing with them face down in the water? I've never seen or read about that technique. Is there a documented procedure for that?

 

[Wildcard]

Nope, none. Just do regular mouth to mouth but upside down. Im speculating here but it makes sense.
Now back to you original question. The diff between 17 ish and 21 ish is not a real issue. You can not feel the air movement by pumping them up with a regulator. infact, the higher pressure will almost assure that you are inflating the stomach not the lungs. Just do like the basic CPR teaches you and ignore the novelties.

 

[BlueDevil]

OK...so you have the reg in the victims mouth, you push the purge button and the gas follows the path of least resistance...OUT THE EXHAUST PORTS!

So lets say you find some clever way to block off the exhaust ports so the gas goes into the victims lungs. Consider the fact that the flow rate of most regs is enormous and there would be a real risk of overpressure injury to the lungs, and more particularly, a very high likelihood of forcing gas into the stomach. Gas in the stomach carries a high risk of regurgitation. Properly designed resuscitation equipment will have an overpressure valve...a dive regulator with the exhaust ports blocked does not.

From a legal point of view remember that you would be using a piece of equipment not designed for the purpose of resuscitation, and that there would be no recognised training course in the use of this equipment. Could you be risking a law suit for not using a properly approved technique (ie standard CPR) which you have been trained in.

Scuba regs are not designed for, nor intended to be used for resuscitation.

PS. There is a body of opinion that argues the best approach is to put all your efforts into landing the victim. If they are in cardiac arrest you are simply wasting you time and energy doing EAR in the water. While there may be nothing to lose if you are forced to wait in the water for a period of time before getting picked up in general the best strategy is to get them out of the water fast so you can provide the best possible level of care.

 

[mempilot]

Thanks for the reply guys. I found it a little hard to 'stomach' as well when I read it. I figured that maybe there was a new thought on the subject, but you're right, do the easy way. Again, thanks for the responses. I'm getting ready to do a rescue/cpr refresher course to keep the skills and knowledge sharp.

 

[bridgediver]

PS. There is a body of opinion that argues the best approach is to put all your efforts into landing the victim. If they are in cardiac arrest you are simply wasting you time and energy doing EAR in the water. While there may be nothing to lose if you are forced to wait in the water for a period of time before getting picked up in general the best strategy is to get them out of the water fast so you can provide the best possible level of care.

Good answer here. If I could add a bit more, there may be a change in this focus even for lifeguards. I wouldn't be surprised if surface in-water rescue breathing becomes out dated for everyone eventually. As a PSD we don't do any in-water rescue breathing for these reasons stated above - just get them out of the water asap.
If its a diver keep the mask on and protect the airway as best you can with the face up! I also want to make sure nobody gets the idea of leaving the patient face down in the water at the suface to do underwater AR. There is a remote chance that the victim may spontaneously begin breathing - if he is face down... well, I think its obvious what will happen - more water in the airway. Even if the diver is trapped or deep I'd say your time is better spent getting him free and to the surface instead of messing around with AR that is inefficient and only delays the time to the surface.

As far as positive pressure ventilation with scuba regs. It has been covered fairly well. The biggest issues that I see are:
-Scuba regs are not designed for this purpose. You would need a mask that would seal the mouth and nose to be effective
-Don't try something you aren't trained to do. The liability aside, you may be causing more harm.

 

[Mako Mark]

Positive resuccitation units are available and the technique valid for trainied medical professionals, however is beyont the training given to laymen and divers in general. Also, the units are on the boat or shore, not inwater.

PS. There is a body of opinion that argues the best approach is to put all your efforts into landing the victim. If they are in cardiac arrest you are simply wasting you time and energy doing EAR in the water. While there may be nothing to lose if you are forced to wait in the water for a period of time before getting picked up in general the best strategy is to get them out of the water fast so you can provide the best possible level of care.

I have also heard that this change is in the wind.... The rationale is that if they are in pulmonary arrest, they are probably in cardiac arrest too, and if they are not, they soon will be. put your efforts in getting them to a stable platform asap followed by cpr and defribulation where available or appropriate.

As far as I know this is not being taught by any agency yet though. It will be interesting to see what comes up at DEMA this year, I know that PADI is revising their rescue course, I wonder if it will cover this issue.

 

[The Chairman]

Positive resuccitation units are available and the technique valid for trainied medical professionals, however is beyont the training given to laymen and divers in general. Also, the units are on the boat or shore, not inwater.

I train divers for this in my CPR and O2 classes. It is not difficult if you have the right equipment.

 

[sharpenu]

Using pressurized oxygen-powered O2 delivery has been removed from most of the EMS agencies (at least in this area) due to overexpansion injuries caused by the devices. Even professional rescuers had difficulty in preventing these injuries during the chaotic envirinment of an actual incident. Instead, bag valve masks with pressure relief devices are used.

As previously stated, it is better to remove the swimmer from the water to perform any CPR or AR, as the best chance of saving an arrested person is early defibillation (within 4 minutes), followed by rapid access to advanced life support (within 8 minutes).


I say this as a nationally registered and state certified paramedic.