CPR in water when close to shore / boat what to do first?

[Medicdiver0125]

once again from a person who has experience doing this in all kinds of places the best action would be to get to the boat and do REALLY good chest compressions. I have had cpr work in less than optimal places, and also seen it go terrible in hospitals. Keep in mind the equipment you have on dive boat or in a remote location is very limited, In my ambulance i have drugs, a heart monitor, i.v. supplies, and intubation equipment, and to honest with you and i am sure some other people would agree with me, I have seen it not work more than i have seen it work. That being said you should always do what ever is necessary and be able to think outside of the box.

 

[DaleC]

Just a general observation and not directed to the post above:

The effectiveness of CPR really depends on the skill of the person providing it. I personally am not comfortable de-emphasizing it's value or suggesting to others that a persons chances of recovery are low or that it loses it's effectiveness after a short period of time. These all tend to make the uninformed devalue it, and when you devalue something you tend not to practice it, and when you don't practice it it really does become ineffective. ie. a self fulfilling prophesy. My fear is a generation of first responders who do CPR for 5 minutes and then call it because they have no AED handy and they know the guys toast anyways. Does he have a pulse? Dunno - never learned how to check that manually.

The current trend towards no pulse checks, breaths and compressions only is partially due to the dumbing down of CPR. OK I guess, if statistically shown to be more effective, but that doesn't mean that someone skilled at rescue breathing and checking pulses can't add value to resuscitation. I'm also fairly confident that those protocols will change again, as they have numerous times since I took my first CPR course in 1977.

Someone also earlier suggested that most of a rescue breath is CO2, which is not true. Small mistruths like that should not be allowed to pass unchallenged or we risk becoming like that insurance lady. BTW, she, or someone in her organization, gained that particular piece of knowledge by watching Ed Harris rescue his lady friend in "The Abyss". I'm sure "Sanctums" contribution will be that whenever a cave diver asks his teammate for help it will be assumed what he really means is "drown me".

 

[TSandM]

I saw that comment, too, Dale . . . but I just let it go. I'm glad you challenged it. The oxygen percentage in average exhaled breath is still about 16%; it will support life and even consciousness.

And it's really important that people realize that good CPR, done correctly, can be very effective in providing enough circulation to keep the brain alive. There was a delightful lady in Monterey who used to be a poster here, who drowned at Monastery and was resuscitated from pulseless apnea, to live, I think, five more years, before perishing in another diving accident. But the point is that, although she spent a long time in the hospital and did not come out unscathed, she survived and was completely neurologically functional. Always try, if it makes any sense at all (the guy they didn't find for three hours, I don't think I'd have tried very long with).

 

[Peter Guy]

Kevr -- which scenario are you describing - the one where you are way out in the blue with no one around and your buddy has arrested OR the one where the skiff is mere minutes away and can take the victim to the boat?

If the former, are you going to start "CPR" and continue until you too are so tired that you'll probably be a second victim? If the latter, then aren't you going to want to get the victim to the skiff ASAP so that she has the best chance of recovery (although probably not a great chance)? In either case, it seems to me that spending so much time doing "In Water CPR" is a fool's errand.

This, BTW, is one reason I really dislike the PADI Rescue scenario of requiring students to do "Rescue Breaths" every 5 seconds while stripping off gear -- and even a greater dislike of the PADI DM and IE "Rescue Scenarios." I believe we are teaching the wrong thing -- take "all the time you need to do this" rather than "get the victim to hard surface ASAP."

 

[Kevrumbo]

Kevr -- which scenario are you describing - the one where you are way out in the blue with no one around and your buddy has arrested OR the one where the skiff is mere minutes away and can take the victim to the boat?

If the former, are you going to start "CPR" and continue until you too are so tired that you'll probably be a second victim? If the latter, then aren't you going to want to get the victim to the skiff ASAP so that she has the best chance of recovery (although probably not a great chance)? In either case, it seems to me that spending so much time doing "In Water CPR" is a fool's errand.

This, BTW, is one reason I really dislike the PADI Rescue scenario of requiring students to do "Rescue Breaths" every 5 seconds while stripping off gear -- and even a greater dislike of the PADI DM and IE "Rescue Scenarios." I believe we are teaching the wrong thing -- take "all the time you need to do this" rather than "get the victim to hard surface ASAP."

Worst case instance of both scenarios --Peter. A drift diving scenario (i.e. Cozumel/Palau), on the surface with full-arrest victim in which the recovering dive-op skiff is delayed a few minutes (2-10min): are you going to swim-tow the victim to the boat while performing only rescue breathing --against the current??? No!!!

The point is --While awaiting recovery in such a scenario, why not attempt some mode of chest compressions and perhaps some Regulator ventilations as well?

Originally Posted by Kevrumbo
What about attempting modified chest thrusts --if you can-- as well as rescue breathing as you're towing the victim? (Modified chest thrusts from behind as in the modified Heimlich maneuver. . .)

What if you're downcurrent in a remote location with a victim in full arrest on the surface, and a skiff from a live aboard coming for rescue?

(You gotta try and do what you can do for as long as you can. . .)

 

[ktkt]

I haven't heard of regulator ventilations being taught -- are they actually effective?

 

[TSandM]

I have never attempted regulator ventilations, but a quick analysis of regulatory mechanics suggests that they would be difficult to do well. Normally, it takes very little postiive pressure within the second stage to cause gas to vent through the exhaust valve; this is critical, because we are not set up to use muscle effort to exhale, and doing so increases work of breathing to a significant degree.

So, to ventilate anyone using a regulator, you have to block the exhaust valve. It's not easy. And assuming you could do it, you now need to provide a seal around the mouthpiece, because otherwise, positive pressure will simply bubble out around the lips. Assuming you COULD both block the exhaust valve, and provide a seal, you have to titrate the pressure, so that you don't blow out the lungs.

If it were my husband in the scenario Kevrumbo posits, I would try anything . . . but I would know, as I did, that what I was doing was fruitless.

 

[Kevrumbo]

I have never attempted regulator ventilations, but a quick analysis of regulatory mechanics suggests that they would be difficult to do well. Normally, it takes very little postiive pressure within the second stage to cause gas to vent through the exhaust valve; this is critical, because we are not set up to use muscle effort to exhale, and doing so increases work of breathing to a significant degree.

So, to ventilate anyone using a regulator, you have to block the exhaust valve. It's not easy. And assuming you could do it, you now need to provide a seal around the mouthpiece, because otherwise, positive pressure will simply bubble out around the lips. Assuming you COULD both block the exhaust valve, and provide a seal, you have to titrate the pressure, so that you don't blow out the lungs.

If it were my husband in the scenario Kevrumbo posits, I would try anything . . . but I would know, as I did, that what I was doing was fruitless.

Plug the exhaust valves (try using your dive gloves' fingers to stuff shut the exhaust; or tear off & wad some Wetnotes pages and stuff them into the exhaust valve --anything to keep that exhaust diaphragm from blowing open) ; establish an open airway; pinch the victim's nose and purse the lips around the mouthpiece. The goal and all you need to see is the chest rising just a bit upon briefly pressing the Regulator's purge valve. . .

(If it was your husband Lynne, I know you would even perform a "Battlefield Cricothyrotomy" if medically indicated [blocked airway] and environmental conditions permitting. . . )

Don't tell me what can't be done . . .but help me figure out techniques as a layperson/first responder to at least try!

Where there's Life --There is Hope. Don't give up either. . .

 

[ArcticDiver]

When I was in the business I found it useful to rember two things. First, the goal is not to get someone to the hospital or continuing care. The goal is for the person to walk out of the hospital after treatment. An extremely small percentage of people who need CPR ever survive to be discharged. Second, all of us are terminal.

So, the best move under all the events i can conceive is to get a person to a place where good CPR can be done and quick transport to continuing care can happen so maybe, just maybe, the person will be among that small percentage that goes on to a productive life.

 

[Kevrumbo]

When I was in the business I found it useful to rember two things. First, the goal is not to get someone to the hospital or continuing care. The goal is for the person to walk out of the hospital after treatment. An extremely small percentage of people who need CPR ever survive to be discharged. Second, all of us are terminal.

So, the best move under all the events i can conceive is to get a person to a place where good CPR can be done and quick transport to continuing care can happen so maybe, just maybe, the person will be among that small percentage that goes on to a productive life.

Again . . .per the worst case blue water drift dive scenario above --what do you do if you cannot get the victim "to a place where good CPR can be done" within 5 to 10min, and you & the victim are downcurrent of a distant dive boat coming for recovery? You obviously are not going to waste time and physical effort by swim-towing the victim --against the current-- in order to hurry the rendezvous with the rescue boat. That doesn't make any sense at all. . .

Therefore, the best action is to attempt CPR --as best you can-- in the water, by the techniques above (modified Heimlich Maneuver) while awaiting pick-up by the rescuing boat.

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