catherine96821:
Really, why? I thought it sounded fairly practical. Of course sealing the airway.....but I am just not convinced that rescue breathing can be done well by a layman on an ocean tow. explain your take.
First, I'll admit that I have not done a thorough review of the literature. In fact, I have only read a few abstracts from studies that were done in the early 80's that actually seemed to suggest that this idea was viable. Therefore, I'm not willing to say that this technique is completely without merit. However, I would think that if there is some recent evidence out there that supports this technique that it would have ‘trickled down’ by now… and… it hasn’t.
The current trend in ventilatory resuscitation is moving towards lower and lower inspiratory flow rates, pressures and volume. We have seen how innefective the opposite can be. The most obvious problem related to high rates, pressures, and volume is gastric insufflation and aspiration. Over pressure injuries such as pneumothorax and pneumomediastinum can also result from pressures that are too high. Venous return to the heart can be significantly impeded by excessive pressures and can lead to hypoventilation. Likewise, there is a significant decrease in total lung capacity that results from gastric and abdominal distension... another frequent cause of hypoventilation. Pre-hospital care has moved away from using high pressure mechanical ventilation for all of these reasons.
I suspect that GUE does not teach closing off the exhaust ports. This would reduce the risk of some of these problems. But it presents additional difficulties. With the exhaust ports open it is likely that there would not be enough pressure to adequately ventilate the victim. As efforts continue lung compliance decreases. Again, an open regulator probably can not provide enough pressure to overcome this increased resistance. Toss in other factors like increased thoracic resistance from a wetsuit and all bets are off.
Some of the posters here are all too familiar with how resuscitative recommendations are developed and how frequently they change. Every two years they psych themselves up for a round of ACLS or ATLS or PALS. How many techniques and different devices have come and gone over the years? EOAs, EPAs, PTLAs, TEAs, and BIPA have fallen in and out of favor. Now we have LMAs and Combitubes that have gained a class IIb recommendation. But mouth to mouth or BVM resuscitation has remained a constant.
I suppose that I just want to warn the layperson that there is a tremendous amount of effort that goes into approving a resuscitative technique. Just because you can purge a gas from a regulator doesn’t mean that it can be used as an effective ventilatory adjunct and just because a scuba agency teaches it doesn’t mean that it is approved. The considerations and parameters involved can be overwhelming to comprehend. My advice is to take a BLS course and adhere to the techniques that have been approved and that are recommended. Take a look in the back of an ambulance, sometime. I bet you won’t see a scuba cylinder and reg… nor any similar device. Ask DivingCRNA if he keeps one in the O.R.
Just for giggles, can anyone tell me how much inspiratory pressure is needed for effective ventilation? How much volume? Try it in PSI. Then tell me what pressure a purged reg gives… with exhaust ports open and exhaust ports closed. Medical professionals… zip it!
and I will understand if you don't want to respond in detail - liability issues and such.
