View Full Version : Using Nitrox for Rescue Breathing.
Hi all.
I had a though ( it happens ! ) regarding administering rescue breaths to an unconscious casualty and it occured to me that if you had a cylinder of Nitrox handy ( as most of us do ) , would it be a good idea to use that to increase the percentage of oxygen in your exhaled rescue breath ?
I'm sure you can see where I'm coming from , you , the rescuer , take a breath in from the Nitrox before then using that same breath to administer RB to the casualty.
Obviously this means they will 'benefit' from a proportionally higher concentration of oxygen than the low grade 16% in a normal exhaled puff.
I'm thinking more in terms of when the casualty has been landed rather than 'in water' which would problably be too awkward.
Good idea / crap idea ?
Cheers JB.
If you had someone else doing the chest compressions giving you time to pop a reg in and out it couldn't hurt I suppose. Although at that stage you are just trying to get oxygen to the brain, not actually treating a bend.
stafforddiver
20-01-10, 14:56
I think you mean a non - breathing casualty?
If you don't have the proper pocket mask handy with attached o2 kit on trickle flow I would be more inclined to do rescue breaths without 02 and make sure i was doing it properly.
Watching for the chest rising and falling, listening / feeling for exhaled breathing and making sure you get a proper seal around the mouth is more important.
If your buddy was doing chest compressions as well, you might need to swap with him / her as its pretty knackering..........
Cheers,
Gareth.
sorry mate, I think it's a crap idea.
As been said before, full CPR is hard work, and very tiring after a good few minutes, never mind trying to breathe from a reg also.
2 breaths and 30 compressions, while you're still in a wet/dry suit, and thats after landing them....I'd be more concerned with getting a de-fib on them.
OK How about this scenario.
You have a non breathing casualty.
You have plenty of folk to get help etc leaving 2 or 3 people to deal with CPR.
The person doing the breaths can easily get a good lung full of Nitrox prior to the first breath. The 2nd breath is just a lung full of air so no faffing with a reg.
Then the chest compression fellow does their thing allowing the breathing fellow to get the reg ready for another breath of goodness.
I certainly wouldn’t advocate teaching it as some would then see it a necessary and try to implement it when they where potentially understaffed for the extra faffing. But surely if you are trying to get oxygen to the brain then having a bit more oxygen in the lungs can only be a good thing?
Yogi Diver
20-01-10, 18:05
OK. Here's a really radical idea.
Carry a proper O2 kit with you when you go diving!! :rolleyes:
OK. Here's a really radical idea.
Carry a proper O2 kit with you when you go diving!! :rolleyes:
And thats the end of that:rolleyes:
CPR without Rescue breaths at all is the way first aid training is going
CPR with rescue breathing interrupts the rhythm of regular chest compressions which deliver vital heart and brain circulation. Valuable compression time is lost when bystanders try to give rescue breaths interspersed with chest compressions
so its gone from 2 to 10, 2 to 15, 2 to 30 and now just all chest compressions.
I woud image someone will fight this change in the same way that some people STILL want to feel for a pulse.
Yogi Diver
20-01-10, 18:50
Chest compresions only on a diving casualty would be a complete waste of time. The purpose is to get oxygenated blood to the brain which works if somebody has a heart attack in front of you and you know they were breathing just a few seconds previously.
A casualty pulled out of the water proably hasn't drawn a breath for several minutes so compressions will just recirculate stale blood. The priority therefore has to be to get some oxygen into the lungs before commencing compressions. Rescue breaths via a face mask with an oxygen feed are the best way to achieve this if available.
this subject a big old can of worms, however there are a few mixed messages which conflict with each other and not too clear whether the victim is breathiing or not.
however, firstly, have a look at this http://www.rescuean.com/
if you have Nx, this is a great adaptor.
breathing Nx into a patient during rescue breathing is highly unlikely to be as effective, the breath rate would probably be too slow for a kick-off & you as a rescuer will probably hyperventilate.
A B C .. airway, breathing & circulation, the basics of first aid.
check the airway for obstructions, see if they are breathing then circulation.
30 compressions then 2 rescue breaths.
the reason 30 compressions first is because the casualty will have his last breath in him and its more vital to use this than your donated breath.
shark-boy is right in saying circulation is more important than rescue breathing & its being proven by medics around the world at the moment.
however the current first aid courses still suggest 30-2 at this time.
having a de-fib with you in the boot of your car is highly unlikely to happen unless you drive an ambulance (they are quite a few hundred quid each) but it would be great if you had access to one as it wont fire unless the casualty requires it.
in the uk, if you use a de-fib and your not quallified, you can be charged.
a bag mask valve is probably the simplest & cheapest peice of kit you could buy. http://cgi.ebay.co.uk/Resuscitation-Bag-Valve-Mask-Resuscitator-Ambu-Type_W0QQitemZ160394070869QQcmdZViewItemQQptZUK_BO I_Medical_Lab_Equipment_Medical_Supplies_Disposabl es_ET?hash=item25583b4b55
less than £10 inc postage and you could save a life!
a casualty pulled from the water will have minimum water in their lungs as your brain closes your trachea function so your lungs dont flood.
a full blown heart attack and/or cardiac arrest, different ball game altogether.
firstly open the airway and start CPR, call 999. if your on a dive site with no first aid equipment, this is probably the best you can do.
if you dont cannulate the patient and give them adrenaline, have access to a defibulater then its unlikely they will recover.
obtaining and maintaining an open airway is the most vital part of any rescue attempt on a non breathing casualty.
as loudy says, plan for the worst, hope for the best.
I think the simple answer that that is doing CPR and / or rescue breaths you are trying to keep circulation going and keeping some oxygen in the persons system, restart breathing. While a higher level of o2 in the brreathe wouldn't hurt and might help a bit it seems unlikely that any help is likely to outweigh the risks of screwing things up trying to breathe out a reg while doing all the other stuff.
I have on of these with a din adapter,it allows it to screw into a normal scuba cylinder,then the small hose can attach to a pocket mask :)
http://image.made-in-china.com/2f0j00oCBasiOKkpkc/Medical-Oxygen-Regulator.jpg
Thanks folks , as usual , as many opinions as there are members :o)
Yes , agreed , ideally we should all have an 02 kit and a defib and an inflatible helicopter and indeed , most of the time I have access to at least the first of these.
My question was , that in the ( occasional ) absence of anything better , is there a benefit in blowing exhaled Nox into the poor sod ?
I agree , circulation is the 'priority' , but the purpose surely of chest compressions is to circulate OXEGENATED blood.
To my simplistic way of thinking , it can only be beneficial that the oxygen level in said blood be as high as possile and to that end , getting as high a %age of 02 into the lungs can only be a good thing.
Where you have 2 persons attending I can't imagine that taking a sook of Nitrox just before each RB would be a difficult thing to do.
OAIWA ?
Ta for the pointers , might just buy one of those bag resus masks.
ATB , John B.
I know as a professional my training wouldn't allow me to do this as it's not the method I was trained in and my employer and I could be sued if it went wrong. Given that with a non breathing casualty before treating any bend you need to get them breathing again and I'm pretty sure the body can only absorbe a certain amount of oxygen when you breathe in. Personally I'd just stick to what I know. But to be honest if I was the casualty I wouldn't complain as long as you did what you thought best at the time. Colin
Dive Tramp
21-01-10, 12:17
CPR without Rescue breaths at all is the way first aid training is going
CPR with rescue breathing interrupts the rhythm of regular chest compressions which deliver vital heart and brain circulation. Valuable compression time is lost when bystanders try to give rescue breaths interspersed with chest compressions
so its gone from 2 to 10, 2 to 15, 2 to 30 and now just all chest compressions.
Wow, this is news to me. State your source Sharkboy?
Just adding my tuppence worth.
Remember, the first thing you want to do for a Diving Casualty is get that O2 (from your breath) into the casualty and get it circulating by Chest compressions. Also, remember that it's the build up of CO2 in the bloodstream that triggers the breathing response so giving higher percentage O2 from your expired air may have the opposite effect of what you're trying to do, getting the casualty breathing for them self again. As soon as they are breathing for themselves (ie, the breathing reflex has returned) you can administer as much enhanced O2 as you like (providing the casualty doesn't have an adverse reaction to 100% O2).
Wow, this is news to me. State your source Sharkboy?
Just adding my tuppence worth.
Remember, the first thing you want to do for a Diving Casualty is get that O2 (from your breath) into the casualty and get it circulating by Chest compressions. Also, remember that it's the build up of CO2 in the bloodstream that triggers the breathing response so giving higher percentage O2 from your expired air may have the opposite effect of what you're trying to do, getting the casualty breathing for them self again. As soon as they are breathing for themselves (ie, the breathing reflex has returned) you can administer as much enhanced O2 as you like (providing the casualty doesn't have an adverse reaction to 100% O2).
Hey DT.
I think SB was joking ( well I hope he was !! )
I'm not sure that the build up of CO2 in the bloodstream would be affected much by the concentration of 02 in the administered breaths.
Surely its more to do with the rate of breathing , ie how fast you are flushing the expirated CO2 OUT of the lungs ?
Dunno , wouldn't bet my life on it.
FYI , we are now ( unless they have changed it again ) taught to give compressions first , not breaths.
I guess the assumption is that there will be some residual air in the lungs and so that 'static' blood will already be well oxygenated.
Not that I think in a real world situation these 'nuances' in the procedures make any real difference.
Cheers JB.
I have on of these with a din adapter,it allows it to screw into a normal scuba cylinder,then the small hose can attach to a pocket mask :)
Cheers Loudy , would you use that on a non-breathing casualty though ?
Dive Tramp
21-01-10, 14:21
I hope so too (about SB's post).
You/we are taught to give Compressions first ONLAND, but Breaths first INWATER,;)
Oh, if the O2 in the blood stream exceeds the level of CO2 needed (partial pressures and all that) then the body will not trigger the breathing reflex as the level of CO2 hasn't been reached. Think of your reasons for not hyperventilating before carrying out a single breath snorkel dive lesson.
I hope so too (about SB's post).
You/we are taught to give Compressions first ONLAND, but Breaths first INWATER,;)
LOL , I've changed my mind we should definately start teaching 'in water' chest compressions :D;)
Not that I'm for one minute arguing with you but.....
Hyperventilating before a breath-hold dive acts to artificially reduce the CO2 level in the bloodstream , its does not increase the level of o2 as the haemoglobin molecules are already saturated.
During the dive the level of co2 will naturally rise due to the metabolic process but may never reach the required concentration to produce the 'strong' urge to breath due to the limited volume of oxygen available for metabolisation. Coincidentally the level of oxygen falls to a hypoxic level and it's off to the land of the dancing dolphins , never to return Oh.
OAIWA ?
Cheers JB :)
Dive Tramp
21-01-10, 16:19
Now that would be something to see, inwater compressions :D Maybe Bob could show us how to... :)
You've got it! But I wasn't intending to infer that O2 sats would increase, no, it was the trigger to breathe I was talking about and the resultant hypoxia that could occur since we don't "feel" the urge to breathe. :crying:
Yogi Diver
21-01-10, 16:37
I think we are missing the point here. The purpose of the chest compressions is to replace the function of the heart which is assumed to have stopped. The compressions allow a very limited supply of oxygenated blood to supply the brain and CNS long enough to give the emergency services a chance of saving the life when they eventually arrive with a defibrillator to re-start the heart.
The urge to breathe does not enter into the scenario so greater levels of O2 can only be of benefit in ensuring the blood gets the maximum possible saturation.
However, I agree, this would be totally impractical breathing from a regulator whilst trying to maintain the rhythm so, unless you have a free flowing supply via a face mask, just breathe normally. You will do more good that way.
Cheers Loudy , would you use that on a non-breathing casualty though ?
Yes :) when we give rescue breaths our exhaled breath has around 17% O2 in it but when using a pocket mask attached to an O2 kit it goes up to around 40% O2.
Hey DT.
I think SB was joking ( well I hope he was !! )
Doesn't look like it
http://firstaid.about.com/od/cprbasics/i/07_nobreathcpr.htm
Yogi Diver
21-01-10, 23:27
Doesn't look like it
http://firstaid.about.com/od/cprbasics/i/07_nobreathcpr.htm
Not all cardiac arrests are from a diseased heart. Sometimes, drowning or drug overdoses cause respiratory arrest that leads to cardiac arrest. In those cases, rescue breathing is an important part of resuscitation efforts.
:rolleyes:
oh, okay, maybe ~I should've read it
Yes :) when we give rescue breaths our exhaled breath has around 17% O2 in it but when using a pocket mask attached to an O2 kit it goes up to around 40% O2.
Thanks Loudy , that's kind of my point also.
ie an exhaled lungful of ( say EANx 32 ) would contain around 28% oxygen , a fair bit more than the normal 17% as your say.
If administering a higher O2 concentration ( 40% as you state ) via an oxygen kit is beneficial , does it not stand to reason that exhaled Nitrox would be much the same.
Additionally , Nitrox is instantly available ( assuming like me you normally have a tin of it strapped to your back ).
Cheers JB.
Doesn't look like it
http://firstaid.about.com/od/cprbasics/i/07_nobreathcpr.htm
well done to Peter on being 'open minded' enough to take the time to look it up rather than being dismissive!
there is numerous reports freely available on the internet regarding CPR techniques including or not including rescue breathing.
should anyone take the time to read them you may learn how it has been more effective in some cases not to do rescue breathing.
in basic, blowing 16% O2 or so around someones body with interupted blood flow is suggestivly proving to be less effective than the lungs taking in small amounts of 21% by their own vacume. your blood can carry the same 21% around your body several times before it becomes 16% and that is where the argument lies.
it may be mistakenly judgemental on your part to assume that a diver who isnt breathing is a drown victim.
in the origional post, he was simply unconscious! so ensuring his airway was open might have been the best 1st aid option.
keep an open mind... ;)
if anyone is interested in doing a CPR course, may i suggest you contact Loudy, he is an EFR instructor & his courses are very reasonably priced.
**in the UK at this time, under current HSE approved training legislation, it is still being taught 30 compressions - 2 rescue breaths**
scubamuppet
22-01-10, 16:09
OK How about this scenario.
You have a non breathing casualty.
You have plenty of folk to get help etc leaving 2 or 3 people to deal with CPR.
The person doing the breaths can easily get a good lung full of Nitrox prior to the first breath. The 2nd breath is just a lung full of air so no faffing with a reg.
Then the chest compression fellow does their thing allowing the breathing fellow to get the reg ready for another breath of goodness.
I certainly wouldn’t advocate teaching it as some would then see it a necessary and try to implement it when they where potentially understaffed for the extra faffing. But surely if you are trying to get oxygen to the brain then having a bit more oxygen in the lungs can only be a good thing?
Your method wouldnt cause any harm and may be of benifit, the main thing to always remember is that good CPR is the best chance a patient has. The act of compressing the chest does allow a small amount of air flow within the lungs and if for any reason you are unable to do rescue breaths just do chest compressions.
Also a point to remember, anyone that has cardiac arrest out of hospital has a very very small chance of survival (its arround 5%), all you can do is what you've been trained to do to the best of your abilities.
I have had a patient that had 10 mins of bystander CPR before the ambulance arrived and a total of 90mins CPR in hospital over a 3 hour period while being treated and defib'd many times, but the patient was able to tell me a joke the next day.
Also everyone should be doing 30 compressions to 2 breaths nowadays as its been proved to have a better outcome for the patient.
Finaly, Im a proffessional and resusitate patients almost daily but I still take a refresher course in CPR every year, you can never be too good at CPR.
Lovely - just when I thoguht this post couldn't get any more contraversial :O)
Reading this article ( and you have to read it very carefully ) there are quite a number of little phrases that need careful scrutiny - for example in support of the 'hands only' approach they state the victims were twice a slikely to survive. however they later also make the statement that in the study group of LAY rescuers , many were reluctant to administer CPR if it involved mouth to mouth.
lies , damned lies and statistics.
Also I quote :
Hands-only CPR is intended for untrained rescuers and only for witnessed cardiac arrest.
FYI , in my original post , yes , I meant a non-breathing ( unconscious ) casualty.
Still - good food for thought I think.
Keeping mind open as instructed :O)
OK. Here's a really radical idea.
Carry a proper O2 kit with you when you go diving!! :rolleyes:
Damn - just noticed that one.
Ok , do you carry it with you during the dive then ?
You don't !
Ok , so where is it then. ?
Locked in the boot of your car - I see.
So here's poor me , you've just dragged me ashore at 'the caves' , unconscious and not breathing.
Now what do you do ?
Leave me while you de-kit , run back up the slope , fish your key out your undersuit pocket ( bet you wish you had a front zip on your drysuit now ) , open the boot , rummage around , open up the case , assemble the cylinder to the pin valve , where does that wee hose go again , Oh yeah , there we are , now the mask , right ho , back down the slope , through the culvert - Damn ! the tides come in another 2 feet while I was doing all that and now the casualty has floated off !!
Ok , I accept that would be seen as a good result as far as you're concerned ;):D , but since we are in the mood for it , why not have a wee debate about the best course of action in THAT particular circumstance.
( All in fun of course Steve ;) )
Yogi Diver
22-01-10, 17:00
Now now John. You know me better than that.
My Car keys are in my outside pocket, flooded and fecking useless till some kind skipper flushes them with hot fresh water and dries them out with a hair drier. :D
By which time you are truly deid.:p
and if for any reason you are unable to do rescue breaths just do chest compressions.
BINGO..! thats where it appears to fail in reality & thats what should be taught more.
some stranger lying there with blood over his/her face is unlikely to attract mouth to mouth so the rescuer dosent do compressions either as they dont know any better!
turns out the poor sod dies after eating a hot-dog and it was only tomato sauce :D
JB,
if that happened to you at the caves, i'd just take the expensive parts of your kit and flog it on eBay. :D
dive granny
24-01-10, 12:49
Kind of in the same thought process. How would you get someone out the water and up that tunnel at the caves if there were only 2 of you diving. I can just about get myself out. I actually injured my knee at the caves once and it was my dry suit that kept it stable. It would be to hard drag someone out there:(
Yeah , I think most people would just follow Stu's good advice.
:O)
Kind of in the same thought process. How would you get someone out the water and up that tunnel at the caves if there were only 2 of you diving. I can just about get myself out. I actually injured my knee at the caves once and it was my dry suit that kept it stable. It would be to hard drag someone out there:(
I don't think you would and don't know if it would be worth trying. Phone 999 and let them do it. You could probably at least beach them depending on the tide and get their upper body on to dry land which is better than nothing. Does make you think about a lot of sites, especially what apear to be "easy" dives. For example, on a spring tide then the water at Finnart is right up to the base of the retaining wall, you've got no dry land to do CPR on or to beach a casualty on. There are a lot of boats as well that I wonder about the chances of getting an unconcious diver back on board, that's why for deeper stuff I always try to use boats with lifts.
I did my ankle coming out the water at Loch Fyne a couple of years ago as well and it makes you realise how vulnerable you are.
scubamuppet
24-01-10, 17:01
[QUOTE=Drambeg;49063]I don't think you would and don't know if it would be worth trying. Phone 999 and let them do it.
One thing to remember is how quickly you can get the emergency services. For example if it was at the Aframes ambulance crew can get very close to an exit point, without endangering themselves.
At the caves the ambulance would need to ask for either the coastguard or mountain rescue / Fire brigade (any difficult rescues they must ask for assistance), but the lifeboat for this area would be able to get closer, but would take 15 - 20 mins to arrive and can remove from either water or beach.
The secret is to ask for everything starting with a helicopter and be prepaired to help.
At the caves the ambulance would need to ask for either the coastguard or mountain rescue / Fire brigade (any difficult rescues they must ask for assistance), but the lifeboat for this area would be able to get closer, but would take 15 - 20 mins to arrive and can remove from either water or beach.
The secret is to ask for everything starting with a helicopter and be prepaired to help.
Which is why I said 999 and not ambulance service. I've always been taught that the Coastguard should be the first point of contact for any diving incident regardless of boat or shore. I've been involved in a couple of shore incidents and the Coastguard has always done a good job of coordinating, in fact they got mountain rescue out before anyone else for one.