Recent discussions
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Stephen Hines
Was any consideration given to the use of the recovery position or otherwise in the post ROSC patient, or is this limited in it's scope? -
WILSON ALVEAR
Very good -
ahmed abbas
none -
cindy valencia
bien -
Wess Long
In drowning scenarios, a CAB approach is problematic for lifeguards rescuing an unresponsive swimmer who has not suffered any other sort of a medical event. Emphasis should be placed to provide respirations as early as possible, including in the water if possible. Time is critically important when treating hypoxia from drowning. By not emphasizing immediate & effective breaths, there can be a considerable time lapse from the swimmer's last breath through the time to recognition, rescue, extrication, dry land assessment, and then begin compressions. This time can be further lengthened if an AED is introduced early and begins assessment. Without immediate breaths, this delay only further lengthens the time that the individual is in hypoxia which then decreases their chance of survival. Conversely 5 in-water or immediate respirations out of the water can be provided quickly and effectively prior to further care without significant delay. I firmly believe early and effective respirations interrupt the drowning process and ultimately save lives. -
Richard Field
I agree that initial ventilations are likely to be of importance in drowning where the cause is hypoxia and this should be taught to those with a duty to respond (lifeguards/healthcare professionals/rescue personnel). However the big question is how many people are willing to do mouth to mouth ventilations? The last 2 years has especially made people more cautious about risks to responders in resuscitation situations. I feel it likely that most would delay ventilations until a barrier device or facemask is available and therefore time should be spent doing chest compressions first whilst awaiting for equipment. However, in certain situations a rescuer may need to wait for help to get the casualty out of the water in which it would be ideal if they could commence ventilations in this period. Another question would be regardless of which order ABC vs. CAB should the first set of ventilations be more than 2 i.e. 5 or more? The idea being to maximise oxygen delivery during the subsequent cycle of chest compressions; this will depend on if supplemental oxygen is being used, the tidal volume being delivered, the patients FRC and clearance of expired gases amongst other factors. The most important point is whatever oxygen you have managed to get into the patient you need it to get from the alveoli to the organs which is only achieved by minimising no-flow time! My suggestion would be if ventilations can be performed immediately give the 5 with an ABC approach. However if there is a delay in obtaining equipment/unwillingness to start without adjuncts then adopt a CAB approach and stick to the standard compression:ventilation ratio to keep it simple. -
Mike Janczyszyn
Thank you for this systematic review. I am new to providing public comments. It's nice to see that there is a recommendation for AEDs >1 years of age. In future reviews, I'd be very curious about Joules used to defibrillate; whether they used child modes or shocked with adult doses and whether there was any effect with CPC. I see that this is under your Research Priorities. Not having to purchase pediatric pads would add to the cost-effectiveness and ease of use. Although this would only relate to less than half the population from the studies; <8 y/o. I have some of the same concerns as Shinichiro where there are three articles published by the same people with some of the same timelines. Not sure if that was taken into account with reporting. Just a note, for the last line of knowledge gaps, is it supposed to say AED, or is it supposed to say performing CPR? -
Chamila Jayasekera
With a confirmed cardiac arrest and airways possibly flooded, it may be prudent to give chest compressions first with the hope of circulating whatever the oxygen. With the manikin study showing minimal delay in giving breaths and considering the fact that consistency is maintained across BLS , it may be best to recommend CAB in drowning. -
Jacqueline Abela
When performing chest compresssions only and without airway maneuvers -
Carl Gwinnutt
As someone who lives by the coast and trains local lifeboat personnel they have recognised that those who suffer a cardiac arrest 'out at sea' can be divided into 2 main groups which I find quite interesting. The first is the 'youngsters' who are most likely to have drowned and have a hypoxic arrest. I have taught the crew that ventilation in this group with additional oxygen (they have facemark with the ability to add oxygen) is important and may in some cases be all that is required. Furthermore, trying to do quality CPR in a RIB is very difficult (see below). The second group are the older generation who frequently have co-morbidities and are more likely to have a primary cardiac cause of their arrest. In this group, the key thing is for them to start chest compressions as a primary procedure and get the person to the nearest AED. The crew have a map of all the AEDs along the coastline they cover and normally this only takes a few minutes, but is weather dependant. If this is delayed by more than a few minutes, they may then decide to add rescue breaths with supplementary oxygen. Doing CPR is very difficult but I decided to let them work out what they feel is the best position for the victim to make this as easy as possible, and they decided that they would lift the victim's legs up and place them on the side of the RIB! This of course may actually be beneficial and help with venous return. Food for thought..........