# have i gone crazy?



## iamjeff171 (Aug 19, 2009)

and forgot how to do cpr? when i last took my cpr class compression:ventilation was 30:2 on everyone but 2 rescuer infant.  however i am doin an online review for my NR test tomorrow and it had this question:

"You arrive on scene with your partner to find an 11 year old boy unconscious after being dragged from the water. He is not breathing and has no pulse. CPR in this case should include________________. 

 Your Answer: 30:2 compression to ventilation ratio 
Incorrect

Correct Answer is: 15:2 compression to ventilation ratio

New AHA guidelines specify that for two person CPR on a child you should use a 15:2 ratio. It would be 30:2 if you were alone and did not have your partner Joe.  
"

has aha changed their teaching, or is this incorrect/old information in the review?

-Jeff


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## Dominion (Aug 19, 2009)

I'm not sure about that.  We just took PALS and I was told the same thing you said above.  30:2 on everyone but infant.


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## spisco85 (Aug 19, 2009)

That's different


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## Brandon O (Aug 19, 2009)

I believe I've run into this, but I always interpreted it to be a misunderstanding by whoever was promulgating it, and that's always what it ended up being.

Wasn't this in the old guidelines? Or am I misremembering?


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## Brandon O (Aug 20, 2009)

Actually I just found some of my notes from the AHA and they have two-rescuer for children as 15:2 as well. I think it's just inconsistent...


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## TransportJockey (Aug 20, 2009)

For PALS and PEPP in my medic program they stressed 15:2 for 2 rescuer infant/child.


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## Dominion (Aug 20, 2009)

I wish I still had my pals books (they were loaners ....sad).  The chart had compression ratios and it had 15:2 for infant and 30:2 for everything else.  Maybe I'm going crazy and need to look at it again.


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## TransportJockey (Aug 20, 2009)

Here's the other crazy question... You have an unconcious kid (9yo) with a PR of 52... Do you do CPR?


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## zappa26 (Aug 20, 2009)

I'm an ARC FA/CPR instructor, and although I'm only trained to instruct lay responders, I hold a professional rescuer cert too and have since I started lifeguarding in 2007.

CPR for Lay Responders is 30:2, for everyone, all the time.  They're not trained in two-person response.

CPR for Professional Rescuers is always 30:2 when you're alone.  It's also 30:2 if you have two rescuers working on an adult, but when you have two rescuers on someone who does not show signs of puberty (that is, infant and child), it's 15:2.


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## MRE (Aug 20, 2009)

I do the same thing as Zappa26, but at both lay responder and pro rescuer levels.  The pro rescuer guidelines are 30:2 for everything except two rescuer CPR on an infant.

I think there was a mistake with the question.  Either the wrong answer was set to be the correct one or the question is from a few years back when 15:2 would have been the correct answer.

You were right, 30:2 is correct.  I wouldn't worry about it any more.


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## Hoofguy (Aug 21, 2009)

jtpaintball70 said:


> Here's the other crazy question... You have an unconcious kid (9yo) with a PR of 52... Do you do CPR?




Umm no, you don't


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## Ella~Emt15136 (Aug 21, 2009)

In our class it is 15:2 for infant or child.  
start CPR on an infant if pulse is less than 60....for a 9 year old with a pulse of 52 no.


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## TransportJockey (Aug 21, 2009)

W1IM said:


> I do the same thing as Zappa26, but at both lay responder and pro rescuer levels.  The pro rescuer guidelines are 30:2 for everything except two rescuer CPR on an infant.
> 
> I think there was a mistake with the question.  Either the wrong answer was set to be the correct one or the question is from a few years back when 15:2 would have been the correct answer.
> 
> You were right, 30:2 is correct.  I wouldn't worry about it any more.



I'm  reading the AHA Currents right after the new guidelines came into effect... On pg 14 it says infants and children (until onset of puberty) 2-rescuer professional CPR is 15:2.



Ella~Emt15136 said:


> In our class it is 15:2 for infant or child.
> start CPR on an infant if pulse is less than 60....for a 9 year old with a pulse of 52 no.


I should have worded that better... If the 9yo is unconcious and shows signs of poor perfusion (actually just the poor perfusion), and the kid has not hit puberty, if hte pulse is under 60, guidelines state start CPR.
-Same AHA Currents (Winter 05, pg 11)


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## MRE (Aug 22, 2009)

jtpaintball70 said:


> I'm  reading the AHA Currents right after the new guidelines came into effect... On pg 14 it says infants and children (until onset of puberty) 2-rescuer professional CPR is 15:2.



The AHA Currents are newsletters, not training or standard documents.  I think most of us know how accurate newspapers/letters tend to be.  I wouldn't rely on this for your standards.

My EMT-B book dated 2007 which states 30:2 for everything except 2 rescuer infant.  All my Red Cross materials say the same, and my last AHA re-cert for CPR said it too.  I think I can safely say that this is the correct info.


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## TransportJockey (Aug 22, 2009)

RE: ratio, Pg 162 of PALS states:
"A universal compression-to-ventilation ratio of 30:2 for lone rescuers is recommended for all victims of cardiac arrest, from infants to adults. The ratio is modified to 15:2 for infants and children if 2 rescuers are present."

RE: CPR w/ pulse, Pg 122-124 of PALS shows that symptomatic bradycardia in an infant or child w/ a pulse rate less than 60 should be treated first line with chest compressions. Pharmacological methods are only used if the symptomatic bradycardia persists while compressions are being performed.

And per AHA definition, a child is older than 1 year but before puberty starts


My PALS books (pg numbers out of Providers manual) are the newest editions with the 2005 guidelines in them.


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## Brandon O (Aug 22, 2009)

All of the AHA material I have here says 15:2 for children. However my EMT textbook says 30:2. This is a bit of a mystery.


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## TransportJockey (Aug 22, 2009)

Brandon Oto said:


> All of the AHA material I have here says 15:2 for children. However my EMT textbook says 30:2. This is a bit of a mystery.



Who are you certified for CPR with? AHA or your EMT textbook?


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## Brandon O (Aug 22, 2009)

Well, if we're being smartass, both, in a manner of speaking.

But while the AHA is the source of the recommendations, the EMT curricula are supposedly drawing from it, so it's odd that we'd see different recommendations there. But it does look like most of the discrepancies reported are between AHA/ARC and EMS training material.


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## Dominion (Aug 22, 2009)

jtpaintball70 said:


> Who are you certified for CPR with? AHA or your EMT textbook?



What jpaintball quoted is what I was told in PALS (I wish I still had the books)

30:2 except in infant and with 2 rescue CPR in infant and children before puberty.  However in the same class I was told that I should remember 30:2 for EVERYTHING except infants only.

As for bradycardia <60 with poor perfusion start compressions, if compressions are ineffective after (I forget help me out here jt)...you can start with pharmacological interventions.

This is what was put forth to us in PALS.


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## TransportJockey (Aug 22, 2009)

Dominion said:


> What jpaintball quoted is what I was told in PALS (I wish I still had the books)
> 
> 30:2 except in infant and with 2 rescue CPR in infant and children before puberty.  However in the same class I was told that I should remember 30:2 for EVERYTHING except infants only.
> 
> ...



I'm at sitting at a coffee shop helping some friends study other subjects, so I don't have my PALS books handy... I think it's after a full 5 cycles (two minutes. Thenyou can try pharm, or in the absolute last resort, pacing.


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## Ditchmedic (Aug 29, 2009)

*have i gone crazy*

Its 30:2 if you are by yourself, 15 and two with two rescuer cpr, especially if intubated.  Ya know, I teach this all the time and still mess it up from time to time


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## Pudge40 (Aug 29, 2009)

Ditchmedic said:


> Its 30:2 if you are by yourself, 15 and two with two rescuer cpr, especially if intubated.  Ya know, I teach this all the time and still mess it up from time to time



No only child and infant goes to 15:2 with two rescuer CPR. Adult stays at 30:2 with both.


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## RescueYou (Aug 29, 2009)

IAmJeff said:


> and forgot how to do cpr? when i last took my cpr class compression:ventilation was 30:2 on everyone but 2 rescuer infant.  however i am doin an online review for my NR test tomorrow and it had this question:
> 
> "You arrive on scene with your partner to find an 11 year old boy unconscious after being dragged from the water. He is not breathing and has no pulse. CPR in this case should include________________.
> 
> ...




AHA has indeed put it out so that it is 30:2. I believe that AHA went crazy when they said the "correct answer" you received. 1 or 2 person CPR shouldn't make a difference in the ratio. In 99% of EMT-B books, that remains true. But it is a fairly recent change. For example, out of the Brady series, only the 11th edition has the 30:2 ratio. The 9th and 10th don't. They are honestly considering taking out the breaths completely, but that is just speculation for now. To be truthful, I think as long as you get at least 15 compressions in and 2 breaths per cycle, it isn't going to make a big difference. I myself would do 30:2, but go by the latest standard for your test.


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## TransportJockey (Aug 29, 2009)

RescueYou said:


> AHA has indeed put it out so that it is 30:2. I believe that AHA went crazy when they said the "correct answer" you received. 1 or 2 person CPR shouldn't make a difference in the ratio. In 99% of EMT-B books, that remains true. But it is a fairly recent change. For example, out of the Brady series, only the 11th edition has the 30:2 ratio. The 9th and 10th don't. They are honestly considering taking out the breaths completely, but that is just speculation for now. To be truthful, I think as long as you get at least 15 compressions in and 2 breaths per cycle, it isn't going to make a big difference. I myself would do 30:2, but go by the latest standard for your test.


According to PALS and AHA it IS 15:2 for 2 rescuer. Most EMT books apparently don't feel the need to tell the providers all the standards


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## RescueYou (Aug 29, 2009)

jtpaintball70 said:


> According to PALS and AHA it IS 15:2 for 2 rescuer. Most EMT books apparently don't feel the need to tell the providers all the standards



Fair enough then. I stand corrected lol. 
AHA is strange, but whatever.  I guess you just do what you gotta do lol. I'm yet to find an EMT book that does specify between provider standards. The Red Cross vs. AHA will probably always remain. 

....when you think about it, I guess it could technically come down to local protocol or what the AIC on the truck says....:unsure:


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## Shishkabob (Aug 29, 2009)

AHA guidelines:
Adult is always 30:2
Single rescuer child / infant is 30:2
Dual rescuer child / infant is 15:2

Reason why it's 15:2 for children / infants is because their arrest are more respiratory based problems then cardiac.


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## Thindian (Sep 1, 2009)

I learned that with ped's and *two providers*, it's 15:2.


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