# Cpr



## musicislife (May 27, 2012)

do you cut the PT's upper body clothing away if cpr is required? (bystander, AED hasnt arrived yet)


----------



## medichopeful (May 27, 2012)

musicislife said:


> do you cut the PT's upper body clothing away if cpr is required? (bystander, AED hasnt arrived yet)



I would say yes (but PLEASE keep in mind patient privacy if at all possible!).  You need to see the area you're working with, get the correct alignment for hand position, etc)


----------



## mycrofft (May 27, 2012)

What did your instructor tell you?


PRO: quicker access for AED when/if it arrives.

CON: Skin may be slippery from diaphoresis, delay in starting compressions due to scissoring.


----------



## NomadicMedic (May 27, 2012)

CPR is ALWAYS done on bare skin. No exceptions to this rule.


----------



## mycrofft (May 27, 2012)

None of the three agencies I teach layperson or professional responder first aid/CPR/AED (NOT first responder or EMT) recommend baring the chest for CPR alone. Two agencies are AHA, the third IS the ARC. 
ALL recommend using an AED if available.
Baring chest then makes sense but not at the expense of delaying compressions and other immediate life saving measures.


----------



## CrackerBDingus (May 27, 2012)

If you're alone when this starts try to lift the shirt, but don't try to remove it. The second person on scene should cut it off to prep the aed.


----------



## Brandon O (May 27, 2012)

n7lxi said:


> CPR is ALWAYS done on bare skin. No exceptions to this rule.



I hate rules. How about principles?

Principle: start compressions as soon as possible (all rescuers)
Principle: AED needs to be applied, but this can be done by a second rescuer "around" compressions
Principle: fiddling with clothing, particularly since most people don't carry shears about town, will probably discourage and certainly delay bystander compressions
Principle: compressions must be effective, but many ordinary garments (T-shirts, etc.) will provide little to no obstacle

Conclusion: I don't care how you do it as long as you fulfill the basic goals (push early, hard, fast, without stopping, and zap), but in many cases I would call it perfectly appropriate to initially compress over clothing, and in some cases (i.e. you spent many seconds stripping off a shirt before compressing) I'd call you wrong if you did otherwise.


----------



## NomadicMedic (May 28, 2012)

This is an EMS forum, not a lay person forum. 

In the realm of EMS, from first responders on up to paramedics, we're going to ALWAYS bare the chest for CPR and application of an AED.


----------



## CANDawg (May 28, 2012)

I agree, privacy needs to be a concern. 

If you're EMS, you should have enough knowledge and training to effectively landmark even with thin to mildly thick clothing. I'm not talking down coats, but I wouldn't have any issues finding the right position through a t-shirt. 

Once an AED arrives, you need to remove clothing, no doubt. Hopefully by then someone else has been able to clear the scene or provide a small amount of additional privacy. But until that point, if I'm in a public area, I would prefer to do CPR with a clothed patient - provided that clothing doesn't inhibit the compressions, and I can landmark appropriately.


----------



## Handsome Robb (May 28, 2012)

The shirt is coming off but like n7 pointed out, I'm not looking at it for laypeople, I'm looking at it as a professional. 

First thing that happens in an arrest is that shirt is getting cut off, someone is starting CPR while the other gets my monitor set up, pads first then leads and clears the pt of any medication patches or jewelry they may have on.

Privacy is great, but are you really going to delay exposing someone and using an AED until you can get the crowd away? I sure freakin' hope not. 

Early CPR and Defibrillation saves lives, not personal privacy.


----------



## mycrofft (May 28, 2012)

Citation please that disrobing the pt supersedes early fast and deep CPR for EMT's and paramedics.


----------



## NomadicMedic (May 28, 2012)

You can nitpick all you want, but the fact remains, all EMS responders, who this forum is directed to, should have the foresight to perform CPR on a bare chest.


----------



## Handsome Robb (May 28, 2012)

mycrofft said:


> Citation please that disrobing the pt supersedes early fast and deep CPR for EMT's and paramedics.



You and I both know there isn't one out there but if you're really going to nit-pick at me here ya go http://circ.ahajournals.org/content/95/8/2183.full

Are you really going to argue to keep the patient clothed while working in the capacity of an ALS or even BLS crew with a defibrillator, automated or manual, on hand is a good decision? It takes two seconds to cut a shirt so cut it off and go to work. Maybe I'm just "green" but I've been involved in and lead plenty of resuscitation efforts in the last 6 months, some successful and some not, they all get stripped the minute we make contact. the pants usually stay on but if we transport the hospital chops the pants off as soon as we get there.

We all know early, fast and deep CPR increases survivability to discharge, but what truly makes the difference is early defibrillation. 

If you don't have a defib on hand then sure do it with or without the clothes it really doesn't matter but in the end they are ending up with a bare chest and pads on them.

Like n7 said, again, this is a professional forum, not a laypeople CPR forum.

Here's another one about early defibrillation http://www.hvremsco.org/Documents/NAEMSP PP.PDF
and another http://www.chainofsurvival.com/cos/Early_Defibrillation_detail.asp


----------



## mycrofft (May 28, 2012)

1. Frankly, with a pair of shears I can have a chest bared fast enough it won't make a clinical difference. The OP is not a "fast draw" and specifies in his thread it is bystander CPR.
2. Again, frankly, I feel many people posting here are not of the level of training or skill that they will undress every apneic patient, especially before CPR.
3. Sorry if anyone's name here is "Frankly". 

Bare everybody before CPR, then put them on a long board, start high flow oxygen via NRB, start two IV's just in case...did I miss any?


----------



## Handsome Robb (May 28, 2012)

mycrofft said:


> Bare everybody before CPR, then put them on a long board, start high flow oxygen via NRB, start two IV's just in case...did I miss any?



Now you're being ridiculous and after 20 12 hour shifts in a row with another one tomorrow I don't have the patience or drive to continue arguing with you. 

There's 10 million ways to get from A to B. As long as you aren't causing the patient harm and you are efficient I really don't give a rat's *** how you go about it.

And you better believe if I get ROSC I'm looking for a second point of access, as high and as big as I can get and yea, they probably are going on a long board or a scoop for the simple fact that it's easier to move them and you're less likely to dislodge an advanced airway. 

Last time I took a CPR class baring the chest was high on the list of priorities.


----------



## Tigger (May 28, 2012)

There are times at the sports medicine job where it is conceivably possible that I will be alone for a minute or two before the AED arrives. During that time I am not going to do anything but compression (assuming there are no pads in the way). Those that bring the AED can start cutting the shirt while I continue compressions allowing minimal off chest time during while applying the AED. If I have the AED with me and some suffers cardiac arrest in front of me (lacrosse ball/puck to chest type scenario), the first thing I'm doing is cutting the shirt off and getting the AED on there even if I'm alone.


----------



## Brandon O (May 28, 2012)

Tigger said:


> There are times at the sports medicine job where it is conceivably possible that I will be alone for a minute or two before the AED arrives. During that time I am not going to do anything but compression (assuming there are no pads in the way). Those that bring the AED can start cutting the shirt while I continue compressions allowing minimal off chest time during while applying the AED. If I have the AED with me and some suffers cardiac arrest in front of me (lacrosse ball/puck to chest type scenario), the first thing I'm doing is cutting the shirt off and getting the AED on there even if I'm alone.



This is essentially correct, except that for most of us this is a TEAM SPORT. Even if you haven't choreographed a specific "pit crew" sequence in your department, it should be clear if you try it both ways that -- starting from recognition of unresponsiveness, pulselessness, and apnea -- one person beginning compressions while another exposes the chest and applies the AED yields shorter hands-off time than one person exposing the chest while the other peels readies the AED and then twiddles his thumbs. (Not much difference here with a manual monitor.) The time to shock may be a few seconds shorter in the latter case, but I would rather have less no-flow time with that delay than the alternative, and that position closely matches current AHA recommendations. Remember that we used to explicitly teach two minutes of CPR before shocking anyway in most arrests, and while it's no longer dogma it hasn't been thrown out either. (Never mind if somebody actually needs to go fetch the defib -- or wait for an AED to cycle through 30 seconds of layperson voice prompts before shocking.)

The point is that in almost all cases, compressions can be started almost instantaneously -- just start pushing -- whereas pretty much everything else takes at least a few seconds to perform. And I'd like people to use their heads about that kind of thing rather than insisting on any particular sequence just because that's how they like to dance.


----------



## DarrenA (May 28, 2012)

*Rip Shears*

There is a great product out called Rip Shears out on the market that actually assist in getting clothing off a bit faster, if you google them they may be what you are looking for in exposing a pt quicker if need be, and they attach right onto the handle of your exsisting shears. Privacy is important but bare chest is best.


----------



## Veneficus (May 28, 2012)

Forgive me, but are we talking about modesty and CPR as if the former actually takes some consideration when performing the latter?

What a tragedy it would be if somebody saw your tits, fat gut, surgical scars, etc, while performing a medical procedure that has no other purpose but to save your life...


----------



## DrankTheKoolaid (May 28, 2012)

+1   People can looked at a nicely dressed corpse, or they can see a naked hopefully revived patient.   A dead body has no modesty


----------



## rwik123 (May 28, 2012)

Veneficus said:


> Forgive me, but are we talking about modesty and CPR as if the former actually takes some consideration when performing the latter?
> 
> What a tragedy it would be if somebody saw your tits, fat gut, surgical scars, etc, while performing a medical procedure that has no other purpose but to save your life...



Ding ding ding


----------



## medichopeful (May 28, 2012)

Veneficus said:


> Forgive me, but are we talking about modesty and CPR as if the former actually takes some consideration when performing the latter?
> 
> What a tragedy it would be if somebody saw your tits, fat gut, surgical scars, etc, while performing a medical procedure that has no other purpose but to save your life...



CPR definitely comes first.  I definitely didn't mean to imply or start a discussion that suggested that CPR should be secondary to privacy! :wacko:


----------



## Brandon O (May 28, 2012)

I agree that privacy should not be a major concern here. No-flow time versus time to defibrillation is what's key.


----------



## Tigger (May 28, 2012)

Brandon Oto said:


> The point is that in almost all cases, compressions can be started almost instantaneously -- just start pushing -- whereas pretty much everything else takes at least a few seconds to perform. And I'd like people to use their heads about that kind of thing rather than insisting on any particular sequence just because that's how they like to dance.



That's the point I was trying to get across. I realize for most in EMS that it's a non issue since we almost always have a partner. There are times though that the cardiac arrest finds us though and some modification to the "rules" might be needed.



Veneficus said:


> Forgive me, but are we talking about modesty and CPR as if the former actually takes some consideration when performing the latter?
> 
> What a tragedy it would be if somebody saw your tits, fat gut, surgical scars, etc, while performing a medical procedure that has no other purpose but to save your life...



I agree wholeheartedly, however I will add that are idle hands on scene that there is no reason why the modesty issue cannot be addressed.


----------



## mycrofft (May 29, 2012)

Yes, I was being silly. Sort of an "ADDuctio ad absurdum". 
:deadhorse:


----------



## Akulahawk (May 29, 2012)

If you need to cut through light clothing fast, just break out one of these...







I can't say that it would cut through denim as I haven't tried it, but it should easily cut through T-shirts and most other clothing... and I do know that they will easily cut through several layers of athletic tape, from personal experience.


----------



## Tigger (May 29, 2012)

Akulahawk said:


> If you need to cut through light clothing fast, just break out one of these...
> 
> 
> 
> ...



The shark! So commonly taken from the training room that they're either hidden or chained down! I bet it cut denim considering how much tape it can cut on a single pass, though it's a little large to keep in my little kit.


----------



## Akulahawk (May 29, 2012)

Tigger said:


> The shark! So commonly taken from the training room that they're either hidden or chained down! I bet it cut denim considering how much tape it can cut on a single pass, though it's a little large to keep in my little kit.



The Shark is a great tool... and the picture is inverted.  

I'd just put it in a larger kit. Since we'd be responding professionally, why not put one in our kits? Why not just physically attach them to AEDs?


----------



## mycrofft (May 29, 2012)

It's not inverted, its an Australian Left Handed Shark!

They also apparently sell a smaller version at 1/4 the price, both have replacement blades sold separately, and do not incoude a guard or sheath for storage/transport.

Here are two more V-blade type cutters for under $5, but they are pullers and do not have replaceable blades. (Use Goof-Off then alcohol to remove glue goo). Ignore the scissoring device.

http://www.enasco.com/c/farmandranch/Livestock+Identification/Ear+Tag+Removers/

But bystander CPR training, per AHA AND ARC does not include baring the chest.


----------



## Christopher (May 29, 2012)

n7lxi said:


> You can nitpick all you want, but the fact remains, all EMS responders, who this forum is directed to, should have the foresight to perform CPR on a bare chest.



The last time I did chest compressions while waiting on somebody to bring me a monitor I left their shirt on. They were too diaphoretic and I didn't have gloves (drive up DOA in a hospital parking lot). The shirt allowed enough traction to do effective CPR.

If you've got the correct landmarks, who cares about removing the shirt until the AED/Monitor arrives. CPR isn't functionally any different. Let somebody else worry about removing the shirt.


----------



## Tigger (May 29, 2012)

Akulahawk said:


> The Shark is a great tool... and the picture is inverted.
> 
> I'd just put it in a larger kit. Since we'd be responding professionally, why not put one in our kits? Why not just physically attach them to AEDs?



It's a thought, last year I cut myself on a pair of shears attached to an AEDs shoulder strap that were too loose to stay closed. A shark might struggle to cut through straps that keep pads together though.


----------



## DarrenA (May 29, 2012)

Hey that is why I love Rip Shears. They attach on to the handle of a regular 7.5" standard shear. Watch the YouTube video or check out the website at www.RipShears.com


----------



## mycrofft (May 29, 2012)

Just dug out my Brady first responder text. Although about 2/3 of the pictures show a bared male chest, not all do, and the instructions do not say to bare the chest except for AED. Seems as confusing as their long spine board material.


----------

