# dumb cpr question



## 2boss4 (Oct 6, 2008)

how is it that giving compressions and rescue breathing at the same time during CPR allows air into the lungs? i would think that this would have an adverse effect on what was trying to be accopmlished. explination prease...


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## southern_guy (Oct 6, 2008)

Pretty sure you stop chest compressions when you give your breaths...


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## 2boss4 (Oct 6, 2008)

...really?


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## VentMedic (Oct 6, 2008)

Same time only with an advanced airway like an ETT or trach.


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## JPINFV (Oct 6, 2008)

Yes. With out and advanced airway in place you are supposed to pause compressions while giving breaths. With an advanced airway you do compressions and ventilations independent of each other.

Edit: Sniped by the ventmaster.


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## 2boss4 (Oct 6, 2008)

oooo. ok got it. its wierd, now that i got an answer, i remember a code we had w/o ALS there to help us, and we didn't do breaths + compressions at the same time
good thing too,cause i would owe some dead patients an apology.


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## thatrescueguy (Oct 6, 2008)

Yes like everyone else here has said you stop compressions, ventilate and then continue compressions.


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## 2boss4 (Oct 6, 2008)

then how does an advanced airway make a difference?


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## JPINFV (Oct 6, 2008)

Because when there's only one place for the ventilations to go then you don't really have to worry about gastric inflation (well, not as much).


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## mycrofft (Oct 7, 2008)

*Used to interpolate inflations, doesn't work in real life.*

The trend is to recognize as was suspected in the beginnings that rythmic compression then rebound of the chest cavity mimics respiration to a degree, but nothing mimics heart contractions like proper compressions, so more attention is given to compressions and less to breathing versus before. It was like ballroom dancing...your turn to curtsy, my turn to blow.:blush:


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## fortsmithman (Oct 7, 2008)

What compression breath ratio you use my agency uses the compression breath ratio of 30:2


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## JPINFV (Oct 7, 2008)

30:2 for adult and single rescuer infant and child is the current industry standard as set by the American Heart Association 2005 curriculum.


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## fortsmithman (Oct 7, 2008)

I ask that because the nurses at our hospital are being taught 15:2 for 2 rescuer not 30:2 which is what we use for child infant 1 rescuer adult 2 rescuer adult.


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## JPINFV (Oct 7, 2008)

The key term there is 2 rescuer, which is 15:2 per AHA.


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## fortsmithman (Oct 7, 2008)

as per cpr taught by st johns ambulance which is what is taught in most of canada it's 30:2 for all CPR it he same for infant child 1 rescuer and 2 rescuer.


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## JPINFV (Oct 7, 2008)

Are we talking about professional health care providers or lay providers (general public)?


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## fortsmithman (Oct 7, 2008)

That is what is taught by st johns ambulance.  st johns ambulance has been around since the year 1080.  in order to enter ems and nursing programs in alberta you need st johns standard first aid and cpr lvl c.  the 15:2 is being taught by the heart and stroke foundation. sta johns used to teach 15:2 for one rescuer and 5:1 for 2 rescuer but they changed it a few yrs ago.
it's confusing when 2 respected organizations have 2 different ways of cpr there should be 1 way.  Almost like the EMS field where different jurisdictions have different licensing requirements.  there should be only one way.


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## BEorP (Oct 7, 2008)

fortsmithman said:


> That is what is taught by st johns ambulance.  st johns ambulance has been around since the year 1080.  in order to enter ems and nursing programs in alberta you need st johns standard first aid and cpr lvl c.  the 15:2 is being taught by the heart and stroke foundation. sta johns used to teach 15:2 for one rescuer and 5:1 for 2 rescuer but they changed it a few yrs ago.
> it's confusing when 2 respected organizations have 2 different ways of cpr there should be 1 way.  Almost like the EMS field where different jurisdictions have different licensing requirements.  there should be only one way.



It's not that confusing. St. John Ambulance taught you the universal 30:2 because they taught you the lay rescuer guidelines. 

If they taught you the HCP guidelines it would be 30:2 for single rescuer (adults, children, infants) and 15:2 for two rescuer children and infants only. This will be the same whether you go to the Heart and Stroke Foundation, Red Cross, or St. John as long as they are following the guidelines.


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## MRE (Oct 7, 2008)

BEorP said:


> It's not that confusing. St. John Ambulance taught you the universal 30:2 because they taught you the lay rescuer guidelines.
> 
> If they taught you the HCP guidelines it would be 30:2 for single rescuer (adults, children, infants) and 15:2 for single rescuer children and infants only. This will be the same whether you go to the Heart and Stroke Foundation, Red Cross, or St. John as long as they are following the guidelines.




I did AHA HCP with my EMT-B last summer and we did it a little bit different.  The ratio was 30:2 for everything except 2 rescuer CPR on a child or infant.  Single rescuer was always 30:2.  I checked the AHA journals with the 2005 updates and this is what they recommend.


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## BEorP (Oct 7, 2008)

KB1OEV said:


> I did AHA HCP with my EMT-B last summer and we did it a little bit different.  The ratio was 30:2 for everything except 2 rescuer CPR on a child or infant.  Single rescuer was always 30:2.  I checked the AHA journals with the 2005 updates and this is what they recommend.



My second "single rescuer" should have been two rescuer.


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## MRE (Oct 7, 2008)

BEorP said:


> My second "single rescuer" should have been two rescuer.



Ok, good to know we are on the same page.


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## Medexpresso (Oct 13, 2008)

most recent AHA guidelines recommend 30:2 for healthcare providers, stop compressions for breaths, watch chest rise and fall, etc...start compressions again...of course it doesn't go that smoothly on a real arrest in the field! ha!


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## rhan101277 (Oct 13, 2008)

BEorP said:


> It's not that confusing. St. John Ambulance taught you the universal 30:2 because they taught you the lay rescuer guidelines.
> 
> If they taught you the HCP guidelines it would be 30:2 for single rescuer (adults, children, infants) and 15:2 for two rescuer children and infants only. This will be the same whether you go to the Heart and Stroke Foundation, Red Cross, or St. John as long as they are following the guidelines.



With two rescuers I think they like to see the children and infants getting more oxygen.  It is still 30:2 for adult two rescuer.


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## Jeremy89 (Oct 14, 2008)

New "dumb" question-  How does capillary gas exchange occur if you have to stop compressions for rescue breaths?  I'd imagine very little O2 gets into the blood from those 2 breaths, considering the heart isn't "beating" to carry away the oxygen-saturated blood and bring in more CO2 saturated blood.

Make sense?  (please say yes)


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## Jeremy89 (Oct 24, 2008)

well....anyone??


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## MRE (Oct 24, 2008)

I don't know a whole lot about the cardiovascular or pulmonary systems, but it would seem to me that when giving respirations, you would only be able to load up the hemoglobin present in the capilaries of the lungs at that moment with O2 since blood is not flowing.  However, you are also leaving air with about 16% O2 in it in the dead space of the lungs, and while compressions are being done, gas exchange to some extent can still occur, now that you do have bloodflow. 

So, gas exchange would still occur, but at a very reduced capacity.


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## rhan101277 (Oct 24, 2008)

Also remember that when you exhale or BVM all of the air in your lungs doesn't go out.  There is still some in there, that should be able to provide some exchange, so I am sure that helps as well.


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## MRE (Oct 24, 2008)

rhan101277 said:


> Also remember that when you exhale or BVM all of the air in your lungs doesn't go out.  There is still some in there, that should be able to provide some exchange, so I am sure that helps as well.



Yup, that be the dead space I mentioned.


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## Mercy4Angels (Nov 2, 2008)

30 to 2 for everyone single rescuer - 15 to 2 double rescuer infants and kids. ALWAYS stop compressions then two breaths...rinse reuse repeat..lol. only continue compressions and ventalations with a et tube in place when directs by a medic it usually ends up being like 6 compressions per one breath. just watch the lifepack monitor to keep up the respiration rate.


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## FLAEMT22 (Nov 8, 2008)

Jeremy89 said:


> New "dumb" question-  How does capillary gas exchange occur if you have to stop compressions for rescue breaths?  I'd imagine very little O2 gets into the blood from those 2 breaths, considering the heart isn't "beating" to carry away the oxygen-saturated blood and bring in more CO2 saturated blood.
> 
> Make sense?  (please say yes)




Not a dumb question, it's actually very intuitive. The whole reason AHA came up with these guidelines to do more compressions, and are actually looking at continuous compressions without breaths, is because the gas exchange is only occurring with the circulation of blood throughout the capillary membrane of the alveoli. If there is no blood circulating then you have no exchange, or very minimal exchange. Therefore, compressions are key to eliminating CO2 from the blood, and delivering O2 back to the organs. However, it is known that compressions during CPR are only delivering 25% of the compression strength and contractility that the heart is delivering on it's own (in a normal state). So, that explains why we have to worry about lack of gas exchange and the body ultimately ending up in a hypercarbic  state, which is why we have to give sodium bicarb to our codes.


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## JPINFV (Nov 9, 2008)

Jeremy89 said:


> New "dumb" question-  How does capillary gas exchange occur if you have to stop compressions for rescue breaths?  I'd imagine very little O2 gets into the blood from those 2 breaths, considering the heart isn't "beating" to carry away the oxygen-saturated blood and bring in more CO2 saturated blood.
> 
> Make sense?  (please say yes)



Simple. Diffusion occurs continuously as long as a concentration gradient is present. The concentration gradient is refreshed when ventilated and doesn't go away the second a breath is exhaled. 

Now, it's important to understand about the different types of lung volume.







Now, if you just relax and exhale you would have about 2.5 liters of air in your  lungs. That is comprised of two separate sets of "volume." Now, in your relaxed state, try to exhale ALL of your air. This is the expiratory reserve volume. Even besides that, there is still some residual volume that you can't exhale. Even if you can't exhale it, it still gets mixed, to an extent, when you breath. That's why you don't have to ventilate continuously.


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## tydek07 (Nov 9, 2008)

2boss4: 

You stop compressions when there is no advanced airway in place. (ex. BVM with NPA or OPA) You do not stop compressions once the pt has an advanced airway in. (ex. ET tube or Combitube) Once there is an advanced airway in place, you do continuious compressions only stopping for rythym checks 

Take Care,


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## Jeffrey_169 (Nov 12, 2008)

*The vacuum*

The only time what your saying is true, as some others have stated, is if an advanced airway is in place and secured. 

The physiology is simplier then one might think really. Technically, if yo have an advanced airway in place, the chest will inhale and exhale with compressions, and the breaths are only suplimental to this effect. When a chest compression is performed, and if it is performed correctly, it will compress the intrathoracic muscles as well as the heart. This will cause the lungs to push out the air, and the diaphram to move in the downward direction. When the compression is released, the muscles in the chest, which are connected to the lungs via the parietal and viceral masses, will cause the lungs to reopen, which will cause the air pressure in the lungs to create a negative pressure, which will cause air to enter the lungs. Its alot like the effect of bulb syringe; when you squeeze it, it pushes out the air, and as it reexpands, it will suck air into it. Once the air enters the alveoli, diffusion does the rest, and the compressions that you are giving causes the heart to circulate the now freshly oxygenated blood. 

Does this help you any?


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