# What would u have done differently here??



## AVPU (Mar 3, 2010)

To assess for a pulse or no? This lifeguard was taught not to (as the Red Cross teaches as well), did not, and her near-drowning victim, who had gone into CA, died.

http://www.dailymail.co.uk/news/art...ifeguard-stopped-CPR-thinking-saved-life.html

Did the lifeguard do everything right??


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## reaper (Mar 3, 2010)

This was already in the news section.

But, yes even  the Red Cross teaches pulse checks. Why would you stop CPR without verifying a pulse?


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## AVPU (Mar 3, 2010)

On children, yes, on adults, no pulse check


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## LondonMedic (Mar 3, 2010)

reaper said:


> This was already in the news section.
> 
> But, yes even  the Red Cross teaches pulse checks. Why would you stop CPR without verifying a pulse?


As was said previously.

Pulse checks work well when they are checked by someone who knows anatomically where the pulse is and is used to feeling and assessing them day in, day out.

Members of the public are, generally, stupid and cannot be reliably relied upon to find a pulse that is there but can be relied upon to find their own pulse instead of the punter's absent one.

Therefore, removing the requirement for them to feel a pulse, instructing them to start CPR if the punter isn't breathing and telling them to continue CPR until they see 'signs of life' will probably save lives.

However, the girl in this scenario followed those rules but was simply not experienced enough to tell the difference between (presumably) an agonal gasp and a 'sign of life'. And that's hardly a hanging offence.

The question, in my mind is three fold. Should we change the guidelines to include a pulse check for people to :censored::censored::censored::censored:-up? Should we teach them in more detail about signs of life for them to forget and misinterpret? Or should we get everyone who might ever see someone get sick to hang around an ER until they can successfully tell the difference between a liver and a deader?


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## AVPU (Mar 3, 2010)

LondonMedic said:


> As was said previously.
> 
> Pulse checks work well when they are checked by someone who knows anatomically where the pulse is and is used to feeling and assessing them day in, day out.
> 
> ...


You are rather cynical. Personally, I enjoy that 

You alluded to a reason perhaps the Red Cross removed pulse-checking on an adult. At least here in the US, adults have gotten much larger than they used to be. Taking time to accurately find a pulse is seen as a waste of time, when instead they could be helping to perfuse blood and give air. 

Given the 3 options you put forth, I say no to the first one. I side with the Red Cross on this one. I vote #2. It's scenarios like this that remind us all how critical lay-person instruction is. Unfortunately usually a tragedy is needed to wake people up.


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## LondonMedic (Mar 3, 2010)

AVPU said:


> Given the 3 options you put forth, I say no to the first one. I side with the Red Cross on this one. I vote #2. It's scenarios like this that remind us all how critical lay-person instruction is. Unfortunately usually a tragedy is needed to wake people up.


I'd agree with you 100% on this. From the sounds of things, all the pieces were in place for a decent chain of survival and with, perhaps, just a little bit more training and experience, this lifeguard could have really made a difference here and potentially saved this poor girls life.

However, I always take comfort from the fact that once you've started CPR they're already dead, anything else is a bonus.


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## reaper (Mar 3, 2010)

Except for the fact that she is not a lay person! She was a lifeguard, that is considered a professional rescuer in the US. Maybe in the UK they only teach lifeguards to lay person CPR?


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## LondonMedic (Mar 3, 2010)

reaper said:


> Except for the fact that she is not a lay person! She was a lifeguard, that is considered a professional rescuer in the US. Maybe in the UK they only teach lifeguards to lay person CPR?


Professional, that depends. I would suggest that the average lifeguard in the UK doesn't do much rescuing and that of those very few require any formal medical care, let alone resuscitation.

As for whether they're taught lay person CPR or not. The resus council over here specifies the following algorithms for ALS, Immediate Life Support, BLS in hospital and BLS out of hospital +/- AED. The problem with the first three is that they assume a level of experience, equipment and supporting staff - which you probably won't find at most swimming pools.

So, yes we could have taught this girl to be a 'professional rescuer' but who's going to pay for the additional training, who's going to provide it, who's going to provide (and maintain and check) the equipment and where would she get the additional experience required for it?


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## LondonMedic (Mar 3, 2010)

I would edit to add;

You sound like you're advocating a further intermediate tier of resuscitation training? Something that police, lifeguards, security or anyone in a job where they may have to break some ribs once or twice in their career should do?

We could do this. Probably the simplest route is to take ILS and remove all references to oxygen, access, drugs and all but the simplest adjuncts. That's easy enough. We could then find the time, the money and the teachers to instruct everyone.

However, where are we going to find all these people the experience? How would you give them amble, supervised, experiences of finding pulses on people with them and noting absent ones on people without? How much experience would they have to do before they can reliably find a pulse in situation where the brown squidgy stuff has just hit the rotating metal thing?


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## reaper (Mar 3, 2010)

I am not advocating for any change.

AHA has healthcare provider. It is more then lay person CPR. Includes CPR and AED. The guidelines are different then lay person.

Anyone that is in the healthcare field takes it. I consider Lifeguards as one, they are rescuers.  Dental hygienist are required to have it. Do they have experience in the field or preforming CPR? I train many Rn's that may work in a Dr's office and have never preformed CPR in their life. They are still required to know it, just in case.

Healthcare provider does not include any drugs or advanced airways. It is designed as the basics of CPR. But, a step above lay rescuer CPR.


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## dave3189 (Mar 8, 2010)

Considering this LG was probably only CPR/FA trained I'd say she did OK considering the circumstances.  First off, nobody has mentioned the obvious which is people generally are not breathing without a pulse.  There are obviously situations when a patient can be breathing and not have a perfusable rhythm.  However, this requires the caregiver to have the knowledge to take a BP or at minimum understand the basics of hemodynamics and heart rates.  Wit the dismal out of hosptial C.A. survival rates, I'd rather doubt that she made much of a difference in the final outcome?


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