# CPR Breath Rate Compression Question



## MJD1521 (Aug 20, 2008)

I know the AHA, and what I was taught, standard is for every 30 compressions,  give 2 breaths.

How come, some nurses and paramedics, will do a breath every 5 seconds amid compressions?  Is there a different protocol for medics and nurses in regards to CPR?

Thanks.


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## Ridryder911 (Aug 20, 2008)

MJD1521 said:


> I know the AHA, and what I was taught, standard is for every 30 compressions,  give 2 breaths.
> 
> How come, some nurses and paramedics, will do a breath every 5 seconds amid compressions?  Is there a different protocol for medics and nurses in regards to CPR?
> 
> Thanks.



No, but alas most field and experienced health care providers realize that those are "only suggestions". That the normal is about 10-12 times a minute, carefully not to hyperventilate the patient. As well, if the patient is intubated, it is controlled airway so it is much easier to administer ventilation's. 

To be forewarned. AHA has fell out of grace of most professional providers in the past ten years. In fact, many believe that the standards are a joke as well as the institution presenting them, also that they only participate in such programs because it is mandated. 

R/r 911


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## VentMedic (Aug 20, 2008)

Is this with or without an ETT?

The recommended is 8 - 10 per minute for ventilation with an ETT while the *compression rate* remains the same.

If this is in the ED, often an ABG is ran at bedside that indicates the need to pickup the rate or slow down a little.  If the pH is at a very critical low you will see the person doing the ventilations adjust to get it compatible with life.


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## mycrofft (Aug 20, 2008)

*Heresy! Heresy, I tell you!*

I hear y'all. AHA and ARC revise their standards annually to sell a new class. CPR (in the field) is usually the equivalent of  "last ditch" fighting in your command bunker with only your mess kit while the enemy is already setting up their radios and breaking out their cots and footlockers.

One breath per five compressions was en vogue for a while, but interposing the breaths with comprssions at that clip and the freq is hard, tends to stall compressions, and probably fails to oxygenate much more than the chest compressions do at a faster rate, especially with supplemental O2. Also tends to promote too-strong vents, stomach inflation (which happens anyway without some obturation). If it's done right, 5/1 or 5/2 it does no harm; but it's hard to do it right, and is bound to get you posted about in EMTLIFE.


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## BossyCow (Aug 20, 2008)

mycrofft said:


> I hear y'all. AHA and ARC revise their standards annually to sell a new class. FONT]




This is a common misconception. AHA makes its money on donations not on selling CPR classes and curriculum. Research the last standard and read the science behind the changes.


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## KEVD18 (Aug 20, 2008)

BossyCow said:


> This is a common misconception. AHA makes its money on donations not on selling CPR classes and curriculum. Research the last standard and read the science behind the changes.



all i can say is wow...


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## Ridryder911 (Aug 20, 2008)

BossyCow said:


> This is a common misconception. AHA makes its money on donations not on selling CPR classes and curriculum. Research the last standard and read the science behind the changes.



That is another misconception. Look at AHA financial statement(s) upon publications and education materials. They disguise it under the ECC ... Yes, they make a large amount upon recommendations for publications as well as their trademark symbol. 

If they were really involved in true cardiac resuscitation studies as they acclaim then we would be treating totally different than we currently are. I used to be a large proponent of AHA when I believed they were a credible organization, now there is too much propaganda to sell stuff, yes even change courses to "sell stuff". For example intubation was a standard procedure in ACLS, now they want to have their "own" course .. of course one would want to purchase all their materials.. 

Personally,  I would welcome another organization to bring credibility to cardiac resuscitation measures and courses. Similar to what AHA *used* to have. 

R/r 911


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## mikie (Aug 20, 2008)

MJD1521 said:


> I know the AHA, and what I was taught, standard is for every 30 compressions,  give 2 breaths.
> 
> How come, some nurses and paramedics, will do a breath every 5 seconds amid compressions?  Is there a different protocol for medics and nurses in regards to CPR?
> 
> Thanks.


 
Protocols changes when a tube is dropped, at least for us.  30:2 w/o advanced airway adjunct.  

So was a tube placed when you saw this?


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## rmellish (Aug 21, 2008)

Rid,

10-12 ventilations / min? Our protocol suggests a rate of 6-8 with a tube or NVA in place on a code with continuous compressions. 

I wouldn't mind seeing some research on this either.


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## mycrofft (Aug 21, 2008)

*Bossycow et al, I appreciate the professional tone of this!!*

 I was being flip about it being the reason for periodic retraining, refreshers are necessary whether or not the standards change.
I'm just looking back at almost forty years of CPR training and thirty of doing it or seeing patients brought in after or during it. Perhaps it is just that rescuers and hospital personnel et al are incapable of performing CPR properly, but the frequent and ongoing changes in CPR technique are not eliciting any great upswings (or downswings, at least until now...we'll see) in patient outcome. After over forty years of the search for this grail, people have not evolved, the technques have been continuously honed by not one but at least two reputable and respectable agencies, and the improvement in real world benefit has probably been insignificant.

It's the last chance, it should be done right, but I am just amused that the next best thing is constantly rolled out like new cars.


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## TheMowingMonk (Aug 22, 2008)

im with rid in that I used to have alot more respect for AHA, especially being that I am an AHA instructor i have to listen to their regional faculty critique my classes. The thing that is really frustrating me is AHA's constant effort to dumb down the class. I was recently monitor by an AHA regional faculty member during one of the BLS for Healthcare provider classes. he main complaint about my class was I taught to many skills.
According to the AHA the little video they play for the class is sufficient for teaching Cricoid pressure, Jaw Thrust and Rescue breathing. I was having my class go through the skills so i could make sure they understand it and can do it on their own since in all honesty most of them don't watch the video that closely. but they are saying not i should do that anymore. Which is dumbing down a class for healthcare providers, i mean i can see them simplifing the heartsaver classes which are CPR for the lay person. But dumbing down the healthcare provider one i think is ridiculous making it so that more people will pass that shouldn't, because in all honest if you cant pass a CPR class, you have no place in a healthcare professional setting. the other thing they have cut out as well is scenarios. When we are testing our students we are no longer suppose to give them a situation where they might have to think a little. Instead its Adult male, no pulse, no breathing, show me what you do. which again is another step in dumbing the healthcare provider course down...lol sorry that was a bit of a rant there but i dont like the direction AHA is going with their certs


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## BossyCow (Aug 22, 2008)

I was also criticized in both AHA and ARC Instructor classes for having too much interaction with the students. We are now supposed 'allow the program to teach' and merely 'assist the student during the practice sessions'

The current local instructors list consists primarily of people who have been through the instructor class but have  never performed the skills they are teaching.


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## MJD1521 (Aug 24, 2008)

mikie333 said:


> Protocols changes when a tube is dropped, at least for us.  30:2 w/o advanced airway adjunct.
> 
> So was a tube placed when you saw this?



The person was intubated, yes.  I didn't know protocols changed with or without an advanced airway adjunct.


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## TheMowingMonk (Aug 24, 2008)

MJD1521 said:


> The person was intubated, yes.  I didn't know protocols changed with or without an advanced airway adjunct.



With an Advanced airway in place the time for breaths changes, the guideline is a breath every 6 to 8 seconds and you dont pause compressions to administer the breath.


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## mikie (Aug 25, 2008)

MJD1521 said:


> The person was intubated, yes.  I didn't know protocols changed with or without an advanced airway adjunct.



Neither did I for some time


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## MRE (Aug 26, 2008)

I teach for the ARC, became a lifeguard instructor before I was an EMT, which means I can also do professional level CPR/AED etc.

They do want you to let the videos teach the class for you, but I tend to do most of the teaching and use the videos as a visual aid.  I'm sure they ARC would be up in arms about this, but my students all learn the correct skills and pass their tests.  I also try to tailor each class to the audience and throw in stuff that would benefit them.

My instructor trainer believes the same thing and has been teaching like this for 20+ years.



BossyCow said:


> I was also criticized in both AHA and ARC Instructor classes for having too much interaction with the students. We are now supposed 'allow the program to teach' and merely 'assist the student during the practice sessions'
> 
> The current local instructors list consists primarily of people who have been through the instructor class but have  never performed the skills they are teaching.


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## snaketooth10k (Aug 26, 2008)

I think we should all just do the best we can in the moment we're in. If you're pumping their heart and filling their lungs you're bound to be helping at least a little.

Anybody hear about the new recommendation to completely removing the breathes from non-advanced-airway cpr?


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## MRE (Aug 26, 2008)

snaketooth10k said:


> Anybody hear about the new recommendation to completely removing the breathes from non-advanced-airway cpr?



Yup.  Everytime that comes up, the ARC sends out a bunch of emails telling us that it is not their position to do this.

The media seems to be making it seem like compression only CPR is as good or better than full CPR with respirations, when really it should be mentioned as an option only when the (lay) rescuer is unable or unwilling to provide respirations.

Some may argue that chest compressions move enough air in and out of the lungs, but I don't think thats true.  Can anyone else comment on it?


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## snaketooth10k (Aug 26, 2008)

I'd like to note that there is a maneuver for performing CPR without giving mouth-to-mouth breaths in the situation where a BVM or pocket-mask is unavailable. The Silvester Method maintains normal chest compressions while replacing the breaths with a technique wherein the arms of the pt are pulled in a distal-superior fashion so they look like they are cheering. It expands their ribs to draw in air. While not as effective as regular ventilation, it's handy for the above cases and also when the patient has somehow destroyed their face. Every basic CPR student should learn this method so they don't get hepatitis or Avian Flu


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## BossyCow (Aug 26, 2008)

snaketooth10k said:


> Every basic CPR student should learn this method so they don't get hepatitis or Avian Flu



In my opinion every basic CPR student should be carrying a barrier device. They are cheap, small and easy to tuck into a first aid kit, wallet or hang from a keychain.


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## Ridryder911 (Aug 26, 2008)

snaketooth10k said:


> I'd like to note that there is a maneuver for performing CPR without giving mouth-to-mouth breaths in the situation where a BVM or pocket-mask is unavailable. The Silvester Method maintains normal chest compressions while replacing the breaths with a technique wherein the arms of the pt are pulled in a distal-superior fashion so they look like they are cheering. It expands their ribs to draw in air. While not as effective as regular ventilation, it's handy for the above cases and also when the patient has somehow destroyed their face. Every basic CPR student should learn this method so they don't get hepatitis or Avian Flu



Your kidding right? What year did you take resuscitation training... 50's, 60's? The "Old Sylvester" method has not been taught since then for a reason. 

R/r 911


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## Jon (Aug 26, 2008)

C'mon Rid... what is old is new again... like Tourniquets. Then again, some things just go away - like MAST.

Snaketooth - do you have a link?


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## BEorP (Aug 26, 2008)

BossyCow said:


> In my opinion every basic CPR student should be carrying a barrier device. They are cheap, small and easy to tuck into a first aid kit, wallet or hang from a keychain.


...or just don't do breaths.


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