ShinyShoe
Well-Known Member
How would you like them to know what the right way to resuscitate some is. You don't get a group of 200 people walking into a clinical setting saying, give me 10 minutes and I'll just stop my heart and you can see if 5:1 compressions or 15:2 compressions are better to restart it. What you get is people did some animal studies a lot of years ago and found a way to restart some hearts. That was transferred to humans. Its since been refined - often for practicality - sometimes because they discover the theoretical setting of say an ITU bed where there are 6 people round a patient and the street where there is 1 person don't quite translate. So its realised that teaching 5:1 resus for 2 operators doesn't increase survival it decreases it because (a) people get it wrong (b) people stop compressions too long while the person at the head does their thing badly etc. But you need a lot of people to work out which is better when they are all basically abysmal.
We now know GOOD compressions are more important than good ventilations. Good compressions we now know is 100-120 compressions a minute. We know that to get that good you need to do 15:2 and the 2 should take no more than 10 seconds. We also know that from simulations compression quality reduces after just 2 minutes.
We used to teach checking for pulse etc - then we discovered even most anaesthetists in an emergency struggle to feel for a pulse accurately. It was better and safer to say start compressions if it looks like they aren't circulating blood. You will get cases where there is a pulse but its so weak and so slow / erratic its not pumping blood.
You could devise some very complex protocols for different arrest situations. Most people will never do CPR even once in their lifetime. Expecting them to do different things for an electrocution induced arrest vs a drowning vs a MI is crazy. We are trying breaths only again for drowning if circulation present.
Some of you may know that in certain arrest situations the standard protocol is to give 1mg adrenaline IV every 2-3 minutes. You may be shocked to know the data is rather poor. It comes from studies where it was injected at higher doses directly into the heart. Provided injecting into the heart didn't kill it did help restart spontaneous circulation. What no-one checked was what happened next. Since then we've taken the view that injecting into hearts is not a great plan, so we put it into veins. But there have since been some small studies that show the vasoconstriction in the brain of an already oxygen reduced patient is probably not a great thing. You get a pulse back but the patient doesn't make it out of hospital. 5 ambulance services in the UK are currently running a placebo controlled trial of adrenaline. If you'd told me that 10 years ago I'd have said it was unethical. But the data is actually not there to support current practice and suggests current practice may be harmful.
Well actually what they said is it increased the RELATIVE RISK of certain cancers by 18%. However the baseline risk of those cancers was already low. What the media didn't explain was what that meant which was probably in the region of 1 in 100 colorectal cancers were related to dietary intake of processed meats. If you are worried about getting colorectal cancer, reducing processed meat intake would be a good idea, and wont do any harm.
