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David, you obviously have never done it with a scuba reg - I have - it works. Now you tell me what to do on the surface with a victim that you just brougt up - should I call for a pocket mask hooked to a bag and a lawyer? You make me sick with this attitude and this long winded effort to discredit real life and then offer nothing viable as an alterrnative. David Reinhard wrote: > > Dear List, > sorry to have come in rather late on this discussion but I have been away > from my computer for a few days. I am sure there are many people on this > list who are better able to discuss legal issues than me, so i will stick > to the medical side of this debate. There are a number of points that need > to be considered. > > Firstly, any resuscitation system requires an interface between that > system and the patient. With resuscitators of any type this generally > invoves a face mask, which encloses both mouth and nose, and has a soft > rubber/silicone cushion designed to seal against the face. The ability to > achieve a good seal with this mask is probably the most important skill in > using a resuscitator. Without a good seal it will not be possible to > ventilate the lungs. Air/O2 will obviously follow the path of least > resistance so if the seal is not perfect (or near to perfect) then gas will > simply escape via that leak to the atmosphere and not into the patients lungs. > If using a scuba regulator as a resuscitation device this principle > obviously still applies. It would be necessary to place the mouthpiece into > the mouth in such a way that a perfect seal is obtained. Not having done > this on an unconscious person I cannot comment on whether or not this would > be easy to achieve. When pressing the purge button with the aim of > inflating the chest the gas will still of course follow the path of least > resistance. This means that the gas will predominantly vent out the exhaust > ports since the resistance in the airways and the need to expand the chest > will be much greater than the passage of gas out of the ports. It would > then be necessary to block both ports in order to achieve lung inflation. > If this was done manually it would obviously require two hands. Since the > nose also provides a path of lower resistance than the airways in the lungs > the nose must be pinched closed. To achieve this (ie blocking both vents, > pinching the nose) while pushing the purge button will require at least two > operators. > "Positive pressure ventilators" that work on a similar principle to a > "purge button" also require a pressure relief valve (typically set at > around 50-70cm H2O) to avoid overpressure injury to the lungs. This of > course is not present on a scuba regulator. The air flow from many > regulators (the Oceanic showerheads are a good example) is quite remarkable > and would pose a significant risk to the lungs. It would also be difficult > at these extraordinary flow rates to judge when to stop pressing the > button, since chest inflation would be very rapid. Another path of least > resistance, especially if the airway is not fully opened (a very common > fault with unskilled operators), is via the oesophagus to the stomach. > Inflation of the stomach would, I believe, be highly likely using a scuba > regulator in this fashion. Inflation of the stomach has two adverse effects > 1) increased likelihood of regurgitation with possible inhalation of > stomach contents (potentially fatal) and 2) an inflated stomach puts > pressure on the diaphragm and thus limits the excursion of the lungs > reducing the ability to ventilate the lungs effectively. > The use of positive pressure ventilators has been gradually phased out > over the last ten years or so (in Australia anyway) in favour of bag and > mask systems. Bag and mask systems are capable of delivering close to 100% > O2 with greater contol over ventilation volumes and at generally lower > pressures than positive pressure ventilators. > Options for divers when treating a non-breathing patient are probably > primarily 1) bag and mask with or without O2, 2) EAR via a "pocket mask > with or without O2, 3) straight EAR (eg mouth to mouth. (EAR = Expired Air > Resucitation) > While I have been involved in probably several hundred resuscitation > attempts I have never done mouth to mouth. I would personally find it very > difficult to place my mouth over someone elses especially when covered with > vomit. Many of the people i have resuscitated have been heroin ODs and > quite frankly I would not take the risk of acquiring the diseases that > these people often carry. I have utilised a "pocket mask" for EAR when I > have not had equipment immediately available and found this to be a > relatively easy technique which would be well suited to a "lay person" with > minimal training. However, normally I use a bag and mask system which I > feel is the best alternative for a trained operator. However if you have > not been well trained, and maintained your skills with regular practice, > the bag and mask may not be appropriate. > While it is desirable to deliver high O2 concentrations to a non-breathing > patient do not disregard the value of EAR just because it delivers only > around 17% O2. Many lives have been saved by EAR. It is far better to > effectively ventilate the lungs with 17% O2 than to improperly utilize > equipment (whether a properly designed ventilator or an improvisation with > a scuba regulator) and achieve little if any ventilation, or put the > patient at risk of further harm by lack of training/experience. > It is my opinion that from a medical viewpoint a scuba regulator has many > disadvantages that would exclude its use as a resuscitation device. I would > not personally use it. In fact you are probably taking a legal risk using > any device that you have not been properly trained for. So unless you have > received traning in the use of a scuba regulator for resuscitation (which > is highly unlikely!!) leave it alone. > > For those of you who think credentials are important I have been an > instructor in CPR and O2 use for over twenty years (accredited by the > National Heart Foundation and the Royal Lifesaving Society of Australia), I > have worked as a professional ambulance paramedic for 16 years, the last > five of which have been on Mobile Intensive Care Ambulances. Despite that I > do however recognize that my opinions are potentially fallible and I remain > open to anyones viewpoint if they can demonstrate any flaws in what I have > written above. > > Regards, David Reinhard. > > -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- > Ocean Internet - "The Quality ISP" > http://www.ocean.com.au/info.html > > -- > Send mail for the `techdiver' mailing list to `techdiver@aquanaut.com'. > Send subscribe/unsubscribe requests to `techdiver-request@aquanaut.com'. -- Send mail for the `techdiver' mailing list to `techdiver@aquanaut.com'. Send subscribe/unsubscribe requests to `techdiver-request@aquanaut.com'.
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