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Very interesting - couple of pts need clarification:
1. Was this on dry land or in water w/ patieng clad in
usual dive gear, wetsuit etc? The testimonial would
indicate that a normal volunteer was being pressure
ventilated. Obviously, if clearance is obtained from
the ethics boards of the institution, this is an
experiment that can be carried in a research setting.
But it also indicates that the P from the reg was able
to overcome the natural resistance of the volunteer to
exclude P fed gas. Thus I think a little more data on
experiment design & controls would B necessary to
evaluate the findings of the good doctor.
Namely: What flow rates & Ps were used?
What back pressure settings were inplace?
How much gas was introduced?
Were the lung contents analyzed for xO2 & xCO2
& did they indeed vary from using exhaled air
More importantly were blood gases analyzed &
compared
2. Was the rescuer using usual dive gear,
resuscitating & towing
3. Any type of resuscitaion is pointless, irrespective
of the FiO2, unless the patient has a working ticker.
4. How many divers dive w/ a ScubaPro reg attached toi
their O2 supply (haow many carry O2?)
5. I would love to C this done in water, in full dive
regalia w/ effective simultaneous resuscitation &
towing. I write this not because I doubt the
experiences of Irvine et al, but because we have tried
it numerous times (on live patients in water, on
relatively sophisticated CPR mannequins in the
classroom) & have had not had success. In the case of
the mannequins we were able to register about 0.6 l
rise in 'inhaled volume'. We got the best results w/
Omega II, wh/ R side vent regs. They still required
two hands when using mitts or gloves.
6. The issue of water being introduced into victim
remains unresolved & would require in ordinate care,
particularly if being performed where seas R an issue.
7. Despite the disparaging of exhaled gas for
ventilation, the mouth to snorkel tech (get rid of
those dumb side vent snorkels) allows for a EZly
taught tech that is efficient from the sndpt of twoing
speed. It does suffer from the issue of introducing
the mouth piece into the mouth of the victim, no mean
feat, but the scuba reg suffers from the same drawback
- yes folks that mouth piece has to go squarely into
the mouth of an unresponsive victim. At times the
mouth may B open, but then at times it is not.
The testimonial of a physician in such a 'pushing the
envelope' tech is welcome, but I am sure he as well as
all of us are aware, things operate a little different
on dry land w/ volunteeer victims as opposed to the
field.
Let me reiterate that I believe in using a demand
valve for +ve P ventilation once the unconscious
victim is on dry land. We teach the technique as a
std part of an O2 & DAM course. Even DAN has finally
accepted merits of same, though still does not teach
it in the basic course.
The issue is O2 or air ventilation using a standard
scuba reg in water. I think, despite testimonial from
the good doctor, it remains an iffy approach.
Safe bubbles
Esat Atikkan
, in waterCPR is going to
> I have been sitting on my hands reading this
> ventilation rag with a
> regulator, but I can't any longer. There are many
> good intentioned people
> with no practical experience spouting off. I know
> the flow rates are not
> ideal and the potential for injury is there, but
> please ventilate me with
> O2 even if it is not perfect. I will take O2 with
> the potential of a lung
> expansion injury vs. brain damage any day. To prove
> that it works, I
> ventilated an anesthetized patient with a ScubaPro
> Mk15/250. This is a
> patient who is apneic, just like a respiratory
> arrest. Lots of wasted gas
> due to the exhalation valve venting lots of gas, but
> I was able to give
> very respectable tidal volumes with this setup. I
> could not measure it
> without a flow meter, but the chest rises
> significantly and breath sounds
> were good. I would have a hard time imagining how
> one could overinflate a
> lung with the small cracking pressure of the
> exhalation side of this
> regulator. I think the doc that was worried about
> the flow rates and
> pressures is assuming a regular mask with no
> automatic venting like the
> exhalation side of a scuba regulator. This system
> sure beats 17%.
> Conclusion: It can be done, and done quite well. I
> think anyone could do
> this, especially a paramedic with their good airway
> skills. Most divers
> could be taught this too, since I think most divers
> have above average
> motor skills. Somehow, however, I can't see the OW
> institutions teaching
> this!!
> You can post this if you want, I just hate all the
> bounces.
>
> Art
>
>
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