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Thursday, September 4, 2008

BLS is nothing but BS for this RT

It was kind of hard to hide my irritation with BS (I mean BLS) last week, considering I had been up all night and had to wait an extra couple extra hours into the day shift before the class started.

Why is it that the admins can't schedule things more convenient for night shift anyway? Well, that's a discussion for another day.

The lady handed me a bag and told me to use it when doing CPR, and then she kept telling me I wasn't getting air in.

"I'm not getting air in," I said, "because this is a dummy. In a real baby, the breaths go in just fine. I know because I had a baby two days ago."

"Oh, you had a baby. Congratulation," she said.

"Well, I already had a baby of my own. But what I mean is, I had a bad baby two days ago. I had a baby I did CPR on right here in the hospital."

"Oh, you did."

"Yes."

"Oh."

I hope I didn't come across as too rood, but doing something that irritates you and being exhausted at the same time equals bluntness.

She gave a scenario for the next Annie baby.

"You are on the playground with your baby and she falls off the swings and is unconscious. What to you do first?"

"I say, 'Baby, Baby, wake up!"

"No."

"I check for respirations?"

"No."

"I...," I give up, "I have no clue."

"You call for help. You are at a playground, there are lots of people around." She seemed irritated I didn't figure this out myself.

"Oh, you didn't say there were other people around." I go to the playground with just me and my daughter all the time.

So, I give two breaths. They don't go in.

She says, "The breaths didn't go in."

"I know." I said.

"Why?"

"Because this is a dummy."

"Well, yeah, but why else wouldn't the breaths go in."

"Um, I have no idea."

"Because the baby is choking."

Now why would a baby who fell off a swing be choking? And, why would a baby be in a swing that he could fall out of in the first place? And if a baby was choking, wouldn't I catch the signs of this before the baby fell off the swing?

As a matter of fact, I could have taught her a few things. Not only am I ACLS qualified and have PALS with neonatal rescusitation. I do this stuff for a living. I've done this in real life. I do this on non-dummies.

Not only that, but I think when doing CPR giving a breath is pointless. I think that step should be cut out altogether.

In fact, the American Heart Association has decided that the breaths should be eliminated. All you are doing is giving less than 21% anyway and wasting time.

The few times I've had to do CPR before I had access to a bag, I did not give breaths. I might look at the guy for a second thinking, "I'm not putting my lips up to that."

But that's not why I don't do breaths. Studies show it's very rare to catch a disease from doing CPR.

I don't give breaths because doing so is pointless. Besides, you're pushing in less oxygen than room air anyway; far less than 21% FiO2.

In fact, that is one of the reasons why they went to 30 compressions to 2 breaths. They actually wanted to go to zero breaths, but some old fart didn't want to give in to the old way of doing things.

Now, if you are in a hospital and the patient is on oxygen, or if the person you find down has a nasal cannula on, keep it on. This will allow the patient to get in at least a little more oxygen than the 21% in room air.

But to blow into a person less than 21%, and to have to stop chest compressions to do it, is even worse for the patient, as my links below will contest to.

You can kind of say that giving breaths during CPR is similar to giving a bronchodilator to everyone who is making annoying lung sounds. It sounds good, but it's pointless.

You could probably make some good comparisons in poliltics too. There are a lot of things politicians in Washington do with our money not because it does anything useful, but becuase it makes them feel good. It makes people think we are doing something for them.

It's not. It's useless. It's a waste of time.

For another thing, there is no proof that giving breaths during CPR has ever done anything for anyone. So why do it? Just because some people sitting in an office somewhere writing a guideline for BS said so?

My fellow RTs will understand this. Remember when you learned about the high frequency jet ventilator. The person is getting breaths so fast the chest never rises. The CO2 jitters its way out the same time O2 jitters its way down to the lungs.

See what I mean? I believe when you are doing compressions, you are causing the same effect with CO2 and O2. So why stop compressions and give less effective exchange with your exhaled FiO2. I see no point in that.

Let's have a little common sense here. It would be so much easier for people to understand CPR, and of greater benefit to the patient, if they simply taught to give compressions and to stop only for AED setup and use.

That might increase the chance of saving someone from 1% to 4%, or whatever the stats are.

Maybe this is just me because I'm annoyed and tired, but I think if you are an RT, or if you have your ACLS card, you shouldn't have to do BS ( I mean BLS), especially when the people teaching it are less qualified than you.

I wouldnt' want to teach it either. I'm not a big fan of doing things exactly according to guidelines. I'm more of a look-at-the-patient-and-use-your-common-sense kind of guy.

And that is the snivel for the month.

Here are some good links:

People more likely to do CPR when no breaths are given.
Major changes by American Heart Association.
Hold the Breath for Bystander CPR.

3 comments:

Anonymous said...

It is pretty obvious you have never seen the outcome of a patient with "anoxic brain injury"!!!

Freadom said...

Plus the negative pressure generated in the chest during CPR forces the pt to take in mini breaths, where the pt will be drawing in more oxygen than when you are giving in your own oxygen depleted breaths.

Freadom said...

Anonymous: You do know we are talking about BLS here. When help arrives, this will give oxygen via an oxygen tank and bag mask ventilation.