Talk:Cardiopulmonary resuscitation

File:CardiopulmonaryResuscitationAdult.jpg

CPR performed on an adult

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Most of this page looks like it was copied directly from the external link. There are probably copyright issues. Bummer. -- Merphant

Changes July 27 look good - thanks philb

I've emailed Columbia University about this. -Smack 20:16, 10 Aug 2003 (UTC)

Outcome of the above email to Columbia not reported here. I assume that means they're okay with it. But even if we don't know that for sure, I would not favour trying to remove copyrighted parts of the text unless anyone really makes a fuss. There is too much risk of messing it up in the process. This is lives we could be talking about. --Trainspotter 00:11, 12 May 2004 (UTC)

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112 will work in the UK, no need to contrast the UK with continental Europe. Several European countries have alternative numbers and these are listed at Emergency telephone number, but for this page 112 is all that's actually needed. (Personally, I'd instinctively dial 999 in Britain, but that's largely because of learning it before 112 was introduced.) --Trainspotter 23:02, 11 May 2004 (UTC)

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added some comment's after look listen & feel for better understanding of CPR by new students --xl5

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I've made quite a few changes to this article (although I've not actually changed as much as all the red text in the edit history would have you believe, honest!). I've changed the order of a few things slightly. I also removed a few bits which were repeated over and over throughout the article so that it reads better and in a more logical manner. I've modified the child CPR section so that it follows the same DRABC structure as the adult CPR section - they are after all the same basic procedure, and previously it was hard to relate child CPR to that for adults. ABC is certainly a widespread training mnemonic, and it is virtually impossible to forget the correct procedure if you learn it this way! DRABC is taught a lot in the UK and I think it is good to emphasise the need to check for danger and response before assuming CPR is necessary. Danger is especially important, as you are useless providing CPR if you injure yourself! I altered the bit about getting help slightly, so that you shout for help as soon as you know it is required (when the person is found to be unresponsive, i.e. you know they're not just asleep), and then call for an ambulance once you have determined whether or not the casualty is breathing. This is the method taught in the UK, and if you are on your own it is certainly wise to check the breathing before going to get help - if the casualty is breathing, they would be much safer placed in the recovery position to protect their airway before you go for an ambulance.

Anyway, I hope that I've improved this article somewhat. I also placed emphasis on the importance of CPR training - this stuff really cannot be learned off "paper" alone. I would envisage this article being used more as a reminder for those who have received some training than as a standalone "teach-yourself" guide.

Maybe one day we could have diagrams or photographs to illustrate the article?! Anyone fancy the job?

Tjwood 20:53, 4 Jun 2004 (UTC)

Commerical external links

I've removed some external links added by an anonymous user (68.7.15.227). They were removed by me, then added by the user again. As far as I can tell they are links to commercial sites and as the user has contributed only those links to wikipedia, I think they are just spam. If the user wishes to add them to the page again could they please explain here their justification for doing so? Tjwood 17:48, 10 Jun 2004 (UTC)

Someone just added a link to Atlantic Life Safety, a training company. Noticed this during RC patrol, because they also added another ad-type article. CPR experts, please decide if this should stay in. Thanks. --John Nagle 03:59, 14 August 2006 (UTC)

This page is too complicated

The recent edits have helped but revisiting this page reminds me that it is overly complicated. Experts are generally moving towards simplification of guidelines to focus on the main points... to this end I may now cut a bit... perhaps we could break out into some subpages... eg:

1. calling for help
2. First aid airway management
3. Expired air breathing
4. External cardiac massage

We could include buckets of esoteric detail in these pages allowing us to keep CPR straight to the point. just a thought Erich 18:02, 13 Aug 2004 (UTC)

I agree, this page is complicated, but the detail is important. Your recent adjustments to the article have helped a bit. If what you are thinking of is a simple summary of CPR procedure, as a reminder for those who know CPR, then maybe we should have a page CPR Summary or something (the subpage idea is good except for the fact that Wikipedia discourages them). A simple flow chart would be one way to lay out a summary but I'm not sure how that would work in Wikipedia.

The trouble with simple summaries is that a layperson who has never had CPR training may read it and then think they know CPR, when of course actual training and practice is the only way to learn it properly.

I also think this article (or any summary article we create) really really needs more illustrations/photographs.

Tjwood 10:40, 21 Sep 2004 (UTC)

I thoroughly support the bunch of recent suggestions to provide a simplify version. We need to have:

• somewhere a clear, simple summary, while still making the point that there is no real substitute for practical training
• somewhere else the nitty-gritty detail, but not in such a way that it obscures the simple summary
• a clear way to navigate between the two

My feeling is that the CPR Summary is a good idea, and then presumably keep the longwinded version on this page, provided that the summary page is linked very prominently from the top of this page and vice versa. I don't so much like the idea of separate pages for calling for help, airway management, etc, because it forces people to chase up a whole bunch of links, rather than have a page to print out and use as handy reference.

In the summary page, let's stick to whatever seems to be the most widespread teaching; it's okay to incorporate bits of teaching from different countries at different points of the procedure, but only if the whole thing is consistent -- a hotch-potch is more to be avoided than national bias.

Realistically, I am not going to get the time to work on this. But a big thank-you to whoever does so.

,,,Trainspotter,,, 22:34, 21 Sep 2004 (UTC)

Okay, I've had a go at creating CPR summary. See my comments at Talk:CPR summary. Tjwood 21:52, 23 Sep 2004 (UTC)

Call for help

I've tried to contribute something about calling for help since I though the section was not very complete, but I realised that the article was organised quite differently than I though. Perhaps we have different systems depending on countries... Do you systematically call for an ambulance when you have an uncounscious patient ? This is what we are trained to do here... Also, we never interrupt CPR unless asked by a physician (typically, patient dead :( ) or by the rescuer who's in charge of the defibrillation (for analysing, shoking, or stoping the CPR if the defibriallation has been successful). Sorry if I've been messy ! Rama 12:03, 29 Nov 2004 (UTC)

Formatting & things

Rama, my compliments on your work here, and the very good drawings (they sure capture the mood!) I'm not sure about the formatting. The disclaimers are unnecessary (there are two on every page), and the uppercase titles are not Wikipedia standard. Would you mind if I changed them? JFW | T@lk 13:17, 1 Dec 2004 (UTC)

Thank you very much. I did not originate the uppercase titles -- I'm actually quite agreed with you that they sort of break the standard formatting, and I'm quite in favour of some change.

Perhaps we want to reduce the "CPR for children" part ? As it is, I think it makes things rather more complicated; why not have a main "CPR for adults" section and reduce the children section to the size of infant ? I don't think the amongt of informations in "children" justifies the size and subdivisions of this part...

Sorry, but which disclaimers are you talking about ?

Speaking of disclaimers, I was thinking about introducing templatised symbols in first aid related articles for thaings like "Lethal danger for the patient", "permanent injury danger", "danger for the rescuer", "Nice thing to do", "tip" (a little bit like "First aid for dummies" would be :p). The idea would be ta make things very clear while unifiying the notations and not over-charging the pages with blinking red bold italic upper-case big disclaimers :) Anyone interested ?

Thanks again everybody for this nice page ! Rama 13:54, 1 Dec 2004 (UTC)

My rewrite

I'm partially done with a big rewrite. These are my aims:

• Wikipedia is not supposed to address the reader. I'm changing all forms to third person.
• There are interspersed comments about defibrillation. In the vast majority of CPR scenarios, no defib is accessible. Apart from occasional mention, these belong in a seperate paragraph.
• There were considerable misspellings ("uncouncious")

Please don't remove my rewrite tag. Editing is free, but I'd like to know where I left off... JFW | T@lk 21:46, 1 Dec 2004 (UTC)

Oups, sorry... I'm afraid I've been editing before this notice appeared ! ^_^;;

Speling mystakes are usualy my fault. Please forgive me.

For the defibrillations part, I'd suggest putting it after the circulation since if makes a nice "ABCD"; that said, I do agree that we'd mainly mention defibrillators as important, mention that one can find them in some public places and in police cars, and link to the appropriate article.

Perhaps we'd need to further simplify some parts, especially the "breath" part -- there is an article about Artificial_respiration should not be duplicated.

I'm adding a few more images, I think we'l be done with these (but if I'm wrong, do tell me)

Thanks again for the nice work and sorry for my clumsiness ! Rama 22:43, 1 Dec 2004 (UTC)

I'd just like to suggest that references to defibrillation remain intact. Defibrillators are increasingly available both in public places and in private homes (I've even seen them being advertised on television). - Nunh-huh 22:48, 1 Dec 2004 (UTC)

Yeah, but there's more to CPR than defibrillation. In the old version, the article started about defibs without even mentioning the ABC algorhythm, let alone the fact that defib is contraindicated in asystole and EMD. JFW | T@lk 13:57, 2 Dec 2004 (UTC)

Icons system proposal for all first aid-related articles

What would you people think about something like this :

• File:Lethal danger.png Always put a pregnant woman in recovery position on her left side to avoid potentially lethal conpression of the inferior cava vein.
• Do not put a conscious patient while back injuries in recovery position.
• File:Ktip.png The rescuer can use his knees to secure the patient's head while administrating oxygen

To be used with parcimony, of course. Just an idea... Rama 09:45, 2 Dec 2004 (UTC)

Wikipedia:Wikipedia is not a how-to manual. I really think these icons distract from the flow of the text. JFW | T@lk 13:57, 2 Dec 2004 (UTC)

Good point... perhaps for the more indicated for [1]. Rama 16:00, 2 Dec 2004 (UTC)

Did you move it there? I moved content from first aid to here, and then later to Wikibooks, i think its a good idea! JamieJones 15:42, 28 December 2005 (UTC)

NPOV

As far as I'm concerned, the recent changes to this article are not NPOV. The re-write is biased very much towards one specific teaching method of CPR which would not be considered correct by many. (In the UK, CPR teaching specifically states that a layperson should NOT check pulse [[2]]). The article used to acknowledge that teaching methods differed, but this has been removed in favour of a specific method of training. Also, you say that the process I would know as "rescue breathing" is called "insulfation", yet I can't find insulfation (or insulphation) in either Dictionary.com or the Oxford English Dictionary, and there are only 47 references to insulfation on the entire web according to Google ([[3]]), so I'm changing this to "rescue breathing". I don't have much time to alter this article right now but I will be trying to get it back to an NPOV whilst retaining as many of your edits as possible.

Juicee News Daily

This article is mirrored by Juicee News Daily with attribution, but without the GFDL notice. I have sent them the standard warning letter and am waiting for a reply. Further status is reported here. Cleduc 5 July 2005 01:54 (UTC)

Wikipedia IS NOT instructive

Should the majority of yhis article even exist? All of the stuff that is instructive really shouldn't be here. It even says so here:What Wikipedia is not - Kilo-Lima 16:39, 30 September 2005 (UTC)

Go ahead and slash away. This article should cover the principles of CPR (circulation and oxygenation), not the way it is done. JFW | T@lk 00:30, 2 October 2005 (UTC)

Sections of this article is a how-to, and should be moved to [[Wikibooks:First Aid where is belongs. I'll see what I can do. Since not the entire article is a how-to, I don't think the transwiki process is appropriate. -- Egil 15:55, 29 October 2005 (UTC)

Thanks for the feedback. I'll try moving the CPR how-to type stuff. What is a transwiki process? Let me know about any further edits. JamieJones 14:53, 26 December 2005 (UTC)

I think there a few problems with this page - firstly, there is some confusion over the terms "resuscitation" and "CPR". CPR is a part of most resuscitation attempts, but it is not resuscitation on its own. You wouldn't say that intubation was resuscitation, for exactly the same reason.

I read it over, and in the "myths" part i think it does a good job of explaining several times that cpr is a part of resuscitation; and since the r in cpr stands for resuscitation, i don't think the article is confusing.JamieJones 15:41, 28 December 2005 (UTC)

I think the stats need referencing. I've not met some of them before; and the ones I have seem to be for success of a full resuscitation attempt, not success of CPR per se. --John24601 21:52, 27 December 2005 (UTC)

good call, i'll look for some references JamieJones 15:41, 28 December 2005 (UTC)

• New stats are good, and are much more in line with what I've seen before; although once again I think we need to be really clear on the difference between CPR and resuscitation - defibrillation, for example, is a resuscitative technique but it is not part of CPR. I know it sounds petty, but I really think that we should create them as seperate pages on wikipedia, treating them as seperate (although obviously interdependent) entities. CPR = chest compressions and ventilation. Resuscitation = CPR, defib, crash drugs, intubation, treatment of underlying causes etc etc.... --John24601 21:43, 24 January 2006 (UTC)

Small Edits and a Suggestion

Just cleared up the "hypothermia seems to protect..." bit; also added a reference.

I think the image should be changed; a photograph of actual people demonstrating/doing CPR would be clearer. Eilu 13:06, 13 January 2006 (UTC)

Who keeps reverting that part about drowning

Please stop. Rescue breating is used on drownings; the Canadian Red Cross First Aid Program (which I teach) does not include the abdominal thrusts you describe. And neither do many swim programs. Please stop putting it in, whoever you are...to others, as i am new to wikipedia, how does one deal with this to avoid a "revert war"? Looks like it's this person: 69.158.140.43 JamieJones ^talk 18:32, 13 January 2006 (UTC)

Not guilty! In the UK, we have no specific instructions regarding resuscitation of drownings (on general first aid courses anyway - I no longer teach lifeguard courses, but I think the training is the same there - I'll check with my colleagues who do). In almost all cases of drowning, only a very small amount of water has got into the lungs (most of it ends up in the oesophagus and stomach), and so I doubt providing ventilation would have any ill effects - certainly in hospital the first thing we do is intubate and start bagging, we suction out the lungs after we've regained circulation. The drowned patient in cardiorespiritory arrest is as much in need of ventilatory and circulatory support as any other, and hence I see no justification for providing abdominal thrusts on the patient, as in doing so you are tieing yourself up and removing the possibility of providing CPR. We did used to teach abdominal thrusts and backslaps for unconcious patients who you couldn't ventilate (which I guess is where this is stemming from), but they were removed from the syllabus in favour of providing chest compressions for all such cases, thereby expelling foreign objects from the trachea/bronchi whilst simultaneously providing circulatory support, a number of years ago. --John24601 19:39, 13 January 2006 (UTC)

I agree with you that many drowning patients require ventilation and compressions - and the Red Cross did make the change to remove abdominal thrusts in favour of compressions. However, the real question is this: When do you find a patient who is not breathing, but still has a pulse? The answer is, it's unlikely, as a patient with breathing will soon loose their pulse. However, in the interim, it is possible, and, of all scenarios, the easiest and perhaps most common to imagine is a person who just recently drowned, say, they were found less than 2 minutes after their breathing stopped. Someone keeps hijacking the rescue breathing page with regard to this issue; and the same on this page, I think. Anyway, I think we agree then that most regulations (and from my experiences, definitely the red cross) does NOT have us pumping water from drowning patients...just performing rescue breathing/cpr as necessary after a primary survey. Thanks for responding John24601. JamieJones ^talk 21:45, 14 January 2006 (UTC)

UK lay-person first aiders no longer distinguish between cardiac and respiritory arrest in the unconcious patient (see UK Resuscitation Council 2005 guidelines), so I think it's a bit of a moot point. Are you from the US? I believe that over there they're still teaching pulse check (that's been out since 2000 over here, in favour initially of "signs of circulation" [breathing, coughing, twitching etc..], and now we teach to just start full CPR as soon as a lack of normal breathing [ie/ anything other than breathing both in and out regularly] is established. The position of healthcare professionals attempting BLS has been a bit poorly thought out, there is some inclusion of pulse-check, but AFAIK no talk of what to do in the case of that revealing a respiratory arrest. As for choking guidelines (which I would say should be applied to patients in which drowning has caused an airway occlusion), if patient concious then encourage to cough, if they can no longer cough then alternate 5 backslaps with 5 abdominal thrusts (this is, in effect, the early stage of respiritory arrest - the patient isn't actually breathing but they are concious and upright; so I guess this is basically what you're saying, although in a slightly different way), once unconcious lower to floor and begin compressions at 30:2 immediately, simultaneously calling for an ambulance (if you're on your own you can give CPR for 1 min before calling ambulance in the case of drowning only). There is no indication in the Resuscitation UK 2005 guidelines to provide any kind of specific care other than full CPR for an unconcious drowned patient. --John24601 21:38, 24 January 2006 (UTC)

Vandal

This ip 198.176.160.18 vandalized the CPR page. I reverted. Should I do anything else? JamieJones ^talk 19:17, 8 February 2006 (UTC)

Football player injury

This needs a reference otherwise it should be removed. It's unsubstantiated and awkward in the text. JamieJones ^talk 23:35, 1 March 2006 (UTC)

Moving the football player injury here until reference is cited.

JamieJones ^talk 12:39, 3 March 2006 (UTC). Quote was:

Recently a footballer died even though CPR was given to him. Improper posture of the person giving him CPR worsened his condition (he had his knee over the injured player's stomach).

Re:- Success rate

Agree with edit by JamieJones. CPR alone has a near 0% chance of success (only likely to work in cases of witnessed arrest due to hypoxia secondary to choking). The statistic removed (2-15% success for out of hospital CPR), is infact the statistic commonly quoted for the survival to hospital discharge rate of pre-hospital cardiac arrest, and therefore is a measure of the success of an entire resus attempt, from the moment the casualty is found and CPR begun to the moment they leave hospital.. in many cases the cardiac arrest is often not reversed pre-hospital, the CPR just helps to keep the body going until the person gets to hospital and receives ALS, so the "success rate" for CPR alone is almost 0, even though it does play a central part in a successful overall resuscitation. This is yet another example of why I think that CPR and resuscitation should have very seperate pages... --John24601 21:21, 2 March 2006 (UTC)

Links

People keep adding all kinds of their favourite first aid links here. Could we set something up to prevent this? JamieJones ^talk 04:57, 12 July 2006 (UTC)

ECC, CPR, heart massage

External Cardiac Compression, CPR, and heart massage seem to be closely related. It would be useful to have some information on the other two as well. Rl 13:40, 25 July 2006 (UTC)

They are related, to the extent where nobody agrees on exactly what the differences are. In my book ECC=the physical act of compressing the chest; heart massage = physically squeezing the heart (which to me implies that the chest has been opened up by a surgeon), and CPR = the combination of ECC and expired air ventilation (mouth to mouth). --John24601 16:03, 26 July 2006 (UTC)

That seems to make sense also in the light of what I read so far (and that I found somewhat confusing previously). Thank you! Of course that means that my creating a redirect from heart massage pointing here is misleading at best, and that the one article pointing there (2000 Italian Grand Prix) didn't really mean a heart massage, but ECC or CPR. Rl 07:40, 27 July 2006 (UTC)

Flow Chart = Good?

flow

I made the flow chart when I was taking a Bronze Med class taught by the Canadian Lifesaving Society, and I am certified CPR B. If changes need to be made, please e-mail me and I'll make them, or send you the original so you can edit in OmniGraffle. Jmatt1122 03:57, 27 July 2006 (UTC)

I'm not sure about Canada, but it certainly does not reflect current practise in the UK or USA (or any other country I am aware of), integrating the adult/child/infant sequences also makes it look overly complicated to the point where I'm not sure it's useful. Bearing in mind that Wikipedia is not a how-to, I think it may be better, on the whole, to leave it out. --John24601 06:52, 27 July 2006 (UTC)

Heh, it sure drives the point home that "simplifying CPR for laypersons" should be a priority. I think the flowchart is a useful illustration, but it needs a caption addressing John's concerns. Rl 07:44, 27 July 2006 (UTC)

John, What do you feel are changes that need to be made to the chart? What is current practice in the UK or USA in comparison to procedure described in this chart? Also, seperation of Child/Adult is required, because compression/breathing ratios are different. I think that also compression depth should be included, but this may complicate it further. Please post feedback to changes that should be made, or inaccuracies in the procedure. This should be as universal as possible. Also, a caption or somthing describing that this chart should not be used as a sole purpose of training, but the person should seek a professional if they wish to learn CPR.--Jmatt1122 17:03, 27 July 2006 (UTC)

http://www.resus.org.uk/pages/blsalgo.pdf <- That is the flowchart produced by the Resuscitation Council (UK). It is identical in content to that produced by the European Resuscitation, which in turn is pretty much identical to that agreed on by the International Liason Committee on Resuscitation (ILCOR), which is the world body of experts in resuscitation. That algorithm says adult, however children and babies should be done exactly the same, with a few modifications (1/3 chest depth compression as opposed to 4-5cm in adults; 5 initial rescue breaths before compressions, 1 minute of CPR before calling an ambulance) if they can be remembered - if not, lay rescuers should use the adult sequence. Remember also that this article is on cardiopulmonary resuscitation (see discussion above of exactly what that is), not on basic life support for lay rescuers (which is what the flowchart is) - a fine line, but one that needs adressing. --John24601 18:18, 27 July 2006 (UTC)

So do you believe that this chart should be removed, or modified? And I don't understand why the Canadian Lifesaving Society hasn't changed procedure. Do you know of any other countries that follow 15:2? Also, I have been taught that children require 5:1 with a smaller depth (1-1½" as compared to the adult 1½-2"). Also, my certification is very recent. I don't understand why Canada would be different than almost everywhere else. --Jmatt1122 18:49, 27 July 2006 (UTC)

The guidelines were agreed and published in europe in November 2005. Here in the UK, most training organisations are switching over this month, although some did it as far back as January, and some are still to do it. I guess the situation is pretty much the same worlwide. Certainly, though, by the end of this year there should be nowhere which is teaching the old guielines, which contained 15:2 for adults and 5:1 for children. As for whether there should be a flow chart - my personal opinion is no, but if there is one it should be on a Basic Life Support page, and not the CPR page. --John24601 19:36, 27 July 2006 (UTC)

Does anyone use Mac OS X and OmniGraffle so that I can send them the original, and changes can be made, in accordance with new standards? Either that, or post what exactly should be changed, so I can change it, and add it to the Basic Life Support page, and delete it from here, depending on the decision reached here. --Jmatt1122 21:16, 27 July 2006 (UTC)

Yes, it needs updating, as the protocols have changed. Regardless, it is essentially how to, or at best, not encyclopedic entry about CPR. Your chart shows all the steps in an emergency. I belive it should stay removed; better still, move it to wikibooks. For more info, see What Wikipedia is not. JamieJones ^talk 04:42, 31 July 2006 (UTC)

Also see "Individual general-knowledge how-tos are being moved from Wikipedia to Wikibooks". JamieJones ^talk 04:46, 31 July 2006 (UTC)

The real survival rate of an unwitnessed, out-of-hospital sudden cardiac arrest is in a range of 6% to admission and even less to hospital

What is this sentence attempting to say?–♥ «Charles A. L.» 13:11, 5 September 2006 (UTC)

Question Moved From article

Since people take oxygen from the air when they breathe and then exhale carbon dioxide, how does blowing carbon dioxide into a person provide them with oxygen? If anyone could explain that I'd appreciate it.DXRAW 08:28, 11 October 2006 (UTC)

Yes, when you do CPR you yourself are not "holding your breath" and the O2 depletion of the air you breath out is minimal. Atmospheric air contains 20% oxygen and the air you breath out during CPR contains at least 17-18% so it is breathable air. I will refrain from giving the pig-feeding analogy in the interest of good taste.--Justanother 15:08, 20 October 2006 (UTC)

"We talk about first aid ABC."

Does anyone know what this sentence is supposed to mean? I think it needs to be rewritten but I'm not sure enough of its meaning to do it myself. Natalie 22:42, 30 October 2006 (UTC)

It's the last sentence of the first paragraph in the "Importance" section.Natalie 22:43, 30 October 2006 (UTC)

I suppose the editor wanted to spell out where CPR fits in the first-aid mnemonic of ABC. ABC article could use some help too. Happy editing. --Justanother 22:59, 30 October 2006 (UTC)

ok here is what they mean. It accually goes HUNABC

H- Hazards (fire, glass, electrict, gas,)

U- unconshish(spelling?)

N- Number (call 911)

A- Airways (open them)

B- Breathing (is the person breathing?)

C- Curclition (is the heart pumping causing blood to flow through the body and to the brain.)

hope this helps, I also added it to the article -mikeh0303