At what point do you tap in a blood choke?

[Steve]

Are we all still having fun? This is fun, right?

 

[Tony Dismukes]

Not really. The "P" is for Pulmonary. It's for cardiac arrest, respiratory arrest, or choking.

Interesting. I wasn't aware that there might be cases of respiratory arrest without cardiac arrest that would benefit from CPR.

I did learn CPR with the rescue breathing as a component, but I read a while back that the Red Cross had updated their training guidelines to just include the chest compressions because so many laypeople would get confused with the switching back and forth. Of course I imagine that the standards for medical professionals kept the full version because they could be expected to stay more on top of their training.

How would CPR help for choking? Do the chest compressions act the same way as abdominal thrusts to clear the airway? Would the rescue breaths be contraindicated in that case since you might be blowing the obstruction back down the airway?

 

[skribs]

Since the subject of CPR has taken over the thread, I might as well share my favorite CPR joke.

They say that when performing CPR, you should sing either "Stayin' Alive" or "Another One Bites The Dust", as those songs are the right BPM for CPR. However, I think if I'm having CPR performed on me, I'd much prefer "Stayin' Alive" to "Another One Bites the Dust."

 

[Monkey Turned Wolf]

How would CPR help for choking? Do the chest compressions act the same way as abdominal thrusts to clear the airway?

I'll let someone else answer as the standards get updated over time and it's been almost 10 years since I've done the instructor course for these, but the answer to this question is yes; the benefit of CPR for choking is specifically that it can help clear whatever is stuck, and potentially bring it close enough up that you can clear the airway.

This would only be for someone unconscious though-if they're conscious do the heimlich. And don't sweep the airway if you don't see the object, as that can just push it back in and undo the work you've already done. I believe that you still give rescue breaths, but less than you would otherwise as they may not get through and getting the object out is more important, but the guidelines may very well have changed since 10 years ago when I did the instructor course, or 2 years ago when I last did the regular course.

 

[Monkey Turned Wolf]

Side note: I didn't realize how long it had been since I did this. Should start looking for a course soon.

 

[Dirty Dog]

Interesting. I wasn't aware that there might be cases of respiratory arrest without cardiac arrest that would benefit from CPR.

Oh sure. Lots. Babies nearly always start out as respiratory. If you're doing compressions on a neonate, you're WAY behind. School age kids generally arrest from respiratory causes, or an arrythmia like sustained SVT. V-Tach or V-Fib arrests in children are pretty uncommon. Many adults with various sorts of pulmonary diseases (COPD, Cystic Fibrosis, etc) start as respiratory distress, then arrest, then cardiac arrest. That is all ignoring traumatic arrests, of course. And trauma requires a drastically different sort of resucitation.

I did learn CPR with the rescue breathing as a component, but I read a while back that the Red Cross had updated their training guidelines to just include the chest compressions because so many laypeople would get confused with the switching back and forth.

Confusion plays a part. So does unwillingness to do mouth-to-mouth due to infection concerns. And it's not really all that important. Cardiac output during CPR is only about 20-30% of normal. That's not a lot of blood to oxygenate... A number of studies have shown that bystander CPR is more effective with compressions alone.

Still, while Hollywood teaches that 75% of arrests will be fine, it's not quite that easy. The survival rate for an out of hospital arrest is around 10%. In hospital arrests are about 25%. And those are mortality rates. Morbidity rates are even worse.

Of course I imagine that the standards for medical professionals kept the full version because they could be expected to stay more on top of their training.

Well, we don't do mouth-to-mouth either. We use a bag valve mask briefly, but we will be placing some sort of definitive airway (endotracheal intubation, cricothyrotomy, etc) pretty quickly. But yes, the rules are different.

How would CPR help for choking? Do the chest compressions act the same way as abdominal thrusts to clear the airway? Would the rescue breaths be contraindicated in that case since you might be blowing the obstruction back down the airway?

You wouldn't do chest compressions for choking unless things had progressed to the point of pulselessness. You'd do abdominal thrusts to try to dislodge the obstruction.

Rescue breathing is still used, two breaths per cycle with the abdominal thrusts. You check the airway before each breathing cycle, and if the obstruction has been dislodged, you would remove it. Rescue breathing is positive pressure, similar to what a ventilator does. It might be enough to squeeze a bit of air past the obstruction. If the obstruction is still in the airway, and you blow it deeper, it's not really any worse, but that's not an obvious thing. An example...
A person aspirates something and it lodges in their upper airway. They cannot breathe and will pass out fairly quickly. You fail to dislodge the thing, and give rescue breaths. You blow the whatever deeper. It lodges in the right mainstem. Good! Because although their right lung is obstructed, their left is now open. They're going to be miserable. They're going to struggle. But now there is time to do a bronchoscopy and remove the obstruction.

 

[Dirty Dog]

Since the subject of CPR has taken over the thread, I might as well share my favorite CPR joke.

They say that when performing CPR, you should sing either "Stayin' Alive" or "Another One Bites The Dust", as those songs are the right BPM for CPR. However, I think if I'm having CPR performed on me, I'd much prefer "Stayin' Alive" to "Another One Bites the Dust."

But it's more accurate...

 

[Tony Dismukes]

Oh sure. Lots. Babies nearly always start out as respiratory. If you're doing compressions on a neonate, you're WAY behind. School age kids generally arrest from respiratory causes, or an arrythmia like sustained SVT. V-Tach or V-Fib arrests in children are pretty uncommon. Many adults with various sorts of pulmonary diseases (COPD, Cystic Fibrosis, etc) start as respiratory distress, then arrest, then cardiac arrest. That is all ignoring traumatic arrests, of course. And trauma requires a drastically different sort of resucitation.

Confusion plays a part. So does unwillingness to do mouth-to-mouth due to infection concerns. And it's not really all that important. Cardiac output during CPR is only about 20-30% of normal. That's not a lot of blood to oxygenate... A number of studies have shown that bystander CPR is more effective with compressions alone.

Still, while Hollywood teaches that 75% of arrests will be fine, it's not quite that easy. The survival rate for an out of hospital arrest is around 10%. In hospital arrests are about 25%. And those are mortality rates. Morbidity rates are even worse.

Well, we don't do mouth-to-mouth either. We use a bag valve mask briefly, but we will be placing some sort of definitive airway (endotracheal intubation, cricothyrotomy, etc) pretty quickly. But yes, the rules are different.

You wouldn't do chest compressions for choking unless things had progressed to the point of pulselessness. You'd do abdominal thrusts to try to dislodge the obstruction.

Rescue breathing is still used, two breaths per cycle with the abdominal thrusts. You check the airway before each breathing cycle, and if the obstruction has been dislodged, you would remove it. Rescue breathing is positive pressure, similar to what a ventilator does. It might be enough to squeeze a bit of air past the obstruction. If the obstruction is still in the airway, and you blow it deeper, it's not really any worse, but that's not an obvious thing. An example...
A person aspirates something and it lodges in their upper airway. They cannot breathe and will pass out fairly quickly. You fail to dislodge the thing, and give rescue breaths. You blow the whatever deeper. It lodges in the right mainstem. Good! Because although their right lung is obstructed, their left is now open. They're going to be miserable. They're going to struggle. But now there is time to do a bronchoscopy and remove the obstruction.

Good stuff to know. Thanks!

 

[Gyakuto]

Gya I'd like your pro take on this. This represents my current understanding of the blood choke effect. The intro talks about the importance of the vagus to homeostasis. The rest goes into detail about how compression to that particular nerve has immediate consequences.

I'm no MD but this article lines up with my experiences.

Vagus nerve compression in the neck: Symptoms and treatments -

Ross Hauser, MD The vagus nerve plays a key role in regulating many of our body’s functions. Its name best describes its physical characteristics, Vagus is Latin for “fugitive,” or “wanderer.” It is the longest and most widely extended of the nerves of the body. The vagus nerves keep us alive by...

www.caringmedical.com

That Russian judo book said the same thing.

I’ve had a quick scan…it looks like a really good article! Is there anything specifically you’d like me to comment on? I find neuroscience a bit boring these days…I’m into relativity now

 

[drop bear]

Interesting. I wasn't aware that there might be cases of respiratory arrest without cardiac arrest that would benefit from CPR.

I did learn CPR with the rescue breathing as a component, but I read a while back that the Red Cross had updated their training guidelines to just include the chest compressions because so many laypeople would get confused with the switching back and forth. Of course I imagine that the standards for medical professionals kept the full version because they could be expected to stay more on top of their training.

How would CPR help for choking? Do the chest compressions act the same way as abdominal thrusts to clear the airway? Would the rescue breaths be contraindicated in that case since you might be blowing the obstruction back down the airway?

EAR for the not breathing heart beating one.

Do you know how to resuscitate someone? - Calanna Whole Health Pharmacy

If you find an unconscious person, DO NOT LEAVE THEM ALONE. Shout for someone to call an ambulance. Begin to resuscitate and follow these steps.

calannapharmacy.com.au

Theoretically a lodgement in the lungs is better than one in the throat.

 

[Jimmythebull]

You stated that doing these things would be better than nothing. It's not. It's the same thing as doing nothing.

In your opinion.

 

[drop bear]

In your opinion.

Is there any evidence to support your system works?

Bear in mind unconscious people recover when you do nothing.

 

[Jimmythebull]

there any evidence to support your system works?

Why would they teach it if it didn't?

 

[drop bear]

Why would they teach it if it didn't?

Because they don’t have the correct processes to separate fact from fiction?

 

[Gyakuto]

In your opinion.

Such a feeble come-back

 

[Gyakuto]

Why would they teach it if it didn't?

I believe that homeopathy, crystal therapy and water divining are also ‘taught’, it’s doesn’t mean they’re efficacious!

In the dim and distant past, performing these rituals (that’s what they are) on some poor, slightly concussed unfortunate revived them in a non-causal manner…it was sheer coincidence. But humans being humans they thought, ‘Ooo…magic? …I’m magic! I’ll perpetuate this technique just in case it does something’ This is why they continue to be taught!

This is a great book that all martial artist should read!

 

[Jimmythebull]

Because they don’t have the correct processes to separate fact from fiction?

The kodokan?

 

[drop bear]

The kodokan?

Yes.

 

[Jimmythebull]

Yes.

they do know not just the kodokan if you read this

Katsu Waza – Kyushin Ryu Jujitsu

www.kyushinryujujitsu.com

Nevertheless the traditional forms of resuscitation are considered advanced techniques of Jujitsu and instructors may wish to study them to complete their training for historical purposes or for use in special circumstances.

this was my point from the beginning

 

[drop bear]

they do know not just the kodokan if you read this

Katsu Waza – Kyushin Ryu Jujitsu

www.kyushinryujujitsu.com

Nevertheless the traditional forms of resuscitation are considered advanced techniques of Jujitsu and instructors may wish to study them to complete their training for historical purposes or for use in special circumstances.

this was my point from the beginning

Doesn't say it works in that quote.