Leave helmet on or off?

Using the patented Mavis Beacon "Hunt&Peck" Technique, Ace

Nope, couple of weeks ago. You're right about the thump being no longer
recommended, but he reckoned that compressions that were sufficiently
hard would break ribs in most cases.

--
Wicked Uncle Nigel - Podium Placed Ducati Race Engineer as featured in
Performance Bikes and Fast Bikes

WS* GHPOTHUF#24 APOSTLE#14 DLC#1 COFF#20 BOTAFOT#150 HYPO#0(KoTL) IbW#41
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Honda GL1000K2 (Falling apart) Kawasaki ZN1300 Voyager "Oh, Oh, It's so big"
Suzuki TS250 "The Africa Single" Yamaha Vmax Honda ST1100 wiv trailer

 

Is the wrong answer.

All the reasons have been gone through by now but the old idea that
you never remove a crash helmet is just plain wrong.

 

Bollocks.

--
Nursey RN
ALS & APLS Provider
MIRTTH#6 IbW#09 4#COFF EFFA MOP#1
Honda CBF600 ABS
(nursey at ukrm dot net)
UKRM FAQ: http://www.ukrm.net/faq/

 

Precordial thump is recommended for a "witnessed, monitored cardiac arrest."

That is to say, the person my be on a ecg machine and have been watched
to go into cardiac arrest.

--
Nursey RN
ALS & APLS Provider
MIRTTH#6 IbW#09 4#COFF EFFA MOP#1
Honda CBF600 ABS
(nursey at ukrm dot net)
UKRM FAQ: http://www.ukrm.net/faq/

 

Using the patented Mavis Beacon "Hunt&Peck" Technique, Nursey

<shrug>

S'wot he said, and he was quoting some A&E consultant blerk.

--
Wicked Uncle Nigel - Podium Placed Ducati Race Engineer as featured in
Performance Bikes and Fast Bikes

WS* GHPOTHUF#24 APOSTLE#14 DLC#1 COFF#20 BOTAFOT#150 HYPO#0(KoTL) IbW#41
SBS#39 OMF#6 Enfield 500 Curry House Racer "The Basmati Rice Burner",
Honda GL1000K2 (Falling apart) Kawasaki ZN1300 Voyager "Oh, Oh, It's so big"
Suzuki TS250 "The Africa Single" Yamaha Vmax Honda ST1100 wiv trailer

 

Compressions *will* always break ribs. The only time that I have seen
it *not* happen is in a 9 year old.

--
Nursey RN
ALS & APLS Provider
MIRTTH#6 IbW#09 4#COFF EFFA MOP#1
Honda CBF600 ABS
(nursey at ukrm dot net)
UKRM FAQ: http://www.ukrm.net/faq/

 

Ace wrote:

Leave the visor closed and watch for the condensation. Once the
condensation stops, it means the rider is dead and problem has ended.

 

Depends whether it's a fit burd or not.

 

Should you be unfortunate enough to require CPR when young, your ribs
are quite flexible and won't break easily. If you are older your ribs
are brittle and snap very easily when doing chest compressions.

--
Nursey RN
ALS & APLS Provider
MIRTTH#6 IbW#09 4#COFF EFFA MOP#1
Honda CBF600 ABS
(nursey at ukrm dot net)
UKRM FAQ: http://www.ukrm.net/faq/

 

If you are doing CPR, then the person is very unlikely to be breathing.

Without any suitable equipment, such as suction, Magills forceps [1] you
wouldn't be able to clear the airway of anything. As you can't move the
neck (or shouldn't) you can't turn it to the side either which would
help you clear fluids from the mouth.

No, the ABC's [2] are still there, and should still be checked, but how
are you going to do this without removing the helmet? [3] If you take
the helmet off, you have to stay with the head and protect the cervical
spine at all times [4].

In the ideal world, you don't move from A until you have it sorted and
you can't really do anything with B until it is. In the real world,
unless you are trained in everything, you are not going to be able to
get along to the next step.

IRL, I can sit here and spout out all the theory that you want as that
is, as of yesterday, my job [5]. As for actually doing, I am trained in
airway techniques up to the level of intubation. Whilst I have the
theory of being able to do tracheostomies, cricothyroidotomies etc., I
wouldn't be able to do it and would never attempt except as a very last
resort.

The probably carry large amounts of kit with them to be able to do this
as well. Fluids is one of the most commonly used resuscitation tools
going, but you have to have skills in cannulation to be able to use it.
Some nurses that I know can't cannulate even though they have been
doing the job for a very long time.

As others have said, D. Getting /expert/ help is the most important.

[1] Long and slightly angled forceps for getting right to the back of
the mouth.

[2] Now actually ABCDE's
A=Airway
B=Breathing
C=Circulation
D=Disability (Neurological examination)
E=Exposure (Having a good check of the whole patient rather than just
what is immediatley wrong. An example is dealing with a cardiac arrest
in hospital and just dealing with the arrest and not getting to E. If
you would have pulled back the covers for the check you would have seen
that the patient in lying in a pool of blood which is the reason for the
cardiac arrest and can be treated).

[3] Starting a circular argument here.

[4] From the APLS (2005) guidelines
A=Airway with cervical spine control
B=Breating with mechanical ventilation
C=Circulation with homeostasis
D=Disability with something else I can't remember
E=Exposure with temperature control

[5] Resuscitation officer which is just a fancy name for someone who
teaches resuscitation in a hospital setting and drinks tea all day.
--
Nursey RN
ALS & APLS Provider
MIRTTH#6 IbW#09 4#COFF EFFA MOP#1
Honda CBF600 ABS
(nursey at ukrm dot net)
UKRM FAQ: http://www.ukrm.net/faq/

 

Has lots to do with the pH of the blood.
--
Nursey RN
ALS & APLS Provider
MIRTTH#6 IbW#09 4#COFF EFFA MOP#1
Honda CBF600 ABS
(nursey at ukrm dot net)
UKRM FAQ: http://www.ukrm.net/faq/

 

But you don't start CPR until stage C, remember, Airways, Breathing,
then Circulation. First you need to establish clear airways and work
out IF they're breathing.

So you're suggesting that we don't bother to check and maintain
airways? Doesn't seem to make sense to me. Clearly one would only do
so if it was a very real question you needed to be sure of, and I
accept that the compression-only approach is probably a very good idea
in these situations, but I'd still want to make sure of no breathing
before starting.

Especially as I'd not trust myself to accurately diagnose a 'no pulse'
situation. I'm sure you could do so without thinking, but I've always
found it quite tricky.

Not really. They specify first-aid kits for us to carry, including
face shields etc. which aren't much short, except in quantity, of what
they carry.

Quite, and most of the ski patrollers don't go that far - they have a
lot of other duties (and kit to carry) as well. There are _some_
paramedic-level guys out there, but by and large they look to heli
rescue, with a doctor on board, to deal with more complex situation.

Yupp. That's what basp have been teaching for at least the eight years
(three courses) I've been doing it. We do (far too many) simulations
of accident scenarios going throught the whole process. IRL, of
course, the vast majority of incidents involve cuts, sprains, breaks
and other minor injuries, so although CPR is still very important[1]
there's even more focus on identifying and stabilising the injuries
we're more likely to encounter.

Heh.

[1] The majority of deaths in ski resorts are still down to cardiac
incidents.
--
_______
..'_/_|_\_'. Ace (brucedotrogers a.t rochedotcom)
\`\ | /`/ GSX-R1000K3 (slightly broken, currently missing)
`\\ | //' BOTAFOT#3, SbS#2, UKRMMA#13, DFV#8, SKA#2, IBB#10
`\|/`
`

 

I agree, but this is the circular argument. I wouldn't take the helmet
off unless I really had to clear the airway. Remember, you can't move
the person even onto their side to clear fluids that are in there unless
you can log roll them and that takes at least 4 people who are trained
in doing it.

I think that experience counts for a lot when dealing with this. My
experience is in the hospital setting and would always defer to people
like yourself if having to do something outside of the hospital setting.
You have more experience in that type of situation.

Are you doing that on a manakin? They can be buggers to feel (if they
have that ability). On a real person it can be quite hard, but by
practicing on people (who you know have a pulse) it can get easier to do it.

This is quite a new concept for me as the resuscitation guidelines
changed just after I recertified in 2006 (even though the guidelines are
2005). When I did the APLS course the full ABCDE was in and took a
little bit of getting used.

Easy work if you can get it ;-)

--
Nursey RN
ALS & APLS Provider
MIRTTH#6 IbW#09 4#COFF EFFA MOP#1
Honda CBF600 ABS
(nursey at ukrm dot net)
UKRM FAQ: http://www.ukrm.net/faq/

 

On real people, yes. The wrist pulse is much harder than the carotid
one, of course, and we don't practice _that_ much.


--
_______
..'_/_|_\_'. Ace (brucedotrogers a.t rochedotcom)
\`\ | /`/ GSX-R1000K3 (slightly broken, currently missing)
`\\ | //' BOTAFOT#3, SbS#2, UKRMMA#13, DFV#8, SKA#2, IBB#10
`\|/`
`

 

On the last course I did (a couple of years back), they had abandoned the
'checking for a pulse' altogether, on the grounds that many people found it
too hard, and wasted vital lifesaving time doing so. The replacement was
'looking for life signs' - e.g. movement of lips and eyes. If you couldn't
see any, you started CPR without checking for a pulse.

 

That's what we were told. Just go straight into breaking their ribs
and then swap spit.

 

Thinking of fluids.............

I have had to do mouth to mouth for real on one occasion.
I would now always recommend placing whatever spare hand you have over
the subjects abdomen. This gives you a seconds warning that the subject
is coming round and is about to throw up over you. You can get your
mouth/head out of the way.

 

Jaw Thrust

HTH

 

On Sat, 31 Mar 2007 15:13:03 +0100, Mick Whittingham

Nice.

Thankfully these days face shields are de rigeur for m2m, and they
should also protect from this sort of thing.

--
_______
..'_/_|_\_'. Ace (brucedotrogers a.t rochedotcom)
\`\ | /`/ GSX-R1000K3 (slightly broken, currently missing)
`\\ | //' BOTAFOT#3, SbS#2, UKRMMA#13, DFV#8, SKA#2, IBB#10
`\|/`
`

 

Not. Even if you can get at the right part of the jaw, which you
certainly couldn't with my helmet, you're not going to be able to
support the head in the right way, so you're much more likely to cause
additional spinal damage that way.

--
_______
..'_/_|_\_'. Ace (brucedotrogers a.t rochedotcom)
\`\ | /`/ GSX-R1000K3 (slightly broken, currently missing)
`\\ | //' BOTAFOT#3, SbS#2, UKRMMA#13, DFV#8, SKA#2, IBB#10
`\|/`
`