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AGONAL BREATHING

Importance of continued CPR

Girl swimmer, 16, died after ‘wrongly trained’ lifeguard stopped CPR thinking she had saved her life

Sophie Konderak suffered a cardiac arrest moments after starting a training session and was dragged unconscious to the poolside.

Full Story:

http://www.dailymail.co.uk/news/article-1253701/Girl-swimmer-16-died-wrongly-trained-lifeguard-stopped-CPR-thinking-saved-life.html

Extracts:

Heart specialist Dr Christopher Duke said Sophie ‘would have survived’ if she had received continuous CPR. He said: ‘You don’t stop resuscitation just because a patient appears to be breathing. You only stop if there’s breathing and a pulse.’

The coroner Catherine Mason said she would write to the Resuscitation Council of the UK, which provides guidelines for life-saving techniques, to ask it to amend its training guidelines to include checking for a pulse.

The inquest heard Sophie’s initial cardiac arrest was caused by an undiagnosed heart condition.

The AoFA were asked to comment on this issue.

AoFA Comment.

The casualty could have easily re-arrested causing death. Detecting a pulse (or the absence of one) would have identified the need to continue CPR. However, it is feasible the first aider misinterpreted ‘Agonal’ breathing (which is a sign of dying) with ‘Normal’ breathing (a sign of life). If this is the case, ineffective training may be the problem not the first aider or the Resuscitation Councils’ guidelines.

A first aider is not a medical professional and in this case the first aider has acted in good faith and within her training. Overall, the first aider should be praised for her actions, not criticised.

(Note: AoFA comments are based on reported news items as stated below.)
UK Resuscitation Council Guidelines:
Studies have shown that pulse checking is difficult and unreliable especially for laypersons including first aiders, Some years ago, pulse check and checking for ‘Signs of Life’ was removed from basic life support (BLS) training and replaced with a single ‘Normal Breathing’ check. This change was designed to simplify and improve the outcome of CPR.

Agonal Breathing:

Agonal breathing is present in up to 40% of pre-hospital cardiac arrests. It is important that first aiders can recognise agonal breathing .
Agonal breathing can sound like gasping, snorting, gurgling, moaning or laboured breathing. It is NOT ‘normal’ breathing.

If in doubt, do CPR. It is better to do CPR when not needed than not to do CPR when needed!

Make sure you know the difference between Normal and Agonal breathing.

There are two videos that can be watched:

http://www.youtube.com/watch?v=CBMxH4xtE8w (Acting)
http://www.youtube.com/watch?v=ICODRFoWZkw (Real incident)

Resuscitation guidelines are periodically reviewed on a worldwide basic.    The next review is due this December blog on again!

with thanks to AoFA for their continued support and information.  To view the AoFA website go to http://www.aofa.org/default.asp

 
 
  
 

WOULD YOU KNOW WHAT TO DO?       How to give CPR to a baby 

 

 D – Danger
· Check that is safe for you to help

R – Response
· Flick the feet and shout to try to wake the baby
· If there is no response, shout for help, but don’t leave the baby

A – Airway
· Carefully open the airway by using ‘head tilt’ and ‘chin lift’ , place your hand on the forehead and gently tilt the head back. Do not overextend the neck as you may close the airway off, this is called the neutral position
· With your fingertips under the point of the chin, gently lift the chin to open the airway

B – Breathing
· Keeping the airway open, look, listen and feel to see if the breathing is normal, take no more than 10 seconds to do  this
· If the baby is breathing normally, consider injuries and place them in the recovery position
· If the baby is not breathing normally ask someone to dial 999 for an ambulance immediately, but if you are on your own and you have to leave    the baby to make the call, carry out resuscitation for about one minute first
· Keep the airway open seal your mouth around the baby’s mouth and nose
· Give 5 initial rescue breaths (blow in just enough air to make the chest visibly rise) Take care not to over inflate the lungs

C – Combine rescue breaths with chest compressions
· Use 2 fingers to depress the chest to a third of its depth
· Give 30 chest compressions at a rate of 100 a minute
· Ensure the airway is open and give 2 more rescue breaths
· Continue repeating cycles of 30 compressions to 2 rescue breaths
· Only stop to recheck the baby if they start breathing normally, otherwise don’t interrupt resuscitation

 If your rescue breaths don’t make the chest rise effectively:
· Give another 30 chest compressions, then before your next attempt:
· Check inside the mouth and remove any visible obstruction (but don’t reach blindly into the back of the throat)
· Recheck there is adequate head tilt and chin lift
· Do not attempt more than 2 breaths each time before returning to chest compressions

 

RECOVERY POSITION

When someone is unconscious and lying on their back, the airway can become compromised by the tongue touching the back of the throat, or vomit if the patient is sick.  Placing the casualy in the recovery position protects the airway from both of the these dangers, the tongue will not fall backwards and vomit will run out of the mouth

  • Remove glasses if casualty is wearing any and straighten both legs
  •  Move the arm nearest you outwards, elbow bent with palm uppermost

2.

  •  Bring the far arm across the chest, and hold the back of that hand against the cheek

3.

  • With your other hand, grasp the far leg just above the knee, and pull it up, keeping the foot on the ground.
  •  Keeping the casualty’s hand pressed against their cheek, pull on the leg to roll them towards you, onto their side.

4.

  • Adjust the upper leg so that the hip and knee are bent at right angles and tilt the head back to keep the airway open
  • Call 999 or 112 for an ambulance
  • Check breathing regularly.  If breathing stops, turn the casualty onto their back again and perform CPR
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