Re: [Paddlewise] Heimlich & CPR

Frank wrote:

>One thing brought up since the accident was trying the Heimlich (sp?)
>before beginning CPR. (Done without being behind the victim as with a
>regular Heimlich, but rather with the victim laying on his or her back.)
>This was described as helping to clear out any water before beginning
>CPR.

Henry Heimlich and Edward Patrick proposed the Use of the Heimlich maneuver
as the initial step for opening the airway in all near-drownings.  As a
protocol to teach in CPR, the current evidence suggests this is a bad
practice.

Using Heimlich first, before conducing CPR is in contradiction to the
current resuscitation guidelines for the treatment of near-drowning victims
proposed by Emergency Cardiac Care (ECC) Committee of the American Heart
Association.

C.f.:  Rosen P, Soto M & Harles J. 1995. J. Emerg. Med. May-Jun;13(3):397-405.

Heimlich will not clear water before beginning CPR. Prior to CPR, first
clearing and maintining the airway: "The swipe," Frank refers to in the
full text of his post. If a neck fracture is suspected, the head should be
steadied first.  Heimlich is used when the airway is obstructed as evidence
of resistance to ventillation. As a matter of routine, the Rosen, Soto and
Harles article points out just how dangerous the Heimlich is because of the
possiblity of further injury in neck fractures or injuries and because
every instant of delay in delivering ventilation increases the probability
of brain injury.

Heimlich is used when the rescusitator discovers resistance (c.f.
Daugherty, C.G., MD. 1992.  Field Guide for the Diver-Medic. 2d Ed. )  to
breathing, then follow: "Heimlich-fingersweep-ventilate" cycles.)

As for the act of drowning, the drowning itself (or near-drowning, if the
victim survives) is usually a case of asphyxia with little or no water
entering the lungs.  The water is prevented from entering the lungs due to
reflexive laryngeal spasms.  While not diagnostically significant because
of other complications, there are often haemorages in   There are very few
incidents where water and or other objects such as sand are aspirated in
near drownings.

Where drowning does allow water to enter the lungs, which is actually a
small probability, and the consequences are more severe in fresh water
where there is a possibility of haemodilution and cardiac ventriculation.

While pulmonary edema is associated with "drowning syndrome" Rumbak, MJ.
(Rumbak, MJ. 1996. The etiology of pulmonary edema in fresh water
near-drowning Am J Emerg Med. Mar;14(2):176-9 ) cites that the edema was
not caused by the ventilation of fresh or sea water, since there were no
significant alterations of serum electrolye levesls.



In other words, don't heimlich first, unless other indications call for it.

Robert

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